Dealing with your initial wound

Easily one of the top five roughest moments of my life was a few weeks after my initial nose amputation. Faced with the prospect of removing my bandages to clean the site, I fought for a full afternoon with a crawling dread, trying to suffocate it or ignore it enough to prevent it from blossoming into full-blown fear. I was going to have to see the wound. To touch it. I was going to have to see myself with my nose cut off.

Courage, I would think to myself when it threatened to overtake me a little. I would need a steady hand, I knew, and thrumming sensations of terror would not be assets in what had to be done. Courage. Courage.

When the time came, I snuck away from the family watching TV in the other room and went alone to the bathroom, turned on some water and let it run, and began. What followed was simply one of the hardest things I've done in living memory. Peeling away the yellow Xeroform bandages to see the wound for the first time, and then, god help me, to touch it. To clean it. Inside and out.

I start with a daunting preamble because it would be dishonest to say that your first couple of times cleaning your nose wound won't be very, very hard. The pure shock of seeing up close, perhaps for the first time, the trepidation of touching it, the pain and foreign sensations - the sheer shock of seeing yourself without a nose. They will all be very hard to experience.

But hold fast, good rhinectomy patient, hold fast. You have to do it, and it's better in the long run to take decent care of it. So take heart. Find something that helps you cope and keep it nearby, then get to it. Get the bandages off. Steel yourself. It's time to suck it up and do something tough.

Ok, for specific tips, here's what I've got. The first thing to know is that you will have a wound around the edge of your cavity that has to be treated. Depending on what was taken and how, this might present differently for different people, but for me it was basically a ring of stitches, buried in a circumference of mangled, glistening flesh. It may not seem like it when you first see it, but over time this WILL heal into smooth skin that slopes inward to your cavity, so the better you take care of it the faster you will get there.

To treat it, you will likely need to apply Bacitracin or something similar, like Aquaphor, which is to help the incision wound heal. My surgeon also wanted me to (shudder) apply some Aquaphor inside my nose a little, for reasons I never fully understood, but I think it was basically to keep my now-open-to-the-world sinus cavity from drying out. The process of touching your wound may not get easy quickly - for me, I never really ever found comfort in doing it, but have discipline and stick to your doctor's orders. Best tools for the job here are Q-tips, long-stemmed cotton swabs or tongue depressors - whatever works best for you to apply the ointment.

Links to the things I buy/bought are in the Supplies You May Want post.

Depending on your surgeon's preferences, Xeroform might also be part of your regular care, and if so, my only tip here is that it's kind of hard to find online, so prepare early and order ahead. That, and make sure you have both good, long surgical tweezers and some very sharp scissors, for cutting it to shape.

That's... sort of it for your initial wound treatments. The biggest part is that you have to 'confront' it, as I used to think of it. Look at it close and absorb it, and get to applying ointment to get it to heal. For me, I also had a vestigial bit of cartilage that stuck up from the bottom, which was pure horror to touch, and if you have something like that, just... do your best. Slather it over as quick as you can and move on. Your doctor will take care of that later as your wound heals, in a later procedure.

Once you've got that the care process taken care of, re-apply whatever cover you like, and go try to relax and forget it for a while. You're done for now. Put it out of your mind.

For me, my day-to-day face covering initially this was a nonstick bandage with a hole cut in the middle to allow air through, with a "mustache" bandage just below the cavity to catch drainage. I cut the non-stick into a vaguely triangular shape, snipped a hole in the center and then taped it on my cheeks and between my eyes. After a week or two, I didn't need the mustache, and the nonstick was all I kept on to cover and protect the wound. I found CVS brand ones to be the best, 3x4 inches in size, cut to fit.

A word about snot

One minor insult to all of this is that your nose will still run, it will still produce snot, and that snot will still run downward out of your nose cavity. So you'll need to deal with that. You'll likely be wearing a mustache bandage much of the time to start so not a huge deal here, but something to be aware of, because it's a factor

For me, I found it to be particularly galling to have to deal with the amputation fallout AND also just rivers of gross snot also being in the mix. There's no good way to put it - you're just going to have to mop it up when you can. Q-tips were my main weapon here, and I would just wipe it away regularly.

A word about blood

One thing I did not realize until further procedures is that surgery leaves you bleeding internally to some small degree, including on this first one, and so you are likely going to build up blood clots somewhere in your nose cavity. These will start to partially block your breathing after a time, and generally make you kind of miserable, so clearing them is a good thing to do.

This can be both satisfying and scary. More than once I've expressed a globulous, semi-congealed mass and thought in a panic "IS THAT TISSUE??? Has something terrible happened? Oh lord what have I done..." but it's never been the case that I've done anything harmful. Clots, especially big ones, can look very alarming when they come out, but usually this is just congealed, collected blood, and once they are gone, you'll find that you're breathing much better.

There are two ways to generally clear them - suck them back and try to spit them out, or irrigate lightly and try to blow them out. I have done every iteration. Note that when you first get home, you may have tubes poking out of your cavity (I did), and this blood may work its way out through there. But I found my only way to clear things when I got home was to suck back - pretty hard - and then just try to cough up whatever grossness I could work back into my throat.

My big fear here was that I would suck back the tubes - but at least in my case that should never have been a worry - they were so long and wedged in, it was all but impossible to really move them backward.

To the second method - irrigating and blowing them out. This may not be something you are ready to do right off the bat - I certainly was not. But once things were kind of healed and I got enough courage to start trying it, this became the much preferred method for getting everything out of the cavity - both snot and blood.

Lots of words about irrigation

At first, this idea is going to seem immeasurably insane, as you have never contemplated spraying water or another liquid directly into your sinuses, instead of irrigating through a pair of nostrils, and then blowing it back out into a sink. No. Frigging. Way, your brain is going to say when you first put a squeeze bottle in your hand. Nope. No thank you. Not today.

That's natural, that's what my brain said. And while squeezing gouts of salty water into your nose cavity is actually a good thing to do and something you will come to be good at, I have good news for you in this first couple of weeks: you don't have to start there. There is another product beyond the NeilMed squeeze bottle your ENT likely wants you to use to clean up in there - you can try as a baby-step: pressurized saline spray.

This is a can of the same stuff that can squirt a mist or jet of cleansing, moisturizing saline into your nose cavity without just leaping off the edge and letting fly with a squeeze bottle into your new wound. Something like this. That's not the one I had, but it appears to just be water and salt, which is what you want.

For your first experience, you may be spraying this up into your tubes - I found this terrifying, but made myself do it, and over time, with a little bit of courage and light blowing, this DID yield some results and helped break up blood clots that I could then suck back or lightly blow out. Basically, you kind of just have to do it - like taking that bandage off the first time. Just give 'er a spray and breathe it in backwards, then blow lightly out. You may find yourself using tweezers to pull out lengthy clots; that's good. Get 'em out.

You may also get nothing; that's also fine. Just working the saltwater back there is good for the whole enterprise, clots or not, so just work it into your routine.

Now, more on this later, but once your initial wound heals a little and you get a little experience, moving up to the squirt bottle is a good move to make. It's... a LOT of water, and at first, again, you're probably going to be like: NOPE. But over time, moving more water in there does help move things out, so it's a good advancement to have as a goal. Especially once you have any tubes removed and it's just the cavity, the squirt bottle becomes a valuable tool.

Irrigate. It sucks and it's messy but it works - I typically did it twice a day once I got rolling. But that's getting ahead of this post.

At first it's ointment and maybe Xeroform, surgical-wound cleaning and dealing with blood and snot. Pain is a factor but maybe not as much as you think. These will some of your hardest days. Steel yourself. Take care. You will move forward. Day by day.

Drive on.