Septoplasty

ianwilliams

Hello,

I had a septoplasty today. Basically its a surgical procedure in which a deviated septum (the bone that divides your nose into two nostrils) is trimmed back so you can breath through both nostrils properly again. Previously the septum had deviated and I was unable to breathe through one nostril.

I'm going to be in bed for the next few days. Its quite a relevant operation to cyclists, and I think there's a fair bit of misinformation online. I deliberated for a long time over having it.

With that in mind, if anyone is thinking of having one or wants to know more, fire away with any questions and I'll respond from my bed!

Cheers

dw300

Why is it relevant to cyclists?

ianwilliams

dw300 wrote:

Why is it relevant to cyclists?

Yeah, I could have worded that better. But basically without it (if you have a deviated septum - more common than you'd think, especially from broken noses) you're only breathing through half your nose.

Obviously if you haven't got a deviated septum then its no issue. If you do, then you can definitely get by (I did for 5+ years) but I'm looking forward to seeing what effect this has on my breathing and, in turn, cycling.

dw300

I'm more of a mouth breather normally, but especially when im flat out on the bike.

I'd always wondered why people wore the Breathe-Right Strips .. youve either got your mouth closed, which cant be right, or you have it open and surely most of the air is going in that way. I've never thought of nostril flow rate as a limiting factor.

ianwilliams

dw300 wrote:

I'm more of a mouth breather normally, but especially when im flat out on the bike.

I'd always wondered why people wore the Breathe-Right Strips .. youve either got your mouth closed, which cant be right, or you have it open and surely most of the air is going in that way. I've never thought of nostril flow rate as a limiting factor.

Nor had I really! I broke my nose years ago in a football match. I knew it was wonky but thought little of it.

Then I moved in with my girlfriend. Turns out I'm a terrible snorer. And no matter how much effort I made to sleep well, I was never refreshed in the morning. Sleep apnea (when you can't get enough air in your sleep, so you constantly wake up in imperceptible amounts) was what sent me to the doc. She diagnosed the deviated septum, recommended the operation and I'm looking forward to seeing what, if any, effect it has on my ability to breathe.

I do suspect that years of not being able to breathe through my nose has turned me into something of a mouth breather anyway, by necessity.

ianwilliams

So, its about 48 hours since I had the operation.

Straight afterwards I woke up talking to a nurse about a Canyon bike he is looking to buy. Small world! I also had a really short, but exciting, feeling of being able to breathe through both nostrils.

Pretty quickly though, things started getting quite blocked up and bloody. I have never had such a comprehensively blocked nose. For about 24 hours I felt like I couldn't breathe at all - it was very uncomfortable. I just sat in darkness and focused on the pain from the operation; the pain was better than realising that I couldn't breathe...

After a bad night's sleep the first day after the op was up and down. Again, a lot of bleeding. That, coupled with not being able to get outside and do anything, was pretty tough going. A lot of pain and some cocodamol helped ease things but with the nose being so blocked it was hard to rest or sleep - I was forever awake.

It wasn't the most painful thing I've experienced, but it was by some margin the most uncomfortable.

By the evening things did seem to be getting better though. Getting up to eat was a good idea, watch a bit of TV. The second night of sleep was again, better, and then I woke up today. Today (2 days after op) is a little better, although the scars inside my nose are starting to heal and (apologies) scab a little, which makes moving my nose extremely painful.

fossyant

Post operatively things take time. I'm just back at work after 5 weeks following surgery on one of my plumbs. Went out on the MTB for a short time over the weekend and was OK, but you have got to let things settle. I'll probably start commuting by bike again next week.

First few days are usually pretty uncomfortable, and for the first few weeks you may think "what have I done", but think about the long term. Once the healing process has had time, and the swelling stops, you'll see the benefit.

I stopped taking codeine after a couple of days (bungs you up) and also had to have antibiotics part way through the recovery time - that bloats you !

Back to the gym now, and hopefully shift these couple of KG's I've put on doing nothing the last five weeks.

Hope all goes well.

ianwilliams

Thanks mate.

I'm looking at this the same way I looked at laser surgery on my eyes. A few weeks (painful) recovery followed by a significant, noticeable health improvement.

I'm feeling better again today, which is also good.

Re: codeine - I had some of that when I broke my ribs. I remember taking it at work and just feeling completely stoned - had to stop taking it, powerful stuff!

Good luck with your recovery too.

herzog

Any idea when you be able to get back on the bike? I'm thinking about having the same thing done in a few months, but am not sure. Also, any sinus problem/reoccurring infections due to the deviated septum?

ianwilliams

Hi Herzog,

I'm not sure when I'll be back on the bike. I'm pretty sure that the doctor at my initial consultation said 2 weeks, but I've since read contradictory things. From what I can gather though, the operation varies a lot depending on who does it (e.g. I've had no packing) - so maybe recovery times vary. When I know I will let you know. I suppose it also depends how hard you cycle.

I never had any problems with nose infections prior to the operation (and none since), but I have had short, sharp periods of sinus pain over recent years. I also found my athletic performance varied wildly and I rarely awoke from sleep refreshed. The problem was most obvious whenever I did meditation or any other discipline that required me to breathe through my nose - I always immediately felt like I was 'running out of air'.

So far its day 4 and my recovery is going well. It just feels like having a bit of a cold now although there is still some bleeding. I think I'm a bit ahead of schedule, but we'll see. I wanted to get it done over winter when the weather is worst. For what its worth, the waiting list here (Leeds) was quite long - about 10 weeks I think.

herzog

Thanks for the reply as it's something I'm seriously thinking about. I noticed that even at moderate levels of cycling, I'm gaping for air through the mouth and when racing I never breathe through the nose. Like you, I rarely feel refreshed after sleep and often feel 'blocked'. I think I'll probably arrange surgery soon (my doc has given me the OK).

Hope you have a speedy recovery!

ianwilliams

Herzog wrote:

Thanks for the reply as it's something I'm seriously thinking about. I noticed that even at moderate levels of cycling, I'm gaping for air through the mouth and when racing I never breathe through the nose. Like you, I rarely feel refreshed after sleep and often feel 'blocked'. I think I'll probably arrange surgery soon (my doc has given me the OK).

Hope you have a speedy recovery!

Thanks dude! I'm glad my posting has been helpful to at least one person

I'll keep posting here through my recovery, until I'm back on the bike. I would say don't be worried by the scare stories that you can find online - although experiences do vary, mine has been totally manageable. Good luck and let me know if you go for it!

herzog

Great, look forward to hearing how the recovery goes.

ianwilliams

Right, so exactly 7 days & nights since my operation.

My nose is far less blocked, and there is no real bleeding anymore. However, as my nose has begun to dry up, so scabs have begun to form and the whole feeling is quite uncomfortable. You really want to scratch your nose, or blow it, but neither are allowed under doctors' orders.

On the plus side, the pain has gone down - although my nose is still sore to touch.

My body is also clearly still spending a lot of energy recovering. I went to the theatre on Wednesday night - nothing major I though. I had the tickets booked months ago and didn't want to miss the show; besides, we would be sitting down all night. That night I slept for over 12 hours straight...

So still a mixed bag. Getting better but as each blip is overcome, so another one arises 8) On the plus side, I have 'snorted' to clear my nose out once or twice (i.e. sort of blew out, without having my hands on my nose) and its mad how much air I can shift through my nose when I really try now. It feels like a turbocharged V8 compared to the polite shuffle of air it made before. I have no idea if this will mean anything for my sports but we'll see as I continue to recover.

Back in work on Monday. The only problem will be if my nose bleeds overnight (as it still does sporadically). Sometimes it can be quite unpresentable. But it will be good to be back and I think I'm over the worst of it now.

herzog

Interesting post, thanks!
Herzog

ianwilliams

So, its been roughly two months since my operation.

Its hard to assess how the operation has worked for me: a gradual, lengthy recovery makes it hard to remember exactly how I felt beforehand.

What I will say is that my exercise stats over Christmas have taken a big leap forward - which generally makes no sense given that I took four weeks off post-op, then had two weeks of minor activity before hitting Christmas and gorging on chocolate.

Take today for example: it was too icy for a ride, so I went for a run instead. And what was supposed to be three miles became 6, then 10 miles - and I only stopped because of a pain in my foot. My ability to sustain an (admittedly moderate) effort over a longer period of time keeps surprising me.

Even things like doing a 10K on the turbo - I'm hitting new personal records with bugger all training.

The only thing I can put it down to is the operation. It's hard to think of what else it could be. At the moment the weather is keeping me largely away from the bike but in terms of running and other cardio-heavy things, I feel pretty surprisingly good.

The doctor says all is good but I can expect to continue recovery for the next month of time potentially.

dw300

The what else it could be, in part anyway, is you visualising for several months how much faster you are going to be afterwards. You've released more of your full potential, compared with before when you felt you had a reason not to be able to perform to your potential.

Plenty of people with great physiology and skill have been limited by their mind .. I can think of Greg Norman and Colin montgomery in Majors golf. It could be something to do with Tyler Fararr's form and crashes over the last few years. There are doubtless lots of other underperformers out there. The mind is a great limiter. To extend this further, there are guys with no arms and legs playing scratch golf when most able bodied people can't get under 18. The majority of people never get near their potential because they don't think they can for one reason or another.

Visualisation might only be a fraction of where the improvement has come from, obviously breathing well is a big help in endurance exercise, but I assume if you were restricted in the actual volume of air you could get into your lungs it would impact massively on your performance. So you might always have had this potential but not been able to achieve it.

Was it like breathing through a straw when you exercised before? If I had an exercise-induced asthma episode that's what it felt like, or like having a person standing on your chest and you'd have to stop. You just cant open your chest cavity because the air isn't rushing in fast enough. If it wasn't, and you could get your lungs filled without significant wheezing, pressure or discomfort on your chest then you were probably never really limited by it. Only you know that.

If you weren't getting enough oxygen even at low levels of exertion you'd not be able to push yourself. If you would you'd be going hypoxic and blacking out all the time. The reason that wouldn't normally happen is because the muscles ability to use the oxygen in the blood is the limiter, and not the lungs ability to get fresh air into the body and hence oxygen into the blood.

I suspect its the comfort and relief and the the visualisation that's improved your performance. If you were really struggling that much before getting air you your nose and into your lungs you'd just have opened your mouth.

Not trying to pee on your bonfire by the way, this wasn't meant to sound negative, I'm delighted your able to enjoy working out more now!

ianwilliams

Thanks for the reply dude!

Good points about visualisation and the mind. Although I was somewhat sceptical prior to the operation I'll have been also aware of what I wanted out of it. What I suspect was the bigger thing for me on the run is the enthusiasm I feel: I've felt for a long while I was 'a runner' and the feeling of confidence that comes back...that's a big thing for sure.

I'm generally interested in the mind and its relationship with the body. I've done quite a lot of meditation and in particular it was interesting to see how easy it was to reduce a feeling of pain or discomfort by stopping waiting for it to end.

Whatever is going on, I'm happy. The next test will be when I get back out on the bike: I haven't yet built up an 'image' of myself as a cyclist like I had with running, so that visualisation aspect will be lessened.

top_bhoy

dw300 wrote:

Plenty of people with great physiology and skill have been limited by their mind .. I can think of Greg Norman and Colin montgomery in Majors golf.

Agreed with Colin Montgomery but Greg Norman won a couple of Majors, desperately unlucky in several others and world no. 1 for so long. In the changing fortunes of sport, how can the 87 Masters ever be forgotten?

Keith47

I'll try to keep a VERY long story short. I was due to have the same operation,finally went to hospital for the op after dozens of tests, consultations and examinations. Got called in to see the doc, " How do you feel after the op then?" says he.
Me, " er, I haven't had it yet".
" Of course you have, I have your notes here, op done on blah de blah"
" I can assure you I haven't". Doc goes a deep shade of crimson, leaves the office and 10 minutes later another doc comes in and says " we have the results of your sleep test, you don't need the op as you're only waking up 16 times a night, good bye" and that was the last I ever heard about it.
Still can't breathe through my nose, still wake up countless times each night.

ianwilliams

Keith47 wrote:

" I can assure you I haven't". Doc goes a deep shade of crimson, leaves the office and 10 minutes later another doc comes in and says " we have the results of your sleep test, you don't need the op as you're only waking up 16 times a night, good bye" and that was the last I ever heard about it.

Eh? That's not good. Have you followed it up?

I didn't have a sleep test or anything like that - just a very quick, simple referral. Probably spent a maximum of 20 minutes with doctors beforehand.

That said I have no idea if it has improved my sleep. My girlfriend says my snoring is worse...

dw300

Top_Bhoy wrote:

dw300 wrote:

Plenty of people with great physiology and skill have been limited by their mind .. I can think of Greg Norman and Colin montgomery in Majors golf.

Agreed with Colin Montgomery but Greg Norman won a couple of Majors, desperately unlucky in several others and world no. 1 for so long. In the changing fortunes of sport, how can the 87 Masters ever be forgotten?

Ok, you got me, I didn't do my homework for that post.

I'm substituting Torres for Norman.

Prestachuck

Hi Ian, I know this is an old thread now, but I’m new to BR, and I just had septoplasty with some minor turbinate reduction yesterday.
I found your thread here to be encouraging. Also, how did your cycling go that spring? You will be relieved to know that the performance improvements to your walking and running were not just psychological. The nasal airway is responsible for up to fifty percent of total airway resistance. This study on the extrathoracic influence of nasal septal surgery was published in March 2016, and shows that Septoplasty results in significant improvements to pulmonary efficiency whether the subject breaths through the nose only, mouth only, or nose and mouth.
https://www.ncbi.nlm.nih.gov/pmc/articl ... 9-1-51.pdf

This year Fabio Aru had possibly the best results of his professional career so far. He attributes a big part of his performance to having his deviated septum corrected last winter.
After reading this study, I’m willing to give him the benefit of the doubt for now.

Cheers!

EBEB

dw300 wrote:

I'm more of a mouth breather normally, but especially when im flat out on the bike.

I'd always wondered why people wore the Breathe-Right Strips .. youve either got your mouth closed, which cant be right, or you have it open and surely most of the air is going in that way. I've never thought of nostril flow rate as a limiting factor.

I actually tracked down the original research (white paper only) touted by one of the major manuacturers; turned out their study was based on people breathing with their mouth shut. Really.

Quite apart from which, maximum exercise is almost always limited by cardiac output and not ventilation anyway.

CptKernow

I had septoplasty and turbinate reduction a few years back. It improved the quality of my life markedly.

However, I don't think it has had a great deal of effect on my cycling. As soon as the effort goes up I'm breathing more or less exclusively through my mouth.

burnthesheep

CptKernow wrote:

I had septoplasty and turbinate reduction a few years back. It improved the quality of my life markedly.

However, I don't think it has had a great deal of effect on my cycling. As soon as the effort goes up I'm breathing more or less exclusively through my mouth.

I've been watching this thread, and as for as long as I can remember I breath through one nostril or the other with the nose.

My dumb $.02: I just don't think many riders spend enough time in really rough efforts for it to make a difference versus what their born-with-it VO2max would be if they were trained.