Cholesteatoma :: Experience With KTP Laser Surgery?
Dec 16, 2014
I just got diagnosed this year with a Cholesteatoma, after a heavy mid ear inflammation in June, following a severe cold. Before that I had no problems with my ear.
My hearing was virtually lost during the inflammation but recovered pretty well, I guess only a 30 % has gone in my right ear. I live in Spain, in the mountains, and have no problems while I am here.
But I just visited the Peruvian Jungle, and it happened two times that after 3-4 days in the Jungle, my ear starts draining liquids and my eardrum perforates. After being treated two times with antibiotics in Peru, and moving to an area where the air is much dryer, the inflammation goes away within a week.
Now, last Friday I talked with my ENT specialist, and he has put me on a waiting list to have it surgically removed. According to him, it is a 'removal' operation, with a high chance of losing my right side hearing completely, as he 'thinks' the ossicles are infected.
When I asked him if a KTP laser is being used, the answer I got was that they don't use KTP laser in these kind of interventions in Spain.
Since I do not want to lose my hearing capacity in the right ear completely, I understood from reading about Cholesteatomas and treatments that a KTP laser assisted intervention has a high chance of preserving the ossicles, and thus hearing capacity.
There is an ENT specialist who has published about this, Dr. Fairley.
Does anybody has experience with him ?
Has anybody had this type of surgery with a KTP Laser ? How were the results ? I am very interesting in your story, As I am considering paying for the intervention myself in another country.
Prices are fluctuating a lot for this procedure, so if anyone knows a good ENT specialist (Cholesteatoma & KTP Laser) I would appreciate your opinion and experiences.
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Well, I got home this afternoon (Thurs) after the op Tues @ 7 p.m. And things seem to be working OK. No more Tamsulosin needed, so that's one benefit right there. I'll update after a few days as the the other possible effects.
The anesthetist chose a spinal anesthetic, which I was somewhat chary of, preferring to be totally knocked out. Later I remembered that there'd been some research that found that older people who had anesthetics died earlier, so he was right on that score. He also told me that this way I had a smaller number of anesthetics (general meant 14!, this way 1 to 3).
I didn't like the thought of being awake and watching the op, but he assured me I wouldn't feel a thing; I wouldn't see anything; and I'd be able to feed and drink more or less straight afterward rather than many hours later. And so it came to pass. Just numb legs for a while. I really didn't feel anything. All over in about an hour. I even dozed a bit on the op table.
However, that night (Tues) was not good. I had a constant feeling of wanting to sh*t. However, no matter how hard I tried (and I used two laxative suppositories), virtually nothing happened. I later found out this is a side effect of the somewhat larger catheter and balloon that was put in place.
So I found it hard to sleep. But just when I did doze off once, the nurse came in for the fourth time to take my blood pressure (2.00 am?). I was really upset and told her not to do any more (all the previous ones had been OK anyway). But by then I couldn't get back to sleep. So I was wretched all the next day (yesterday).
However, last night I got to sleep about 8:30 pm; and slept right through to breakfast. Bliss.
The surgeon had come in on Weds; told me about the defecation urge origin; said I could go home today if my urine was pretty clear by then and the catheter had come out. I see him again in a couple of weeks, when the result of the biopsy will be with him. He also said only 10% need the op again in 10 years; most are fixed for good. Here's hoping.
I was apprehensive about the removal of the catheter. In the end though, it wasn't too bad. I did most of it myself, easing it and rotating it a bit when it seemed to stick. Whew! Great. Then I pee'd a couple of times to test things; told I was OK to go. I left.
Home by 3 pm today. Then did a good walk (4 miles) and all's well. Still some blood and bits, but most clear. Good flow. Now to see how I am at night.
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My name is Gary. I am 57 and have had problems with hemorrhoids for years. It was getting to where I was spending two weeks out of the month basically ok due to constipation from opiate medication I have to take. Then one week where I use the prep H to push the roids back into place. Then often a week of just pain, stool softeners vs pain killers, and out of service.
I got referred to a surgeon recently and he said I had a bad case and set me up for surgery. They decided to do a colonistmy (colon probe. where I guess they pump you full of air and put a tube all the way up). I did not know that it was that extensive or I might of gone without it..at least not with this surgery.
I was told afterwards that I had some of the largest they had seen. Also the colon test showed some polyps they had to burn out. They did not look cancerous.
I had trouble getting cleaned out prior to surgery due to the pain and the opiates. As required I took 250 grams of miralax stool softener, 4 laxatives, and waited. I took them at 4 pm, had surgery lined up for 8:00 am with a 6:00am arrival. The drugs did not take effect until 1:00am so I was up until we had to leave for the hospital still on the toilet..and in severe pain.
I was still eliminating when we arrived. I was given a couple of ememas to use on myself. I couldn't hold them but they came out clear so they started the surgery, colon probe, and prostate exam.
I awoke after 2 hours of surgery. I was still under the anesthesia (I was put out) and not in terrible pain. I got up and was able to urinate. I had packing in me and was told to go home, take a bath, and they would come out. I had terrible cramps and gut pain, prostate pain, and severe anus pain. I have lots of stitches down there.
I went home and ate a small bowl of cereal and some oatmeal...and waited. I drank a bunch of juice and water but could not urinate. I was leaking blood everywhere. I took several baths and finally the packing came out. I took stool softeners and drank a lot. Finally the first meal, or what was left over from before, came out in the bath. I didn't have a full bowel push because of the pain but a bunch of crap, in small strings, some packing, and a huge amount of blood came out. I would say a pint.
I ate some more: a bacon and cheese bagel, some oatmeal, and stool softeners. I drank a bunch. I also had to take a bunch of painkillers. One the third day I had an involuntary bowel push but came up empty. I couldn't take the pain. Blood was still coming out in drips all the time with a small amount of feces. I called the doctor and got more pain killers. I set up a plan last night to have a bowel movement this morning. I ate some more oatmeal after one day without food. I took several sleeping pills and some painkillers to stop the urge to have a bowel movement. I had to get up at 12:00am and take more pain killers to stop an early bowel urge which would come up with nothing as is my experience. I awoke at 7:00am, as planned, and held the pain killers aside. I forced a bowel movement and produced a large pile of soft serve sh*t which was full of blood. There was more to come but, now 6 days out, I was in too much pain to push again.
It becomes a real fight to live. I am addicted to painkillers from years of degenerative disk disease and arthritis due to an 80 foot fall in 89. I don't get my refill until the 13th which is 3 more days. I have enough for today. I have stayed away from the long acting painkillers unless I run out. I hope to pass more later today. I will probably try the same procedure.
Again, it is the sixth day, and I still cannot walk without using the furniture. I try and move around as much as possible. I have some blood a fecal leakage which I clean up each time with a bath or a soaking wet warm wash cloth. Then I fold a washcloth in half and put in between my swollen cheeks until dry. They shave you down there and the stubble that grows back is very painful to the opposite side. I have never felt such pain. Each day has been a little better except for the third in which I was worse.
I would've still done the surgery if this all turns out ok. I will eat better, drink more, and do whatever I have to do to keep this from recurring.
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I'm posting this (rather long) history of how I finally solved my hemorrhoids problem in the hopes it will help people who are still trying to figure it out.
I'm a 58 year old man in good health and at the correct weight for my height. I'm not on any prescription drugs, I eat sensibly and work out at least 2-3 times a week.
I've had hemorrhoids for many years and pretty much ignored them, but then about 3 years ago they started getting worse, eventually to the point where I had to do something because they started to affect my life style.
The lifestyle effects were mostly about physical exercise. For example, when I played more than 9 holes of golf, the hemorrhoids would start acting up and get so uncomfortable I couldn't focus on my game. Or playing racquetball for more than a half hour would cause the same problems. The symptoms were pain, sometimes some type of clear fluid discharge (I know - totally gross), and sometimes bleeding. I could actually feel the hemorrhoids stick out of my butt. The pain could last for several days and would be constantly on my mind to point where enough was enough, I had to get help.
So I got a referral from my regular doc to a colorectal doc. It was a bad experience... he examined me and afterward said, "Yup, you got a nice bunch of marbles down there," and told me I needed surgery and how painful it could be. His nurse told me that she'd had post-op patients call her and literally scream and swear at her because they were in so much pain. I left that office and never went back. I forgot about "getting better" and figured I'd just have to live with it for now.
But a month or two later I was playing softball at a meeting away from home and the hemorrhoids got real bad and when I got to the hotel they were bleeding and I had to go out to dinner with a bunch of associates, then get on a plane early the next morning. I didn't know if I'd be able to do either, but I somehow got through it and vowed to go back to the doc.
So I got a referral to another doc and he was a little better. But he too recommended surgery and told me there would be a 2 week period I'd have to take off from work. I still wasn't ready for that, but he did give me a very good key piece of advice, and that was to take one big tablespoon of orange flavored sugar-free Metamucil (he was very specific) mixed with a big glass of water once a day, and to drink lots of water each day. I started taking it the next day and it made a big difference in my bowel movements. They became much 'easier' and didn't bother my hemorrhoids nearly as much as before. That was about 18 months ago and I've taken it every day since (I think it's good for cholesterol reduction too as a side benefit).
Still searching for a non-surgical solution, I got a referral to another doc and the third time was the charm for the time being. This doc examined me and said I definitely didn't need surgery, that my main problem was a couple of internal hemorrhoids and they could be handled with rubber band litigation. I said what about the external ones that I could see with a mirror? He said those weren't the offenders, which was quite different from what the other two docs said. So he did the procedure. He picked the biggest one and put the band on it. It took about 5 minutes and was very uncomfortable but not painful. He told me that's it, that there's no after-care, there should be no pain and to come back in a couple of weeks.
Well, he was wrong about the pain. I woke up that night at 2 am in pain. I took a couple of Advil which didn't help much, so an hour later I took two Tylenols and that did the trick. The procedure had been on a Friday, so I couldn't call the doc to see why I was having pain, but I looked it up online and saw that it wasn't uncommon, especially if the rubber band had been placed too low, i.e., too far towards the lining of the rectum where it would pull on the wall.
I had to keep that up the meds for the next 2-3 days. The whole area was swollen and felt like a typical 'bad' attack, and I was bummed out thinking this wasn't going to work. On Monday, I called the office and found out they're closed on Mondays. Great.
On Tuesday things were starting to get better. There was still some pain but no big deal. I called the doc's nurse and she said I could come in, but it sounded like I was progressing ok and that yes, sometimes there is pain if the band is too low, and that's exactly what this sounded like. So I decided not to go in, and day by day it got better.
After about a week, I was back to working out, and for the first time in a long, long time, I didn't have hemorrhoid problems. I was now able to resume most activities without having those nagging problems anymore. What a relief!
I say 'most' because I still would have some minor problems after longer periods physical exertion, say after 3-4 hours, like a round of golf. But again, the issues were much less.
At 6 months after that first procedure I was still having some issues, so I decided to get another band done to get the second-worse internal hemorrhoid taken care of. I had it done, and this time there was no pain at all afterwards. The procedure was still uncomfortable, but now knowing what the result would be, I went into it with much less trepidation, and knew that even if I did have the same pain as the first time, it would be worth it.
So for me, it was all about getting those internal hemorrhoids dealt with. I still have the external ones, but much to my surprise they really don't cause any issues. I had always thought they were the culprits since I could see them, but I guess that's one of the pitfalls with self-diagnosis; the obvious answer was the wrong one. I may still have one more internal one to take care of, as the doc said they usual form in groups of three. But with the first two, worst ones taken care of, I think most of my problems are gone.
For any of you fellow sufferers out there, I hope you can learn something from these first experiences. The whole thing was embarrassing (to me) at first.... having those first docs checking me out 'down there' took some getting used to, but now I look at it as just another medical procedure, somewhat typical to what women have to go though their whole lives, or so my wife says.
About a year later and I was still having problems with at least one internal hemorrhoids. I went back to my doc who it put a rubber band on but it didn't help all that much. I went back again and he said well, there is another one, and I'll try to band it. I didn't really get what he was talking about with the try (he was never hesitant before) but said go ahead anyway. He said the issue was that he couldn't get the band all the way around the base of it but hopefully this would work. The next morning well sitting on the toilet, the band popped off. I realized that the banding procedure was no longer an option and thought that maybe it time to get surgery and get this finished once and for all.
I asked a separate doc that I trusted for a referral to a younger (<45) doc who knew all the latest procedures, as I was looking for the most non-invasive possible. I found one. When meeting with him he told me all the different techniques he uses and said that during surgery he'd decide which was best depending on how things presented themselves, and I was good with that approach.
I had the surgery and it turned out to be more complex than we thought. Initially, we knew there was at least one internal hemorrhoid that was the main culprit, but during surgery he found two other internals and one external. In fact, the main internal one was connected to the external one, so they both had to come out. So the surgery, which was in a full-blown operating room and I was completely unconscious, was rather extensive. Although it was scheduled to be outpatient I couldn't pee afterwards so they inserted a catheter and keep me overnight (The catheter insertion was weird and uncomfortable and freaked me out a little as a friend had just had one a month before and told me how awful it was. In reality, the fear from that was much worse than the actual procedure. But next time I would still ask for a Xanax or something first). I came home the next day in some pain. He gave me Percocet which helped quite a bit. (He started out with one 5 mg every six hours and it wasn't nearly enough. I had up it to two 10 mg every four hours for the first day or two.)
Here's the recovery process, which I wrote as it happened:
Day 1, Thursday Surgery @ 7:30 am. Prep was nothing to eat or drink after midnight and an enema the night before (more on that later). Woke up after, no pain yet but felt pressure in lower abdomen. Because of the catheter, they kept me overnight and removed it the following morning.
Day 2, Friday I went home, slept a lot, caught up Netflix (the one silver lining). Took 10 mg Percocet every 4-5 hours, which did a good job of containing pain. Was able to walk if needed, e.g., to the bathroom, but only felt like laying in bed. Total meds: 30 mg Percocet, 1 Senokot, 2 Colace, 2 Advil.
Day 3, Saturday - I'm now in the third day after the surgery and things seem to be getting better. I still haven't had a bowel movement which I am anticipating will be somewhat painful, But I'm looking forward to get through it because that will be kind of the last step. Total meds: 10 mg Percocet, 3 Colace, 3 Senokot, 1 Miralax, 2 Advil. (Might have taken more pain meds, but I was asleep quite a bit.)
Day 4, Sunday Had first bowel movement. Was more uncomfortable than painful and I wish I had been taking more stool softeners, because the surgical area is apparently swollen and theres not much room for stuff to exit. I upped my dose immediately to Colace 3x a day and one dose of Miralax before bed. The pain occurred afterward about 5 minutes after I was done, an aching started in the surgery area and got quite bad, to the point where I had to lay down in bed and wait for 10 mg of Percocet to kick in. Thank God for Percocet. From there on, I pre-medicated for the next few days which helped a lot. Had two more BMs that say, the 2nd followed by 2 Advil, 3rd by 2 Percocet. Total meds: 30 mg Percocets, 6 Advil, 5 Senokot, 3 Colace, 1 Miralax,
Day 5, Monday Stayed home from work. Sent email to direct reports why I was out (hadn't told them previously). Woke up at 6 am took 2 Advil. Took various softeners and pain killers throughout the day, had two BMs. Still painful with achiness but not as bad due to taking more softeners and stating ahead on the pain meds. Total meds: 6 Advil, 10 mg Percocet , 2 Colace, 2 Senokot, 1 Miralax.
Day 6, Tuesday - Getting a little better each day. Still stayed home for work, but had a one hour meeting downtown, so I went to that. It was good to be out. I had been noticing that there was a light hygiene issue with some minor staining and a little leakage, so my wife gave me a mini-pad that sticks to your underwear. It worked ok, but was hard to position properly. After that, I switched to the maxi-pads, which also stick to the underwear, but cover much more area and worked better. Good peace-of-mind as I didn't have to worry about being out in public. Had one BM, as I did from here on out. Total meds: 6 Advil, 2 Colace, 1 Percocet.
Day 7, Wednesday Back to work for the full day. Still a little awkward to get up and sit down, so I stayed at my desk most of the day, felt pretty good, maybe 80-85% better. If I had a job where I had to be on my feet all day, I would have stayed home again. Cut Colace down to 1, which was a mistake due to difficult BM the next day, immediately went back up to 3/day. Total meds: 4 Advil, 1 Colace.
After that first week, things continued to get better each day. I continued to have some achiness after each BM and took couple of Advil proceeding each one which helped. I went back to the doc for a checkup at the end of the 2nd week and he was pleased with progress. He said probably best not to take Advil as it causes bleeding, ok to take 2.5 or 5 mg of the Percocet, so I did that for a couple of days, then switched to Tylenol. I eventually stopped taking even that at about the 3-week mark. I continued to use the maxi-pads until about the 2-1/2 week mark. BMs at the end of the 3rd week were still a little difficult, especially to get them started. It felt like the opening wasn't big enough and I had to strain to get it going, but once stared it opened up and progressed normally. Maybe I was just too tensed up?
At the 4-week mark, the BMs are more normal with almost no straining. I was still taking 3 Colace a day, but considering going down to two. I should also mention that I was taking Metamucil 2x a day during the entire time period. I had been taking it once a day (1 heaping TB of the orange sugarless mixed in water) for the past several years on the recommendation of one of my first docs, and it helped a lot.
I also went back to playing racquetball just shy of the one-month anniversary. My doc cleared me after 2 weeks, but I was still too achy and just not ready. On my first day back to work, there was some pain from the BM (minor) and I was concerned that t would get worse when I played. I took a couple of Tylenol before playing and the pain was non existent. I was tired from not exercising for a month, but it was a good tired and, most importantly, no pain afterwards for the first time in years.
I should also mention that the hemorrhoid pain was gone after 3-4 weeks. It was hard to tell for the first 2-3 weeks, as there was pain form the surgery, but as it started to fade, I noticed that the old pain was no longer present after exercise of BMs. Yes! After all, this was the whole point in the first place, but it's sometimes difficult to remember as you're going through the post-op period.
Things I learned or wish I had known.
Surgery prep I was advised to do an enema 6 hours before surgery which I did (Actually the night before because the surgery was early). But looking back, I wish I had done a more extensive prep similar to a pre-colonoscopy exam, as that would have cleaned out everything and postponed the first BM for a day or two more. Maybe this isn't a viable option for some reason, but Id definitely ask the doc about it if I had to do it over.
Catheter - I was told there'd be a 50% chance of needing one because I'm a man over 50 (58). I wish I had just asked to have it inserted during the surgery, as it was stressful to have it done yet another procedure just 6 hours afterwards. And Id ask for a Xanax or Valium or something.
The recovery time is 6 weeks. Yes, it's possible to be back at work within a few days, but for me, it was really a couple of weeks before I was feeling anywhere near normal enough that I wasn't aware of the surgery, pressure, pain, the pad, etc. After 4 weeks, Id say I was 85-90% recovered. From all outside appearances I was 100%, and most of the time I was unaware of the event. To me, I'll be 100% recovered when I'm thinking/aware of the surgery 0% of the time. Put another way, Id say I was 100% functional 3-1/2 weeks afterwards, but 85% recovered. The 15% difference was that BMs were still an issue I was taking softeners still and there was some pain or achiness, but not much. I stopped taking pain meds for this at about the 3-1/2 to 4 week mark. I should also mention that, due to the softeners, the BMs happened almost first thing in the morning, typically after one cup of coffee. You should have access to a toilet because when I had to go I HAD to go. If I had had to wait more than a minute or two, it would have been a problem.
Because the recovery time is long, I was glad I had no big events or travel planned for a few weeks afterwards. We hosted Thanksgiving at my house exactly 3 weeks afterwards, which I had thought was a no brainer recovery-time-wise. It turned out fine, but I was glad it was at my house as I still wasn't 100%.
Id err on the side of more pain meds and definitely more stool softeners. I was warned that too many softeners could cause diarrhea, but I never experienced that, but I can definitely say that too few cause pain. For the pain meds, Id take them 1 hour before each BM for the first few weeks. Don't wait until afterwards because its too late. Be preemptive. Don't take Advil; take your prescribed meds or Tylenol.
Plan to be in bed for the first 4 days (day one being surgery). Although I was up and around by day three, it was really day 5 when I felt good enough to put away the tray table and resume downstairs life (our bedroom is upstairs).
Recovery clothing The only thing I was comfortable wearing for the first week was sweat pants. Unfortunately I only had two pair and they tend to get soiled easily in the first few days. I recommend having 5-6 pair available. And bring a soft, fluffy pillow to the surgery for the ride home. You'll be very glad to have it.
Was the surgery and pain worth it? Definitely. I knew what was coming more or less, but I really wish I had more details about recovery so I could set expectations, which I why I'm writing this in the hopes that it will help others. While the docs and nurses tell you about recovery, they don't really have the details, the day-to-day stuff. So here they are. Obviously, this surgery could be more or less invasive or extensive. Mine was a little more extensive than planned, but still, I feel like mine was a middle-of-the road case, maybe a 6 or 7 out of ten. A total guess really, but I had 3 internal and one external removed, so maybe you can judge by that.
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It is 10 days now since I had Open Myomectomy surgery. 32 Fibroids were removed, which surprised me, and I was in hospital for 5 nights. I am now home and getting stronger each day. The days before the surgery were anxious days but at the same time I was looking forward to the sugery and being free from the many symptons that fibroids cause. I had a great surgeon and anathestist and went fully prepared mentally, physically and spiritually for the surgery.
Surgery took 2 hours and remember being brought back to my hospital bed hooked up to IV fluids, catheter, oxygen and equipment on my legs to stop blood clots. Pain was minimal, similar to mild period pain and I was encouraged to use the Morphine pump to manage the pain for 2 days. Morphine did make me feel nauseated which is common. Once I was free from catheter and IVs on day 3 I was encouraged to do my Pelvic exercises and to walk around the hospital corridor. I was given paracetamol and ibuprophen at regular intervals and BP, tempearture and Pulse was moniored on a regular basis, which were all fine. I was encouraged to drink more fluids and had no issues with empyting my bladder or bowels so knew everything was working OK. Getting in and out of bed and sitting up was difficult during the first 5 days but became easier each day. Its amazing how much we rely on our stomach muscles for so many things. Once I was home on Day 6 I started doing very light duties around the house and a 10 minute walk outside plus regular naps whenever I felt fatigue. I can now do 15 minute walks and looking forward to getting stronger each day. I have some swelling around the incision but that is normal at this stage. Will see the surgeon 20 days after my surgery for post-op checks.
Overall my surgery went very well and I am very pleased with the progress I am making. Although Open Myomectomy is major surgery, becasue of the advance in technology, the skills of the surgeon and the excellent pain management and hospital care it is a much easier experience than I thouht it would be.
If you have been told by your consultant that you need Open Myomectomy surgery do not be afraid, focus on the positive aspects of being free of fibroids symptons, read up on the procedure, watch videos of the procedure if your that way inclined, understand the risks, prepare yourself physically and mentally and follow the advice given by your consultant on the aftercare.
I am grateful to God that my surgery went well and I am looking forward to getting back to the gym in dure course and having a better quality of life without fibroids.
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