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Tuesday, March 03, 2009

"What are you trying to say?"

Thanks to everyone who offered excellent feedback and advice on yesterday's post via comments and email.  The most often repeated bit of advice seems to be that I get a sleep study done to see if I am suffering from some sort of apnea.  I'll be sure to look into this.  Thanks.

One helpful friend emailed to ask if I'd ever considered having my dentist make me an 'appliance' that I could sleep with that would advance my lower jaw enough to prevent snoring.  I have to admit I got a giggle out of that because all I could picture in my mind's eye was sleeping with a refrigerator or stove in my mouth.  But yeah, I will certainly look into that too.

Another helpful friend emailed me to ask if I'd checked to see if maybe I had a deviated septum since that might cause one to snore.  This perfectly innocent question reminded me of a funny incident that I've been meaning to share:

So to begin with, yes... I have considered the possibility that a deviated septum might be making me snore.  In fact, I had an exam by an Ear, Nose and Throat doc many years ago, and he informed me that I did indeed have a deviated septum... and that if I wanted to have it repaired it might improve the snoring (meaning reduce the occurrence of snoring... not make it more pleasant or entertaining) that my new bride was starting to complain about.

While I was sitting in his exam chair getting the news about my deviated septum and the possible health /quality of life benefits I might derive from having it repaired, he looked me in the eye and said:

"Look, if we're going to schedule the surgery to repair your septum anyway, and your insurance company is already footing the bill for anesthesia and the operating room, why not let me fix your nose while I'm in there?  For an extra two or three grand I can set you up with a nose like a movie star!"

First of all, I am well aware that with my schnoz few people are going to mistake me for an Episcopalian. 

Some of the proportions and contours of my nose are a direct result of poor blocking technique in some of the schoolyard skirmishes I joined as a kid.  But even if I hadn't been a crappy fighter, there was already a pretty impressive genetic pre-disposition for a Streisand-esque snout due to countless generations of selective Eastern European Jewish breeding.

So no, I wasn't particularly surprised by someone taking note of the size of my nose.  I was, however, more than a bit put off by the bluntness of the doctor's offer of corrective cosmetic surgery... as if I was horribly disfigured and it was a given that I would jump at the opportunity to make myself presentable at any cost!

So I decided to have some fun.

I looked him in the eye, and with a combination of hurt and anger in my voice and my eyes open to their widest indication of indignation, I said, "What are you trying to say?  What's wrong with my nose?!"

You've never seen anyone back-pedal as fast as this doc did. "Er, um, I didn't mean to imply... of course your nose is perfectly fine... a matter of personal preference... some people have different aesthetic sense..." and on an on he rambled.

I let him blabber for a good two minutes before holding up my hand and cracking a smile.  I said, "Look, I know I have a big nose.  Anyone can see that.  And I'll even ask my wife if she wants me to have a nose job while I'm under the knife.  But while it is tempting to change something that has been the brunt of so much teasing throughout my life, I'm wondering where one draws the line.  Is the next step getting hair implants and maybe having my 'love handles' liposuctioned?"

We agreed to revisit the topic when I came back for my pre-surgery visit and I left the office.  But not before I noticed him pass the sleeve of his white lab coat across a sweaty brow. 

I did bring up the option of a nose job to Zahava, and to this day I'm not really sure whether she was humoring me or giving me her honest opinion.  But her response was something along the lines of, "Is your nose on the large side?  Yes.  Would it look better smaller?  I honestly don't know.  Would I love you more if we spent several thousand dollars making it smaller?  Absolutely not!"

And with that the issue was settled. 

I had the surgery to have my deviated septum repaired... and it didn't have the slightest impact on my snoring.  To this day I don't know exactly what benefit the surgery may have provided other than to segregate the air going in and out of my nose.

But since then, whenever I have to see a doctor and the nurse gets to the point in taking the medical history regarding any previous surgeries I may have had, I just smile widely below my impressive Jewish nose and explain that I once had nasal surgery... the only benefit of which was to make the surgeon who performed the operation just a tad more humble.

[Thanks to Karl Newman for reminding me of this story with his emailed advice]

Posted by David Bogner on March 3, 2009 | Permalink

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Yes.

Because I am all about the "humoring" people with my responses! :-)
You seem to forget that you are the diplomatic member of this pair!

Posted by: zahava | Mar 3, 2009 1:12:31 PM

My Lebanese ENT has a pretty good honker on him, too. He'll be adding a few more holes to my head this morning. Yay!

Posted by: Karl Newman | Mar 3, 2009 1:33:04 PM

Zahava... What, you'd prefer I let people know how blunt you are? :-)

Karl Newman... Best of luck with the surgery. It really isn't a big deal... but be prepared for a few days of discomfort. Also, make sure to ask the surgeon how to sneeze without destroying all his hard work. You'll need to sneeze through your mouth, but it is more easily demonstrated than explained via a comment response. You will sneeze. Be prepared. It's impossible not to sneeze when your nose is filled with scabbed blood for a week or more.

BTW, in case anyone asks if this is major or minor surgery, here's how you tell the difference

Major surgery is what happens to you. Minor surgery is what happens to other people.

Posted by: David Bogner | Mar 3, 2009 1:44:47 PM

I'm just having tubes put in my ears today, the deviated septum is coming soon. But thanks for the advice.

Major or minor, I just hope that I won't scream like a little girl after it's over. :)

Posted by: Karl Newman | Mar 3, 2009 2:00:42 PM

Um, babe... I'd say that the cat is out of the bag with regards to my being blunt.... But, thanks for being my knight in shining armor and trying to protect my reputation.... :-)

Posted by: zahava | Mar 3, 2009 4:33:19 PM

The problem is often snoring has less to do with the nose and more to do with the palette pushing the airways closed.

My husband was told by his ENT that fixing his deviated septum will most likely allow him to breathe through his nose when upright and awake better and improve his chronic stuffy nose problem, but he doubted very much it would do anything for the snoring.

And he was right. It wasn't until my husband started using the CPAP, which basically pushes air into the airways, that the snoring stopped and his sleep improved.

Posted by: Devo K | Mar 3, 2009 6:21:48 PM

Major surgery is what happens to you. Minor surgery is what happens to other people.

Same rule applies to falling down the stairs. When it happens to someone else it is hysterically funny. But if it happens to you it is a tragic accident.

Posted by: Jack | Mar 3, 2009 6:52:19 PM

When Mendel first went to the ENT to get a camera down his throat, there was a medical student in the room. The two of them (doctor and medical student) were discussing what the camera was showing, and one said to another, "Wow, he's got a really small nose." This gave Mendel pause. "Are you talking about me?" Silence. Then one of them said, "Well, it's small on the inside."

Posted by: uberimma | Mar 3, 2009 6:58:20 PM

I have a friend who definitely improved her appearance via a nose job, and she got married a few years later. She conveniently lost all her pictures, and did not mention the change to her husband. I have always wondered how she explained the magnificent honkers on their children. Reversion to the Mean?

Posted by: Barzilai | Mar 3, 2009 9:19:59 PM

Been there, done that!

About 12 years ago, I found that one of my nostrils was collapsing. Having never been able to breath through my nose anyway, I was not really concerned about the breathing factor, but it did bother me aesthetically (and I'm NOT a vain person). I went to see the otorhinolaryngologist (ENT) and found that:

a) I have moderate-to-severe sleep apnea,
b) I had a severely deviated septum,
c) the turbinates in my nose were unduly large, which restricted my breathing even more,
d) and, of course, the cartilage in my left nostril was collapsing.

During my pre-surgical consultation, the doctor suggested that he might remove a small portion of the end of my nose... [WTH??] to which my wife immediately agreed that he *should* take just a little bit of it off... [WTH?? my own wife??]

I ended up having the surgery. I awoke during the surgery when the assisting surgeon was using a metal mallet and chisel to break my septum. I remember thinking "this doesn't hurt, but it's INCREDIBLY loud". The primary surgeon then told her to turn the mallet over because the other side had a rubberized covering (I guess he thought it was too loud also). I told my surgeon (later) that I had awoken during the procedure and he discounted it until I related that story about the mallet. You could see the wheels turning.. Finally, he said, "Yeah, I do remember that happening now that you mention it".

After the surgery, I awoke in recovery and they told me that instead of out-patient surgery, they decided they were going to keep me overnight because I had 3 significant (apnea) episodes during surgery when I quit breathing. I think it was that, plus the fact that my wife was 8 months pregnant with our second child and they weren't sure about her being able to nurse me back to health :-)

I faded in and out of conscientiousness during the night -- just vaguely remembering I had a difficult time standing to use a chamberpot to relieve myself during the night with the aid of a nurse to help me stand up. My wife said she called 3-4 times during the night to check on me. They had 4 nurses to oversee 9 beds at the surgical center -- I understand from my wife that I was the only patient in the facility and that they had pizza delivered around midnight.

At any rate, I went home the next day. Bruising starts about 24-48 hours after the surgery and I looked like I had gone 3 rounds with Mike Tyson -- even my ear was bandaged because they took cartilage from my left ear to rebuild my nostril! I also vividly remember when they removed the nasal packing (a.k.a rhino rockets) about 10 days later. I remember 2 things very distinctly about that visit -- 1) I couldn't believe how bloody the things looked and 2) I literally felt like bottle of soda. When they removed the packing, I heard and felt the vacuum of air being broken -- a VERY weird sensation!

Anyway, sorry for rambling on, but your post touched on so many experiences I could relate to...

Shalom,
Joe

Posted by: ProphetJoe | Mar 3, 2009 9:42:53 PM

Um, babe... I'd say that the cat is out of the bag with regards to my being blunt.... But, thanks for being my knight in shining armor and trying to protect my reputation.... :-)

Memories of the Marx Brothers' movie Duck Soup:

"Remember men, we're fighting for this woman's honour; which is probably more than she ever did..." :)

Posted by: efrex | Mar 3, 2009 11:15:33 PM

I've had issues with snoring and sleep apnea over the years... back in 2002 and prior, my apnea was severe enough that it's a miracle I didn't die in my sleep. Really.

Having my nasal septum repaired - it was badly deviated, though I never knew it - and my turbinates shaved down made a huge difference... as did losing a few pounds. When my weight is reasonable - and if I can avoid sleeping on my back - I may snore a bit, but I don't suffer from sleep apnea.

Get the sleep study. If you are having episodes of sleep apnea, you can't ignore it. It's dangerous... and at the very least, it interferes with your ability to get a decent night's sleep. Which means you're spending your days walking around like a zombie.

Posted by: Elisson | Mar 3, 2009 11:41:43 PM

why not let me fix your nose while I'm in there?

Step away from the nose! The nose is sacred!

I'm rather comfortable with my own nose, even though Savage Kitten calls it a big barbaric honker. I inherited it from both parents (their noses were very much alike). It is also lopsided, just like theirs.
My dad's got broken when he was going to sea. While on shore leave, one of his companions got shnockered and whacked him in the shnozz.
My mother's was broken once in the navy. Once while in college. And once after marriage.

All three times by a refrigerator door in the middle of the night. Moral: if you're going to snack, fercrepessakes put your glasses on!

Oddly, I cannot remember how mine ended up slightly sideways. But I like it just fine. Everytime I look in the mirror, it reminds me of my parents.

Posted by: At The Back of the Hill | Mar 3, 2009 11:46:20 PM

I once got the same advice from an older ENT in Queens. For most of my life I could hardly breathe through my nose, and got way more colds than my friends. He wanted to do the whole shebang - fix the septum, scrape the sinuses,, and the nose job. In the end I didn't do anything at all. For some reason since moving to Israel I breathe perfectly through my nose and rarely get a cold. No change in the size, though :-)

Posted by: yonah | Mar 4, 2009 1:52:08 AM

if you have the study and it turns out you do have apnea, go for the kind of cpap mask my husband uses. he never could get comfy with the regular one, but the one that looks like overgrown oxygen tubing works like a charm.

Posted by: bratschegirl | Mar 4, 2009 2:01:34 AM

That's a great one!

As a Jewish girl with a small nose, your story reminded me of one of my own: When I was 5, we moved to NY from Israel. At my school hearing test, while wearing the headset, I was apparently supposed to raise the hand on the side on which I heard the 'tone'. I must have been new enough to this country to think that I just needed to raise a hand any time I heard a noise, and I raised the same hand the entire time. The school informed my mother that I was "deaf in one ear". The specialist to whom she promptly took me let her know that her daughter had "perfect hearing, and a three thousand dollar nose."

Kudos to Zahava for her great attitude. Here's to all the snorers and the spouses who nudge/tolerate them!

Posted by: RaggedyMom | Mar 4, 2009 4:20:14 AM

You should definitely have the sleep study done. I know they have good sleep clinics at the Technion, because an old friend of mine, Peretz Lavie, is the head of the program. He is one of the leading sleep medicine researchers and practitioners in the world, and has been doing work on sleep apnea for decades.

About five years ago, he wrote a terrific book on sleep apnea, called Restless Nights, published in the U.S. by Yale University Press, and is available in many other languages. It was translated from Hebrew. Anybody interested can check Amazon to get more information.

If Haifa is not convenient, I am sure there are good sleep clinics elsewhere, including I would think, Jerusalem.

Peretz has written articles not only on the sleep disordered breathing, but dental appliances and as I recall, the surgery. You might be better off with continuous positive airway pressure (CPAP) anyway. Not everybody is successful with the surgery, although CPAP, while often very effective, doesn't necessarily help everyone, either.

I live in the U.S., but became friendly with Peretz and his wife many years ago when he studied here. I am not in the medical field, but I use CPAP.

Peretz didn't put me up to writing this, either. In fact, he does not know that I did. I just try to give as much help and information to people who might also suffer from the syndrome since it is important that people become aware of it and get diagnosed and treated.

Hope this helps.

Posted by: BethesdaDog | Mar 4, 2009 4:53:35 PM

You should definitely have the sleep study done. I know they have good sleep clinics at the Technion, because an old friend of mine, Peretz Lavie, is the head of the program. He is one of the leading sleep medicine researchers and practitioners in the world, and has been doing work on sleep apnea for decades.

About five years ago, he wrote a terrific book on sleep apnea, called Restless Nights, published in the U.S. by Yale University Press, and is available in many other languages. It was translated from Hebrew. Anybody interested can check Amazon to get more information.

If Haifa is not convenient, I am sure there are good sleep clinics elsewhere, including I would think, Jerusalem.

Peretz has written articles not only on the sleep disordered breathing, but dental appliances and as I recall, the surgery. You might be better off with continuous positive airway pressure (CPAP) anyway. Not everybody is successful with the surgery, although CPAP, while often very effective, doesn't necessarily help everyone, either.

I live in the U.S., but became friendly with Peretz and his wife many years ago when he studied here. I am not in the medical field, but I use CPAP.

Peretz didn't put me up to writing this, either. In fact, he does not know that I did. I just try to give as much help and information to people who might also suffer from the syndrome since it is important that people become aware of it and get diagnosed and treated.

Hope this helps.

Posted by: BethesdaDog | Mar 4, 2009 5:09:23 PM

my husband is in snoring denial - he refers to his loud nasal disruptions as 'breathing heavy". I find that a good kick or elbow to his side, accompanied by yelling at him to stop snoring, usually works ... that is, for a little bit of time. I wish we had an apple so we could use that software - I would love for him to listen to his snoring, but he would say, that he would love to point out my bed hogging and restless leg syndrome - so I guess we are even.

Posted by: jaim | Mar 5, 2009 8:05:49 AM

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