Part 5: Bloody Noses and a Tumor

There are a few things in life you don't want to need.

For example, you don't want to need an undertaker. You don't want to need a bail bondsman. You don't want to need your oxygen mask in the middle of a flight. Likewise, I didn't want to need a cardiologist, but as I shared in my previous post I had become one of those middle-aged men who was lucky enough to have a cardiologist on his speed dial. 

Even though I didn't want or need a cardiologist, I did leave my cardiologist's office with great news. My heart was functioning well as a strong pump in my body and after altering my blood pressure medication slightly, I quickly got the numbers down and closer to the normal range which allowed me to begin the monthly blood donations once again.

For those keeping score, the disease processes in my body had grown to include: fatty liver disease, hypertension, high iron levels and the beginning levels of obesity. As if that wasn't enough disease markers, a new area of my body began to feel neglected and began to show up on the scene.


Toilet Valves and Bloody Hell
I began to notice that whenever I caught a simple head cold, my sinuses would congest horribly. Once again, I didn't pay much attention to what my body was saying. I assumed my congestion was associated with the same allergies that many in the central valley of California struggle with. However, even when my cold symptoms disappeared, I noticed that the congestion remained and I felt like I could never really clear my airways. Two things began to grab my attention.

First, whenever I blew my nose, my airway would immediately clear. But, as soon as I sucked air back up through my nose, my nasal passages would slam shut. It almost felt like a flapper valve in a toilet. It was an odd feeling and I actually felt like something was moving inside of my sinuses.

Second, for the first time in my life I began to experience nose bleeds, but these were not regular trickling nose bleeds that you could pinch off to stop. These were uncontrollable bleeds that felt like I had ruptured an artery high inside my nose.

I began to avoid heavy sneezing and blowing my nose, because every time I did it was like I was standing in the middle of a murder scene. As things progressed, there was a point when I even considered asking Kendra to buy me tampons to shove up my nostril. When the bloody noses showed up at work it was time for me to address the issue with my family doctor.

Big Cameras and A New Doctor
With a quick scope up my nose, the toilet flap I felt in my nose had a new name. It was simply a nasal polyp and required a referral to the local ENT's office where I discovered a fun fact: Specialists have much LONGER cameras. With a few puffs of anesthetic to numb my nasal passages it felt like he wedged a McDonald's straw up between my eye balls. Delightful. Really. You should try it at home.

I thought it would be a simple removal. I actually expected him to remove the polyp while I was in his office at my consultation. But, my ENT requested I get a CT scan and an MRI so he could get a better sense of what we were dealing with. It seemed like overkill, but I'm glad he did. The results were astonishing.

Yellow outline of the polyp in my left nose/sinus

Yellow outline of the polyp in my left nose/sinus

For those unfamiliar with the CT scan, pretend I am looking right at you. Those grey roundish oblong things are my eyeballs. All the white structures are bones. The dark spaces are the airspaces in my sinus cavity. So, my nasal polyp (highlighted in yellow) began high in my left sinus and extended down just above my nostril. The MRI confirmed this as a three dimensional worm-like mass that seemed to be attached to the bone at the base of my brain. As I sat down with the ENT to go over my results, he explained that based on the location of the polyp, it might be better to see a specialty surgeon at a university hospital and that meant either Stanford or UC San Francisco.

Yellow outline of the size and location of my tumor

Yellow outline of the size and location of my tumor

Stanford Surprise
If you are keeping score, this little toilet flap growth that seemed to be the source of my horrific nose bleeds had now landed me in my third doctor's office in a few months. I chose Stanford University (because I love Palo Alto, CA) and was looking forward to scheduling surgery and by now had become very familiar with the routine for initial exams: Anesthetic spray deep up both nostrils and then a long camera tube up my nose. This time it was a little different. First, my new doctor gave me a pair of glasses connected to his scope. So, what he saw on his endoscope, I saw in my glasses. As he poked around, he was speaking with his attending students and mentioned two disconcerting things. First he mentioned wanting to get a biopsy. What did he say? A biopsy? Second, he mentioned the need to diagnose the tumor. Tumor? Did he just say tumor? What happened to polyp?

I interrupted the doctor and told him I thought I had been sent to Stanford based on "where this growth was located" and he was quick to explain that it was not only "where" this growth was in my sinus, but "what this tumor might be." Somehow I missed it, but his business card did list him as an ENT oncologist. Needless to say, I was surprised. My oncologist discussed a variety of things that each had their own list of questions: the possibility of cancer, submission to the Stanford tumor board for treatment planning and admission to the hospital for surgery and recovery. Before we really had a chance to process what he was saying, he was back in my nose with a pair of biopsy forceps and scissors. I watched it all with my fancy glasses. A quick snip and a chemical swab to burn the incision and we were on our way back home to wait for the results.

Diagnosis and Results
The good news is that the results came back favorable. "Just a nasal growth" is what he said when he called me personally on the phone. "We'll do the surgery in my office and you'll be back home that night recovering." What a relief. No pun intended, but I felt like I could breathe again.

Within a month we were back at Stanford and I was sitting in the same chair with several needles being injected into my nostril. Briefly let me pause and say that as a treating dentist, it was good to be a patient. It reminds you what it means to be gentle and communicate well. I know this, but it was great to experience it too!

They numbed this mass from every angle and then proceeded to cut and tug it out of my sinuses. I didn't get to watch this time and although I've seen a lot of traumatic oral surgery in my own dental practice, I am glad I did not get to see this. When it finally detached it felt like my doctor was pulling an oversized slug out of my nose. I looked down on the gauze and saw this nasal mass that was about the size of my pinky in length. It was way bigger and way uglier than I expected. My doctor commented on the color of the blob and suggested he might get a follow-up biopsy. He spent a few more minutes cleaning my sinus with a giant rooter blade and then sent me home. No bleeding. No packing. To this day, he is one of my favorite medical professionals I have ever had the pleasure to work with.

Having fun at Stanford

Having fun at Stanford

"This Changes Things"
As we left Stanford, I felt like I could smell things from across the county. The doctor assured me that the surgery was a success, but it was wonderful to take deep breaths out of both nostrils. He also said that he would contact me if there was any additional information. It did not take him very long.

One week later, Kendra and I were enjoying a Sunday night walk through the orchards around our home. My phone rang and I noticed it was a Palo Alto phone number. I was shocked to hear my doctor's voice, but I assumed it was a standard one week post-op phone call. I should have known better. When a doctor calls you personally on a Sunday night, there's probably a reason.

I quickly learned this was not an ordinary follow-up conversation, he explained that the new biopsy had revealed more information and a new diagnosis. My "toilet flap growth" that became a "nasal polyp" and then became a "nasal mass" had now become an actual tumor. It even had a name: Glomangiopericytoma. I've detailed this all here, but if you want the basics: It is a rare nasal sinus tumor. It is non-cancerous, but it can be aggressive in growth and localized destruction, which for me was the bone at the base of my brain and the nerves I use for smelling things.

"This changes things," he said. Instead of basic recovery from my in/out surgery, I was now on a 5-year evaluation plan. My doctor was going to need to look in my nose every 3 months and then every 6 months and eventually once/year. If there are no changes in growth, shape or color, I am in the clear. But if my tumor shows any rebound, we will need to go back in surgically (hospital visit) and find clean borders all around the tumor. The chances are good this will happen at some point, but as of now we have seen no changes. I still have great airway breathing and I have not had a nose bleed since surgery.

How Does This Relate To Diabetes?
During the time I discovered the growth in my sinuses and managed the horrible nose bleeds, I did not know I had diabetes. But, this was one more domino falling in my declining health. Circling above the blood pressure, the liver disease, the tumor and the weight gain were the thick black clouds of stress and depression. I'll talk about that more in the next part of this series.

Quietly Making Noise,

PART 1: Middle Age Status
PART 2: Fatty Liver Disease
PART 3: Ironman Is Here
PART 4: Hypertension
PART 5: Bloody Noses and a Tumor
PART 6: Stress and Depression
PART 7: Diagnosis: Diabetes!
PART 8: Get Out and Get Walking!
PART 9: Kicking Sugar to the Curb!