Pain several weeks after surgery is normal.  For one native Californian however, the pain following nasal surgery in the US lasted three decades.  So when he learnt of a possible treatment in Singapore, hell or high water couldn’t stop him. 

In 1974, casino dealer Michael Hornholtz was rolled into the operating theatre, expecting doctors to fix his broken nose.  The septoplasty was meant to straighten his nasal septum (the partition between the two nasal cavities).  Not an uncommon procedure, even at the time, still, it was obvious the moment the anesthesia had worn off, that something was wrong.   

Recalls, the 66-year old, “I had a torturous and intolerable pain at the site of the surgery.  This was accompanied by extreme irritation of the membrane and floods of mucus, and the sensation that something was trapped in my nose.” His doctor attributed this to an allergy.  That hardly convinced him seeing that he had no history of allergies of any kind.  Yet, that was to be the least of his problems.  “No matter how much I asked, requested or begged, I could not get anyone to go back and look at the original operation site to determine the true nature of my condition,” he insists. 

Life of overwhelm

Although prescribed with pain-reliving medication, its effects were limited unless he over-medicated himself to the point of unconsciousness.  A topical steroid spray was later added to his pain-fighting repertoire of drugs and although it did suppress the symptoms somewhat, he knew it was merely masking the underlying condition.  Hornholtz maintains, “I had to carry pockets full of paper towels wherever I went in order to accommodate the rivers of mucus I would produce on a daily basis.  There was a sense of entrapment and I was horrified that I may have to take steroids for the rest of my life.” 

Though he had had ‘more X-rays than he can remember’, all they revealed was that his septum had been successfully corrected.  CT scans and MRIs also failed to point out anything conclusively.  Disillusioned, he did some research and found out that the only way to determine the exact nature of the condition was a minimally-invasive examination using a microscopic camera.  The only problem was that his doctors did not think that his condition warranted it.  

Eventually, in 1996, a surgeon agreed to correct the problem but did so without success.  Another surgeon attempted the same in 2003 but he too failed.  In time, psychiatric treatment was instead recommended, signaling where the doctors thought his pain was emanating from.  To add to his woes, he had developed sleep apnea, which was preventing him from getting a decent night’s sleep.   

Down but determined 

Even though Hornholtz was emotionally drained and financially strained by this point, he persevered for a solution.  He did not want to remain drugged up all the time.  Furthermore, no matter what he did to maintain a level of self-sufficiency, it was getting increasingly harder with age.  Still, determined not to sit and watch his quality of life erode, he took his search online.  It paid off.  From the different options available, he decided to see consultant ENT surgeon Dr Lau Chee Chong, from the Ear, Nose and Throat Centre CC Lau, at Mount Elizabeth Medical Centre in Singapore.  Dr Lau is also part of eMenders, a group of specialist doctors based at the centre. 

“Dr Lau was very responsive and reassuring and seemed to have a better understanding and a more positive approach.  He also addressed all my questions clearly and listened carefully to all my requests.  I was impressed with both his promptness and thoroughness.  Although I was excited and couldn’t wait to get to Singapore, at the same time I was disturbed by the idea that I had to travel around the world for medical treatment.  I view this as a failure and harsh criticism of the entire healthcare system in my country,” declares Hornholtz, who has never before traveled outside North America. 

The 33-year wait ends

In May 2007, Hornholtz arrived in Singapore.  With medical reports earlier sent to him, and after conducting his own clinical examination, Dr Lau outlines Hornholtz’s chronic nasal problem.  “What I saw was a lot of scar tissue in the anterior ethmoidal, an area where the nerves run.  His septum had deviated to one side and was pressing against the lateral wall of the nose, a condition known as nasal neuralgia.  This probably resulted when the doctors were trying to straighten his nose.” He adds, “There was some infection and he also had sinusitis.  However, I felt that the impinging of the nerves was the root of his pain.”  

During the hour-long surgery, Dr Lau went into the area where the nerve runs and removed some of the bony chips he found.  He also cleared up the sinus infection and scar tissue left behind from his previous surgeries.  Hornholtz recounts how he felt after surgery.   

“I had undergone extensive nasal work with a great deal of structural correction so it was initially a little difficult to determine which pain was which.  However, gradually, it became apparent that the trauma that had plagued me and controlled my life for so long was finally gone.  Unbelievable.”  

With 17 years of ENT experience behind him, Dr Lau notes how this problem is easily one that can be wrongly diagnosed.   

“The patient might be in pain but there is no clear-cut indication of a problem.  Even a scan may not reveal anything.  The hunting of the nerve comes with knowing what you are looking for.  Otherwise, you will miss it.  Sometimes, just listening to the patient will give you an idea.  Owing to that, more often than not, painkillers are prescribed and the patient is sent on his way.” 

After an over-night stay in the hospital, the American spent the next six days recuperating in his hotel before leaving for home.  He is expected to follow up with an ENT specialist back in California.  Speaking via email a month after surgery, an elated Hornholtz reports that though still recovering and not yet back to work, he is happy with his progress.   

“I can’t begin to explain how grateful I am to Dr Lau for treating my condition when all the top nasal specialists from esteemed medical schools and clinics in the US had turned me away.  He has given me a gift that cannot be measured.” Hornholtz has also much to say about the excellent and professional medical services available in Singapore.  This he says with a resounding belief and more importantly, with a breath of relief.   

About eMenders

eMenders (www.emenders.com) is a group of more than 50 leading specialist doctors in Singapore covering over 25 different branches of medicine and dentistry based at Mount Elizabeth Medical Centre in Singapore.  To help patients make well-informed decisions, the doctors’ profiles; qualifications and training backgrounds are available on their website.  eMenders also provides referral services to match patients with the appropriate medical specialists for their medical conditions.