Ep.8 - First Visit, Endoscopy and NOSE TV

Dr. Ron Swain | Mobile Alabama Sinus Doctor | Sinus and Allergy Specialist | Sinus Surgeon

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In this Swain Sinus Show episode, let's talk about your first ENT office visit for Dr. Ron Swain. Host Stacy Wellborn has a lot of questions about the “endoscopic procedure” which we find out is "the use of a small camera to look in the patient’s nose and sinus cavity." Dr. Swain eases Stacy’s anxiety by reassuring her that he and his pro staff make this important sinus diagnostic procedure as comfortable and quick as possible. If you've ever wanted to see the inside of your nose on a big screen, this is your chance to be the star of NOSE TV.

What you will hear:

> What you should expect on your first ENT appointment. > What is an endoscopy? > How long does the endoscopy procedure last? > How long is my first appointment? > How many appointments will it take to get a proper diagnosis? > What are all the diagnostic equipment options available.

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Call Dr. Swain’s nursing staff at 251-470-8823 or schedule an appointment here.

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Stacy: In this episode, we're gonna talk about the first visit. Dr. Swain, when I come see you, what's gonna happen to me?

Dr. Swain: That's a good question. Hopefully, you're going to be happy. I think the number one thing is, is we're there to make a diagnosis, and how do you go about finding out what the problem is with someone's nose. Any time somebody comes in, we look everywhere. We look at the ear, nose, and throat. So, we'll look at your ears. We'll look at the outside of your nose. We'll take a little nasal speculum, and kinda open up your nostrils, and look on the front part of your nose. We’ll look in the back of your throat. And then we'll, you know, obviously talk first and figure out kinda what the problem is. A lot of times, we have to do an endoscopic procedure to look on the inside of the nose. That’s why people are there to be seen because they’re having problems. And really if you wanna know what’s going on, the most important tool we have to try to help figure out what’s going on is to be able to visualize the inside of the nose.

Stacy: Tell me, what does endoscopic mean?

Dr. Swain: That's a great question. It means looking through a scope on the inside of something. In this area of minimally invasive, you know, surgery, we can look inside the nose without making a cut by just using a small little camera.

Stacy: So there's a camera on a thing you're gonna put inside my nose.

Dr. Swain: There is a small little...almost looks like a little rod. We’ve got a fiber optic light cord attached to it that we project images on television. This is your first chance to be on Nose TV.

Stacy: Well, I'm not gonna lie. That kind of freaks me out to put anything up in my nose, so how are you gonna make me not freak out?

Dr. Swain: That's a good question, too. Any time we're looking on the inside of the nose with an endoscopic camera, we always put some numbing medicine and a little bit of decongestant, some Afrin spray, so there's more room to breathe in the nose. Universally, no matter what we do, that stuff doesn't taste real good. So you're gonna get a sucker, Stacy.

Stacy: All right. Do I get to pick my flavor?

Dr. Swain: You get to pick your flavor. We’ll give you a sucker afterwards that will kinda help with the taste of it, and then very gently, we'll look in the nose with the camera on both sides, on the right and the left side, and we'll go all the way in the back of the nose to look at the nasopharynx and look and see, you know, what we see. Is there a deviated septum? Are other polyps? Is there a mass? You know, are we worried about a tumor? So, the most important thing we have really and the most important reason to see a doctor is to be able to have them examine you, and so this is the best way we can go about examining the inside of your nose.

Stacy: So that gets the nose part, but what about the sinuses?

Dr. Swain: So the sinuses empty into the nose in the nasal cavity. Now, if you’ve had sinus surgery and all those sinuses have been opened, well, then I can take that camera and go and look in your nose and look into all of your sinuses. But if you haven’t had surgery, we can’t see in your sinuses which sometimes leads us to have to go do an x-ray or a CAT scan to be able to look inside the sinus cavity themselves. You get a lot of information by just looking in the nose because, again, all the sinus cavities drain into the nose. So we’re able to look and see where the sinuses drain or what they are draining. I mean if you look in the nose and you see a lot of, you know, purulent drainage, it’s pretty obvious that someone has a sinus infection. But sometimes we have to take some pictures as well to see what’s going on.

Stacy: So the first time I come to see you, how long is that appointment, this process?

Dr. Swain: Well, it depends. You know, a lot of times people come in, they have a lot of questions. And then you've got to get a history. So you've got to be able sit down and try to figure out exactly what somebody is complaining about, how they've been previously treated, what antibiotics or any type of medicine they've been on, how that affects things and then you examine them. And usually by that time, they have a few more questions and then sometimes you have to check an X-ray or a CT scan as well. So, you know, it can take 20, 30 minutes. Some of it takes longer depending on what you see. If you look in there and you see something that requires a lot of discussion, things take longer.

I guess the best way to say it is there’s no universal cookie-cutter time, I'm not looking at my watch going, "Okay, your 10 minutes are up. It’s time to move on." It's just a question of what is the problem, and what do we need to do to address the problem. Every patient's different.

Stacy: And typically, does it require several appointments before making a diagnosis or can you make a diagnosis during that first appointment?

Dr. Swain: You know, a lot of times, you can get some idea of what's going on. A lot of times we're limited by, you know, some people's insurance requirements. You know, you never wanna go and look at someone and say, "Hey, you know, you need an operation." So a lot of times if we're trying medical therapy first, it may take a visit, or two, or three to figure out, "Okay, is this working or is this not working?" You know, if you come in and we put you on medicine, some steroids, and you come back, and you say, "Well, I'm a little better," well, that's progress. That's not something we just go jump to the operating room for. And if you come back and you say, “Look, I’m not any better,” and we’ve tried some medical therapy, then we’ve got to typically be more aggressive.

And again remember it’s not just you and me or me and patient in the exam room. There’s me and the patient and the insurance company.

And if you come back and you say, "Look, I'm not any better," then we've tried some medical therapy, then we've got to typically be more aggressive. And again, remember, it's not just you and me, or you and me and the patient in the exam room, there's me and the patient and the insurance company. And so you've got to do things in such a way that it's very obvious to all, everyone involved, that, well, it's being recommended it's in the best interest of the patient.

Stacy: I'm not gonna lie, I wanna go back to this endoscope in my nose.

Dr. Swain: I understand.

Stacy: I'm still a little freaked out. How long is that part of the procedure?

Dr. Swain: The procedure itself does not last very long, probably, about a minute. You know...

Stacy: Okay, I think I can handle that.

Dr. Swain: Yeah, it's not as bad as it sounds. I think, you know, seeing is believing. I probably need to get you down to the office and, you know, perform an endoscopic examination of your nose, just to make you feel a little better. It's not something that we're looking to hurt people with, obviously, but, you know, at the same time, there are, I mean, if you're going to look down your nose and down your throat, no one's going to wake up in the morning going, "Oh, great, it's Tuesday, I want someone to look in my nose and my throat." But if we don't do it, if someone is not having a complaint, if you have a complaint and a problem we got to try to figure out how we can get you better.

Stacy: All right, I'm a little less worried now, and so do I get to see the camera? Do I get to see what you're seeing?

Dr. Swain: Oh, yeah. You get to see what we're seeing.

Stacy: So you have it on TV screen, I can see what is going on.

Dr. Swain: We have it on a TV screen. Sometimes people don't want to see it, some people would just want to close their eyes, which is okay, too, but that image is projected in the room.

Stacy: I am pretty fascinated by it, so I would wanna see it. Well, this makes it feel a little less scary about coming to see you the first time, so I hope that others will do it, too. Tell me how to make an appointment to come see you.

Dr. Swain: It's really easy to get an appointment to see me. If you would call and speak to my nurses, the direct line is 251-470-8823. Again, that number is 251-470-8823, and of course, we're trying to make appointments online, there's drronswain.com for appointments as well. My nurses are Mandy Webster, and Chasity Wooten and Emily Demet. If you'd call that number directly, my nurses can help you get set up to have an appointment to see me.

Stacy: Great. Thanks, Dr. Swain.

Dr. Swain: Thank you.

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