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Tonsillectomy and Adenoidectomy -- continued
Despite precautions, the instrumentation used in the performance of the operation may produce complications. The gag used to hold the mouth open must place some pressure on the tongue, lips and teeth. Occasionally, these tissues are unusually sensitive to this pressure. The tongue or lips may swell and become uncomfortable. Teeth, particularly first teeth, may loosen.
The electrocautery device utilized to control bleeding has also been associated with minor difficulties. Since it operates by generation of an electrical spark, the spark could jump from the instrument to normal surrounding tissues as well as to the sites of bleeding. This occurs at times depending upon certain conditions in the throat but is often unpredictable. It is also possible for the electrocautery instrument to malfunction and to produce a minor burn in the mouth or throat.
Most of these instructions relate to patients who have had a tonsillectomy. Patients undergoing an adenoidectomy without a tonsillectomy generally have fewer problems with post-operative pain and swallowing due to the location of the operative site high in the throat.
1. LIMIT ACTIVITY and TRAVEL.
Your child should not return to school for approximately one week following the operative procedure. I suggest the he or she avoid vigorous play or athletic activities for two weeks. If your child plays a woodwind or brass musical instrument, I do not recommend resumption of play for one month following surgery. Keep in mind that your child will likely not feel completely recovered for at least ten days to two weeks. Your child can pursue quiet activity at home and need not stay in bed. School friends should not visit during this time, as they may bring illness into the home. I suggest that you not travel with your child out of the immediate metro area for two weeks following surgery as post-operative bleed remains a possibility during that time.
2. YOUR CHILD'S DIET.
It is absolutely necessary that your child immediately increase oral intake of food and fluids. Of the two, food is more important since it contains the calories which fuel healing and is 80% water. The fluids in juices, water, and in food maintain the body's hydration. Swallowing solid food also helps to remove unwanted debris and scabs which tend to accumulate in the throat.
The optimal food plan for a quick and more pleasant recovery following tonsillectomy and adenoidectomy contains many carbohydrates in general and sugar in particular. I call it the TWINKIE DIET and it includes complex carbohydrates such as pasta but especially simple carbohydrates such as the sugars found in cake, ice cream, cookies, donuts, and pastries of all types such as the ever popular Ring Dings, Yodels, and SnoBalls. Remember that everything tastes better with whipped cream, and cans of it are now available in many flavors including chocolate, strawberry as well as the classic vanilla. Studies have shown that sugar aids the pain-killing effects of both non-narcotic medications.
Try to begin real food as quickly as possible. The calories will improve your child's disposition and fuel the healing process. Food should be neither crusty nor dry. Foods such as potato chips, crackers, dry toast, and pretzels may scratch the healing operative sites and cause bleeding. They should be avoided during the first post-operative week. Anything else is fine!
3. PUSH FLUIDS.
I cannot stress strongly enough that fluid intake must be maintained remembering that food is 80% fluid and has the necessary calories to sustain healing. This will prevent your child from becoming dehydrated and running a fever. Dryness will slow the healing of the throat and make swallowing even more uncomfortable. Inadequate fluid intake is also the most common cause of a fever occurring once your child goes home. Also, I recommend that your child not use straws for the first 10 days following surgery.
Be aware that throat pain often refers to the ears. For this reason, it is common for children to develop pain in one or both ears which intensifies on swallowing. Such pain during involuntary swallowing at night may awaken your child from sleep. Be assured that in most cases patients experiencing such sensations do not have ear infections. If, however, the pain is intense and unrelenting, please notify me. As above, you will be giving your child Tylenol™ or another aspirin-substitute four times a day for the first four to seven days to minimize both ear and throat pain. More severe pain is controlled using narcotic medications.
5. NO IBUPROFEN OR ASPIRIN CONTAINING PRODUCTS.
Ibuprofen containing products such as Motrin™ and Advil™ or aspirin will interfere with your child's blood clotting capacity. This could lead to uncontrollable bleeding during the post-operative period. Read the labels of any medications that your child is taking to be certain that they do not contain either ibuprofen or aspirin.
6. IN THE EVENT OF BLEEDING.
If you notice any evidence of bleeding, PLEASE NOTIFY ME OR ONE OF MY ON-CALL ASSOCIATES. I may be reached through the office line at 860-236-3277 during the day. At night, call the same number but press ZERO. If your child is having a bleeding problem, make an attempt to contact me. In most cases you should bring your child immediately to the hospital emergency room. I or one of my associates will meet you and your child for an emergency examination.
In children, slight oozing will occur from the tonsil beds as the scab falls off at about the sixth through the ninth days. This type of bleeding is very slight and is usually self-limited. If it occurs, give your child a small glass of ice water to drink and wash out the throat. If the bleeding persists, contact me.
I will schedule a post-operative visit during the first week or two following the operation. At this visit, I will assess your child's general progress as well as the degree of healing within the throat. An additional visit is necessary at about 6 to 12 weeks following the surgery to check intermediate-term healing of the throat.
Good communications are important and parents are the best judges of how their child is progressing after surgery. If you feel that your child's post-surgical course is worrisome, please contact me as soon as possible. Reach me during the day or at night through my office phones at (860)-236-3277.