Microsoft word - potonsils.doc

POST OPERATIVE INSTRUCTIONS FOR TONSILLECTOMY PATIENTS

The most important instruction we give our patients following a tonsillectomy
is for the patient to EAT AND DRINK APPROPRIATELY. This can be a problem due
to pain after the surgery. THE MORE YOU EAT AND DRINK, THE LESS PAIN YOU WILL
EXPERIENCE. During the active swallowing the throat is kept cleaner, therefore,
decreasing the chance of infection and postoperative bleeding. It is also
important to AVOID EXCESSIVE PHYSICAL ACTIVITY. There is a TWO-WEEK HEALING
CYCLE following a tonsillectomy during which we need to take precautions. We
will go into this in greater detail, but this time frame needs to be kept in
mind. TAKE THE MEDICATIONS GIVEN to reduce pain and the antibiotic to reduce
the likelihood of infection.
EATING AND DRINKING
• The diet can be very liberal following a tonsillectomy provided it is • AVOID ANY HARD OR CRUSTY FOOD FOR TWO WEEKS. This includes crusty food such as: potato chips, other chips, popcorn,
hard crust of bread, etc.
• Most other foods are OK if you will chop them up. This includes: pancakes, eggs, chopped chicken, chopped hamburger. You can start eating like this the very first day of surgery. • In general, we like to see the patients eating as soon as possible. This will reduce pain and allow for quicker healing. • The patient should drink fluids proportionate to their size. A six year old child can usually drink 24 oz. to 1 qt. Per day. An adult can drink a quart and a half or more. • Please avoid eating or drinking dairy products such as milk, ice cream, etc. for the first four days following surgery. Dairy products tend to make saliva thicker and more difficult to swallow, something we want to avoid. After four days, these dairy products can be used. • Instead of ice cream, Popsicles are recommended. They can be crushed or eaten as is, providing a cool and soothing effect on the throat. • Chewing gum is also helpful, due to the role active swallowing plays in • Other than the choice of dairy, beverage choice is left up to the patient. Soft drinks, tea, and fruit juices are all acceptable. You may choose to avoid some fruit juices as they may sting the throat. However, if you prefer them, they are okay to drink. • This aggressive eating and drinking should continue for a full two weeks • If eating and drinking does not occur as mentioned above, the following will likely result: There will be more throat pain, which may spread into the ears. Body temperature may start to rise up to 101 or higher. There will be an increased chance of post-operative bleeding. HUMIDIFIERS
• We recommend using a humidifier in the bedroom for two weeks postoperatively. This will prevent the throat from drying out
excessively. This is a problem at night especially. Keeping a glass of
water at the bed stand is also helpful, allowing the patient to drink at
night when he/she wakes up. HOWEVER, it is extremely important that you
follow the cleaning instructions for your humidifier. Some
manufacturers sell cleaners which help to prevent the growth of
bacteria and fungus. A dirty, moldy humidifier will definitely hinder
your post-operative recovery.
BAD BREATH
• The first two weeks after surgery, most all patients will have bad breath. As the healing process occurs, this will go away. • If you happen to look in the throat, you will notice two large yellow/white patches on either side of the throat. This does not represent an infection. Rather, it simply is the appearance of a wet scab over the tonsil bed and is the normal post-operative appearance. • On the other hand, if there is a lot of debris in the tonsil bed and excessive mounding of crusts, this usually indicates the patient is not eating and drinking sufficiently. POST OPERATIVE PAIN AND MEDICATIONS
• THERE IS SIGNIFICANT PAIN AFTER A TONSILLECTOMY FOR THE FIRST TEN DAYS.
• The patient will have both good and bad days during this time period and
thereafter every day is definitely better. • On occasion, the first few days after surgery are fairly easy and the more significant pain begins on the fourth or fifth day. Be sure to take your pain medication on a ‘round the clock basis. • It is very important for the entire two week healing period to eat and
drink according to the above guidelines. This will greatly diminish
post-operative discomfort.
• Some throat pain can be felt in the ear. We term this type of pain as "referred pain". This is normal. • It is important to control pain with medications such as Hydrocodone or Darvocet. Some side effects that can be seen with these include nausea, constipation and bad dreams. It is helpful to take all prescribed pain medication, antibiotics and Prednisone with food or on a full stomach to avoid gastric upset. • Do not take medications such as Aspirin, Advil, and other Ibuprofen drugs and Vitamin E postoperatively. This can cause thinning of the blood and other bleeding episodes. • Taking pain medication on a 'round-the-clock basis, the first few days post operatively, will help relieve discomfort and allows the patient to eat and sleep better. • Carafate gargle and spit medication will be called into your pharmacy as well. This medication coats the throat and helps in pain relief. Please use this medication as directed. RETURNING TO SCHOOL
• Generally, children will miss a week of school following a tonsillectomy. Sometimes this is extended a few more days at the parent's discretion. They should remain out of physical education classes for two full weeks and activity should be limited. It is important to eat and drink appropriately while at school and at home. It can be helpful to have a water bottle available at the patient's desk throughout the school day. POST OPERATIVE ACTIVITIES
• For two weeks after surgery, excessive physical activity should be avoided. This includes physical education at school, weightlifting, or lifting any heavy objects, aerobics, gymnastics, dance and strenuous bicycle riding. POSTOPERATIVE BLEEDING AND THE HEALING PROCESS
• The most common time for bleeding is approximately seven to ten days following surgery. During this time, new blood vessels are growing back
into the tonsillar area and they can sometimes ooze. This is not very
common. When it does occur, a patient usually coughs up a clot of blood
and it is very obvious. This is not just a little blood-tinged saliva,
but rather an obvious clot and an obvious bleeding episode. Should this
occur, the most important thing to do is to give me a call immediately,
day or night.
• The usual procedure for post-operative bleeding is to meet the patient in the emergency room where a Tannic Acid powder will be applied to the
tonsil bed to control any bleeding. The patient will then go home
without further complications. The only way to get in trouble is to
ignore this problem and WE NEVER DO THAT. If you have any questions,
simply call me.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL DR. CRAIG AT HIS OFFICE OR AT THE
NUMBERS PROVIDED BELOW:
ROBERT D. CRAIG. M.D.
777 S. NEW BALLAS RD. SUITE 320 E
ST. LOUIS, MO 63141
OFFICE: 567-4868
EXCHANGE: (314)388-5208

Source: http://www.robertcraigmd.com/downloads/post-op%20tonsillectomy.pdf