Preoperative Instructions Very Important: For one week prior to surgery you should not be taking any aspirin, baby aspirin, advil, ibuprofen, vitamin E, Plavix or any medication that can increase bleeding or decrease clot formation. If you are on Coumadin or other blood thinners, this will need to be stopped by your internist or medical physician prescribing the blood thinner, approximately 4-5 days before surgery.Contacting Us: Postoperatively If you have any concerns postoperatively we encourage you to contact us any time day or night. Showers and Bathing: You can shower the next day after surgery. Try to keep the wound dry and if it gets wet, simply pat it dry.Activity: The day after surgery you can resume most normal activity. We suggest that you take off at least 5-7 days after surgery from work in order to allow your body to recuperate. Avoid strenuous activity like heavy lifting and vigorous exercise for about 1 week after surgery. Elevate the head when laying down by sleeping on 2 pillows. After one week you can resume your normal routine.Diet: You can resume a normal diet after your surgery as tolerated. Sometimes there can be nausea after anesthesia, but this is usually temporary. You are not limited in what you can eat, but it is best to avoid foods that are difficult for you to swallow or digest.Pain Control: Most patients experience only mild pain or discomfort at their surgical wound site which lasts for 1-2 days. You will be given a prescription pain medication in case you experience moderate pain. Many patients get by with no pain medication or taking only Tylenol.Calcium and Vitamin D Supplements: Patients with primary hyperparathyroidism should supplement with Calcium and Vitamin D supplements. All patients should be taking this routinely daily postoperatively and continuously. This will help to re-build your bone calcium stores that were lost. There are many formulations on the market of Calcium with Vitamin D. Your physician will instruct you on taking this supplement.
Surgery for Parathyroid Disease
Hyperparathyroidism is an uncommon problem that effects the glands in the neck. Symptoms of hyperparathyroidism are rarely very disturbing taken individually, but as a whole, can cause a lot of misery. The most common symptoms are chronic bone and joint pain, often blamed on arthritis. Also, it causes disturbance in mood, eg. depression, and people also complain that their thoughts are not clear. Many of these are not noticed until the underlying problem is corrected and patients just feel a lot better. Rarely, hyperparathyroidism can cause kidney stones.
Surgery for parathyroid disease is difficult for many reasons. First of all, the number of parathyroids are not always consistent from patient to patient. There are usually 4 glands, but there can be as few as 2 or as many as 6, 8, or even in rare cases 10 or 12.
Secondly, the parathyroids are very small, with the normal size of a parathyroid gland being about the size of a black-eyed pea. They live inside small fat globules in the neck and are only identifiable by the slight difference in color to normal fatty tissue.
Thirdly, the parathyroid glands are not always where they are supposed to be. Parathyroids are in their normal location about 90% of the time. When they are not there, they can be difficult to find.
Most of the time, hyperparathyroidism is caused by a single gland becoming enlarged and producing a lot of parathyroid hormone. This is the case in about 90% of the patients with hyperparathyroidism. Occasionally, all of the glands can become enlarged and produce too much parathyroid hormone. Therein is another difficulty of performing parathyroid surgery.
Normally, surgery to remove a parathyroid gland takes around 45 minutes to an hour to perform. There are times, when it can take much longer, on the order of 3 to 4 hours when the glands are difficult to find.
The abnormal gland is localized before surgery so that the surgery can be done more quickly. It also allows the physician to be able to explore one side of the neck rather than having to look on both sides. This lessens the potential problems that you can see after this type surgery.
A rapid parathyroid assay is also used during surgery so that we can be assured that the problem is fixed. Blood is drawn before surgery to check the parathyroid hormone level, then 10 minutes after the gland is removed we redraw the blood to make sure the blood level has fallen. If the blood level of parathyroid hormone falls enough, we can be confident we have fixed the problem before we leave the operating room.
After surgery, you can have problems with your blood calcium level falling too low. If this happens, it can make you have tingling sensations in your face and fingers. If it falls even lower, it can result in muscle spasms. This problem, if present, needs to be addressed with calcium supplements after surgery. Your physician will discuss taking calcium supplement with you.
Ear, Nose and Throat Physicians of North MS PA