Most people think of tonsillectomy as a children’s surgery. Indeed, many of us in the United States had our tonsils removed as children. There was a time when the surgery was performed with such frequency that siblings might have their tonsils removed simply because an older brother or sister was having a tonsillectomy. The pendulum swung back hard in the 1970’s. The value of the tonsils in warding off illness was often viewed as reason to keep them in spite of frequent bouts of tonsillitis, strep infections, and tonsil stones.
Today, many adults find themselves facing the possibility of undergoing this, “children’s surgery.” Anyone who has cared for a child after tonsillectomy might assume that the recovery is a fairly short and unremarkable experience. This may be true if you’re eight years old. The fact is that an adult will face a longer and more painful recovery than a child will in almost every case. While children have the benefit of a young and robust regenerative body, a grown man or woman has knowledge and experience to help them through stresses upon the body. If we as adults are to avoid the irony of crying like a child over the difficulty of what we thought was a child’s surgery, we must arm ourselves. We must advocate for ourselves.
Gathering knowledge, asking questions, and clearly articulating one’s expectations can greatly improve the adult’s tonsillectomy experience. Patients need to talk frankly with their doctors about the benefits and risks of surgery, and also the risks of keeping those troublesome tonsils. There is still much for the medical community to learn about obstructive sleep apnea, but all indications are that, left untreated, those suffering from this sleep disorder are at high risk for higher blood pressure, depression, sexual dysfunction, and heart disease. While many ear, nose and throat doctors do not view tonsillectomy as an indicated treatment for the disorder, there is ample anecdotal evidence that many tonsillectomy patients experience improved sleep patterns. The short and long-term effects of recurrent tonsillitis and throat infections is hard to measure, but it’s certainly worth a good college try.
Once the decision to undergo tonsillectomy surgery, adults must have frank discussion with their health care provider about pain management. The time to have this discussion is before surgery, not at 3 a.m. some morning when the prescribed pain medications are exhausted and pain is soaring through the roof. Further, there is no reason for a person with cauterization burns covering an area recently carved at with a knife or other instrument should be expected to swallow pills. It’s shocking how often doctors fail to prescribe liquid forms of the medicines they prescribe to tonsillectomy patients.
A plan should also be made to ween the patient off narcotic pain killers. Most tonsillectomy patients complain of depression symptoms in the second week of recovery. While lack of sleep, poor diet, and lack of social interaction often contribute to these feelings, it appears obvious that there is also a chemical component. Most patients experience an ebb and flow of pain during the two weeks following surgery. Initially, residual anesthesia seems to curb breakthrough pain. After this initial one or two-day honeymoon, pain levels rise. After a week, many patients feel some reduction in pain as the tissues heal. During this time, the patient may try reducing or eliminating the narcotic pain medicine, perhaps in favor of an over the counter medicine like acetaminophen. Pain can elevate to its highest levels in the second week, when scabs begin to detach from the tonsil beds. A serious risk exists in managing these pain levels. Most narcotic pain killers in the United States also contain acetaminophen. If a patient attempts to switch from the prescription drug to an over the counter pain reliever like acetaminophen, they may find it inadequate. Switching back to the narcotic pain medicine, acetaminophen levels continue to rise. For this reason, it seems practical for doctors to prescribe these two drugs separately. Without suggesting or insisting on this, patients are very unlikely to receive prescriptions in this manner.
Finally, to ensure the best tonsillectomy recovery experience, adult patients need to have clear understanding of the period of time that will be required In the U.S., the Family Medical Leave Act protects workers from losing their jobs because of family illness. Approval of this type of leave is usually dependent upon doctor’s orders. Patients must strongly advocate for themselves in this process to ensure adequate time is allowed for recovery. Most adult require a minimum of ten days before returning to work. More often two weeks are needed. Communication between patient, employer, and doctor is imperative.
As adults, our happiness and health are not the responsibility of others. We must arm ourselves with information when facing medical decisions and the resulting conditions. Medical professionals are in the business of caring for patients. They need patients’ help to best deliver this care.