Friday, April 1, 2016

Surgeries, Pain Management, and Gross Surgeries Not for the Faint-of-Heart

This is what i'm looking forward to for the next couple of days once the IV comes out, which makes the idea of deriving any pleasure whatsoever from painkillers to seem like a figment of some truly twisted person's imagination.

I'm not yet ready either to run a marathon or to spend a night partying, but I'm closer to being a part of the world of the living than I have been since Tuesday morning. Opiates are still in my system and probably will continue be for a few more days, but I'm no longer bona fide stoned. I managed, under the influence or not, to get in a solid eight hours of USMLE preparation today.

Tonsillectomies used to be almost the rule rather than the exception. Among those who came of age in the early 70's or before, close to half of those who received regular medical care lost their tonsils somewhere along the way. Since then, medical attitudes have shifted. It was concluded that tonsillectomies didn't necessarily solve quite as many problems as was previously thought, and the assessment of risk versus  benefits of the procedure was looked at more carefully, especially considering current knowledge of inherent risks associated with any use of general anesthesia. Still, sometimes tonsillectomies are medically necessary.

For practical purposes, the distinction between a minor surgical procedure and a major one lies in who in undergoing the procedure. If someone else is having a tonsillectomy, I would probably consider it to be a minor procedure. If, on the other hand,  a tonsillectomy is happening to me, it's clearly a major procedure. I don't claim to be even as stoic as the average person. I do not like pain and do not go out of my way to bring it on myself.

I've undergone more surgical procedures than I'm willing to bore my readers with in this blog. My experience has led me to the conclusion that, with a few exceptions, surgeries are approximately equally painful. Obvious exceptions to this are procedures such as open-heart surgeries during which a person's sternum has to be split in order to access the heart, or even maxillary or mandibular osteotomies, in which an upper- or lower-jaw bone must be cut or fractured by a surgeon. Procedures such as these are in leagues of their own in terms of the resulting discomfort. I've also been told that a few ocular procedures -- particularly the orbital decompression, wherein a surgeon makes an incision through the inside of a person's upper lip, takes instruments through the incision to the cheek bones, drills holes in the cheek bones, takes instruments though those holes to the eye sockets, pushes the eyes out of the sockets, shaves bone from two to four walls of the eye orbit, suctions the shaved-off bone and extraneous fatty tissue through the nose, puts the eyes back, and stitches the incision in the inside of the upper lip -- are more than a bit grim. While this sounds like something that could have been dreamed up by an author of combination science-fiction-and-horror-film genres,  the procedure is for real. My mom underwent it about seventeen years ago. 

For most procedures, however, the difference in the level of discomfort is in the post-surgical pain medication that is given. Adults usually get better pain meds than kids do, which now works in my favor. In-patients are given more potent meds than out-patients are, which hasn't worked out to my advantage with this most recent procedure, as tonsillectomies are now in-and-out procedures. 

A tonsillectomy -- with or without an adenoidectomy -- is, in the grand scheme of things, objectively speaking, a minor surgical intervention.  The procedure itself is more complicated for an adult than it is for a child, though, primarily because each time a person's tonsils or adenoids are infected, more scar tissue builds up, making it more difficult for a surgeon to get to the organs to remove them. (Anesthesia, however,  is a trickier proposition for a child.) Adults suffer more than twice as many post-surgical complications from tonsillectomies as do children, primarily because of the greater difficulty in accessing the organs and because the tonsils of adults are larger (not necessarily larger in proportion to the size of a person's body, but larger nonetheless), leaving larger surface wounds upon removal. 

I'm legally and technically an adult, but my tonsils were more like those of an adolescent than of an adult. My surgeon reported that my throat was an even bigger mess of scar tissue than he had expected, but that removing it all wasn't terribly difficult. As much as it pains me to admit this, my pain hasn't been any greater than is the pain of the average person who has undergone a tonsillectomy and adenoidectomy.  I did have a whole lot of nausea, but I have enough doctor relatives that I'm able to have an IV at home to prevent dehydration -- which is essential in recovery from a tonsillectomy.  

The proverbial diet for tonsillectomy recovery is ice cream. I didn't get to have any until this evening because of my nausea, but I'm now able to tolerate ice cream. If I continue to keep things down, I will have my IV removed tomorrow. I'll be very glad to lose the IV, but I will have to  deal with liquid pain medication once the IV is gone. I'm not sure how to explain my disgust for liquid pain medication other than to say that if given a choice, I would opt to eat a teaspoon of dirt from the yard outside rather than to consume the same quantity of liquid medication of any kind. Dirt from the garden, however, will do nothing to alleviate the pain from the rather large holes in my throat, so I'm stuck with the liquid medication for now.

That's all I really need to share about my tonsillectomy. People who recount their hospital stories ad nauseum are tiresome. I'll try not to be one of such people.


  1. The only surgery I have ever had was the sinus lift I had done in January. For that, I got ibuprofen. Lucky you that you're in the USA and have lots of doctors around! Hope you're all healed up soon. I've missed you!

  2. When I first donated blood I was sure they just used a sharpened point of the Alaska Pipeline to shove into my arm.

  3. Glad you're on the up. You have definitely had your share of surgical interventions! Hopefully your lifetime allotment.

    Bone surgery certainly carries its own pain ,as I'm sure you'll attest. I've had my share of that, but won't bore you with details. My daughter had to undergo maxillary and mandibular osteotomies a couple of years ago. Like you she is blessed with a single brother, who dutifully visited her in the ICU next morning and was horrified at the sight of all the monitoring and tubes. He has no medical training , but looked over her post op X-rays., turned to her and said "my God! You look like a hardware catalogue" as he saw all the plates and screws. She didn't bother to write a reply on her board. She too,was in a world of opiates,

  4. Thank heaven for ice cream after a tonsillectomy. Hope you're better soon.

  5. My thrifty Mormon parents arranged to have all their kids' tonsils out at once. We shared a room and they probably arranged for a discount on the surgery. I was around 4. (This was the olden days.) Then they went on a short holiday. Even so, I should thank them for not letting me wait until I was an adult! La Perla.

  6. With proper meds and meditation, you'll recover very fast and no more tonsils to deal with. Likwid analgesics is good tasting now than cough syrups. I still have my tonsils, but not my 4 wisdom teeth. Speedy recovery to you.