Parathyroidectomy (cont.)
What about care after parathyroidectomy?
After surgery, patients go to the recovery room where nurses monitor them for about
one hour. In most situations patients spend one night in the hospital,
although some patients undergoing a minimally invasive parathyroidectomy may go home the
same day. A friend or family member usually is required to pick patients up from the surgical facility if they are going directly home. It
is a good idea for someone to be at home with the patient for the first
night.
Patients' necks may be swollen
and bruised
after surgery, and in most instances there will be a bandage wrapped around the neck. Bandages usually are
removed one or two days following surgery. There may be a small plastic drain exiting
through the skin. If so, the drainage of fluid from the drain will
be monitored in the recovery room or hospital. Sometimes patients may even go home with a
drain in place after the nursing staff teaches them how to manage the drain. Sutures taped to the neck should not be cut or
trimmed.
Starting several
hours after surgery and possibly for several days, blood calcium levels usually are monitored.
It is not uncommon for there to be a fall in the blood
calcium level following surgery. (The remaining parathyroid glands are
"sleepy" following surgery.) As a result, patients may need to take supplemental oral calcium for several
days or weeks following surgery. Permanent calcium problems are rare. If patients experience numbness and tingling of the
lips, arms, or feet,
and or twitching of the muscles--symptoms
of low blood calcium--they should contact their surgeon or endocrinologist immediately. In most situations in which these symptoms occur, surgeons will ask patients to take supplemental calcium, such as
in Tums-Extra Strength, after surgery. This helps to replenish calcium that
is moving back into the bones.
Numbness, slight swelling, tingling, discoloration,
bumpiness, hardness, crusting, tightness, and a small amount of
redness around the incision are a normal findings after surgery and should improve
with time. It is usually alright for patients to wash their face, neck, and hair
after the bandages have been removed. Excessive scrubbing of the wound should
be avoided, and a gentle soap and shampoo should be used.
In the hospital and after going home, patients generally lie
in bed and rest with their head elevated on 2-3 pillows. By keeping their head elevated
above their heart, swelling of the
neck due to edema may be
lessened. Patients get out of bed with assistance to use
the bathroom, however. It is good to avoid straining
when having a bowel movement, and, if constipation is a problem, a stool softener
or a gentle laxative is a good
idea.
It may be better to eat a light, soft, and cool
diet as tolerated after recovery from the anesthetic. Even though patients may be hungry
immediately after surgery, it may be best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit
one or two times immediately after surgery. If vomiting
persists, the doctor may prescribe medications to settle the stomach. A good overall diet with ample
rest promotes healing.
Antibiotics often are prescribed after surgery. Patients should finish all the pills
that have
been ordered. Some form of a narcotic pain medication usually will be prescribed and is
to be taken as needed. Patients who take narcotics should not drive. If there is nausea or vomiting
postoperatively, patients may be prescribed medications such as promethazine
(Phenergan). If patients have any questions or feel that they are developing a reaction to any
of the medications, it is important that they consult with their doctor. Patients should not take any
other medication, prescribed or over-the-counter, unless they have discussed it with their doctor.
Sutures are removed approximately 7 days after
surgery. If not already scheduled, patients should call
the surgeon's office to arrange for a follow-up visit. Routine follow-up care depends on the nature of any problems
that develop. After healing has occurred, patients usually return to their endocrinologist for long-term monitoring of their
calcium levels.
Patients may go back to work or school only when their doctors
say they may. Patients probably should rest for the first week following
surgery and avoid excessive talking, smiling, hard chewing, strenuous
activities, lifting heavy objects, and bending over. Alcohol and tobacco should
be avoided because they may prolong swelling and healing. Tanning is discouraged
for 6 months after surgery; if patients must be in the sun they should
use a number 15 or greater sun block and consider wearing a hat. Make-up may be
used anytime after surgery.
After
3 weeks, if there are not problems with bleeding or excessive swelling, it is reasonable to resume
exercise and swimming. To allow for postoperative care, it is probably a good idea not to travel out of town for three
weeks after surgery.
Next: When should I contact the doctor? »
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