Post-Op Instructions

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For Tonsillectomy and/or Adenoidectomy

After a tonsillectomy and/or adenoidectomy patients can expect the following four symptoms:

  • Sore Throat: You will have a sore throat. This will last between several days and up to two weeks. Most patients who had a tonsillectomy experience a worsening of the sore throat between four and seven days after surgery. After that time, the pain diminishes over a few days up to one week.
  • Fever: You may have a low grade temperature. The younger the patient, the higher the temperature may be. This may be treated with Tylenol tablets, elixir or suppositories as needed. If the temperature exceeds 101o F, you should contact this office. If your doctor has allowed you to be treated with ibuprofen this may also be used for fever.
  • Ear Pain: You may have ear pain. This pain is typically the result of referred pain from the region of the tonsils and not from infection of the ears. It will resolve as the surgical sites heal. If the ear pain persists as the throat pain improves or if there is drainage from the ears, you should contact this office.
  • Bad Breath: You will have bad breath. This will persist for about 2 weeks during healing after surgery.

Eating/Drinking: Although there are no dietary restrictions after surgery, patients and their families should not be concerned about eating solid foods. This will return in time. Rather, patients should be encouraged to drink liquids frequently. Post-operative dehydration tends to increase the patient's discomfort. The minimum fluid intake is enough to allow the patient to urinate a couple of times each day as normal. If the patient is unable to meet this goal, then they may require emergency room evaluation for intravenous rehydration. Typically water and clear, non-citrus, non-carbonated beverages such as pedialyte, Gatorade, and popsicles are tolerated best. Dairy products tend to thicken the saliva and can make this harder to swallow, however if tolerated by the patient these are also acceptable. During the first few days after surgery it may be helpful to take a dose of pain medication 20 to 30 minutes before attempting to drink liquids.

Activity after surgery: There is no activity restriction after surgery. Patients may return to work or school as they tolerate. Most patients after adenoidectomy will need 1-2 days of recuperation prior to normal activities and most patients after tonsillectomy require 1-2 weeks, possibly more.

Bleeding after surgery: Between about 7-10 days after tonsillectomy, the scab in the back of the throat will come off. This does not occur with adenoidectomy. Although this typically occurs unnoticed, it may be accompanied by some blood streaking of the saliva. This is normal and should clear quickly. However, if this bleeding persists and is greater than 1 tablespoon in amount, the patient should be seen by his physician promptly. Rarely, this bleeding will not stop spontaneously and the patient may have to return to the operating room to stop it. If more than 1 tablespoon of bleeding is noted from the mouth please call the office.

Pain medication after surgery: Tylenol may be used per package dosing if needed. Ibuprofen may be used at 1/2 the package dosing for children and 200mg every 6 hours if needed for those of adult weight. You may be given a prescription for narcotic pain medication prior to leaving the hospital for pain not controlled by Tylenol/lbuprofen. Do not drive or drink alcoholic beverages while taking narcotic pain medication.

PLEASE NOTE: narcotic medication (hydrocodone, oxycodone, Percocet, Vicodin, Hycet) must be refilled by physical paper prescription only and cannot be called, faxed ore-prescribed to the pharmacy. Due to this, these medications cannot be refilled on nights, weekends, or holidays. Please plan to refill if needed during regular business hours only! Most insurance will only provide a 7 day supply and will not refill prior to 7 days!

If you do not have a post-operative appointment date one or need to change this date/time please, or have any other issues or questions please call 970-644-3800.


Pain Management Following Tonsillectomy Surgery

Tylenol (Acetaminophen): may be used per package dosing every 6 hours.

Ibuprofen: may be used at 1/2 package dosing for children or 200mg for those of adult weight every 6 hours.

Hydrocodone/Acetaminophen (Hycet): may be prescribed and can replace the regular Tylenol dose in your pain management schedule as below.

Steroids: may be prescribed for you depending on age. The dose for the day may be taken at once with breakfast as taking this later may impact sleep.

  • For methylprednisolone: If this does not come with instructions for each day please take 6 tabs Day 1 (1st morning after surgery), 5 tabs Day 2, 4 tabs Day 3, 3 tabs Day 4, 2 tabs Day 5, 1 tab Day 6, then stop.
  • For prednisone: please follow instructions on bottle

Pain medication schedule: You may stagger your pain medicine by 3 hours to be able to take some form of medication every 3 hours, a generic example of this is below:

  • Tylenol or Hydrocodone/Acetaminophen at noon
  • Ibuprofen at 3pm
  • Tylenol or Hydrocodone/Acetaminophen at 6pm
  • Ibuprofen at 9pm
  • Continue as above

To start this schedule please note the time medications were given in the hospital to establish your specific schedule for taking medication if needed. You may decrease/remove doses from the schedule as you feel better.

Click here for a pain medication tracking sheet.


Tympanostomy (Ear Tubes)

Your child's hearing should improve once the tubes are in place. For best results, follow up as instructed by your child's surgeon. In some cases, ear problems may continue. However, you can help prevent ear infections by using good ear care.

Follow-up visit

  • Shortly after the surgery, your child's surgeon may want to examine your child. This follow-up visit ensures that the tubes are still in place and that you r child's ears are healing.
  • After the initial follow-up, the healthcare provider may want to see you r child every few months. Do your best to keep these visits. They're the only way to make sure the tubes remain in place and stay open.
  • Most tubes stay in place for about a year. Some last longer. The life of the tube often depends on your child's growth.
  • Most tubes fall out on their own. In rare cases, tubes need to be removed by the surgeon.

Fewer problems

  • Even with tubes, your child may still get ear infections. Cranky behavior, ear drainage, and fever are all clues that you should be calling your child's healthcare provider. However, as long as the tubes are working, you can expect fewer problems and a quicker recovery.
  • If an infection does happen, it will likely respond to antibiotic ear drops. For more severe infections, oral antibiotics may be added. Always make sure you r child finishes the entire prescription. Otherwise, the medicine may not work. Use only eardrops prescribed by your child's provider.

Ear care

  • Ask your child's healthcare provider if your child's ears should be protected from contact with water. Your child may need to wear earplugs du ring swimming and bathing if they put their heads under water.
  • Do not use any ear drops in your child's ears, unless prescribed by the surgeon or another provider.
  • Do not use cotton swabs to clean the ears. Used carelessly, they can clog tubes with wax or even damage the eardrum.

When to call your child's healthcare provider

Call your child's provider if he or she is showing any signs of the following:

  • Bloody drainage from the ears
  • Drainage from the ears that doesn't stop
  • Ear pain
  • Fever
  • Trouble hearing
  • Problems with balance


Septoplasty and/or Turbinectomy With Endoscopic Sinus Surgery

Activity:

  • No travel for 1 week
  • No bending, lifting or straining for 1 week
  • No rigorous activity until permitted
  • No air travel for 4 weeks

Restrictions:

  • DO NOT BLOW YOUR NOSE, until given permission to do so (usually 1 week after surgery). However, you may gently sniff through your nose.
  • DO NOT SUPPRESS THE NEED TO COUGH OR SNEEZE, but do so with your mouth open. This will relieve pressure on the nose.
  • DO NOT USE ANY ASPIRIN OR ASPIRIN-LIKE PRODUCTS UNTIL PERMITTED. If you are uncertain about the use of a medicine, please call the office.

Wound Care:

  • You may have some bleeding from your nose for several days after surgery & then after each office debridement. Do not blow your nose for the first 10 days following surgery- this may loosen crusts and cause bleeding. When you do begin blowing your nose, please blow both sides at the same time.
  • Do not snort the blood in thru your nose or blow your nose; this will increase the bleeding. Heavy bleeding from the nose (hemorrhaging) is rare and usually not serious. Should it occur, try to remain calm, keep your head elevated, and apply ice compresses to the side of the bleeding. Place a towel under your nostrils to absorb the blood, but do not insert cotton or paper into your nose as this may damage the result of your surgery.
  • A small amount of bleeding or nasal discharge will occur from your nose during the first 48 hours following your operation. This will gradually go away over the course of the next several days. Change the gauze drip pad under your nose as necessary (usually several times a day at first). You may remove the gauze pad while dining to make it more comfortable for you to eat.
  • Again, do not use aspirin-like compounds, since they can cause bleeding. ANY HEAVY BLEEDING THAT LASTS FOR MORE THAN 10 MINUTES SHOULD BE REPORTED TO US IMMEDIATELY - WE MAY WISH TO SEE YOU EMERGENTLY.
  • After 2 to 3 weeks you will have some thick brown drainage from your nose. This is mucous and old blood, and is normal, as the sinuses begin to clear themselves. It does not indicate infection.
  • Keep your nostrils clean and free of drainage using Q-tips dipped in hydrogen peroxide. Reach inside the nose only as far as the length of the cotton on the Q-tip. Use saline nasal spray every hour or two while you are awake until you are instructed otherwise. Squirt 2 sprays in each nostril. This will help moisten your nose and prevent large crusts from forming in your nose and sinuses. These items are available over the counter at your local drugstore.

If You Have Nausea:

  • Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery.
  • Relax, decrease your activity and don't eat any heavy foods- Just try some clear liquids. All nausea should be over 8-10 hours following surgery.


Nasal Surgery

How you will feel

You will be drowsy and tired following surgery due to the medicines we have given you to make you comfortable. Most patients wake and doze on and off during the evening after surgery. The day following surgery, you may still feel a bit tired, but resume everyday activities as soon as you can. You may move about normally without fear of disrupting your surgery. Your energy will return more rapidly if you do.

If you have nausea

Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery. Relax, decrease your activity and don't eat any heavy foods-just try some clear liquids. All nausea should resolve by 8-10 hours following surgery.

Discomfort

We've prescribed a pain medicine to be used as directed. Take a pain pill before going to sleep the evening of surgery (preferably after you have kept something in your stomach). Take another pain pill the morning following surgery as you may feel a bit stiff and uncomfortable when you begin to move about. After two days, extra strength Tylenol should control your discomfort well. Do not use aspirin, advil or similar medicines for two weeks before and after surgery. These medicines cause bleeding and can damage your surgical result. If you have questions about a medicine, please ask us before using it.

Swelling

You may experience some swelling and discoloration around your eyes following surgery. This swelling will increase overnight. To reduce swelling, you may gently apply an ice pack to the eyes during the first 48 hours following surgery. If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over 4 to 5 days. Rarely, your eyes may swell shut for the first 24 hours following surgery. If this occurs, please notify your doctor. In anticipation of swelling, you may be prescribed a Medrol dose pack. Please take this medicine as directed

Fever

Fever of up to 101oF following surgery is common. Please call us should your fever reach 102oF.

Nasal Discharge or Bleeding

A small amount of bleeding or nasal discharge will occur during the first 48 hours following your operation. This will gradually go away over the course of the next several days. Change the gauze drip pad under your nose as necessary (usually several times a day at first). You may remove the gauze pad while dining to make it more comfortable for you to eat.

Nasal Hemorrhaging

Heavy bleeding from the nose (hemorrhaging) is very rare and usually not serious. Should it occur, try to remain calm, keep your head elevated, and apply ice compresses to the side of the bleeding. Place a towel under your nostrils to absorb the blood, but do not insert cotton or paper into your nose as this may damage the result of your surgery.

Again, do not use aspirin-like compounds, since they can cause bleeding. Any heavy bleeding that lasts for more than ten minutes should be reported to us immediately, we may wish to see you emergently. In this case, please contact our office at 970-644-3800.

Antibiotics and Infections

You will need to take antibiotics as prescribed after surgery. Infection after nasal surgery is very rare, but if you notice increased redness or swelling accompanied by tenderness, fever or discharge, please call us so that we may examine you.


Parotidectomy/Thyroidectomy

Activity:

  • No travel for 1 week
  • No bending, lifting or straining for 1 week
  • No rigorous activity until permitted

Restrictions:

  • DO NOT USE ANY ASPIRIN, IBUPROFEN, OR ASPIRIN-LIKE PRODUCTS UNTIL PERMITTED. If you are uncertain about the use of a medicine, please call the office.
  • There are no diet restrictions following this surgery. Drink plenty of fluids.

Wound Care:

  • You may shower within 24 hours after your surgery. It is important after showering that you are careful to pat the wound dry without pulling on the wound or rubbing the steri-strips or stitches as they are delicate.
  • Some numbness surrounding the incision around your neck is to be expected. This will typically resolve within several months following surgery. However, some permanent numbness is to be expected. Men should be careful when shaving over the numb area to prevent trauma to the operative area.

Call the Office For:

  • Temperature over 101oF
  • Increased neck swelling
  • Shortness of Breath
  • Increasing pain or bleeding from the operative area.
  • Severe or persistent diarrhea (from antibiotics)


Lesions and MOHS

Please complete these steps two to three times a day until seen in the office for follow up. If there are steri-strips covering your incision then you do not need to complete these steps.

  1. Please get a standard bottle of H202 (Hydrogen Peroxide) Solution. This is an over the counter medicine and can be obtained at any pharmacy. You can buy any brand including the generic brand (CVS, Rite Aid, etc.).
  2. You will need to make a half strength solutions....this is easy to do. Pour out one half of the hydrogen peroxide bottle and refill it to the top with tap water. This will dilute the hydrogen peroxide by one half. This is the solution you will use to clean all incisions.
  3. Take a cotton swab or gauze and saturate it with the hydrogen peroxide solution. Gently clean all incisions being careful to not traumatize or pull the incision apart. It is very important to do this gently by only dabbing and never rubbing the incision. This step will help clean the wound by breaking down any dried blood and/or crusts that have formed. You may see the solution fizz and bubble when applied, this is normal.
  4. Carefully dry the area by patting with a clean/dry gauze or swab.
  5. Take a small amount of the antibiotic ointment (Bacitracin, Erythromycin ointment, etc.) and cover the incision line. If you haven't been given a prescription for this ointment then you should use an over the counter double antibiotic ointment.
  6. Please call the office with any questions at 970-644-3800.

Eyelid Surgery

How you will feel

You will be drowsy and tired following surgery due to the medicines we have given you to make you comfortable. Most folks wake and doze on and off during the evening after surgery. The day following surgery, you may still feel a bit tired, but resume everyday activities as soon as you can. You may move about normally without fear of disrupting your surgery. Your energy will return more rapidly if you do.

If you have nausea

Although we give anti-nausea medicines before, during and after your surgery, it's still not unusual to have some nausea following surgery. Relax, decrease your activity and don't eat any heavy foods-just try some clear liquids. All nausea should be over 8-10 hours following surgery.

Discomfort

We've given you a pain medicine to be used as directed. Take a pain pill before going to sleep the evening of surgery (preferably after you have kept something in your stomach). Take another pain pill the morning following surgery as you may feel a bit stiff and uncomfortable when you begin to move about. After two days, extra strength Tylenol should control your discomfort well. Do not use aspirin, advil or similar medicines for two weeks before and after surgery. These medicines cause bleeding and can damage your surgical result. If you have questions about a medicine, please ask us before using it.

Severe, deeply-felt pain in or behind the eyes must be communicated to your doctor at once. It may represent bleeding within the eye and may result in permanent blindness if not immediately treated.

Swelling

You may expect some swelling and discoloration around your eyes following surgery. This swelling will increase overnight. To reduce swelling, you may gently apply an ice pack to the eyes during the first 48 hours following surgery. If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over 4 to 5 days. Rarely, your eyes may swell shut for the first 24 hours following surgery. If this occurs, please notify your doctor.

If you have any question call our office at 970-644-3800.

In anticipation of swelling, you may be prescribed a Medrol dose pack. Please take this medicine as directed.

Fever

Fever of up to 101oF following surgery is common. Please call us should your fever reach 102oF.

Antibiotics and Infections

You received antibiotics in your IV prior to surgery, but will need to continue taking antibiotics as prescribed after surgery. Infection after eyelid surgery is very rare, but if you notice increased redness or swelling accompanied by tenderness, fever or discharge from the eyes at any time, please call us so that we may examine you.

Visual Changes

Any visual changes, whatsoever, (blurred vision, double vision, etc.) must be reported to your doctor at once.

However after fracture repair this is quite common and can persist 1-4 weeks. This is mostly temporary.

Eye & Eyelid Care

An ophthalmic antibiotic ointment should be placed along your suture line and within your eye. Place a small amount about the size of this "0" in the outside corner of each eye. Place a similar amount on a Q-tip and apply it to your incision while looking in the mirror.

Some discoloration around your incision can be expected. However, should you experience a great deal of redness and itching around your suture line, please call our office. You may have a rare allergic reaction to either the sutures used or the ointment being applied to your suture line. Again, your doctor or his nurse will be able to help.

Nylon sutures are placed to close the incisions. We will remove these sutures during your first post-operative visit. Under no circumstances should you attempt to remove these sutures yourself. Such action could truly damage the results of your surgery. Other sutures inside your lower eyelids are designed to slowly dissolve over time and will not need to be removed.

Do not lift anything over 15 lbs and do not blow your nose for 2 weeks. If you feel that you need to sneeze, open your mouth.