The Medical Consumer's Advocate

Summer camp after tonsillectomy?

 

Q: My 13 yr old daughter is having a tonsillectomy/ adenoidectomy on Friday the 11th. She is scheduled to go to a week-long girls camp on the 21st. (We tried all sorts of other time schedules for the surgery but this was the only weekend that would work until September.) She is mainly getting her tonsils and adenoids out to help her breathe easier; she has not had tonsillitis. She is otherwise in good health and is a very active, sports-loving kid.

My question is what kind of restrictions should we ask the camp to put on her, if any? She normally is a quick healer so we are hoping that bleeding will not be an issue (if it is we will keep her home from camp). She tolerates anesthesia well (she had hand surgery two years ago). The camp is less than an hour away from home should there be an emergency. They have a one-night backpacking hike planned. Should we request that she not go on that hike? Thank you so much for your advice. (PS I will also ask her ENT for his opinion as well - as they say "two heads (opinions) are better than one.")

A: You have to appreciate that doctors, as a rule, see risk different than most other people on the planet. With respect to tonsillectomy, if there is a 1 in 20 risk that something bad is going to happen, then it is going to happen to me perhaps two or three times per year. If there is even a 1 in 1000 chance that something REALLY bad is going to happen, then it is going to happen to me perhaps a few times in my career. So... when people ask me for advice, "Is it safe to..." then it has to be pretty damned safe for me to say "sure, that's okay."

That being said, I would have to say that you are courting disaster. While most complications (delayed bleeding being the most important one) happen in the first 10 days, bleeding beyond 10 days is still possible. I usually prefer my patients to be within 30 minutes of an emergency room.

Q: Thanks so much for your speedy reply. My email was perhaps a bit misleading in that it did sound like she will be an hour away from an ER; she will be an hour away from our home but there is a hospital about 20 minutes from the camp. They also have a full time nurse there at the camp. After reading your email I do believe we will, regardless of how well she feels, have her stay back from the hike. I will watch her and just play the question of "to go or not to go to camp" by ear according to how she is healing.

A: I am reassured by the fact that there is a full time nurse, and that there is a hospital only about 20 minutes away. Another consideration, how mature is your daughter? I like my patients to avoid sharp foods ("foods you can scratch your back with") for a few weeks after surgery. I also think strenuous exertion is a bad idea for the first few weeks (which is not to say that she should be a couch potato...)

I don't know what your ENT is going to advise, but can you trust her to follow his advice, without mom looking over her shoulder?

I agree -- definitely no overnight trip. Hopefully she will see the reason behind this and there won't be too much anger and tears.

Q: Just thought you might want an update. The surgery went well today. She is home and although very groggy from the codiene, doing well. Her ENT said that her adenoids were the largest he had ever removed so she should notice a b-i-g difference in her breathing. As to your question as to her maturity, I am sure she will follow her orders for light duty and soft foods. She is very mature for her age and I trust her to follow orders. In fact, as we searched for soft foods at the grocers yesterday afternoon, her test was . . . "will it scratch my back" so your advice made it almost a game to search for the appropriate foods. Her only question was (said with a smile) "will gummy bears scratch my back?" PS She didn't get the gummy bears.

By the way, my daughter wants to know just how the doc got her tonsils and ads out . . . did they use a specific tool just made for that or what?

A: I can't remember, offhand, if this bit of advice is on my site: many kids do well initially, but hit a "low" at 6 to 7 days. Keep a closer watch on her through this interval.

How are tonsils and adenoids taken out? Adenoids are typically scraped out with a sharp curet. The curet is shaped so that it can be passed up behind the soft palate. The doc feels the leading edge of the curet hit the top of the throat, and then draws it down the back of the throat, taking the adenoids with it. Tonsillectomy is a bit (a LITTLE bit) more artful. The tonsil is grasped at its superior pole with a forcep and is "pulled" outward. The tonsil isn't actually removed in this way; the "pull" helps the surgeon identify where the tonsil stops and where the muscular wall of the throat begins. An electrical cautery is used to cut through the tissue in this plane. Some surgeons use a knife to do this, some use scissors, but I like cautery.

Q: Got a question for you. She is not recovering as fast as we had hoped. Camp is definitely out. Here is the scoop. She still can't eat more than a couple of bites of anything without severe ear pain. She is eating popsicles and drinking water and a little soda pop each day but has not eaten more than a couple of tablespoons of jello, mashed potatoes, applesauce or pudding at any one meal since surgery (the 11th). She is urinating okay and the color of the urine is acceptable. The problem is that she has not had a bowel movement since the surgery. Is this something I should worry about? She knows she needs to eat but it has been a real struggle for her. Her ENT has her on Tylenol with codeine and I know that is constipating in and of itself. She was taking 2 teaspoons of it every four hours but now she is down to 1 tsp every six so I am hoping that means she is on the mend. She has experienced no bleeding and she has good color and is not overly lethargic. Do I need to take her in to see the ENT or is this something that is within the bounds of "normal"? I know that this surgery is much harder for older kids than it is for younger and I'm just hoping that is the reason for the slow recovery.

A: Your daughter is now 8 or 9 days out from surgery, right? It's not that unusual for her to still be on soft foods. The lack of bowel movements is certainly related to codeine, which is very constipating, and also due to her lack of food intake. Is she uncomfortably constipated? If so, a bit of milk of magnesia might help. The ear pain is referred pain from her throat, almost certainly, and will respond nicely to a topical anesthetic for the throat (Sucrets with dyclonine, or Cepacol, which also contains dyclonine. Both are available over the counter.)

When will she be seeing her ENT? Usually, I see these kids around day 10. He'll be able to tell you whether she is doing unusually poorly. Let her call the shots regarding advancement of her diet.

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Q: She is doing well. She finally was able to eat and that made all of the difference. She really lost a bit of weight and her voice is quite different. She also complains that it is hard for her to swallow without the drink going up her nose but her ENT says that is normal and her palate will learn how to move properly soon. Again, thank you so much for calming a nervous mother whose only child was in pain (the lozenges helped her to be able to eat).

A: The fact that her voice is noticeably different AND she's having velopharyngeal insufficiency (the medical term for the palate problem you mentioned) tells me that her tonsils and adenoids must have been enormous. She's probably breathing much, much better now. I wouldn't say that the problem is normal (I have not seen this happen all that often) but the stats show that it almost always resolves in a few weeks, all by itself, so I would agree with your ENT that you shouldn't worry too much about it.

 

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