Tuesday, April 8, 2008

Tonsillectomy/Adenoidectomy a.k.a. The Big Day

I am a nervous wreck. My four-year-old is having his tonsils and adenoids out Tuesday. If you have never had to go through this, it is a big deal. It is a fairly common procedure, so I didn't realize the seriousness of it and the risks. I am dreading the tears as he asks me if he has to go back to the operating room. Parents are not allowed to go back there on the day of surgery. He has to go by himself. Ugh!

As you can imagine, I got all the information I could from the doctor. Here's my interview with Dr. Michael Gootee.

Jen: How common is this surgery?

Dr. Gootee: "Like a lot of things in medicine, it's a pendulum. Everyone was getting their tonsils out, , then no one was doing it. Now the children that have indications for having tonsils out do get it."

Jen: What are some of the reasons for getting tonsils and adenoids taken out?

Dr. Gootee: "Recurrent infections, airways obstructions, missing school due to illness, snoring, restless sleep and poor quality of sleep are the main reasons." Dr. Gootee said infections can include ear infections, tonsillitis and strep throat.

Airway obstruction is why my son is having the procedure. The doctor said his tonsils rate at a 4 on a scale of 1-4. They are very large. I tried to take a picture for the blog, but it was impossible. My son kept getting his tongue in the way and my camera wouldn't focus that close. This is a disgusting picture I found on the Internet, but the tonsils are about the same size.
Dr. Gootee: "I see more pediatric ENT patients than others in the area. I have been in practice for 13 years and I had 6 years of residency before that. I have probably done 4000 tonsillectomies."

Jen: What are the risks?
Dr. Gootee:
"The biggest risk is bleeding afterwards. It happens in maybe 2-3 cases out of 100. Sometimes it happens about a week to ten days afterwards. In rare cases, you have to take a patient back in to get cauterized. It's pretty obvious when it happens. We ask parents to avoid foods with red in them just in case you have bleeding. We don't want parents to questions whether there is bleeding on just red juice."

"Sometimes certain foods that are really scratchy can cause bleeding sooner. I always use the analogy -If there's a scab on the knee and it comes off early there's bleeding. The kids who bleed more usually haven't done anything to provoke it, it's really more bad luck than anything else. There's no good way to prevent it. "

Jen: What age is common for a tonsillectomy/adenoidectomy?

Dr. Gootee: "Typically kids anywhere from 3-years-old up to 7 or 8 is a pretty common range. but a lot of the time we see it in the adolescent years too.

Jen: I have always heard the surgery is easier on your body as a kid than as an adult.

Dr. Gootee: "You are not at more risk when you're older, we just don't tolerate pain as well when we're older. You tell them(kids) you will have a sore throat, they live with it. And we don't heal as fast. Kids tend to bounce back quicker. Adults don't recover as quickly."

Jen: Do parents every push to have the surgery when it's not necessary?

Dr. Gootee: "Most of the time, not with the indications. We have a pretty good idea. This is a serious surgery. We say lets give it some time, most of the time if things don't add up, we will talk to the family physician. Most parents are not going to want their kids subjected to something if they don't need it."

Jen: What are the benefits of the surgery?
Dr. Gootee:
"If the child has chronic infection, they can expect to see fewer. "

Jen: My son has airway obstruction. He can have 6-8 night terrors a night. (Night terrors are when the person is in a deep state of sleep and starts screaming or thrashing.) We are having the surgery to hopefully let him get better sleep.

Dr. Gootee: "Sleep apnea can be linked to kids not paying attention in class. Sometimes they are labeled as hyperactive. There's some thought that these kids are sleep deprived and they act out. There are certainly kids who have sleep apnea and when they get their tonsils out, they become different kids. I never promise parents their behavior will improve, but I am surprised by how many parents say this had made a difference."

Jen: I have had several people say to me this surgery is no big deal. (It's kind of offensive. Maybe I'm a little sensitive? Probably!)

Dr. Gottee: "Somebody once said it's only minor surgery if it involves someone else. Of all the surgeries we do, tubes and tonsils are the most common. It's not a simple surgery by any means, but the kids do well with it. "

Jen: I am concerned about giving a four-year-old general anesthesia.
Dr. Gootee:
"Anesthetic concerns are understandable, but the anesthesiologists are really good. The ones I use are more geared toward pediatric anesthesia. With so many improvements in anesthetic agents, these kids recover much quicker than they used to. No more lingering sleepiness. That makes a big difference."

Jen: Can you explain the actually surgery to me?

Dr. Gootee: "The main thing we do is prop the mouth open and remove the tonsils and adenoids. The adenoids are a pack of tissue that sit behind the palate in the back of the nose. They used to use a blade and cut the tonsils out and cauterize the back. The standard of care over the last few years has changed. Now you cauterize the vessels themselves while you take out the tonsils. Coblation is what we're doing now. There's no painless surgery, but I think it makes the kids have less discomfort."

"Tonsils and adenoids are part of the body that fights infections, but we have over 300 lymph nodes, so we do just fine without them. The kids who have their tonsils out are actually less likely to have infections. That's because sometimes they trap bacteria in the tonsils."

Jen: Why do some kids have problems with their tonsils/adenoids and not others?

Dr. Gootee: "I don't know if anyone knows the answer to that. It may be genetic."

Jen: You put the kids on antibiotics afterwards, but that's not always the case.

Dr. Gootee: : "I have looked at studied that have shown kids have less post operative pain and drink more when they are given antibiotics. (They need to drink a lot afterwards to avoid dehydration.) It's a personal choice. There are some physicians who don't do that.

Have your kids been through this?
Anyone have any comforting words for me as I get ready to take my son for this procedure?

-NewsAnchorMom Jen


Anonymous said...

He will be happy to know you get lots of popsicles and ice cream! I think that was the only fun part, aside from the gifts people brought me!

Maria said...

My son hasn't had this done, but I did have my tonsils out when I was 5...maybe it was 6. I remember eating a lot of Popsicles and not drinking milk. Overall, I'd say i bounced back quickly... after the initial anesthesia wore off, and I stopped refusing to eat. They wanted me to eat Jello, but I hated Jello. Finally they listened to my mom and brought me a Popsicle.

My 10 year old cousin had it done the first week of March. The first couple of days he was sore, but after that he seemed pretty good to go!

Good luck!

Jennifer said...

My daughter had tubes in her ears and adenoids out when she was three years old. It went really well and she bounced back really fast. Almost too fast, actually, once the anesthetic started to wear off at the hospital she was wanting to run around and they are really supposed to take it easy for awhile. I think your son, at four, will be a bit easier to reason with and that will help.
I wouldn't worry so much about the seperation at the hospital, either, they really are great with the kids and you are more likely than your son to be upset at that point.
Oh, and I agree, anyone who dismisses your fears is being insensitive. As a parent I think it's harder to handle your child facing something like this than to deal with it oneself and it's scary anytime your child is having a procedure. My daughter had to have 4 teeth pulled out last year (for her braces), and even though she was 12 and it was minor I still worried.

Rixblix said...

As I said in my email, my son's surgery went very well; even with the added stress of his bleeding disorder. He had a 5 day hospital stay at Children's Hospital in Milwaukee. At the time his surgery was done, coblation wasn't widely used but his ENT did the tonsillectomy this way. The bleeding was minimal! My son had lots of soft food and no drinking through a straw. He was given a mild sedative prior to going to surgery so that the separation from me was easy and not remembered. He also refused pain medication after the 1st day.

Your son will be up and ready to run around sooner that you are!

newsanchormom.com said...

Thank you all for your support! I just posted about how it went. It could have been worse, but it certainly wasn't best case scenario. I didn't expect all the dry heaving and burping up air. It was really scary. He couldn't catch his breath. His face was all swollen too. By this afternoon, I was telling him to settle down and stop jumping. So, I am hopefully he will bounce back quickly.

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