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Courtjester

My 14 year old daughter just had her tonsils out this morning. Any recovery/treatment advice?

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Went in at 6:00 and she was home by 9:00. Just amazing the modern medical world we live in.

I bought a couple dozen Powerade bottles, a bunch of those flavored waters, jello, Popsicles, Gogo fruit. We were told to stay away from dairy for 48 hours, but we have pudding and ice cream as well. The doctor wants her eating solid (really soft food) by tomorrow.

The nurse told us this is one of the worst surgeries to recover from--especially for a teenager. 

They prescribed her a big time pain-killer--Hydrocod. When I went to pick it up yesterday, the pharmacist actually took me aside and warned me how powerful this stuff is and was concerned about the dosage being prescribed. When I addressed that with the surgeon this morning, he said he actually prescribed her less than what he normally does just because of her age. He was also sort of pissed and said, "What is it with these pharmacists who want to be doctors?" It is an Oxy based liquid so that worries me and I want her off it as soon as possible, but the doctor said you have to stay in front of the pain and she will be miserable for 10-14 days. 

Any FBGs have experience with this surgery. Are we missing something we didn't buy?

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I'm guessing she's on a clear liquid diet today, and then can start soft mechanical either tonight or tomorrow? Chicken broth, jello, and popsicles are good for clears, then when you move on to soft foods you can do mashed potatoes or macaroni and cheese. I've never heard of the dairy restriction before. On my unit, we offer ice cream and milkshakes on day 1. How many mg of hydrocodone was she prescribed and how often? 7.5mg every 6 or 8 hours?

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5 minutes ago, Tecumseh said:

I've never heard of the dairy restriction before. On my unit, we offer ice cream and milkshakes on day 1.

No kidding. The only thing that convinced me to do the surgery when I was 6 was the promise of getting unlimited ice cream afterwards.

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I had my tonsils out when I was about 35. It was very painful. The only time I could stand the pain of swallowing was soon after taking the hydrocodone as prescribed. I ate mostly Ramen for the first week or so. The pain actually got worse after the first day or two, because the doc had given me some IV painkiller during/immediately after surgery. Once that wore off, it was pretty rough for a few days. I also used bags of frozen veggies on my neck, on the outside of the surgery site, and that helped. 

I didn't enjoy the hydrocodone at all, and I've been known to enjoy just about any substance I could ingest. It made me feel dizzy and nauseated, basically like I was carsick, plus constipation. I absolutely needed it to get through (I even had to ask my doc to call in a refill) but was very happy to get off it as soon as the pain allowed. I think you're very wise to keep an eye on weaning her off, but don't be stingy with the meds in the short-term. You don't want her to suffer needlessly and you want her to eat, which she might not if it hurts too much to swallow.

The good news is that having tonsils removed made a huge positive difference in my health. I went from getting full-blown strep throat every time I caught a sniffle to literally not getting sick one time for the better part of a decade. That's worn off a bit now, but I still only get something once or twice a year vs. every 4-6 weeks like I did before.

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12 minutes ago, Tecumseh said:

I'm guessing she's on a clear liquid diet today, and then can start soft mechanical either tonight or tomorrow? Chicken broth, jello, and popsicles are good for clears, then when you move on to soft foods you can do mashed potatoes or macaroni and cheese. I've never heard of the dairy restriction before. On my unit, we offer ice cream and milkshakes on day 1. How many mg of hydrocodone was she prescribed and how often? 7.5mg every 6 or 8 hours?

It is Hydrocod/Acetaminophen 7.5-325/15 ml with her getting 11.25 ml every 4-6 hours.

They said that didn't want the scabs to get coated too early is what the rationale was. 

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Good luck, I wish her a speedy recovery  . My youngest had tonsils/adenoids & tubes done when she was 5.

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6 minutes ago, Courtjester said:

It is Hydrocod/Acetaminophen 7.5-325/15 ml with her getting 11.25 ml every 4-6 hours.

They said that didn't want the scabs to get coated too early is what the rationale was. 

That's Norco, and not a crazy dose for a teen.

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I don't want to scare you but having them out as teenagers can be rough. My son was about 15 I think. For him at least, there was a window when it got better but around day 7 if I remember, it got worse. Something about the healing process. Hang in there. 

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My son had his out when he like 4 or 5. My biggest takeaway was this:

DO NOT WAIT UNTIL THEY ARE IN PAIN TO START THE MEDS.

We waited too long, and we just couldn’t seem to get in front of it. Poor guy was miserable for 3 solid days.

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Thanks for the advice all. She has thrown up twice now since coming home. We have tried to just tell her they said that this could be a normal reaction to the anesthesia, but I can't imagine how much that must hurt with her throat that raw. If this persists, I am going to get a little concerned because that is impacting her hydration and we may need to make a call. She is scheduled for another round of meds here in 90 minutes and I want to make sure there is something in her stomach before giving it. Going to try and let her sleep a bit--this could be a long night.

 

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Vomiting is normal. She'll also probably have some bloody drainage via nose and mouth. 

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My 3 year old is having her tonsils and adenoids removed next month. She did the sleep study and they said 1 per hour of stopped breathing is considered sleep apnea. She had 21

she had strep in February and her tonsils never reduced 

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Why did she have tonsillectomy? You're supposed to fulfill the Paradise criteria, which include multiple episodes of severe tonsillitis/pharyngitis in the preceding 1-3 years. I only say this because it is one of the more common unnecessary procedures in the US. 

And I agree with the pharmacist - Tylenol or ibuprofen are the recommended starting analgesic post-procedure. Kids, especially teenagers, have a much higher risk of developing problems with substance abuse from prescription opioids.

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I may have to get mine out soon. Not looking forward to the recovery at all if I do :(

Hope she recovers soon. It'll be rough. And that's a reasonable dose of pain meds. As stated, stay ahead of the pain. 

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4 hours ago, Courtjester said:

Went in at 6:00 and she was home by 9:00. Just amazing the modern medical world we live in.

I bought a couple dozen Powerade bottles, a bunch of those flavored waters, jello, Popsicles, Gogo fruit. We were told to stay away from dairy for 48 hours, but we have pudding and ice cream as well. The doctor wants her eating solid (really soft food) by tomorrow.

The nurse told us this is one of the worst surgeries to recover from--especially for a teenager. 

They prescribed her a big time pain-killer--Hydrocod. When I went to pick it up yesterday, the pharmacist actually took me aside and warned me how powerful this stuff is and was concerned about the dosage being prescribed. When I addressed that with the surgeon this morning, he said he actually prescribed her less than what he normally does just because of her age. He was also sort of pissed and said, "What is it with these pharmacists who want to be doctors?" It is an Oxy based liquid so that worries me and I want her off it as soon as possible, but the doctor said you have to stay in front of the pain and she will be miserable for 10-14 days. 

Any FBGs have experience with this surgery. Are we missing something we didn't buy?

What is with this bullcrap?  I had my tonsils out at 21.  It hurt a fair bit for two days.  I was told not to eat fried or scratchy things for ten days.  I had Tylenol.  That should be sufficient. Maybe codeine at a low dose in a pinch.  

What is it with idiot doctors who over-prescribe and wonder why we have so many addicts?

(Seriously, I wouldn't even fill that script.  Let her sleep it off.  Get her a signaling device for when she needs something.  I had an actual cowbell.)

Edited by Mrs. Rannous

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The vomiting can't be much fun.  Perhaps some cough drops would take the taste out and soothe her throat.  Did they give her a cold pack made for the troat area?  Those are very nice.

Edited by Mrs. Rannous

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1 hour ago, Courtjester said:

Thanks for the advice all. She has thrown up twice now since coming home. We have tried to just tell her they said that this could be a normal reaction to the anesthesia, but I can't imagine how much that must hurt with her throat that raw. If this persists, I am going to get a little concerned because that is impacting her hydration and we may need to make a call. She is scheduled for another round of meds here in 90 minutes and I want to make sure there is something in her stomach before giving it. Going to try and let her sleep a bit--this could be a long night.

 

Also. 100% get with your doctor and their office. I love the forums but this is not the place for medical advice. 

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9 minutes ago, Terminalxylem said:

Why did she have tonsillectomy? You're supposed to fulfill the Paradise criteria, which include multiple episodes of severe tonsillitis/pharyngitis in the preceding 1-3 years. I only say this because it is one of the more common unnecessary procedures in the US. 

And I agree with the pharmacist - Tylenol or ibuprofen are the recommended starting analgesic post-procedure. Kids, especially teenagers, have a much higher risk of developing problems with substance abuse from prescription opioids.

In my daughter's case she had tubes inserted and Adenoids removed when she was three after bout after bout of ear infections. She was really a sick kid back then.

Fast forward--she started having sore throat after sore throat in early 2018. We would take her in and the doc's would say the same thing--tonsillitis, Script for amoxicillin--move on.  Rinse and repeat. What kind of moved us forward was, during one of her monthly orthodontists appointments (she got braces last summer) , the doc expressed concerns about how swollen her tonsils were. He actually used the term, "It looks like she is breathing through a straw back there."  She snored something terrible and we know she never slept soundly. We got the appointment with the ENT specialist in April and he said her tonsils were at a 3+ on a scale of 4+ and he said she is definitely a candidate for surgery. My daughter is active in drama--she got a lead as a freshman this year. She has an amazing voice (yeah I am biased)  and is in the top honor choir at her high school. She was struggling to keep up with all this. Believe me, we were in no hurry to have this done, but she made the decision that she couldn't endure another year of sore throats and doctor visits, so that is how we arrived here. 

You last statement is a fear of mine--I see too many stories of people talking about how they got hooked on something after surgery.  It worries me big time

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2 minutes ago, Courtjester said:

You last statement is a fear of mine--I see too many stories of people talking about how they got hooked on something after surgery.  It worries me big time

I don't think I'd worry too much about this.  This pain should be fairly mild after the first couple of days.  If it's really bad, you need to take her back to the doctor.

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6 minutes ago, Mrs. Rannous said:

I don't think I'd worry too much about this.  This pain should be fairly mild after the first couple of days.  If it's really bad, you need to take her back to the doctor.

I hope so. what I have read (and as Joe posted in his example)  is the most prevalent pattern in the recovery process is at the 4-7 day mark, things tend to get  a little weird for some reason. Every kid is different, so we can only control what we can. I am lucky to have a wife of 30 years who is off for the summer and able to be there every minute with me. 

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44 minutes ago, Courtjester said:

In my daughter's case she had tubes inserted and Adenoids removed when she was three after bout after bout of ear infections. She was really a sick kid back then.

Fast forward--she started having sore throat after sore throat in early 2018. We would take her in and the doc's would say the same thing--tonsillitis, Script for amoxicillin--move on.  Rinse and repeat. What kind of moved us forward was, during one of her monthly orthodontists appointments (she got braces last summer) , the doc expressed concerns about how swollen her tonsils were. He actually used the term, "It looks like she is breathing through a straw back there."  She snored something terrible and we know she never slept soundly. We got the appointment with the ENT specialist in April and he said her tonsils were at a 3+ on a scale of 4+ and he said she is definitely a candidate for surgery. My daughter is active in drama--she got a lead as a freshman this year. She has an amazing voice (yeah I am biased)  and is in the top honor choir at her high school. She was struggling to keep up with all this. Believe me, we were in no hurry to have this done, but she made the decision that she couldn't endure another year of sore throats and doctor visits, so that is how we arrived here. 

You last statement is a fear of mine--I see too many stories of people talking about how they got hooked on something after surgery.  It worries me big time

Sure. I was just pointing out there are objective criteria to make the decision for surgery. Probably spilling over from a thread on the politics forum where I'm debating the idea of appropriate care vs. rationing.

Most people don't get hooked with short term opioids. But adolescents have increased risk, and there is no good reason not to start with non-opioid alternatives - the otolaryngology guidelines gave a strong recommendation for using acetaminophen/ibuprofen instead:

Quote

The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years. (2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. (3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy.

  The surgeon's response to calling him out is very telling - at the minimum, he should have taken the opportunity to emphasize the risk of his chosen analgesic instead of complaining about the pharmacist.

Edited by Terminalxylem

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4 hours ago, Ketamine Dreams said:

Vomiting is not normal after a tonsillectomy. 

But it can be after anesthesia.  Some people react that way.  As long as it stops reasonably quickly, she should do well.

How is she, by the way?

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On 6/20/2019 at 4:37 PM, Joe Bryant said:

I don't want to scare you but having them out as teenagers can be rough. My son was about 15 I think. For him at least, there was a window when it got better but around day 7 if I remember, it got worse. Something about the healing process. Hang in there. 

My nephew is 13 and just had tonsils and adenoids out a couple weeks ago and it has hell for him for 10-12 days. He was in a lot of pain.

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