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What to expect on the day of surgery and afterward How long will it take for my symptoms to go away? How soon will my calcium level be normal? Do I need to take calcium after surgery, and if so, what should I take?
Scan this QR code to your smart phone or iPad, and bookmark this page regarding post-operative instructions. It will be a handy quick reference after surgery.What to expect on the day of surgery and afterwardYou will be instructed to arrive a few hours before the scheduled start time for the surgery. After checking into the Surgical Admitting Center, your nurse will start an IV line. You will then be taken to the nuclear medicine Department for the sestamibi scan, to be done right before the surgery. Following this relatively short test, you will be taken back to the Surgical Admitting Center, and from there to the operating room. Dr. Kennedy and the anesthesiologist will have discussed with you in advance the type of anesthesia to be utilized during the surgery. When you wake up from the surgery, you probably will have some mild pain along the incision in your neck, and perhaps some soreness in your throat, depending on the type of anesthesia used. You might have hoarseness, but not to worry. If you are hoarse, it usually is related to the anesthesia effects, and should resolve over a few hours, sometimes, though, over a few days. You will still have an IV in your arm, but of course it will be removed before you leave. Following your recovery from anesthesia, you'll be discharged from the hospital, usually in about 2 hours. After the surgery is completed, Dr. Kennedy will talk with your family or whomever else accompanied you to the hospital. You'll receive some postoperative instructions with plans for followup, and probably some instructions regarding taking calcium and vitamin D daily (see below).
Go to top of pageHow long will it take for my symptoms to go away?The symptoms that can be associated with a high calcium level are discussed elsewhere in this website. You can expect some fairly quick relief of the musculoskeletal types of symptoms you might be suffering from, if they are due to the high calcium level. Other symptoms such as memory problems, concentration problems, headaches and irritability typically improve over the first week or two. If you are having reflux symptoms related to a high calcium level, you are likely to see some dramatic improvement in the very first day or so. Symptoms of depression may take a month or two to improve. I wish I could guarantee that everyone with any of the listed symptoms will see dramatic improvement, but there is no guarantee of this. Fortunately, many patients do experience at least partial and often dramatic relief of their symptoms.Post-operative instructionsIt's not too uncommon to have some nausea from the anesthesia, but if you have an appetite, you may eat regularly. Driving is discouraged until you are really comfortable turning your neck about. This may be just a day or so, for up to one week. You will have some pain pills to use as needed.A postoperative visit is typically scheduled 1-2 weeks after the surgery in Dr. Kennedy's office. A water resistant dressing is usually applied over the incision, which will allow you to shower. Underneath, the sutures used are absorbable, and will not need to be removed. You can usually just leave the bandage in place until you go back for your visit. For out of town patients, discuss with Dr. Kennedy what type of followup will be planned.A written list of more general postoperative instructions will also be provided to you. If you have any questions or problems that you don't have answers for, feel free to call the office number, which is forwarded to the on call surgeon after office hours and on weekends.How soon will my calcium level be normal? After the surgery, your calcium level usually normalizes in just a day or so. The level of the parathyroid hormone drops almost immediately. In fact, the other glands sometimes don’t become active quickly enough to keep your calcium level in the normal range. As a result, you may actually have symptoms from a low calcium level. These symptoms include numbness and tingling around your mouth and in your fingers, anxiety, or lack of energy. If you have these symptoms after surgery, it is a sure sign that the overactive parathyroid gland was removed. But if left untreated, your calcium level may drop even further, and cause more severe symptoms, such as cramping, and difficulty breathing. These symptoms are prevented by taking calcium by mouth temporarily. Go to top of page
Do I need to take calcium after surgery, and if so, what should I take? Patients with hyperparathyroidism don't process calcium properly. The elevated PTH level stimulates your bones to release calcium, rather than store calcium, so until the elevated PTH level is corrected with a successful operation, your bones won't be able to properly maintain their own health. Immediately after the surgery, your PTH level will drop to normal, and in fact, until your other (normal) parathyroid glands get "revved up" again, your body might have trouble keeping your blood calcium level high enough. This is just temporary, though, and once your PTH level comes back to normal levels, your bones can start storing calcium again like they should. And so, calcium supplements can ensure your body has enough calcium to restore the deficit in your bones. Temporarily, we usually suggest above normal dosages of calcium (and vitamin D) to counteract this effect. Calcium can be taken in a variety of ways. Good food sources of calcium include dark green leafy vegetables (like spinach), cheeses, salmon, ice cream, calcium fortified orange juice, and calcium fortified cereals. A glass of milk (300 mg) is another option. If you don't have any calcium tablets at home, you may want to get them from your pharmacy before your surgery so you can start taking them as directed right away. You will receive specific instructions about this, usually taking a few 600 mg tablets twice a day for a week, then decreasing to 2 tablets once daily, to continue as a maintenance dose. Particularly for women, those with or without hyperparathyroidism, this is usually thought to be a good idea to ensure your calcium intake is adequate for good bone health, and for prevention (or as part of the treatment for) osteoporosis. There are a few options for calcium supplementation, including calcium by itself (either as calcium carbonate, calcium citrate, or calcium gluconate), or any of these combined with vitamin D. You do not need a prescription for calcium tablets. Calcium carbonate supplements (includes OsCal, Rolaids, and Tums) are usually the least expensive and well tolerated. But if you are on a drug which decreases stomach acid (for example, Pepcid, Zantac, Protonix, Nexium, Axid, or similar "H2 blockers" or "proton pump inhibitors"), calcium citrate (CitriCal) is probably a better choice, because of better absorption. The supplements with vitamin D are often recommended as an added margin of safety to ensure adequate vitamin D levels, since this vitamin is necessary for the metabolism of calcium in the body. This is not necessary for everyone, but essentially safe for anyone, so you may as well use these. Most women, even without a parathyroid problem, should take a calcium supplement daily. If you have some tingling even with this dose, then you should take some more. Occasionally a patient might need as much as 10 grams of calcium (that’s almost 20 tablets!) temporarily to get rid of the symptoms. But once the normal glands kick in, your calcium level will be maintained in the normal range without the need for supplements. If you are still having some tingling symptoms in your hands or around your mouth even with some extra tablets, you should call Dr. Kennedy's office. On occasion, a patient might be sent to the hospital for some calcium by vein, though this is not often necessary. Go to top of page
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DeKalb Surgical Associates ©2012
DeKalb Surgical Associates
2665 North Decatur Road
Suite 730
Decatur, Georgia 30033
Phone: (404) 508-4320
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