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What to Expect after Surgery

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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? 

Pain Medication

Bandages

Diet

Driving

Return to Work

Followup Office Appointment

 

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 afterward

You 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).

 

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How 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.

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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 donít 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.

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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 (thatís 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.

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    Pain Medication:

       The medicine which was used may affect you for up to 24 hours after your procedure, so you might feel sleepy; this feeling will slowly wear off.   BECAUSE THE MEDICINE MAY STILL BE IN YOUR SYSTEM FOR THE NEXT 24 HOURS, YOU SHOULD NOT:

        Drive a car or operate machinery or power tools

        Drink any alcoholic beverages

        Make any important decisions, such as signing important papers

         A prescription for pain medication may be given by your physician. This should be taken as directed, and if the pain is not relieved, contact your physician. If your physician does not prescribe medication, you may take a non-prescription, non-aspirin medication which can be purchased at your drugstore. Please follow the directions on the label. Please be aware that any pain medication can affect your judgment.

          The narcotic medications typically prescribed (eg, hydrocodone or oxycodone) can cause nausea, itching, or other side effects.  It is best NOT to take these on an empty stomach.  If you are nauseated or just not eating much yet, at least take a cracker along with this medication, to help lessen the possibility of worsening nausea.  If you experience itching after taking one of these narcotic medications, it is likely due to an allergy to the medication.  While in most cases, this is not severe, it is most likely best not to use even smaller doses of that specific narcotic in the future.  You can use over the counter medications, such as Tylenol (acetaminophen), Aleve (naproxen), or Motrin or Advil (ibuprofen) instead, and in many cases, these options will be sufficient.  But if not, call to report your problem, and an alternative choice will be given.  And if you have experienced an allergic reaction, be sure to note the medication name, and add it to your written list of drug allergies and adverse effects.

          Be aware that the narcotic medications (eg, hydrocodone (Lortab), oxycodone (Percocet)) usually include some acetaminophen.  This improves the effect of the narcotic.  Be aware that large daily total doses of acetaminophen can cause liver damage, so be sure to follow the instructions on the package or prescription.  Here is a link to more information about acetaminophen.

       Bandages:

        The use of ice packs is optional, but many patients find that it helps to lessen their pain, and speed up their recovery. Some swelling or bruising at the incision sites is normal.

        Keep any clear plastic dressings on until your followup visit if possible.  If "surgical glue" is used, you don't need any additional dressing and you may bathe normally.

        Your may take a brief shower leaving the clear dressings in place; do not soak in a tub bath.

        Your dressings may become soaked or may leak.  If so, you may remove the dressings and replace with dry gauze and adhesive tape daily.  You may still gently shower and re-cover with gauze and tape afterward.

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          Diet:

        After general anesthesia, you may not have much appetite for the first 1-2 days after surgery.

        Start with light foods (breads, bananas, soups) and advance as tolerated.

        If you are nauseated, limit yourself to liquids until the nausea resolves.  If the nausea is your worst symptom, you may call the office phone number (404-508-4320) and ask for some medication to help with it.

        Be aware that the pain medications prescribed, such as hydrocodone and oxycodone frequently cause constipation. If you are using these medications regularly for pain control, consider taking milk of magnesia once or twice daily to help prevent constipation from being a problem.

 

      Driving:

        The main reason for restricting your driving is that your incisions will be sore, and you might not be able to put on the brakes comfortably enough to be a safe driver.  Once you do this quickly and without pain, you may resume driving.  But before getting out on the road, take a practice run just in your neighborhood.

 

     Return to Work:

        In many cases, one can return to work in less than a week, but it does depend on what type of work you do, whether you have resumed driving as discussed above, and how much pain you are experiencing after surgery.  If your job involves heavy lifting, or lots of standing and walking, your return to work could be delayed a bit longer.  You can get a written work release and permission to return to work from the DeKalb Surgical office if needed.

 

      Followup Office Appointment:

        In most cases, your surgeon will want to see you back in the office in about one week, unless you have been instructed differently. You can call during regular office hours to make the appointment, using our main office phone number, 404-508-4320. Please be sure to make note in advance whether you have sufficient pain medication left, and if not, you can request a refill during your appointment. If there is any pathology report to go over, your surgeon should typically have it available by the time of the first visit. You may have a copy for your own records if requested. Prior to your appointment, it would be good to write down any questions you need answered, to be sure you don't forget.

 

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DeKalb Surgical Associates ©2014
2665 North Decatur Road
Suite 730
Decatur, Georgia 30033 (a suburb of Atlanta)

980 Building, Suite 430
980 Johnson Ferry Road, NE,
Atlanta, Georgia 30342

Phone: (404) 508-4320
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