Archives: Instructions

*No Aspirin or Ibuprofen for two weeks prior to surgery.

1. Normal activity can be resumed after the first week depending on the patient’s comfort level. For the first week there should be no heavy lifting or exertion.
2. The patient may have soft foods such as oatmeal soups pureed fruits and vegetables jello ices and ice cream in the first few days following surgery. Avoid hard foods that cause straining or pain.
3. It is extremely important that the patient drinks sufficient water/liquids to avoid dehydration. The patient should drink at least four glasses of water each day. Sufficient pain medicine should be administered if pain is preventing the patient from taking in enough fluids. Your child may not want to eat any food – this is acceptable. However your child must drink to prevent dehydration that causes further pain and discomfort.
4. It is necessary to keep the mouth and teeth clean after a tonsil operation. The teeth should be brushed gently two or three times a day. If you have a humidifier it should be used.
5. Many patients complain of earache after a tonsil operation. This is normal and frequently the ear pain is worse than the throat pain. This is not an ear infection. This pain is coming from nerve endings in the throat. Usually the pain is most intense on the third to sixth postoperative day.
6. Some fever is expected. If it is over 102 degrees F call my office. There may be a white covering/scab where the tonsils were. This is normal.
7. It is expected that there will be some bloody secretion. Should there be a significant amount of bright red blood remain calm and call our office immediately. If the phone is answered by the answering service the doctor will be notified immediately. Should there be any problem or difficulty with contacting the doctor report to the emergency room. The emergency room physician will have to see you in this situation and contact the covering surgeon as necessary.
8. Your child’s voice may sound higher for several weeks after surgery. This will return to normal.
9. Call the office for an appointment two weeks following surgery. School may be resumed about one week after surgery or when feeling comfortable.

1. Swallowing and diet: You may feel some discomfort with swallowing for several weeks after surgery which usually resolves with time. Eat soft foods in the beginning then progress to a normal diet.
2. Pain medication: Moderate pain and discomfort is expected for the first postoperative week. You will be given Tylenol with codeine as a pain medication.
3. Thyroid medication: If a total thyroidectomy has been performed (your entire thyroid was removed) then you will be placed on thyroid replacement medication. We will determine if this is the correct level by checking your TSH level (blood test) at six-week intervals.
4. Calcium medication: Frequently the calcium level can drop after a total thyroidectomy. Calcium replacement with Calcium Carbonate pills (tums) or Calcium Carbonate with vitamin D (OsCal) is recommended at about 6 pill per day. You do not require a prescription for this medication. You may be given Rocaltrol which is a strong vitamin D preparation.
5. Radioactive Iodine: If you have the diagnosis of thyroid cancer you will sometimes be given an appointment with a Radiation Oncologist who will administer I131 which is a radioactive iodine that eliminates any microscopic thyroid cancer cells that may be in the body. Not all people are given radioactive iodine and this is decided on a case by case basis.
6. Wound care: Your suture will be removed eight days after surgery. Make an appointment in my office for the following week after surgery. For several weeks there may be some redness to the wound and some swelling at the top half of the neck. This is normal and will usually resolve. You can replace your dressing if you feel more comfortable with it covered. Otherwise it is perfectly acceptable to leave the steri-strip covering open to air.
7. Activity: You may resume your normal activity about 4-5 days after surgery. Normal bathing can be resumed 2 days after surgery. As you feel comfortable you can resume you normal routine. The key determinant is listening to your own body and not going beyond your limits.

1. Cover the wound with antibiotic ointment (Bacitracin/Bactroban/Neosporin) at least three times a day.
2. If you have a graft a “bolster” will be placed. This is a yellow dressing with sutures over it. This will be removed about one week after surgery.
3. Activity: you may resume your normal activity diet and bathing the day after surgery. If the wound gets wet simply pat it dry and cover it with antibiotic ointment.
4. Follow-up: Make an appointment to see me in my office about 8 days after surgery to remove the sutures.

1.  The tube placed in the patient’s eardrum helps equalize pressure and prevent accumulation of fluid in the middle ear. This will improve hearing and prevent recurrent infections.
2. Water that gets in the ear can cause infection. For routine bathing earplugs are not necessary unless you child puts his head under water or water is routinely poured in and around the ear. Also if your child dives under the water when swimming then ear protection is necessary. However for playing on the surface or in the kiddy pool earplugs are not necessary.
3. If your child swims with his head below the surface or if water frequently gets in the ear when bathing then custom earplugs are recommended. These can be fitted by one of our audiologists in any of our offices. Standard earplugs can be purchased in any pharmacy. Alternatively cotton with Vaseline can be placed in the outside of the ear canal to prevent water from entering the ear. When swimming and going under water a neoprene headband “Ear Band-It” on top of the earplugs is recommended.
4. The tubes will fall out of the eardrum anywhere from 4 months to 2 years following the surgery. Your child’s ears will be checked every 4 months.
5. If eardrops have been prescribed three drops should be placed three times a day with the head tilted all the way to one side for 30 seconds.
6. If a tonsillectomy has been performed at the same time as the tubes are placed then the ear pain your child experiences is due to the tonsillectomy and not from the tubes. This is not an ear infection. If an adenoidectomy has been performed in addition to placement of tubes then your child may have some bloody discharge from the nose for one to two days after the procedure. Also there may be some neck discomfort.
7. Call the doctor if there is ear drainage (pus) for more than one day. This may be an ear infection.
8. No heavy lifting or nose blowing for three days postop.
9. A normal diet bathroom use and bathing (except as directed above) may be resumed after surgery.
10. Call the office for an appointment 2 weeks after surgery.

What To Expect: Minimal pain low grade fever temporary nasal voice mild ear pain nasal discharge.

Special instruction: A small amount of bleeding from the nose or mouth often occurs during the first 24 hours. Call and/or go to the hospital emergency room for excessive bleeding. Medication: Tylenol is usually adequate. Antibiotics are not prescribed.

Activity: No restrictions

Diet: No restrictions

Post-Op Appointment: Usually 2 weeks after surgery. Call the office to make an appointment 845-294-0661.

When to Call: Call office during routine hours for questions concerns changes or refills of any medication. After hours calls should be limited to urgent problems such as excessive bleeding or fever over 102^oF that does not respond to fluid or Tylenol.

Post-Operative Pain Control in Children After a Tonsillectomy/Adenotonsillectomy:

• After surgery younger children (age 9 years and younger) are most commonly treated with acetaminophen (Tylenol). Acetaminophen can be given every four hours as either an oral liquid or rectal suppository.  
• Children and teenagers should not be given aspirin 7 days prior to and after a tonsillectomy/adenotonsillectomy due to the increased risk of bleeding.
• While acetaminophen (Tylenol) with codeine is commonly used for pain control after a tonsillectomy/adenotonsillectomy in children it may have side effects from the codeine due to differences in the way the medicine is processed by the body.  We will write you a prescription for this medication; however if your child shows these signs stop giving the codeine and switch to Tylenol alone or Tylenol supplemented with Advil:
• Unusual sleepiness
• Disorientation or confusion
• Labored or noisy breathing
• Blueness on lips or around mouth
• If any of the above symptoms do occur please call us immediately at 845-294-0661.
• If Tylenol or Tylenol with Codeine does not provide adequate pain relief then liquid Ibuprofen (advil) can be used to supplement. Ibuprofen (5mg/kg) every 6 hours for post-procedural analgesia following tonsillectomy/adenotonsillectomy in children provides excellent pain control and has not been shown to increase the risk of postoperative bleeding in children without a history of bleeding disorders.
• You can read more on this by referencing the following articles and websites:
• http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM315528.pdf
• http://www.medscape.com/viewarticle/725693
• http://www.entnet.org/content/tonsillectomy-pain-management
• If you have any questions please contact us at 845-294-0661.

Laryngoscopy is a procedure involving examination of the structures from the tongue base to the voice box and vocal cords. It is also used for surgery on the vocal cords or removal of a foreign body or tumor. It is frequently preformed and considered to be one of the safest.

Among the few complications that may occur are injury to the teeth risks of general anesthesia bleeding after biopsy and failure of the vocal cords to heal after biopsy. If polyps nodules or small well-circumscribed cancers are present the laser may be used to remove these lesions. Voice changes and/or hoarseness are possible after such vocal cord surgery.

Post Operative Instruction:

1. Throat discomfort may persist for several days. Tylenol or prescribed pain medication should relieve the pain; if it becomes worse please notify Dr. Gordon.
2. Do not take aspirin Motrin Advil Aleve or any Ibuprofen containing products for 2 weeks after surgery.
3. If any of the following occur you may contact Dr. Gordon through the office at (845) 294-0661.
• Spitting up bright red blood
• Fever higher than 101.5 F
• Inability to eat or drink
• Difficulty breathing shortness of breath abnormal wheezing high-pitched crowing-like sound when breathing or bluish discoloration of the lips.
4. Absolute VOICE REST for 2 days after surgery and no excessive voice use (shouting or whispering) for 2 weeks after surgery when vocal cord polyps or lesions are removed.
5. No smoking or alcohol.
6. Maintain high humidity at home with a vaporizer or sauna.
7. Follow up appointment should be about 2 weeks after surgery.

Please call our office immediately if you experience:

• Difficulty breathing or swallowing
• Neck swelling
• Bleeding from the wound
• Fever greater than 101 degrees Fahrenheit
• Purulent discharge (pus) coming from the wound
• Increasing redness around the wound

Office phone: (845) 294-0661

PARATHYROIDECTOMY INFORMED CONSENT Minimally-Invasive Parathyroidectomy Parathyroidectomy is an operation in which one or more parathyroid glands are removed. This operation is performed to control hyperparathyroidism (over activity of the parathyroid glands) which is either caused by a benign tumor of one or more of the glands (parathyroid adenoma) or generalized growth and over activity of all of the glands (parathyroid hyperplasia).

In rare instances surgery is performed on the parathyroid glands in order to remove a parathyroid cancer. Hyperparathyroidism is associated with loss of calcium from the bones (osteoporosis) elevated serum calcium (hypercalcemia) generalized weakness and fatigue lethargy kidney stones stomach ulcers joint aches and pains and constipation. Any operation has general risks including reactions to the anesthetic excess scar formation Lung infections blood clots heart and circulation problems and wound infection.

In addition there are specific risks associated with parathyroid surgery as follows:

• Post-operative bleeding may cause swelling in the throat and difficulty breathing due to pressure on the windpipe. It is usually fixed by a further operation to remove the blood clot
• Injury to the laryngeal nerves may cause hoarseness of the voice. This is usually temporary but may be permanent in up to 1% of cases. It may improve with speech therapy or further surgery to the vocal cords. If you are a singer or public speaker any surgery to the thyroid may cause subtle long-term changes to your performing voice.
• Postoperatively the calcium level in the blood may drop (hypocalcemia). It is treated with calcium and vitamin D tablets and usually improves in a few weeks.
• Even in the most expert hands up to 5% of parathyroid tumors cannot be found at operation and the blood calcium will remain elevated (persistent hyperparathyroidism). Sometimes after successful surgery one of the other parathyroid glands may also then become overactive and cause the blood calcium level to rise again (recurrent hyperparathyroidism).
•  The ability to perform minimally invasive parathyroid surgery is dependent upon the preoperative localization studies. At the time of surgery it may be necessary to perform a full parathyroid exploration. This may cause the incision size to be larger than initially anticipated.
• The diagnosis of primary hyperparathyroidism is based on the best judgment of your surgeon and endocrinologist. However based upon the findings at surgery this diagnosis may need to be re-examined if after surgery an adenoma is not located. I/We have been given an opportunity to ask questions about my condition alternative forms of treatment risks of non-treatment the procedures to be used and the risks and hazards involved and I/We have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us and I/We understand its contents. I/We understand every effort will be made to provide a positive outcome but there are no guarantees. Patient / Legal Guardian:______________________________________________________________________________________ Date: _________________________Time__________ Witness:_________________________________________________________