Its not my intended subject matter, I have no expertise in this field. Still, I went through the experience, and given that I want to write about things that people may experience this seems like a good one. Warning, this is long and maybe a little graphic for some.
Firstly, I suffered from obstructive sleep apnea. I had a pretty high Apnea Hypopnea Index (AHI), which is the number of Apnea/Hypopnea events that occur per hour. My AHI was a tick over 80 per hour. To give you context, severe is considered to be anything over 30, moderate is 15-29, mild is 5-14 and none/minimal is 0-4. These numbers were determined via a sleep study, in which you’re wired up and they check readings of things like AHI, Oxygen Saturation and a raft of other measurements.
I got sent to a Otolaryngologist, or Ear/Nose/Throat (ENT) specialist, to investigate my ability to breathe and any inhibitors. As it turns out, I had oversized tonsils, a severely deviated septum and enlarged turbinates. Basically my nasal passages were a series of sharp S bends which had airflow obstructions (the turbinates function as airflow control and humidifier, but they were oversized), with my throat passages being smaller than they should be.
As a result, I needed to get a Tonsillectomy, Septoplasty and Turbinoplasty. This would remove the tonsils, cut away part of the deviated septum to straighten it out and removal of small amounts of turbinates tissue to reduce the size of them. This is considered routine surgery, so I opted to have all done simultaneously – the combination of these requires you to be put under General Anaesthetic (GA). The involvement of obstructive sleep apnea combined with the family history of diabetes, heart disease and a raft of other things meant that it was critical for me to get these procedures done.
The next part is pretty much what happened, and is also for anyone else who’s looking to undergo the procedures so they understand what they’re likely to be in for. This is probably more applicable for the Australian medical system, but it should be relatively adaptable to other countries.
Tonsillectomy/Septoplasty/Turbinoplasty Recovery Timeline
Day 0 – This is the day of the surgery. You won’t be able to eat/drink from around 7-8am, this includes water. Drink a reasonable amount of water well before the cutoff time, since you wont have an opportunity afterwards. I checked in to the hospital at 12pm, as requested. Upon arrival, I found out that I was way down the list of patients as the surgeons tend to prioritise children over adults. In my case, I was 13th of 14th so nothing happened until around 1620, with the surgery itself at 1700.
When things start to happen, it’ll be a case of them making sure they have everything they need (MRI/X-ray/CT scans that you may have been requested to bring in) and then come every single nurse you encounter asking you for your name, what procedures you’re undergoing and if you have any allergies (cross checking all the information to make sure you don’t get the wrong thing done). After that, you’ll meet the Anaesthetist who’ll do much the same and just go over what you’ll get and what to expect. Finally, you’re wheeled in to the operating theatre, administered GA and you’re asleep.
Once you wake up, you’ll be in post-op care. You won’t be able to do much because you’re really groggy. I got given about 3 or 4 half cups of water and painkillers to help manage my pain, but they weren’t keen on giving me too much water. Beyond that, you’ll just need to stay awake long enough until they feel there’s no immediate issues, then you’re wheeled back to your room.
Back in your room, you can finally eat – no, there is no abundance of ice cream or jelly sorry to say. I think that’s for kids, and only to get them to consume something because they tend to be fussy when they experience pain. Expect to be given painkillers though, and you’ll start getting access to water. Both are good things, even though you won’t feel like you need it immediately. I was given local anaesthetic in my nasal passages and throat during the operation, so when I woke up I wasn’t in too much pain. It meant I could eat sandwiches soft fruits without it causing me grief.
Before I go further, I want to talk about the importance of water. You need to drink a fair bit of it to keep hydration up. As you recover, scabs form on the wounds on the back of your throat and these need to be kept well hydrated or else they hurt immensely if they’re dry and come off. It also increases the chances of primary bleeding after surgery if you don’t drink water. I worked out that I needed to consume about 250ml of water every hour specifically for recovery (on top of what I was normally drinking), and that’s roughly what I did for the entire time I was recovering. Before you leave the nurses will need to verify you’re passing urine and see a reasonable quantity – my unconfirmed theory is that the painkillers, GA and local anaesthetic do some weird stuff to your system and make it hard for you to take a leak (more on this later though). I struggled, but drinking large amounts of water eventually forced the issue due to, uh, “pressure relief” requirements.
For ongoing pain relief, I was prescribed Tramadol, Endone and Panadeine Forte with specific consumption schedules. The Panadeine Forte was taken every 6 hours with Endone taken 30 mins after and Tramadol a further 30 mins after that. You basically take all 3 pain medications 4 times a day to try to even out your base pain levels and stabilise it so things are bearable.
Post-operatively, I also experienced bloody mucus running down the back of my throat (and out my nose) from the Septoplasty and a small amount of blood leaking from the Tonsillectomy that hadn’t fully clotted. Combining that with the pain medications, drinking water and the GA/Local I ended up getting nauseous. Luckily, I only threw up once and that was late enough into the night that it was only water. I had to replace the water, but its less of a hassle the second time around since there’s less blood. Hopefully if you throw up, you wont raise your blood pressure too high that it causes a bleed, which I’d guess is universally bad. If you know breathing techniques to stop yourself throwing up, start using them.
Before you go home, make sure you have the following information:
- What drugs will you need? Are they issued by the hospital?
- Overall pain management program?
- Any suggested diets?
- Care information?
- Next scheduled visit with the specialist?
There’s some stuff you need to be aware of that you probably won’t be told:
- Have issues urinating
- Constant drowsiness
- Inability to concentrate
- Weight loss
- Occasional light bleeding from your throat and nose
If you’re like me, you’re going to trawl the internet looking for other people’s experiences. There’s no problem with this but don’t get sucked into doing some crazy diets that some people suggest. Stick to what your medical professionals tell you.
Remember this, if nothing else, consume water regularly. There’s water consumption calculators all over the net, as requirements change depending on weight/activity levels and ambient temperature. In my case, I was shooting for 4.5-5 litres/day as I’m 196cm. Drinking water regularly is the difference between it being an “as usual” recovery in 14 or so days, or going back to the hospital with a primary or secondary bleed which requires cauterization and the whole recovery process to start all over.
For the most part, all of the recovery is about the Tonsillectomy. The Septoplasty/Turbinoplasty procedure largely takes care of itself, just use the saline spray as recommended and that’ll be fine after about 5 days.
Day 1 to Day 2:
You will still have residual anaesthesia in your system. As a result, you can only function semi normally but without that much discomfort. Dont assume that the rest of the time will be like this, it isn’t. Hate to say it, it only gets worse from here (for a short time). Eat what you can, as your intake of food will drop. Dont worry if all you can stomach is ice cream or jelly or the like, though try to avoid ice cream and other dairy products initially, as they will cause mucus production which will feel like you’ve got crap stuck in the back of your throat. I will stress, make sure you stick to your pain management plan with its prescribed times. I delayed one a little and never made that mistake again due to the pain I experienced. Oh, don’t forget to drink water.
Day 3 to Day 6:
You’re going to get a ton of referred pain during this phase, I’d suggest chewing gum to keep your muscles semi active. Not too long, maybe 45 mins across the day. Expect your sleep to be heavily disturbed, every time you wake up you’re going to inadvertently swallow and experience a huge amount of pain. Using a wheat bag that you’ve chucked in the freezer will be helpful, it’ll feel like it’s making a difference. Basically it just needs to rest against your throat to help reduce swelling.
I struggled to eat during this time especially. I ended up using small amounts of food every so often. There were points where the pain was so bad after swallowing a single mouthful of food I’d started to regret doing this. All I can say is to persevere with eating and try to time it around when you’re taking your pain killers as having something in your stomach is apparently good before downing the meds. My ENT strongly recommended I return back to a normal diet and avoid going down the ice cream and jelly route, as somewhat abrasive foods will help clean the throat and make the removal of scabs a little easier. As a result, I ate lightly buttered toast as it was abrasive enough to help with that. It does hurt, but if it’s going to help later on it’s worth trying.
As a precautionary measure, I scheduled an appointment with my General Practitioner (GP) on the 6th day. This was purely so he knew I had the surgery and also knew where I was at with it in the event I needed to call him for emergency medical advice. It worked out well in my case, as he ended up changing my pain management program and switching my Tramadol prescription to a 12 hour version as opposed to the 4 hour one that I had. This meant less issues for me overall, as I had constant pain management. As a side effect of this, I was able to reduce my overall intake of pain medications, which did wonders for me in other ways.
I’ll cover some of the points that I listed above. The painkillers will cause you to become constipated, there’s no easy way around that. Hopefully you received some laxatives as part of your medications (Coloxyl in my case), which you want to take as recommended. It may not be too much of an issue at the start, as you may not be eating that much during this time, but it is something you will want to consider as it isn’t healthy to be blocked up for too long.
The other major point is that the painkillers can cause urinary retention which is not fun. There are some tricks to getting around this, with one of them being the sound of running water causing your brain to generate the need to go. It’s hasn’t been rigorously tested, scientifically speaking, but apparently it might be a thing. Find what works for you and stick with it.
You’ll also be constantly drowsy due to, at least in my case, Endone. Resist the temptation to sleep for large amounts of time; if you start getting into oversleep territory, it can be really hard to get out of it. Try and limit your sleeping to about 8-9 hours per day at a maximum.
One thing I found is that I got bored pretty quickly. There’s only so many TV shows and movies you can watch before it gets tedious. Try and find other ways to occupy your time, but try not to pick things that require significant amounts of concentration as that will be a bit of a struggle with the pain meds. They’ll interfere with your ability to think clearly, which is why you should also avoid making any real decisions during this time.
Day 7 to Day 9:
At this point, your base level of pain should reduce. You’ll actually be able to reduce the amount of painkillers you’re on, because the only time you experience pain is hopefully when you swallow. Around now, the scabs on the back of your throat will start to come off with regularity. The underlying skin will be hypersensitive to cold or cool sensations. As such, microwave your glass of water for about 10-15 seconds to bring it closer to body temperature as this will allow you to swallow it with minimal discomfort. Expect the pain to be sharp though. I had minor bleeding at this point, usually not true blood itself but a mucus-y version of it. Nothing to be alarmed by, as the quantity of blood was less than 10ml or so. Anything over 10ml with regularity and I’d strongly suggest seeking medical advice pretty quickly.
Food will be easier to eat, but you’ll still have pain. This is where the dealing with the constipation early will pay off, as you’d probably not want to be trying to fix it now. Reducing your pain meds won’t have a significant effect on this or the urinary retention side of things, but easing off them is a good thing since Endone can be highly addictive if you keep using it for an extended period of time (I believe Tramadol is the same).
Day 9 onwards:
I started being able to eat “regular” food, within reason. I ate foods that were reasonably close to body temperature, as it was easier to swallow. Don’t go overboard here, as you really don’t want to push yourself with your intake of food. Still maintain drinking plenty of water, as it will wash away any slight bleeding you might still experience (rare mind you, but I did have one occurrence). Definitely consider switching to a high fibre diet, as the effect of the painkillers will still be there for a few days. I had a appointment with my ENT on day 10 and then an appointment with my GP on day 15. Both of them commented that I was doing well.
After day 15, I resumed a normal diet.
With the above experience, I lost around 10kg simply because I found that not eating for such a long period of time meant my body was using depleting excess fat. I’m not a small guy, so for me this was actually a bonus. The other side effect I experienced was that my stomach shrank and/or my brain reset its expectation of serving size. What I used to eat as a full meal is now too large, so I’ve cut my meals down by about a third to half for the most part. This whole weight loss thing has been a huge bonus for me, so I’m calling the surgery a win. Nearly 8 months in, I’ve actually maintained the weight loss and lost a further 4kg or so which is great.
As part of the Septoplasty, I had to go see my ENT every couple of months – my last appointment was on 13th March. He has advised that everything has healed correctly, though somethings will still take time to resolve (because I have significantly improved airflow, I have to re-learn how to breathe through my nose).
At the very start, I said that the reason why I did this is due to sleep apnea. Turns out the effect of fixing my nasal passages, removing my tonsils and losing weight has actually reduced my AHI numbers from 80+ down to 1 (determined via a second sleep study). The sleep specialist and my ENT both said that it’s an outstanding result which bodes well for my health in general.