Dr. Wolfe's Parathyroid Surgery Discharge Instructions

You had a parathyroid exploration. We removed the parathyroid adenoma.

Since you’ve had General Anesthesia

Do not drive or operate machinery for 24 hours or while taking pain medication.
Do not consume alcohol, tranquilizers, sleeping medications or any non-prescribed medication for 24 hours.
Do not make important decisions, sign any important papers, or use internet for the next 24 hours.
You should have someone with you at home for 24 hours.

Wound care

Your sutures are buried, and the incision was sealed with a skin adhesive. Since the incision is sealed, there is no wound care needed.
Watch for signs of infection: spreading redness, pus from the wound, increasing pain and tenderness, increasing swelling. Call with any concerns about the incision.
The Steri-strips covering the incision will start to roll off after about 10 days. If they peel off easily with a light pull, then they can be removed. Stop pulling with any resistance.
The glue under the Steri-strips can start to darken and appear dirty. This is normal. The glue starts to peel off in 10-14 days revealing the healing incision underneath.
It is OK to shower; no direct water or submerging in bath, pool, or hot tub. Water can run over the incision. Just dab it dry gently.

Pain

Most patients are sent home with a narcotic pain medication. Take this as needed and as directed.
It is common that acetaminophen and ibuprofen are adequate for the pain. Acetaminophen can be started right after the procedure, but the ibuprofen should be started the next day. You can alternate between these medications. Do not take more than 3000mg of Tylenol in 24 hours.
Ice packs also work well for the first 2 days after surgery. Gently place ice over surgery sites as needed. Please place a thin, clean towel over skin first and then place ice bag over towel. Direct contact with the skin can cause damage. Ice for 10 minutes at a time every hour.
It is always best to taper the narcotic medications as soon as possible to prevent side effects, commonly constipation, itch, nausea, sedation, constipation, and headache.

Activity

You need to be up and around for daily activities. It is OK to lie down when tired but refrain from staying in bed for extended periods during the day. Lack of moving around increases the risks of blood clots in the legs and pneumonia.

There should be no strenuous activity or heavy lifting (15 pounds) for 1 week.

Diet

There are no dietary restrictions. It is normal to have a sore throat. You can eat whatever is comfortable. Sore throat lozenges can be used to help the discomfort. The other pain medications will also help.

Constipation

Constipation after surgery is very common. It is caused by the anesthetic and narcotics. It is very important to stay hydrated. Drink plenty of fluids. It can be prevented with stool softeners (Metamucil, Citrucel, Colace) or laxatives (MiraLax). These are over-the-counter and do not need a prescription. Use as directed on the packaging.

Calcium

You will be sent home with supplemental calcium. These tablets are over-the-counter. I recommend dosages of 1000 mg. Some formulations may have vitamin D added. These are also OK. Occasionally, you may be sent home with a prescription for calcitriol, a more active form of vitamin D. These improve the absorption of calcium after you take it.

Calcium Supplementation

Calcium carbonate can be bought over-the-counter at any pharmacy. They come in several strengths. It is easiest to buy tablets that are 1000 mg or 1200 mg per pill. It is OK to get 500 or 600 mg tablets and take 2 at a time.

Some formulations contain vitamin D. This can improve absorption of the calcium. This is OK for you UNLESS Dr. Wolfe tells you to not use it.

Week 1: Calcium carbonate 1000 mg every 8 hours
Week 2: 1000 mg mg every 12 hours
Week 3: 1000 mg daily until changes are discussed with the clinic.

This regimen may change as calcium levels are monitored with blood tests as ordered by Dr. Wolfe

Symptoms of low calcium

Watch for numbness and tingling in the lips and fingers. These are symptoms of low calcium. If it is uncomfortable, you can take an extra dose of calcium. Calls us if it continues or worsens.

Watch for cramping in the extremities. Take an extra dose of calcium and call the clinic. You will need to go to the Emergency Room for a calcium check and possible supplementation.

At the post-operative visit, we will draw blood for a calcium and a parathyroid hormone level.

When to call your doctor

Low calcium: Numbness & tingling in the lips and fingers. If cramping in the extremities occurs, seek help at an Emergency Department.
Nausea: If nausea or vomiting continues beyond the day of surgery, anti-nausea medications or a change in pain medication may be needed.
Fever: 101F degrees F (38.5 deg C) or above may require increasing fluid intake or the need for antibiotics.
Dehydration: Drinking adequate fluids is essential to recovery, call if patient is not drinking enough.
Bleeding: Call the surgeon’s office if significant bleeding occurs. This may look like bloody drainage, significant swelling at the operative site, or both. Seek medical attention immediately if you experience difficulty swallowing, talking, or breathing.
Difficulty urinating If no urine in more than 6 hours, seek help at an emergency department.

Note: Some pain medications require a written prescription at the pharmacy, so call for refills before you run out of medication.

For questions, concerns, medications, or emergencies, call our office day or night.

Dr. Wolfe – (206) 838-8345

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