Tonsillectomy and work?

[low n' slow]

Hi all.
I've been having problems with my tonsills the past year. Last time it was about two weeks ago and I went to the company doc who gave me penecillin. The medication stopped three days ago and now I feel the tonsills swelling up again with white spots. My symptoms are sore tonsills and a sore throat allmost constantly and usually I get a fever which I don't feel comfortable working with. It also drains me of energy and I feel tired most of the time. As this has been going on since easter more or less, I feel its time those little bugger came out of their hole and were binned forever.

That leads me to som questions though. How do they go about the procedure and will they give me any anasthetics for it? And if they do sedate me, how long will I be grounded before I can go to work again? I know it should say in JAR FCL 3 somwhere, but I couldn't find it. Any one who has gone through this and could give me an insight on how long I should plan to be off work? Also, did it cure your problems?

Regards/ LnS

[modtinbasher]

I don't know if this may be your problem but research the net as I have done.

Symptoms. As you describe. Please examine your tonsils and if they are large and "puffy" and appear to have holes in them, these "white spots" maybe the visible end of plugs of waste matter, stuck in the holes or fissures of your tonsils and are made up of food debris, oral secretions and bacteria, and not very nice bacteria, either. These plugs are far from nice, they can (and do) smell diabolical, and (with a certain amount of practice where you suppress your gag reflex) can be prised out with your finger nail or other suitable (no, not that one) instrument. I am being serious now!!

I have carried out (as a layman) considerable research into this well known affliction, because I am so afflicted. .and have been so for many, many years, as is most likely 90% of the people with halitosis.

Please look up tonsilloliths on the net, and there will be the answer, I believe, to your query.

What do you do about it? Well, having your head cut off is one, which is not advised, even a do-it-yourself job!

Also do not depend on any face covering as it does not disguise the smell! But please, in the interest of those you converse with, do pursue a rigourous dental and oral hygeine, give your tonsils a good poke now and then, and above all, get it seen to. ASAP. I can smell you from here!

[low n' slow]

Do you mean like squeezing the tonsills like you yould squeeze a pimple?
Sounds like it actually could work but I'm hesitant as it would probably make me throw up. I'll looke it up on the web but I've decided to go and see a specialist soon to have them cut out.

/Lns

[modtinbasher]

Yes, exactly like squeezing a pimple! You get used to not throwing up, the only problem is, when you require to make yourself sick, such as if you've eaten something that you wish you hadn't, you have to wave your finger about in the back of your mouth for about 5 minutes before it takes effect!

[Standard Noise]

low n' slow - Trust me, have 'em out mate. I'd been bugged by tonsillitis (and ear infections, both of which required lots of time off) since I was 18. An RAF doctor told me they would 'die off in the next few years'. Well, I'm glad I didn't join the RAF, cos she was well wide of the mark!

For various reasons, it took me until I turned 34 last year to convince a GP that I needed to see a consultant about them. When I told the consultant how I had to have Antibiotics adn two weeks off work about three times a year, he told me that if I wanted rid, I would be put on a waiting list. 5 months later, they came out (into hospital early one Sat morning, general anaesthetic and op done mid afternoon, out next morning and two weeks off to recover). I was told by the surgeon that it would be the most painful thing I've ever felt, well, it was no more painful than a bout of tonsillitis, but lasted for two weeks.

Best thing I ever did, since November last year, I've not had a day off work, no ear infections and not even a 'normal' sore throat. Oh yeah, and I'm sleeping better than I have in years!

Whip 'em out and say goodbye to your relationship with drugs, that's what I say!

[Northern Highflyer]

I had mine removed about this time last year and was off work for 2 weeks. I notified the CAA Medical section who just said I could return to flying when I felt ready, no need to let them know.

They are cut out under general anaesthetic and the wounds are left open, i.e. no stitches or anything. My throat was very sore but I got an infection in the wounds which required a course of antibiotics to clear up. The pain was pretty bad but it was worth it in the end. You are encouraged to eat as normally as possible, and they do recommend TOAST :eek: as it helps keep the throat clean. I struggled due to the infection and was eating very little for a few days. You are given strong painkillers which help a lot.

Just trying to give an honest account of my experience. Try not to let it put you off as you will be glad that you had it done in the end.

[low n' slow]

Sounds really scary I have to say. My throat just cleared up :E
I'll see what happens, if I get another round of throatbother, they are coming out. There should be no problem to have them seen to as it was suggested by my GP a couple of weeks ago during the last round of bothers.

Thanks all for your information. Two weeks is a lot of time for me to take off work, but perhaps I recover a bit quicker as I'm still quite young. I heard that the longer you leave it age wise, the longer time it takes to recover.

/LnS

[LOOPYGIRL]

Go for it,

i had mine out as a teenager , my grandaughter who's only six had hers out 2 weeks ago within 7 days she was great, she had been bugged by this since she was 8 months old , it an infection it drains the bodys defenses, the drugs you take, the body fights them too. think being a older your be off work 2wks max .

since i was 16 i have never had a problem since , just the normal tender cold cough sore through nothing major

[gingernut]

The white bits are dead white blood cells which have done their job of killing infection.

Questions you should perhaps be asking your GP should include the safety and effectiveness of the procedure.

At one time, this operation was commonplace, but is now being performed less and less, as the evidence suggests that it is somewhat innefective.

True tonsillitis is indeed a pain, and can make you feel pretty rotten, but it is usually self limiting, and patients make a full recovery. Weigh this up against the risks of a surgical procedure, which may not actually help your condition.

Are you looking after your health generally?

[Mac the Knife]

Tonsillectomy was widely performed in the past, often for no very good reason.

Generally, these days it is only performed for chronic, recurrent tonsillitis which has responded poorly to medical/conservative treatment. For this indication, it is very effective.

To insist that patients struggle on through recurrent episodes of tonsillitis on principle is unkind.

An otorhinolaryngologist/ENT (despite his/her perceived bias) might be better able to advise you on the safety and effectiveness of the procedure.

[tart1]

This may not be relevant to you at all ... but just a contribution.

I had my tonsils out at the age of 9 (in 1967) when 9 was considered fairly elderly for this op. Predictably, I got an infection and was very ill for several weeks.

Once I was over the infection, I was extremely well. After years of being a fragile child, prone to many bouts of tonsillitis and other infections, I was blooming with health. After years of not eating much and being thin and frail, I suddenly began eating like a horse.

I would say that the op was a total success except that I have been prone to throat infections all my adult life and I developed late-onset asthma after having pneumonia in 1989. Who knows what the effect of having my tonsils out was. Maybe it has made me healthier ... maybe not.

It certainly appeared to have a good effect on me during my teenage years, but since then - I am not sure. I do know that the operation is painful and and can take quite a while to get over.

My 18 year-old son has had similar problems and our doctor decided it was best to leave well alone. Only time will tell whether this is the correct approach with him.

[gingernut]

The effectiveness of, tonsillectomy, even for chronic recurrent tonsillitis is questionable.

You have a choice, take the advice of an "expert," who may give you his opinion based on his experience- (which is sometimes very valid), or take the advice of a clinician who prefers to follow the evidence.

Such a clinician should be seeking out the results of unbiassed, robust, scientific trials, or the results of several of these trials , (The Cochrane database is a good starting point.)

Be careful you don't get a blinkered approach.

[low n' slow]

But I mean for the last 5 or so years I've had antibiotics, probably about 5 times a year or so, due to throatinfections. What can happen if I take them out? Can something get worse or is it just a risk that nothing will get better?
I can never have more than two days in a row without literally having a pain in the neck (throat). Whatever I do, I'm constantly reminded that my tonsils hurt and it drains me of energy. Even though I might not have a fever my tonsils still feel hot and clammy. This I think leaves a tonsillectomy as the last way out.

[tui doll]

After years of suffering the same problems and taking loads of time off work, I finally had the operation at the age of 32.

The post op pain was fairly severe and I can only describe this as 'having razor blades down your throat'. However, this only lasted for about a week and then it was 'uncomfortable' for another two.

It was the best thing I ever did and only suffer the odd mild sore throat feeling, which throat pastilles relieve it.

[Mac the Knife]

You have a choice, take the advice of an "expert," who may give you his opinion based on his experience- (which is sometimes very valid), or take the advice of a clinician who prefers to follow the evidence.
Such a clinician should be seeking out the results of unbiassed, robust, scientific trials, or the results of several of these trials...

Putting "expert" in inverted commas implies that the otorhinolaryngologist is not an expert. Presumably this means either that his training is questionable or that his inherent bias nullifies his expertise (he/she is intrinsically unable or unwilling to follow the evidence). This is confusing! If an "expert" is not an expert, or his experience is only valid some of the time (and you can't tell when) then who do we turn to?

You can get a personal opinion based on the experience of a specialist or you can get a general statistical analysis of your case based on the results of clinical trials.

Statistics are excellent for determining public health policy, but less good at determining individual patient treatment.

This is what sometimes makes clinical decisions difficult. Just because "the majority of patients showed no clinical benefit" (and this could be 51% or 99%) does not mean that one particular patient may not benefit. This is where experience and clinical judgement come in to play (if they're allowed to).

Here - http://www.clevelandclinicmeded.com/ccjm/aug2003/tonsill.htm - is a very reasonable analysis.

"Be careful you don't get a blinkered approach." - this good advice cuts both ways.

[low n' slow]

The following passage is what applies to me:

"The indications for tonsillectomy may be based on the presence and severity of one or more of these symptoms. Such patients would be considered "candidates" for tonsillectomy because the symptoms affect quality of life but are not life-threatening."

Thankyou MTK for that interesting link. Lets not get into an argument on who to trust on wether to have this surgery. The input that I get from this thread is only input (valid as it may be) but I would never base a descision, to have my tonsills out, on a thread in a pilotsforum :ugh: That I'll decide upon in agreement with my GP...

/LnS

[gingernut]

low "n" slow, unfortunately you have been caught up in an argument between two posters, one of which seems to believe that medicine is an art, the other, that it is a science.

Your original question was "did it cure your problems?"

The beauty of this forum, is that you can gain some insight into actual patient experience, and it would appear from the answers of posters who have undergone the procedure, that tonsillectomy has indeed helped them. (Although we will never know if these patients would have got better anyway.)

I guess the underlying issue for you, is, is it worth me undergoing the inconvenience of surgery (and the risks it carries), for the benefits I may expect.

It would appear that the evidence is scant in this area.

From the article presented by my learned surgical colleague, some "experts," would suggest that having 3 episodes of tonsillitis in a year warrants consideration of the procedure. Other , more robust, articles may beg to differ.

I have to go now, my lnuch hour is over, and I'm going to be busy trying to keep patients away from hospitals.:)

[Standard Noise]

(Although we will never know if these patients would have got better anyway.)
I guess the underlying issue for you, is, is it worth me undergoing the inconvenience of surgery (and the risks it carries), for the benefits I may expect.
It would appear that the evidence is scant in this area.

But then again, gingernut, I wasn't willing to wait another 16 years to try your theory out and I doubt very much whether anyone who has recurring bouts of tonsillitis as an adult would wait 32 years just to find out if you are right.

As for the idea of whether it's worth the 'inconvenience of surgery', well, I can only speak from experience and my good experience says that it is worth it, the benefits have far exceeded any so called 'risk'. The evidence may be 'scant', but it doesn't mean it isn't there.

[gingernut]

I think that's fair enough comment, and although primarily a large part of my job is to inform patients of the facts, based upon the evidence, I acknowledge that patient choice plays a large part in the decision to refer.

And it has to be said, that if I had suffered as low and slow has, I would perhaps be exploring other options.

Having said that, performing surgery is not always the kindest option.

[Mac the Knife]

To buttress his contention that the procedure is almost never necessary gingernut quotes Bhattacharyya selectively, so it's worth reading the whole paragraph instead of just his choice.

"As a rough rule of thumb, adults who have three or more episodes of infectious tonsillitis per year with severe symptoms should be seriously considered for tonsillectomy, and those who have more than four or five episodes per year should definitely be considered. A pattern of such infections year after year makes an even stronger case for the surgery.

The number of infections per year should not be the only guide, however: the decision should also focus on the severity of the symptoms. For example, patients who have only two or three infectious exacerbations per year but for whom each infection causes a full week of missed school or work should also be considered."

Theoretically gingernut is right. Eventually, after repeated infections and possibly a quinsy or two, the tonsils will scar up and episodes will become milder and fewer. The question is, how much discomfort and time off is the patient prepared to put up with in order to support gingernut's principles.

Lots of life's minor (and they may not feel so minor at the time) ills will get better on their own, without either medicine or surgery. Analgesics aren't strictly necessary for aches and pains that will resolve in time. Your child with otitis media will get better without antibiotics (though he'll stop crying a blessed 24 hours sooner with). Your wife's menopausal symptoms will eventually regress without HRT. Even a good-going boil will eventually burst with hot fomentations - neither antibiotics nor incision & drainage are REALLY needed.

Given that patient are more likely to receive a lecture than relief in gingernut's hospitals, it would indeed seem like a good idea to keep away!

Do I believe medicine to be an art? Yes indeed! Do I believe it to be science? Most emphatically! Do I believe in research and statistics? No one who hears the story of how John Snow took the handle off the Broad Street pump could fail to be inspired.

My colleague is an ideologue of the first water, a perfect apparatchik. I wish you joy of him.

For myself, I choose the unfashionable words of Hippocrates,

"To cure sometimes, to relieve often, to comfort always."

[gingernut]

Well Mac, it's difficult to add to that.

and those who have more than four or five episodes per year should definitely be considered what exactly does that mean ?


I guess that we could argue about the merits of critical appraisal all day.

I must say, I do feel a little bruised at the suggestion that the quality of care I give to my patients is poor.

I would like to think that the opposite is true, and this has certainly been reflected in the objective measures in place to ensure this. (Although sometimes difficult to measure in primary care.)

For the record, I don't work in hospital, but I am involved with commissioning their services, so it is essential, not only from a clinical view point, that I have a grasp on what is effective, and what is innefective.

From my own personal experience, I find that most of my secondary care colleagues do realise the benefits of working with us in primary care, to thrash out effective, evidence based care pathways, referral guidelines etc, but unfortunately the occasional dinosaur does exist- thankfully most of these have left the NHS or are close to retiring.

I have heard the story of the water pump, but I'm not sure what an appartchick is.

I note from your profile/history that you live a long way from the UK, but I'd be more than happy for you to visit my practice to gain a further insight into the workings of primary care in the UK. I think you'll find that things have moved on a bit.


Cheers and good health:)