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Author: admin | 04.05.2014 | Category: Tinnitus Causes And Treatments

The large majority of people would prefer to die in their own homes, but in modern America, the majority of people die in the hospital, usually with multiple invasive tubes and iv lines inserted into their bodies.
So, people who would have rather died peacefully in their own beds end up being transported to the hospital, kept in the ICU for 2 weeks, had breathing and feeding tubes placed, and then die in the hospital after racking up 6 figures in pointless medical bills. If you would want to have everything done to keep you alive in that situation, you have every right to that treatment!  But most people with a terminal illness (meaning that your doctor believes you have a non-curable disease and likely will die within 6 months) do not want heroic efforts to keep them alive.  Most people in that situation are much more concerned with staying comfortable and being able to appreciate their last few months, weeks, and days with their loved ones. I am fortunate to be in a specialty without very many terminally ill patients, but I do see some patients with head and neck cancers who cannot be cured with surgery, radiation, or chemotherapy.  For these unfortunate patients, I strongly urge them to think about Hospice. The surgery involves removal of the two tonsils which are visible in the back of your mouth as well as the adenoids, which live in the back of your nose behind the soft palate (roof of your mouth).
Very large tonsils and adenoids can cause narrowing of the airway which can cause breathing problems while asleep. After the patient is asleep under anesthesia, the surgery is all done through the mouth with no skin incisions. After removal of the adenoids, nasal congestion, bad breath, and neck stiffness are all common complaints during the healing period.
Some patients will be sick to their stomach during the first 24 hours after surgery, usually because of lingering anesthesia effects. It is very important that patients strictly follow a soft and liquid diet for a full 2 weeks after surgery. Patients should avoid any running, heavy lifting over 10 pounds, or strenuous play for 2 weeks after surgery. If you look in your mouth or your child’s mouth during the healing period, you will see white or yellow patches where the tonsils were removed. I like to see patients back in the office 2-3 weeks after surgery to make sure things have healed properly. Acid reflux occurs when stomach acid backs up into the esophagus and throat rather than moving forward into the intestines as it should. Classic symptoms of acid reflux are heartburn, bloating, stomach pain, burping, and bad acid taste in the mouth.
If the stomach acid backs up into the esophagus and stops there, patients typically experience heartburn.
The most common symptom associated with LPR is a sensation of something caught in the throat, or a lump in the throat. Other very common symptoms of LPR are hoarse voice, difficulty swallowing (usually worst with pills or large bites of food), frequent throat clearing, cough, lots of phlegm in the throat, and post-nasal drip sensation. Smokers and people with nasal allergies can also have similar throat symptoms and may also have LPR at the same time.
LPR is diagnosed by a patient history consistent with the above symptoms (though not all patients have all symptoms). The good news is that while LPR is annoying and unpleasant, it is not a serious or life-threatening issue. The first recommendation I make for patients with LPR is to adjust their diet to foods that are less likely to cause acid reflux (click here for more details).
Overweight or obese patients should lose weight because excess weight around the stomach makes reflux more likely. Finally, I will prescribe a anti-reflux medication such as prilosec, nexium, protonix, dexilant, or other similar drugs.

For certain patients with reflux that does not improve with the above treatments, I will refer them to a gastroenterologist for further evaluation. You can also use hydrogen peroxide (I recommend mixing half and half with water) or a variety of over the counter wax softening products. I'm an ear, nose, and throat doctor serving the South Austin metro area including Kyle, San Marcos, Buda, and Lockhart. Evans Leave a Comment Today’s post is a bit more morbid than my usual topics, but I think it’s something that is very important to think about for everyone, no matter how young or how healthy you might be. Evans Leave a Comment Tonsillectomy and adenoidectomy (T+A) is one of the most common surgeries performed in the United States each year. In teenagers and adults, frequently the adenoids do not need to be removed because they have already shrunken away completely. Chronic tonsillitis is an infection which does not completely go away after at least 3 months despite antibiotics. I use an electric knife which is able to cut tissue and cauterize bleeding at the same time to remove the tonsils. The risk of serious or life threatening problems is extraordinarily rare (as in “struck by lightning twice” rare) and would usually be caused by bad reactions to anesthesia.
Also patients will occasionally notice that liquids go backwards into the back of their nose while swallowing during the first few days after surgery.
The average patient will have 1 week of a miserable sore throat after surgery and then a second week of slowly improving sore throat. If you continue to have significant nausea or vomiting more than 24 hours after surgery, it might be a side effect of your pain medication.
Soft diet means that you can only eat things that you don’t have to chew up before swallowing.
Evans Leave a Comment Laryngopharyngeal reflux (LPR) is a very common problem which affects the throat. If the acid backs all the way into the throat, many patients will not have heartburn but rather common throat symptoms associated with LPR. These symptoms are frequently worst in the early mornings after patients have been lying flat all night. In addition, I will perform an endoscopic exam where I pass a small camera through the patient’s nose to see the back of the throat and the voice box (larynx). Many patients have a sensation of a lump in their throat because of the acid reflux, and they are worried about the possibility of a tumor. Some kits will provide irrigating bulbs to flush out the wax- this works well for a lot of people but be careful to not flush too forcefully. I can usually get the ears cleaned completely in one visit but in certain difficult cases with lots of thick wax packed onto the ear drum, I will usually have you use baby oil drops at bedtime for 2 weeks and then come back.
If this is you, I recommend starting baby oil or other wax softening drops 2 weeks before your appointment. For the adenoids, I usually use a device to burn the tissue away (rarely I need to actually cut the tissue out).
The anesthesiologists I work with are very experienced with these surgeries and with patients of all ages.
This would include jello, pudding, mashed potatoes, scrambled eggs, ice cream, popsicles, etc.

When lying flat, it is easier for stomach liquid to reflux back up the esophagus into the throat. There are several classic abnormalities I can see during the endoscopic exam which are associated with reflux. It is partially composed of an oily substance which is made by glands in the skin of your ear canal.
Some people make very large amounts of wax or very thick wax which can block up the ears and cause problems hearing or infection. Q-tips are especially bad because they can cause part of the wax to be packed down onto the ear drum.
These are very inexpensive and you can use a dropper to put several drops in each ear at bedtime.
Many times, patients are able to go home safely the same day as their surgery, but in certain cases they may need to stay overnight in the hospital for monitoring.
There are other less common reasons including tonsillar or peritonsillar abscess, recurrent tonsil stones, asymmetric size of the tonsils with suspicion of a tumor.
The best way to minimize risk of bleeding is to strictly stay on the correct diet and activity restrictions (see below).
You cannot eat hamburgers, chips, fries, chicken tenders, pizza, cereal, or anything else solid that requires chewing. Adult patients can return to work when they want, but must avoid strenuous activity for 2 weeks and must stay on the proper diet.
If there is not enough improvement after 3-4 weeks, the medication can be increased to twice daily.
The other major component of ear wax is dead skin layers which have been sloughed off from inside the ear. New patients coming to see me for ear wax cleaning can get this process started early to make things easier.
Snoring alone without evidence of true sleep apnea is generally not a reason to need T+A surgery.
I prescribe plenty of liquid pain medication for patients after this surgery, so don’t be afraid to take it. I would strongly urge any adult patients to have stopped taking prescription pain medication for at least 24 hours before returning to work.
In uncertain cases, a sleep study can be very useful to determine who does and does not need surgery or other treatment.
If true bleeding occurs, go to the nearest emergency room right away so that the problem can be addressed. I also prescribe one week of liquid antibiotic to take after surgery (amoxicillin unless the patient is allergic). Getting dehydrated will start a vicious cycle of worse throat pain, increased risk of bleeding, and more difficulty swallowing.

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