Safe Surgeries Not Without Risk

Not only am I a pediatric nurse, but I’m a mother of two girls age 9 and 11. I tend to worry. Not about the little every day illness and injuries– like say my daughter’s broken arm that I didn’t have evaluated for 24 hours. Hey, it wasn’t deformed and she had good blood flow. Perfectly okay to see if rest and Ibuprofen made a difference.

What I do worry about is those zebras in the forest. This phrase is typically used for those diagnoses that happen but are a rare occurrence. Like your child with a nose bleed probably (99.5% of the time) doesn’t have cancer.

But– this is what I worry about out. Every headache is a brain tumor. I probably palpate lymph nodes more than I should which got me into an anxious worry cycle when my youngest was around three-years-old.

I looked at her one day and she has a lymph node bulging from her neck. She was otherwise fine– which was actually more worrisome, because she didn’t have a reason for the lymph node to be so prominent. No ear pain, sore throat, fever, scratch . . . etc.

I took her to her pediatrician and he wasn’t concerned. They did a CBC– which is a blood test that looks at red and white blood cells. It can give an indication of cancer but is generally not considered definitive. Even after the CBC came back normal, my mind wasn’t completely at ease so I scheduled to take her to the ENT. They, too, were nonplussed but could see how worried I was and so the physician says– “I don’t think it will show anything to biopsy this node but I will take it out if it will make you feel better.”

And that’s when my nursing brain kicked in and began to override my mommy brain. I was risking surgery to ease my anxiety. I was going to give her a scar so I could sleep at night when this trained and well-respected physician and given me reassurance. I asked him what would be the most conservative bridge between surgery and easing my worrying and he offered to track it by exam every three months for a year.

Done deal.

Not too long after that we cared for a patient that got an infection after this type of surgery. Post-operative infection is a known complication of ANY surgery and doesn’t imply that there was negligence.

My concern is this– many parents are choosing surgery as first line defense when, perhaps, problems could be managed another way. Doctors are deferring to parents, at times, against their medical gut to cover themselves from potential lawsuits– such as a parent insisting on a CT for head injury. This isn’t always in the best interest of anyone. 

Next post I’ll be analyzing the case of Jahi McMath– who is the girl who suffered a surgical complication that led to brain death. Do I think, from what’s been written about the case, that the hospital could be responsible for her death?

Tonsillectomy: Useful But Not Without Risk

I’ve been fascinated by the case of Jahi McMath, who is the girl who suffered surgical complications after a tonsillectomy and has been left brain dead. I’ll be discussing other aspects of this case next week but I thought I’d invite fellow medical musketeer and ENT physician, Dr. Richard Mabry, by to discuss the risks/benefits of this procedure.

I happily endorsed Richard’s forthcoming novel Critical Condition. It’s a great story and gives insight into that elusive area of the hospital– the OR. I hope you’ll check it out when it’s released in April.

Welcome back, Richard!

Any resident physician in otolaryngology (ear, nose and throat) can tell you that tonsillectomy is not a benign procedure. It’s very useful when indicated, but strict criteria for its consideration have been developed.  These include recurrent documented infections as well as sleep-disordered breathing. Attention to these criteria is important before tonsillectomy is considered.
Prior to the procedure, parents should feel free to ask questions or seek clarification of any points they don’t understand. Most physicians have instruction sheets that are given to help prepare families for the procedure.
The procedure itself is typically short—30 to 60 minutes—after which the child is observed in the recovery room until they are fully awake and stable. The child may be discharged later that day if they’re doing well, but sometimes complications necessitate an overnight stay.
The risk associated with a general anesthetic administered by competent personnel is tiny. Probably equally or more important is the possibility of complications occurring after the procedure. 
Undoubtedly, the number one risk is post-operative bleeding. If the child expectorates clots or large amounts of bright blood, parents should seek medical attention immediately. They are also warned to watch for and report fever, persistent vomiting, or difficulty breathing.
The tonsils receive their blood supply from branches of five different arteries, so bleeding—at surgery and afterward—can be a problem. To deal with this possibility, various methods—primarily application of caustic chemicals, use of ligatures, or various types of cauterization—have been traditionally been used. In recent years, surgical methods other than sharp dissection have become more popular. These include partial tonsillectomy and use of lasers to remove tonsil tissue. Thus far, the perfect solution hasn’t been found.
What are the risks associated with tonsillectomy? According to a recent journal article, the risk of dying from the operation ranges from 1 in 10,000 to 1 in 35,000 cases. Although mortality (i.e., dying) is rare, morbidity (i.e., complications) still occur. The most important, of course, is bleeding after the surgery. In one study, the incidence of bleeding was reported at from 2% to 3% of cases. The two most common times for post-tonsillectomy bleeding to occur are immediately after the surgery and after about a week, when scabs separate.
Does that mean that all parents should shy away from a tonsillectomy for their child? Not at all. It’s a very beneficial procedure when indicated and performed by a competent physician. But it behooves every parent to ask questions, learn what to watch for, and participate in the care of their child while they recover from the surgery.
Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and author of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award. You can follow Richard on his blog, on Twitter, and his Facebook fan page.