My Account of Hyperparathyroidism and Parathyroid Surgery Part 3
Choosing the right surgeon to perform parathyroid surgery is very important. The procedure is highly successful when performed by an experienced surgeon.
Dr. Peter Mowshcenson is a surgeon on staff at Beth Israel Deaconess Medical Center in Boston. Thyroid and Parathyroid Surgery are two of his clinical interests, among several others. He has an MD from the University of London Faculty of Medicine. He is also an Assistant Clinical Professor of Surgery at Harvard Medical School.
I was anxious on the day of my appointment with Dr. M. and was a good half hour early. I had a book with me but trying to read while waiting was impossible. The words didn’t make any sense. Much to my surprise, I was called in to see the Dr. after only a few minutes.
I sat down in his leather office chair and was a bundle of nerves. After a brief exchange, he started to go over my forms. Reading what I put for occupation he said, “You’re a writer?”
“Just part time.” I said.
“Aren’t we all?” He chuckled.
He then asked for the name of my primary care Dr. and I told him Dr. Maria Munos. After searching on his computer, he said he couldn’t find her.
“How do you spell it?” he asked.
“M-U-N-O-Z,” I said.
With a twinkle in his eye he playfully said, “You have M-U-N-O-S on your form. “You call yourself at writer?” I found myself laughing with him despite my nerves.
He discussed my test results and the diagnosis of primary hyperparathyroidism. I told him that he operated on my father twice.
“Oh what’s his name?” he asked.
“John Davis.” I said.
“Oh. How’s he doing?” he politely inquired.
“He’s just fine.” I said.
After hundreds of operations, I don’t think Dr. M. remembered my father, however, telling him somehow made me feel better.
After our discussion of my symptoms, test results, and his review of the sestamibi scan, Dr. M. concurred with my endocrinologist’s recommendation for surgery. He did a quick exam of my neck and briefly described the surgery. The operation requires making an incision in the lower neck along the collar line in order to remove the enlarged parathyroid. The incision is usually 3-8 centimeters long.
Dr. M. determined that no further scans or ultrasounds were necessary. The result of the sestamibi scan was enough to proceed. He handed me a four page “note” to help me better understand parathyroid surgery and sent me on my way. I scheduled my surgery for the following month.
The Day of Surgery
Dr. M. expects patients to arrive at least an hour early on the day of the operation. We were nearly two hours early. Yes, in addition to dying on the operating table, I was worried about being caught in traffic heading into Boston before dying on the operating table.
I sat with my husband for just over two hours waiting to be called. I admit, the night before I was in tears thinking about my kids, foolishly fearing that I would die during surgery. I was experiencing high anxiety.
To make the experience more interesting, I had a splitting headache which was probably from caffeine withdrawl, as I couldn’t have any that morning. I was not allowed to take aspirin or anti-inflammatory drugs like Motrin 10 days before the surgery. The drugs can interfere with platelet function and increase the amount of bleeding. Needless to say, I felt horrible.
After waiting just over two hours, a nurse finally called my name. Within minutes I had changed my clothes and crawled into my hospital bed with my head still pounding.
Despite my headache, the BIDMC staff was top-notch, following every pre-surgery procedure with precision. I was interviewed by at least four different medical personnel regarding my surgery, with questions like what medications was I taking, if I had taken any anti-inflammatory drugs, when was the last time I had eaten, and so on.
In accordance with his “note” Dr. M. arrived and marked the incision with a pen. Moments earlier my blood sample was sent for the rapid PTH test in the holding area. I told Dr. M. that I had a splitting headache and asked, “What if I throw up all over the place when I wake up?” To which he replied, “Please don’t.”
Once the anesthesiologist had my IV in place, my husband kissed me, wished me good luck and I was wheeled into the operating room. While I was sound asleep, Dr. M. cleaned the skin with an antiseptic. He used his pen mark as a guide to open the skin, creating flaps above and below the mark to expose the area. He then inspected the area and determined the best approach. He found the enlarged left gland and removed it safely. The gland was a single fragment of tan-pink soft tissue, measuring 0.8 x 0.6 x 0.3 cm and weighing .24 grams.
Once the gland was removed, a second blood sample was taken to determine the PTH level, before sending me to the recovery room. My levels dropped back to normal immediately. Dr. M. was confident that the hyperparathyroidism had been fixed.
Dr. M. closed the incision very neatly with buried stitches, which are stitches that don’t need to be removed. A dressing was placed over the wound and I was taken to the recovery room.
The surgery took about an hour and a half. I was in at 10:55 and out at 12:26. I woke up pretty groggy a little before 1:00. Shortly after waking, I was given 2 - 500 mg tablets of Vicodin. According to the “note” Dr. M. saw me in the recovery room and discussed how everything went, but due to the anethesthia, I didn’t remember that.
I was wheeled to a recovery area where my husband was waiting. The worst part of the recovery was feeling nauseous and exhausted from the anesthesia. The vicodin was very effective, as I didn’t feel much of any incision pain.
Since 1994, BIDMC introduced the same day discharge for patients undergoing parathyroidectomy. It was no surprise that we were discharged as early as 3:30. My instructions were not to take Motrin, ibuprofen or aspirin but I did have a prescription for Vicodin. I was also instructed not to remove the steri-strips, which are the thin paper strips that covered my incision.
The pain from the incision was minimal, the worst being the day of surgery where I would rate it a five on a scale of one to ten. While my voice was fine, some people experience an abnormal (hoarse voice) after the surgery. At times, the enlarged parathyroid gland is very close or attached to the nerve, which controls the voice box or larynx. In order to remove the parathyroid, the nerve has to be gently dissected off the gland, creating the hoarseness. Recovery from this could take a few weeks.
That weekend I took it easy, but remember thinking how well I was feeling. I almost wished for a little more pampering from my family, but I was literally back on my feet the next day.
Two weeks later I saw my endocrinologist, Dr. L. who said my scar looked "pretty". A blood test indicated that the levels of calcuim and PTH were back to normal. I was free to go with no follow up necessary.
Four weeks later I saw Dr. M. It was just a quick visit to examine the incision and see how I was feeling. He also thought I was good to go and that was the last time I was required to see him.
Nearly Two Years Later
My incision was quite noticeable for several months. It looked like I survived a knife fight! Nearly two years later, it has healed quite nicely and I don’t think much about it.
I was lucky that my symptoms weren’t more severe and that my hyperparathyroidism was recognized at an early stage of the disease – from the routine blood work, required for a routine physical.
I was amazed at how quickly my symptoms vanished after my surgery. My insomnia disappeared within days. I was no longer constantly irritable. Overall, I felt like me again.
Thank you Dr. Mowschenson for your expertise, my surgery was smooth sailing from the day I met you in your office. Thank you for providing all of your patients with the “note”. Without its information, I wouldn't have the surgical details referenced throughout this hub.
This concludes my three part series. If you haven't already, check out part 1 to read from the beginning of my experience with hyperparathyroidism. I discuss the symptoms, causes and treatment. In part 2, read about the various tests I needed when hyperparathyroidism was suspected.
Are you are gearing up for parathyroid surgery? I wish you smooth sailing from start to finish and good luck!