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Open parathyroidectomy brochure nebsc

Dr. Mark Sywak FRACS
Dr. Mark Sywak FRACS
Suite 1, Level 2, 27 Belgrave Street Dr. Mark Sywak FRACS
69 Christie Street, St. Leonards 2065 Open Parathyroidectomy
Wound Care: Your wound will be covered with In addition, if you have been placed on calcium tape, which should be left in place for about 2 supplements, you need to be seen by your local weeks. The tape will be removed at your first doctor on a weekly basis to have a blood test to postoperative visit. You may notice some dried check your calcium level, and to have your cal- blood under the tape but that is of no concern. cium supplements progressively reduced (see You can wash and shower with the tape in place “Calcium Supplements” below). You will also and even get it wet. Once removed or fallen off, need to be reviewed by your endocrinologist 4 to Your patient has been discharged on calcium the tape needs to be replaced and you need to 8 weeks after surgery to monitor your progress. supplements following their thyroid surgery. change it every 2 or 3 days for the next 2 to 3 Your local doctor or endocrinologist may need to months in order to get the best possible cos- see you more frequently for specific review if weekly basis to have their serum calcium metic result. The preferred tape is narrow, flesh level checked and their medication reduced coloured Micropore which can be obtained from Country Patients: If you are unable to return to Sydney for follow-up, it may be possible for the If your patient is just on Caltrate tablets: Activities: You should generally restrict vigorous tape to be changed and for your follow-up to be activities for 1 to 2 weeks after surgery. Activi- undertaken by your local doctor. We would need ties which involve turning the head suddenly, to confirm these arrangements before you leave If calcium is normal at one week reduce to: such as driving in heavy traffic, should be avoided for 5-7 days post surgery, although local Calcium Supplements: The calcium level falls to If calcium is normal the next week reduce to: driving is acceptable. Commonsense is the best normal very quickly after successful parathyroid surgery. Sometimes this fall is associated with Local symptoms: A variety of local symptoms symptoms such as tingling around the mouth and are common for several weeks after surgery in- in the hands and, very occasionally, cramping If your patient is on Caltrate + Rocaltrol: cluding tightness and swelling of the local area (“tetany”) of the hands and feet. A temporary around the wound. Numbness of the skin above drop in calcium levels below normal also some- 2 Caltrate twice a day + 2 Rocaltrol twice a the wound may be present and may last for times occurs. The calcium level is checked in hos- pital and if it is normal, you will generally not need If calcium is normal at one week reduce to: calcium supplements. If the calcium level is low, 1 Caltrate twice a day + 1 Rocaltrol twice a Late Complications: The only delayed complica- you will be sent home on calcium supplements. tion of concern is wound infection. This may You will then need to see your local doctor every If calcium is normal the next week reduce to: have occurred if the wound becomes very red, week after discharge to have a blood test and to 1 Caltrate daily + 1 Rocaltrol daily hot and more swollen. If that occurs you must have the calcium levels checked. If, at each visit, If calcium is normal the next week reduce to: seek attention from your local doctor straight the calcium level in the blood is normal, then the away who will arrange for you to have antibiot- dose needs to be reduced according to the proto- col below. Please give this protocol to your local Follow-up: Generally your follow-up will be: DOCTOR, IF YOU HAVE
If you have any problems, following your thyroid ANY QUESTIONS OR CONCERNS
1 A visit at 2 to 4 weeks after surgery to have PLEASE CONTACT MARK SYWAK
the tape removed and pathology discussed. surgery, please contact Dr. Sywak or your local AS LISTED ON THE OVER LEAF
You will need to ring the office to make an 2 A second follow-up consult at 3 months. Dr. Mark Sywak FRACS

Source: http://www.sydneyendocrinesurgery.com.au/wp-content/uploads/2011/12/OPEN-PARATHYROIDECTOMY-BROCHURE-NEBSC.pdf

Methylprednisolone, valacyclovir, or the combination for vestibular neuritis

The new england journal of medicineor the Combination for Vestibular NeuritisMichael Strupp, M.D., Vera Carina Zingler, M.D., Viktor Arbusow, M.D., Daniel Niklas, Klaus Peter Maag, M.D., Ph.D., Marianne Dieterich, M.D., Sandra Bense, M.D., Diethilde Theil, D.V.M., Klaus Jahn, M.D., b a c k g r o u n d Vestibular neuritis is the second most common cause of peripheral vestibular vertigo.

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