Dr. Mark Sywak FRACS Dr. Mark Sywak FRACS Suite 1, Level 2, 27 Belgrave Street Dr. Mark Sywak FRACS 69 Christie Street, St. Leonards 2065Open 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
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.
Las municipalidades, con el objeto de promover la salud y el desarrollo comunal, pueden implementar nuevas prestaciones de salud, insertas en planes comunales de esa naturaleza, en los casos en que no exista política pública ministerial, en la medida que tales prestaciones sean financiadas directamente por el paciente particular o haciéndose cargo el propio municipio de asumir su costo y no se