Tonsillectomy....some questions?

[Kimflow]

For tonsillectomy???

Any hints on what to make sure to get done.

 

IV antibiotics during surgery? We are currently on Clindamycin. Then to go to Rifampin.

 

Dr. L also said try to do when IVIG on board. I read about 21 days half life. What do I do first? The IVIG is still waiting on insurance approval. It could be 7 more days. I see ENT tomorrow.

 

Or should I just get the tonsillectomy done and let the IVIG clean up. I think the best thing is get IVIG, then tonsillectomy withint 14 days of it.

 

Also, I am going to ask for deep nasal swab culture and sensitivity to rule out MARCoNs????

Should I ask for culture and sensitivity of tonsils too? I would think yes.

 

Finally, I need a simple article to take to ENT as I am not sure he will support tonsillectomy ....I hope to educate him on PANDAS. yes, I know it is not a guarantee that they will never get strep again....but it is reomoving a big reservoir.

 

I did watch the link to the doctor recently posted. maybe I can take that link along fo rhim to peruse on his free time.

 

Thanks Kim

[airial95]

I can't chime in on the IVIG/nasal swab questions, but I can share our experience on the rest.

 

Absolutely INSIST on iv abx during the surgery. Our ENT said years ago it was standard protocol for T&A, but it's not anymore. He had no problem supporting the request because of the PANDAS element, but he said that they don't do it in routine cases.

 

Request a culture/sensitivity of the tonsils as well - in our son's case, it came out negative, which surprised everyone becuase of the dozen or more positive cultures in the previous 21 months.

 

And of course, insist on post op abx. This is where our ENT quasi-failed for us, he would only write a 7 day rx for us, and if the culture came back + he would refill. Fortunately, both Dr. M and our pediatrician agreed that was insane and wrote the extended script.

 

As it relates to preventing future strep infections - unfortunately that has not been the case with us. He was 100% symptom free for 6 weeks (one new tic when we tried to lower the abx dose), and then BAM - positive again after the first of the year. Since Jan he's had 4 positive cultures and one myco infection (currently). Our daughter - who is mild PANDAS and got her T&A 2 weeks after our son (the results were that amazing) also had IV abx, was on cefdinir pre-op for a strep infection, and stayed on the cefdinir for 45 days post-op. She has since tested + 2x, and is currently being treated with full strength abx as a result of her reaction to confirmed exposure (3+ cases in her adjoining class that shares a restroom, and her anxieties have been through the roof!!!)

 

Eventhough we're fighting re-infection all over again - I would do it again in a heartbeat - that 6 weeks of recovery was so important in so many ways!!!