Step One: Know When It Is Necessary
I struggled with this for a long time. All throughout my 20s I was running to doctors for emergency steroids to heal my swollen, busted tonsils. I had strep at least three times a year, often resulting in abscessed tonsils that needed immediate lancing (the worst), or massive antibiotics and steroids to stop the infection and bring down the swelling. It was miserable, but as an opera singer, I was afraid of removing tissue from my throat and changing the resonance.
I adopted many holistic approaches to stave off infections. I started putting Organic Apple Cider Vinegar (with 'The Mother') in my water every day. I obsessed over getting vitamins and eating ginger and garlic. I also noticed a link between seasonal allergies and a spike in infection occurrences (always worse in the spring and summer), so I upped my allergy meds. These things did help for a few years, but by 29, I was getting tonsillitis on a monthly basis. I started getting it every few weeks by the time I went to an ENT (Ear, Nose, Throat Doctor) in Manhattan who specialized in Opera Singers. His response? :
"Well, you have two options: one, you go on steroids and antibiotics every two weeks for the rest of your career, and cancel performances regularly. Or two, you get your tonsils out."
So, we set up the surgery date for three weeks later. July 2014 was a really good time (sarcasm).
I had already seen two ENTs before this who had recommended I get them taken out. Don't wait this long. My stubbornness not to mess with my instrument and my vocal technique, as well as being way too constantly busy and refusing to take three weeks off to recover made me dig my heels in. But I could really have benefited from doing this sooner. Nevertheless, my life has changed completely since and ironically, my voice tripled in size after the surgery and soared in places it never had before now that the constant swelling in my throat was gone.
So, before deciding to do this, my tips:
- How often are you getting treated for Strep infections? Many people will have differing opinions on this, but I believe if it is more than 3 times a year, and still occurring well into your adulthood, (20s and up), it is worth discussing it with an ENT.
- Be picky about the surgeon and do your research/ ask around for recommendations. Especially if you are a singer - my ENT had performed the surgery on many singers and was wise about removing enough of the tissue to prevent any infections from happening again, but not taking so much out that it altered my resonance too much. I was able to start singing again about one month after the surgery without feeling too much tightness or discomfort.
- Make sure you have someone who can really help you recover for at least a week after the surgery. I was lucky to have a mother who was willing to come live with me in NYC for a week after and pretty much forcefeed me ice chips and medicine.
- Give yourself 2-3 weeks of NO work to recover. Sleep will be a big part of this process and trust me - speaking will not be much of an option. But if you use that time wisely, and the procedure was done well, you should feel a lot better after the 2nd or 3rd week is done.
Step Two: Surgery Prep and The Big Day
I had my surgery done at Lenox Hill Hospital in Manhattan, and a couple of days beforehand they required that I go get blood tests to make sure there were no infections going on. It can be very dangerous for a tonsillectomy to be performed if there's an infection, so I had actually canceled surgery on them a few years prior because I had a full blown strep infection.
At the time of my surgery week, I had been getting strep infections once a month (as stated earlier) for the few months prior, and I was right on schedule for the next one. And, like clockwork, I was beginning to feel that strange itchy/ scratchy feeling in the back of my throat. I prayed it wouldn't effect the surgery. But after getting my bloodwork done the two days before, the hospital called informing me that my white blood cell count was high (INFECTION), but they were going to go ahead with the surgery anyway because it wasn't high enough to pose any real danger.
However, the stress of prepping for the surgery with work (and anxiety in general), made that infection worsen pretty quickly and the morning of the surgery I was in tears in the back of my parents' car at 6am on the way to the hospital with my right tonsil the size of a golf ball.
The doctor went ahead with the surgery anyway (to my great relief), saying that at this point it was much more important for us to remove them. Again, it was early on in the strep infection, but if you have a more severe case going they most likely will not perform surgery.
So we got to the hospital at about 6:30 in the morning, went through typical check-in steps (questions like DOB, health insurance plan, and so on). Then, I was ushered to a little flimsy private room to change into a hospital gown and cap, and taken to another area of examination recliners where I sat and waited with my Dad for the ENT (surgeon) and Anesthesiologist. After 15 years of frequent illness and resulting voice issues, I was quite nervous and grateful I didn't have to wait alone. At this point, I was prepped for the surgery by the doctors and hooked up to my IV where they would be administering the anesthesia through in a few minutes. I have a vague memory of the Anesthesiologist joking with me about how I had just missed their 'spa special' and would not be getting my nails done during the surgery this time. I appreciated the humor and felt ready to go from there.
The Surgeon talked me through what would happen, and explained that even though I had an infection and my tonsils were already swollen, I didn't have a fever and it was still early enough to safely perform the surgery. In my case, I was experiencing recurring infections once every few weeks over and over, so it was clear that I needed the tissue removed.
He talked to me about what to eat after the surgery and said, simply: "Hydration will be the priority. Calories and proper nutrition will be difficult to obtain at first, and managing the pain will be the first step." Then I said goodbye to my parents and went into the operating room.
Once I came out of the surgery, I felt a miraculous amount of relief. I didn't expect this at all, but since I was still under the effects of the anesthesia, I didn't feel any pain, and could feel immediately that my tonsils were out. My throat no longer hurt from the infection and better yet - there was absolutely NOTHING swelling in my throat. I knew the pain and swelling from the surgery would set in the next day but that first day was actually very comforting to me. The doctor explained that not only did I have tonsillitis, but I also had a panel of infected tissue resting behind one of the tonsils, impossible to fully treat. He had removed that as well, and my adenoids, so I would feel a big change. He had removed all of the necessary tissue, while still leaving enough that my vocal recovery should not be too daunting. I went into the same private room I had before the surgery, sat for a bit with some ice chips and my parents, and after about an hour, tops, we left the hospital.
Step Three: Recovery - Diet, Tools, and Pain Killers
Here is my list of essentials to have prepared for this phase of your tonsillectomy:
- A loved one (for me this was my mother) to be by your side for 2 weeks. My surgery was in Manhattan, and I was living near there at the time, so after the procedure, my mother lived in my apartment for that week. The second week I moved upstate to my parents' house where I worked from home, continued to recover (it was still a doozy at that point) and experimented with getting out of the house on days I felt better. So, 2 weeks is the ideal timeframe to have someone with you to help in your recovery.
- On that note: Be Absolutely Certain you have at least two weeks off of work or school. Three is actually better, but two is essential. You really need to rest and move slowly as one day you'll feel better at times, and the next you will feel worse. It's a roller coaster.
- Buy ice trays molded to form small ice cubes. They should be available at most grocery stores, Walgreens, CVS, Duane Reade and elsewhere, but I will link to an Amazon version below if you want to order them. WHY: During recovery, drinking liquids becomes difficult because of the amount of swelling in the throat. For this reason, getting the proper hydration really has to come in the form of sucking on ice cubes, and normal-sized ice cubes were difficult for me. With ice trays you can freeze water, coconut water, juices, vitamin water, etc, and add nutrients and calories throughout the day.
- Have a blender and stock up on easy fruits and veggies, and other smoothie additions low on acidity. Acidity, too much salt and even too much sugar will make the back of your throat sting and burn as you heal, so stick with the following for smoothies: Bananas, Avocados, Almond Milk, Honey or Dates, Spinach or Iceberg Lettuce, Cucumbers, Whey Protein. Avoid anything with Seeds (Strawberries, Raspberries, etc.) or anything with small particles like oatmeal, because none of that feels okay with the wounds in the back of your throat.
- Buy a months' worth of ice pops. Try not to get the ones with high syrup content because they can really sting your throat. Believe it or not, pedialyte pops were my absolute favorite for recovery.
- Stock up on Coconut Water. It is extra hydrating and soothing, and you need this in your recovery.
- Hunt your grocery store for Ensure Nutrition Shakes. I didn't really love how they tasted, but they have a lot of what you will be missing in the weeks following your surgery for nutrition, and I noticed a difference when I added them to my day.
- Jello and pudding, whipped cream. These things will seem incredible.
- Yogurt with bananas and honey (smash up the bananas. Even chewing hurts and opening your jaw can be painful as well.)
- If you don't have one already, buy a humidifier (linked below) and keep it cleaned and running at all times beside your bed. Keeping hydrated and humidified allowed me to sleep - as soon as my throat felt dry my pain level shot through the roof.
- Ice Packs for your neck. I think my doctor gave me one, or maybe mom Mom found one, but this really helped. I kept this wrapped in cloths, around my neck just under my chin for the first few days.
- Oral throat numbing spray (linked below). The pain killers will help, but it's an added level of comfort I was grateful to have.
- A notebook to chart your meds and your pain. In my case, I was given two pain killer meds: liquid codeine and children's tylenol, and I eventually started to replace codeine with just the liquid tylenol so I could wean off of the narcotic. I was also on a liquid antibiotic, so I had to keep track of all the meds like this. I also recommend you set an alarm on your phone for 15 minutes prior to your next dose of pain killers.
- Every movie you ever wanted to watch. :)
mini ice cubes
Oral Throat Numbing Spray
Step Four: Life After Tonsils
This step was my favorite, because after struggling for years with constant infections, I noticed an immediate improvement in my voice and singing. I had more space to use without having to warm up for over an hour before singing, and I felt a kind of openness in my airways and voice in general that I hadn't felt ever.
I had two follow-up appointments with my ENT: one at the two week mark, and one a couple weeks after that. He noted I was healing quickly, and confirmed I would be able to start singing in another two weeks. He informed me that I would experience some tightness in my throat, but that I should sing past that feeling (unless there was pain), because it was important for the throat to adapt to the new space. I noticed this, but in general my voice felt much freer than ever. I started singing fully about two weeks after that first appointment, and all was fine.
I have experienced throat problems since with the occasional cold or flu, but I have never ever had strep or anything close to it since the surgery. Nothing has ever been more worth the pain! In my case, it improved my sound, resonance, and confidence as a singer. It completely changed my capabilities and strength vocally. If you would like to hear more about my experience, please view my video on Youtube below!
Thanks for reading, and I hope this helps those who are considering having this done or are preparing for it. Good luck!