Recovering from Pituitary Surgery
Recovery from pituitary surgery takes place in two phases: recovery in the hospital and recovery at home after leaving the hospital.
In the first hours and days after surgery, the nurses will pay close attention to any changes in vision; how much fluids are taken in and urine produced; and any discharge from the nose. Patients may be asked to help keep accurate records of the fluids they drink and the amount of urine they void.
As soon as the patient has recovered from the anesthesia, he or she will be encouraged to be active. This will happen in stages. The patient first will sit in a chair and then walk. The patient will be given a device called an incentive spirometer. This is used to help clear the lungs and prevent pneumonia. During the operation and until the patient is up out of bed, the patient's legs will be wrapped in sequential compression boots. These help prevent blood clots in the legs.
To help contain any drainage from the nose and back of the throat, a dressing (a snuffer dressing) may be taped over the front of the patient's nose. This is only used until the patient is able to handle any secretions with a tissue as needed. The patient must not try to blow his or her nose for a few weeks after surgery. This allows the site where the surgery was done to heal. Often patients will feel nauseated for the first day after surgery. This can occur because blood from the surgery drips down the throat and into the stomach. Anti-nausea medications are given as needed.
Patients may begin drinking liquids once they have recovered from the anesthesia. If there are no problems handling liquids, the patient may begin eating again. Sometimes patients prefer softer foods for the first few days. The incision under the upper lip inside the mouth may be sore at first. People who wear dentures may choose not to wear them until this area has healed. The stitches that join the edge of the incision dissolve over time as the wound heals. They don't need to be removed by a doctor.
Most patients have some headache or discomfort for a few days after surgery. While in the hospital pain medicine like Tylenol with codeine, morphine or Vicodin may be ordered by the doctor. Once the patient goes home, regular Tylenol will be enough to take care of any discomfort.
Patients will be given a salt solution to spray into each nostril four times a day for two to three weeks. This keeps the lining of the nose moist and prevents bleeding and cracking. This helps the wound to heal as well.
After surgery, patients can begin taking their regular medications. Usually patients will be given a hydrocortisone (Cortef), which is a steroid hormone. This is intended to replace the corisol that is usually produced in the adrenal glad but may be lacking after surgery.
Unless the patient's doctor has determined that he or she lacks this hormone, the patient will be weaned off the steroid during the week after surgery.
Most patients stay in the hospital only one to two days after surgery. It is important for patients to drink fluids as they feel thirsty. Drinking less won't prevent or control diabetes insipidus and may contribute to dehydration. Patients may be asked to monitor their urine output at home for a few days after leaving the hospital.
Patients are also taught to watch for the signs of a clear, watery drainage from the nose (a cerebrospinal fluid leak). There may be a salty taste in the mouth or a feeling of fluid draining in the back of the throat. If the patient isn't sure, he or she should call and report the symptoms. The condition could lead to an infection around the brain (meningitis) if left untreated.
Once getting back home, a patient should avoid lifting anything heavier than 10 to 15 pounds for one month after surgery. Patients should not blow their noses or pick at any crusting that might develop. They should avoid straining.
If a patient has been put on Cortef, he or she should continue to take it until being weaned off of it. Suddenly stopping it can cause nausea, headache, a general aching feeling or flu-like symptoms, and fatigue. However, patients should call the doctor if they experience any such symptoms as they reduce the amounts of hydrocortisone taken so that the tapering schedule can be adjusted.
Before leaving the hospital patients will be told when to see their doctors for a follow up appointment. Generally, they will see the neurosurgeon two weeks after the surgery and the endocrinologist six weeks after. A magnetic resonance imaging (MRI) scan will usually be done around three months after surgery.