My #1 rule for postop patients: Treat recovery like a process, not an event.
This is one of the most frequent questions that I get about parathyroid surgery, and also one of the hardest to answer.
The symptoms of parathyroid disease – including fatigue, bone pain, insomnia, headaches, depression, heartburn, and so on – tend to improve in the weeks and months following a parathyroid operation. But this is not always a linear process, and it will be different for every patient. One patient may notice immediate improvement in bone pain after her operation, but still have weakness and depression months later. Another may feel his energy level improve in the first weeks, and then gradually notice his insomnia and headaches resolving months later.
When asked “When will I feel better?” I usually answer with generalizations and averages: “On average, most people notice improvements in the weeks following surgery. Bone pain generally resolves quickly, while other symptoms generally take weeks or months to show improvement.” This is all true, but somewhat unsatisfying for the patient and for me.
It is time to reframe the question. Underlying the question, “When am I going to feel better?” is often an assumption that health is dichotomous: health vs. sickness. I'm either healthy or I'm not. And when you are “cured” of a disease, you are removing the sickness label from yourself, and reapplying the healthy label. In the case of parathyroid disease, patients are cured of parathyroid disease within minutes of having a diseased parathyroid gland removed. Once they are cured, jumping from being “sick” to being “healthy,” patients expect to feel better, if not immediately then very soon after.
But then some symptoms persist, disheartening patients and their doctors alike. One patient may still have trouble sleeping, another has ongoing bone pain, and another is still tired. Lab tests may not be helpful. Even when blood tests come back entirely normal after parathyroid surgery, symptoms can last. Calcium levels may normalize long before the symptoms resolve.
Instead of thinking of discrete categories of “sickness” and “health,” we are better off thinking of health and illness on a continuum. No one is perfectly healthy and no one is perfectly ill. In any given year, or any given day, we are somewhere along this health continuum.
None of us are perfectly healthy or perfectly ill. We are all somewhere in between.
It is possible to have sudden large jumps along the continuum. For example, imagine a runner being struck by a car. He would go from the healthier end of the continuum to the illness end fairly rapidly, and then would slowly return to the healthier end during his recovery. But these large shifts are uncommon, and fast shifts to the healthier end almost never occur. You don’t move from severe illness to perfect health in an afternoon. More often, we have small daily changes that can add up to major shifts over time.
Parathyroid surgery is an event that you can mark on your calendar. Recovery from parathyroid surgery is not. Recovery is a process that starts with an operation and may continue to develop for months or years after that. It is a journey, during which you move yourself from the sickness end of the health continuum and toward the healthier end. Some of this occurs naturally as your body recovers and heals, and some of it depends on your active engagement with your health.
Parathyroid disease often leads to fatigue, low energy, and a lack of enjoyment in life. A natural response to this is often to pull back from your regular routines and fall into unhealthy habits such as eating poorly, becoming less active, and withdrawing from friends and community. These lifestyle changes, instigated by parathyroid disease, can themselves have profound effects on your wellbeing. Parathyroid surgery can fix the original biochemical derangement, but will not itself restart a healthy lifestyle.
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Give yourself time to recover from your operation, and then gradually resume the activities that promote health. Cook a plant-based dinner, go for a walk, or call up an old friend. Over time, each of these activities will add up to a healthier lifestyle and greater wellbeing. Remember: recovery is a process, not an event.
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