During my first flare-up, I did research into a potential link between tonsils and psoriasis. Later, while reading one of many books (The Keystone Approach) I was reminded of this:
Having read multiple explanations online, I broke the science down to get my head around it:
Streptococcal infections are caused in the throat tissue/tonsils by a type of bacteria (known as Streptococcus).
The tonsils are part of the immune system: they contain immune cells known as T cells which are supposed to only attack foreign cells- such as bacteria.
Psoriasis is an autoimmune condition: this means that it’s caused by an immune response (i.e. producing T cells) that attacks healthy cells.
Guttate psoriasis is triggered by the immune response to Streptococcus.
Strep infection -> immune response (producing T cells) -> these T cells attack healthy cells -> guttate psoriasis.
It’s therefore suggested that, if the tonsils are removed, there will be less T cells causing the self-damage that brings about psoriasis.
Although several websites do say that the tonsils play an important part of the immune system, the NHS says as you get older, the tonsils become less important in fighting germs and usually shrink. Your body can still fight germs without them.
Multiple scientific/medical journals backed this up, as did a doctor I spoke to during a virtual GP appointment in addition to the dermatologist I saw for my light therapy re-referral (she described a tonsillectomy in my situation as "not unsensible").
Tonsillectomies through the NHS are only for patients experiencing repeated tonsillitis. In other words, I needed to find a private provider. The procedure takes about 30 minutes and is done under general anaesthetic. Recovery time is around two weeks.
Given that a sore throat led to both of my psoriasis flare-ups, it all seems to point to the above. The specific form- guttate- is associated with streptococcal infections. In addition, I can safely discount all the other major potential triggers including stress, certain operations (e.g. hip replacement).
In relation to the second flare-up, it’s not like my diet was bad- just a little more indulgent than usual. I’ve never in my life been intolerant to potatoes, tomatoes, dairy etc. so it just doesn’t make sense that I’d suddenly become ‘allergic’ to them.
I will have no doubt spent hundreds of pounds on
psoriasis-related “remedies” by now. I drink horrible drinks, limit my diet to
a potentially pointless extent and undergo time-consuming moisturising
routines.
With this in mind, I arranged a consultation with Practice Plus Group down at their Bristol clinic. I was told that a tonsillectomy could be performed, but the anaesthetist would only be willing to do so once all my psoriasis was gone.
This wasn't the response I was expecting. Let's take this opportunity to take a look at some potential streptococcus-reducing methods:
Regular warm water gargles
Peroxide-based mouthwash
S.salivarius K12 oral probiotic lozenges
Natural antimicrobials: Lactoferrin | Allicin | Berberine
Fortunately, my light therapy then started. During this time, I read another book in which the sore throat/psoriasis link is directly addressed, further fuelling my motivation to get my tonsils out:
Day
1 (18/11)
I was told to arrive at the hospital for 7:30am. Though an early start, I was glad to have it out of the way and this also made the nil-by-mouth period easier (no food 7 hours prior) since I was asleep for most of it. After changing into patient wear, the anaesthetist followed by the surgeon came to confirm my details and speak to me about the procedure.
It was done by 10:30am: the last thing I remember was lying on the hospital table discussing which part of Yorkshire contains Huddersfield before waking up in recovery. Two nurses then wheeled my bed down to my room.
After a couple of hours, I could drink water- shortly followed by a tub of ice cream and then a cheese omelette. Visiting time then started, and my dad was able to stay with me throughout the rest of the afternoon and teatime (a tuna and sweetcorn sandwich as well as a raspberry yoghurt) until 10pm.
My
pain level out of 10 only reached 2-3 all day and the nurses were surprised at
how much I was using my voice- probably because of the lasting effect of the
anaesthetic. I stayed overnight on account of home being so far away and was
advised to sleep in a half-sitting position: since I’m a side sleeper, this
took some adjusting to.
Day
2 (19/11)
My blood pressure was being taken regularly…not the 6am wake-up call I was hoping for. My medication consisted of:
Amoxicillin (3 times a day)- an antibiotic
Co-codamol (4 times a day)- a painkiller containing paracetamol
and codeine
Ibuprofen (4 times a day)- an anti-inflammatory painkiller
Difflam oral rinse (2-3 times a day)- an
anti-inflammatory mouthwash
I had porridge and toast for breakfast, after which I was discharged. I had a service station sandwich on the way home, and chicken in a creamy mushroom sauce with noodles for tea.
My pain level didn’t exceed 4 out of 10, but I installed a text-to-speech app on my phone to do my talking.
In my post-op information pack, it warned against hot bathing, instead suggesting a lukewarm shower. I opted to do so every other day but went back to daily after experiencing an outbreak of seborrheic dermatitis.
Day
3 and 4 (20-21/11)
These days were manageable, though the pain level was increasing to 5/6. I had both toast and cornflakes for breakfast, soup for lunch and salmon risotto for tea. Taking painkillers around half an hour before food made eating a lot more bearable. It’s recommended to stay indoors 3-4 days after the surgery, but I had no intention of leaving the house anytime soon.
Pain-relieving activities include:
Applying cold compresses
Chewing gum (and crushed ice)
Drinking lots of water (2-3 litres a day)
Gargling with warm salt water
Having boiled sweets/lozenges
Sucking an ice lolly prior to eating
Using difflam spray/mouthwash
Day
5 (22/11)
Every morning I had been waking up around 6am due to discomfort. This wasn’t ideal as it was too early to start taking painkillers (I wanted to be able to spread them out during the day). I returned to just toast for breakfast: the pain level was rising to a high 8. I had a shiitake mushroom omelette for lunch and teriyaki chicken with pasta for tea.
To pass the time, I watched several TV series that had been sitting in my bookmarks, read, played my Switch, started Christmas shopping(!) and listed games etc. on Vinted. There was one small patch of psoriasis that the light therapy didn't reach: I took the below picture to see if it would disappear quicker post-tonsillectomy:
Day
6 (23/11)
This
was the worst day in terms of pain: an overwhelming 10. It drove me to tears. I
managed some porridge for breakfast, but swallowing was a horrendous experience.
My teeth ached, my jaw ached and my tongue ached when moving it around my mouth.
The tiredness- a mix of poor sleep and co-codamol-induced drowsiness- was
getting to me.
I was only able to tolerate one slice of cheese on toast for lunch. I was short-tempered and spent a lot of the day in my room.
Any reliable source advises to eat/drink ‘as normally as possible as soon as you can’ as stated in numerous NHS tonsillectomy info documents. This is because chewing/swallowinghelps healing by using the throat muscles. Coarse foods including cornflakes and toast are highly endorsed, but anything acidic, hot, spicy and/or effervescent should be avoided.
I
just about endured a portion of shepherd’s pie for tea. Later in the evening, the
pain subsided a bit.
Day
7 (24/11)
Thankfully, the pain level dropped to around 7. It’s always worse first thing in the morning, and swallowing still felt like an absolute chore. I had porridge for breakfast, avocado with eggs on toast for lunch and casserole for tea.
In
terms of snacking, well…I basically didn’t. However, after meals I would have watermelon,
yoghurt, ice cream, sorbet and Kit-Kats.
Day 8 (25/11)
Another drop in the pain level, down to 5, if not 4. I had two hearty meals of Bolognese and salmon.
Day 9, 10 and 11 (26-28/11)
I only experienced a pain level of 3 as soon as I woke up, which wore off after an hour or so. I started taking my supplements on Day 9, drank my first kombucha on Day 10 and went back to work (and had my first bag of crisps) on Day 11. Teas over these 3 days were butter chicken, scampi and a meatball pasta bake. Swallowing still felt unusual- but not painful.
Day 12, 13 and 14 (29/11-1/12)
By this point, there was no longer any sort of quantifiable pain. I felt well enough to return to Manchester on Day 12, where I went back to sleeping on my side. I took part in a badminton tournament on Day 13: other than not raising my voice and needing a drink more often, this went down fine. However, I did take it easy on Day 14!
I read that small threads are placed in the throat to prevent bleeding during the operation and that they fall out after 2 weeks. However, I didn't experience this, nor did I come up against the common side effects of ear ache and bad breath. I did have white areas where my tonsils used to be for a while, though.
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