SurgeryFilter: how would one remove ones own tonsils in a safe fashion?

July 7, 2005 6:12 PM

SurgeryFilter: Hypothetically, if someone wanted to perform relatively minor surgery on themselves, say a tonsillectomy, how would this someone go about it? Seriously. I want to know equipment, drugs, and procedure. How do you keep things sterile, stop bleeding, etc. Assume the individual in question can override the majority of his reflexes, including gagging, at will.

I'm sorry if this question seems a bit macabre, for the fourth time in as many months I've been afflicted with swollen, pus enamaled tonsils that hurt like you would not belive and are not the result of strep. Nonetheless, this is a hypothetical question, so surgeons and other people with first hand knowledge feel free to contribute.

posted by Grod to Health & Fitness (32 answers total)

um..... hypothetically? He wouldn't. My friend's an ENT resident, and learning how to perform a tonsillectomy is hard enough when you can actually see what you're doing on a patient who's conked out and propped open in front of you (and with operating assistants to suction and retract and so forth). Even a trained surgeon, with super-precise skills and an in-depth knowledge of the anatomy, wouldn't attempt such an operation on her/himself.
posted by youarejustalittleant at 6:22 PM on July 7, 2005

Response by poster: Well, what if you rigged up some sort of video feedback, taped all the necessary suction stuff etc... it is hypothetical, after all. Such a thing must be possible, even if extremely difficult, the question is: how?
posted by Grod at 6:28 PM on July 7, 2005

Clear the tea things. Wash your hands. Do the surgery. (Or something close to that, Monty Python classic on "do it yourself brain surgery.")

Weirdest. Askme. Question. Ever. (But I love it.)
posted by realcountrymusic at 6:28 PM on July 7, 2005

I think bleeding to death and/or suffocating on your own blood would be a real danger here. Frankly, you just can't see back there well enough (even if you could reach) to be sure you did it right, much less finish the job correctly. You really don't want an infection in that vital an area either.

Not to sound macabre myself but why not stab yourself with a sterilized fork or something and immediately report to a hospital with a punctured tonsil? I'm not a doctor, but I'd think that would pretty much seal the deal on them removing them.

I am not advocating this, I think it would be pretty painful and stupid, but its an idea.
posted by Pollomacho at 6:31 PM on July 7, 2005

Just out of curiosity, in this hypothetical situation, what sort of motivation would the hypothetical person have to perform such a surgery on him/herself? If it was simply for experience or to tell people about it, my guess is that their chances of living to tell the story would be pretty slim. If it was a financial reason, they probably could figure something out with doctors, state hospitals, state health coverage, etc. If the DIY surgery was motivated by fear of hospitals, a home hospital has to be even scarier.

So, I know this is not an answer to your question, I'm just trying to figure out what sort of situation would require a self-tonsillectomy (even in a hypothetical world).
posted by necessitas at 6:34 PM on July 7, 2005

Not specific to tonsils, but you could get some self-inflicted surgery info by looking up extreme body modification instructions. Definitely you'd find info on sterilization of tools, pain management, explaining the injury to doctors if things go awry, etc. (Warning: links are way, way, WAY gross: link 01, link 02.)
posted by xo at 6:58 PM on July 7, 2005

oh, and sorry about the existence of those awful links. (NSFW, by the way.)
posted by xo at 7:01 PM on July 7, 2005

One would call one's psychiatrist (because of course to think of such nonsense one probably already has one) and then one would ask what it would take to get one's self committed for a short period until this mania passes.

For crying out loud, what the hell is the matter with you even thinking such thing? You are going to get an infection and die if you try this yourself. We (well at least I) do not want this to happen

The censors will probably remove this as a "non-answer" as I have failed to tell you how to kill yourself as you have asked. So read this quickly and save yourself. If you need the tonsils out get a proper doctor and afterwards enjoy some ice cream in your recovery.
posted by caddis at 7:04 PM on July 7, 2005

Response by poster: Motivation? I don't know. You are all acting like I or someone I know would actually try this. I was just hoping for an expert opinion on how someone could do this, just for the knowledge. Probably only an idiot or a crazy would even want to do such a thing. I'm not crazy, nor am I an idiot. It is just morbid curiosity.

Someone once asked what the best way to dispose of a body is. I don't see this question as all that different.
posted by Grod at 7:07 PM on July 7, 2005

Hypothetically, you could use liquid nitrogen to freeze your tonsils and break them off. Of course, you would then have to ask how to hypothetically self treat frostbite and gangrene at the back of your throat.

Do not try this at home!!!!! Go see another doctor!

You wrote for advice about this last month. What was the diagnosis then?
posted by Yorrick at 7:11 PM on July 7, 2005

If you drink 1/3 bottle of whiskey, then break the bottle on a metal railing, you might be able to dig out a bullet with the broken bottle before you pass out. That would be cool.

Do it yourself with Coyle and Sharpe: I'm not a doctor, but I'm gonna perform an operation, or what you would call an operation, on this man.
posted by planetkyoto at 7:19 PM on July 7, 2005

Response by poster: No, last month was about finding a doctor. This month I'm just blowing off steam. I swear I would never do this, I don't even like removing splinters, I'm not about to cut bits of myself off. Also, I have no control over my gag reflex. Really, in all seriousness, this is purely hypothetical motivated by idle curiosity and frustration sort of a "if only I could just end this annoyance" leading to, "I wonder how that would work" If I actually get a useful answer the only application it will ever see is, perhaps, in a piece of fiction. That's it.

seriously, I can't look when they draw blood at a physical. When I see stuff like what xo linked I think "what is wrong with these people?" Please, those who question my motivation for posting such a question, I'm just interested. Did you read the thread on how to dispose of a body? I did. Did you apply that information? No, what a coincidence, neither did I. Lighten up.
posted by Grod at 7:23 PM on July 7, 2005

Hypothetically speaking, if a person was interested in self-tonsillectomy because said person was in major pain and had no insurance, I would suggest that the person ask a more practical question like "I need treatment for my festering tonsils and I don't have insurance. What options are available to me (I live in XYZ state)?"

I would be more than happy to donate my question this week If there is a person out there with such an affliction who already used his ask.mefi question this week.
posted by necessitas at 7:28 PM on July 7, 2005

Tonsillectomies seem simple enough, just wack off those discrete little balls on the sides of your throat, right?
Actually, this procedure can become pretty complicated when you consider all the plumbing surrounding them. A person performing the procedure must consider not only the arteries feeding the tonsils, but also the possiblity of a very tortuous carotid artery that could be nicked in the removal process, (which would be really bad to say the least). Plus, they must also be careful not to damage the cranial nerve (IX) innervating your throat muscles.
All I'm trying to convey is that this is certainly not as simple as it sounds.
(just as a side note: tonsil stones anyone? those things are the nastiest things ever to come from my body, yet at the same time I find it fascinating that I can birth such wretched objects from by own throat.)
posted by aceyim at 7:36 PM on July 7, 2005

So, if someone's about to die, we doctors are taught to check things in the order of their importance: A, B, C. Airway, breathing, circulation.

The tonsils are too close to the airway to make this idea anything like reasonable. You screw up your airway, you are 4 minutes from irreversible brain damage and 8 minutes from demise. You will be incapacitated much sooner than that. Blood, chunks of removed tissue, suction apparatus, and surgical instruments all threaten your airway.

DIY is for home improvement, not tonsillectomy. There is a reason people pay ENTs big bucks, and it's not because of their toothsome smiles.
posted by ikkyu2 at 7:50 PM on July 7, 2005

Best answer: That said, if I were going to do this, I'd want a good mirror or maybe 3, a big curved sucker with a vacuum source, a compressed-air-sprayer of lidocaine (or cocaine 1%) and phenylephrine, a pair of long Kelly clamps, a tonsil knife, and a Bovie electrocautery. You could sterilize these by boiling them, in an ethylene oxide bag, or whatever. Sterility in an oral operation is not so important as the oropharynx is totally colonized with nasties anyway - a real ENT would paint the tonsils with iodine but it's probably just superstition.

The cocaine would do double duty as local anesthetic and confidence booster.

So, I'd spray the coke and phenyl transnasally, grab the tonsil with the Kelly, cram the sucker down my throat, take a swipe with the curved tonsil knife, remove the Kelly with tonsil attached, and suck while I jammed the Bovie down there and tried to cauterize the back of my throat without perforating it or tearing a hole in the soft palate.

I'd have a second standing by with a wakizashi in case my own attempt was unsuccessful.
posted by ikkyu2 at 7:58 PM on July 7, 2005

Hypothetically he would be a dumbass. Contrary to popular belief, a tonsillectomy is not that minor a procedure, and not only is excellent visualization of the oropharynx an absolute requirement, but the patient is also usually paralyzed and on a ventilator. At least when it's done right.
posted by drpynchon at 8:02 PM on July 7, 2005

I'm stuck on how the one doing the surgery on himself would perform the surgery while under anesthesia. But I'm sure once you get that part worked out, the rest will be easy.
posted by geeky at 8:25 PM on July 7, 2005

what sort of motivation would the hypothetical person have to perform such a surgery on him/herself?

Because he's the LAST PERSON ON EARTH and his throat hurts. So let's assume this happens the proverbial Few Years From Now.

The first thing you'll do is read up, a lot, for what has to happen when, and how, and why. And for what can go wrong.

Next, you'll want to assemble the appropriate robotics.

The first thing your Doc-In-A-Box will need to be able to do is see -- you could do this with wee tiny stereo cameras. Probably more than one set, so it can see outside and inside. Getting robots to see well is difficult in the real world, but not in The World Of A Few Years From Now. There will probably be a firefox extension for it.

ikkyu2 or other playful physicians: could you also do this by feeding the data from several ultrasounds into a machine to give it a 3-d model of what's going on in yer throatular region?

Next, your DIAB will need to be able to do something. One way you could go with this would be with several robotic arms to hold normal surgical instruments. Alternatively, you could locate several of the tools onto the same arm, like you see in a CIC machine tool. At minimum, you'd probably want one arm to hold your mouth open, one for grabbing and pulling, one for cutting, and one for cauterizing. But a real man would also program an additional unit to pat you on the back and say "There, there, it's all right" in Cylon-voice.

Nearly there! Now, grab a corpse -- there are zillions about, you're the last man on Earth after all -- and put it in The Chair. Make sure the corpse has tonsils! Then fire up your de-tonsillator. You'll probably find that you have programmed badly and that the corpse has been gruesomely decapitated, or had its jaw removed, or been circumcised. Try, try again -- remember, your sore throat waits for no man.

Eventually, you'll have a system that works well enough for whatever safety margin you want. Sterilization: pour some Everclear on the relavent bits of machinery and light it; that oughta be good enough for the likes of you. Now just sit down in the chair, open wide, and push the button. 40 milliseconds later you'll either be cured or paste.

Alternative: become Davros to a race of very small Daleks who hate tonsils and turn a crowd of them loose in your throat. When you stop hearing EX-TER-MI-NATE!! and start hearing tiny semirobotic cheers, drink a big swig of booze and send them to an acid grave in your stomach
posted by ROU_Xenophobe at 8:38 PM on July 7, 2005 [1 favorite]

Playful physicians please - Why wouldn't you use this method on yourself? From the sounds of it there is only a local anesthetic and there aren't any chunks to choke on. You would only have to know where to stick the probe in.
Radiofrequency ablation (Somnoplasty): Monopolar radiofrequency thermal ablation transfers radiofrequency energy to the tonsil tissue through probes inserted in the tonsil. The procedure can be performed in an office setting under light sedation or local anesthesia. After the treatment is performed, scarring occurs within the tonsil causing it to decrease in size over a period of several weeks. The treatment can be performed several times. The advantages of this technique are minimal discomfort, ease of operations, and immediate return to work or school. Tonsillar tissue remains after the procedure but is less prominent. This procedure is recommended for treating enlarged tonsils and not chronic or recurrent tonsillitis.
posted by tellurian at 9:10 PM on July 7, 2005

I believe that a Russian doctor performed a self-appendectomy while in the Antarctic in the early 1960s. I don't know if any detailed description of the procedure exists, but possibly you could find some pointers there if it does.
posted by bac at 9:11 PM on July 7, 2005

You should read Stephen King's short story "Survivor Type" in his book "Skeleton Crew." A surgeon ends up marooned on a desert island -- when he starts to starve, he amputates various parts of himself for food, as surgically precisely as he can (I think he has a lot of heroin, which reminds me now of the ABC show "Lost"). I still get chills at the last line...
posted by GaelFC at 9:18 PM on July 7, 2005

No real content, but I nominate ROU_Xenophobe for best answer.
posted by RikiTikiTavi at 9:46 PM on July 7, 2005

So let's assume this happens the proverbial Few Years From Now.

Well, in the proverbial Few Years From Now, you'll be able to engineer and program a horde of nano-bots that will do all the work for you. They'll be thirsty for your tonsils. Just sit down in front of a good movie and breathe into a paper bag full of tiny, dust-sized robots and it'll be done before you know it.
posted by Jon-o at 9:57 PM on July 7, 2005

tellurian: you probably could do some sort of RF ablation yourself if you had the gear. But it's not the same as tonsillectomy...
posted by drpynchon at 10:05 PM on July 7, 2005

in the proverbial Few Years From Now, you'll be able to engineer and program a horde of nano-bots that will do all the work for you.

Way ahead of you. Very small Daleks.

Or perhaps microsmurfs. Or nanomice with picks (see Scratchtasia for effectiveness of basic technique).
posted by ROU_Xenophobe at 10:26 PM on July 7, 2005

ROU_Xenophobe wins.

Though, if I had proper magic nanodust, I'd rather become a transcendent nano-being, having transcribed myself and my form and (just in case) recorded my DNA.

Then I would take the form of an interstellar vessel and go exploring, stopping along the way to mimic various other space-beings and make out with them.
posted by loquacious at 12:12 AM on July 8, 2005

You might talk to these two about their experience:

I recently heard (CBC, I think) about a guy on a solo sailing race who accidentally bit off his tongue, and had to sew it back on by himself. He may have received medical tips via radio, and IIRC the operation was successful. Hurts just thinking about it. Couldn't find the story on Google. Anybody?

Then there’s the Mexican woman who successfully delivered her baby by self-administered Cesarean section. All she had was a kitchen knife.
DO NOT TRY THIS YOURSELF.
posted by weapons-grade pandemonium at 1:48 AM on July 8, 2005

People like Amanda Fielding trepanned themselves back in the '60s--this can't be much harder, right? And they were, um, *totally sane*. More recently, here is an account (with gorey pictures, be warned) of one man who no doctor would trepan, so he took matters into his own hands... I'm sorry, I can't find a good written account of Fielding's trepanation, but she used morphine for local anesthetic, a power drill, and a mirror. Oh yeah. Excerpts of her film of the procedure can be found in the documentary A Hole in the Head (1998).
posted by ibeji at 6:01 AM on July 8, 2005

Not a tonsillectomy, but here's a story about a guy who decided he was too impatient to wait for his scheduled surgical date to remove a plate from his ankle, so he cut himself open and tried to do it on his own. Which worked up until he got to the last screw, which was fused to the bone.

(Registration required, but it's worth it just for the dry humor of the doctor who wrote up the article. Plus there are pictures! Nothing too gross, I promise.)

"Although Tuke's Dictionary of Psychological Medicine[4] stated that self-mutilation was encountered "not infrequently" by the "alienist" doctor "both within and without the asylum," it seems likely that such behavior was observed chiefly in psychotic or mentally retarded subjects. This case suggests that normal individuals under alcohol intoxication are no exception."
posted by MsMolly at 9:50 AM on July 8, 2005

Excellent question!
As someone who has had very bad luck in the past with miserably swollen, bad-news tonsils, I would probably follow ikkyu2's advice here.

aceyim - I am also fasinated by random tonsil stone action(I've always heard them referred to as toniloliths, which sounds even better).
posted by sluggo at 4:53 PM on July 8, 2005

I gave no advice in this thread. I will give some now: do not attempt to remove your own tonsil.
posted by ikkyu2 at 11:41 PM on July 21, 2005