Patient Instructions after Surgery

Q: What do I need to know about care after surgery?

· Same day surgery:

You might experience pain in your shoulder, chest, and upper abdominal areas caused by the gas. It is normal to have tenderness at the incision sites. These discomforts usually diminish markedly after 2 days. Because fluids are often left in the abdomen to prevent adhesion formation, you might notice that fluid might leak from the incisions and observe swelling in these areas. This fluid leakage and swelling should disappear within 2 days. There is usually some bruising at the incision sites. This disappears in approximately 2 weeks. Most patients go home the day of the surgery and need to be accompanied home by a responsible adult.

· Incision care after laparoscopy:

o Your skin incisions will be closed with suture, which is concealed underneath the skin.  The suture underneath the skin will hold the incision together until it heals. If the sutures are present, they will dissolve approximately 4 weeks after surgery. This suture is dissolvable and does not need to be removed.  However, it might be felt for several weeks, which is normal. 

o The incisions will be covered by a sealant called Dermabond—it is “surgical superglue” used to protect and seal the skin.  It will fall off in a week or so after surgery and does not need to be removed.

o Your doctor will check your incisions when you come in for a check up 2-4 weeks after surgery.

o Gently wash incisions daily with soap and water when you shower.  You may shower the day after surgery unless instructed otherwise. 

o You may take a tub bath ____ weeks postop.

· Intestinal function:

o You may resume your normal diet: you many find liquids, crackers, and toast more tolerable at first.  Avoid eating greasy, spicy or heavy foods for the first few days.

o Take over-the-counter stool softener such as Colace (generic name is Docusate sodium), one tablet 2 to 3 times daily to keep you from being constipation.  Drink 6-8 glasses of non-caffeinated beverages daily.  Milk of Magnesia and high fiber diet are also helpful.

· Sexual activity and pelvic rest:

o You may resume sexual activity ____ weeks after surgery.  Please abstain from sexual intercourse until then.

o Do not use tampons or douche for _____weeks

· You may drive when you are not taking narcotic pain medication and when you feel comfortable enough.

· Pain medications:

o You may have cramping and you may bleed and for 3-4 weeks.  Heating pad on your lower back and abdomen may lessen the discomfort.

o We strongly recommend the following pain medication regiment after surgery to help you recover safety and quickly.  Pain medications commonly used are NSDAIDs (non-steroidal anti-inflammatory medications) such as Ibuprofen (Motrin, Advil) and Naproxen (Aleve), narcotic medication such as Percocet (combination of Tylenol and Oxycodone), Oxycodone, Tramadol, and Tylenol (Acetaminophen). Your doctor will go over instructions on what medicine you should be taking. 

o In general, most patients should be taking pain medication as follows:

§ Ibuprofen (Motrin, Advil): 600 mg tablet every 6 hours) around the clock immediately after surgery for the first week.  If you need to continue taking for longer than a week, that’s ok.  If you prefer to use over-the-counter Ibuprofen, it is 200 mg tablet, so you need to take 3 of them every 6 hours.  Please do not take it on empty stomach (take it with a little bit of food like crackers and juice).

§ Acetaminophen (Tylenol):  650 mg tablet every 4 hours or 1 g tablet every 6 hours.  Take in addition (not instead of) Ibuprofen and Percocet (1-2 tablets every 4-6 hours) in addition to Ibuprofen as needed.

§ Oxycodone 5 mg tablet: you may take 1 or 2 tablets in addition to Ibuprofen and Tylenol if needed for stronger pain.  Most patients do not need to make more than a few tablets during their recovery.  

§ Please note that since all of above medications work differently you cannot overdose by combining them together and taking them at the same time.  Moreover, they work better in combination, allowing you to use less narcotics medication such as Oxycodone as it in some cases might result in sedation and constipation.

§ Your doctor might change your pain medications based on your specific circumstances.

o You should take your pain medication as follows:

§ 1. Take Ibuprofen first, wait 30 minutes. 

§ 2. If you need more pain medication, take Acetaminophen next, and wait 30 minutes

§ 3. If you need more pain medication, take oxycodone 5 mg tablet next, and wait for 30 minutes.  You may take 2^nd oxycodone tablet in 30 min if you still need more pain medication.

§ Repeat the cycle of pain medication as above.  You might want to keep track of when your last does of pain medication was taken and when the next is due by writing it down.

§ Start taking ibuprofen as soon as you get home from the hospital, and stop taking it when no longer needed (on average, patients take it for about a week).

§ Stop taking oxycodone first, then acetaminophen, then Ibuprofen in that order, when no longer needed.

§ It is a common misconception that narcotics like oxycodone are better for pain because they are “stronger.” As a result, patients skip Ibuprofen and Tylenol and got to oxycodone directly. This is not effective for pain control. Because of mechanism of action of those drugs, Ibuprofen and Tylenol should be taken around the clock first before oxycodone is added to the regiment.

§ Some patients find it easier to write out reminders to themselves about when their next pain medication is due. An example of such medication reminder chart can be found at the end of this document.

o Do not wait until the pain is too bad before taking the medicine.  It may not work as well if you wait too long to take it. If it makes you drowsy, do not drive or do anything else that requires you to be alert.

o Most patients find it easier to have enough pain medication in stock PRIOR to surgery to avoid having to go to the pharmacy immediately after.  Please note that narcotic medication prescription expires in 30 days after it is written and cannot be faxed or called in; it must be picked up in person.

o If you had laparoscopic or abdominal surgery, you might have pain in your neck or shoulder because of the gas that was put into your abdomen during surgery.  Using heat pads and elevating your head and shoulders might help.

o Other helpful medications:

§ Benadryl 25 mg tablets (can be bought over-the-counter).  Maybe taken for insomnia (do not take narcotics “to fall asleep”) to help with sleep and to help with itching (which is a side effect of a narcotic medication).

· Physical activity:

o Lifting: There are no strict limitations on lifting, but in general, it is best not to not lift more then 40 lbs for the first 6 weeks.  Sit-ups, abdominal workouts and weight lifting: please wait 8 weeks to resume this type of activity.

o It is desirable to be active as possible immediately after surgery it facilitates healing.  Walking is great way to maintain your adequate activity level.  Taking a walk 3 times a day (walking around your apartment or a house) is the minimal amount of activity recommended.  The more you can walk the better.  You may start with bicycle, treadmill or elliptical machine if you line, but running and doing similar high-impact activates are best to wait until 6 weeks after surgery.  You may return to your usual exercise routine, sports or heavy housecleaning in ______ weeks.

· You may return to work in_____ weeks.  Please hand out on instructions prior to surgery on more details. 

Q: What do I do to prepare for my surgery and how I can assure fast recovery?

• You and your family or support persons play important role in your recovery. We encourage you to be an active team member by following your doctor’s instructions, as well as asking questions to make sure you understand what is being asked of you.
• Having surgery is like running a race in terms of physical and mental stress. To prepare, it is important to stay physically active and exercise and eat healthy.  After surgery, the most important part is resuming all your normal activities as soon as possible.  That would include:
• Getting out of bed to move around. 

This is the most important aspect of recovery.  You will be asked to get out of bed soon after surgery.  This can mean sitting in a chair, standing, walking of combination of those activities. Moving around will encourage your bowel to return to its normal function, to speed up your recovery and to decrease the risk of complications. The day of surgery, your goal is to move around at least twice.  Your goal is to spend at least 3-6 hours out of bed your first day after surgery, 6-8 hours in days to follow.  Walk a minimum of 6-8 times during each day around your apartment or a house, and start walking outside as soon as possible.

• Return to your normal eating and drinking. 

Staring to drink liquids right away and eating regular food will help your bowel recover. You might not have much appetite for the first few days, which is normal. Chewing gum (in recovery room and for the first few days after surgery) might help expedite this process. Fresh fruits and vegetables, spicy or fried food should be limited for the first few days, focus on drinking at least 7 glasses of liquids per day. Bland food (bread, bananas, oatmeal, crackers, juice) is easier on your stomach initially.

Q: What do I need to watch for?  When do I need to contact a doctor?

· If you have an incision, look for redness on the skin, swelling, and pus or liquid coming out of it.

· If you are bleeding more then your regular period, causing you to change a sanitary pad every hour for 2 hours because it is soaked

· If you have an unusual foul-smelling green or yellow vaginal discharge

· If you are having pain in your abdomen that is not controlled with pain medication that was given to you or if the pain is increasing

· If you are vomiting or have nausea and cannot keep food or liquid down

· If you have difficulty urinating

· If you are heaving diarrhea often

· If you have trouble breathing all of a sudden

· If you are not passing gas or stool from the rectum

· If you are running a fever, more than 100.4 F or 38.0 C for more then 24 hours

· A nurse or a doctor will call you the morning after surgery to see how you are doing.  During the workweek, a nurse in the office will go over your concerns and contact your doctor as needed. After hours and on the weekends, a doctor on call will be contacted when you call the office number.

Q:  How do I contact a doctor?

· Please call (718) 405-8200 ext. 7238 to speak with the receptionist.  If receptionist is on another call, you will be forwarded to a voicemail. When leaving a message on our voicemail systems, please leave your name and a phone number where we can best reach you and time at which is best to reach you, name of physician who is taking care of you and a reason for the call.  Please make sure your phone line is set up in such a way that it accepts blocked numbers (check your caller ID to make sure our call is not filtered out). Messages left on our voicemail are checked several times a day.  If you contact us by email, please allow at least 24 hours for response, as email messages are not checked on hourly basis.

· All calls received by the nurse after 9 am before 5:00 pm will be returned the following business day. If you are experiencing an emergency do not leave a message and go to emergency room or call 911.  Please choose the option to get on-call doctor paged, and covering physician will return your call right away. 

· In the event that you have an urgent question after 5:00 pm, on a weekend or holiday, please call and choose the option to have the on-call doctor paged.  For non-emergent matters such as medication refills please leave a message and your phone call will be returned the next business day.

· After hours “on-call” emergency coverage by our physicians takes place on rotating basis between physicians who are partners in our practice.

Q: What happens to pathology report after my surgery?  How do I find out the results?

• It takes approximately 2 weeks after your surgery to get final results on pathology.  Your doctor will review those results with you when you come back for your post-operative visit.

Q: I have a form that needs to be filled for my job.  How do I handle that?

• Please call the office and explain what the form is needed for and fax it or email it to us. Forms, letters or record releases might require up to 7-10 business day turn around time unless there is an emergent issue which will be handled on a case by case basis.

Medication name and dose	Last taken	Next dose due
Ibuprofen 600 mg	4/6/18 at 10 pm	4/7/2018 at 4 am
Tylenol 1000 mg	4/6/2018 at 10:30 pm	4/7/2018 at 4:30 am
Oxycodone 5 mg	4/6/2018 at 11 pm	As needed, wait minimum of 4 hours in-between doses