Post-Operative Care Instructions for Minor Surgery  (Click here for downloadable/printable version)

You have just had minor surgery. Please follow my instructions to help minimize pain and length of recovery after your procedure. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• You most likely have skin glue over your wound.  It is water proof and will wear off on its own.  If you have a clear plastic dressing over your wound. This dressing is also waterproof, but allows air to get to the wound to facilitate heating..

• You may notice some blood underneath the plastic dressing. This is quite common and, unless It is a large amount, is not cause for concern.  If there is a bubble of blood under the plastic dressing, I would advise making a tiny opening with the tip of scissors or a pin and gently squeeze the blood out into a gauze pad or tissue. I would then just continue to allow the dressing to stay intact.  If the blood is leaking out from under the dressing, I would recommend getting some sterile gauze and tape and placing it over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops. I would still not recommend removing the dressing. If you feel you need to remove the dressing, please call the office.

• 50% of the time the sutures are not visible and are self-absorbing. You may see little white tapes over the incision, which help to hold the wound together. These may become stained with blood and, again, that is nothing to worry about. If you see sutures under the wound, these will be removed in the office at the appropriate time.

• Starting around the second or third day, you may begin to notice blood under the skin or a “black-and-blue mark.”  Again, this is not a cause for concern and it will all be re-absorbed over a period of a week or two.

• You may also notice swelling in the area of the wound and this generally begins to appear on the second or third day and peaks around the fifth day. If you had a lump removed, it may actually appear as if it has returned. This, often times, is just some fluid under the wound which could be re-absorbed on its own or which I may remove at your first visit with a needle. Again, it is nothing to worry about and is quite common. The lump should go away over a period or two or three weeks.

PAIN CONTROL:

• Most often Tylenol or Ibuprofen is enough for a minor surgical procedure. If you feel that your pain relief is not substantial on these simple medications. please call the office so we may call a stronger prescription in for you.

• For the first two days, ice is important in keeping the swelling down and reducing pain. You may use an ice pack that does not get the wound wet. Ice should be applied twenty minutes on and twenty minutes off. The ice should not be in contact with the skin directly for more than twenty minutes as it can cause frostbite. Ice is only effective tor the first forty-eight hours. Following the first forty-eight hours, a heating pad can be used and, again, for only short periods of time – ten or fifteen minutes, as not to bum the skin.

ACTIVITY:

• I will discuss the activity that is possible following your particular procedure. Be sure to ask me about this at the time of your surgery.

• You may shower starting on post-operative day one, unless otherwise Instructed. You may not bathe unless otherwise Instructed. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the waterproof dressing.

DIET:

• Unless otherwise indicated, you should have no dietary changes.

BOWEL MOVEMENTS:

• These are generally not affected by minor surgery.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Temperature greater than 101 for more than 24-hours.
2. Excessive bleeding, beyond that which was described in the first section.
3. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.
4. Increased swelling associated with redness over a period of three to five days.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Open Wounds which require packing (Click here for downloadable/printable version)

1. Your wound was left opened because an Infection was present at the time of your surgery. When wounds are closed in the presence of an infection, infection re-occurs and goes on to cause wound-healing problems.
2. The wound may initially be hypersensitive during the packing process and you may need to take pain medication a half an hour before the packing change is done. After three or four days, the wound becomes desensitized and packing and unpacking should not be bothersome to any large degree.
3. The principal of a packed wound Is that It closes from the bottom up and, therefore, it is important that when you pack the wound, you pack to the full depth of the opening.
4. Packing changes should be done two or three times a day, as discussed with me. There are various types of packing used, and I will discuss with you the packing that is best for your wound.
5. Remember, these wounds are not sterile, but simply clean. it is permissible to shower into these wounds and, in fact, it is quite healthy for them. I would recommend having a daily routine of unpacking your wound, taking a shower, and re-packing the wound. You should then cover the packed wound with dry gauze and tape the dry gauze into place.
6. If the wound is in the groin or anal-rectal area, a feminine napkin may be utilized instead of the overlying dry gauze to prevent tape from being applied to the skin.
7. Often the wound will ooze a small amount of blood during the changing process and this ls perfectly normal and nothing to worry about. If excessive bleeding occurs, the wound should be packed tightly and pressured held and the office notified.
8. You may note a small amount of green discharge on the packing when it is removed. This is normal and is the purpose of the packing. This is to remove the infected material from the wound as it is unpacked.
9. Depending on the type of wound and the location, you may be packing with a dry packing, with a packing dampened with saline, or with a packing dampened with a prescription liquid.
10. Don’t be discouraged! Wounds often look as If they are not closing and then suddenly seem to contract by magic.
11. If your wound becomes difficult to manage, I may refer you to our wound care center.  I also may elect to have a “wound-vac” placed.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Patients with Jackson-Pratt drains  (Click here for printable/downloadable version)

1. A drain has been placed in your wound because of the type of surgery that you had. Often times fluid will accumulate following surgery and the drain has been placed in order to prevent the fluid from accumulating and thus help the wound to heal.
2. If you do not understand how to empty the drain, a nurse can be arranged to take you through the first few times until you are comfortable doing it on your own.
3. The nurse in the recovery room will go over emptying the drain and re-sealing it with you.
4. There is a water-proof dressing over the drain. Some drainage may occur around the drain itself and it can be reinforced with gauze and tape and if it becomes messy, carefully remove the dressing and wash with hydrogen peroxide and apply bacitracin or antibiotic ointment to the site and apply a large band aid as a dressing.
5. You may shower lightly over the drain if it is permissible to shower after your surgery.
6. Please call me If you are experiencing any problems with the drain.  Most drains do not stay in longer than five to seven days.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Laparoscopic Cholecystectomy (Click here for printable/downloadable version)

Congratulations! You have just had a laparoscopic cholecystectomy. Please follow my Instructions to help minimize pain and length of recover. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• You have skin glue covering dissolvable sutures that is waterproof for showers but not for baths or swimming for about 10d.  It will wear of on its own.  After about 10 days, you may peal it off if it is still there.

• Starting around the second or third day. You may notice blood under the skin or a “black-and-blue mark.”  This can be extensive and is not a cause for concern and it will all be re-absorbed over a period of a week or two.

• You may also notice swelling in the area of the wound and this generally begins to appear on the second or third day and peaks around the fifth day. Often times this will be resorbed over a period of two or three weeks.

• If you notice swelling around the umbilical wound, which appears to worsen and get red and tender, this may indicate that you have a wound infection. If this is the case, please call the office.

PAIN CONTROL:

• In general, your pain should improve a little each day following the second day of surgery. If it appears to worsen following the second day of surgery and it is not due to constipation, please give the office a call.

• The umbilical wound tends to be a little more sore than the other wounds for a period of time. This is not unusual.

• You may notice pain in your shoulders and your upper abdomen and it may almost feel as if you are having a gallbladder attack. This is secondary to the gas that was utilized to expand your abdominal cavity during the surgery. This may take as long as seven to ten days to resolve. Again. It is important to realize that this should be getting a little better each day, rather than a little bit worse.

• You have most likely been given a prescription for pain medication. Most people find that they do not require it for more than the first two or three days, at which time it is fine to switch to Tylenol or Ibuprofen.

ACTIVITY:

• For the first two days, only walking is permitted. You may climb stairs as necessary and this will not bring harm to your wound, however, it may cause excessive soreness. Following the first two days, you may begin walking or climbing stairs more. You may lift light objects; however, heavy lifting is not permitted for the first one to two weeks. After a week, you may begin light exercise. If you have a work out regime, I would recommend using 50% of the weight you have been using pre-operatively. You should target one month at a time when you are exercising to the extent that you were prior to surgery.

• You may engage in sexual activity after 24 hours. Obviously, adjustments may need to be made for comfort.

• You may shower starting on post-operative day one, unless otherwise instructed.  You may not bathe for one week. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the wounds.

• You may drive in 3-4 days.  Try a local drive with someone in the car first to see how you feel

DIET:

• Water is your friend. You should drink approximately eight glasses of water a day. This will make you feel better and keep your bowel movements nice and soft.

• You should maintain low-fat diet for the first one to two weeks, or until your bowel movements are totally normal. I would suggest staying away from foods which make you gassy or bloated, or from foods which tend to constipate you, such as rice or potatoes.

BOWEL MOVEMENTS:

• Approximately 10-15% of patients will experience urgency to move their bowels following meals. This tends to last for only one to three weeks and is always self-limiting. If this appears to be going on longer or is severe, please call the office.

• If you have not moved your bowels in forty-eight to seventy-two hours after surgery, I recommend taking 45cc of Milk of Magnesia, either in the morning or prior to bed. Remember, it takes eight hours for the Milk of Magnesia to work, so you do not want to take it so that the time sequence would fall in the middle of the night. When you strain to move your bowels, press firmly against the incision. This will alleviate some of the pain, which comes with pushing out bowel movements.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Persistent diarrhea or vomiting.
2. Temperature greater than 101 for more than 24-hours.
3. Excessive bleeding, beyond that which was described in the above.
4. No bowel movement 24-hours after taking Milk of Magnesia.
5. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Umbilical and Ventral Hernia repair (Click here for printable/downloadable version)

Congratulations! You have just had your ventral / umbilical hernia repaired. Please follow my Instructions to help minimize pain and length of recovery after your repair. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• Please note that you have skin glue as a dressing over your wound. This dressing is waterproof and allows you to shower.  It will wear off on its own over time.

• You may notice some blood underneath the dressing. If the blood is leaking out from under the glue, I would recommend getting some sterile gauze and tape and placing it over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops. I would still not recommend removing the glue unless you speak with me first. If you feel you need to remove the dressing, please call the office.

• If you have an umbilical hernia repair, the sutures are not visible and are self-absorbing. You may see gauze between the dressing and the incision, and this may become stained with blood. Again, that is nothing to worry about.

• Starting around the second or third day. You may notice blood under the skin or a “black-and-blue mark.”  This can be extensive and is not a cause for concern and it will all be re-absorbed over a period of a week or two.

• You may also notice swelling in the area of the wound and this generally begins to appear on the second or third day and peaks around the fifth day. It may actually appear as if your hernia has returned. This, often times, is just some fluid under the wound which could be re-absorbed on its own or which I may remove at your first visit with a needle. Again, it is nothing to worry about and is quite common. The lump should go away over a period or two or three weeks.

• You may have been sent home with a Jackson-Pratt drain for which I will give you separate instructions.

PAIN CONTROL:

• Your wound was injected with a long-acting local anesthetic prior to starting the procedure. This wears off in anywhere from four to eight hours. It is important that you start taking your pain medication before this medication wears off. It is much easier to prevent pain from occurring than It is to stop it once it has occurred. Keep this in mind when taking your oral medication as well. You will be given two kinds of pain medications in the recovery room. One is an anti-inflammatory type medications and the other is a narcotic. When you go home, you will be given the same two medications. You should take the anti-inflammatory medication on a continual basis for one to two weeks. You should not wait for pain to begin to occur, but should take it according to the clock. The narcotics should be taken on an as-needed basis. Many patients find that after two or three days the narcotic is no longer necessary and that the pain can be handled with the anti-inflammatory medications alone.

• For the first two days, ice is important in keeping the swelling down and reducing pain. You may use an ice pack that does not get the wound wet. Ice Should be applied twenty minutes on and twenty minutes off. The ice should not be in contact with the skin directly for more than twenty minutes, as it can cause frostbite. Ice is only effective for the first forty-eight hours. Following the first forty-eight hours, a heating pad can be used and, again, for only short periods of time, ten or fifteen minutes, as not to burn the skin.

• You may have pain on and off for three to six months as you heal and resume full activities

ACTIVITY:

• For the first two days, only walking is permitted. You may climb stairs as necessary and this will not bring harm to the repair, however, it may cause excessive soreness. Following the first two days, you may begin walking or climbing stairs more. You may lift light objects; however, heavy lifting is not permitted for the first three to four weeks. After three to four weeks, you may begin light exercise. If you have a work out regime, I would recommend using 25% to 50% of the weight you have been using pre-operatively. You should target six weeks at a time when you are lifting 75% of that weight, and eight weeks when you are back to full-strength. It is unlikely that straining will cause the hernia to return, however, it may lead to prolonged pain. Remember, being a little patient will allow the wound to become more comfortable more quickly.

• You may engage in, sexual activity after forty-eight hours. Obviously, adjustments may need to be made for comfort.

• You may shower starting on post-operative day one, unless otherwise instructed.  You may not bathe for one week. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the waterproof dressing.

• Driving:  If your incision is less than 3 inches long, you may begin to drive in 4 days.  If it is longer, you may begin to drive in 1-2 weeks.  Please ask me at your first visit.

DIET:

• Water is your friend. You should drink approximately eight glasses of water a day. This will make you feel better and keep your bowel movements nice and soft.

• You may eat anything you want. I would suggest staying away from foods that make you gassy or bloated, or foods which tend to constipate you, such as rice and potatoes. I would also stay away from greasy or fatty foods, which may tend to nauseate you, for the first twenty-four to forty-eight hours.

BOWEL MOVEMENTS:

• Pre-operatively a stool regime was recommended to you. I would continue that stool-softening regime for the first one to two weeks. You may stop taking the mineral oil after one week. I would continue the Metamucil for the second week, and you may continue that indefinitely.

• If you have not moved your bowels in forty-eight to seventy-two hours after surgery, I recommend taking 45cc of Milk of Magnesia, either in the morning or prior to bed. Remember, it takes eight hours for the Milk of Magnesia to work, so you do not want to take it so that the time sequence would fall in the middle of the night. When you strain to move your bowels, press firmly against the incision. This will alleviate some of the pain, which comes with pushing out bowel movements.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Persistent diarrhea or vomiting.
2. Temperature greater than 101 for more than 24-hours.
3. Excessive bleeding, beyond that which was described in the above.
4. No bowel movement 24-hours after taking Milk of Magnesia.
5. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Excisional breast biopsy and Lumpectomy (Click here for printable/downloadable version)

You have just had an excisional breast biopsy or lumpectomy. Please follow my instructions to help minimize pain and length of recovery. call the office as soon as possible for a post- operative appointment.

WOUND CARE:

• Please note that you have a bulky pressure dressing over your wound. This is to apply compression to the breast to help prevent It from bleeding post-operatively. These dressings are not waterproof and must be kept dry for three full days. You should wear your sports bra directly over this dressing during that time. After three days, carefully remove the bandages, at which time it is okay to take a light shower with your back to the shower. You may notice white tapes over your wound, which may be blood stained. The blood staining Is nothing to worry about. You may have skin glue as a dressing.  Let the glue wear off on its own.  Once the dressing is removed, you should continue to wear your sports bra for 24-hours a day for a total of two to three weeks. You may put gauze between the wound and the sports bra once the dressing has been removed. It is not necessary to use tape to hold the gauze in place. The bra should do that on its own.

• In certain instances, the breast will not be dressed in a bulky dressing, but simply with a clear plastic dressing over the wound or skin glue. This dressing and glue are both waterproof and should not be removed for a week. You may shower after two days. You should still wear your sports bra over the dressing for 24-hours a day for a total of two to three weeks, as above.

• Please note that your sports bra should fit snugly and compress the breast well. If It fits loosely, it is too large.

• When you remove the dressing, you may note black-and-blue marks around the incision site. These will fade away over two to three weeks. You may also note some swelling in the area of the excision. It may even feel as though the lump has returned (If a lump were palpable to start out with). This is simply fluid and scar tissue, which accumulate post-surgically. This will soften up over a period of anywhere from two weeks to two months. Eventually the breast will have a completely normal texture without the lump palpable.

PAIN CONTROL:

• Your wound was injected with a long-acting local anesthetic prior to starting the procedure. This wears off in anywhere from four to eight hours. It is important that you start taking your pain medication before this medication wears off. It is much easier to prevent pain from occurring than it is to stop it once it has occurred. Keep this in mind when taking your oral medication as well. You have been given a narcotic, unless you otherwise specified. You may need this only for a short period of time, after which you can switch to either Tylenol or Ibuprofen.

• For the first two days, ice is important in keeping the swelling down and reducing pain. You may use an ice pack that does not get the wound wet. Ice should be applied twenty minutes on and twenty minutes off. The ice should not be in contact with the skin directly for more than twenty minutes, as it can cause frostbite. Ice Is only effective for the first forty-eight hours. Following the first forty-eight hours, a heating pad can be used and, again, for only short periods of time, ten or fifteen minutes, as not to burn the skin.

ACTIVITY:

• You may carry out most of your daily activities, including driving. Be sure to wear your sports bra during these activities. Even after two weeks go by you might find it more comfortable to wear your sports bra whenever you are active for the first month or so. I would recommend avoiding contact sports and vigorous exercise for the first few weeks. Once the wound is no longer tender to touch and you have seen me for your first post-operative checkup, we can discuss what type of activity you would like to engage in and how long a period you should refrain from that.

• You may engage in sexual activity at any time after the surgery that you wish.

DIET:

• You have no dietary restrictions that you did not have existing pre-operatively.

BOWEL MOVEMENTS:

• If you are taking Percocet for a period of several days and certainly if you are taking it more than once a day during this period of time, you may begin to experience constipation. If this is the case, I would recommend taking Milk of Magnesia or Senokot or a similar laxative if you have not had a bowel movement for a total of 72-hours.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Temperature greater than 101 for more than 24-hours.
2. Excessive bleeding or swelling, beyond that which was described in the first section.
3. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

*   If you have also had an axillary node biopsy, axillary node dissection, or sentinel node biopsy, please see the separate instruction sheet included with this.

Post-Operative Care Instructions for Inguinal Hernia Repair (Click here for printable/downloadable version)

Congratulations! You have just had your Inguinal hernia repaired. Please follow my Instructions to help minimize pain and length of recovery after your repair. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• Please note that you have skin glue as a dressing over your wound. This dressing is waterproof and allows you to shower.  It will wear off on its own over time.

• You may notice some blood underneath the dressing. If the blood is leaking out from under the glue, I would recommend getting some sterile gauze and tape and placing it over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops. I would still not recommend removing the glue unless you speak with me first. If you feel you need to remove the dressing, please call the office.

• 95% of the time the sutures are not visible and are self-absorbing. You may see little white tapes over the incision, which help to held the wound together. These may become stained with blood and, again, that is nothing to worry about.

• Starting around the second or third day. You may notice blood under the skin or a “black-and-blue mark.”  This can be extensive and is not a cause for concern and it will all be re-absorbed over a period of a week or two.

• You may also notice swelling in the area of the wound and this generally begins to appear on the second or third day and peaks around the fifth day. It may actually appear as if you have a lump growing under your arm. This, often times, is just some fluid under the wound which could be re-absorbed on its own or which I may remove at your first visit with a needle. Again, it is nothing to worry about and is quite common. The lump should go away over a period or two or three weeks.

• For Men:  You may also notice that the testicles, penis, and scrotum become markedly swollen. This happens more frequently when both sides are fixed at one time. Remember that blood and body fluids are affected by gravity and they will accumulate at the lowest point. You may help to prevent this by wearing briefs or an athletic supporter and elevating the scrotum on rolled up towels while lying in bed. Regardless, again, this always goes away in a period of anywhere from two to six weeks.

PAIN CONTROL:

• Your wound was injected with a long-acting local anesthetic prior to starting the procedure. This wears off in anywhere from four to eight hours. It is important that you start taking your pain medication before this medication wears off. It is much easier to prevent pain from occurring than It is to stop it once it has occurred. Keep this in mind when taking your oral medication as well. You will be given two kinds of pain medications in the recovery room. One is an anti-inflammatory type medications and the other is a narcotic. When you go home, you will be given the same two medications. You should take the anti-inflammatory medication on a continual basis for one to two weeks. You should not wait for pain to begin to occur, but should take it according to the clock. The narcotics should be taken on an as-needed basis. Many patients find that after two or three days the narcotic is no longer necessary and that the pain can be handled with the anti-inflammatory medications alone.

• For the first two days, ice is important in keeping the swelling down and reducing pain. You may use an ice pack that does not get the wound wet. Ice should be applied twenty minutes on and twenty minutes off. The ice should not be in contact with the skin directly for more than twenty minutes, as it can cause frostbite. Ice is only effective for the first forty-eight hours. Following the first forty-eight hours, a heating pad can be used and, again, for only short periods of time, ten or fifteen minutes, as not to burn the skin.

• You may notice numbness or tingling underneath the incision and extending partially into the scrotum.  90% of this should resolve over a period of a month. You may be left with a small numb patch under the wound, which will be permanent.

• You may have pain on and off for three to six months as you heal and resume full activities.

ACTIVITY:

• For the first two days, only walking is permitted. You may climb stairs as necessary and this will not bring harm to the repair, however, it may cause excessive soreness. Following the first two days, you may begin walking or climbing stairs more. You may lift light objects; however, heavy lifting is not permitted for the first three to four weeks. After three to four weeks, you may begin light exercise. If you have a work out regime, I would recommend using 25% to 50% of the weight you have been using pre-operatively. You should target six weeks at a time when you are lifting 75% of that weight, and eight weeks when you are back to full-strength. It is unlikely that straining will cause the hernia to return, however, it may lead to prolonged pain. Remember, being a little patient will allow the wound to become more comfortable more quickly.

• You may engage in, sexual activity after forty-eight hours. Obviously, adjustments may need to be made for comfort.

• You may shower starting on post-operative day one, unless otherwise instructed.  You may not bathe for one week. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the waterproof dressing.

DIET:

• Water is your friend. You should drink approximately eight glasses of water a day. This will make you feel better and keep your bowel movements nice and soft.

• You may eat anything you want. I would suggest staying away from foods that make you gassy or bloated, or foods which tend to constipate you, such as rice and potatoes. I would also stay away from greasy or fatty foods, which may tend to nauseate you, for the first twenty-four to forty-eight hours.

BOWEL MOVEMENTS:

• Pre-operatively a stool regime was recommended to you. I would continue that stool-softening regime for the first one to two weeks. You may stop taking the mineral oil after one week. I would continue the Metamucil for the second week, and you may continue that indefinitely.

• If you have not moved your bowels in forty-eight to seventy-two hours after surgery, I recommend taking 45cc of Milk of Magnesia, either in the morning or prior to bed. Remember, it takes eight hours for the Milk of Magnesia to work, so you do not want to take it so that the time sequence would fall in the middle of the night. When you strain to move your bowels, press firmly against the incision. This will alleviate some of the pain, which comes with pushing out bowel movements.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Persistent diarrhea or vomiting.
2. Temperature greater than 101 for more than 24-hours.
3. Excessive bleeding, beyond that which was described in the above.
4. No bowel movement 24-hours after taking Milk of Magnesia.
5. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions for Sentinel node biopsy, Axillary node biopsy and Axillary node dissection  (Click here for printable/downloadable version)

You have just had either a sentinel node biopsy, an axillary node biopsy, or an axillary node dissection.  Please follow my instructions to help minimize pain and length of recovery. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• Please note that you have skin glue for a dressing over your wound. If you have had a lumpectomy simultaneously you may not see this dressing, as it may be under the breast dressing. You will see it when you remove the gauze covering the breast. This dressing is waterproof and allows you to shower.

• You may notice some blood underneath the dressing. If the blood is leaking out from under the dressing. I would recommend getting some sterile gauze and tape and placing it over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops. I would still not recommend removing the dressing. If you feel you need to remove the dressing, please call the office.

• 95% of the time the sutures are not visible and are self-absorbing. You may see little white tapes over the incision, which help to held the wound together. These may become stained with blood and, again, that is nothing to worry about.

• Starting around the second or third day. You may notice blood under the skin or a “black-and-blue mark.”  This can be extensive and is not a cause for concern and it will all be re-absorbed over a period of a week or two.

• You may also notice swelling in the area of the wound and this generally begins to appear on the second or third day and peaks around the fifth day. It may actually appear as if you have a lump growing under your arm. This, is likely just some fluid under the wound which could be re-absorbed on its own or which I may remove at your first visit with a needle. Again, it is nothing to worry about and is quite common. The lump should go away over a period or two or three weeks. If you are very uncomfortable, please call and we may have you come in sooner.

• You may also have a Jackson-Pratt drain, which is a clear plastic tube leading to a bulb. Please see the separate instruction sheet, which I have given you for Jackson-Pratt drains if this is the circumstance.

PAIN CONTROL:

• Your wound was injected with a long-acting local anesthetic prior to starting the procedure. This wears off in anywhere from four to eight hours. It is important that you start taking your pain medication before this medication wears off. It is much easier to prevent pain from occurring than it is to stop it once it has occurred. Keep this in mind when taking your oral medication as well. You have been given a narcotic, unless you otherwise specified. You may need this only for a short period of time, after which you can switch to either Tylenol or Ibuprofen or Aleve.

• For the first two days, ice is important in keeping the swelling down and reducing pain. You may use an ice pack that does not get the wound wet. Ice Should be applied twenty minutes on and twenty minutes off. The ice should not be in contact with the skin directly for more than twenty minutes, as it can cause frostbite. Ice is only effective for the first forty-eight hours. Following the first forty-eight hours, a heating pad can be used and, again, for only short periods of time, ten or fifteen minutes, as not to burn the skin.

• You may notice numbness or tingling underneath the incision and underneath the arm. Most of this should resolve over a period of a month. You may be left with a small numb patch under your arm, which will be permanent.

• It is important to start moving your arm as soon as possible. I would discourage you from doing vigorous activity, however, I would use your arm for normal activities of daily living, such as reaching for plates and dishes on a cupboard shelf. At your first post-operative visit. I will give you instructions for exercises so that your shoulder does not stiffen up.

ACTIVITY:

• You may carry out most of your daily activities, including driving, see below. Be sure to wear your sports bra during these activities. Even after two weeks, you might find it more comfortable to wear your sports bra whenever you are active for the first month or so. I would recommend avoiding contact sports and vigorous exercise for the first few weeks. Once the wound is no longer tender to touch and you have seen me for your first post-operative checkup, we can discuss what type of activity you would like to engage in and how long a period you should refrain from that.  We will give you exercises to do at your first visit.

• You may engage in sexual activity at any time after the surgery that you wish.
• You may drive in three days.  Start with a short trip.  Do not drive while using the narcotic.

DIET:

• You have no dietary restrictions that you did not have existing pre-operatively.

BOWEL MOVEMENTS:

• If you are taking Percocet for a period of several days and certainly if you are taking it more than once a day during this period of time, you may begin to experience constipation. If this is the case, I would recommend taking Milk of Magnesia or Senokot or a similar laxative if you have not had a bowel movement for a total of 72-hours.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Temperature greater than 101 for more than 24-hours.
2. Excessive bleeding or swelling, beyond that which was described in the first section.
3. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Arm exercises after Lymph node operation  (Click here for printable/downloadable version)

CIRCLES

Lift arm shoulder height to the side. Make 5 small circles then 5 large circles using entire arm. (Swing from the Shoulder.) Do five times a day.

SWINGING

Use the arm opposite to surgical site to hold side of a chair (or table) for support. Keeping body steady, swing hand (on side of surgical site) in front of body from left to right. Then swing hand back and forth. Do each 5 times a day.

WALK UP THE WALL (ltsy Bitsy Spider)

Start sideways to the wall and walk your hand up until it is straight and your hip touches the wall. Stop if it hurts.  Goal: To reach as high as your hand opposite to the surgical site can. Do 5 times a day.

BACK SCRATCHING

Scratch your back with hand opposite to surgical site keeping elbow bent and close to your head. See if you can point your elbow to the ceiling.  This is your measure for the surgical side.  Next. scratch your back with the hand on the same side as the surgical site using your opposite hand to straighten and pull your elbow close to your head.  It is good to do this in the mirror. Do 5 times a day.

Post-Operative Care Instructions For Laparoscopic and Open Colon Surgery (Click here for printable/downloadable version)

You have just had a portion of your colon removed, whether it was done laparoscopically or via traditional opened fashion, the internal anatomic procedure was exactly the same. Please follow my instructions to help minimize pain and recovery after. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• If you had an opened operation you probably have clips, which were placed at the time of your procedure. You may shower over these clips. You also may apply Bacitracin or Neosporin ointment over the clips as well.

• If you had a laparoscopic procedure, you have skin glue over the wounds. Please leave this in place until you see me. You may shower.

• You may notice some blood under the clear plastic dressing. This is quite common and unless it is a large amount, it is not a cause for concern. If there is a bubble of blood under the plastic dressing, I would advise making a tiny opening with the tip of a scissor or a pin and gently squeeze the blood out onto a gauze pad or tissue. Then, just continue to allow the dressing to stay intact. If the blood is leaking out from under the dressing, I would recommend getting some sterile gauze and tape and placing It over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops.

• The most common occurrence after a colectomy is a wound Infection. This will evidence Itself by puffiness and redness around the wound. You also may have increasing pain rather than decreasing pain as time goes along. Certainly, if puss or bleeding is draining from the wound in significant amounts, this would be another sign. In any of these cases, please call the office Immediately as I may need to treat this Infection both physically and with antibiotics.

PAIN CONTROL:

• By the time you have been discharged from the hospital your pain should be decreasing. I probably have sent you home on a narcotic, which is Percocet or Vicodin. It is important that you relieve your pain, however remember that these medications will constipate you so do not use them too extensively. It is also permissible to take anti-inflammatory medication along with the narcotic. This may be Advil or Aleve (over-the-counter) or I may have given you Celebrex as a prescription. These medications should be taken with food. If you have stomach upset with them, please discontinue them.

• It is common for wounds to hurt most when you are trying to fall asleep. This is because you have no external stimuli to distract you. Also, as you begin to Increase your activity you may notice soreness around the wound. The anti-inflammatory medication is quite helpful for this kind of soreness. You may use a heating pad on the wound, but be careful not to burn yourself as the wound may be slightly numb. Remember you may have pain on and off for three to six months as you heal and resume normal activities. This pain does not necessarily indicate an actual Internal problem. It is simply indicative of the normal healing process.

ACTIVITY:

• Initially you may walk or climb stairs only. After the first ten days or so after surgery you may begin light lifting. You may also begin to drive (provided you could drive before surgery!). Beginning the first two weeks after both traditional and laparoscopic surgery you may begin to lift light-weight objects. Two weeks after laparoscopic surgery you may return to your full activity. If you have had opened surgery, I would recommend waiting a full three weeks prior to beginning full activity and heavy exercise. Remember, being a little patient in the beginning will allow the wound to become more comfortable more quickly.

• You may engage in sexual activity after forty-eight hours. Obviously, adjustments may need to be made for comfort.

• You may shower starting on post-operative day two, unless otherwise instructed. Certainly, you probably have not been discharged from the hospital until day three or four, so that you may shower by the time you get home. You may not bathe for one week. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the waterproof dressing.

DIET:

• Water is your friend. You should drink approximately eight glasses of water a day. This will make you feel better and keep your bowel movements nice and soft.

• Initially you should stay away from fibrous foods, such as raw fruits or vegetables.  Starting about a month or so following surgery, you may begin to eat anything that you would like.  I would also recommend staying away from greasy or fatty foods, which may tend to nauseate you, for the first three or four days when you have begun eating.

BOWEL MOVEMENTS:

• Bowel movement can be quite irregular the first three or four weeks after colon surgery.  Your initial bowel movements in the hospital may have been loose and begun to have firmed up by the time you have gone home. If they have not, this is not abnormal. Depending on the amount of colon that you had removed and the portion of the colon that you have been removed, your bowel habits may have changed slightly forever, i.e. If you have had one bowel movement per, now you have two.  It should not be extreme however, if you have noticed increasing diarrhea or increasing abdominal pain, you should call the office right away.  This may be related to an antibiotic induced infection that you may have contracted at the hospital and can be easily treated with another antibiotic.

• If you do not move your bowels for a three-day period at any time during the first month after surgery, I would like you to give me a call. This may simply be related to constipation from the pain medication; however, I would like to know about It.

• If you have small amounts of blood in your stool, this also is probably normal. If it continues for several days or increases, please give me a call. It may help you to push against your incision when you go to move your bowels. This may alleviate some of the pain which comes along with pushing.

• It is not a bad idea to pick up acidophilus capsules from the pharmacy. I would recommend taking two capsules three times a day.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Persistent diarrhea or vomiting.
2. Temperature greater than 101 for more than 24-hours.
3. Excessive bleeding, beyond that which was described in the above.
4. No bowel movement 24-hours after taking Milk of Magnesia.
5. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.

Post-Operative Care Instructions For Laparoscopic and Open Appendectomy (Click here for printable/downloadable version)

You have just had an appendectomy, whether it was done laparoscopically or via traditional opened fashion, the internal anatomic procedure was exactly the same. Please follow my instructions to help minimize pain and recovery after. Call the office as soon as possible for a post-operative appointment.

WOUND CARE:

• If you had an opened operation you may have clips, which were placed at the time of your procedure. You may shower over these clips. You also may apply Bacitracin or Neosporin ointment over the clips as well.

• If you had a laparoscopic procedure, you have skin glue over the wounds. Please leave this in place until you see me. You may shower over the wounds.

• You may notice some blood under the glue or dressing. This is quite common and unless it is a large amount, it is not a cause for concern. If there is a bubble of blood under the plastic dressing, I would advise making a tiny opening with the tip of a scissor or a pin and gently squeeze the blood out onto a gauze pad or tissue. Then, just continue to allow the dressing to stay intact. If the blood is leaking out from under the dressing, I would recommend getting some sterile gauze and tape and placing it over the dressing for the first twenty-four to forty-eight hours until the leakage of blood stops.

• The most common occurrence after an appendectomy is a wound Infection. This will evidence itself by puffiness and redness around the wound. You also may have increasing pain rather than decreasing pain as time goes along. Certainly, if puss or bleeding is draining from the wound in significant amounts, this would be another sign. In any of these cases, please call the office immediately as I may need to treat this infection both physically and with antibiotics.

PAIN CONTROL:

• By the time you have been discharged from the hospital your pain should be decreasing. I probably have sent you home on a narcotic, which is Percocet or Vicodin. It is important that you relieve your pain, however remember that these medications will constipate you so do not use them too extensively. It is also permissible to take anti-inflammatory medication along with the narcotic. This may be Advil or Aleve (over-the-counter) or I may have given you Celebrex as a prescription. These medications should be taken with food. If you have stomach upset with them, please discontinue them.

• It is common for wounds to hurt most when you are trying to fall asleep. This Is because you have no external stimuli to distract you. Also, as you begin to increase your activity you may notice soreness around the wound. The anti-inflammatory medication is quite helpful for this kind of soreness. You may use a heating pad on the wound, but be careful not to burn yourself as the wound may be slightly numb. Remember you may have pain on and off for three to six months as you heal and resume normal activities. This pain does not necessarily indicate an actual Internal problem. It is simply indicative of the normal healing process.

ACTIVITY:

• Initially you may walk or climb stairs only. After the first ten days or so after surgery you may begin light lifting. You may also begin to drive (provided you could drive before surgery!). Beginning the first two weeks after both traditional and laparoscopic surgery you may begin to lift light-weight objects. Two weeks after laparoscopic surgery you may return to your full activity. If you have had opened surgery, I would recommend waiting a full three weeks prior to beginning full activity and heavy exercise. Remember, being a little patient in the beginning will allow the wound to become more comfortable more quickly.

• You may engage in, sexual activity after forty-eight hours. Obviously, adjustments may need to be made for

comfort.

• You may shower starting on post-operative day two, unless otherwise instructed. Certainly, you probably have not been discharged from the hospital until day five or six, so that you may shower by the time you get home. You may not bathe for one week. I do not want the wound to be soaked. You may, however, stand with your back to the shower and let water gently run over the waterproof dressing.

DIET:

• Water is your friend. You should drink approximately eight glasses of water a day. This will make you feel better and keep your bowel movements nice and soft.

• Staying away from greasy or fatty foods, which may tend to nauseate you, for the first three or four days When you have begun eating.

BOWEL MOVEMENTS:

• Your initial bowel movements in the hospital may have been loose and begun to have firmed up by the time you have gone home. If they have not, this is not abnormal. If you have noticed increasing diarrhea or increasing abdominal pain, you should call the office right away. This may be related to an antibiotic induced infection that you may have contracted at the hospital and can be easily treated with another antibiotic.

• If you do not move your bowels for a three-day period at any time during the first month after surgery, I would like you to give me a call. This may simply be related to constipation from the pain medication; however, I would like to know about It.

• If you have small amounts of blood in your stool, this also is probably normal. If it continues for several days or increases, please give me a call. It may help you to push against your incision when you go to move your bowels. This may alleviate some of the pain which comes along with pushing.

• It Is not a bad idea to pick up acidophilus capsules from the pharmacy. I would recommend taking two capsules three times a day.

YOU SHOULD CALL ME IF ANY OF THE FOLLOWING OCCUR:

1. Persistent diarrhea or vomiting.
2. Temperature greater than 101 for more than 24-hours.
3. Excessive bleeding, beyond that which was described in the above.
4. No bowel movement 24-hours after taking Milk of Magnesia.
5. If your pain is increasing steadily over a period of several days rather than slowly decreasing, I would recommend that you give me a call.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK OR OTHER EMERGENT PROBLEM, PLEASE CALL 9-1-1 FIRST TO HAVE AN AMBULANCE BRING YOU TO THE HOSPITAL, THEN CONTACT THE OFFICE TO LET ME KNOW WHAT IS GOING ON.