About Your Surgery Pre-operative Instructions Prior to Surgery Post-operative Instructions How to Reach Us

Transcription

1 About Your Surgery Pre-operative Instructions Prior to Surgery Post-operative Instructions How to Reach Us

2 Patient Name: Procedure: Other: Surgery Date: Pre-operative Instructions Vaginal Colpopexy Sacral Colpopexy Hysterectomy Uterosacral Vault Suspension Colporrhaphy Enterocele / Rectocele Repair Colpocleisis / Colpectomy Removal / Revision InterStim Pubovaginal Sling Medical Clearance Blood work at Lab Blood work on Admit. You are required to be medically cleared for surgery by your primary care physician and/or cardiologist within 30 days of your scheduled surgery. You have been given a medical clearance form that your physician will need to complete, as well as a script for an EKG and bloodwork. Please contact your physician and schedule your medical clearance appointment for the week of (not before this date). If your physician sends you to a lab for bloodwork, we suggest you do this at least two to three days before your appointment, but not before the date indicated above. We will need copies of your test results and completed medical clearance form faxed to us at the number on the form at least three (3) business days prior to your surgery. If you have any questions, please contact our nursing department. Please Note A physician at The Institute for Female Pelvic Medicine & Reconstructive Surgery is available for emergencies 24 hours per day. Office hours are Monday through Friday, 8 a.m. to 4 p.m. After hours and on weekends, you can leave non-urgent messages that will be returned the next business day. For urgent situations, the answering service can page the physician on call. Anesthesia 1 The type of anesthesia we recommend for your surgery is indicated below. However, when the anesthesiologist evaluates your medical needs, it is possible that a different type of anesthesia may be utilized. IV Sedation The anesthesiologist will administer medication through your intravenous line to make you sleep. You will breathe on your own as you sleep. Epidural/Spinal The anesthesiologist will place a thin catheter or perform an injection into the middle to lower back. This will numb the lower half of your body, and you will breathe on your own as you sleep. General General anesthesia causes a patient to be completely unconscious during surgery. A breathing tube will be inserted into your windpipe to maintain proper breathing during surgery. You may experience a sore throat after surgery. 10

3 How to Reach Us Allentown Office: Appointments Extension 100 Nursing Extension 102 Billing Extension 105 Surgery Scheduling Extension 109 Research Nurse Extension 103 North Wales Office: Appointments Option 1 Nursing Option 2 IMPORTANT REMINDER At your initial visit, you indicated with your initials and signature that you read and fully understood our financial policy and agreed to be bound by its terms. Appointment Cancellation/Reschedule Policy You may be charged a fee if you cancel/reschedule your surgery within ten (10) business days of your scheduled surgery date, or fail to show the day of your scheduled surgery. Facilities St. Luke s Allentown, 1736 Hamilton St., Allentown, PA The hospital staff will call you the business evening before surgery between 4 p.m. and 8 p.m. to inform you of their pre-surgery instructions and your arrival time. If you have any questions, please call the hospital s main number at St. Luke s Anderson, 1872 St. Luke s Blvd., Easton, PA The hospital staff will call you the business evening before surgery between 4 p.m. and 8 p.m. to inform you of their pre-surgery instructions and your arrival time. If you have any questions, please call the hospital s main number at Abington Memorial Jefferson Health, 1200 Old York Rd., Abington, PA The office staff will call you within 5 business days prior to surgery to inform you of your arrival time. The Pre-admission Testing department will call prior to surgery for a phone interview and inform you of their pre-surgery instructions. If you have any questions, please call the hospital s main number at Abington Surgical Center, 2701 Blair Mill Rd., Suite 35, Willow Grove, PA The center staff will call you the business day before surgery to inform you of their pre-surgery instructions and give you your arrival time. If you have any questions, please call the center s main number at Einstein Montgomery Surgery Center, 609 W. Germantown Pike, Suite 100, East Norriton, PA The center staff will call you the business day before surgery to inform you of their pre-surgery instructions and give you your arrival time. If you have any questions, please call the center s main number at Other: 9 2

4 Prior to Surgery Discontinue use of the following medications that have anticoagulant (blood thinning) properties seven (7) days prior to surgery. NSAIDs including but not limited to ibuprofen, Advil, Aleve, Motrin Asprin products including but not limited to Excedrin Anticoagulants including but not limited to Plavix, Coumadin, vitamin E, Elmiron, Meridia Herbal medications and supplements (all kinds) Multivitamins Please check with your primary care physician and/or the anesthesiologist regarding use of other medications you are presently taking (blood pressure, diabetes, cholesterol lowering, etc.). Leg Stretches Some patients experience discomfort in their legs and/or buttocks from positioning during surgery. To help minimize discomfort, we encourage you to stretch your legs each time you get in or out of bed for one month before surgery. While lying in bed, one leg at a time, simply bend your knee at a 90-degree angle. Rotate the hip to bring the knee out to the side until you feel a pull in the inner thigh. Hold this position for a few seconds, then pull your knee toward your ear and hold this position for a few seconds. Rectal Preparation Follow-up Visits A nurse will call to check on your progress 2-3 days after your surgery. At that time, you will schedule a post-op appointment approximately two (2) weeks from your surgery date. Our doctors/nurse practitioner will recommend subsequent office visits as necessary, generally a six (6) week post-op visit, and a six (6) month follow-up visit. If you had general anesthesia, you may feel tired the first couple of weeks. Keep moving, and you will recover more quickly. If you feel feverish, take your temperature. If it is greater than degrees, please call the office. You may take stairs, touching each step with both feet (as a toddler does) for the first few days, then as tolerated. Do not drive until you are free of discomfort from your surgery. If you can walk up and down the stairs and get in and out of a chair without discomfort, you may drive. Walking is a good, safe exercise. Please ask your doctor about resuming your usual exercise regimen. Remember to drink plenty of water when you exercise. No tub baths, hot tubs/spas for two (2) weeks. You may cool off in private swimming pools after your physician examines you at your first post-op appointment (no diving). Notes One day prior to surgery: At noon, the day before your surgery, take two (2) tablespoons or two (2) tablets of milk of magnesia. Take one (1) Fleet enema as directed on the box before bedtime the night before your surgery. Two (2) to three (3) days prior to surgery: Low-residue diet This will help decrease the distention of your bowel, which is beneficial for surgery. 3 8

5 Restrictions After Surgery (cont d.) For first two (2) weeks after surgery: Do not push, pull or lift more than 8 pounds (a gallon of milk). Minimize bending at the waist. No exercising, gardening or swimming (ocean or public pools). Do not drive a motorized vehicle (unless you are completely pain free). No long-distance traveling (more than 3 hours), no flying. For six (6) weeks after surgery: Nothing in the vagina (no tampons, intercourse, douche, vaginal estrogen, etc.). For next two (2) months: Avoid heavy lifting (20 to 30 pounds). Some restrictions may require up to 12 weeks; ask your doctor. When lifting or bending to pick up things, bend at your knees, not your back. Protect both your back and surgery. Notes Hospital Stay Most of our patients have outpatient/overnight, a brief one (1) to two (2) day hospitalization. We encourage you to return to your home environment as soon as possible. It is there that you will sleep and eat better, which is very important to your recovery. The hospitals are teaching centers and, therefore, resident physicians will be involved in your hospital care, always under your doctor s direct supervision. We ask that you be receptive to their participation in your care. We also have fellow physicians. These doctors have completed their residency in gynecology and are involved in subspecialty training exclusively with our practice. Our practice also utilizes a nurse practitioner who is specially trained in post-op patient care, medication follow-up, and routine pessary and other urogynecology care. Indwelling Urinary Catheter Post-operative Instructions Approximately 30% of patients experience temporary difficulty emptying their bladder after pelvic surgery. Swelling and discomfort can inhibit your ability to relax, the first step to a normal void. If you are unable to sufficiently empty your bladder, you may be discharged from the hospital with a temporary indwelling catheter. The temporary catheter will be secured to a leg bag that collects urine. Be sure the catheter collection bag is below the level of your bladder for proper drainage. If you have any questions on the care of your catheter, feel free to call our office. Our nurses will schedule a visit within several days to assess your ability to void and to have the catheter removed. Urinary Symptoms After Surgery If your surgery included a pubovaginal sling, you can expect improvement, hopefully resolution, of loss of urine with coughing, bending and lifting (stress incontinence). Surgery for prolapse will also likely improve your voiding. However, certain symptoms such as urgency, incontinence with urge, or frequency may persist after surgery. These symptoms are from functional changes in your bladder over time, and may well require additional medical and behavioral therapies after your surgery. 7 4

6 Items for Home Care Have the following over-the-counter medications and items ready for use at home: NSAIDs (ibuprofen, Advil, Motrin, Aleve ) Extra Strength Tylenol Stool softener (Colace or generic) Milk of magnesia Fleet disposable enema Epsom salt Thin maxi pads and/or pantiliners Pain Management Every effort is made to minimize your discomfort; however, pain after surgery is common, normal and to be expected. The following medications will help to alleviate discomfort in your legs and/or buttocks due to positioning for vaginal surgery. These pain medications work differently and can be used safely together. Take three (3) ibuprofen tablets every six (6) hours with food for relief of mild to moderate pain, swelling and soreness. For additional pain relief, you may take two (2) Extra Strength Tylenol capsules every four (4) hours. Post-operative Medications Resume your pre-operative medication unless instructed otherwise. Bowel Movements In order to protect your surgical repair, you should not strain for a bowel movement. Take one (1) 100mg Colace or generic equivalent tablet in the morning and one (1) tablet in the evening for stool softening. You may increase to two (2) tablets twice a day. Depending on your surgery, Colace should be used for two (2) to twelve (12) weeks or as directed by your doctor. In addition to stool softening, it may be helpful to use a gentle bowel stimulant or laxative if you fail to have a bowel movement for two (2) days. Take one (1) to two (2) tablespoons of milk of magnesia every six (6) to eight (8) hours as needed. Vaginal Incision You will have a vaginal incision with dissolvable sutures that will disintegrate on their own. You may note vaginal bleeding or spotting for possibly 6-8 weeks post-operatively. Please call if the bleeding becomes heavier than a period. You may notice a yellow vaginal discharge, which may have a mild odor while the vaginal sutures dissolve. A sitz bath may be ordered. DO NOT do a sitz bath while vaginal packing is in place. If you are able to safely get in and out of the tub, use two (2) cups of Epsom salt in six (6) inches of warm tub water for 20 minutes daily for two (2) weeks. You may use a commode sitz bath on your toilet with two (2) tablespoons Epsom salt in warm water. You may apply ice packs to the perineum (outside the vagina) for up to 20 minutes as often as needed. If you notice a rough, sticky patch in the groin or buttock area, do not attempt to remove it. This is surgical glue (used instead of stitches), which will loosen and fall off on its own. There may be oozing, bruising and/or pain at the external incision. This is normal and will resolve. You may apply ice or a BAND-AID as needed. You may have a slower urine stream after surgery. Take your time when you empty your bladder and reposition to empty as well as possible. This may or may not resolve over time with the decrease in swelling. Restrictions After Surgery You have just undergone pelvic surgery, and now it is your turn to play an important role in the long-term success of your surgical treatment. Surgery and the recovery period can be a difficult time. The following guidelines are presented with the goal of helping you recover from your procedure and give you long-lasting satisfaction from your surgery. If you continue to have a difficult bowel movement, please call the office. 5 6