Preparing for Colon or Rectal Surgery

Transcription

1 Preparig for Colo or Rectal Surgery A successful surgery starts with plaig OUR MISSION As people of Providece, we reveal God s love for all, especially the poor ad vulerable, through our compassioate service. OUR CORE VALUES Respect, Compassio, Justice, Excellece, Stewardship Please visit our website to watch a video about preparig for your colo or rectal surgery: Providece.org/surgery We do ot discrimiate o the basis of race, color, atioal origi, sex, age, or disability i our health programs ad activities.

2 Pla ow for successful surgery This booklet is supplemetal to your surgeo s istructios ad is iteded to help you successfully recover from your upcomig colorectal surgery. Preparig for surgery ca be a stressful time. We hope the iformatio outlied here will aswer some of your questios ad ease your stress. Please make otes if you have questios, ad let us kow how we ca help. Our highly skilled surgeos wat to esure your safety. If you have chroic medical coditios, such as diabetes or aemia, we may refer you to a perioperative specialist or to your primary care provider before surgery i order to help fie-tue your medical coditios to optimize your outcome. Before surgery Preparig for surgery Please go olie ad watch this video about preparig for colorectal surgery: Providece.org/ surgery ad click o the Preparig for Colo or Rectal Surgery lik at the bottom left. If you smoke, stop smokig. This is the most importat thig you ca do. Stoppig for at least 2 weeks before surgery will be greatly beeficial. For help to quit smokig, call Providece Resource Lie ( ) or Quit for Life (1-866-QUIT4-LIFE, ), or go to Providece (Providece.org/stopsmokig) or the America Lug Associatio ( Impact Advace Recovery is available at the followig Providece locatios for $35: Stay physically active ad eat a healthy, balaced diet. CONTENTS BEFORE SURGERY Pla ow for successful surgery... 2 Preparig for surgery...3 Pla ow for your discharge from the hospital...4 Takig your medicatios...4 Eatig ad drikig... 4 Examples of colo or rectal procedures... 5 AFTER SURGERY IN THE HOSPITAL Eatig ad drikig... 6 Beig active... 6 Discharge from the hospital... 6 AFTER SURGERY AT HOME Post-operative Pai Maagemet... 7 Chroic Pai Medicatios PREPARING FOR COLON OR RECTAL SURGERY Activity... 8 Drivig... 8 Bowel movemets... 8 Diet... 9 Icisio (Woud, Scar)... 9 Sleep... 9 Steroids... 9 Uriatio Work Warig sigs About ostomies What is a stoma? Will I eed oe? Is it permaet? What to expect post-operatively If you are overweight, talk with your doctor about safe ways to lose weight ad by avoidig sugary driks (i.e. o soda or juice) ad processed fast foods. Emphasize fresh fruits ad vegetables ad lea protei (fish, chicke, beas). Losig oe to two pouds of weight per week is safe ad ca help reduce your risk of complicatios. Providece Plaza Pharmacy o the campus of Providece Portlad Medical Ceter 5050 NE Hoyt St., Suite 142, Portlad Providece St. Vicet Medical Office Buildig Pharmacy 1st Floor Lobby 9155 SW Bares Road, Portlad Providece Medford Medical Ceter, Emilie Café located o the groud floor of the hospital 111 Crater Lake Ave, Medford Cafés at Providece Newberg, Providece Hood River, Providece Milwaukie, ad Providece Willamette Falls Outside of Providece (prices vary): Amazo.com Nestleutritiostore.com CWIMedical.com If you are uderweight, eat a healthy diet with extra calories ad protei. Icrease sacks. Homemade or store bought (i.e. Boost, Esure or istat breakfast driks) utritio driks or protei bars ca help. Your doctor may also advise you to drik Impact Advace Recovery (a immuoutritio drik) three times a day, five days before, ad five days after your surgery. To lear more, please visit: 3

3 Before surgery (cotiued) Before surgery, shower accordig to your surgeo s istructios, usig soap or a 4% chlorhexidie glucoate (CHG) atiseptic solutio, such as Hibicles. Do ot shave the area where you will have surgery. Remove jewelry prior to comig to the hospital. If you have body piercigs, these should be removed as well. If your employer requires paperwork i order to accommodate your absece from work, sed it to your surgeo s office before your surgery. Pla ow for your discharge from the hospital Prepare your home. Look aroud your home ad idetify ay potetial hazards with beig able to move ad get aroud. You may eed to rearrage your furiture. Remember you should ot lift more tha 10-15lbs after surgery, so makig sure thigs are i place before surgery will really help i your recovery phase. Coordiate with your support system (family/ frieds) to be available to help you durig your recovery. If you feel you do ot have adequate support at home, iform your surgeo, so they are aware ad ca provide you with iformatio o possible resources. Pla your meals ahead of time. Do your grocery shoppig, prepare ad freeze several meals before you come to the hospital. You will likely be o a low fiber diet at time of discharge (o raw vegetables or fruits for about two weeks after colo surgery). This allows your body time to heal, without overworkig the digestive tract to absorb food ad utriets. Takig your medicatios Prior to surgery make sure your medicie cabiet has acetamiophe ad ibuprofe (if your surgeo says you ca take). You will eed these for your postoperative recovery period. O the day of surgery, take your regular medicatios as istructed by your surgeo with a sip of water. A urse at the hospital will review all prescriptios, supplemets ad over-the-couter medicatios that you ormally take at home. Please make a list of the ames, stregths ad dosages of all of these products. Brig this list to the hospital with you. Our aesthesiologist will likely call you before your surgery to discuss the sedatio process, improvig postoperative pai, ad reducig the risk of ausea. Eatig ad drikig Your surgeo will istruct you regardig bowel preparatio ad whe to stop eatig solid food. You ca drik clear liquids (i.e. aythig you ca read a ewspaper through), such as black tea or coffee, pulp-free juice, or Gatorade, util two hours before you are scheduled to arrive at the hospital. (For example, if you are scheduled to arrive at the hospital at 7 a.m., you may drik clear liquids util 5 a.m.) If you have diabetes, cosider a sugar-free versio. EXAMPLES OF COLON OR RECTAL PROCEDURES Right Hemicolectomy ascedig colo ad cecum are removed. The colo is the recoected to the small itestie. Left Hemicolectomy descedig colo is removed. The trasverse colo is the recoected to the rectum. Sigmoid Colectomy sigmoid colo is removed. The descedig colo is the recoected to the rectum. Low Aterior Resectio The sigmoid colo ad a portio of the rectum are removed. The descedig colo is recoected to the remaiig rectum. Abdomial Perieal Resectio sigmoid colo ad the etire rectum ad aus are removed. A colostomy is the performed. 4 PREPARING FOR COLON OR RECTAL SURGERY 5

4 After surgery IN THE HOSPITAL After surgery AT HOME Most patiets are i the hospital for oe to five days after surgery. If a uriary catheter was placed at the time of surgery, it will likely be removed oe or two days after surgery. Eatig ad drikig You will likely start drikig clear liquids immediately after surgery. Typically, if you are feelig well, you will start a low-fiber diet the ext day. Beig active Your urse will help you get up after surgery. You will get up at least three times the day after surgery. Gettig out of bed ad walkig aroud will help reduce your risk of prologed hospitalizatio. Advocate for yourself! Your urses are busy, so you may eed to remid them that you have t walked yet. Ask them to get you up. We will provide you tools to help with your recovery, such as a icetive spirometer to help with deep breathig exercises. Pai after surgery Pai from the icisios is ormal. It will vary from day to day ad with activity level, but should gradually decrease over time. It would be urealistic to presume you will have zero pai immediately after surgery, but keepig your pai well cotrolled with a combiatio of over-the-couter medicatios ad low dose opiates as eeded will speed your recovery. The most importat compoet to good pai cotrol is beig proactive with pai, ot reactive. Oral pills cotrol pai better tha itraveous (IV). If you are eatig, IV should be the last optio for pai cotrol ad oly i limited, acute situatios. If you had a laparoscopic surgery, you may have aches i your shoulders ad abdome. This is due to the carbo dioxide placed iside your abdome durig the surgery, this is harmless, ad will disappear withi a few days. You may also otice some small air bubbles uder the ski of your abdome or chest that crackle whe pushed o. This is also ormal ad will resolve itself i a few days. Crampy abdomial pai ad bloatig is ot ucommo. This should also improve slowly over time. Eatig small frequet meals (as opposed to large ifrequet meals) may help prevet bloatig. Gas Pais: As the bowels are recoverig it is ot ucommo to get occasioal sharp, gas pais, that travel across your abdome. Walkig will really help to alleviate this discomfort. Takig opiates for gas pais is ot effective, as they come ad go too fast before the medicie has time work. Opiates also slow dow bowel fuctio, ad could make thigs more ucomfortable. Some patiets feel simethicoe (products like Gas-x ) are effective whe walkig is ot a optio. You will be discharged from the hospital whe: 1. You ca tolerate your diet without ausea or vomitig 2. Your pai is cotrolled with oral medicie oly 3. Your surgeo may require bowel fuctio (passig gas or have ileostomy output) before discharge. Post-operative Pai Maagemet Over-the-couter medicatios are very helpful at cotrollig post-operative pai. If you received these i the hospital, you should cotiue use at home util your pai improves. Acetamiophe ad ibuprofe (if your surgeo approves) are the medicatios that reduce the iflammatio that is the primary source of post-operative pai. Usig these medicies as the first lie of defese for pai cotrol will sigificatly improve your recovery ad reduce the eed for opiates. Acetamiophe 650mg (2 pills, 325mg each) every 6 hours or up to 4 times per day. DO NOT USE if you have liver problems. Ibuprofe 600mg (3 pills, 200mg each) every 6 hours or up to 4 times a day. Use oly if istructed by your surgeo. DO NOT USE if you have kidey or stomach problems, history of ulcers, or are over 75. You may be discharged with prescriptios for the same or similar opiate pai pills we prescribed you i the hospital. This program should ease your pai ad reduce ay problems with the retur of bowel fuctio. Your opiate pai medicatio if prescribed (i.e. Tramadol, Oxycodoe, Vicodi, or Norco) should be used sparigly, ad oly if the above over-the-couter medicatios are ot adequate. Try to stop the opiates as soo as possible after surgery to avoid costipatio ad ausea. You should quickly wea from opiates to prevet depedecy issues i the future. Use acetamiophe ad ibuprofe (if able) as they are the workhorses for pai cotrol because they reduce the iflammatio that causes pai. The best way to cotrol pai is to leap frog betwee differet pai medicatios roughly every three hours, so that you have cosistet coverage. That way, as oe medicatio is wearig off, the other is kickig i. If your surgeo has recommeded postoperative use of acetamiophe ad ibuprofe, a example schedule would be: 7 a.m. 650 mg acetamiophe (add opiate if severe pai) 10 a.m. 600 mg ibuprofe 1 p.m. 650 mg acetamiophe 4 p.m. 600 mg ibuprofe 7 p.m. 650 mg acetamiophe Bedtime 1-2 opiate We typically prescribe a week of opiates with the expectatio that every day you will be less paiful tha the day prior. Opiate refill requests are ot automatic, ad will be decided o a case by case basis. Ideally you should wea off opiates withi a week or two of surgery. If you eed refills that are ot icluded with your origial prescriptio, please call your surgeo durig office hours (M-F, 9 a.m. to 4 p.m.) to request a refill. Refills will ot be give o weekeds/ ights by the o-call physicia. Allow at least 48 hours for a refill to be processed. If you have severe abdomial pai that does ot improve over time, or have crampy abdomial pai associated with vomitig please call your surgeo. 6 PREPARING FOR COLON OR RECTAL SURGERY 7

5 Chroic Pai Medicatios If you are receivig chroic pai medicatios (opiates) you will eed to cotact your prescriber, ad let them kow you are havig surgery. Your surgeo s office will ot prescribe or refill chroic pai medicatios, so keep i touch with your provider to make sure your baselie medicatios are provided by them. Activity Reduce your risk of complicatios by gettig out of bed to sit i a chair or walk i the hallway. Uless otherwise istructed, it is appropriate to walk, climb stairs, ride as a passeger i a car, ad perform tasks of daily livig. Liste to your body ad do t overdo it early o. It is ormal to feel fatigued after surgery. It is also commo to eed more sleep tha usual. Cotiue to walk frequetly, push yourself to go a little further everyday with your activity level. Avoid sittig or lyig i bed for log periods. As you recover you will slowly feel more like yourself, but your eergy level will take time to retur because the body eeds time to heal. After abdomial surgery, avoid heavy liftig (10-15 lbs. or more) for 6 weeks to allow most of the woud healig to occur. Eve small icisios still pose a heria risk, because the abdomial wall has bee weakeed from the icisio. We will discuss at your follow-up appoitmet whe it is appropriate to advace your weight restrictios depedig o your specific surgery. Uless otherwise istructed, sexual activity may be resumed as tolerated. Drivig You will eed to avoid drivig for 1-2 weeks or more depedig o your specific surgery. You will eed to arrage trasportatio home from the hospital. Pai ad use of opiate pai medicatio will impair your ability to drive safely. You may feel you are safe to drive, but stop ad let someoe else help you get to where you are goig. DO NOT DRIVE WITHIN 24HRS OF TAKING OPIATE PAIN MEDICATION. Drivig uder the ifluece of drugs ca be dagerous, ad it is illegal. Bowel Movemets It is ormal to have chages i your bowel fuctio after surgery, icludig costipatio (ofte a result of opiates). Immediately after itestial surgery, bowel movemets may be more frequet ad upredictable. It is commo to have loose, watery stools for several days. Powdered fiber supplemets (Metamucil, Citrucel, Kosul, Fiberco, Psyllium, Beefiber, Fibersure) are all quite helpful. These products are ot laxatives. They work by absorbig water ito the stool to icrease its bulk. They ca help with loose stools as well as costipatio. Drik eough water (6-8 glasses a day) to allow the fiber to work i the itestie. Avoid caffeie ad alcohol durig your recovery. Depedig o what surgery you had, your bowel fuctio may ot retur to its pre-operative state. However, it is importat to remember that this almost always improves with time, but may require a discussio with your surgeo. The best way to avoid post-operative costipatio is to miimize opiate use by usig the over-thecouter medicatios described above ad remai active. If this remais a issue, discuss with your surgeo. If watery diarrhea persists for more tha a few days, it may be sig of a imbalace of bacteria i the itestie, which may eed to be treated with a atibiotic. Please call your surgeo if this occurs. If you have abdomial pai, bloatig, ausea, or vomitig ad are uable to pass gas or a bowel movemet, this may be sigs of itestial obstructio (blockage). Call your surgeo or go to the Emergecy Room (ER) if this occurs. Diet Some patiets feel full half-way through a meal. Small, frequet meals are more easily tolerated after abdomial surgery tha your typical three large meals. You may be asked to remai o a low fiber diet (avoid cruchy vegetables ad raw fruits) for the two weeks followig major abdomial surgery. Slowly reitroduce vegetables ad fruits back ito your diet after two weeks, uless directed otherwise. Chew food well. It is importat to drik eough fluid to stay hydrated. A good rule of thumb is to drik eough to keep your urie a light yellow color (usually at least 6-8 glasses daily). Avoid alcohol ad caffeie because they ca cause dehydratio. Sackig o protei foods like eggs, peaut butter, ad cheese, or drikig utritio supplemets with protei (Impact, Esure, Boost, ad Caratio Istat Breakfast) will help with recovery. Icisio (Woud, Scar) Wash your hads before ad after you chage your gauze dressig or touch your scar. Uless told differetly, you may shower whe you feel up to it after surgery. No baths for 2 weeks after discharge from the hospital. Do ot scrub icisios, let the soap ad water flow over them to clea but do ot scrub. Make sure to rise body well. Pat dry with clea towel or gauze. Keep your icisio clea ad dry all day. Do ot use oitmets, creams or lotios o icisio(s). Mior draiage of clear yellow or red-yellow fluid from the icisio is ormal. Thick, opaque, dark yellow fluid or redess spreadig beyod icisio site o ski may be associated with ifectio. Please call if this occurs. Bruisig aroud the icisio sites is ormal ad will resolve o its ow with time. If bruisig icreases i size after discharge, call your surgeo to discuss. Bloody rectal discharge is also ormal. You do ot eed to keep the icisio(s) covered, but occasioally a gauze badage will help protect clothig if you are still havig some draiage from the icisio. May icisios are closed with absorbable sutures that do ot eed to be removed. If surgical staples or o-absorbable suture is used i its place they will be removed at your follow up visit i days depedig o your specific surgery. Most healig takes place withi 6 weeks after surgery, but the scar will still softe over time. The fial appearace of the scar may ot be apparet util oe year followig surgery. Sleep Major surgery ad beig i the hospital ca disrupt sleep patters. They usually retur to ormal over time. We do ot routiely recommed sleep medicatio for home use. Steroids If you were takig steroids (Predisoe, etc.) i the moths prior to your surgery, you may also eed to take them for a short period of time followig surgery (typically 3-4 weeks). Your surgeo will direct you o dose chages. Uriatio If you had a catheter (foley) placed ito your bladder at the time of surgery, it is ot uusual to experiece mior discomfort durig uriatio for several days after catheter is removed. If this discomfort persists or worses, It may be a sig of ifectio, please call your surgeo. Occasioally the bladder does ot empty properly after surgery. This is usually a temporary problem that resolves with time. If you are uriatig small amouts frequetly (every hour or so), please call your surgeo. Occasioally it is ecessary to replace the catheter for a few days. 8 PREPARING FOR COLON OR RECTAL SURGERY 9

6 Work Uless otherwise istructed, employmet may be resumed as tolerated as log as your occupatio does NOT ivolve heavy liftig. Please ask your surgeo or the cliic about ay FMLA forms eedig to be filled out related to work, isurace or disability issues. Warig sigs Be aware of warig sigs that may develop. These may idicate that a problem, such as a ifectio, is developig. Call your surgeo if you develop ay of these sigs: Fever higher tha F Icreasig abdomial pai Persistet ausea or vomitig Redess, tederess or icreased warmth aroud icisio Pus-like or foul-smellig draiage from icisio Go to the emergecy departmet or call 911 if you thik you are experiecig a life-threateig coditio. About ostomies What is a stoma? Depedig o the type of surgery you have, you may eed a ostomy, also kow as a stoma or a bag. A ostomy is whe the itestie is brought up through a opeig i the abdome to allow for removal of stool. Whe it is made from the colo, it is called a colostomy. Whe it is made from small itestie, it is called a ileostomy. Will I eed oe? Your surgeo will decide whether a ostomy is medically ecessary for you. If it is, a ostomy urse will set up a appoitmet with you to teach you how to care for the ostomy, to cousel you ad to aswer your questios. This urse will also visit you i the hospital. They are excellet resources. There are may olie resources, as well, icludig: or Is it permaet? It depeds o the reaso it was created. Most of these are loop ileostomies to protect a colo or rectal hookup (i.e. aastomosis) dowstream, with the pla for reversal i 3-6 moths if everythig has healed. If you have a ileostomy: It is very importat to keep yourself well hydrated to compesate for the loss of fluid through the stoma. A good rule of thumb is to drik eough to keep your urie a light yellow color. Ileostomy output goal is uder 1200 ml per day (approx. 1 liter or 1 quart per day). You should measure this for the first 2 weeks after surgery to make sure that you are i this rage. You will have to be aware of your output. Too much output ca make you dehydrated very easily. Ileostomy stool cosistecy will vary based o what you eat. Goal cosistecy is like thi applesauce. If it is too thi, start with thickeig foods, like the BRAT diet (baaas, rice, applesauce, toast), peaut butter, or marshmallows. A dietitia or ostomy urse ca help. NOTES My surgeo s ame Alteratively, ileostomies ca have too little output, which may represet a blockage. If you ve ot had ay output i 12 hours, or if the stoma becomes swolle ad ot producig, call your surgeo immediately or go to the local ER. Foods that will icrease ad/or thi your ileostomy output iclude sugary driks (juice, Gatorade). If you have difficulty with keepig a pouchig system o for at least 24 hours or if there is recurret bleedig, severe pai, swellig aroud the stoma, the stoma stops fuctioig, or the stoma output is >1200 ml i 24 hours, please call your physicia. If you have questios or cocers, please call your surgeo. Most urget medical issues ca be hadled by your surgeo i the cliic durig regular busiess hours. Callig your surgeo first may help you avoid log, uecessary waits i the emergecy departmet. What to expect post-operatively You will receive istructio o how to care for your stoma while you are i the hospital ad you should feel comfortable with its care at the time of discharge. Learig to live with a ostomy will take a adjustmet. It is almost like re-toilet traiig. You should always brig a extra stoma wafer ad bag to all medical visits. My surgeo s phoe umber My surgery will be doe at My surgery is scheduled for I must arrive at the hospital by Additioal istructios All ostomy ad urie output must be recorded. If you empty it yourself while i the hospital, please leave it for the staff to measure. Colostomy output varies as it is typically solid stool. It is ormal to ot have colostomy output every day. 10 PREPARING FOR COLON OR RECTAL SURGERY 11