Welcome to our new patients

Preoperative Instructions and Recovery Information
This document is intended to help you to be prepared for your surgery, to reduce
any fear, counteract any misinformation, and ease any anticipation about your
upcoming surgery. As you read this, please highlight and underline any
areas of concern, and write your questions on the sides of the pages so
that you can be sure to ask them during your surgery-planning visit. Bring
this material with you to every pre-operative visit and to the hospital so that
you can read and refer to it after your surgery because it also contains your
discharge orders. Your spouse, partner or friend who will be your main
caregiver should also read this entire document to be most helpful during
your hospitalization.
Choosing a date for your surgery –Recovery from a laparoscopic outpatient
minor procedure is one week. For a laparoscopic hysterectomy the recovery is
two weeks. For open laparotomy incision surgery of any type, the recovery is six
weeks. We build our office and surgical schedules around our commitment to
your surgery date. Choose your surgery date to allow for your recovery and so
that you will not have any reason to cancel your surgery at the last minute. Last
minute cancellations waste time and resources because we cannot simply
substitute another patient at the last minute.
Insurance - Make sure that we have all your up-to-date insurance information so
that we can obtain authorization for your surgery. We do this as a courtesy, so
you will know your portion of the probable charges.
Contacts - Please make sure we have your local and your cell phone numbers
so you can be contacted by the operating rooms if needed for any last-minute
change in the surgery schedule.
Pre-operative Visit–Your physician will formally review with you your findings
and will explain the risks, benefits, and alternatives of your specific surgical plan.
After that, you will be asked to sign consent forms for your surgery. Remember
that these consents are written to assure your and our understanding of your
proposed procedure. They are not contracts, so you can always change your
mind. Ask all your questions, and know that there is no pressure to sign anything
without your complete understanding and agreement. You will be given a folder
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 for all of your surgical documents that will include both your copy of these consent forms, and the hospital’s copy with your admitting orders for blood work, EKG and Chest X-Ray. Please remember to give all of the documents in the “Hospital Documents” section to the nurses when you check in at the hospital. Allergies and Current medications: Please fill out the last page list of
medication allergies and a list of all of your current medications with doses
and frequencies, including herbal, naturopathic, and over-the-counter
drugs. Stop taking any aspirins or Motrin, Nuprin, Advil, ibuprofen-like
substances 3 days before surgery. Use Tylenol (acetaminophen) if you need pain
relief before your operation. Stop all herbal remedies and nutritional
supplements, Meridia, Fastin, Ionamin, Adipex and any amphetamines 7 days
before your surgery. You must stop taking Mardil, Parnate, Eldepryl, Marplan
Clorgyline, Brofaromine, Moclobemide and Tolozatone at least 14 days before
your surgery. Stop all Plavix and Coumadin, 7 days before your surgery and
discuss Heparin/Lovenox with your physcian.
Pre Operative testing: If you have had any blood work in the last few months,
let us know, so we can avoid unnecessary blood-draws. Sometimes it is still
necessary to draw your blood to establish recent baseline values prior to surgery
and to crossmatch for possible transfusion. All patients with heart or lung
problems need a recent Chest X-Ray and EKG. These tests may be ordered
ahead of time or we may ask you to have them done after your final pre-
operative visit. Please remain flexible so that you can possibly stop by the
hospital for these tests when requested.
Blood Transfusions – About 2% of women having laparoscopic surgery and
10% of women having open incisional surgery need some type of blood
transfusion. There is a charge of $150 to process each unit of self-donated blood.
Thus, donating your own blood will not be worth your trouble. If you are having
surgery for a cancer, you may not donate your own blood. The risk of receiving
hepatitis or HIV from the transfusion of banked blood is about 1 in 300,000, rare.
Also, if you receive blood during your hospitalization, please arrange for a few
friends or family members to donate for you after your surgery to replace the
precious gift of blood that you received.
Preparing and packing for your hospital stay – Wear comfortable clothes that
you can wear over your incisions during the drive home. Sweat suits are a great
choice. Do not wear or bring jewelry to the hospital. There is really no need for
pajamas as the hospital provides covering for you. Bring your toothbrush and
necessary cosmetics, a few light sanitary pads and any particular health aids.
Wear glasses, not contacts, and be reassured that you can wear glasses, partial
teeth, and hearing aids until the very last minute, taking them off in the operating
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 room just before you go to sleep, and find them with you in the recovery room ready to put back on/in as soon as you wake up. While you are welcome to shave your legs if you prefer, do not shave the surgical site for us. We will shave only what is essential for the incisions in the operating room. Shaving the surgical site before this time actually increases wound infection rates. No eye make-up on your surgery day! It can get into your eyes while asleep, and hurt lots when you wake. Power of Attorney: If you are single, widowed, or in an unregistered domestic
partnership, bring a copy of your durable medical power of attorney, or plan to
sign one upon admission to the hospital. This will make certain that health
decisions are made for you by the right person, if, for any reason, you cannot
make your own decisions. If you are married, your spouse is already legally your
next-of-kin.
Bowel Preparation for Surgery – If you are having surgery for possible or
known cancer, the entire length of your intestines must be emptied prior to
surgery to make the surgery safer, the recovery easier, and to reduce the risk for
colostomy. Please purchase well ahead of time each of the following:
• 2 one-quart bottles of Gatorade or Vegetable/Chicken Broth or Knudson Organic Recharge Thirst Quencher, if you prefer. Keep at room temperature. • A 3-ounce bottle (or two 1.5-ounce bottles) of Fleets Phospho-Soda oral liquid laxative (over-the-counter)(be sure that you don’t buy the Fleet’s Enema or other Fleets products (!)) • 1 roll of very soft toilet paper, or Huggies brand non-scented moist towelettes for wiping, or A & D Ointment (to schmear over your anus (or all three!)). • Aleve 220-mg gel caps, 30-tablets, for preventing pain after you go home. Even if this did not work for your arthritis…it works for surgical pain. Buy it. • Optional: Milk of Magnesia to relieve any constipation after you go home. • Optional: 6 containers of natural yogurt (Dannon, Yoplait, etc) or Acidophilus in any form for regulating your bowel after you go home. • Must: buy healthy, delicious, favorite, easy to prepare foods for you to come home to, as you won’t be driving for a week. • Note: if you receive any advice from the anesthesiologist about when your last sip of water can be—follow the advice of the anesthesiologist. Otherwise follow these instructions. Two days before surgery: Eat regular food today. Pack your bag. Clean your
house. You will be a new and healthier person when you come home!
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 One day before surgery:
a. Eat low fiber food (meat, fish, dairy) for breakfast and lunch to facilitate the bowel prep. You won’t be eating dinner. You will not be hungry during or after the bowel prep. b. At 4:00pm: Drink 1.5 ounces of Fleets Phospho-soda (It’s okay to mix the Phospho soda with a cup of Gatorade or 7-Up or similar to make it more palatable) then drink one quart of Gatorade or broth. Then drink the second 1.5 ounces of Fleets Phospho-soda followed by the 2nd quart of Gatorade or broth. Note: after this combination, at some point, you will develop painless diarrhea, which will become almost clear once the intestines are cleaned out, and then it will become brown again. This can happen quickly, or it could take several hours. Whenever your stool fluid becomes nearly perfectly clear, and without any formed solid material, (tiny flecks are fine) you may stop drinking the Gatorade or broth, and go to step C. c. After you develop nearly clear rectal outflow, continue drinking any clear fluid of your choice such as tea, soft drink or even more Gatorade until your urine is pale, dilute, and nearly clear before going to bed. This hydration is very important preparation for your comfort the next morning. Drink fluids until the urine is pale. Don’t worry that your bowels will become turbid and brown again. d. Call your physician’s office if you have any problems or questions about the bowel preparation or medications. Call your physician if you cannot follow the above instructions, as they may need to modify them for you, or postpone your surgery. 2. Finish cleaning your home. This is a time for a real cleansing! Finish 3. After midnight: Do not eat or drink anything. (The anesthesiologist may tell you that you can have some clear liquid breakfast on the day of your surgery if your procedure is much later in the day. You may only have clear liquid, but carefully stop eating or drinking precisely according to the anesthesiologist’s instructions.) For your safety, your surgery will be cancelled for another day if you have not followed these instructions correctly. The day of surgery:

1. Meds: Take your daily prescription medications with a sip of water. 2. Diet: Do NOT eat or drink anything unless instructed specifically to do so. 3. Go to the hospital on time. Remain available by local phone or cell phone (make sure we have both of your numbers) in case your surgery time is changed. 1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 4. Call the hospital (972-487-5176) if you feel weak from not eating so you can go early to the pre-operative area to get your intravenous fluids started. This will relieve your weakness. Hospital Check-in – Bring your surgical folder containing your consents and
orders with you and give the nurses all of these when you check in to the
hospital. At the admitting desk, you will be required to show your insurance card
and you will be asked to pay for your portion of the cost of the hospital stay. Keep
the receipts and all printed information that you will receive during the check-in
and pre-op processes in your surgical folder.
Pre-operation Paperwork – A nurse will be assigned to you to assist you with all
of the details of pre-op. The nurse will go over the forms with you that you
completed at your physician’s office, and will ask you questions to complete new
forms. Please be aware that you may be asked to acknowledge that you know
that your operation is “elective,” or optional, and that you know that you will not
be able to have a baby afterward if you are having a hysterectomy. The word
“optional” can make you question your decision; but even surgery for cancer is
elective or optional, because at all times you are in charge of your body, and
have elected or opted for this therapy after considering all the risks, benefits, and
alternatives.
Pre-operation Procedures – Once the paperwork is complete, the nurse will
give you your hospital gown. You may also receive a shot to help prevent blood
clots. The nurse will put sequential compression devices around your legs. These
are similar to automatic blood pressure cuffs and compress your legs during and
after surgery to improve circulation and prevent clots. They actually give your
legs a wonderful “massage” and are something to look forward to! If you have
any questions about what is happening to you, don’t hesitate to ask these
nurses. They want to relieve any anxiety that you might have, and answering all
of your questions is one of the best way to accomplish that.
The anesthesiologist – A fully trained anesthesiologist will provide your
anesthesia during the entire case. He/she will meet you in the pre-operative area
after you have checked in to discuss your anesthesia plan. Be sure to tell the
anesthesiologist if you tend to get easily nauseous because today there are
medications that can be added to your IV to significantly reduce the chance of
nausea after surgery. The anesthesiologist will start your IV and will give you
medication that will help you to relax (quite nicely!) prior to surgery. All of the
abdominal cases, by laparoscope or by open incision, require “general”
anesthesia, that is to say, you will sleep painlessly through the surgery.
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Pre-operation Waiting Time – While all efforts are made to have you in pre-op
for only a short period of time, an operation preceding yours, or an Emergency
Room patient, could delay your start time—up to a couple of hours in some
cases. A family member or friend is allowed to stay with you in the pre-op area.
Bring something like a book or a magazine to pass the time.
The assistant surgeons – Usually your physcian will stop by to see you in pre-
op to answer any final questions. There is almost always an assistant surgeon
who helps your physician with the surgery, but your physician will perform your
entire surgery. In addition, other fully trained medical doctors with other specialty
expertise may be consulted to help in your care.
Have your spouse or the friend who is helping you after your surgery read
this section carefully, as they will be caring for you when you come back
from the recovery room. List their name on the last page of this form. You
should re-read these following sections in the hospital as you recover from
surgery, and before you are discharged home.
Going to the operating room for Surgery – The person who accompanies you
can stay with you right up until you are taken in to surgery. Your physician will
give her/him an idea of how long the surgery will last. It is a good idea for that
person to get something to eat right after you go in, so that she/he will be in the
waiting room when you are done. The person waiting for you should be told that
it is not unusual for a surgery to run way past the estimated time period and not
to panic if this occurs. The surgery might not have even started until hours after
you were taken from the pre-operative area into the operating rooms. Someone
will notify him/her if surgery is running late, so even if two hours have passed, tell
this person to try not to worry.
Once you arrive in the OR, the anesthesiologist will give you the medications to fall asleep. The anesthesiologist who puts you to sleep is board certified, and will be with you during the entire case. There are no trainees giving your anesthesia. During the operation, you will not feel pain and you will not wake up; nor will you remember any part of the operation. Post-operation ––You will be taken to the Recovery Room after your surgery,
and you will wake up slowly. You will not have any sense of the amount of time
that has passed since you closed your eyes, so it can be a bit confusing. You will
have a tube in your bladder to drain the urine so you won’t have to get out of bed
to empty your bladder. You may feel an urge to urinate, but be assured that your
bladder is being emptied for these first 24 hours through the tube. When you
wake up, the nurse in the Recovery Room should ask you how your pain is on a
scale of 1 to 10 with 10 being the worst pain imaginable. Be honest when asked,
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 because that determines the pain medication that you will be given. This is when your physician dictates the operation and will go out to tell your family about the findings. After this time is another good opportunity for your family members to eat because it will be approximately ninety minutes before you will be taken to your hospital room where they can be re-united with you. Once settled in your room, you will probably experience a little bewilderment
that you got through it all! You will also probably be surprised that you are not
having much pain. There will be an IV in your arm to keep you hydrated and for
pain medication. You will have a tube in your bladder to drain it so you won’t
have to get up to empty your bladder. The sequential compression devices will
be on your legs and will inflate periodically to prevent blood clots. There will be a
fingertip sensor-clip that measures your oxygen levels. You might feel “trapped,”
but you can sit up when you feel like it, get out of bed to sit in a chair or walk
around in the hallways. Hold a pillow to your stomach to help you get a good
cough and clear your throat and lungs frequently. Stretch and move in bed.
Walking helps you to be mentally alert and in charge of yourself. Ask the nurses
to help you move around. More walking is better!
The recovery is entirely humane. Everyone experiences pain differently.
Whatever your pain threshold, expect to experience some discomfort after your
surgery, but not too much. Report to your nurse what the level of pain is from 1 to
10: 1 is very minimal pain, and 10 is unbearable pain. There is prevention and
medication for each level of pain. For many women, just understanding the cause
of the discomfort can help.
Three different causes for post-surgical discomfort, and three different
ways to manage each:
1. Incision discomfort. This is dull and constant and will actually subside significantly over the first 12 hours, becoming more of an ache. You will have two intravenous medications for incisional pain: one to prevent it and one to treat it, followed later by two oral medications that also prevent and treat the pain. Your incisional pain is prevented by an intravenous medication. The nursing staff gives the medication as a patient controlled anesthesia (PCA) device to continue to prevent the pain. When you go home you will continue to take oral medication to prevent the pain for the first three days. For any “breakthrough” pain that the IV does not prevent, you will receive a morphine medication as a push-button demand drip. You can use the PCA until you are taking medication by mouth, when you 1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 will begin using the Vicodin or Darvocet. If you are not having significant incisional pain, try to minimize use of PCA and Vicodin or Darvocet as these drugs will slow the bowels from pumping and can delay and prolong the cramping phase. The incisional pain from laparoscopic surgery is minimal after a few hours, and many patients use very little of their If you have a vertical open laparotomy incision, you will wake up with a binder (like a girdle) compressing your abdomen. Keep this binder centered over your incision to keep comfortable pressure on it. Use the binder at home only if you still want to, but keep it on in the hospital. Your incision should cause less pain every day, and not require Vicodin or 2. Intestinal cramps. After surgery, your bowels quit pumping. About 12-36 hours after surgery, it is normal to go through a 2-4 hour cramping phase as the gut resumes pumping. Some people experience no cramps, and only a very few will have severe cramping. We will give you Simethicone, which can help ease the crampy pains, but the key to alleviating this pain is to walk in the hallways as soon as possible to stimulate your bowels to resume normal function rapidly. Nothing you eat or drink will affect the “crampy phase” and there is no cure for it other than a “tincture of time” and walking. Neither PCA nor Vicodin should be used for this pain. 3. Shoulder pain can result from the gas that was used to inflate your abdominal cavity if laparoscopic surgery was performed. This gas is deflated from the abdomen after the surgery, but a small amount still remains and may cause you to have a sense of pain in your right shoulder (and sometimes in your left shoulder). It is mild, constant and tolerable and usually starts the morning after the surgery. There is nothing wrong with your shoulder, however. This pain can take several hours to a few days to completely resolve. Moving around in bed into different positions and getting out of bed to walk can relieve this pain sooner, and Aleve can 1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Sore throat – You may notice that your throat is sore or that you are hoarse or
have laryngitis after the surgery. This is because a tube was placed to help you
breathe during the surgery and was removed before you woke up. If bothersome,
ask for some throat spray for relief.
Your Lungs – Since the breathing tube in your lungs induces mucus secretion,
you will have a cough when you wake up. Hold your pillow over your incision(s)
for comfort while you cough. Use the breathing device (spirometer) frequently to
help to re-expand and open your lungs to their normal volume; otherwise, a fever
may develop. If you feel short of breath, cough a few times, and use the
spirometer. The nurses check your oxygen levels frequently and may ask you to
wear a little tube near the outside of your nose to add some extra oxygen to your
blood.
The day after surgery – The tubes come out and you move!!!! The intravenous
line, the bladder catheter and the leg device are removed. You may shower and
pat your incisions dry. The injections of Toradol and PCA are discontinued and
replaced by oral medications: Naprosyn (Aleve) or Ibuprofen (Motrin/Advil).
Vicodin is for breakthrough pain. Once you are at home, take two Aleve/Motrin
every 8 hours for the first 4 days after surgery to maximize your comfort,
maximize your mobility, and minimize the need for constipating Vicodin. If you
need Vicodin, try to take only half tablet at first, and see if you need the other half
after 30 minutes.
Your Bowels –The most important factor in your bowels resuming normal
function is walking. Get out of bed as soon as the nurses let you and walk in the
room and later in the hallways to hasten the recovery of your intestinal function.
You may experience a painful cramp every time you empty your bowels for about
two to even four weeks after the surgery, especially if you already have some
irritable bowel syndrome (IBS) or just crampy bowels in general. This will get
completely back to normal once the normal post-operative inflammation from the
surgery has resolved, by one month. Try to remember this fact when you have
cramping after meals two to four weeks after your surgery—it is normal! And
temporary!
If you have had open incisional surgery, your intestines will take about 5 days to resume their normal function. You will go through a phase of belching (intestines not pumping), then bloatiness (intestines not pumping much), then gas pains (intestines pump in an uncoordinated fashion) and finally passage of gas (intestines coordinated) when you finally feel normal. This is sometimes the most trying part of the recovery, but everyone goes through it and resumes normal function. 1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Your Abdomen – Some women worry about how the space occupied by their
uterus will be filled. The intestines and the colon move about in the abdominal
cavity sliding over each other every minute as they pump. Removal of a normal
or enlarged uterus/ovaries simply makes more room for the intestines to slide
around on each other and for you to have a slightly flatter stomach. The lower
abdominal wall will be swollen after your surgery, but this will mostly resolve
within two weeks. You may notice that your upper body is swollen and puffy after
the surgery. This is due in part to the surgery being done with your body in a
head-down tilt, and in part to fluid shifts from the surgery. All of your upper body
swelling will resolve within a few days.
Your Bladder – Once the catheter (the tube that drains the bladder) is painlessly
removed on the morning after your surgery, some women notice a feeling in their
bladder as it empties in its new configuration. This “odd” feeling is normal and
disappears usually within two weeks after the surgery. Some women have
trouble sensing when their bladders are full at first, but this resolves also within
the first two weeks. Try to empty your bladder every two to four hours to begin to
familiarize yourself with your renewed bladder function.
Call the nursing staff if you find that you cannot empty your bladder within four hours after the catheter is removed. Some women need an extra day of bladder rest before their bladders work well again and may need to have the catheter re-inserted. You will notice that you will pass about a quart of urine more than usual on the days following your surgery. This is because the body holds water in and reduces formation of urine during times of stress, and then releases it once the stress has passed. This is normal and, in fact, reassuring that all is well. It is called the “diuretic phase.” Your incisions – Your incisions should stop hurting in a few days after your
surgery. Even long vertical midline incisions generally stop hurting in less than
one week. Call your physician for any development of new or increased redness,
tenderness, discharge, swelling of your incision.
If your umbilical or other incisions develop oozing after you go home, cover it and
call your physician only if they do not already know about it. The umbilical
incision often does ooze for a day or so, especially if the “skin-glue” is dislodged
a bit—not to worry. You may shower, swim, bathe or soak in a hot tub any time
after your laparoscopic surgery, once the four incisions are dry.
If you have vertical open laparotomy incision, you may shower, swim, bathe or
soak in a hot tub once the incision are dry and closed. If you have any wound
packing or dressing, leave the dressing on while you shower (but no bath or hot
tub) and then put on a new dry dressing after you get out. Once all incisions are
sealed (no more discharge or wetness), you may swim or bathe in a hot tub.
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Hormone therapy – If your ovaries were removed, or if you are already on HRT,
hormones can be started on the day after surgery, and you will go home on
them. Make sure you have your prescription for home use of hormones. Read
the materials you were given about hormone therapy so that you can help
yourself get to the optimal dose for you as soon as possible. If you are already
menopausal and not using hormones, it will not be necessary for you to start
taking them, as you will likely only notice a difference for a short while. Even
though you may have been in the menopause, without hormones for along time,
you may still get a few hot flashes after your ovaries are removed.
About complications - Your consent form mentioned that there could be
unexpected effects of the surgery. While 96% of surgeries go perfectly well,
many factors can affect the experience. Some of these factors are a result of
unforeseen situations from your anatomy or the condition being treated. No two
people are built the same. The reasons for your surgery, be it pain, bleeding,
cancer, endometriosis, ovarian masses, or whatever, have a multitude of
physical presentations. Unexpected findings can necessitate a change in
approach, or even result in a second surgery. Adjacent organs can be impinged
upon by adhesions, cancer, endometriosis, or other organs, and can be injured
on purpose or incidental to your primary procedure. Excess bleeding or internal
bleeding after the surgery is done occur in about 1% of women. Injury to the
bladder, ureter or bowel occurs in 2.5%. While your physician takes every effort
to prevent and avoid these complications, they occur in about 4% of women.
Unfortunately, when a complication happens to you, it is easy to forget that you
are part of a small 4%, as it definitely is 100% of you! Even if you have to have
another operation, as some 5% do, you will get back to your normal health and
life. Rest assured that with their years of surgical experience, your physican has
seen and managed most every type of clinical presentation and surgical
outcome. Your surgical and medical care will be consistently managed and
expertly provided by your physcian and their associates every day of your
hospitalization and recovery.
Your informed consent - Overall, the benefits of the surgery have to outweigh
the 4% risks of surgery. But when your body has a problem that is highly likely to
be correctable by surgery, then a small amount of risk is very reasonable to
undertake. The alternative is always not to operate, or to try medical or other
therapies, and accept responsibility for the results. When you sign up for surgery,
you are also accepting the surgical results, a very high likelihood of correcting the
problem and a very low likelihood of complication. It is this understanding that
constitutes your informed consent to surgery.
Discharge to Home – Walk, Eat, Pee, Gas. Plan to go home after you are
eating, emptying your bladder, passing gas, and walking well. You should have
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 no nausea. You will use the Aleve pills you were prescribed for the next four days, taking two every 6-8 hours to prevent pain. If you suffer from constipation: do not push at home!!! You may need your usual stool softener for greater ease in passing stool at home. You may shower and simply towel-dry your incisions. Leave your incision sealant (Dermabond) for your physcian to remove at your post-op visit at the office. 1. Diet: Resume eating regular food and drink plenty of fluids. If your bowels are not yet regular, take some prune juice or Milk of Magnesia to facilitate normal function. If you suffer from constipation: do not push!!! You may need your usual stool softener for greater ease in passing stool at home. For gas pains or constipation: Take Milk of Magnesia as directed on the bottle. Don’t take Vicodin for crampy GI gas pain as it will delay its ending. Get out and walk. You should have no nausea, but call if you do. 2. Exert yourself. Walk for 20 minutes three times daily to regain energy and relieve crampy GI pain. Increase your energy gradually by walking outside your house whenever you can. The pain after surgery is not as limiting a factor as fatigue. Recovery occurs as you regain your energy over time. It is fine to push yourself and walk as much as you can to facilitate your recovery. Raise your energy level by stretching and walking frequently in the hospital and at home. 3. To prevent incisional and surgical pain: You will use Motrin or Aleve pills you purchased for the next four days, taking two every 8-12 hours to prevent pain. This really works for surgical pain and reduces the need for the Vicodin or Darvocet (which constipates and slows GI function and makes you listless). Even if you think the Aleve did not help you before—this is surgical pain, and it does work. You will also have a prescription for Vicodin or Darvocet in case you have any breakthrough pain. Use either one half or one Vicodin or Darvocet (or other prescription pain medication given to you) for breakthrough pain only. Surgical pain is virtually absent within a few days after surgery and by this time you should not need any medication for pain. Call your physician if you need pain medications after one week. CALL OUR OFFICE– If you feel that you are getting sick or worse than what
you had in the hospital, increasing or new pain any time, or not getting
better, if you have fever over 101.0, any shaking chills, burning upon
urination, cloudy or smelly urine, or if you still have pain after one week, or
think you may need more than the 10 Vicodin you were given.
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Return to sexuality - The surgery in your abdomen does not involve removal of
any of the organs of sexual activity or enjoyment. The female orgasm takes place
in the muscles surrounding the vaginal opening, not any deeper, even though the
orgasm feels very deep within. The uterus and cervix are not part of the orgasm
and their removal does not impact on the ease of achieving orgasm, quantity of
contractions, or quality of your orgasm. Good research has been done on women
comparing their sexual function before, and at 3, 6, 9, and 12 months after,
hysterectomy, revealing a slight improvement in sexual function for most women,
but overall, no determent. Some women will notice differences if their hormones
are not kept tuned afterwards. Your physician is adept at finding the right
hormone replacement regimen, as needed, to keep you feeling your normal best.
Sexual enjoyment should be exactly the same. Let us know if it is not. You may
return immediately to sexual activity on the outside of your vagina in any and
every way that pleases you. This is a great time to learn new cleverness in your
sexuality and add to your repertoire of techniques for pleasure and orgasm, both
by yourself and with your partner. So please go ahead and check it out (again,
stay on the outside, please!) just as soon as you feel like it! You will be able to
resume vaginal penetration after the upper vaginal incision is checked at the 4-
week exam, or possibly later in the healing is not adequate. When you resume
penetration, be gentle for another month.
Return to exercise – Just do it. Surgery causes more exhaustion than pain
after the first day or so. The challenge is to get back to your usual exercising self
as soon as possible. You will nap plenty in your early recovery, and nap less as
your energy returns to normal. Once you get out of bed, you are encouraged to
begin walking vigorously as much and as often as tolerated immediately, both in
the hospital, and definitely after your discharge. You may go up or down any
amount of steps, any number of floors, and are encouraged to do so
frequently in your recovery. You may lift 10 pounds or less if you feel comfortable
when you go home. You may resume all of your floor stretches, exercises and
Yoga immediately. Do not begin or resume power weight lifting (as with
dumbbells and barbells) until one week after laparoscopic surgery and two weeks
after standard open abdominal laparotomy. Vigorous recovery and activity are
encouraged, and you can nap in between.
Do not drive until one week after laparoscopic procedures and two weeks
after open incision procedures. This is not because you can’t physically
accomplish the task of driving, because most can. But what you cannot do is
reliably jam on the brakes in an emergency without hurting yourself or another
person in the early phase of healing after surgery.
Your first post-operative visit – We will check your recovery and make sure
that you are healing well. Your abdominal dressings will be removed and
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 incisions inspected during this post-operative visit. If you were started on hormones in the hospital, the adequacy and efficacy of your dose will be assessed at this meeting. If the dose of estrogen you are taking is too much, you may develop tender breasts. Too low a dose of estrogen can result in insomnia, hot flashes and depression. Call for an adjustment of your hormones if you have these symptoms before your visit. About 10% of women require changes of dose, route or type of hormone a few times until it is just right for you. Vaginal Bleeding - You might experience a two-day period of bright red bleeding
around the 14-28th day after your surgery. The stitches at the top of the vagina
dissolve at this time, allowing the end of the vagina to “settle” into its new
position. The bleeding can be quite red, but not bigger than a period, and
typically resolves without treatment. (Imagine taking off your bra after a long day,
your breasts simply settle into their natural position!) In 6% of women the
bleeding has required an emergency trip back to the office or hospital for cautery
or suture, because it was profuse. If you think the bleeding is heavier than a
period, call the office. If you have any sense of emergency, go to the Baylor-
Garland Emergency Room, and have them call your physician’s answering
service. If the bleeding is dramatic, simply go to your nearest hospital
emergency room and have your physician called through the office number.
Vaginal discharge –The inner end of the vagina from which the cervix and
uterus above were removed has been sewn shut. Even though the outside skin
incisions heal promptly and rather perfectly, the inner vaginal incision does not. It
really takes about 4-6 weeks to close. It is normal to have some vaginal
discharge that is tan to brown to frankly bloody for the first four to six weeks. Rest
assured that your discharge will resolve completely once the upper end of the
vagina has completely healed. The upper end of the vagina will nearly always
develop some excessive growth of scar tissue called “granulation tissue.” This is
treated with a medicated Q-tip at your 4 week post-op visit. The granulation
tissue may take a few monthly treatments with medicated Q-tips before the upper
end seals completely and you have your normal minimal opalescent vaginal fluid.
Final Visits – Your next visit will be in 4-6 weeks. The inner vaginal incision will
be inspected with a speculum at this visit. There is usually some excess scar
tissue, called granulation tissue, at the inner vaginal cuff, which will need to be
touched with a silver nitrate medicated Q-tip. A repeat inspection 4-6 weeks later
may be necessary for a few months to be sure all the granulation has resolved.
This is normal. There is no charge for these additional visits, as they are part of
your normal surgical recovery. If you are from a distance, you may choose to
have the granulation treated by your local physician.
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819 Disability Leave after Surgery – The general rule is that an open surgery
(laparotomy incision) entails a 6-week period to resume normal, full workloads,
including heavy lifting. A laparoscopic hysterectomy, with the four tiny incisions,
entails a 2-week disability leave. Your physician cannot extend the disability
unless you have a documented medical problem from the surgery.
Because surgery is our passion and what we trained for and continue to perform, we offer what we believe to be the very highest quality of care. We will not operate on a problem that is not likely to be correctible. We do not do certain procedures that we believe are not indicated or tried and proven, or that are irresponsible. We will refer you to any surgeon whom your situation would be better managed by. Our commitment to your health is absolute. We urge you to partner with us in that endeavor by reading all of our information, asking all your questions, living a healthy lifestyle, and following through on our care plans. We will give you our best. Dr. Bascom, Dr. Lux, and Dr. Salter
1919 S. Shiloh Road Suite 333 Garland, TX 75042 Telephone (972) 276-9902 Fax (972) 276-9819

Source: http://www.advancedobgynassociates.com/PreopInstructns-RecoveryInfo.pdf