Helpful Answers to Common Questions Before and After

I have questions about:

 

What should my wound look like?

Your wound may be closed with absorbable sutures and paper tapes, staples, or sutures. Any dressing should be left in place until your follow up visit. Unless you are told otherwise, you may shower but remember Keep your incision dry. If your dressing becomes saturated, please bring it to our attention as soon as possible. If the skin that is 1/2 inch away from the incision is red, warm, and tender, then your wound may be infected and it may require opening. You should contact the office (717-718-7707) and make arrangements to be seen in the office.

When can I remove my surgical bandage?

Generally, the dressing can be removed 24 hours after surgery. It is not uncommon to see some blood staining the dressing. If staples are in place, then apply Betadine along the staple line until you come back to the office and have the staples removed.

How should I manage the drains that were left in place?

Prior to discharge from the hospital/surgical facility, you will have received instructions about managing your drain. This should be emptied and recorded every eight hours. You should apply Betadine to the exit site of the drain from the skin and do not take a shower or conventional bath. Take a "bird bath" or sponge bath instead.

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I noticed some bloody fluid draining from my wound. What should I do?

If you have an abdominal incision, this can be due to drainage of a seroma. The fluid is usually blood tinged and straw colored and can saturate a dressing sponge. This fluid will escape and may stop on its own. If the wound if red and tender and if the fluid that is draining looks gray, yellow or pus-like, then you likely have a wound infection and this will need to be drained. If this occurs, you should make arrangements with the office (717-718-7707) to come in that day or the next and have your wound checked. Until then, place and dressing over it and allow it to drain.

How should I manage the staples that are holding my incision together?

Application of Betadine may cut down on the redness that can occur where the staples enter the skin. A light dressing over the incision after the morning shower can keep clothing from grabbing on the staple line.

I feel a knot in my incision. What is it?

In the early postoperative period, the wound will swell and feel firm. Breast biopsy cavities fill with fluid and feel firm and may feel larger than before the surgery. Hernia incisions typically also have mesh in them and this can add to the feel of a lump. Generally, your abdominal wall is closed in layers. Very thin patients may feel the suture knots which are buried under the skin. As your healing progresses, this suture will dissolve.

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There are blisters beneath my steri strips. Why are they there, and what should I do?

Blood blisters often occur when there is swelling in an incision after surgery. These are related to traction on the skin and do not necessarily represent a tape allergy. When they rupture, apply Neosporin and a light dressing so the surrounding area does not dry too much while healing occurs.

I cannot urinate. What should I do?

Depending on your age and the procedure that you had, you may experience some difficulty. Older men with underlying prostate hypertrophy can notice difficulty urinating with the increased fluids that they receive in the operating room. Anyone who has had surgery on ano-rectal area (bottom) (i.e. hemorrhoids, fissure, fistula, warts etc) or an inguinal hernia can have spasm of their pelvic floor resulting in difficulty voiding. This is especially true of elderly male patients who may have a pre-existing prostate problem. Sitting in a tub of warm water and allowing urination to occur in the tub can relieve this condition. A warm towel applied to the bottom can relieve some of the pain associated with ano-rectal surgery. A warm bath is probably the best. Urinary distension can cause severe, vague discomfort in the lower abdomen. If you are still unable to urinate, then you should call the surgeon and you will need to come to the ER for a bladder catheter. This may need to stay in place for a few days and then be removed in the office. You may choose to contact your urologist and make other arrangements if that is a better option.

I am nauseated after I take my pain medication. What should I do?

Nausea after narcotics does not represent an allergy but intolerance to some of these opiates. Sometimes patients cannot tolerate codeine but can take hydrocodone or oxycodone. If you take the prescribed drug and you develop the "heaves" then we will need to make arrangements for you to receive an alternate drug. We cannot call in to the pharmacy drugs like oxycodone. Hydrocodone can usually be phoned into the pharmacy. If you are not having that much pain, then try relying on another the counter pain reliever such as acetaminophen or ibuprofen. Try to call during the 9am-4pm window when these arrangements can be taken care of without causing a trip to the ER.

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I haven’t had a bowel movement. Can I take a laxative?

The answer is generally yes. If you have had a bowel prep (GoLytely) before your surgery, then it may take longer for you to produce stool. However, narcotic pain relievers can cause constipation and this can be prevented by drinking adequate liquids and using a laxative. Patients should use a laxative that has worked for them in the past or try a mild laxative such as Milk of Magnesia. Enemas should be avoided in patients who have had recent colon or rectal surgery.

Is it normal to feel tired and washed out after surgery?

Yes — General anesthesia will affect one’s stamina. This can be manifest by a sudden loss of energy, tiredness, and breaking out in a sweat. It’s OK to rest more often but continue to increase your exercise tolerance.

How much can I lift after surgery?

What is 20 lbs to one may be like 50 lbs to another. As a general rule, if you feel yourself tightening your abdominal muscles and straining (Valsalva), you are lifting too much during that first 4 weeks after surgery. After abdominal surgery you may want to wear an abdominal binder when working to protect your incision and back. A sore abdomen that doesn't hold the abdominal contents in very well leaves your back vulnerable to strain and/or hernia (recurrence). As a rule of thumb, patients are advised to lift only 15-20 lbs. for the first 2 weeks following surgery.

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When can I have sex?

For most general surgical procedures, there is not any specified interval to avoid sexual intercourse (i.e. as in vaginal procedures, post partum, etc.). Soreness at the incision site may require more patience and time. The patient should control the pace and should return to sexual functioning when they feel well enough. If the surgery has required you to miss birth control pills, then you will need to take other precautions if contraception is desired.

When can I drive? Ride?

The answer here has a lot to do with common sense. DO NOT DRIVE WHILE TAKING ANY PRESCRIPTION PAIN MEDICATION!!! You should have good mobility and stamina. Before you embark on a trip across town, try driving around the block. Have another licensed driver with you when you first drive after surgery.
After surgery you may be able to travel (ride) short distances (2-3 hours). You should get out and walk around the car about every 30 minutes and be sure to drive plenty of fluids. Discuss this with your surgeon before a trip.

I need more pain meds. When can I get my prescription refilled?

Our office nurses (717-718-7707) will be glad to take your calls after 9am and before 4pm Monday through Friday. Certain prescriptions for oxycodone (Percocet) cannot be called to the pharmacy. You may need to pick those prescriptions up at the office. The nurses will contact your surgeon and determine if more pain medications are indicated. PLEASE have your pharmacy name, phone number and location with your date of birth available and/or leave a message containing this information.
If you wait until the weekend, then you will need to go to the Emergency Room for evaluation before pain meds can be prescribed. If you will require more pain meds over the weekend, be sure to call before Friday at 4 pm.
The pain prescription that you were provided may contain acetaminophen. Taking that pain pill along with an over the counter remedy that contains acetaminophen (like Tylenol) could produce liver damage from too much acetaminophen. Therefore it is important to follow the pain prescription guidelines on the bottle of your prescription.
Unless you have an allergy or sensitivity to Ibuprofen, it is recommended to alternate this with your prescription for Lortab, Vicodin etc.

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When should I be concerned about an elevated temperature?

First you should have a thermometer to take your temperature. Temperatures in the morning tend to be lower and then they tend to rise in the afternoon and evening. Low-grade temperatures (99-100 F) may occur especially after general anesthesia and when the patient is not taking deep breaths. The reason for not taking deep breaths can be related to abdominal soreness from incisions. Fevers associated with burning with urination may signal a urinary tract infection.
The most significant fevers after surgery occur with shaking chills followed by temperatures over 101 degrees. You should contact us at 717-718-7707, as we may need to see you either in the office or the emergency room.

What can I eat after surgery?

This depends on the type of surgery you have had. Generally after outpatient surgery, you will be instructed to take only liquids until the next morning. The more important issue after any surgery is that you are able to take down plenty of liquids (water, Gatorade, noncarbonated). Let your appetite be your guide after most other surgery unless directed otherwise.

When should I call the surgeon on call?

There is always a surgeon on call and available. Regardless of the time of day or night, the surgeon may be evaluating an emergency or operating on a patient. If you feel that you need to speak with the surgeon on call please call (717-718-7707). If the surgeon is in an operating room then you will likely speak with the circulating nurse. If you need to be evaluated after the office is closed then you will be referred to the ER where you may be evaluated by the surgeon or the emergency room physician. ER visits may be more costly and time consuming than a visit to the MIS office. 

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