Prior to your surgery

Smoking - If you smoke, you should stop before your operation. Any period of nonsmoking helps, but to get the most benefit you should quit for at least 2 weeks before surgery. Quitting or cutting down on smoking will allow you to tolerate an anesthetic more easily. It will also be easier for your lungs to resume normal function after surgery. You will not cough as much and the risk of infection is decreased.

Medications - If you are taking aspirin, ibuprofen or any of the non-steroidal anti- inflammatory medications that can inhibit blood clotting you should discontinue this 2 weeks prior to your surgery. Using Tylenol until the time of surgery is acceptable. Fen/Phen can interact with anesthesia and should be discontinued 2 weeks prior to surgery. You should make your doctor aware of all other prescription and non- prescription medications that you may be taking.

Blood donation - The nurse will provide you with a copy of "If You Need Blood...". This pamphlet provides information about donating your own blood (autologous) or obtaining direct donor blood. If you would like to store blood for your surgery in advance, call the American Red Cross at 557-2000. They will provide information about cost and insurance coverage. You should ask your physician about the likelihood of needing a blood transfusion as most surgeries do not utilize blood transfusion.

Anemia - If you are anemic, you may feel better if you take iron supplements before your surgery.

Consent - If you are having a tubal ligation or hysterectomy performed, you must sign a sterilization consent at least 72 hours prior to surgery. This must be done in advance or your surgery will be canceled. A copy will be given to you to bring to the hospital in addition to being sent to the hospital by your doctor's office.

Pre-operative doctors visit - You may have a pre-operative visit scheduled with your doctor. This is the time that you should have all of your questions answered. Your doctor may perform another examination at this visit. Bring a current list of your medications and drug allergies to this appointment. You may be asked to sign a surgical consent at this time and you may be given your post-operative medication prescription at this appointment. If you are nervous, your doctor can prescribe medication to help you relax. Make your post-operative appointment at this time.

Hospital preparation - You will be asked to pre-register at the hospital or surgery center, and obtain blood work, EKG, or chest X-ray 2-3 days prior to surgery. You do not need an appointment for this lab work and you do not need to restrict your diet. The hospital hours are 7:00 AM until 9:00 PM seven days a week. You need to check in at the admitting desk and they will direct you to the lab. Your orders may be in admissions or you may be given them by your doctor's office. The outpatient surgical center does not require any pre- operative blood work. You may have your hemoglobin checked on the day of surgery.

The day before surgery

Diet - If you have having an abdominal surgery, you may experience gas pains and slower recovery of normal bowel function. To help with recovery, your doctor may suggest a clear liquid diet on the day prior to surgery. A Dulcolax suppository or Fleets enema may also be requested.

Anesthesia - Your anesthesiologist will probably call you on the night prior to your surgery to discuss your anesthetic. Be prepared to discuss your health history including any drug allergies, previous anesthetics and any medications you take. Your surgeon will request a general, regional or local anesthetic depending on the type of operation, the state of your health and your wishes. A general anesthetic makes you go to sleep. First, you will have an IV started where you will receive an anesthetic medication. Oxygen will be provided through a mask. After you are asleep you will continue to receive medication through the IV line. A mask or a tube that is placed in your mouth and down your windpipe may be used for your anesthesia. A regional anesthetic does not make you unconscious. It works by blocking feeling in a region of the body. You may still feel pressure in this part of your body during the operation. A local anesthetic is given by injection into the area where the doctor will operate. It does not numb as large an area as does a regional anesthetic.

Fasting - You should not eat or drink anything, including water, for 8,hours prior to your surgery. Your anesthesiologist may ask you to take some of your medications with a sip of water on the morning of your surgery.

On the day of surgery

Checking in - You should arrive in admitting 2 hours prior to your surgery at the hospital and 1 hour prior to your surgery at the outpatient surgical center in order to prepare you for surgery.

What to bring - Your doctor may ask you to bring your normal medications to the hospital with you. Leave any valuables and jewelry at home. If you will be staying overnight, bring with you those personal items that you may need.

Pre-op - The pre-op nurses will help you get ready for surgery. They will give you a special surgical gown and cap to wear into the surgical area. They will take your health history again and ask you many questions related to your surgery. They will ask you to sign a surgical consent for your operation and answer any questions that you still have about the process. The nurses will ask you to remove any dentures, hearing aids, contact lenses, wigs, jewelry that you may be wearing. You may be given a laxative if your doctor has requested this. You may also be given a drug to help you relax prior to being taken to the surgical area. Sometimes special stockings or compression devices will be fitted to your legs. An intravenous (IV) line may also be started during the pre-op in order to administer medication.

Operating room - When it is time for your surgery, you will be escorted to the operating room by an orderly. In the hallway outside the operating room, the circulating nurse will introduce herself and verify the type of surgery you are having. She will also ask you many of the same medical questions you have already answered. The anesthesiologist will also meet you at this time and may listen to your lungs and examine your mouth and throat. Once this is completed you will be escorted into the operating room.

After the operation

Once the operation is over, you will be moved into the recovery area. This area is specially equipped for monitoring patients after surgery. Your surgeon will go out to the waiting area to tell your family about the surgery. You will not remember much about what you are told on the day of surgery due to medications that you are given both before and after the surgery. Most patients are in recovery about 1-2 hours. Your family will not be able to see you until you get transferred to your hospital room or until you are ready to go home. In recovery, you will probably have an IV line in your arm or wrist to provide fluids and medications. You may also have a tube in your nose or a mask over your face to provide oxygen. Other tubes may be in place to drain fluid from the operating site or your abdomen. You may also have a catheter draining urine from your bladder.

Recovery in the hospital

Pain - Your doctor will order pain medication for you. You are encouraged to ask for the medication on a regular basis before the pain becomes severe. You will not become addicted to pain medication if it is taken to recover from surgery. lbuprofen may be prescribed in addition to a narcotic to enhance the effect of the narcotic without increasing side effects.

Medications - You should continue to take most of your regular medications while in the hospital. In addition, your doctor may prescribe antibiotics. Medicine to help with nausea, sleeping or headaches is also available.

Activity - After the surgery, it is important to re-expand your lungs. You will be asked to breathe deeply, cough and change your position in bed often. A Voldyne breathing machine may help you with your breathing exercises. As your strength returns, the nurses will have you move around as much as you can. Depending on the type of surgery you've had, you may be able to start walking soon after your operation. The sooner you resume activity, the sooner your body's functions can get back to normal.

Length of stay - Your insurance company will have a standard length of stay for an uncomplicated surgery of your type. You should contact the company ahead of time to determine this.

Recovery at home

Outpatient surgery - After outpatient surgery, you will probably be able to go home within 1-2 hours. You should not drive for 24 hours after outpatient surgery so you should arrange to have someone drive you home when you're ready to check out.

Activity - Gradually resume normal activities as tolerated. No strenuous activities or heavy lifting are allowed until after your first post-operative visit. Do not drive while you are still taking prescription pain medications. Walk several times a day. Expect to feel extremely fatigued during your recovery. This is a normal response and gradually passes with time. Limit lifting to 15 pounds or less during the first four weeks of recovery. Climbing stairs should cause no problems.

Medication - Take your pain medication as needed. lbuprofen acts to enhance narcotics and may be recommended in addition to a narcotic. Tylenol may also be sufficient. Resume all of your usual medications as previously prescribed. A Dulcolax suppository or Fleets enema may be used if needed for a bowel movement. A stool softener (Colace, Citracel, Fibercon) may also be helpful during the first week or two of recovery.

Diet - Your doctor may recommend a special diet for recovery from some operations. In general start with liquids and gradually move to thicker foods such as mashed potatoes, soup or bananas. A low fat, bland diet is best. Avoid highly spiced or acidic foods. Drink more water daily than you are used to drinking. Avoid carbonated beverages.

Incision - Pain and bruising around the incisions are normal after surgery. Remove outer bandages (if any) two days after surgery. Steri-strips can be removed on the day of your post-operative visit. You may shower after the gauze dressings are off. Do not pull out or cut any sutures. Do not use ointments, topical antibiotics, or peroxide on the wound unless you are directed to do so. If your skin folds over the incision, you may use a hair dryer to keep the incision dry. The incision is usually healed by 6 weeks after surgery. If you have staples, drains or sutures that need to be removed in the doctor's office, call to schedule an appointment when you get home.

Additional instructions - Call the office for temperatures over 101 degrees, severe pain, nausea, vomiting, redness or drainage around the incisions, urinary burning or if you have any other questions.

Follow-Up - You should be seen in the office 5-10 days after an outpatient surgery and two to three weeks after an inpatient surgery. Please call the office if you do not have an appointment.