Post Operative Instructions

The physicians and staff of Virginia Beach Surgery wish you well in your recovery. We hope the following information will be helpful to you as a general guide, however if you have any specific questions, please call our office for more assistance.

You must call the office if:

You have a temperature of greater than 101
You are experiencing increasing wound pain
You are experiencing increasing wound redness
You are experiencing increasing wound drainage
You are experiencing prolonged nausea and vomiting

For emergencies, call 911 directly.

Examples would include:

Significant chest pain
Shortness of breath
Passing out
Sudden paralysis or loss of sensation
Seizures

When in doubt, call 911 first!

Bandages/Dressings

Unless otherwise directed by your surgeon, keep your bandage/dressing in place for 24 hours. After the first 24 hours you may remove the bandage. You may see steri-strips (butterfly tapes) or surgical glue directly over the incision, please leave these in place. You can expect these steri-strips to loosen and separate after 2 weeks; when they become loose, you may remove them yourself. If your incision has any drainage please apply another dressing, on a daily basis, until your wound is dry.

Cold pack/Heating pad use

You may apply a cold pack to incision sites every 4 hours for 20 minute periods to reduce pain, swelling and bruising. After 48 hours post surgery you may switch to a heating pad at low or medium settings to further aid in healing and pain reduction. These instructions may be modified by your surgeon at time of discharge

Bathing

After you have removed your bandage, you may take a quick shower the day following your surgery. Please avoid any hot tubs, prolonged baths, and swimming pools for two weeks. Do not swim in the Ocean or Bay until you have been approved to do so by your surgeon.

Meals

Generally, a light diet is recommended after surgery, you may return to your regular diet as your condition improves. Diabetics must be careful to balance their food intake with their diabetic medication.

Activity

It is common to feel fatigued after an operation, so do not be surprised if you cannot immediately return to your normal lifestyle. Gentle exercise, such as walking, is beneficial and encouraged in moderation. You may climb stairs at any time you feel comfortable enough to do so, but do not climb stairs if you are, in any way, unsteady on your feet. If your activities are causing you increasing pain, you must stop and rest. The following guidelines may be modified by your surgeon at time of discharge from the hospital, but in general:

If you have had laparoscopic surgery, please avoid any strenuous activities for two weeks; during this time do not lift or carry more than 20lbs.

If you have had major "open" surgery on the abdomen, then please avoid any heavy lifting or straining (20lbs max) for 6 weeks.

If you have undergone limb surgery, you may walk on, or use, the extremity within your pain tolerance, or as directed by your surgeon at time of discharge.

Driving

You should never drive your car while taking narcotic pain medication! These medications seriously, and adversely, affect your judgment and response times, so please drive responsibly. You should also refrain from driving until you are not hampered by painful movements, in that way you can quickly respond to emergency driving situations. This will generally be two weeks for most major operations.

Post Operative Pain Management

Pain control is an important part of your recovery from surgery. Multiple pain medications are often used together to get the benefit of pain relief without the side effects of large doses of any one type of medication.

Acetaminophen (Tylenol) is an effective Over the Counter (OTC) pain medication that has few side effects and works well in combination with others. It’s important NOT to take more than 4 grams/24 hour period. You may take up to 1 gram (2 Extra Strength (500 mg) or 3 Regular Strength (325 mg) every 6 hours as your first line medication.

Ibuprofen (Motrin) or Naproxen (Aleve, Naprosyn) are also good OTC pain relievers and can be added to Acetaminophen. These are medications in the Non-Steroidal Anti-inflammatory Drugs (NSAIDS) class. The OTC dose and frequency to be taken are listed on the bottle. For a short period of time after the surgery, you may take the prescription dose of these medications (600 mg every 6 hours Ibuprofen or 500 mg every 12 hours Naproxen.) Take one medication or the other (Motrin or Aleve) but NOT both in addition to Acetaminophen. Try to take these medications with a meal, snack or drink other than water to reduce the chance of stomach irritation.

Oxycodone and Hydrocodone are prescription narcotic pain medications. They should be taken only as prescribed BUT may be added to Acetaminophen and/or NSAIDs to help with acute pain control. These medications can cause constipation and may require the addition of a stool softener or laxative if needed. Alcohol and sedative medications should NOT be used if taking narcotic medication. You may NOT drive a vehicle or operate machinery while taking a narcotic. Narcotics are usually the last medication added and the first to be stopped when the pain is decreasing.

Percocet (Oxycodone/Acetaminophen) and Norco (Hydrocodone/Acetaminophen) are Combination medications that include a narcotic and Tylenol. Take these medications only as prescribed. You may NOT take any additional Tylenol while taking these medications but you may use with NSAIDs.

Medication Refills

Requests for prescription refills should be called to the office and left on the Nurse Voice mail Monday through Friday. All prescriptions are now filled electronically. Narcotic prescriptions can no longer be called to a pharmacy. Please leave the Name and Street Address of the pharmacy where you want the refill sent. Prescriptions typically take 24-48 hours to fill so plan ahead. Prescriptions requested after Noon on Fridays may not be filled until the following Monday.

Please call your family doctor for prescriptions not related to your surgery nor prescribed by your surgeon.

Post Operative Appointments

Please call the office the day after your discharge to arrange for your postoperative visit if one was not schedule pre-operatively. Please identify yourself as a post-op patient so that we may accommodate you on our schedules. If you require any tests prior to your visit, please notify our staff when you call, so they can make the appropriate arrangements.

Drains

If you have any drains or tubes when you leave the hospital, please follow the directions you were given before discharge. In general, on a daily basis, write down the amount of drainage present over the previous 24-hour period. Then bring this record for your surgeon to review at your next office visit.

Care At Home

Occasionally you may require a nurse or therapist to visit you at home. This may be to administer medication, or assist you in wound care and recovery or to monitor your condition. This is usually arranged prior to your discharge, and you should be contacted by the visiting service within 24 hours of arriving home. If you have not been contacted within 48 hours, please call our office for further assistance.

For Women

You may experience some menstrual irregularity after surgery, usually early onset of your period. This is normal and comes from the stressful effects of the operation. You should return to your normal cycle after completing your first postoperative period.

If you are taking oral contraceptives, you should continue to take them on your regular schedule.

If you have had breast surgery, you may be more comfortable wearing a bra than by going without one, but do what seems to be most comfortable for you personally. You may wish to consider wearing a sports bra. In addition, it is very common to develop extensive bruising and a lump under the incision after a breast biopsy. This is not unusual and will resolve by itself over the next few weeks.

Mastectomy patients should refrain from wearing a bra until you have seen your surgeon in the office. While your drains are still in place, please do not use your arm excessively; this helps to minimize the fluid output through the drain. After your drains have been removed, we will start your arm exercises to bring your arm motion back to normal.

Patients with a new diagnosis of breast cancer should NOT take any oral contraceptives or any hormonal treatments without first consulting with your physician. This includes over the counter supplements

Hernia Patients

As you recuperate from your surgery, please carefully follow your surgeons’ instructions regarding activity. This is important to allow good healing and to prevent a recurrence of the hernia.

For those patients with groin (inguinal) hernias we want you to know that bruising and swelling is common near your incision, and for our male patients this may markedly extend into the penis and scrotum. Please do not be alarmed by these developments, as they will resolve with time leaving no residuals.

Varicose Vein Patients

If your surgery was performed in the office, continue with the instructions for wearing compression hose for two weeks and activity limitations provided to you at the time of the procedure.

For those patients who have had surgery at a surgical center or hospital, you may remove your bandages 48 hours after your surgery. Please leave any steri-strips or butterfly tape in place and take a quick shower if you so desire. After showering, you will probably be more comfortable if you rewrap your legs with ace bandages. Remember to start your wrap at the toes and work back up to the thighs keeping steady, even pressure on the bandage. You should continue to use the ace wrap for support, as long as it provides comfort to you, after that point you no longer need to wear them. You do not need to wear the ace wrap to bed. You will also find that elevating your legs will be most comfortable for you. Walking and light exercises are not harmful, but heavy exercising may cause more bruising to develop.

As you recuperate, you can expect mild swelling and extensive bruising to develop in the legs. This is normal, and wearing the ace wrap as well as elevation of the legs are helpful in this regard. You may also experience a pulling sensation or tightness and possibly feel a thickened cord along the course of the varicose veins that were removed. This again is not unusual and will resolve as your healing continues.