Your Guide to Colorectal Surgery

Preparing for and Recovering from Surgery

Patient Name

Index:

Your Checklist ...... 2

Getting Ready for Surgery ...... 7

The Day of Surgery ...... 18 Planning for Recovery and Going Home ...... 23 Concerns After Discharge ...... 28 Notes ...... 33 Important Contact Numbers...... Inside Back Cover

ii | Your Guide to Colorectal Surgery Welcome to the Johns Hopkins Department of Surgery. Preparing for surgery can be overwhelming. You may be receiving a lot of information. Know that the Johns Hopkins colorectal surgery team is here to help you from beginning to end.

This booklet includes details about: . Getting ready for your surgery . What to expect on the day of surgery and while recovering in the hospital . Planning for recovery and going home after surgery . What to expect once you are home

It is important to remember that every patient is different. Your care team will tailor your recovery program to your needs.

Please try to read this booklet as soon as you are able to and bring it with you to all of your appointments and hospitalizations. Keep track of your questions and be sure to ask your surgical team when you see them, or call our office at 410-955-7323, option 3. It is important for you, your family and your friends to understand what to anticipate so that everyone can fully participate in your recovery.

Best wishes for a speedy recovery! The Johns Hopkins Colorectal Surgery Team

Your Guide to Colorectal Surgery | 1

Your Checklist

2 | YYourour GuideGuide to to ColoColorrectalectal SurgeSurgerryy Your Checklist 3

y of of r

w a 12 e

Surge d

need

vi e r be be ed ed ectal

r t page , one one

r if Colo on

escribed. 14 14 Outpatient to r

e . p should questions. old

medica e t surge PEC PEC f ting i

r t

Guide us

page

a u n eparation. be epa

eparation

t y: the

r This r n r our our s r

our p p

y p y Y

Hopkins mi

PEC PEC al.

will o -

oper t

use t or r

f .

Surge the

skin p

e eparatio our

last t e of do and r

v ohns t y and .

during J

Y or p e a

hospi

s y f

t ri y o . er t

R our

l t R r o r y r s y Y

t y e r a e w off

r o

ch d t

R s 14 the g instructions

the

a GE y Y o GE

ow ou or

t instructions r

e ee f an in

o his R

b y

R d

t sur GE n

surge p

the surge ,

r page R in a

the

GE SU e er SU and

e w ou

ou o y with time t

r t so

o R with y a

y on SU

af eparation,

ow r f

. w r oll CTION

y o e medical p wing SU ppointment. f sh be

F discuss

help r

A o

what

e ,

what

liquid ograms. d el bring labora our o o tim

t surge t oll our y ov

o f OF

r p ou

o t y er) y c t

ow ed e , BEFORE t

y r BEFORE

t ning.

e of

p g r

on r ed.

w a t y

neede BEFORE

S e ds a

s r Cen instructions clinical so mo Y sur d

viders ). vi de

guide surge

e and o a A g

medication r r A at

eco checklist

a medica

D p r

or y the

the D the

r instruc our education

our

eminding

as e liquid y e a supplie r will

estin y in MONTH MONTH ork

the

k our

as l escribed

T MORNING

, r a w e y al wing ed t

r r ou y

p t sur FEW

. e call o

Evaluation o ONE e o r Y

video f ess e o Use v

e v medical cklist

t r

a e

oll a e

ONE g f us be h change v ounce h

our be

anesthesia

- blood y

ch p u

our a sur or ou (Exp medica e y o y phone

20 t

or y

r y surgeon e

so f e

oper e

r with

e r r e v assigned er hours op medications booklet.

t r t night the

eoperati s

f e o w our r

k e epa y ppointment. ecei w o or r

a t this liquid f medications be a t Cen (P Drink The T Use Ensu If Meet Comple R P Ensu summa Vi

□ □ □ □ □ □ □ □ □ □ □ □

Use this Use

Name:

DONE WHEN CHECK Patient

Patient Name: Date of Surgery:

CHECK WHEN ACTION DONE AFTER SURGERY

Oxygen □ Wear the oxygen mask that is placed over your nose and mouth for two hours in the recovery room.

Mobility □ Get out of bed and to a chair two hours after your surgery. □ You will receive juice or water and can drink clear liquids as you Diet feel up to it. □ Take all medications that have been prescribed to you to control Pain your pain. If you are still experiencing pain, let the nurses know, management and they can help you control your pain and remain comfortable.

FIRST DAY AFTER SURGERY

□ Spend at least six hours out of bed. Walk at least twice in hall- Mobility way. State one benefit of mobility to your nurse.

□ Drink clear liquids as you feel up to it. You may be offered soft or solid food if you feel well. Diet □ You will be disconnected from the intravenous fluids. Ask if it is not addressed by your care team.

□ Take all medications that have been prescribed to you to control Pain your pain. If you are still experiencing pain, let the nurses know, management and they can help you control your pain and remain comfortable.

Urinary □ Your urinary catheter may be removed. Ask if it is not addressed catheter by your care team. □ Participate in your ostomy care. Describe your plan for care If ostomy after discharge.

4 | Your Guide to Colorectal Surgery Your Checklist

. e , if if

ell ol w in in r y this this e

abl w o k

t m r Ask o eam. kn solid solid

o t t

ma .

cont f

om om

Discuss Discuss

e e

times r e r os o o f r

t t eating

Discuss y com ection, ection, ca

e ee urses don mo

f olled.

r m our

n ou r

o y in and o y th

dy t t

our

a hom o of y of

the e

t dration os cont

can use can dration.

emain - y

at r y dration.

h least medication. ck h let ection.

ell

ou a f oms h bag. de with liquid. y t w at

dvance de tr

drinking

use

and in eam.

not

y de

t empty y

is pain e

walking. pain, if r

or m ent

alk e an m escribed

f o ent

eep

r r t o

o will symp pain t e

k ent t on ev

W p

ed ev

v ca

pain r and w Y ou

R v os a p o os ev

p t o y r

o h R

and our discharge and h p o w

d if

t y bed. our

our GE r w

olled been

bed

em y

ou y o e r o

GE medications

n or r supplies e and

t t R f e

y k

diet R a v

r eco

y e a b

signs r a t

er t be

k y SU f

and cont experiencing h k m

a - o SU

out of t plan o what t

urse t out it. cont

think pp

as,

can can ell will n a a y CTION thic

still w g os o

essed a that

w t discharged ou can o

r ou A o

e d ou t er er y urse h demonstra d y r on

t v

ood. our

y hours

n f a d

be a

up be

ou y

anding if AFTER .

o o

w a

t h

t t y

e the

AFTER o

es o

ced six ou t r Y output t h

eel our passing a do

y cathe

f ou Y of A

urs solid e e

y y pl t t

A If y o dy n D been urse urse management

t r

o m should a can help can

n n D

unders t y least

ctions e

y uch eat be . t r a

medications y measu

that our e not m at

o a o e

y os pain pain. as y our our t t r f f urina pain

all

th what nausea),

w y y will

e r os has

a our our our erbalize erbalize our our t ood ou ou a and with output. y y (no y and it hal f THIRD Y Y Demonstra Check V Identi Demonstra V Spend S Y Y Ask Ask Spend T Identi

SECOND SECOND our □ □ □ □ □ □ □ □ □ □ □ □ □ □ y □ □ □

y y y

er r m m t o o t t Pain Pain Pain Pain Diet Diet os os

Urina planning Mobility Mobility cathe If If Discharge Discharge Discharge instructions management management

DONE WHEN

CHECK

Your Guide to Colorectal Surgery | 5 Your Surgery Colorectal to | Guide Patient ______Name: Surgery: ______of Date Patient Name: ______Date of Surgery: ______

Before you leave the hospital, you should have:

□ Hospital discharge instructions

□ An outpatient appointment with your surgeon within one to two weeks of discharge

□ Prescription for pain medication and any other medications you need

□ A hospital bag containing all ostomy supplies, if needed

6 | Your Guide to Colorectal Surgery

Getting Ready

for Surgery

Your Guide to Colorectal Surgery | 7

Your Guide to Colorectal Surgery | 7 My Pre-surgery Planner Instructions: Mark the date of your surgery in the last row of the calendar on the appropriate day of the week. Use this calendar to mark and track each of your appointments leading up to surgery (for example, anesthesia clinic, primary care provider, etc.), and any reminders for the activities you will need to do in the days leading up to your surgery.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

8 | Your Guide to Colorectal Surgery Getting Ready for Surgery e

r o — f date date

be etc. to

ou,

the

y y the the

a er

d v or o

aspirin,

go the

y utpatient

r to d opriate. O

medications r e

the

visit surge

app

ormation of each if clopidogiel, f

which

, our

r appointment with appointment in y

clinic

floor r an

farin, for docto

e r our

v a y

first

can visit.

clearance ha including elief

scheduled?

e y r

contact — e

the ou r v

e y will be t

Surge escribing during

on r e

pain

p r ou y

da y r y r - o

include: thinners ,

eoperati o

one and eparation, eoperati r y t

and r r r

y - p whe

r p

Surge

will

surge

up scheduler y blood plan

need

for

and r

laborato team surge

e one y

histo r e

visit

r ou our av 9 y y

our

umber our Prior h | surge

need

in the in surge

This e r Y

eoperation

surgical of of ocedu a r will

esting) ou r specialist medical anesthesia p

T y p

Surge a

our if y (done

with managementof our our our ess ,

viders. phone phone

our r y y that k ectal y y y

o r

diogram,

month r b y when r

with a r

e xp for p -

morning of of of

E Month

of Colo g wo

. X meet

, oca

one w w w y

n r r su

to lan done

e e e and

P e e

will time be lood k eferrals evi evi evi

lect

g w Guide ithin R R R B R E Chest o

Cente take the take

ote: ou will □ N □ □ □ □ □ □ One W anesthesia and Ma includi sur Scheduling H Y our Y

Your Pre-Anesthesia Evaluation Visit

Where will your pre-anesthesia visit take place? You will meet with your anesthesia providers in the Preoperative Evaluation Center (PEC), which is located on the lower level (LL) of the Outpatient Center. Once off the elevator, register at the kiosk located next to the elevator, then report to the pre-anesthesia evaluation desk.

What do you need to bring to your appointment? Bring this booklet, your insurance card, complete list of medications, contact information for your primary care doctor and all pertinent medical information.

Preregistration for Your Surgical Stay During your visit to the preoperative clinic, you will also have the opportunity to preregister for your surgery and hospitalization. It is best to do this ahead of time to prevent delays when you come for your surgery.

Insurance Authorization Our pre certification team will be contacting your insurance company to secure authorization for your surgery and admission. Please notify your surgery scheduler immediately if there have been any changes regarding your insurance since your last visit. The pre certification office will contact you for any deductible or copayment. You are expected to pay any deductible or copayment the day of surgery.

If your policy is an HMO, you may need referral from your primary care physician for services. Please contact the customer service number on the back of your insurance card for clarification. If you are going to be admitted to the hospital and have questions regarding your insurance, please call the Admissions Office at 410-955-6055.

10 | Your Guide to Colorectal Surgery Getting Ready for Surgery 11

y r Surge

ectal r

Colo is is

ou to

y or may may ou ou

a things things r

office office y

es.htm. and e anced anced s

cisions ’ v Guide v v

l for e

e ance ance assistance assistance d the for about about unless

medical, medical,

our our d v

ecti w ,

A Y

assistance friend y r

to . o i waist e ehabilitation ehabilitation r ad someone them.

r y

enera

shopping the

k D H

need r ength w simple

G easier r life. e

e one

or as een An

what

st g copy e ma

home surge ,

w each

a ance r

will r with f a

this our v

e I

ca r d say . y sur bet our

pick a y ou

information

things A y r

after

ttorney

y e to wnstairs. help

o r er o A

t along bring t

equentl o etch r he often t

y r

e, af

e e agent; that days

make sustain

egain r surge r

used ou, v

hospital. r y e

T y day day d eathpol/

v ca use r to yland

be dditional

or y e. H r fi

ecti ou r visit/admission.

and need the eam r a b

may A

y after home, ou

likely intermediate the

to ca di g y M

can

is used at

t will health t ee

that I

d I

our the the

made a be time. stairs while

in an in

y ance

leaving

duri during v

y need ou. Surge

of things

any for ad upcoming

bend t e for may

stay wise.

r r r use name climb the

after will o at

calling hospital

to will for

the f pa to y to

.oag.state.md.us/ e things to

that

othe b home. brief v w assistance

put

to the

y be

a , be ha r

e go

hospital evised ou e ww able

used r

having r

going y other

esponsible

ou into

r decision e

found

be be expect decisions y apply or ca can

first v

ticula

oid f

e Prior equi

r eatments I r gi and v r to

immediately to be in the in

t ou This can es assistance v

pa ou

ca team visiting

y our

o v y ou be e who

to y

WILL

can coming v y in in

food the

em e to e c

r t r es family

e ou time. about e

want of ecti

y patients when r r facilities home: health e told

eeks optional.

or of r things

therapy

ha di

height 7000

e ou plan a befo

ecti - Di r

t y dina r get ’

a that W kitchen, r n

stock can

the

if some do

and

member

make

These a ou e

576 es

ance

do . -

v y v v difficult o period y

the ences friends y to

surgeon coo

should ring can uy t

ad n eali ou r ance

be shoulder B r B I ecti ecti w 410 v y dvance

efe

r r

om ust ou ou our r f r r 2. 3. I y when 1. facilit sho nursing fami and Y y f limited, ad at T p di hospital di A An t

Eat a healthy diet during the period leading up to your surgery, as this helps you to recover quicker. Get plenty of exercise so that you are in good shape for surgery.

If you smoke, you will need to stop smoking because of the risks related to anesthesia and the healing process. Ask your primary care physician for assistance prior to surgery, if necessary.

One Day Before Your Surgery

Bowel Preparation Before Surgery (Eating and Drinking) Usually, your doctor will prescribe a bowel preparation with antibiotics to prevent infections after your surgery.

You will need to purchase the following items for your bowel prep, if you didn’t receive them already from your Johns Hopkins care team:

1. One bottle of MiraLax powder (238 grams), laxative (over-the-counter medication)

2. Bisacodyl, 5-milligram tablets (four tablets), laxative (over-the-counter medication)

3. Neomycin sulfate, 500-milligram tablets (nine tablets), antibiotic (prescription)*

4. Erythromycin, 250-milligram tablets (12 tablets), antibiotic (prescription)*

*Please call our office if you have allergies to any of the above medications (antibiotics).

12 | Your Guide to Colorectal Surgery Getting Ready for Surgery

TE soup soup

A please please

any

Y or oth

R ed: r Your Guide to Colorectal Surgery | 13 Your Surgery Colorectal to | Guide ep, juice b

eam eam wheat

r p GE ow

c juice juice uit

of soups r R

el than all or

SU o

eam eam ilk ilkshakes b range atmeal rapef rits r r

omato juice juice omato O C Not M M T O G C other O G T

our y

PRIOR

during

A ed:

D ough. r

drated th .

r y

juice all h

- liquids. see

ONE

r ell suga

eam) a

w r can

grape

clear

FOR and

or c

eam) y stay

ems ed

t c i w

apple, uit to o chicken

Aid uit) f - r DIET

all (no pepper or f

liquid

ool tant pulp: liquid r

K the

salt, beef any

coffee

or of

without

( use impo without

oth: ( clear LIQUID

r tea,

ices is

without

many I may

liquid

ater elatin atorade odas, ou opsicles uices talian S P I J Y Lemonade G These W Clear G

ote:

N drink CLEAR Clear

Skin Preparation Before Surgery Usually, your doctor will prescribe a skin preparation with medicated liquid soap to prevent infections after your surgery. You received medicated liquid soap to use prior to your surgery.

General Information:

□ Do not shave for two days prior to surgery.

□ Do not allow the medicated liquid soap to come in contact with your eyes, ears, mouth or nose. Do not use internally.

□ Shampoo hair prior to using the liquid soap.

□ Make sure your entire body is wet and turn off shower. Use the soap on a clean washcloth to wipe each area of your body, paying particular attention to your surgical area.

□ Wipe each area in a back-and-forth motion. If you feel itchy or if your skin turns red, rinse your skin with water and stop using the product.

□ You may need to ask for help to reach all areas.

□ When complete, turn the shower back on and gently rinse off.

□ Pat yourself dry.

□ Do not apply lotions, makeup, powders, deodorants or creams, as they may reduce the effects of the soap.

□ Dress in clean sleepwear or clothes. Use clean sheets on your bed.

14 | Your Guide to Colorectal Surgery

Getting Ready for Surgery 15

y r Surge

ectal r

Colo

and cin cin

y other

8 a

om . . om (500 Guide r r This r r

any , until ,

.m., mouth (238 .

our

form r p yth yth

Y y (or r r

wate wate b mix. hou 7

e e

der

tablets will

of of

w wate

the o

p drink cin

this y w

iraLax tablets ts glass glass of

r , on , FOUR hour (at hour FOUR o r M

ell; . y glass r

r w spo one one neom

e a

the

hou and and v

oll

bottle e

y hou

der r e

F r e with with w

other with

o e milligrams) one

w w

tablets tablets or enti o o

.m.). t liquid

THREE THREE finishing

p for

mix

an 13). foll foll and

(250

tablets

ake clear

T after chill

cin and and

atorade and page of

G iraLax

liquid

and on .m.) pouring milligrams) milligrams) M

om .m.

of r p

p y glass r

b list mouth mouth 4 ections

the

yth 11 11 milligrams) ” r

y y (500 (500 x

e y b b antibiotics: of wate

bottle

bottle r antibiotics: (see

.m., mi ounce and

of cin cin - p

of Di antibiotics:

y y 8 efrigerator

the

3 r glass

diet

.m.

tablets tablets an ounce p dose

Surge ➤ FOUR - glass

dose iraLax

neom neom .m.,

d hake o r 32 bisacodyl p 10 M dose and

drated. in the in

ounce

16 “

liquid

a and one

2 y -

drink thi first

h 8

.m., four the

to (at lace p

AST page

into an ou

our our P clear with

F Prior

all y y second r . 9 r

THREE THREE THREE THREE milligrams) milligrams)

liquid).

w y

su o

a epa rink egin e ake ake ake ake r ake ake .m., .m. .m. .m. .m. .m. D P B T B T T T D milligrams) foll p keeps finished T (250 T (250 grams) clear slush

p p p p p

8 ❒ ❒ 7 ❒ 2 ❒ 6 1 ❒ ❒ NOON ❒ BREAK ❒ continued One Checklist

Checklist and Directions to Follow Cont’d

Before Going to Bed ❒ Take a shower or bath. Then use one medicated liquid soap and follow directions on page 15.

Midnight and Morning of Surgery ❒ You may continue to drink CLEAR LIQUIDS ONLY up until the time you leave to come to the hospital, at which time you will drink the prescribed Gatorade. DO NOT eat any solid food or drink, any thicker liquids like milk or pulped juices, or add cream to any clear liquid drink.

❒ The morning of surgery, take your medications with a sip of water before leaving to come to the hospital. ❒ Use the second medicated liquid soap following the directions on page 15. ❒ DO NOT eat mints, candy or chew gum after midnight the night before your surgery. ❒ Drink a 20-ounce bottle of Gatorade on the way to the hospital.

16 | Your Guide to Colorectal Surgery

The Day

of Surgery

Your Guide to Colorectal Surgery | 17 The Day of Your Surgery

Taking Your Medications Before Surgery Make sure you know what medications you should take the morning of surgery.

You will receive a call the day before your surgery to review your regular list of medications and to confirm the time you need to come to the hospital. If anything is confusing, ask questions!

What to Bring Leave all valuables at home or give to the person(s) accompanying you. We encourage you to only bring essential items the morning of surgery, including:

□ Insurance cards

□ Personal identification card, e.g., driver’s license

□ Copy of your advance directive (optional)

□ A list of all your medications, including dosages and how often you take them

□ Your Guide to Preparing for and Recovering from Colorectal Surgery (This book!)

□ Payment for any deductible or copayment

Please be aware that there may be some downtime/wait time prior to your surgery. We will do our best to predict how long the operations of the day may take, but unexpected delays are sometimes unavoidable. Therefore, bring a book or something to do while you wait.

Belongings for Your Recovery Computers, tablets and cellphones are allowed in the hospital. Internet access is available. Towels and gowns will be provided, but many people like to bring their own bathrobe and toiletries. We will give you all of your medicines needed for your recovery. Leave your medications at home. It is best to have your family or friends bring these personal belongings to you after surgery. Don’t pack nonessential, valuable items.

18 | Your Guide to Colorectal Surgery The Day of Surgery 19

y r Surge

ectal r

- to to

Colo

- to off off

e th e r r ,

r our our walk r our our o edding edding

eet prior y e y r

Guide N w t

w and S befo

and

o egistra our

v r T Y o and

ed prior king em contact hours y

r r , and

a includes einberg

y efferson anything Z ee pa r J

be r

W e

oadway v this th r hours on

for

B du the ha surge

heikh e

r must S

th to two

r y

oc time r w o r two e

el the j N p

e uilding, day

cannot w

B e or

ou ample any een atorade the

OR arri

entrance

w G w

All

. o ear

the of bet t

w tal r all uilding einberg i

main to please

W t

s cings.

r not epo r o

r the of

bottle

rleans o h scheduled.

pie epo to tant at

O D e ocess, is

r e h y r p einberg t r on

ounce 5717. W o will y body

- t

impo r whe

ailable

basement 20 g ou v

surge

a n Y 502

clothing.

t arage,

loor -

in the in other In is G

F our .

floor -

our in. de about y

y Surge er omi

g egistration y

d r a

be d 410 arage,

r c

r w desk. eet

table e any o 3 r

r r 3

king t o t at or

, r

t S in y T

- are t., surge a may check drink

and d Check whe

G e ear to Buildi

ou comfo ou oadway

smooth y

questions

y on alet y a This W

check a einberg oadwa

rleans e

eet B r and

Z v our r

e o

O W t B scheduler as r rleans

t .

ea.

buildings. th

ha S the y r forget earrings

y after y

loose, O t r r

r scheduled r at: at: t

o a ’

to ed ou k k

ensu n N einberg

y r r ear y

olfe o ptional

a a a our o f surge O Z I Sheikh 1800 P W W N. 401 P of y ing tion depending drink Parking T Drink D surge Wh W rings, surge

Your Hospitalization Once your team is ready, you and one member of your family, if desired, will be brought to the presurgery area. Here, the nurses and anesthesia providers will check you in and make sure everything is set for your surgery. A catheter will be placed in your vein (IV), and your weight will be measured. You will also be given several medications to help manage your pain and nausea during and after surgery, e.g. gabapentin, acetaminophen, celecoxib and scopolamine skin patch. If it is appropriate for your procedure, the anesthesia provider will perform an epidural anesthetic by using a small needle to inject medications directly into the pain fibers in your back. This is important, because we would like to minimize the amounts of narcotics—such as oxycodone or dilaudid—which cause constipation and nausea after colorectal surgery. The use of these narcotics can significantly delay your recovery after surgery. You will then be taken to surgery, and your family will be taken back out to the patient/family lounge.

Operating Room Many patients do not recall being in the operating room because the medications you are given during surgery cause amnesia. You will be connected to monitors. After this, you will be given a blood thinner shot to prevent you from getting blood clots and antibiotics to prevent a wound infection. The anesthesiologist will put you to sleep with a general anesthetic.

Once you are asleep, your surgeon will begin your surgery. A resident surgeon with an average of three to five years of surgical training will assist your surgeon during the operation. During surgery, the OR nurse will call your family every two hours to update them. In general, most operations last between two to four hours, but do not be alarmed if the procedure takes longer than this.

Recovery Room After surgery, you will be taken to the recovery room, where you will wake up from anesthesia. Once awake and stable, you will be given water or juice to drink. The surgeon will talk with your family immediately following surgery and let them know about the operation. Most patients remain in the recovery room for about

20 | Your Guide to Colorectal Surgery The Day of Surgery 21

y r Surge

ectal r e r Colo

for for .

e, y to to r may may

get get om om

stay stay sit sit

our

for for close close

soon f

ws egular egular y

ou to r eunited eunited measu o

lounge Guide r Y r

can will ailable

nly

d thinner thinner

y family our into our day

be O a

can

Y ou

which

y blood a

e y

ving king. temperatu our

family w a r o ents

quite

will

on y

fluid blood v

and unit. m

so clots. wo a

our r

be ou

e units, times

r e ou p for y is ou Y hours, r

the y of

companion

in the in chairs

a ee

r placed still

to essu or also

r blood th

time two This get

be dose check

up surgical r will

giving to ent

and uilding.

v o gum kidneys than B eclining will l ou y will e

good

the

y e a blood e a arm tant p r

member

eceptionist ou r v of bladde e

r our

is o Y v

y staff and , wing

our

y . e ec first come arburg r y our help y one

ell

The

ecei impo da y

This r for

The family M w

in in

ou y to

r our 24/7, diabetes, in in y

en A

w e

y e v this .

o v the

will r r

day bed. oom h unit. gi a

drip sent home.

up a of

tube

some of y

it when at be

immediatel Y be r

e the

and e . v

of as v y

numbe visit hours out r floor o

on ha

times also

small will

speeds e ec

to a drink r ou r

a packed ou y e

oom, eral oom will egularly surge will

y to r r v r

making v

ception

This isiting ou ou

pneumonia. e y e x second ou ha . se

r r V r y y

ed e

help

Y e a in the in our Y r

after w advised

y e

oom, o the

o and

e r

will r essu

ou the

a r

will y once ec all a y oom.

on surge

r r on.

ou ving

e ou xygen. y o be is clots v

o with family

o staff

m f (injection)

urine I

belongings after

ec en sleep family

family blood in the in

will r Unit

in the in our

v els

cases, medications. y

blood w or gi our

our ou o the y and patients

Y b y y

much

nursing be hours. chair tell

most w possible om

r our o ein. n The pulse friends medications, thinner y medication I h also v with bring will with visitors Surgical F most two a in as getting

Planning for

Recovery and

Going Home

22 | Your Guide to Colorectal Surgery Planning for Recovery & Going Home 23

y y a r d r Surge

. Satu up r ectal - r

w o Colo

to foll

y calendar calendar

a e calenda v

our Guide rid ha

y the

our of Y

w likely

o r

y a will

first

ou ursd Y the

h T appointments en. on

up gi -

eek y w w a o

been

the foll

v dnesd of

e ha our

W day k ou

r y

M y

date a

opriate Planner r

uesd y app T r

the discharge. e discharge

v in in

the y o

after a

r date

s ec ’ ma y

Mond R

uctions: toda then

r dd

nst appointments My I A and y a Sund

In-Hospital Recovery Plan

Team Caring for You After Surgery In addition to the nursing staff on the unit, the colorectal surgery team will care for you. This team is led by your surgeon and includes a resident in his or her last year of training, as well as other residents, medical students, and a physician assistant or nurse practitioner. There will be a physician in the hospital 24 hours a day to tend to your needs. The residents and students report directly to your surgeon, who is the one overseeing all of your care.

Pain Relief After Surgery Your pain will be assessed regularly on a scale from 0 to 10. Pain assessment is necessary to guide your pain relief. It is essential that you are able to take deep breaths, cough and move. Prevention or early treatment of pain is far more effective than trying to treat severe pain. Therefore, we have devised a specialized regimen to stay ahead of your pain and use almost no narcotics, which can slow down your recovery process. If you have an epidural catheter, you will receive a constant infusion of pain medication through your epidural. If you need additional pain relief, you will be able to push a button to increase the medication in your epidural. You will also be given acetaminophen and an ibuprofenlike medication to keep your pain under control, along with a lidocane patch placed close to your incision. You can always ask for additional pain pills if you are not comfortable. In most cases an anesthesiologist with expertise in pain management will visit you every day and help design your pain management plan.

One Day After Surgery Focus on drinking and walking. You will start drinking clear liquids after surgery. The intravenous fluids will be stopped, and the catheter may be removed from your bladder. We expect you to get out of bed, with the nurses’ or assistants’ help, sit in a chair for six hours and start to move about in the hallways. You will also meet with a case manager to assess your discharge needs, including home nursing. Your physician may order home care to assist with your transition home. Home nursing visits, which are intermittent, help you get readjusted to home by teaching treatments, monitoring medications, and performing clinical assessment and reporting back to your physician. Other services may include therapy and medical equipment. If you are going “home” to a different address upon discharge, please alert us. A home care coordinator can visit with you while in the hospital to discuss your options. If you have questions, please call 410-955-1930 or speak with your case manager. If you need rehabilitation at a facility, a social worker will assist with this.

24 | Your Guide to Colorectal Surgery Planning for Recovery & Going Home 25

y r Surge

ectal r a

to to

Colo

it. it. is

om om to sick, sick, of

e r

ood ood ou

if if r f to food food f

y after after

until until best best

ileus. ileus. ,

meals

r feel olled, olled,

the get Guide up of

possible, possible,

r for e

and needed. f

ourself ourself

v an s I

designed designed

to y , our with as do for for e home t

pain

as The Y

y e feel

k of w

majority r cont

v r s

o ou someone someone

go e

hospital stomach

equent

y able ou H g ha r

keep ell

the f

y wo to e

difficult

if e

r w

cotic

disconnected the , our a

as sur done r it r

amoun W

y for

and e

will

days. as quickly be stomach. v

assistance ou eady mall,

without to e r

r y

likelihood

diet

ee f

our

eady bed w

pain arrangements r of the ileus. y

o will be

drink

small th al

with of ou sick the H making

and

nurses

, y an

er our solid ess

to t r

eleased y can e may

r not

make out

feel

gas mouth.

wn,

y af

this. discharged

with a tubing if o y

educe t ou ou

to be to

two be

d r

le called mo y S

amount

hallwa

ostomy

a r ed,

to is to

al as The decomp

v drated, not t

discharge

lasts educe g o y passing need

to shut

r the

the to diet.

h e

ed. patients y taking r

easons. This em in the in possi will v to of not long sur a r

r e

will

can o common

r only

Hospi

get a ou nose of

y as

As possible ou el be

em one will Y duce change t y esidue

e r

w to ourself

our r , e ou expect times

e v

o -

y pass. the af r e Y y

e b w will

v w

is uch ee

and

usually ariety y o o

, r t W

l l r y t ything intestines. v

I wn m

. r stri e it a.m.

r home. the th

keep

o medication

a y y

will

, ostom likely is e olong

d r v situation. diet e ear r y

as our

the g: g:

it e ou to w r

ou w P

y amount amount n for

nauseated, bladder

o y

least y el el

ileus, will

soft do up a H e

at ostom

tube Surge

or eat

ileus

at v that a the

a ead

surge M

ough ow our

an Surge r

in this in to

gi e

t et y omiti b

er to

our v delays wn. a t g v e enough an wound,

r th

f y er

small t

ha nausea

W best elop

om Th be f

wing

A educe a

eating . v the r e

our o f for ou

time y oid t r

our ou

walking pass A

ogram accompany e and belching y in mind in r

the e y

r de

r a

ys e

y y e

oll t

r av a e may f g to tions to F ys

continue sta on

e e p a ca

do e a

and drinking not on r o

equi

su t ula surge liquids. keep

e e r

gas should

to ca r r

I dications, ou

y r catheter will will m ee a a drinks the

drated,

e o

day

r a

our ou y

Ileus: Nausea f esent. ound essing w e m sti and and our I may w or h y y

ou ou r lease ou ou our r r □ Complic □ someone p P but w Discharge Dischar Th Y y y a y learn the T Y The d

□ Anastomotic leak: This is a rare but serious complication. Anastomotic leak develops usually five to seven days after the surgery, and it happens when two ends of the bowel that we join together fail to heal, thus leaving a hole. Patients usually have severe abdominal pain, fever and vomiting. This often requires another operation.

□ Wound infection: If a wound infection develops, this usually happens three to 10 days after surgery.

□ Urinary retention: This is if you are unable to urinate after the catheter from your bladder is removed. The catheter may need to be reinserted until you are able to urinate on your own. This can be caused by anesthesia, pain medication and decreased activity.

When you are preparing to go home, you will receive:

□ Detailed discharge instructions, with information about your operation and medications

□ All prescriptions for medications you need at home; prescriptions can be filled while you are in the hospital if you would like

□ Ostomy supplies, if necessary

□ An appointment to see your surgeon or provider one to two weeks after you leave the hospital for follow-up

26 | Your Guide to Colorectal Surgery

Concerns

After Discharge

Your Guide to Colorectal Surgery | 27 Once you are discharged: Call us at any time if you are worried about your recovery.

During regular office hours (8:30 a.m.–4 p.m.), call 410-955-7323, option 3. After hours, call 410-955-5000.

Call us immediately if: □ You have a fever higher than 101.5 degrees.

□ Your wound is red, more painful or has drainage.

□ You are nauseated, vomiting or can’t keep liquids down.

□ Your pain is worse and not able to be controlled with the regimen you were sent home with.

□ If you are on narcotics, the goal is to wean you off of them. If you are running low on supply and need more, call the nurse a few days before you will run out.

It is generally easier to reach someone between 8 a.m. and 3 p.m., so call early if you think something is not right. A nurse or nurse practitioner is available every day to answer your questions. After hours and on the weekends, the calls go to the resident doctors in the hospital. It may take longer for your phone call to be returned during this time.

If you have a true emergency, such as severe abdominal pain, chest pain, shortness of breath or any other acute issues, call 911 and go to the local emergency room. Have them contact our team once you are stable.

YYoouurrGGuuidideettooCCoololorreeccttaallSSuurrggeerryy Concerns After Dischar ge 29

y r Surge

ectal r . Colo y

ou all all

y to

- or the the

e full first first the the at at up F

and and

may may

may any

one

955 su wing Guide

in the the in

stool stool discuss discuss - the

o affect, ou

at us take

our Y to y

ake typically typically

the ed

410 foll

than ou r

soaking minutes k, M y

r diarrhea edictable

ou emptying

r up r best

during w y ailable call eek desi

e oatmeal,

contact wo is f e

constipated. w

a mo

t not t after unp

’

a time. I

bulk n

be is .

walks y be r first

befo

for medication. to

intestines,

hour hour with should does

is that

concern, lasting dail until the until may

ogu

continuous the

may

lasts ou our e

egular one ou bladder this v y y r

any

packet.

fiber

pain

like and

ha I

in in

for e dayse

normal

. tablets or of our r ell,

e during y days. e take this

r y ou

30 minutes 30 fi w

usually v

e y

antidiarrheal y o

of loose stoolsloose food, f un r se

to or d the fluid

a type

these and

that e loose, an

option 3. option sponge

ee v

pain (colic) back to ,

r a

end is

any

into

th settle ee twice ening

Surge get r v fluids ed y

e the This

like ou 7323,

r e

to x feeling th

(Loperamide) pains - eight

e w

generally

y equent

of become common at

drink v a o r which

el. f

will

f our act e

H for w

and

955

medication. to Y

Discharge eeks

feel

o -

get to

may b w up our

this most

listed

y this plenty not

teaspoons) this

410

and

time. gripping er

our wing may y eral fiber the t

r take spasms. (3 y v Imodium o er

teaspoon

teaspoon f

T v is ving call

ou morning se

ements operation.

o drink 1 the loperamide,

with using oll y fe

suffer A een patients,

F , y may

o a

numbers and w

y es

to b w

our o

v to e m take Continue of

tion imp

tion

with ou ening. y

r . the in

t all v c r Y el

meals, r tion Pain e

ha to ns esol

ease

po etamucil w will counter c r

tablespoon prior r surge ta r

o Fiber

cramping, a

after M S or

will contact b 1

wate

Fun

el . us and inc els away bet tablet

step r

the

unusual e.

number Fun w at -

y w

o our r o e al eeks cess er b This r b el fibe rhea: Y

ast usually

v x one v

first

may hours w not a

. with r

goes

e v

o r nutritious o e diarrhea.

v is ugsto ow y

ou our ou r t em r 7323, option 3. option 7323, Urina After This t take ha this abdominal the Y y The with d morning fibe two telephone Dia Abdominal I r but first. the eat two Conce B Y

Wound Care For the first few weeks following surgery, your wound may be slightly red and uncomfortable. You may shower and let the soapy water wash over your incision. Avoid soaking in the tub for one month following surgery or until the wound is well-healed. It will take the wound several months to “soften.” It is common to have bumpy areas in the wound near the belly button and at the ends of the incision.

If you have staples, these should be removed when you are seen by your surgeon at the follow-up appointment. You may have a gluelike material on your incision. Do not pick at this. It will come off over time. It is the surgical glue used in surgery to close your incision. You also have sutures inside of you that will dissolve over time

Post Surgery Diet Attention to good nutrition after surgery is important to your recovery. If you had no dietary restrictions prior to the surgery, you will have no special dietary restrictions after the surgery. However, consuming enough protein, calories, vitamins and minerals is necessary to support healing. Some patients find their appetite is less than normal after surgery. In this case, frequent small meals throughout the day may help.

It is not uncommon to lose 10 to 15 pounds after surgery. However, by the fourth to fifth week, your weight loss should stabilize.

It is normal that certain foods taste different and certain smells may make you nauseous.

Over time, the amount you can comfortably consume will gradually increase. You should try to eat a balanced diet, which includes:

□ Foods that are soft, moist, and easy to chew and swallow

□ Canned or soft-cooked fruits and vegetables

□ Plenty of soft breads, rice, pasta, potatoes and other starchy foods (lower-fiber varieties may be tolerated better initially)

□ High-protein foods and beverages, such as meats, eggs, milk, cottage cheese, or a supplemental nutrition drink like Boost or Ensure

□ Drink plenty of fluids—at least eight to 10 cups per day. This includes water, fruit juice, Gatorade, teas/coffee and milk. Drinking plenty is especially important if you have loose stools (diarrhea).

30 | Your Guide to Colorectal Surgery Concerns After Dischar ge 31

y r Surge

ectal r Colo

our ou our ou at

y Y

for for y

. This This f

be be Guide , I y

r to egular quickly quickly y

disability disability e

eeks eeks r

r eeks

our to wing wing v contact contact

office

goals Y w e

w o

ant or

w v or eact activit

take o er

our surge r foll

y H

ele four of four

r to

small

operation. el unusual our

to et

v be the unde eeks ou. y

eeks. le y w empl ee

our to r not w

them to them

10 pounds 10 may th

is enough

after

our six t fax y

drate I during at eight

plan

y . eeks. r r normal wing f than wounds. to

e - w o for

soon foods.

wait

v which

this

deh

o of our six our foll

occurs

y pain ec

y should eater

r to

form ease spicy

ules,

may

r g . to

r .

y k should eeks this y and r or

up Y r heal

inc activities

fully

. this

y wo to back ding r for

y -

to r

six appointment or appointment

lifting e

and first couple r to

surge

cotics

each - a to

ega since up

nap

r e - patients, surge

then

seasoned

ou our w

energy gradually heavy er

y o

k, eturn

four y in the in r

months mo our r

off na

o hobbies k y most

a e r

foll

this and ee any

wo r

r to caffeine, highly after a until until

egetables. little wo th empl

do afternoon

our

erages v

of after

day a

ou need

t y

’ to

to and using y a

n an r

our

be eturn lot do o . ou

e is r and

e y manual

foot. y

month

y r

D r two to

easy o f

r eturn I

operation when

y can r

g uits tivities

ec to

r r

first equi

with to them r body t k. e

r heavy

to v ou

surge

our eral times stairs. A encouraged up

y ou braking v the y

es our

9866. wo dri ,

y and is fried, carbonated raw

drinking

v and -

, bring

check

. ol to for our take wing

v oid oid y oid oid r o climb 614

may wing l normal help ts

v v

cise v v - in

o r - ork A A A A is can e alking enerall

oursel x eturn t t with fol 410 Driving Y I job should r papers, surge y W G will I fatigued e foll may spo Hobbies/ W □ □ □ □

Notes Write down any questions you may have to ask your care team.

32 | Your Guide to Colorectal Surgery No tes 33

y r Surge

ectal r Colo

Guide

our Y

team.

e r ca

our y

ask

e v ha

may

ou y

questions

any

o d es t rite No W

Notes Write down any questions you may have to ask your care team.

Important Contact Numbers

Colorectal Surgery Office Preoperative Evaluation (General questions and Center concerns) OFFICE HOURS:

OFFICE HOURS: Monday through Friday, Monday through Friday, 7:30 a.m.–4 p.m.

8:30 a.m.–4 p.m. Johns Hopkins Outpatient Center, 600 N. Wolfe St., Blalock 618 Lower Level

Baltimore, MD, 21287 601 N. Caroline St.

Tel: 410-955-7323, option 3 Baltimore, MD 21287 Fax: 410-614-9866 Tel: 410-955-6945 or 410-955-1832

Surgery Scheduling Office Weinberg operating room (for

(Logistical questions related to questions on the day of surgery): presurgery appointments and 410-502-1022 surgery scheduling)

OFFICE HOURS: Zayed operating room (for Monday through Friday, questions on the day of surgery):

8:30 a.m.–4:30 p.m. 410-955-6472 Surgery Clinic

Johns Hopkins Outpatient Center, Marburg 2 (inpatient unit where

Eighth Floor you will probably recover): 601 N. Caroline St. 410-502-1080

Baltimore, MD 21287 Tel: 410-502-5717 Hospital operator for after-hours Fax: 410-502-2389 calls: 410-955-5000

Outpatient Clinic

(Where you will be seen before and after surgery) OFFICE HOURS:

Monday through Friday, 7:30 a.m.–5 p.m.

Contact Surgery Clinic

Johns Hopkins Outpatient Center, Impo

Eighth Floor

Numbers

tant 601 N. Caroline St.

Baltimore, MD 21287

Tel: 410-955-4006 or 410-955-4790 Your Guide to Colorectal Surgery | 35