www.fpminstitute.com About Your Surgery Pre-operative Instructions Prior to Surgery Post-operative Instructions How to Reach Us
www.fpminstitute.com Pre-operative Instructions Please Note
Patient Name:
Procedure: Vaginal Colpopexy Enterocele / Rectocele Repair A physician at The Institute for Female Pelvic Medicine & Sacral Colpopexy Colpocleisis / Colpectomy Reconstructive Surgery is available for emergencies 24 hours per day. Hysterectomy Removal / Revision Uterosacral Vault Suspension InterStim® Office hours are Monday through Friday, 8 a.m. to 4 p.m. Colporrhaphy Pubovaginal Sling After hours and on weekends, you can leave non-urgent messages Other: that will be returned the next business day. For urgent situations, Surgery Date: the answering service can page the physician on call. Medical Clearance Blood work at Lab Blood work on Admit. You are required to be medically cleared for surgery by your primary care physician and/or cardiologist within 30 days of your scheduled surgery. You have been given a medical clearance form that your physician will need to complete, as well as a script for an EKG and bloodwork. Please contact your physician and schedule your medical clearance appointment for the week of (not before this www.fpminstitute.com date). If your physician sends you to a lab for bloodwork, we suggest you do this at least two to three days before your appointment, but not before the date indicated above. We will need copies of your test results and completed medical clearance form faxed to us at the number on the form at least three (3) business days prior to your surgery. If you have any questions, please contact our nursing department.
Anesthesia The type of anesthesia we recommend for your surgery is indicated below. However, when the anesthesiologist evaluates your medical needs, it is possible that a different type of anesthesia may be utilized. IV Sedation – The anesthesiologist will administer medication through your intravenous line to make you sleep. You will breathe on your own as you sleep. Epidural/Spinal – The anesthesiologist will place a thin catheter or perform an injection into the middle to lower back. This will numb the lower half of your body, and you will breathe on your own as you sleep. General – General anesthesia causes a patient to be completely unconscious during surgery. A breathing tube will be inserted into your windpipe to maintain proper breathing during surgery. You may experience a sore throat after surgery. 1 10 How to Reach Us Facilities
St. Luke’s Allentown, 1736 Hamilton St., Allentown, PA 18104 The hospital staff will call you the business evening before surgery between Allentown Office: 610.435.9575 4 p.m. and 8 p.m. to inform you of their pre-surgery instructions and your arrival time. If you have any questions, please call the hospital’s main number at 610-628-8300. Appointments Extension 100 St. Luke’s Anderson, 1872 St. Luke’s Blvd., Easton, PA 18045 Nursing Extension 102 The hospital staff will call you the business evening before surgery between Billing Extension 105 4 p.m. and 8 p.m. to inform you of their pre-surgery instructions and your Surgery Scheduling Extension 109 arrival time. If you have any questions, please call the hospital’s main number at 484-503-3000. Research Nurse Extension 103 Abington Memorial Jefferson Health, 1200 Old York Rd., Abington, PA 19001 The office staff will call you within 5 business days prior to surgery to inform you of your arrival time. The Pre-admission Testing department will call prior to North Wales Office: 215.855.4713 surgery for a phone interview and inform you of their pre-surgery instructions. If you have any questions, please call the hospital’s main number at 215-481-2000. Appointments Option 1 Abington Surgical Center, 2701 Blair Mill Rd., Suite 35, Willow Grove, PA 19090 Nursing Option 2 The center staff will call you the business day before surgery to inform you of their pre-surgery instructions and give you your arrival time. If you have any questions, please call the center’s main number at 215-443-8505. IMPORTANT REMINDER Einstein Montgomery Surgery Center, 609 W. Germantown Pike, Suite 100, East Norriton, PA 19403 At your initial visit, you indicated with your initials and signature that you The center staff will call you the business day before surgery to inform you of read and fully understood our financial policy and agreed to be bound by their pre-surgery instructions and give you your arrival time. If you have any its terms. questions, please call the center’s main number at 610-239-2600. Appointment Cancellation/Reschedule Policy Other: You may be charged a fee if you cancel/reschedule your surgery within ten (10) business days of your scheduled surgery date, or fail to show the day of your scheduled surgery.
9 2 Prior to Surgery Follow-up Visits
Discontinue use of the following medications that have anticoagulant (blood A nurse will call to check on your progress 2-3 days after your surgery. At that time, thinning) properties seven (7) days prior to surgery. you will schedule a post-op appointment approximately two (2) weeks from your surgery date. Our doctors/nurse practitioner will recommend subsequent office • NSAIDs including but not limited to ibuprofen, Advil®, Aleve®, Motrin® visits as necessary, generally a six (6) week post-op visit, and a six (6) month • Asprin products including but not limited to Excedrin® follow-up visit. If you had general anesthesia, you may feel tired the first couple • Anticoagulants including but not limited to Plavix®, Coumadin®, vitamin E, of weeks. Keep moving, and you will recover more quickly. Elmiron®, Meridia® If you feel feverish, take your temperature. If it is greater than 100.5 degrees, • Herbal medications and supplements (all kinds) please call the office. • Multivitamins Please check with your primary care physician and/or the anesthesiologist regarding You may take stairs, touching each step with both feet (as a toddler does) for the use of other medications you are presently taking (blood pressure, diabetes, first few days, then as tolerated. cholesterol lowering, etc.). Do not drive until you are free of discomfort from your surgery. If you can walk up and down the stairs and get in and out of a chair without discomfort, you may drive. Leg Stretches Walking is a good, safe exercise. Please ask your doctor about resuming your usual Some patients experience discomfort in their legs and/or buttocks from positioning exercise regimen. Remember to drink plenty of water when you exercise. during surgery. To help minimize discomfort, we encourage you to stretch your legs each time you get in or out of bed for one month before surgery. While lying No tub baths, hot tubs/spas for two (2) weeks. You may cool off in private swimming in bed, one leg at a time, simply bend your knee at a 90-degree angle. Rotate pools after your physician examines you at your first post-op appointment the hip to bring the knee out to the side until you feel a pull in the inner thigh. (no diving). Hold this position for a few seconds, then pull your knee toward your ear and hold this position for a few seconds. Notes Rectal Preparation One day prior to surgery: At noon, the day before your surgery, take two (2) tablespoons or two (2) tablets of milk of magnesia. Take one (1) Fleet® enema as directed on the box before bedtime the night before your surgery.
Two (2) to three (3) days prior to surgery: Low-residue diet
This will help decrease the distention of your bowel, which is beneficial for surgery.
3 8 Restrictions After Surgery (cont’d.) Hospital Stay
For first two (2) weeks after surgery: Most of our patients have outpatient/overnight, a brief one (1) to two (2) day hospitalization. We encourage you to return to your home environment as soon as • Do not push, pull or lift more than 8 pounds (a gallon of milk). possible. It is there that you will sleep and eat better, which is very important to • Minimize bending at the waist. your recovery. • No exercising, gardening or swimming (ocean or public pools). • Do not drive a motorized vehicle (unless you are completely pain free). The hospitals are teaching centers and, therefore, resident physicians will be • No long-distance traveling (more than 3 hours), no flying. involved in your hospital care, always under your doctor’s direct supervision. We ask that you be receptive to their participation in your care. For six (6) weeks after surgery: We also have “fellow physicians.” These doctors have completed their residency in • Nothing in the vagina (no tampons, intercourse, douche, vaginal estrogen, etc.). gynecology and are involved in subspecialty training exclusively with our practice. For next two (2) months: Our practice also utilizes a nurse practitioner who is specially trained in post-op • Avoid heavy lifting (20 to 30 pounds). patient care, medication follow-up, and routine pessary and other urogynecology care. Some restrictions may require up to 12 weeks; ask your doctor. When lifting or bending to pick up things, bend at your knees, not your back. Protect both your Post-operative Instructions back and surgery. Indwelling Urinary Catheter Approximately 30% of patients experience temporary difficulty emptying their bladder after pelvic surgery. Swelling and discomfort can inhibit your ability to relax, the first step to a normal void. If you are unable to sufficiently empty your Notes bladder, you may be discharged from the hospital with a temporary indwelling catheter. The temporary catheter will be secured to a leg bag that collects urine. Be sure the catheter collection bag is below the level of your bladder for proper drainage. If you have any questions on the care of your catheter, feel free to call our office. Our nurses will schedule a visit within several days to assess your ability to void and to have the catheter removed.
Urinary Symptoms After Surgery If your surgery included a pubovaginal sling, you can expect improvement, hopefully resolution, of loss of urine with coughing, bending and lifting (stress incontinence). Surgery for prolapse will also likely improve your voiding. However, certain symptoms such as urgency, incontinence with urge, or frequency may persist after surgery. These symptoms are from functional changes in your bladder over time, and may well require additional medical and behavioral therapies after your surgery.
7 4 Items for Home Care Vaginal Incision Have the following over-the-counter medications and items ready for use at home: You will have a vaginal incision with dissolvable sutures that will disintegrate on their own. • NSAIDs (ibuprofen, Advil®, Motrin®, Aleve®) • Extra Strength Tylenol® You may note vaginal bleeding or spotting for possibly 6-8 weeks post-operatively. • Stool softener (Colace® or generic) Please call if the bleeding becomes heavier than a period. • Milk of magnesia You may notice a yellow vaginal discharge, which may have a mild odor while the • Fleet® disposable enema vaginal sutures dissolve. • Epsom salt • Thin maxi pads and/or pantiliners A sitz bath may be ordered. DO NOT do a sitz bath while vaginal packing is in place. If you are able to safely get in and out of the tub, use two (2) cups of Epsom salt in Pain Management six (6) inches of warm tub water for 20 minutes daily for two (2) weeks. You may use a commode sitz bath on your toilet with two (2) tablespoons Epsom salt in Every effort is made to minimize your discomfort; however, pain after surgery is warm water. common, normal and to be expected. The following medications will help to alleviate discomfort in your legs and/or buttocks due to positioning for vaginal You may apply ice packs to the perineum (outside the vagina) for up to 20 minutes surgery. These pain medications work differently and can be used safely together. as often as needed. Take three (3) ibuprofen tablets every six (6) hours with food for relief of mild to If you notice a rough, sticky patch in the groin or buttock area, do not attempt to moderate pain, swelling and soreness. remove it. This is surgical glue (used instead of stitches), which will loosen and fall off on its own. There may be oozing, bruising and/or pain at the external incision. For additional pain relief, you may take two (2) Extra Strength Tylenol® capsules This is normal and will resolve. You may apply ice or a BAND-AID® as needed. every four (4) hours. You may have a slower urine stream after surgery. Take your time when you empty Post-operative Medications your bladder and reposition to empty as well as possible. This may or may not resolve over time with the decrease in swelling. Resume your pre-operative medication unless instructed otherwise.
Bowel Movements Restrictions After Surgery In order to protect your surgical repair, you should not strain for a bowel movement. You have just undergone pelvic surgery, and now it is your turn to play an important Take one (1) 100mg Colace® or generic equivalent tablet in the morning and one (1) role in the long-term success of your surgical treatment. Surgery and the recovery tablet in the evening for stool softening. You may increase to two (2) tablets twice a period can be a difficult time. The following guidelines are presented with the goal day. Depending on your surgery, Colace® should be used for two (2) to twelve (12) of helping you recover from your procedure and give you long-lasting satisfaction weeks or as directed by your doctor. In addition to stool softening, it may be helpful from your surgery. to use a gentle bowel stimulant or laxative if you fail to have a bowel movement for two (2) days. Take one (1) to two (2) tablespoons of milk of magnesia every six (6) to eight (8) hours as needed. If you continue to have a difficult bowel movement, please call the office.
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