sign in sign up
<<
Home , Carisoprodol

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Healing Body & Mind

Once you have the procedure you waited a long time for, it is time to be patient and wait, again, for your body to heal. Unfortunately, a surgeon’s scalpel is not a magic wand and healing will occur at different rates for different people. You must allow yourself to heal and be aware it is natural to be impatient for the results and a little anxious because you often look worse before you look better. Being aware this can happen will help you understand these normal feelings.

Sharing your experience with friends and family can help give you a support system during your recovery, but realize they may unintentionally make you question your decision with concerns during your recovery. While you may think that you are looking pretty rough around the edges, we may tell you that you are healing beautifully. Trust us. We will share with you if there is a concern, so if we tell you that everything is healing normally, it is.

Your healing will depend on many things such as your general health, your willingness to follow instructions, and your mental attitude toward recovery. While I can perform the surgery, I cannot “heal” you. It is up to you to be an active participant in your recovery process to help your body heal the best that it can. Following all of our instruction is very important, as is working with us to address any complications that may arise. Even surgeries that are done exactly right, can have complications during recovery. It has to do with the human factor. We are not machines and every person can react differently and heal differently even when the surgery is done exactly the same. Every surgeons has unexpected results from time to time.

It is important you approach your surgery and especially your recovery with the mindset that we are a team, and you are an integral part of that team. We must trust each other to be working for a common goal, your successful results. As the surgeon, I enjoy my work and strive to achieve an ideal result during every surgery for every patient. I have rigorous standards that my staff must meet in order to be involved in your care. I am looking forward to working with you to achieve a great result and do not anticipate any post-operative problems.

In the unlikely event that you have a complication, I am committed to working with you to resolution. I need you to be just as committed to working with me under these circumstances.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 1 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Your Anesthesia Experience

Anytime you undergo anesthesia, your general health condition must be considered. Depending on your age and the results of your history and physical, you may need preoperative testing such as blood work, chest x-ray, or EKG. This is done to ensure that your current health does not put you at any additional unnecessary risk while under anesthesia.

You will be required to abstain from food and fluids prior to your surgery if you are having anything beyond just local anesthesia. This is done for your protection to empty your stomach to prevent aspiration of food or fluid from the stomach into the lungs during anesthesia.

Either prior to or on the day of surgery, your anesthetist will have questions for you regarding your health, height, weight and past anesthesia experiences. Complete and honest answers are required to assist your anesthetist in planning and administering the safest level of anesthesic possible.

As you wake up from your anesthesia, your vitals will still be monitored closely for as much time as it takes until you can be safely discharged. Often you will be given additional medications for discomfort and/or nausea. Once you are awake and aware, you will be released to a responsible adult to go home.

Please follow the post-operative instructions closely regarding supervision requirements and activity restrictions. Drinking lots of fluids will help rid your body of the medications used for anesthesia more quickly.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 2 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Medications to Avoid

If you are taking any medications on this list, they should be discontinued 2 weeks prior to surgery and only acetaminophen products, such as Tylenol, should be taken for pain. All other medications – prescriptions, over- the-counter and herbal – that you are currently taking must be specifically cleared by Dr. prior to surgery. It is absolutely necessary that all of your current medications be specifically cleared by Dr. and the nursing staff.

Aspirin Medications to Avoid: Affect blood clotting. 4-Way Cold Tabs Cama Arthritis Pain Isollyl Improved Percodan products 5-Aminosalicylic Acid Reliever Kaodene Phenaphen/ #3 Acetilsalicylic Acid Carisoprodol Compound Lanorinal Pink Bismuth Actron Cataflam lbuprohm Piroxicam Adprin-B products Cheracol Lodine Propoxyphene Compound Aleve Lortab ASA products Alka-Seltzer products Trisalicylate Magan Robaxisal Amigesic Argesic-SA Choline Salicylate Magnaprin products Rowasa Anacin products Cope Magnesium Salicylate Roxeprin Anexsia w/Codeine Coricidin Magsal Saleto products Arthra-G Cortisone Medications Marnal Salflex Arthriten products Damason-P Marthritic Salicylate products Arthritis Foundation Darvon Compound-65 Salsalate products Darvon/ASA Salsitab Arthritis Pain Formula Mesalamine Scot-Tussin Original 5- Arthritis Strength BC Dipenturn Methocarbarnol Action Powder Disalcid Micrainin Sine-off Arthropan Doan's products Mobidin Sinutab ASA Dolobid Mobigesic Asacol Dristan Momentum Sodol Compound Ascriptin products Duragesic Mono-Gesic Soma Compound Aspergum Easprin Motrin products St. Joseph Asprimox products Ecotrin products Naprelan Sulfasalazine Axotal Empirin products Supac Azdone Equagesic Night-Time Effervescent Suprax Azulfidine products Cold Synalgos-DC B-A-C Excedrin products Norgesic products Talwin Backache Maximum Fiorgen PF Norwich products Triaminicin Strength Relief Fiorinal products Olsalazine Tricosal Bayer Products Orphengesic products Trilisate BC Powder Gelpirin Orudis products Tussanil DH Bismatrol products Genprin Oxycodonc Tussirex products Buffered Aspirin Gensan Pabalate products Ursinus-Inlay Bufferin products Goody's Extra Strength P-A-C Vanquish Buffetts 11 Powders Pain Reliever Tabs Wesprin Buffex Halfprin products Panasal Willow Bark products Butal/ASA/Caff IBU Pentasa Zorprin Compound Indomethacin products Pepto-Bismol

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 2 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Ibuprofen Medications to Avoid Affect blood clotting. Acular (opthalmic) Haltran Nabumetone Rhinocaps Advil products Indochron E-R Nalfon products Sine-Aid products Anaprox products Indocin products Naprosyn products Sulindac Ansaid Naprox X Suprofen Clinoril Nuprin Tolectin products Daypro lbuprin Ocufen (opthalmic) Tolmetin Dimetapp Sinus lbuprofen Oruvail Toradol Dristan Sinus Meclofenamate Oxaprozin Voltaren Feldene Meclomen Ponstel Fenoprofen Menadol Profenal Genpril Midol-products Relafen

Avoid ALL Diet Aids – Including Over-the-Counter & Herbal serious cardiovascular effects.

Tricyclic Antidepressants to Avoid Intensify anesthesia, cardiovascular effects. Adapin Maprotiline Tofranil Elavil Norpramin Triavil Amoxapine Endep Nortriptyline Anafranil Etrafon products Pamelor Vivactil Asendin Imipramine Pertofrane Aventyl Janimine Protriptyline Limbitrol products Sinequan Desipramine Ludiomil Surmontil

Other Medication to Avoid: Affect blood clotting. 4-Way w/ Codeine Dicumerol Miradon Stelazine A.C.A. Dipyridamole Opasal Sulfinpyrazone A-A Compound Doxycycline Pan-PAC Tenuate Accutrim Emagrin Pentoxyfylline Tenuate Dospan Actifed Enoxaparin injection Persantine Thorazine Anexsia Flagyl Phenylpropanolamine Ticlid Anisindione Fragmin injection Prednisone Ticlopidine Anturane Furadantin Protarnine Trental Arthritis Bufferin Garlic Pyrroxate Ursinus BC Tablets Heparin Ru-Tuss Virbamycin Childrens Advil Hydrocortisone Salatin Vitamin E Clinoril C Isollyl Sinex Warfarin Contac Lovenox injection Sofarin Coumadin Macrodantin Soltice Dalteparin injection Mellaril Sparine

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 3 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Vitamins and Herbs to Avoid Affect blood clotting, affect blood sugar, increase or decrease the strength of anesthesia, rapid heartbeat, high blood pressure, damage. Note: Just because it is not of this list does not mean that it is safe to take while preparing for surgery. Ackee fruit Devil's club Goldenseal Muwort Alfalfa Dong Quai root Gotu Kola Nem seed oil Aloe Echinacea Grape seed Onions Argimony Ephedra Guarana Papaya Barley Eucalyptus Guayusa Periwinkle Bilberry Fenugreek seeds Hawthorn Selenium Bitter melon Feverfew Horse Chestnut St. John's Wort Burdock root Fo-ti Juniper /Valerian Root Carrot oil Garlic Kava "The natural Viagra®" Cayenne Ginger Lavender Vitamin E Chamomile Gingko Lemon verbena Willow bark Chromium Gingko biloba Licorice root Yellow root Coriander Ginseng Ma Huang Yohimbe Dandelion root Gmena

If you are taking anything not on this list, please call the office at (864) 968-0456 to notify us and make sure that it is okay.

Suggested Homeopathic Supplements (Optional) Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 4 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Although there is no scientific proof as yet that homeopathic medications are effective, starting this regimen before surgery and continuing it through the post operative period may reduce pain, swelling and /or nausea, and result in less scar tissue leading to better overall healing. Explanations of Homeopathic Therapies • Arnica Montana: Also known as leopard’s bane: this powerful agent helps minimize surgical bleeding, bruising, inflammation, and promotes healing. It works well both in an oral form and as a cream, but avoid putting the cream near an open wound and fresh incision. If taken before surgery, there will be less bleeding and swelling afterward. If taken after surgery, pain and bruising will be minimized. • Bromelain: This is a natural proteolytic enzyme derived from pineapple and helps reduce inflammation, thereby decreasing pain and speeding the healing process. • Nux Vomica (multiplex): Also known as poison nut; it helps alleviate the side effects of anesthesia, helping y ou feel more like yourself soon after the surgery. It decreases nausea and dyspepsia and helps detoxify your body after surgery. • Pycnogenol (grape seed extract): This herb has a special affinity for skin tissue and may promote healing. It helps to shorten the recovery period by accelerating the rate of repair of your tissues. Special precautions need to be taken while using these medications because they can be inactivated by contaminants and care must be used in their handling and taking to maximize their effectiveness. If you choose to use these suggestions, please follow the following instructions: 1. Do not touch Arnica Montana pills with your hands. Place the pills in the bottle cap, put them under your tongue and let the pill dissolve. 2. Hold liquid remedies under you tongue for a full minute before swallowing. 3. Do not eat, drink, smoke or take other medication for 15 minutes before and after taking homeopathic supplements or they will be made ineffective. The only exception is Pycnogenol (grape seed extract), which should not be taken on an empty stomach. Wait 15 minutes after eating to take this. 4. Store remedies in a cool, dry, odorless place to prevent inactivation. 5. Compounds such as , camphor vapor, chocolate, coffee, tea, eucalyptus, garlic, mint, mint toothpaste and onions can inactivate the remedies and should be avoided. If you take them , you should wait at least 1 hour before or after taking the remedies.

Dosing and timing of homeopathic formulas is not as critical as for regular pharmaceuticals. Certainly you should try your best to take them as directed, but do not worry if you miss a dose. In contrast, you should be diligent about taking your other medications as directed on the bottle since efficacy and safety are based on the dose as written. The Surgery Program is a pre and post operative nutritional supplement designed for patients undergoing more extensive surgical procedures. These include rhytidectomy (facelift), plus other facials procedures, breast reduction and reconstruction, abdominoplasty and liposuction. The surgery program provides nutrients to speed wound healing, support the immune system, prevent infection, minimize inflammation and reduce bruising. The program contains Clinical Support for Surgery, Bromelain and Arnica Montana 30X. The surgery program is started two weeks before surgery and is completed two weeks after surgery. Large Surgery Pack $106.00 (tax included) Small Surgery Pack $53.00 (tax included)

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 2 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Pre-Operative Instructions – General

The following instructions should be followed closely except when overruled by specific procedural instructions. 2 Weeks Prior to Surgery 1. NO ASPIRIN or medicines that contain aspirin* since it interferes with normal blood clotting.

1. NO , Aleve, or other medicines contain ibuprofen* as it interferes with blood clotting.

2. Please DISCONTINUE ALL HERBAL MEDICATIONS* as many have side effects that could complicate a surgical procedure by inhibiting blood clotting, affecting blood pressure, or interfering with anesthetics.

3. Please DISCONTINUE ALL DIET PILLS whether prescription, over-the-counter or herbal as many will interfere with anesthesia and can cause cardiovascular concerns.

4. NO SMOKING because nicotine reduces blood flow to the skin and can cause significant complications during healing.

5. You may take Tylenol or generic forms of this drug. These do not interfere with blood clotting or healing.

6. The healthier you are, the quicker your recovery will be. We have an excellent vitamin protocal available through our spa. It encourages healing and decreases post operative swelling and bruising.

(* See Medications to Avoid for a detailed list.)

One Week Prior to Surgery 7. DO NOT take or drink any or drugs for one week prior to surgery and one week after surgery as these can interfere with anesthesia and affect blood clotting.

8. If your skin tolerates, use a germ-inhibiting soap for bathing, such as Dial, Safeguard, or Lever 2000 for at least the week before surgery.

9. DO report any signs of cold, infection, boils, or pustules appearing before surgery.

10. DO NOT take any cough or cold medications without permission.

11. DO arrange for a responsible adult to drive you to and from the facility on the day of surgery, since you will not be allowed to leave on your own.

12. DO arrange for a responsible individual to spend the first 24 hours with you, since you CANNOT be left alone.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 3 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Night Before Surgery & Morning of Surgery 1. DO NOT eat or drink anything (not even water) after midnight the night before your surgery. Also, no gum, candy, mints or coffee the morning of surgery. Do not sneak anything as this may endanger you.

2. Take 300mg of Zantac OR 40mg of Pepcid the night before surgery. These are over the counter medications.

3. Apply the Scop Patch behind your ear the night before and remove it the day after your surgery. If you are having facial surgery, please place it on the inner aspect of your upper arm.

4. If you are having abdominoplasty surgery, please shave the suprapubic area prior to surgery.

5. Please get all prescriptions filled and bring them with you to surgery.

6. DO take a thorough shower with your germ-inhibiting soap the morning of surgery. Shampoo your hair the morning of surgery. This is to decrease the bacteria on the skin and thereby decrease the risk of infection.

7. DO NOT apply any of the following to your skin, hair or face the morning of surgery: makeup, creams, lotions, hair gels, sprays, perfumes, powder, or deodorant. Using any of these products will add bacteria to the skin and increase the risk of infection. No dark colored finger nail polish.

8. You may brush your teeth the morning of surgery but do not drink anything.

9. DO NOT wear contacts to surgery. If you do wear glasses, bring your eyeglass case.

10. DO wear comfortable, loose-fitting clothes that do not have to be put on over your head. The best thing to wear home is a button-up top and pull on pants, no jeans. You will want easy-to- slip-on flat shoes.

11. DO NOT bring any valuables or wear any jewelry (no rings, earrings, chains, toe rings, other metal piercings or watches). We will need to tape wedding rings if worn.

12. You must have an adult drive for you – to and from surgery. Please note that a cab or bus driver will not be allowed to take you home after surgery. On arrival, be sure we know your driver’s name, phone numbers, and how we will be able to reach them.

13. If you are not recovering at home, it is very important that we have the number where you will be after surgery.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 4 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

14. If applicable, all pre-op assessment tests have been done and copies are in your chart. Lab work ______(initial) EKG ______(initial) Medical clearance ______(initial).

15. An anesthetist, will attempt to reach you the night before your surgery. If he/she is unable to speak with you, he/she will review your history during your pre-op the morning of surgery.

16. You have a gift certificate to the spa from your surgeon for a post op lymphatic therapy massage. The massage is a light touch massage that will help decrease the swelling. This is stored in our computer system and can be used up to 1 month after your surgery date.

17. Please be on time. If you are the first case of the day, (8:00 or 8:30) please come to end of the building. There is a “RESERVED” parking space right next to the back door, this space is for you. There are two white doors, please knock on the door on the LEFT and a nurse will let you in.

18. Occasionally, surgery will finish early or be delayed. Please be available 2-3 hours before your scheduled surgery time for us to notify you with any changes. The best phone number to reach you the morning of your surgery is______. The amount of time it takes you to get to our office is approximately______. Thank you.

Patient signature______Date______Time______

Witness______

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 5 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

MALIGNANT HYPERTHERMIA QUESTIONNAIRE

Personal History:

Y or N Have you ever had general anesthesia? Y or N Severe muscle spasm? Y or N Unanticipated fever immediately following anesthesia or serious exercise? Y or N Malignant hyperthermia? Y or N Muscle or neuromuscular disorder? Y or N High temperature following exercise? Y or N Any other unexpected problems with anesthesia?

Family History:

Y or N Unexpected death following general anesthesia or exercise? Y or N Malignant hyperthermia? Y or N Muscle or neuromuscular disorder? Y or N High temperature following exercise? Y or N Any other unexpected problems with anesthesia?

Testing for Malignant Hyperthermia:

CHCT (Caffeine- Contracture Testing) is available for mailignant hyperthermia at Wake Forest University (336)716-4497.

Genetic testing is also available. For further information: http://www.wakehealth.edu/anesthesiology/patientcare/malignant-hyperthermia/

Referral can be made as needed or per patient request. Please let us know.

I certify that I have read and understand the above.

______

Patient Signature Date

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 2 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

Post-Operative Instructions – General

The following instructions should be followed closely except when overruled by specific procedural instructions. You must follow your surgeon’s instructions as indicated for your specific surgery. Notify your doctor of any unusual changes in your condition and feel free to call the office with any questions.

1. You MUST HAVE AN ADULT DRIVE YOU home from the facility. You will not be allowed to drive yourself or use public transportation. 2. After surgery you MUST HAVE A RESPONSIBLE ADULT STAY WITH YOU a minimum of 24 hours. You CANNOT be left alone. The 24 hours begin when you are discharged from the office or hospital. Have everything ready at home PRIOR to surgery. Make arrangements for someone to stay with you. Let the person or persons know you cannot be left alone. This is important because of the danger of falling and you may lose the concept of time for the day and overmedicate yourself. 3. The effects of anesthesia can persist for 24 hours. You must exercise extreme caution before engaging in any activity that could be harmful to yourself or others. 4. DRINK fluids to help rid the body of the drugs used in surgery. If you have straws in the house you will tend to drink more fluids the first few days after surgery. 5. Diet may be as tolerated. Eating foods that are bland and soft for the first day or so – foods like after you have had the flu – may be best tolerated. You must eat more than crackers and juice, otherwise you will continue to feel weak and will not heal as well. REMEMBER to take the medications with a little something to eat or you will get sick to your stomach. 6. Please avoid the use of alcoholic beverages for the first 24 hours (it dilates blood vessels and can cause unwanted bleeding) and as long as pain medications are being used (dangerous combination). 7. Take only medications that have been prescribed by Dr. for your postoperative care and take them according to the instruction on the bottle. Your pain medication may make you feel “spacey”; therefore, have someone else give you your medications according to the proper time intervals. 8. If you experience any generalized itching, rash, wheezing or tightness in the throat, stop taking all medications and call the office immediately, as this may be a sign of a drug . 9. You can expect moderate discomfort, which should be helped by the pain medications. The greatest discomfort is usually during the first 24 hours. Thereafter, you will find that you require less pain medication. 10. Call (864) 968-0168 if you have: SEVERE PAIN not responding to pain medication; Swelling that is greater on one side than the other; incisions that are RED or warm; a FEVER of 101.5; or if any other questions or problems arise. 11. Keep any DRESSINGS ON, CLEAN AND DRY. Do not remove them until instructed to do so. There may be some bloody drainage on the dressings. If you have excessive bleeding or the bandages are too tight, call the office immediately. 12. After surgery it is important to have a bowel movement within a day or two. If you do not, you may take over the counter laxatives to encourage your bowels to move.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 3 of 13 in Article 1 of 1

Upstate Plastic Surgery

Patient Name: Misc Acct Procedure Date:

13. Minimal activity for the first 48 hours. No house cleaning, furniture rearranging, etc. Relax, be pampered, and let your body heal. The less energy you use on doing things, the more energy your body can focus on healing. We do want you up several times the first few days, please refer to the DVT form given to you in Recovery the day of surgery. 14. Limit lifting, pulling or pushing for 10 days. 15. Position after surgery is different with different types of surgery. If your surgery is from the waist up we ask that the head of the bed be elevated 45 degrees. This requires a pillow under the small of your back, two pillows under your shoulders and head, and if you have a pillow under each elbow you will relax and stay in position. 16. You are requested to remain within a reasonable traveling distance of the office for approximately ten days. 17. Once cleared to shower you may do so every day. Please do not use the bathtub for 2 weeks. 18. NO SMOKING for the first 7 postoperative days. Any cheating will delay healing. 19. You may drive two days after anesthesia, once you are off the pain pills, and when you experience no pain with this activity (you need to be able to react quickly). 20. All surgeries involve some scarring, which can take up to a year to fade. No matter how small they may be, we still want them to heal as well as they are able. Exposing red scars to the sun can cause permanent discoloration. A good sunscreen (SPF 15 or higher) can help and will protect the surrounding tissues that might not feel a sunburn developing while the nerves are healing. Sunlight can even reach scars under a swimsuit, so take adequate precautions. 21. DO NOT use a hot tub for 4 weeks. 22. AVOID sports or strenuous activities 4 to 6 weeks as your surgeon gives you clearance during your post-operative visits. This is to avoid any unnecessary complications (bleeding, bruising, swelling). 23. You may return to work when you feel able and are cleared to do so by your surgeon. 24. Feel free to call upon us at any time. We want you to be as comfortable as possible during your healing period.

Patient Initials: ______

(864) 968-0168 www.upstateplasticsurgery.com Page 4 of 13 in Article 1 of 1

«Practice_Name» Patient Name: «Person_First_Middle_Last» Procedure Date: «Procedure_Date»

Jackson Pratt Drainage Record

The following information will instruct you how to empty the Jackson Pratt Drain bulb whenever they become half full. Procedure: 1. Wash your hands. 2. Open drainage plug on the top of the bulb. 3. Release pressure. Bulb will fill up with air. Determine if bulb is at least ½ full. If so turn bulb upside down and squeeze drainage into measuring cup provided. 4. Record the amount of drainage on this record. Note the date/time/amount. Record the amount of drainage in cc’s. Total amount of drainage for each 24 hour period. 5. Squeeze all of the air from the empty bulb and insert plug to maintain suction. 6. Strip your drains at least 3 times a day using a small amount of lotion or alcohol wipe to help fingers slide along tube while squeezing. 7. Bring this sheet with you to each post op visit for the doctor to evaluate removal of the drain/s.

Date/time 1 2 3 4

Patient Initials: ______

«Practice_Phone» Page 5 of 13 in Article «Packet_Article_Number» of «Practice_Website» «Packet_Article_Count»