Post-operative activity
Please, please, please take it easy. It is very tempting to use
this time you have taken off off work to catch up on all your chores
at home. Please resist. Even minor procedures can stress the body.
Give yourself some time for extra rest.
If you have had facial surgery, over activity can prolong or increase
swelling and can stir up bleeding. If you have had breast or abdominal
surgery or liposuction, over activity can leave you exhausted and
hurting. If in doubt – DON”T.
This is a good time to catch up on quiet projects. Write that letter
to your long, lost cousin, read War and Peace, organize the junk
drawer.
It is almost always okay to go out for a walk within a few days
of your surgery. This will help your attitude and get you some fresh
air. In the summer, you should go out in the cool of the morning
or evening to avoid getting overheated. Start with a slow and short
walk and gradually increase.
I will give you specific instructions on increasing your activity
as your healing progresses.
Prevention of deep venous thrombosis (DVT) and pulmonary embolus (PE)
Any prolonged period of immobility, such as surgery, prolonged bed rest, leg fractures or long haul airline flights, can lead to sludging of blood in leg veins and subsequent deep venous thrombosis. If blood the clot breaks off and travels through the blood stream to the lungs, the life threatening condition of pulmonary embolus results.
Certain medical condition increases the risk for DVT/PE. They include obesity, cancer, treatment with female hormones for birth control or for menopause, a personal or family history of DVT/PE. There are several things we do at your surgery to help prevent DVT/PE and there are several things you can do to minimize your risk.
Sequential compression devices (SCD’s) are placed on the legs at the time of surgery. They compress the legs and prevent the blood from sludging. I also encourage patients to be up and about as soon as possible after surgery. Occasionally, if a patient has several risk factors, special medication that will delay blood clotting will be prescribed. (They are not routinely prescribed because an increase in bleeding can be associated with their use). When you are resting in bed, be sure to flex your ankles several times each hour. This works the calf muscles and keeps the blood moving. Also, a pillow behind your knees may help your circulation. If you have any compression garments that seem too tight, especially around the knee area, try to loosen this area up. You can even cut a slit in the constricting band if necessary. If you are planning on traveling within a few weeks of your surgery, take extra care to be up and around as much as possible if flying, and stop every hour or so for a stretch if traveling by car.
After surgery, puffiness of the legs and feet (and hands) is very common due to the body’s tendency to retain fluid when it is under stress. Marked swelling, especially if only on one side, should be reported. Also, pain in the calf, unusually prominent veins, or discoloration of the leg or foot should be reported. If I suspect DVT, an imaging study will be ordered.
Sometimes, there are no symptoms of DVT and the problem goes undiagnosed until a pulmonary embolus occurs. The most common symptoms of a PE are chest pain and shortness of breath. If you should develop these symptoms, this is a call to 911 BEFORE you call me. A PE is very serious and must diagnosed and treated promptly!
Treatment of DVT/PE involves giving a blood thinner. In severe cases, surgery may also be indicated.
Postoperative nausea
We’ve come a long way from the ether drip (guaranteed to
make you vomit) anesthesia, but postoperative nausea and vomiting
are still a problem. It is almost always limited to the first postoperative
24 hours.
Always eat something with pain medications – yogurt, crackers,
or toast. Pain medications on an empty stomach are guaranteed to
make you sick.
Take your antinausea medication as prescribed.
Take comfort in knowing that this too will pass. If you continue
to be miserable, we can prescribe a stronger antinausea medication
for you.
Postoperative bowel dysfunction
Feeling a little, err, irregular? Postoperative constipation
is very common. It is caused by decreased level of activity and
postoperative pain medications. You can help your bowel function
return to normal by increasing the fiber in your diet, drinking
a lot of fluids, cutting down on the pain medication and getting
our for a walk a couple of times a day.
If you’re still having problems, over the counter Dulcolax
can help. When all else fails, try Citrate of Magnesium. It’s
available over the counter as well. Start with 1/2 the bottle and
if no results in four hours, drink the rest. Do not leave your house
until you have had results!
Postoperative diarrhea is unusual but can be an indication of a
serious bowel condition caused by overgrowth of a particular bacteria.
Antibiotics can throw the bowel bacteria out of balance and lead
to this condition. It has a fancy name called pseudomembranous colitis.
It is diagnosed by sending a sample of stool to the lab and treatment
is with a specific antibiotic. If diarrhea persists a couple of
days or is accompanied by fever and chills, please call the office.
Postoperative bladder dysfunction
Sometimes patients have trouble urinating after surgery. This can be caused by several factors including dehydration, medication used during anesthesia or postoperative pain medications. If you do not feel like you have a full bladder, start by hydrating yourself. I recommend a couple of glasses of water to start with. Avoid salty sports drinks for the first few days after
surgery because they can cause generalized swelling.
If you feel like you have a full bladder but just can’t get it started, try just sitting on the john, relaxing, dipping your hands in warm water and running the bathroom faucet. If that doesn’t work, give the old warm water sitz bath a try. Fill a CLEAN bathtub with a few inches of warm water. Sit in the water and relax and urinate into the water. You can do this even with a postoperative compression girdle on. Don’t worry about contamination. Tap water is clean and urine is sterile. It may seem a little gross, but it almost always works and you will feel so relieved.
After, that nice “oh, I feel so much better” rinse off with some fresh water, dry off with a clean towel, and if you have a wet garment on, dry it off with a cool blow dryer. It’s all much easier and less expensive than a catheter!
Postoperative scarring
Higher organisms (that would be you) heal by scarring. There
are some things plastic surgeons do to minimize scarring such as
placing incisions in existing skin creases or folds and using several
layers of fine suture to support the skin while healing. Despite
doing everything we can, scarring is also dependent on a patient’s
biology. People of color tend to scar a little more, people of pallor
a little less. Children scar more than senior citizens. Some areas
of the body such as the shoulder and central chest almost always
scar poorly whereas the eyelids and nose rarely do.
All scars go through a maturation process. In the first few weeks,
there is a thickness to the area of the incision, the so called
healing ridge. After a month or so, the scar becomes red and raised
and itchy. After 6 – 12 months, the scar usually fades and
flattens out.
I will often recommend that patients wear tape on their scars for
about 3 months. This seems to speed up the maturation process. Any type of medical tape will do. Make sure to pick a type that
does not cause skin
sensitivity. In excess scarring persists despite taping, silicone
sheeting or gel may be indicated. In rare cases, injection
with low dose steroids may be indicated.
I ask that patients refrain from putting anything on their scars
other than regular skin lotion without checking with me first. Vitamin E in particular can weaken young scars and cause them to
spread.
I rarely make the decision to revise a scar until it is a year old. Mother
nature and “tincture of time” are often the best treatment. If you have
concerns about your scars, please bring them up at the time of your
postoperative visits.
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