The process of planning surgery involves several steps, some of which will be required of you and some that will be our responsibility. The decision to undergo surgery is generally a big one and affects you, your family and friends and probably your job.
Discussing your plans for medical treatment with friends, family and co-workers is very important for ultimate success of your treatment. Let’s go through how your own self and all of the close people in your life should prepare for your treatment and recovery.
If you have a job, your employer will need some idea of how long you will be out and what your return will be like and if any special accommodations will be required for you. Have this discussion with your doctor when you two discuss your surgery in the office.
In most cases your doctor can give you a fairly accurate idea of when you may return, this depends, in large part, not only on the type of surgery you have but on the physical demands of your particular job. Obviously if you are a desk or office worker you may be able to get back earlier than if you push, pull or lift for a living.
You should discuss the Family Medical Leave Act or FMLA provisions with your employer.
Please keep in mind your doctor's predictions for return to work are best-case scenario, meaning they based on your uneventful and uncomplicated surgery and recovery. Complications can and do occur, fortunately in small numbers, and can extend your hospital stay, delay your recovery and, in turn, your return to work.
Your family and friends will most likely bear much of the burden of your care after surgery. What each of these two groups can contribute depends on your unique situation. Some of us have large extended families that live near by and others have little or no family members to count on. Hopefully you will have friends that can fill in if that is the case. In the case where there is no family or friends available, and depending on your post-operative needs, your insurance company may be able to provide some type of home-based services. You will typically be asked about your discharge needs by the nursing staff at the time of your hospitalization. It would behoove you to call your health insurance carrier prior to surgery if you anticipate needing such services.
The types of help that you will need include getting to and from the hospital. It is rare that anything other than a comfortable car is needed for the ride home. You should not stay an extra day in the hospital just because you have not arranged for a ride home.
The staff should be able to give you a day for discharge within a day of your surgery. At worst they may off by one day. If you arrange with your “driver” to have that flexibility then you shouldn’t have to stay in hospital longer than needed. If you come from a distance, consider breaking up your trip home with stops along the way, say, every 45 minutes or so. You will feel less stiff when you get out of the car. If your car allows you to lay down comfortably then stops may not be needed. If you live more than a few hours away or you think you may encounter heavy traffic that could prolong your trip home then consider staying in a nearby hotel or motel for a night or two. My office can provide information on discounts with some nearby hotels.
Once you are home, you will need what I call “some love” from your friends or family. This includes someone with a patient manner, who can get you a cup of coffee and a snack if you need it, a soft pillow or a kind word. It helps if they can keep an eye on your dressing or your surgical incision since you won’t be able to see it. You may need help in the bathroom as well although that should be minimal.
Depending on the extent of your surgery, consider arranging for help with your young children, pets, taking out the garbage, food shopping and house cleaning. Good friends and loving family should be willing to pitch in. they may need your help someday. My philosophy is that life is always a team sport.
In general, we don’t let our patient’s go home unless you meet four criteria:
As you can see, once you reach these goals, all the nurses are doing is giving you pills and food, which someone at home should be able to do for you or you can do for yourself. That is the point when you should go home. Our doctors encourage everyone to go home as soon as these criteria are met.
Now we get to the most important person, you. Your long term success with surgery depends on everything mentioned above and how we get you ready for one of the most significant events of your life.
We believe you should understand what you are going to have done. You may not remember or be able to pronounce all the fancy medical words but you should understand, in simple terms what is wrong and what is going to be fixed.
Any family or friends that come with you to the office or the day of surgery should also understand what you will be going through. Having said that, the morning of your surgery is not the time for your sister or son to ask, “Doctor, what surgery will you be doing?” I say this only because there is very little time for these types of discussions the morning of surgery when everyone involved in your surgery is doing there part to complete the paperwork and get you safely to the operating suite.We are happy to have these discussions in the office or on the phone with anyone you designate, in the days or weeks prior to your surgery.
You may be asked to see your primary care provider or other specialist, such as a cardiologist to make sure you are physically capable of undergoing general anesthesia and the surgery itself. It also provides an opportunity to correct any underlying medical issues that may negatively affect your recovery.
You will be asked to come to the hospital a few weeks before your surgery for “pre-screening.” This is a process where a nurse and an anesthesia team member interview you. Blood work may be completed and chest or other x-rays taken. You may need an EKG as well. Be prepared to spend about a half a day completing this process. These are all the things that get done prior to surgery that then allow you to come in the morning of surgery fully prepared. There was a time when patients were admitted to the hospital the night before surgery and all of this process was completed that evening. Those days are long gone! If you are young and relatively healthy this process is quite short and shouldn’t take up much of your time.
Regardless of the type of surgery you are having, you will be asked to not drink or eat after midnight the night before your surgery. This allow your stomach to completely empty which avoids having any of the stomach contents from coming up and finding their way into your lungs. This is called aspiration and is a very troublesome complication that can make you very sick after surgery.
We also suggest that you eat lightly for a day or two prior to your surgery so that your gut is not so full. This could include light soups, salads, fruits, and juices. Above all, drink plenty of fluids the days before your surgery.
After surgery you should also eat lightly and drink plenty of fluids. This prevents constipation, which results from inactivity and pain medications. Nutrition is very important and often overlooked following surgery when many patients just don’t feel like eating much either because of pain, as a result of the pain medications or because they are sleepy.
Nonetheless, at the very least, keep a glass of water or juice handy at all times. We suggest a multivitamin for at least a few months after surgery to make sure your body gets all the elements it needs to heal.
Healthy meals are the most important part of healing and recovery. I recommend lots of fresh fruits and vegetables, lean meats and fish, and dried fruits and nuts. Remember, lots of water as well; one of the most frequent problems we see post-op is dehydration which will not only make you feel lousy but could land you back at the hospital and compromise your recovery.
The last thing we will mention is incision care. Our surgeons close all of their incisions with several layers, all beneath the surface. The last layer is just below the surface and you will not see any sutures or staples that need to be removed.
You may have “steri-strips” or small pieces of white tape over your incision or, with smaller incisions, skin glue. Nothing needs to be done with the glue but you will be instructed when to change your dressing and when to remove your steri-strips at the time of your discharge.
If there is ever a question or issue with your dressing or incision call the office number immediately (210-561-7234).
Most of the time you or your friends or family will have to do nothing more than change your dressing and make sure there is no drainage or redness around your incision sight. Keep the area clean and dry and covered until your incision is “healed and sealed.” This is usually obvious.
We need to make sure that we have all the tests we need to make the correct diagnosis and plan for the appropriate surgical procedure.
We will also need to make sure that you are medically capable and ready to undergo this surgery. Your doctor may require certain blood tests, x-rays and scans, or consults with specialists. These are all designed to give you the best chance to eliminate or reduce your symptoms in the safest possible manner with the most appropriate surgical procedure.
Your surgeon promises to get good nights sleep and have a good breakfast the day of your surgery. Your surgical team will have all the tools, implants and support in the operating room necessary for your particular procedure.
Your surgeon will always have an assistant with them in the operating room; this may be a physicans assistant, surgical resident or fellow. If you have any questions about this please ask.
Your surgeon may operate with additional specialist surgeons depending on your procedure but would discuss this with you ahead of time.