POST-OP INSTRUCTIONS

Post-Operative Instructions
1. There are no restrictions on what you may eat. 2. Please refrain from intercourse or tampon use for six weeks, you may engage in other sexual activities. 3. No heavy lifting of objects greater than 10 pounds for six weeks. 4. You should not drive a car for at least two weeks. Remember to wear a seat belt at all times. You may ride in a car as a passenger as long as you wear a seatbelt. You should avoid long trips. Avoid driving if your abdomen is too tender since this may prevent your from reacting appropriately in an emergency. Never drive a car while under the influence of any pain medication prescribed for you. 5. Most women are able to return to work six weeks after surgery. Some desire to return to work sooner. If you desire to return to work earlier, call Dr. Shirleys office to discuss the situation with her or her nurse before returning to work. 6. You may use a pad for any vaginal discharge. You may have some bloody vaginal spotting, and this is normal. 7. A narcotic prescription for pain has been given to you to help decrease the discomfort from the surgery. Try to use Tylenol or Advil first since the narcotic medications tend to cause drowsiness or may make you dizzy. 8. You may shower the first week after surgery using plain soap and water and tub bathe as desired after two weeks post-op. If the surgical clips are not removed prior to your leaving the hospital, you will be given an appointment to have them removed. Keep the incision site clean and dry. Dont soak the incision underwater for the first two weeks after surgery; just gently clean the site with soap and water. 9. If you develop any severe abdominal or pelvic pain, excessive vaginal bright red bleeding, or temperature greater than 101 degrees, you should call the office immediately at (478) 923-3331. If you have questions that are not of an emergent nature, please call the office after 9 am Monday through Friday.

Laparotomy

Laparoscopy with Tubal Ligation

Post-Operative Instructions
1. Please make your post-op appointment now for two weeks from the date of the surgery. Please call the doctor or her assistant if you have any problems or questions. 2. As soon as you feel like it, you may eat any food or drink in moderation. It is recommended that you do not drink any alcohol within 24 hours following the surgery. 3. Do not lift over ten (10) pounds for two (2) weeks. 4. You should not drive any vehicle for 24 hours after surgery. Some patients prefer 2-3 days of leave from work, however, you may return to work the next day if you are up to it. Women will vary when they can resume full activity. 5. Please refrain from sexual activity for two weeks after your procedure. 6. Bruising may occur at the site of the incisions. Stitches or glue may be used to close the incisions and will dissolve with time. It is not uncommon to have slight drainage from the incision. If this occurs gently cleanse the area with hydrogen peroxide two to three times a day, rinse, pat dry and let air dry. The band aids may be left on but need to be changed daily. You may shower or bathe in a tub using plain soap and water. Dont be afraid to wash the wound with soap and water, however, do not rub. Report any signs of infection such as pus, marked swelling, or redness. 7. You may have vaginal spotting for 4-6 weeks. You may have an odor, but if it becomes foul smelling, or if excessive bleeding occurs, contact your doctor. Do not us tampons or douche for two weeks. 8. There are always unpredictable reactions from the anesthesia used during surgery ranging from no complaints to being tired for several days. You may have a sore throat for the first 24 hours caused by the airway that is place in your throat during the procedure. There may be aches in your shoulder and chest due to the carbon dioxide place in your abdomen. This is harmless and will dissipate in a few days. The pain can be relieved by lying flat in bed with a pillow under you hips. 9. Notify your physician if you experience increasing abdominal or pelvic pain, fevers, chills, shortness of breath, or a temp over 101 F.

Hysteroscopy / Dilation and Curettage (D&C)

Post-Operative Instructions
1. Rest at home today and gradually increase your activity as tolerated. Do not drive a car or sign any legal documents today. Have someone drive you home. You may bathe or shower as desired with plain soap and water. Please refrain from sexual intercourse and douching for two weeks. 2. You may experience a sore throat during the first 24 hours following surgery from the breathing tube that was placed during the operation. 3. Use a sanitary napkin for vaginal bleeding. Do not use tampons or douches. You may have some light bleeding or spotting for 7-10 days. If it becomes abnormally heavy (saturating one pad repeatedly every 15 minutes) please call. 4. Intercourse should never take place for at least two weeks following the surgery. You should not have intercourse until your physician has specifically instructed you that it is safe to resume after your post-op visit. Most patients with no complications may return to sexual activity within tow weeks of surgery. 5. A prescription for pain medication may be given to you for discomfort. Take this medication as directed. Call if it is not effective or if you require a refill. 6. Do not lift objects more than ten (10) pounds for two (2) weeks. 7. Please use good common sense when deciding what to eat after your surgery. If you are nauseated, consume only liquids you can see light pass through. Advance your diet as tolerated but go back to clear liquids should nausea return. Your diet, otherwise, amy be advanced as quickly as desired. 8. You will need to be seen in the office for a postoperative check-up in two weeks. If this appointment is not scheduled for you before you leave the hospital, please call and schedule this appointment when you get home. 9. If you develop any severe abdominal or pelvic pain, excessive vaginal bright red bleeding, or temperature greater than 101 degrees, you should call the office immediately at (478) 923-3331. If you have questions that are not of an emergent nature, please call the office after 9 am Monday through Friday.

LEEP Procedure
Post-Operative Instructions
1. Do not lift objects weighing more than 20 pounds for 2 weeks. 2. Do not have sexual intercourse or douche for 2 weeks. 3. You may shower as desired using plain soap and water but, please do not take tub baths for two weeks. 4. You may use a sanitary napkin for vaginal bleeding, but do not use tampons. You may have some light bleeding or spotting for 7-10 days. If your bleeding becomes heavy (saturating one pad every 15 minutes or you are passing many large clots) please call your doctor at (478) 923-3331. Occasionally, there is a yellow to bloody water discharge, or a dark brown dirt-like discharge. This is normal and should be controlled with a sanitary pad. 5. A prescription for pain medication may be given to you for discomfort. Take this medication as directed. 6. You will need to be seen in the office for a postoperative check-up in two or three weeks. If you have not made a post-op appointment, please call your doctor at (478) 923-3331 when you get home. 7. Please call for a temperature greater than 101 F, excessive bleeding, pain unrelieved by your pain medication, or a foul-smelling discharge that persists for more than 3 days.

Cervical Cone Biopsy

Post-Operative Instructions
1 Gradually increase your activity as tolerated. 2 Do not drive a car or sign any legal documents today. Have someone drive you home. 3 You may shower using plain soap and water as desired but avoid tub baths for the next 2 weeks. 4 Please refrain from sexual intercourse until after your postoperative check-up. Once sexually active, have your partner wear a condom during intercourse for two more weeks. Please refrain from heavy lifting or vigorous exercising (aerobics, calisthenics, weight lifting) for 2 weeks. 5 Use a sanitary napkin for bleeding. Do not use tampons or douches. You may have some light bleeding or spotting for as long as two weeks. One of the most likely times to experience bleeding complications after this procedure is from 8 to 14 days after your surgery. If, at any time, the bleeding becomes abnormally heavy (saturating one pad repeatedly every 15 minutes) please call your doctor at (478) 923-3331. 6 You will have a small packing placed in your cervix. This packing will usually fall out 2-3 days after surgery. This is normal and is not cause for alarm. 7 A prescription for pain medication will be given to you for discomfort. Take this medication as directed. 8 You will need to be seen in the office for a postoperative check-up in two weeks. If this appointment is not scheduled for you before you leave the hospital or when you signed your pre-op consents, please call and schedule this appointment after you get home. 9 Please call for any temperature of 101 or greater, excessive bleeding as described above, pain unrelieved by your pain medication, sudden chest pain or shortness of breath, abdominal pain, or difficulty with bowel or bladder function.

Hysterectomy and Major Surgery

Post-Operative Instructions
1. There are no restrictions on your diet unless you were otherwise instructed in the hospital at the time of your dismissal. 2. It is important that you avoid any heavy lifting or strenuous activity for six weeks after your surgery. Limit lifting to less than ten pounds. You should not perform housework or cleaning for at least two weeks. After that, you can ease into doing these things as you seem to tolerate them as long as you continue to watch the lifting limit. Avoid climbing stairs as much as possible. After two weeks, you may drive. Do not drive for the first two weeks. You can go places, but have someone drive you there during that time. It is good to get some light exercise such as walking in your neighborhood. You can walk as much as you want. It is important to get plenty of rest. You will get tired more easily than you expect. Be patient. Your body is devoting a lot of your energy to healing, so your reserve may not be as much as you expect. 3. Vaginal bleeding may or may not occur. If it is present, it may continue for approximately two to six weeks. Use a pad/sanitary napkin for the bleeding. Do not use tampons or douches. Report heavy (repeated saturating of pads in 15 minutes or less) bright red bleeding. 4. We would prefer that your shower with plain soap and water rather than bathe in a tub until after your six-week visit. Do not go swimming until after your sixweek check up. 5. Please do not have intercourse until after your six-week check up. This is VERY IMPORTANT! 6. If you had a vaginal procedure (vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, vaginal/bladder/rectal repair), all of your stitches are internal. As they dissolve, you may notice small bits of dark string come out from time to time. This is normal. If you had an abdominal procedure, your incision staples may be removed before your dismissal. If so, your incision will be taped with Steri-Strips. Dry these off well after showering. You should remove the Steri-Strips one week after leaving the hospital. If any of them become ragged or partially come off, you may remove those sooner. Be sure to report to your doctor any drainage from your incision or any opening of the wound. (CONTINUED ON NEXT PAGE)

(CONTINUED) 7. It is normal to take 4-5 days before your first bowel movement after your surgery. You may have already been instructed to take stool softeners (Colace) and Milk of Magnesia daily for a couple of weeks. Follow those instructions and call if you have difficulty with your bowel movements. If you are not on stool softeners and Milk of Magnesia, you can take a laxative such as Dulcolax tablets at bedtime every night until your first bowel movement. These medicines can then be used as needed 8. If you have hemorrhoids, straining with bowel movements can make them worse. You may need to use a laxative or stool softener of your choice for them. Corticaine cream, which can be purchased without a prescription, can also be helpful for the inflammation and itching. 9. Your visits for follow-up in the office should be scheduled for two weeks and six weeks following your surgery. If your follow-up visits were not scheduled prior to your surgery, please call the office at (478) 923-3331 to schedule these appointments after you return home. 10. A prescription for pain may be given to you. Take this medication as directed on the bottle label. Please call if it is not effective or if you need a refill. You may also receive prescriptions for antibiotics, hormones, or iron pills. Please follow the instructions on the bottles for this medication. Call us if you experience problems with these. 11. Please call if your have any excessive bright red vaginal bleeding, a temperature of 101F or greater, pain unrelieved by your pain medication, difficulty with bowel or bladder function, or wound concerns.

Diagnostic Laparoscopy
Post Operative Instructions
1. You may experience a sore throat during the first 24 hours following surgery from the breathing tube that was placed during the operation. Symptoms such as chest soreness and shoulder pain may occur from the gas that was placed into your abdomen during the surgery. While uncomfortable, this discomfort is harmless and will diminish over the first few days. You may lie flat with a pillow elevating your hips to alleviate the pain. 2. Please use good common sense when deciding what to eat after your surgery. If you are nauseated, consume only liquids you can see light pass through. Advance your diet as tolerated but go back to clear liquids should nausea return. Your diet, otherwise, may be advanced as quickly as desired. 3. Because your thinking and reflexes may be impaired from anesthesia, you should not operate any heavy equipment for at least 24 hours following the surgery. The type and amount of activity tolerated following the first 24 hours after surgery will vary from person to person. In general, you will not want to do any heavy lifting or pushing during the first week following surgery. Understand that you should only drive after you have returned to a normal level of physical activity. 4. A blue/green colored vaginal discharge may be present if dye was placed in the uterine cavity to document tubal patency. A small amount of vaginal bleeding is normal if cervical or uterine surgery was performed. Bleeding heavier that a normal menstrual period that seems to be getting worse is not expected and you should contact the office. Please do not douche or have intercourse after pelvic surgery. The cervix may be more open allowing bacteria to be flushed up in to the uterus and tubes during intercourse resulting in a severe pelvic infection. 5. Intercourse should never take place for at least two weeks following the surgery. You should not have intercourse until your physician has specifically instructed you that it is safe to do so after your post-op visit. Most patients with no complications may return to sexual activity within two weeks of surgery. [CONTINUED ON NEXT PAGE]

[CONTINUED] 6. Your stitches or glue will dissolve over time. Bruising around the incisions is to be expected. Small strips of paper may have been placed over the incisions and may able replaced with a Band-Aid three days after the surgery. Please do not shower for the first 24 hours following the surgery. It takes the first layer of tissue at least 24 hours to seal. When you do bathe or shower, use simple soap and water to clean the incisions and do not vigorously scrub the incisions. If you can see the stitches in the incisions, these may be clipped or plucked out on week following surgery. 7. It is not recommended that you travel beyond a two-hour drive for at least 14 days following the surgery. While surgical complications are rare, you will be forced to go to an unfamiliar emergency room and be seen by unfamiliar physicians should you start to develop problems. 8. You will be given a narcotic prescription for your post-operative pain. Do not hesitate to take this medication-you will not become addicted with the prescribed dosage. The pain may also be controlled with the use of extra strength Tylenol, 2 tablets every 4 hours as needed.(Do not use if you are allergic to Tylenol) Please do not mix the prescribed medication with the over the counter medications or alcoholic beverages. Please contact the office if there is an increase in abdominal pain not controlled by your medication. 9. You may use the over the counter medication of your choice for diarrhea or constipation. Please contact the office if you have specific difficulties which are not remedied with these medications. 10. You will be asked to return to the office for a post-operative visit 2 weeks following your procedure. If you did not schedule this visit when you signed your pre-operative consents, please call the office at (478) 923-3331 to schedule this appointment after you return home. 11. Please notify our office if you develop a fever of 101F or greater, pain the does not improve with time or medication, vaginal bleeding or a thick drainage from an incision site, or spreading redness around your incisions.

Cesarean Section
Post-Operative Instructions
1. You may resume your normal diet. You will begin to feel better and heal faster with well balanced nutrition. If nausea is a problem, start with liquids and soft foods. Avoid carbonated beverages fro 48 hours but add a protein shake or a liquid protein supplement, once a day for two weeks. It is OK to use a mild laxative or a stool softener. 2. You will experience pain around the incision site while the uterus contracts back down to its normal size. You have been given a prescription for pain medications and if you need a refill, please call during office hours. 3. Do not drive for two weeks following your surgery. Your incision site requires time to heal and that can take up to 6 weeks. During this time do not lift anything heavier than the baby. Limit your activities and DO NOT drive or operate machinery if you are taking pain medication. You may resume normal activities, including sexual intercourse, generally within 6 weeks after your surgery. 4. Keep the incision site clean and dry. Sutures or staples have been placed with steri-strips overlying. Remove the steri-strips on post-op day five. You may shower using plain soap and water but remember to keep the incision site clean and dry. Clean with hydrogen peroxide and pat dry after the shower. You may resume tub baths when your incision has healed, generally by seven days postop. Watch for signs of infection (redness, swelling, drainage) around the incision site and return for a check-up if any occur. 5. It is normal to experience light vaginal bleeding following your surgery. This bleeding is usually dark and not bright red. It may require 2-3 pads per day. However, using more than 3 pads per day is too much bleeding. The bleeding may continue on and off until your two week post-op appointment. If the bleeding becomes heavy and soaks through a pad in one hour for three hours then, contact the office and be prepared to come in for an examination. Please have your pharmacy number ready in case we need to call in a prescription. 6. Once you have completely healed and have been seen by your doctor, you may resume sexual intercourse. Remember to use birth control unless you want to get pregnant again. Breast feeding may delay ovulation but, you cannot rely on it for contraception. [CONTINUED ON NEXT PAGE]

[CONTINUED] 7. Please make an appointment to see us in the office two weeks after surgery for a post-op incision check and then again six weeks after surgery for a post partum check. 8. Call the office at (478) 923-3331 if you experience a fever greater than 100.4 F, heavy vaginal bleeding, pain that is not relieved by pain medication, constipation, irritable bowels, nausea and vomiting, drainage from the incision site and/or if your incision site has opened. A small percentage of time the incision will become infected and the edges will separate. If this happens, you will need to clean the site with hydrogen peroxide and keep it covered with sterile gauze.. Sometimes antibiotics are needed for ten days.