A few things I wish I knew before surgery

Post-op constipation is real.

The combination of narcotic pain medications, decreased activity, and poor dietary intake can lead to some serious constipation, so drink all the water, eat all the fiber, and walk, walk, walk. Unless you have other medical issues, you’ll need 2-3 liters of water (sorry, your coffee doesn’t count), and 20-30 grams of fiber every day. For reference, a serving of bran cereal has about 5.5 grams; fiber supplements like Metamucil can help you meet your goal and are actually pretty tasty these days.

As for walking, we like our patients up and walking the same evening of surgery (but always defer to your doctor’s instructions). Walking not only staves off constipation, it’ll also help prevent potentially fatal blood clots, so win-win.

What you eat, drink, and do can affect wound healing.

We already discussed the copious amounts of water and fiber you’ll be consuming, but there are other nutrients you’ll need to be aware of to help maximize your recovery. Low fat protein, zinc, calcium, and vitamins C & D are important factors in wound healing. And while it’s always better to get your nutrients from whole food sources, supplements may be beneficial to some people. Try a calorie tracking app on your phone to see how your nutritional intake stacks up.

On the flip side, there are a few things you should avoid, as they are known to delay or complicate wound healing. Nicotine is the biggest “NO” out there, but you should also monitor your intake of caffeine (like that coffee we talked about), alcohol, and excessive salt and sugar. A balanced diet of fresh fruits, veggies, and lean protein is almost always best.

What about lymphatic massage? We get asked this a lot. Lymphatic massage purportedly helps relieve pain and swelling, break up scar tissue, and improve blood flow to the area, thus promoting healing. There isn’t much data available to back up these claims, but some people swear by it (while others find it painful). We tell our patients they are welcome to try it if they’re interested, but we can’t promise any specific results from it.

Post-procedure depression can happen.

A lot goes into your emotional wellbeing after surgery, such as a personal history of depression/anxiety, reaction to medications, concerns about recovery, feelings of guilt for depending on others, or financial stress. For some people, these negative emotions can linger to become post-op depression. If you can’t shake the negativity or if you’re having excessive fatigue, changes in appetite or sleep, increased irritability, or any other symptom of depression, it’s important to get the help you need. Talk to your doctor if you have concerns about post-operative depression.

Good help will be invaluable and meal prep is a life saver.

In the days leading up to your surgery, go over your needs and expectations during recovery with your primary caregiver. Will you need dressings or other supplies? Get them now. Depending on the surgery, you might want to have gauze, medical tape (look for soft fabric or paper tape, not plastic), and maybe some “chux”/puppy pee pads  – those absorbent pads you can put down to catch drainage, etc. Have some gloves available if you need help with dressing changes. Check with your doctor to see what you might need. Don’t forget your personal hygiene needs during this time as well. You might want to pick up some dry shampoo, baby wipes, or body powder if full showers are limited. A bidet attachment on your toilet might be worth the investment – they’re under $50 and easy to install. Do you have periods? Stock up on your supplies and discuss any assistance you’ll need with your caregiver.

Also use this time to meal prep – whip up some big pans of lasagna or casserole to freeze for later. Stock up on easy to eat, nutritious foods like whole grain toast with peanut butter, soups, and produce. If you know you’re prone to nausea, crackers and ginger ale are good to have on hand. Fresh out of anesthesia, the B.R.A.T. (bananas, rice, applesauce, and toast) diet is nutritious and easy to digest.

One last consideration is maneuverability in your home. If you’re going to need assistance – whether it’s another person or it’s equipment like a walker or crutches – you’ll probably need to make space. Take some time to move trip hazards like area rugs or power cords and consider if you’ll need things like grab bars in your shower or near your toilet.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Postop Recovery Tips first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Like movies? Biofilm is the most important film you’ve never heard of! Biofilm is the technical name for the slime that bacteria secrete. It’s a problem in the case of breast implants and fillers. We generally worry about blatant infections from bacteria but in the case of implants and fillers, biofilm can cause problems other than a frank infection. Curious? Keep reading.

Biofilm and how it affects you

Obviously your doctor knows about the risk of infection anytime they inject a filler into your face or place a breast implant during breast augmentation. That’s why the doctor cleanses the skin with alcohol (in the case of fillers) or betadine (in the case of breast augmentation). But with billions and trillions of bacteria on the skin, it’s not always possible to get rid of 100% of the bacteria.

That doesn’t mean we just give up when it comes to cleanliness and good surgical technique. That’s still critical. We just have to understand the potential risks. Even if there are a few bacteria still present during surgery or non-injectable treatment, your body does a pretty good job neutralizing most of them. However, some bacteria can attach to the filler or implant after placement. The bacteria then secrete a slime that all together, represents biofilm.

With biofilm present, it’s harder for antibiotics to kill the bacteria with their protective slime covering. This doesn’t result in infection. In the case of fillers this can result in granulomas and nodules. In the case of breast augmentation, this can result in a thickening of the scar tissue around the implant. If the scar tissue around the implant is thick enough to distort the implant and breast, that’s capsular contracture.

So how do we reduce the risk. First let’s discuss fillers. As the image above shows, the more needle sticks into the skin to inject fillers can potentially bring more bacteria from the skin surface and into the filler. By using the blunt cannula technique, your doctor only makes one needle stick, rather than many. In other words, the treatment can be performed with one entry point rather than five or ten. You can see an example of the blunt cannula technique in the video below.

Blunt cannula technique video

In the case of breast augmentation, protecting the implant from any skin bacterial contamination is beneficial. For example, inserting the implant without the implant touching the skin or covering the nipple, and it’s bacteria hidden within the nipple milk ducts, can help. You can see an example of “nipple shields” in the video below.

Nipple shields video

To check pricing on any of these procedures from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Considering breast aug or fillers? You need to know about biofilm! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Check smokers’ compliance

There are urine and blood tests that can screen for the by-products of nicotine to ensure compliance.

While patients think they’re supposed to quit smoking due to the risks of lung cancer, which is true, the main problem when it comes to surgery is not smoking, it’s the nicotine.

So I’m clear with the patient that not only do they need to quit smoking, they need to quit all forms of nicotine (patches, gum, dip, cigs, cigars) since the nicotine impedes the normal ability to heal incisions. Incisions that don’t heal well can trap bacteria and lead to infection.

If a patient states they can only stop temporarily, I require they quit 2 weeks before and 2 weeks after surgery.

Sure it’s possible for a patient to lie and “fool” me and get their surgery. But in the end, they’re only fooling themselves if they risk an infection for an operation they just paid out of pocket for.

After you quit smoking, check pricing for procedures from Dr. Kaplan by clicking here!

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Smokers and Surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.