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.

Why you should call your postop surgery patients

When I had my tonsils removed as a kid, I went home soon after the procedure. Later that night, Dr. Pate, my ENT, called to check on me. He was surprised I answered the phone myself. While I may have surprised him, it was probably also reassuring that his postop patient was feeling well enough to answer his call. And honest to G-d, ever since then, I realized calling to check on a patient at home was the way to go. For several reasons.

Obviously, calling a patient the night after their outpatient procedure means a lot to the patient. But it also means a lot for the doctor and speaks volumes. First, it shows the patient’s pain is tolerable enough that they can answer their phone.

Secondly, it means the patient is able to take care of themselves. Let me explain. The morning of surgery, I ask the patient for their mobile number. If they have a family member in the room, the family member sometimes offers to give me their phone number. The family member means well. They figure the patient won’t feel like answering the phone so they’ll help out. But that’s not always good for the patient and I insist on getting the patient’s phone number.

The patient can and should take care of themselves after an outpatient procedure. They don’t need a “helicopter mom” or caregiver doing everything for them. It’s ok if the patient fends for themselves, especially easy tasks like picking up their cell phone!

So when I call to check on the patient and they answer, there’s an immediate calm and reassurance that comes over me. I instantly know the patients pain is under control and I know they’re active enough to move around, use the bathroom and take care of themselves. That kind of physical movement reduces the risk of blood clots in the leg, a pulmonary embolus and many other postop complications. And then I can sleep better at night, just like my patient.

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

The post When postop surgery patients answer your phone call first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why do surgeons hate fingernail polish for surgery?!

One of the least invasive ways to monitor the oxygen level in your blood is with a pulse oximeter. See the photo above. A pulse oximeter, or ‘pulse ox’ for short, lightly clamps onto the finger tip and monitors the level of oxygen in your blood in real time. This is certainly easier than drawing blood from the patient’s artery every time the anesthesiologist wants to check the level of oxygen.

The pulse ox needs clear access to the blood vessels in the fingertip and nail polish can affect the readings. This study set out to assess how these 10 different colors affect pulse ox readings:

“Ten different colors of Wet ‘n’ Wild (Pavion; Nyack-on-the-Hudson, NY) fingernail polish were used: red, yellow, dark blue, green, black, purple, fuchsia, light blue, brown, and white.”

According to the study, black and brown were the only colors to alter the readings to a statistically significant degree. However, even in those circumstances, if the pulse ox was placed on the finger in the ‘side-to-side’ direction rather than the normal ‘top-to-bottom’ direction of the finger, the readings were again accurate.

So next time you go to surgery, you have 3 options:

1. 1. don’t wear any nail polish.
2. 2. allow the OR staff to remove your nail polish.
3. 3. argue with the staff and cite this article and tell them to place the pulse ox in the side-to-side position if you’re wearing black or brown nail polish. Or the top-to-bottom position if wearing any of the other 8 colors above.

 
I would recommend against the 3rd option. Arguing with OR staff before your operation is bad karma!

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

The post Do you really need to remove fingernail polish for surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What to wear for surgery

Determining what to wear for surgery requires knowledge of what happens in the operating room. Obviously the surgeon needs access to the area where the operation is occurring. Is it the chest, arms or abdomen? Maybe the face. So you want to make it as easy as possible to get out of your clothes upon arrival. But more importantly, you want to wear clothes that are easy to get back into after surgery.

For example, if you’re having facial surgery, you should wear a button down shirt so you don’t have to pull a shirt over your head. If you’re having breast surgery, there’s no reason to bring a bra because your surgeon will probably place a postop garment on you after surgery. There’s no need to wear tight jeans because you don’t want to put yourself in the situation where you have to struggle to put your pants back on. In light of these situations, you should focus on baggy clothing. That includes a button down shirt for the reasons mentioned above and sweat pants. Slip on shoes are best so it’s easy to get back on after surgery.

But what about accessories?

I know you want to look as pretty as possible for surgery but you really don’t need to wear any makeup or jewelry. It’s best if piercings are removed but I understand non-traditional piercings can be difficult to remove. For patients that have nipple rings, we cover these with a sterile dressing during surgery if we’re not making incisions around the areola. By allowing the patient to keep those piercings in place, there’s less frustration for the patient and it avoids a delay in surgery trying to get them out!

Don’t forget to wear similar loose-fitting clothing for your postop appointment so it’s easy for your doctor to examine your surgical site. Best of luck!

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

The post What should I wear for surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.