Health and Surgical Associates
1. Drink clear liquids the day before surgery
2. At Noon and 8 pm, take 2 Dulcolax (Bisacodyl) tablets
3. At 1 pm, mix one capful of Miralax into an 8oz. glass of liquid and mix well before drinking - Repeat process every 15 minutes until bottle of Miralax has been consumed
1. Bring all medications with you to the hospital at admission
2. Take all heart, lung, asthma, anti-seizure medications as usual on morning or surgery
3. Do NOT take blood thinners for five day before surgery
4. Do NOT take Glucophage pills for 2 days before surgery. (Other hypoglycemic medications are safe)
5. Do NOT take aspirin, Tylenol, etc. for 2 weeks before surgery. Do NOT take Goody powders or BC packs for 2 weeks before surgery. If you take these medications for pain and feel that you cannot keep from taking them, please take them as little as possible. These medications make people bleed more freely and make surgery more difficult.
6. Do NOT take any of the following herbs for a full weed before surgery: Echinacea, Ephedra, Garlic, Ginkgo, Ginseng, Kava, St. John's Wort, Valerian.
7. Do NOT eat or drink anything after midnight.
8. Do NOT wear lotion or nail polish on your surgery date.
9. Do tell us if you use a CPAP machine AND bring it with you when you come for surgery
10. DO call if you have any questions
During the pre-operative work up on the same day as Surgery, patients families will be allowed to stay with them until they go to the immediate preoperative holding area during the preoperative work up on the same day as surgery. Patient families will be allowed to stay with them until they go to the immediate preoperative holding area which occurs approximately one hour before the beginning of the surgery. An IV will be started and to preoperative antibiotics administered and this preoperative holding area. Throughout the surgical procedure, family will be informed of the surgeries progress. At the time of surgery, I will see the anatomy in a full relaxation state and sometimes I will see a need for additional surgery in the pelvic compartment to address a defect that was not visible in the office. I will proceed with this repair if it addresses symptoms that a patient currently has or prevents problems which would likely require further surgery. If I am considering doing a procedure that is not directly related to the surgery goals at hand, I will discuss and obtain a consent for that additional surgery from a family member intraoperatively. On the other hand, I may choose to forgo a portion of a surgery discussed if I believe that there will be an unreasonable risk for the patient because of unexpected findings such as scar tissue or in the event that a patient becomes unstable medically under anesthesia.
In the hospital you will receive scheduled pain medicine to allow optimal rest which improves healing time. Antibiotics will be given during surgery and in some surgeries afterwards as well depending on the type, location, and sutures used during your surgery. Medicines to prevent nausea will be given before surgery. Some people are aware that they have nausea problems after surgery and for those patients I will give scheduled nausea medicine post operatively as well. The bladder will lose it's ability to feel if it is full and sometimes to empty for a short while after surgery. Some bladders wake up in one day and others (less than 1%) may take as long as 4 to weeks.
At home it is important for patients to rest well and take their pain medication as directed. Other instructions that are important to follow are those of bathing and showering. After rectal surgery of any type sitting in a bath tub is very important as the heat draws our immune system to the area to promote healing and the cleaning of the soaks prevents infection of this very bacteria laden area. Office follow up instructions will be given and allow me to watch for any potential problems. It will be important for you to report vomiting, fever, increasing pain, diarrhea, unusual bleeding or any other strange symptoms.
After non-prolapse surgery activity may return to normal completely. There is not much research about non-mesh prolapse surgeries but I can speak from 20 years of experience doing these surgeries and following patients over time. In general I would not recommend any repetitive upper body lifting over 10 pounds and 20 pounds lower body pressing. This includes children and grandchildren. For exercises, focus on reps not weight. For parents and grandparents if you must carry a heavy little one, try to hold them close to your body to decrease abdominal strain and if possible have children climb to your height so that you can avoid lifting them as much as possible. Also avoid high impact exercise. Some of these restrictions are affected by patient habitus. Remember that any pressure that you put on your pelvic floor through activity is compounded by your actual weight. Another problematic issue for some patients is the presence of a chronic cough or times of deep coughing associated with colds or asthma for example. I tell these patients to wear a device called Impressa which is a tampon like device that gives your prolapse repair a little additional support during these episodes. There are many patients who want to do activities that are relatively vigorous and even activities that violate these restrictions. I encourage people to speak with me and allow me to follow them as they increase their activity level to look for early evidence of prolapse so that they can cease the activity if it appears to be problematic. I have been surprised through the years about the many people who engage in vigorous activities and do just fine long term but I feel obligated to give my general recommendations with a conservative slant.
At the time of surgery, I will see the anatomy in a full relaxation state and sometimes I will see a need for additional surgery in the pelvic compartment to address a defect that was not visible in the office. I will proceed with this repair if it addresses symptoms that a patient currently has or prevents problems which would likely require further surgery. If I am considering doing a procedure that is not directly related to the surgery goals at hand, I will discuss and obtain a consent for that additional surgery from a family member intraoperatively. On the other hand, I may choose to forgo a portion of a surgery discussed if I believe that there will be an unreasonable risk for the patient because of unexpected findings such as scar tissue or in the event that a patient becomes unstable medically under anesthesia.
Cancelled surgeries within 24 hours prior and no-shows will be charged a $200 fee.
If for any reason you will be late for surgery, or if you must emergently cancel surgery, contact the hospital operator and have her notify Dr. Azar immediately.
If surgery needs to be rescheduled for anything non-emergent (whether rescheduling for location, surgery type or date), a $75 rescheduling fee will be collected first.
Please be aware that you will be contacted by our billing department regarding the estimated out of pocket cost of your procedure(s). This amount must be paid prior to your surgery. This estimate will not include hospital, etc. fees.
© Published in 2018 by Arden Azar
Property of Renaissance Health and Surgical Associates
Special thanks to Freepik for the icons! Visit https://www.freepik.com/