Postoperative Instructions - Ramsey Stone, M.D.

The following is a compilation of some of the more common postoperative details and may aid in answering common questions. Below is a list of common surgeries. If your surgery is not listed please see the general guidelines below.

General postoperative guidelines and instructions:

Whether you take a few or a whole bunch, pain medicine tends to lead to constipation. My recommendation is to at least take a stool softener while taking pain medicine. Typically, I recommend Colace twice a day. Sometimes even this is not enough, though. Do not let it go for more than a few days without a bowel movement – it only gets harder! I would recommend over-the-counter laxatives if you have not had a bowel movement after a few days (a few days in 2 or 3 days, not a week!). I usually recommend miralax at this point. Dulcolax and some of the other over-the-counter laxatives are also good. If you find this not working, usually an enema is the next line of therapy (if you have had colon surgery, please consult us before using an enema). The last line of therapy would be something like magnesium citrate, etc. If you have home remedies or certain foods that work for you, feel free to do this as well.

Please bring these papers by the office for our nursing staff to fill out. You may bring them at the time of follow up visit. Unfortunately, we may not be able to get these back to you the same day.

For most surgeries we would like to see you back in the office to see how you are doing. We typically like to see you back 2 weeks after your surgery. Please call the office to make your follow-up visit.

Wound care depends on what was used to close the incision. General rule of thumb is to keep the wound/incision out of the sun (or at least well sunscreened) for an entire year – they will scar a darker color if exposed to the sun during the first year.

– Dermabond: dermabond is a surgical glue that we use mostly. This is a hard film that you will feel over your incision. All of the stitches are on the inside and will dissolve. There is nothing to take care of! This seals the wound and also helps keep it together. You may take a shower the next day (typically after 24hrs after the surgery). Wait a week before soaking in a bath or swimming in a pool (completely submerging). The film will naturally fall off in about two weeks. Do not use any lotions/creams/etc until at least two weeks.

– Skin Staples: skin staples are used to hold the incision together. These are obvious as numerous metal fasteners on your wound. You may get these wounds wet after 2 days. Typically these are removed in the office after about 2 weeks. Don’t fret! They come out a whole lot easier than you think. We will place steri-strips on the wound at that time. These are small white bandages that can get wet and will fall off on their own in about 2 weeks after they are placed. The staples may be left in for slightly shorter or longer time periods depending on the wound and location.

– Stitches: stitches usually look like small black or blue strands near your wound. These are typically used for office procedures and incisions on your back or extremities. You can get this area wet after 2 days. Depending on size and location, these usually are taken out after 2 -3 weeks. We will place steri-strips on the wound at that time. These are small white bandages that can get wet and will fall off on their own in about 2 weeks after they are placed.

– Steri-strips: these are small white bandages that cover the incision. If it appears that your wound only has steri-strips then the stitches are likely under the skin and will dissolve. You may get this area wet after 2 days. These steri-strips will fall off on their own in about 2 weeks.

wounds typically heal with a small amount of pink/red around the incision. Also itching is normal. Bruising (all colors: blue/purple/yellow/green) can also be seen at the incision site or around it. A small amount of clear/reddish fluid drainage can sometimes be seen as well and is usually ok. If the incision site becomes bright red or starts to drain excessively, please contact the office.

Postoperative fever is normal – several days of low-grade fever is normal after a procedure/surgery. This means fever may be normal up to 101.3 f. The best thing to do for low grade fever is to work your lungs. Your lungs are the most common source for this fever. If you were sent home with a clear breathing machine, work on that several times every hour. If you do not have one of these machines, purchase a balloon (any balloon works) and practice blowing the balloon up several times an hour. The purpose is to expand your lungs (deep breaths) and will help the fever. You may take tylenol for but DO NOT take tylenol with pain medicine that already has tylenol (acetaminophen) in it.

Nausea after surgery can be normal. This is especially true during the first 24 hours. The main thing is to stay hydrated and try to keep fluids down. Typically, nausea medication is prescribed and can be taken as needed.

Please refer to the specific surgeries below. In general, the more activity the better. This means walking around and other non-strenuous activity. It is better to hurt a little more and be active than to lay on the couch for a week. Your legs need to help circulate your blood so you don’t get blood clots. They do this best when walking. You will notice that your energy level is not what it was before surgery. This is normal. When you feel tired, it is time to rest. It usually takes longer than you think to get your energy level back. For most surgeries, I recommend no heavy lifting (> 15 pounds) for 4 weeks after the surgery.

Some itching is normal. The best treatment for itching is over-the-counter Benadryl. Please be aware that this can cause drowsiness. This is preferable to anti-itch creams but these too may be used if you have no relief with Benadryl (although preferably not directly on the incisions). Occasionally people will develop a rash right around the incision(s). If this happens, you are likely allergic to either the dermabond, stitches, or your body reacts this way to incisions. The same treatment as above is recommended. Also, a few people will have a generalized rash that covers a wide area (if abdomen – the entire abdomen). This likely signifies that you are allergic to the cleaning solution used to prep the skin before surgery. Again, the same treatment as above is recommended. For relief, sometimes around the clock Benadryl is needed for several days.