ATTENTION:
READ THE FOLLOWING INSTRUCTIONS CAREFULLY AS YOUR HEALTH DEPENDS ON IT.
· NO ASPIRIN (acetylsalicylic acid) or products related to aspirin. These should not be taken 2 weeks before and after surgery, because they increase the tendency to bleed. For this reason it is very important to carefully review the contents of any medication before using them. Many products for headache, flu and “hangover cures” contain aspirin (acetylsalicylic acid) such as:
Acetidine, Alka-Seltzer, Anacin, APC, Bromoquinin, Bromo-Seltzer, Bufferin, Coricidin, Ecotrin, Excedrin, Pepto-Bismol, Therazina, Midol, Liquiprin, Persistin, among others.
· NO Products related to aspirin such as:
Advil, Anaprox, Ansard, Artrotec, Cataflem, Celebrex, Clinoril, Daylo, Diclofenac, Dolobid, Etodolac, Feldene, Indocid, Ketoprofen, Lodine, Mobic, Motrin, Naprosyn, Naproxen, Nuprin, Orudis, Oruvail, Ponstel, Tolectin, Toradol, Vioxx, Voltaren, among others.
Consult with Dr. Carmona if you are not sure if a drug contains aspirin.
You can replace these products with TYLENOL (acetaminophen) if you require pain medication prior to surgery.
HERBAL REMEDIES AND NUTRITIONAL SUPPLEMENTS
• Some herbal medicines or nutritional supplements may also increase bleeding or photosensitivity (sun sensitivity). Please discontinue all herbal medications and nutritional supplements 2 weeks before and after surgery.
Some herbal remedies that can increase bleeding:
Billberry, Bromelia, Cayenne, Dong Quai, Echinacea, Fish oil, Garlic, Ginseng, Ginkgo biloba, Hawthorn, Kava kava, Licorice root, Sweet flower, Melatonin, Tonka seeds, Valerian, Vanilla leaves, Yohimbe.
Some herbal remedies that can make you sensitive to the sun:
Fruit and Root of Angelica, Celery, Dill, Fennel, Khella Fruit, Lomatium Root, Lovage Root, Parsley, Queen Anne’s Bow Tie, Agrimonia, Bergamot’s Shell, Sour Orange Peel, Buttercup Plant, Fig, Goose leg, Lemon peel, Lament leaves, St. John’s wort, Milenrama.
Consult with the doctor before ingesting any herbal medicine.
VITAMINS
If you are taking multivitamins, you must suspend them. As well as vitamin E or D tablets please stop 3 weeks before and after surgery because this may increase your chance of bleeding.
PRESCRIBED MEDICATIONS
If you are taking prescription drugs, for example, for high blood pressure, continue to do so, even the morning of surgery, except:
1. If you are diabetic, please refrain from taking diabetes pills or insulin injection the morning of surgery because you will not eat or drink anything that morning. Please also check your blood sugar levels that morning before coming to the hospital. If your sugar is too low (below 80) you should take a few sips of orange juice.
If you are taking medications prescribed for pain (e.g. for arthritis) please notify the doctor, some medications contain aspirin or similar products that can cause bleeding.If you are asthmatic, use your inhalers on the morning of your surgery, just as you routinely do.
DIET
Do not eat or drink anything (including gum, mints, etc.) after midnight before surgery. The morning of the surgery you must not drink or eat anything.
TOBACCO
Nicotine in any form, including cigarettes, chewing tobacco, chewing gum, and even transdermal patches, can adversely affect wound healing. Please stop all forms of nicotine 3 weeks before and after surgery, especially if Dr. Carmona is undergoing extensive reconstruction. You can compromise the success of your surgery if you continue to use nicotine products.
ALCOHOL
Refrain from drinking recurrently 2 weeks before and after surgery. If possible reduce even the moderate social drink, 1 week before and after surgery.
ON THE DAY OF THE SURGERY
• BRING 2 PRINTED COPIES OF YOUR LABS (HOSPITAL REQUIREMENT)
• Attend on an empty stomach, do not drink water.
• Consume your last meal at around 10:00 pm with your medicine (in case of medical prescription) the day before the surgery.
• Take a shower in the morning and do not put any cream or lotion.
• Remove metal objects including piercings.
• Do not bring valuables to the clinic.
• Remove any dentures.
• Wear comfortable clothes and shoes.
• No false nails (on one finger)
• Bring your prescribed medications to the clinic so you can take them after surgery.
ALSO PLEASE READ YOUR POST-OPERATIVE INSTRUCTIONS CAREFULLY NOW BEFORE YOUR SURGERY
GENERAL INDICATIONS FOR POST-OPERATIVE CARE
• POST OPERATIVE ANESTHESIA
After anesthesia, you may have a feeling of nausea and even get to vomit during the first 24 hours. You can take a prescribed anti-nausea medication to relieve your symptoms. Please contact the doctor if vomiting persists despite medication. You should tell your doctor if you have nausea or vomiting after the first 2 days. Sometimes the narcotic drugs you are taking for pain may upset your stomach and / or cause nausea. Try to take these with some food. It is also natural to feel a little fatigue during the first 2 to 3 days after surgery, while your body recovers from the combined effects of surgery and anesthesia.
SHOWER AND EXPOSURE TO WATER
Please do not wet your wounds until all bandages have been removed. If you do not have bandages, do not shower or wet your wounds during the first 24 hours.After this period of time you should remove the bandages and patches to take a shower with fresh water, preferably sitting in a plastic chair with backrest to make you more comfortable and relax.You can only shower with soap and water from your daily use and you should gently rub the areas of the wounds so that they are washed perfectly to avoid infections.When finishing the shower, dry the area perfectly and place only compressive garments.
* Do not enter pools or sea during the first 4 weeks after surgery.
WOUND CARE
1. Careful cleaning of the suture line should be done 2 to 3 times a day, using a cotton ball applicator or wet cotton ball and dry carefully. In case of Dr. Carmona prescribed antibiotic (Bacitracin or Neosporin), apply to the edges of the wound with a clean applicator (do not use fingers and thus avoid an infection in the suture or the possibility of crusting). If you develop a red / blistering area after applying the cream, stop application of this cream due to the allergic reaction.
2. Avoid hot baths because you can burn without realizing it. After surgery, the wound area will be numb for several weeks and you may burn yourself if you apply an object that is too hot (such as a dryer, iron, etc.) near or over your operated skin.
3. You can stop applying Bacitracin when removing sutures and start applying Vitamin E ointment for 2 weeks once or twice a day, which helps with scar healing. (Do not take vitamin E pills because it increases the chance of bleeding).
4. Avoid any excessive rubbing or scraping of the wound area, as this can break the suture line or cause darkening of your skin. If you have severe itching around the wound area, contact us immediately.
NOTE: Do not use any ointments/creams unless prescribed by the surgeon.
ANTIBIOTICS
The use of antibiotics should not be taken with alcoholic beverages for any reason as they can have consequences on your health.
If we prescribe antibiotics, please take them as directed. It is advised to take them with meals, to minimize any possibility of stomach upsetting. If you have nausea, please wait until the nausea goes away to resume your antibiotics.
If you have diarrhea, stop taking antibiotics. If diarrhea persists, please contact us. If you develop a fever greater than 38 degrees after the first 2 days, please let the doctor know.
• If CLEXANE 80 mg is prescribed, it should be taken after your surgery as prescribed (apply every 24 hours for 6 days subcutaneously or as indicated by the surgeon)
PAIN MANAGEMENT
Take medications prescribed for pain if you have significant discomfort after surgery. Also, since these drugs are narcotic, you are advised to avoid driving while you are taking them. Further, you should not drink alcohol when you are taking these narcotic pain medications. In case of mild pain, take a Tylenol. However, you should wait 4 hours to resume the other pain killers because some already have Tylenol in it and you do not want an overdose of Tylenol. You should avoid taking other medications not prescribed by Dr. Carmona. And in case of unexplained pain you should report it to the doctor.
CONTUSION AND INFLAMMATION
It is normal for you to have moderate or even significant swelling and bruising during the first two weeks after surgery. You will notice every day that these will decrease.You can apply an ice pack intermittently on the swollen part of your body for two days. However, if you notice more inflammation, especially in the first 2 to 3 days, you should report it to the doctor immediately. It is important to be patient with the swelling process and avoid using home remedies as it can complicate the recovery process.
For the contusion you should remember that it is important to relax your shoulders and back to avoid major contractures.
TEMPERATURE
It is normal to have changes in body temperature after performing a procedure. In this case, it is recommended to take a shower with fresh water and rest. If on day 5 to 10 after your surgery you have a fever greater than 38°C, it is important to tell the doctor to monitor your progress.
SUN EXPOSURE
Sun exposure in the first 3 weeks after surgery can lead to swelling and skin damage. Sun exposure on the wound area can also cause wound darkening (hyperpigmentation). If you are under the sun, apply sunscreen (No oils, no fragrance) preferably with titanium dioxide or zinc oxide (Tizo3) available at our clinic.
EXERCISE AND DAILY PHYSICAL ACTIVITY
During the first 2 weeks, refrain from leaning or physical exertion, activities such as carrying heavy objects, doing chores or cooking. Resting in the first few days after an intervention is of paramount importance for a successful recovery without health complications.
It is acceptable to begin a gentle walk, 24 hours after surgery. Jogging and gentle exercise cannot be resumed before 4 weeks. The sports of major effort (gym, weights, yoga, box, Zumba, etc.) require at least 6 weeks of recovery to be safely resumed.
You should not drive a vehicle until 3 weeks after surgery, due to the physical effort that is presented or, to avoid any automobile accident due to having limitation of your movements.
It is also not allowed to have sexual intercourse until the first month after surgery, to prevent any injuries, and incisions from opening or getting infected.
If you feel that you are too weak to perform a given activity, you should listen to your body and rest properly. Remember that your body is healing and some of your energy is spent in the healing process.
DIET
Now that the surgery has been completed successfully, you can ask yourself what you can eat. After a surgical procedure, you should eat as healthy and as much as possible, as this will help your body to have a better and faster recovery. You should make at least 5 to 6 meals a day. Protein contains amino acids that help with regeneration of body cells, so after a surgery you must consume them so that the tissue heals faster and prevent swelling.
Fruits and vegetables are an excellent source of antioxidants that enhance the body’s ability to resist infections and speed recovery of tissues. Liquids such as water, smoothies and natural juices help to keep the body hydrated and it is very important to take at least 2 liters a day to recover and avoid headaches.
Sometimes it is normal to have nausea or vomiting after a surgical procedure, but the most important thing is to stay hydrated and try to eat some soft foods such as gelatins. If you are constipated you can use a laxative prescribed by the doctor, this will help to feel better within a few hours after going to the bathroom.
USE OF COMPRESSION GARMENTS OR BANDAGES
The use of your compressive garment 24/7 the first month is very important (should be removed only when taking a shower). These allow adequate blood circulation to the skin and healing tissues. It also keeps the tissues of the treated area in place after surgery, without compromising the patient’s posture and ease of movement when performing daily activities. They also help to exert pressure evenly vertically and horizontally for the tissues to heal properly.
COMPRESSION TIGHTS FOR THE PREVENTION OF DEEP VENOUS THROMBOSIS (DVT)
By applying pressure to the legs, particularly at the calf level, compression tights help activate blood flow. The pressure, combined with the movement of the legs, helps the blood from the superficial veins to travel to the deep veins and return to the heart. Blood is thus less likely to clot in the deep veins, which could be fatal if the clot moves to the lungs.
Therefore, the compression tights should be used for 2 weeks after surgery. They can be lowered to the knee in case of discomfort or remove in case of walking. Using these tights is mandatory until the surgeon approves the removal.
USE OF MAKE UP, COLOGNES, PERFUMES and PIERCINGS.
If you routinely use makeup on the wound area, please refrain from doing so for at least the first two weeks after surgery. Make-up can cause significant irritation of the skin and adversely affect wound healing. Moreover, perfumes and lotions can irritate your wounds; Therefore, try to minimize or stop the use of this class of products for at least the first 10 days. Like hair dye, you should wait at least 4 weeks before applying it. In order to wear a piercing in any area where a procedure has been performed, you must wait 6 months after surgery.
MASSAGING ON THE AREA OF THE PROCEDURE
The massage is done in circular motion, pressing and sinking slightly. The massage will become more vigorous as sensitivity allows. The more constant the better. Consult with the Surgeon when you can start giving these massages and if it is needed for your procedure.
HOW TO SLEEP
Sleep at night with your head elevated with a couple of pillows for the first week after surgery. Sleep only on your back (or on your side if the surgeons advises to). Do not try to lie down or get out of bed (ask for help in performing these activities).
REMOVAL OF STITCHES
The removal of stitches is usually performed at the first post-operative appointment that takes place 5 to 10 days after surgery; confirm with Dr. this information so you can schedule your appointment.
WHEN TO TRAVEL
It is recommended that during the first 5 days after the surgery you stay in the city where the procedure was performed. If your surgery was short, performed under local anesthesia or was a non-invasive procedure, you can travel after your first post-operative visit, which is usually 6-8 days after surgery. If your surgery was invasive, you should try to travel after two weeks of your surgery, as long as you consulted with the doctor and are fit to fly.
SKIN HEALING
Healing is a process that is acquiring the skin from the deepest part to the surface. At first, It is normal that the wound is be red and pronounced; as time goes on, this color will change as well as its shape. It is important not to use any cream or product that Dr. Carmona does not prescribe for the recovery of the wound.
OTHER THINGS TO TAKE IN CONSIDERATION
Please read carefully the pre-operative indications sheet and review all medications, vitamins and supplements you should avoid before and after surgery, including advice about smoking and drinking alcohol.
Doubts should be written down in a notebook and taken with the day of your first post-operative consultation. No doubts are resolved by social networks. Sending badly taken pictures or the little detailed description of your question, do not help to give a solution. Physical examination is important in order to appreciate the problem and provide an adequate solution to the patient’s problem.
To schedule your appointments, please feel free to contact us at the office to be able to attend and follow up on your progress.
