WHEN YOU HAVE DECIDED TO HAVE SURGERY

Preparation For Surgery
Once you have made the decision to proceed with a hysterectomy or more conservative surgery, you should begin to prepare yourself both mentally and physically. The stronger and healthier you are going into surgery, the shorter and easier your recovery will be.

If you exercise regularly, continue to do so. If not, begin an easy program of daily walking that you can continue post-operatively Many women will undergo surgery for excessive bleeding and are therefore likely to be iron deficient if not frankly anemic. Bone marrow stores of iron may be depleted by the body’s continual need for rebuilding red blood cells. A multi-vitamin supplement with iron will help keep your body supplied with essential nutrients.

A strong immune system is important for your speedy and uncomplicated recovery. Vitamin C boosts the immune system. Begin taking 500-1000 mg of vitamin C daily and continue it through your recovery process - at least six weeks post-operatively.

Stress is a major depressor of the immune system. Facing the prospect of major surgery can be distressing. Try to minimize your anxiety by being well-informed and in control. Be sure you understand why you have elected a surgical option and exactly what you can expect both while you are in the hospital and afterwards. This handout will be helpful, but it is not a substitute for frank and open discussions with your physician about your hopes, fears and anxieties. There are many audio tapes available which may be useful in helping you with relaxation, stress reduction and healing. Some surgeons may encourage you to bring cassettes with headphones into the operating room. Soothing music and relaxation tapes have allowed many patients to approach surgery much more comfortably.

Appointments Before Surgery
Under most circumstances, all pre-operative testing and teaching is done as an outpatient during the week prior to your surgery. You will be admitted to the hospital several hours before surgery, not the evening before. Be sure to have all your questions answered during the pre-operative appointments since you may not see your surgeon again before you reach the operating room. If more questions arise, call your doctor. You will also have a pre-operative appointment at the hospital. At this time your registration materials will be reviewed and any financial or insurance questions will be addressed. A nurse will review your medical history with you, take your temperature, pulse and blood pressure, and draw blood for routine laboratory studies. A chest x-ray, electrocardiogram and special breathing studies may also be ordered.

Blood Donation
It is possible to donate your own blood to the blood bank for use during your surgery if you need a transfusion. This is called autologous blood. Because the need for transfusion in gynecologic surgery is so rare (<1%) autologous blood donation is generally not recommended.

Before Surgery
As the surgery date approaches, some people have enough anxiety that sleeping is difficult. It is important to communicate with your physician and get a prescription for some mild sleeping pills if necessary. Adequate rest will help you deal with the mental and physical stress of surgery more easily. Exercising regularly and avoiding excessive alcohol and caffeine will also help you.

The morning of surgery, leave yourself time to take care of last-minute details regarding children, pets and household. Shower, wash your hair and put on whatever make-up you like to wear. Avoid mascara that could scratch your cornea during surgery. The more you look like you, the better you will feel. It is o.k. to brush your teeth, but spit the water out.

1)      You should have nothing to eat or drink (including water) after midnight the night before surgery. If you normally take medications in the morning, check with you doctor about taking them. They may be allowed with a small sip of water.

2)      Wear loose, comfortable clothes to the hospital. It is not uncommon to have some abdominal swelling for awhile after surgery, and you will need to wear these clothes home.

3)      Do not bring anything valuable to the hospital. Nice jewelry, watches and certainly cash tend to grow legs and walk away while you are asleep.

At The Hospital
When you check into the hospital, you will be asked “name, rank and serial number” many times. What’s your name? Who’s your doctor? What are you having done? What are you allergic to? When did you last have anything to eat or drink? The questions become tiresome and may make you wonder why you bothered to answer them the last time, but please keep in mind they really are for your safety. Every once in a while someone may remember an important part of her medical history only after being prompted many times.

You will be given a plastic identification bracelet to wear along with a “fashionable” hospital gown. Bring a robe with you to cover up so you will feel comfortable walking in the halls. While you are getting situated in your room, your family or friends may stay with you. The nurses will be gathering your chart together, making sure that all of your lab work is available and that your paperwork is in order.

Before your Operation
When the surgery team is ready for you, you will be escorted to the operating room area. Your family will be shown to a comfortable waiting area where your doctor can find them as soon as your surgery is over. Some hospitals allow people to walk to the operating area; others require that you be wheeled on a stretcher. Once you arrive in surgery, you will be in a holding area where someone dressed in surgery clothes will ask you the same questions all over again. An I.V. (intravenous tube) will be started — usually in your left hand or forearm. This should be about the only thing you feel. Medication can be given to you through the I.V. so that everything else will be comfortable for you. You may have spoken with an anesthesiologist (the doctor who keeps you numb or asleep during your operation) at your pre-operative appointment. Now the anesthesiologist who will be taking care of you will review your chart and discuss with you your options for anesthesia.

Anesthesia
Fortunately, for pelvic surgery, there are many choices for anesthesia which are both safe and effective.

General Anesthesia
Some people prefer to be “out cold” for surgery. This is called a general anesthetic. Medication to make you sleep is given through your I.V. while you breathe oxygen through a mask. It usually takes about 15 seconds for you to drift off to sleep. Once you are asleep a breathing tube will be placed in your windpipe and anesthetic gases are used to keep you asleep and comfortable during the operation. The tube is usually removed before you are fully awake.

Occasionally people notice a sore or scratchy throat after general anesthesia. The other common side effects are nausea and vomiting from the anesthetic drugs and general wooziness which may last many hours.

Regional Anesthesia
The other type of anesthesia which can be used is called regional ‘A anesthesia or a “block.” Two types of blocks can be used. For a spinal anesthetic, a very tiny needle is placed through your back into the spinal canal. A small amount of local anesthetic is added to the fluid bathing the nerves in your back making you numb from about the waist down in 2-5 minutes. For an epidural anesthetic, a larger volume of local anesthetic solution is injected into the space surrounding the spinal canal. The solution slowly covers the nerves as they leave the spinal canal, and therefore more gradually causes numbness. With any type of regional anesthesia you may feel some pressure sensation during the surgery, but your anesthesiologist will make sure that you have no pain. Medication can be given through your IV. to make you as groggy as you would like to be once the block has been given.

In The Operating Room
After you have finished your discussion with the anesthesiologist, your nurse will bring you into the operating room itself. It may feel cold, and the operating table is hard as well as cold. You will be asked to slide from the stretcher onto the table. If your nurse does not automatically bring you a warm blanket, ask for one. A blood pressure cuff will be placed on your arm opposite the I.V., three sticky cold pads will be placed on your chest and side to monitor your heart (EKG leads), and a clip (it does not pinch) will be put on your finger to measure the amount of oxygen in your blood. It seems like a lot of wires and beeps and can be frightening - remember all of these devices help your surgeon and anesthesiologist keep you safe during your stay in the operating room.

At this point, whatever anesthetic you have chosen will be administered. After you are either numb or asleep, the nurses and your surgeon will position you on the operating table - lying flat for an abdominal procedure, or with your legs in stirrups for vaginal surgery. A small amount of pubic hair may be clipped or shaved to keep the operating field clean, and a small tube may be placed in your bladder (a catheter). You won’t feel any of this. Finally the surgical area on your skin is washed with special antiseptic soap and sterile drapes applied.

After Surgery - The Recovery Room
The operation itself may take anywhere from one to several hours. As you emerge from the anesthetic, you will probably have the catheter in your bladder and a sterile dressing over the incision if your surgery was done through the abdomen. A sanitary pad will have been placed between your legs and you will be moved back onto the stretcher to be taken to the recovery room. In recovery you will be monitored carefully for an hour or two until all the anesthesia has worn off. If you begin to feel any nausea or discomfort, tell your nurse. Medication has been ordered by your doctors to help relieve these symptoms.

When you return to your room, your family will be notified and you will be able to see them. Ask them to keep visits brief, as you will still feel sleepy and you need rest.

Pain Control
Pain assessment is now considered a “vital sign” of your well-being after surgery. The goal is to keep you completely comfortable. This is a team effort. It is important for you to tell your surgeon about medications that have caused you problems in the past as well as any difficulties you have had with prior surgery. Post-operative discomfort is best controlled by pre-empting pain - that is giving you medications that prevent the nerves from becoming too stimulated. You will be given anti-inflammatory medication prior to surgery as well as strong pain medications in your IV before surgery starts. In addition, we use local anesthetic to block signals from the area of surgery BEFORE the nerves can fire.

Please let us know if you have had any difficulties with nausea with anesthesia or if you tend to get carsick or seasick. We can prevent nausea with medication you take before surgery. If nausea is well- controlled, most patients can begin taking strong pain medications by mouth shortly after surgery. BE A SQUEAKY WHEEL! Let your nurse know if you are experiencing discomfort. We want you to receive whatever medication is necessary to keep you comfortable. Once we know what medicines work well for you, you will be discharged home on those same medications. Take the anti-inflammatories around the clock whether you think you need them or not. Keeping the swelling out of tissues will help you feel better. If you have nausea or stomach discomfort, notify your physician. Be assured – you will not become addicted to any medication during the surgical recovery time. Take whatever medication you need to feel comfortable and to allow you to move around, use the bathroom and sleep. Notify your physician if pain is increasing or poorly controlled.

After Surgery
During the first day or two after surgery, your doctors and nurses will be watching you carefully for any signs of infection, abnormal bleeding or other complications. It is very important to move your ankles and legs frequently, even when you are in bed, to help prevent blood clots. You should also concentrate on breathing deeply and coughing when awake. Your nurses will help you get up and walk around within 4 hours after surgery. It may seem formidable to move around especially if there is an incision in your abdomen, but people feel much better once they are mobile. Once you can reach the bathroom comfortably by yourself the tube in you bladder will usually be removed. In most cases this is done the morning after surgery. You will be given liquids to drink at first, then if you are medically stable and have no nausea you will be permitted to eat whatever you wish. Your I.V. can then be removed, and all medications necessary are switched to pill form. Once you are eating reasonably well, going to the bathroom (urinating) without difficulty, and your doctor is comfortable that you are recovering without complications you may be discharged home. Depending on the extent of surgery and your general health this could be anywhere from one to seven days after surgery. If you are discharged within a few days and you have an incision, you may need to return to your doctor’s office to have stitches or staples removed. If you are anemic, your doctor may send you home with some iron to take, in addition to your pain medications. You may also be given hormones to take if your ovaries were removed or some antibiotics if there is any sign of infection. Your nurses will give you a list of medications you are to take and some general post operative instructions before you go home. Your doctor may also provide you with an instruction sheet which should include a phone number for you to call should you have any questions or problems after you go home.

Back At Home
Once you go home, you should not be confined to bed. Stairs are o.k. to climb but the effort will make you tired, so try to plan your day so that you are not up and down too much. You will find that you need several naps a day for the first few weeks. Gradually increase your activity as your discomfort diminishes. It is quite common to experience night sweats for a couple of weeks after surgery even if your ovaries were not removed and your hormones are normal. If you think you may have a fever, take your temperature. Any elevation over 100 degrees Fahrenheit should be reported to your doctor. Also, if at any time your level of discomfort is increasing rather than decreasing, call.

The most common problem women have after surgery is difficulty with constipation. Your activity level is diminished which tends to make the bowels more sluggish, and narcotic pain medications make the situation worse. It is recommended that you drink at least eight glasses of water a day and add fiber to your diet. Many products are available in the drug store should your problem become more severe. Dulcolax tablets, Milk of Magnesia and similar drugs will work overnight. Dulcolax suppositories work in a matter of hours. Laxatives will cause abdominal cramping, however, so be prepared.

Driving
After the first week or so, it is o.k. to go out for brief periods of time. You should not try to drive until you are off all pain medication and your doctor has approved. It is permissible to ride in a car for short trips. Be sure to wear a seatbelt even if it feels uncomfortable across your abdomen.

Back To Work
Generally women feel ready to return to work in four to eight weeks. A decision to go back to work should be made with your physician’s advice. People may need a longer leave of absence from physically strenuous jobs than from office work. If possible, it is helpful to return for half days your first week back. It is amazing how much energy it requires to heal - even if you are feeling well.

Resuming Normal Activities
When you leave the hospital, your physician will instruct you to avoid placing anything in the vagina. Minipads or panty-liners should be worn as necessary during recovery. Douching and sexual intercourse may compromise healing at the top of the vagina. Your doctor will check that area at your post-operative visits and let you know when it is o.k. to resume normal activities. Until then, other forms of sexual contact are permitted as long as you feel comfortable. Orgasm will not hurt you.

You may gradually begin walking for exercise but should not resume strenuous exercise until at least six weeks after surgery. Your body needs energy to heal. If you begin exercising too quickly it may prolong your recovery.

For the most part, using common sense and listening to the messages your body sends you will help you have a safe and uneventful recovery. If you have any questions or concerns you should contact your surgeon — not your friends or your mother or even another physician. You must work together with your surgeon as a team to accomplish a successful outcome and rapid healing.