Pre-operative patient instructions
Fasting Instructions:
Stop eating and drinking six hours before your admission time. You can drink clear fluids (weak cordial, water, BLACK tea) in small volumes (1/2 cup) up to 2 hours before surgery. Do not drink anything within 2 hours of your operation. The rationale behind this Is that the medication you receive as part of your anaesthetic, will impair the body’s protective reflexes that prevent stomach contents from being regurgitated into your lungs. This is called aspiration. Aspiration pneumonia is a life-threatening condition and is largely preventable in elective surgery. For your own safety, it is of utmost importance that guidelines for pre-operative fasting are followed to minimise such risk.
Medications:
Take your usual medications on the day of surgery (with a TINY sip of water). Do not take the medications that have specifically been ceased pre-operatively. If you are at all confused, please call the staff at Surgical Health Specialists. Medications to stop 2 weeks prior to surgery: all non-essential natural supplements eg. Ginger, Fish Oil, Gingko, Melatonin, Turmeric, Vitamin E Medications to stop 7 days prior to surgery: all anti-inflammatories eg. ibuprofen, aspirin, ‘diet’ pills and all over-the-counter medicines Blood thinners (Patients taking Aspirin, Clopidogrel, Warfarin, Ticagrelor, Ticlopidine, Dabigatran, Rivaroxaban). Follow the instructions given to you by your physician. After surgery, you will be told when it is safe to resume these. Diabetics: Do not take your diabetic tablets on the day of surgery, when you are fasting. If you are taking insulin you should follow the specific instruction provided to you by your physician.
Special considerations:
The anaesthetist will typically make contact with you before the surgery and on the day of your operation. Please advise your anaesthetist of your medical history, have a list of medications, report any allergies or adverse reactions. If you have a pacemaker or implantable defibrillators you may need to liaise with their cardiologist. Ultimately, if you have any concerns please contact us.
Personal items:
Please remove jewellery, makeup, nail polish, contact lenses and hairpins. Leave valuables at home. You will be most comfortable in loose fitting clothes and pyjamas.
Things to bring:
- Inhalers and CPAP machines – if you use them
- Pyjamas and casual clothes
- Toiletries
- Usual medications
- Medicare and health insurance cards
- Phone and charger
Smokers:
Smokers have a higher risk of wound and general complications compared to non-smokers. It is advisable to stop smoking as soon as possible before surgery, to reduce this risk.
In the operating room:
You are the most important person in the operating room and your care, comfort and safety is our priority. In the operating room you will be asked questions to verify your name, date of birth and planned procedure. There may seem to be a lot of activity in a cool room with bright lights. This is normal but please let us know if you are uncomfortable. You will have a general anaesthetic and stay overnight in hospital.
After surgery:
You will be taken to a recovery area or intensive care unit depending on your condition. We will update your next of kin. Once your status has improved, you will be transferred to a ward or prepare for discharge if you are a day case. You may then:
- Eat and drink as tolerated.
- Walk around the ward.
- Shower (within 24hours).
- Be visited by friends and family (per nursing staff).
Pain:
Severe pain after surgery is uncommon and often indicates a problem, so please tell a staff member. The most common complaint is a sore throat or headache. The first line of treatment is to use simple medications in an alternating fashion. We will help you.
Post-operative day 1:
On the morning after surgery, you will have blood tests (neck cases) and will be reviewed in person prior to discharge (all patients). Typically, if your wound is flat and you can eat, drink, pass urine and ambulate you will most likely be able to go home.
Review after discharge:
Your post-operative check-will be scheduled within 2 weeks. At this point we will:
- Remove the dressing
- Review the pathology
- Discuss any concerns
- Arrange any additional treatment
Exercise and Work:
You should avoid strenuous activity and lifting (10kg max) for 4 weeks after surgery. If you cough or sneeze, you should apply firm counter pressure to your wound using a clean towel. Most people feel well to return to work after a week, but patients are highly variable and it depends on your level of activity at work, extent of surgery and fitness beforehand. Be guided by how you feel.
Driving:
You are not allowed to drive (legally) within 24hours of surgery. It is best to use your common sense with respect to resuming driving. As a minimum you need to be able to turn your head fully and react quickly.
Post op patient instructions
Things to look out for:
- Signs of infection (fever, swelling, increase in redness or pus from incision)
- Signs of dehydration (weakness, fatigue, dizziness when standing or walking, fast heart rate, low urine output or very dark urine).
- Wound swelling (rapid or sudden swelling of your wound)
- Tingling or numbness around your mouth/lips or your fingers/hands
- Difficulty urinating or feeling like you aren’t emptying your bladder fully
- If you experience any of these symptoms, please contact us immediately.
- If you are having trouble breathing call 000.
Pain:
At the end of the operation local anaesthetic is infiltrated into the wound. This means, that you should wake up from the operation feeling relatively comfortable. You may have a sore throat (related to the breathing tube) but this should improve naturally over 2-4days. You may suck on ice chips, sip on cool drinks and use a throat spray for comfort. You may also have a headache. This is often related to the position of your head on the operating table and also usually improves with simple measures over a short time. We recommend simple pain relief as the first measure. This works best when used alternately eg. Ibuprofen 400mg (2x200mg tablets) every 6hours with food and Paracetamol 1000mg (2x500mg tablets) 6hours. Depending on the nature of you surgery and personal factors, additional pain medication may be used. Our aim is for you to be as comfortable as possible.
Wound care:
Your skin will be closed with stitches, staples, medical glue or a combination. There will also be a small piece of medical tape (“steri-strip”) covering your incision and further supporting the skin edges. Ideally, the tape should remain in place for at 10 days but if the edges start to curl and become bothersome, you can remove the tape. Otherwise, leave it in place until your follow-up appointment. After discharge, and often much sooner, you may shower and gently wash your incision. Do not vigorously scrub the wound. Allow it to air dry. Furthermore, do not rub any creams, ointments or apply make-up to your wound. The best way to ensure a nice scar is to keep it clean, minimize tension to the area (no straining activities) and to avoid smoking. Your wound will continue to remodel over 6-12 months. What you see in week 1 after surgery will be very different to what you seen in week 52.
Medication:
After neck surgery: You should take one calcium supplement three times per day. You may purchase the calcium with or without vitamin D over the counter. Any dose around 500mg is fine, so 1500mg/day. This does not need to be filled by a pharmacist. If you take thyroid medication (levothyroxine) you should avoid taking the calcium at the same time, as it will interfere with the efficacy and absorption of your thyroid medication. A good strategy is to take the thyroid medication on waking and then calcium at breakfast, lunch and dinner. If you experience any tingling or numbness of the hands/toes or around your mouth, take a calcium-based antacid (eg. Gaviscon). Your symptoms may be related to low calcium, as the parathyroid glands have been irritated by the surgery. You can take the calcium-based antacid hourly if needed but if the symptoms are severe or not controlled, please call staff at Surgical Health Specialists. If you have been started on thyroid hormone replacement (levothyroxine) you should take this medication every day for the rest of you life. Ideally you should try to take it around the same time each day, usually as soon as you wake up. Do not eat or drink anything for sixty minutes after taking levothyroxine. Do not take levothyroxine at the same time as the calcium supplements, as it will be less effective. If you forget to take your dose in the morning, but remember in the afternoon, take it when you remember. If you forget to take it completely one day, take two doses the next day. It is better to have the same overall dose for the week. If you were previously taking anti-thyroid medication but have now had you thyroid removed, stop taking the anti-thyroid medication. If you were previously taking Aspirin, Plavix, Coumadin, Marevan or any other blood thinners then please discuss with staff at Surgical Health Specialists exactly when you may restart these medications. You may resume all other medications as previously prescribed. If you are at all uncertain, please call and ask.
Diet:
It is important to eat a regular balanced diet after surgery and drink plenty of fluids to stay hydrated. If your appetite is initially small, just have what you can manage and make smart nutritious choices. Remember there are no miracle foods or drinks.
Return to Work, Exercise and Driving:
You may return to work as soon as you would like. However, if your job requires heavy lifting or strenuous physical activity, you should wait to return to work until after your post-operative appointment. Do not do strenuous exercise (running, climbing, lifting more than 10kgs) for 4 weeks after surgery. The rationale is that straining can cause the scar to stretch which will make it unsightly and put you at risk of an incisional hernia. Following this, advance activity as tolerated. Walking is fine particularly if you feel comfortable. Please use common sense with respect to driving. It is illegal to drive within 24hours of a general anaesthetic. You need to have a complete range of motion in your neck, reactivating in an emergency, wear a seat belt comfortably and be able to turn without hesitation.
General FAQs
- What should I bring to my appointment?
- An up to date referral letter
- Any medical letters or reports (eg. operative notes, imaging (reports or films), histology, blood tests etc). These can provide valuable information to the current problem and also insightful into other health issues. Repeating some tests may be necessary but often is a waste of money.
- Medicare or DVA Card: If applicable, please also bring your Pensioner Concession Card (PCC), Health Care Card (HCC), Veteran’s Affairs card and Work cover details. These concessions will reduce the cost of a consultation. Private Health Insurance (PHF) Details: PHF generally do not pay for costs incurred seeing a surgical specialist out of hospital. However, PHF may cover much of the expenses incurred as a patient in hospital, for example having surgery. Policies vary enormously. You should check with your PHF what is covered.
- A list of your medications (including all your OTC natural supplements)
- A list of your previous surgeries
- A list of your family history (if relevant)
- A list of any drug allergies
- A support person (if possible, as often there is a lot of information to digest)
- Are my medical records kept private and confidential?
Your medical file is handled with the utmost respect for your privacy. Our staff are bound by strict confidentiality requirements as a condition of employment regarding your medical records. We will not release the contents of your medical file without your consent.
- What should I expect during my first visit?
Clinical assessment: During your initial visit, your surgeon will listen to your main concerns about the problem and will usually ask a number of questions. They will then likely examine you in relation to your problem. This is the clinical assessment. A personal electronic medical record will be created for you. Your surgeons will review any test results that you have had and help you to understand.
Recommendations: Following this, your surgeon will give you their opinion and recommendations for ongoing care. This may be reassurance with nothing further to do, additional tests, a biopsy or recommendations for surgery. It is extremely important to us that you understand the treatment plan and you will have ample opportunity to ask questions or seek clarification.
Tests: Further tests may be required. At times you may also need to repeat tests that you have already had. This is important to confirm a trend before rushing to treatment. The Surgical Health Specialist team can assist you with booking appointments for extra investigations.
Surgery: If you are recommended to have surgery, this will be explained to you, including the nature of the procedure, the risks and benefits. Sometimes there is a lot of information to absorb which is why having a friend or family member to accompany you can be helpful.
Correspondence: After you leave, your surgeon will send a detailed letter back to your referring doctor, with copies to any other doctors involved in your care. Good communication between your doctors is essential and helps to make sure you receive the best possible care.
Change of details: If your personal details change (address or referring doctor), please advise the team.
- What are the fees for my consultation?
Surgical Health Specialists is not a bulk-billing practice The fees for your consultation pay for our staff, office space and medical expertise. Standard fees are: New patients $250 (with Medicare rebate of $75.05) Review patients $150 (with Medicare rebate of $37.07) Pensioner Concession Card (PCC) and Health Care Card (HCC) holders will be charged a reduced fee (in excess of Medicare Benefit Schedule (MBS) fee). Patients covered by Veteran’s Affairs and Workcover will not incur any fees, but any costs generated as a result of collecting fees will be passed onto the patient. Payment is expected on the day of consultation using EFTPOS, Visa, Mastercard or cash. Informed financial consent will be provided to patients who require surgery in hospital. We reserve the right to charge a consulting fee if you cancel an appointment within 24 hours of scheduled time.
- How can I contact my surgeon?
Dr Edwina Moore Phone: +(61) 03 8763 3462 (All enquiries) or 0419 568 936 (Emergencies) Fax: +(61) 03 9782 2403 Email: admin@surgicalhealthspecialists.com.au Mr Vladimir Bolshinsky Phone: +(61) 03 8763 3461 (All enquiries) or 0412 690 694 (Emergencies) Fax: +(61) 03 9782 2403 Email: admin@surgicalhealthspecialists.com.au
- Where does my surgeon consult and operate?
Peninsula Private Hospital
Suite 16 525 McClelland Drive Langwarrin, VIC, 3910