Procedural/Surgical Instructions:
Office Procedure - Patient Instructions
Expect spotting and cramping for the next several days. Take Ibuprofen (600mg every 6 hours) and/or Tylenol (1000mg every 6 hours) for pain and cramping. If you were given other pain medications, you may take those every 4 hours as needed.
Call if you are saturating 1 menstrual pad every hour, have a fever greater than 100.4F or have severe pain after taking Ibuprofen and Tylenol.
Generic Surgical Consent:
Risks, benefits and alternatives for this surgery were discussed. Risks include, but are not limited to, bleeding, infection, injury to internal organs, and/or cardiopulmonary complications. These complications may lead to treatments such as blood transfusion, antibiotics, additional medical or surgical interventions, or longer hospital stay. We discussed expectations for the day of surgery and for postoperative recovery. Patient acknowledges these risks and wishes to proceed with surgery.
Consent for Oophorectomy for Pelvic pain/Endometriosis
Risks, benefits and alternatives for laparoscopic bilateral salpingo-oophorectomy (removal of tubes and ovaries) were discussed. Risks include, but are not limited to, bleeding, infection and injury to internal organs. These complications to lead to treatments such as blood transfusion, antibiotics, additional medical or surgical interventions, or longer hospital stay. We also discussed that oophorectomy would put her into surgical menopause, which can present with a variety of bothersome symptoms that will likely require medical treatment, such as hot flashes, mood swings, and irritating vaginal and urinary symptoms. We also discussed that while an oophorectomy should improve her cyclic (menstrual-type) symptoms, this surgery may not improve stop her non-cyclic pelvic pain. Pelvic pain is very complex and is not guaranteed to be immediately cured with surgical intervention. The patient acknowledges these risks and wishes to proceed with surgery.
Tubal Ligation:
There is a less than 1% chance that you could become pregnant even after a tubal ligation. If you become pregnant, there is an increased risk of ectopic pregnancy, or pregnancy outside of the uterus, which is dangerous and can be fatal if not treated. If you have signs of symptoms of pregnancy after your tubal ligation, take a pregnancy test and let us know immediately if you are pregnant.
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Surgery Instructions:
- Call the hospital the day before your surgery to find out what time to be there the day of your surgery (434-799-4459).
Diet:
- Nothing to eat or drink after midnight the night before your surgery.
- Leading up to your surgery, strive to have a diet high in fruits, vegetables and protein (lean meat, dairy, nuts). Make sure to drink plenty of water.
Exercise/Activity:
- Continue regular exercise routines leading up to your surgery.
- If you do not currently exercise, you should start walking or doing a light activity for 30 minutes every day until your surgery.
Medications:
- You may take sips of water with your medications the morning of surgery if instructed to at your preoperative appointment at the pre-admission testing.
- Stop Aspirin or aspirin containing medications for 3 days prior to your surgery, unless otherwise notified.
- Do not take Metformin or other non-insulin diabetic medications on the day of surgery.
- Stop smoking at least four weeks prior to surgery to decrease postoperative complications (such as respiratory difficulties and wound healing).
- Stop drinking alcohol for four weeks leading up to surgery.
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Postoperative Instructions (major surgeries):
Activity:
- Increase ambulation every day as tolerated. You may walk stairs, but use caution.
- No strenuous activity or exercise routines for at least 3-4 weeks.
- No lifting greater than 10 lbs for 6 weeks.
- After car ride home, no riding in the car for 1 week (or until your postoperative appointment).
- You may shower the day after your surgery. No baths until after your postoperative appointment unless otherwise instructed.
- After showering, pat dry incision with towel, then blow dry with cool air.
Diet:
- No dietary restrictions, but strive to have a diet high in fruits, vegetables and protein (lean meat, dairy, nuts). Make sure to drink plenty of water.
- You may want to keep your diet bland the first several days after surgery.
Medications:
- Take pain medications as prescribed. If you use all of your prescription pain medications, use over the counter Acetaminophen and Ibuprofen.
- Do not strain to have bowel movements.
- Take magnesium 200-250mg twice daily or Colace 100mg twice daily until your bowel movements are regular.
- If no bowel movement within 3-4 days, take Miralax. If no bowel movement 5-7 days postop, use an enema (which can be picked up at your local pharmacy).
Wound Care:
- A small amount of vaginal bleeding is normal for several days after surgery, it is typically less than a normal period. Sometimes vaginal spotting can occur for up to six weeks.
- No sexual intercourse or anything in the vagina for at least 6 weeks.
If you have abdominal an incision(s):
- A small amount of spotting or fluid from abdominal incisions may occur.
- Keep incisions clean and dry as instructed above. Call if you have increasing redness at your incisions, heavy bleeding or foul-smelling discharge.
- Remove steri strips (white bandages) in shower before your postoperative appointment. They usually come off in the shower within the first week after your surgery.
Pain:
- Expect to have some pain after surgery, the medications we provide will not completely remove the pain, but should keep it controlled enough for you to do basic functions at home.
- Take your pain medications as prescribed. If you are still have pain, an ice pack over your incision(s) or on the perineum can help with pain control.
- If you use all your prescribed pain medications, you can use over-the-counter Ibuprofen and acetaminophen as needed
When to Call: Call the office if you have a fever (greater than 100.4F), uncontrolled vomiting, heavy or increased bleeding, a foul odor from the surgery site, or if you have urinary or rectal bleeding. If you are unable to urinate or have a bowel movement despite the instructions above, please call.
Follow-up:
- The office will schedule your postoperative appointment 1-3 weeks after your surgery.
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Postoperative Instructions (minor surgeries):
Activity:
- Increase ambulation every day as tolerated. You may walk stairs, but use caution.
- Slowly increase your activity as tolerated.
- No strenuous activity or exercise until after your postoperative appointment.
- You may shower the day after your surgery. No baths until after your postoperative appointment unless otherwise instructed.
- After showering, pat dry incisions with towel, then blow dry with cool air.
Diet:
- No dietary restrictions, but strive to have a diet high in fruits, vegetables and protein (lean meat, dairy, nuts). Make sure to drink plenty of water.
- You may want to keep your diet bland the first several days after surgery.
Medications:
- Take pain medications as prescribed. If you use all of your prescription pain medications, use over the counter Acetaminophen and Ibuprofen.
- Do not strain to have bowel movements.
- Take magnesium 200-250mg twice daily or Colace 100mg twice daily until your bowel movements are regular.
- If no bowel movement within 3-4 days, take Miralax. If no bowel movement 5-7 days postop, use an enema (which can be picked up at your local pharmacy).
Wound Care:
- A small amount of vaginal bleeding is normal for several days after surgery, it is typically less than a normal period. Sometimes vaginal spotting can occur for up to six weeks.
- No sexual intercourse or anything in the vagina for at least 2 weeks.
If you have abdominal an incision(s):
- A small amount of spotting or fluid from abdominal incisions may occur.
- Keep incisions clean and dry as instructed above. Call if you have increasing redness at your incisions, heavy bleeding or foul-smelling discharge.
- Remove steri strips (white bandages) in shower before your postoperative appointment. They usually come off in the shower within the first week after your surgery.
Pain:
- Expect to have some pain after surgery, the medications we provide will not completely remove the pain, but should keep it controlled enough for you to do basic functions at home.
- Take your pain medications as prescribed. If you are still have pain, an ice pack over your incision(s) or on the perineum can help with pain control.
- If you use all your prescribed pain medications, you can use over-the-counter Ibuprofen and acetaminophen as needed
When to Call: Call the office if you have a fever (greater than 100.4F), uncontrolled vomiting, heavy or increased bleeding, a foul odor from the surgery site, or if you have urinary or rectal bleeding. If you are unable to urinate or have a bowel movement despite the instructions above, please call.
Follow-up:
- The office will schedule your postoperative appointment 1-3 weeks after your surgery.
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Vaginal Delivery - Postpartum Instructions:
Activity:
- Increase ambulation every day as tolerated. You may walk stairs, but use caution.
- No strenuous activity or exercise routines for at least 4 weeks. You may start gentle exercises and stretches 1-2 weeks after delivery.
- No lifting anything heavier than your baby in its car seat for at least 4 weeks.
- After the car ride home, limit riding in the car for 1 week (or until after your incision check appointment). Limit driving for 2 weeks, or until you can easily move your foot from the accelerator to the brake without pain, and you have stopped narcotic pain medications.
- You may shower the day after your delivery. No baths, pools or hot tubs for 1-2 weeks unless otherwise instructed.
Diet:
- No dietary restrictions, but strive to have a diet high in fruits, vegetables and protein (lean meat, dairy, nuts). Make sure to drink plenty of water.
Medications:
- Take pain medications as prescribed. If you use all of your prescription pain medications, use over the counter Acetaminophen and Ibuprofen.
- Do not strain to have bowel movements.
- Take magnesium 200-250mg twice daily or Colace 100mg twice daily until your bowel movements are regular.
- If no bowel movement within 3-5 days, take Miralax or similar over-the-counter laxative.
Wound Care:
- Vaginal bleeding is normal after delivery and can last at least 6 weeks. The bleeding usually changes to lighter colored discharged over 1-2 months after your delivery.
- No sexual intercourse or anything in the vagina for at least 6 weeks.
Pain:
- Expect to have some pain after delivery, the medications we provide will not completely remove the pain, but should keep it controlled enough for you to do basic functions at home.
- Take your pain medications as prescribed. If you are still have pain, an ice pack over your incision(s) or on the perineum can help with pain control.
- If you use all your prescribed pain medications, you can use over-the-counter Ibuprofen and acetaminophen as needed.
When to Call:
- Fever (greater than 100.4F), severe abdominal or pelvic pain, uncontrolled vomiting, heavy or increased bleeding, a foul odor from the surgery site, or if you have urinary or rectal bleeding.
- Severe breast pain, swelling, foul smelling or bloody breast discharge.
- Inability to urinate or have a bowel movement despite the instructions above.
- Severe headache even after taking pain medications.
- Red, swollen, warm area of leg. Chest pain or significant shortness of breath.
- Feelings of anxiety or depression.
Follow-up:
- The office will schedule a postpartum appointment 6 weeks after your delivery.
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Cesarean Section - Postpartum Instructions:
Activity:
- Increase ambulation every day as tolerated. You may walk stairs, but use caution.
- No strenuous activity or exercise routines for at least 6 weeks. You may start gentle exercises and stretches 2 weeks after delivery.
- No lifting anything heavier than your baby in its car seat for 4-6 weeks.
- After the car ride home, limit riding in the car for 1 week (or until after your incision check appointment). Limit driving for 2 weeks, or until you can easily move your foot from the accelerator to the brake without pain, and you have stopped narcotic pain medications.
- You may shower the day after your surgery. No baths, pools or hot tubs until after your postoperative appointment unless otherwise instructed.
- After showering, pat dry incision with towel, then blow dry with cool air.
Diet:
- No dietary restrictions, but strive to have a diet high in fruits, vegetables and protein (lean meat, dairy, nuts). Make sure to drink plenty of water.
- You may want to keep your diet bland the first several days after surgery.
Medications:
- Take pain medications as prescribed. If you use all of your prescription pain medications, use over the counter Acetaminophen and Ibuprofen.
- Do not strain to have bowel movements.
- Take magnesium 200-250mg twice daily or Colace 100mg twice daily until your bowel movements are regular.
- If no bowel movement within 3-4 days, take Miralax. If no bowel movement 5-7 days postop, use an enema (which can be picked up at your local pharmacy).
Wound Care:
- Vaginal bleeding is normal after cesarean section and can last at least 6 weeks. The bleeding usually changes to lighter colored discharged over 1-2 months after your delivery.
- No sexual intercourse or anything in the vagina for at least 6 weeks.
- A small amount of spotting or fluid from abdominal incisions may occur (you can place a clean, dry peri-pad over your incision if needed.
- Keep incisions clean and dry as instructed above. Call if you have increasing redness at your incisions, heavy bleeding or foul-smelling discharge.
- If you have steri strips (white bandages) over your incision, remove these in shower before your postoperative appointment. They usually come off in the shower within the first week after your surgery.
Pain:
- Expect to have some pain after surgery, the medications we provide will not completely remove the pain, but should keep it controlled enough for you to do basic functions at home.
- Take your pain medications as prescribed. If you are still have pain, an ice pack over your incision(s) or on the perineum can help with pain control.
- If you use all your prescribed pain medications, you can use over-the-counter Ibuprofen and acetaminophen as needed.
When to Call:
- Fever (greater than 100.4F), severe abdominal or pelvic pain, uncontrolled vomiting, heavy or increased bleeding, a foul odor from the surgery site, or if you have urinary or rectal bleeding.
- Severe breast pain, swelling, foul smelling or bloody breast discharge.
- Inability to urinate or have a bowel movement despite the instructions above.
- Severe headache even after taking pain medications.
- Red, swollen, warm area of leg. Chest pain or significant shortness of breath.
- Feelings of anxiety or depression.
Follow-up:
- The office will schedule an incision check appointment within 1-2 weeks after your cesarean section and a postpartum appointment 6 weeks after your delivery.
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Medical Instructions/Education:
OB:
Third Trimester Instructions:
If you have contractions every 5 minutes for an hour, a gush of fluid/constant leaking vaginally, or bleeding like a period, please call our office or present to the Birth Center for evaluation.
Diabetes in Pregnancy:
Diabetes in Pregnancy may affect you and your baby's health. Good blood glucose (sugar) control throughout the pregnancy is very important to try to reduce these risks. You may be required to have additional testing or monitoring during pregnancy. Risks to you and your baby include, but are not limited to the following:
For baby:
A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first trimester of pregnancy. High blood glucose levels can be harmful during early pregnancy and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine. High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, have a shoulder dystocia or other delivery complications, have breathing problems or low blood glucose right after birth. High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby.
For you:
Hormones during pregnancy change how your body uses sugar. Even if you had diabetes before pregnancy, you may need to start new medications (such as insulin), and make diet and exercise changes. Diabetes in pregnancy puts you increased risk for preeclampsia (toxemia), which can be life threatening for you and your baby. Depending on your blood sugar levels, you may need an early induction or labor or a cesarean section. Diabetes in pregnancy increase your risk of diabetes complications such as diabetic retinopathy, kidney disease and cardiovascular disease.
High Blood Pressure in Pregnancy:
High blood pressure (hypertension) in Pregnancy may affect you and your baby's health. You may be required to have additional testing or monitoring during pregnancy. Risks to you and your baby include, but are not limited to the following:
For baby:
Hypertension in pregnancy can lead to a small-for-gestational-age baby (growth restriction), preterm delivery and placental abruption. Preterm delivery can lead to additional difficulties for baby.
For you:
Hypertension in pregnancy increases your risks of hypertension emergency, pre-eclampsia, stroke and heart attack. Having hypertension in pregnancy can lead to an early delivery via induction of labor or cesarean section. After pregnancy, you are at increased risk of having hypertension, other cardiovascular disease and diabetes.
If you experience severe headache, right upper abdominal pain or vision changes during pregnancy, you should notify your doctor immediately.
Obesity in Pregnancy:
Obesity is a body mass index (BMI) greater than 30. BMI is a calculation of your height and weight, which can determine your health risks. Having a BMI of 30 or greater puts you at risks of several health problems. These include, but are not limited to diabetes, preeclampsia/eclampsia and sleep apnea. Each of these have their own risks to you and your baby. Some of risks to baby include miscarriage, birth defects, difficulty with monitoring (like Ultrasounds), preterm labor, Macrosomia and stillbirth.
Choose My Plate (www.choosemyplate.gov) is free resource to help with diet and exercise.
Your goal for exercise should be 60 minutes of moderate activity most days, or 30 minutes of vigorous activity. Start with small amounts of activity (even 5 minutes a day) and increase up to your goals.
For your diet: at least one half of your plate should be fruits and vegetables. The other half should be grains and protein foods. Protein foods include meat, fish, beans and peas, nuts and seeds, and eggs. You also should have a small amount of dairy foods, such as milk, cheese, or yogurt, at each meal. Try to make at least one half of the grains you eat whole grains, such as brown rice, whole-wheat bread, and whole-wheat pasta. Eat fewer foods that are high in sugar and fat.
GYN:
Chronic Pelvic Pain:
Chronic pelvic pain is very complex, and for many women takes years to diagnose the cause. There are many causes of pelvic pain that are not related to your reproductive organs (uterus, cervix, tubes or ovaries). Other causes include musculoskeletal, gastrointestinal, urinary or vascular. Many times pelvic pain is not caused by just one of these areas, but by multiple areas.
It is very important for you to keep a journal of your pain. Make notes if your pain only occurs around a certain time in your menstrual cycle (around your period), or if it is associated with constipation or diarrhea. You may notice pain when you eat certain foods. Sometimes pain only occurs with intercourse, or is always associated with urination or a full bladder. Make notes of certain movements, activities, or times of day that make your pain worse. Also make notes of all the things that improve your pain (medications, body positions, heat or ice packs, etc...).
To find the cause of your pain, it is very important for us to review your notes. We also may order blood tests, urine tests, and imaging such as a pelvic ultrasound. Sometimes, trying a new medicine or having a procedure/surgery can help us find the cause of your pain and help treat your pain. Even once the source of your pain is found, the treatments for chronic pain are usually focused on controlling, rather than “curing” or eliminating the pain.
Kegels (pelvic floor exercises):
The muscles you are contracting, or flexing, during these exercises are the muscles you would use to try to hold back urine or to keep from passing gas.
Studies have shown that you may need to continue these for 3-4 months to see significant results.
- Tighten muscles for 10 seconds, then relax for 10 seconds. Repeat 10 times. Complete this routine threee to four times daily.
- You may change to 20 repetitions twice daily with increased pelvic floor strength.
- Add quick kegels (tighten, then relax for 1 second each), throughout the day as you wait in line, or sit at traffic light.
*You may have to start by only holding the kegels for a few seconds at a time, and work up to 10 seconds of tightening.
Benefits:
- If you leak urine with coughing/laughing/sneezing: Contract your muscles when you are about to cough/laugh/sneeze to avoid leaking.
- If you have a sudden urge to run to the bathroom: sit or stand still and contract your pelvic muscles. After the urge diminishes, you can then proceed to the toilet.
- If you have mild fecal incontinence (leakage of stool), contract your muscles to prevent leakage.
- Improve symptoms from pelvic organ prolapse.