Before your surgery:
- You were asked at the time of your office visit or scheduling phone call to review the pre-procedure information. Please make certain that you fully understand this information well in advance of your surgery or colonoscopy and call our office if you have any questions.
- You may be asked to pre-register by telephone or online by the facility where you procedure will be. Please do so if asked, as it will shorten your intake process on the day of your surgery or procedure and allow for the entire process to be more relaxing.
- Please prepare for your departure from the surgery center well in advance of the day of your procedure. You may not leave after your procedure unless you are accompanied by an adult (family, friend, or coworker) who is willing to sign as a responsible party.
- If you live alone and are having surgery, please make arrangements for a relative or friend to stay with you the night of surgery. Failure to do so may result in the cancellation of your operation as we feel it’s best to have help for the night of your procedure (this does not apply to patients having colonoscopies or minor operations such as the removal of small lipomas)
What follows is a list of medications that interfere with blood clotting and can lead to excessive bleeding during or after your colonoscopy or surgical procedure. It’s not safe to take them up to the day of the colonoscopy or surgical procedure. Depending on the medication, it will need to be stopped anywhere from 24 hours to 1 week prior to your scheduled procedure/surgery date.
It’s essential that you check with your cardiologist (best if you have one) or your PCP before stopping these prescription medications prior to surgery or colonoscopy. Here’s a list of the primary medications to be aware of. There may be others as new medications are constantly being added:
Anticoagulants (blood thinners) that must be stopped prior to surgery:
- Enoxaparin (lovenox) 24 hours, heparin 24 hrs
- Warfarin (Coumadin) 7 days or nl INR
- Eliquis (Apixaban) 48 hours
- Dabigatran (Pradaxa) 2 days if normal renal function, longer if abnormal renal function.
Antiplatelet Agents that must be stopped prior to surgery:
- Aggrenox (aspirin and dipyridamole) 5 days
- Agrylin (angrelide)
- Clopidogrel (Plavix) 5 full days
- Dipyridomole (persantine)
- Ticlid (Ticlopidine)
- Pentoxyphylline (Trental)
- Rivaroxaban (Xarelto) 2 days
- Prasugrel (Effient)
- Ticagrelor (Brilinta)
After the Removal of a Lump or Bump
Most answers to common questions are addressed on the postoperative instruction sheets for each particular procedure. Below I’ve expanded on several points. For post-op instructions, please refer to the Patient Resources tab.
Can I shower after surgery?
Absolutely. You may shower the evening of surgery. If you’ve had a hernia repair or have any incision on your abdomen, torso, arm, leg, or neck: please don’t submerge in a bathtub for several days. If you had surgery on your anus or rectum then bathing and soaking is encouraged.
If you have a gauze dressing on your incision – please remove it prior to getting wet. If there are fibrous strips covering the wound (Steristrips), please keep those on. It’s safe to shower with them. They will fall off on their own or I will take them off if they’re still present when you follow-up with me in the office.
What do I do if there’s a bloody dressing over my incision/incisions?
If there’s oozing of blood from your incisions, please hold gauze (or paper towel if you don’t have gauze) for 20 minutes with firm pressure applied directly to the wound. If the gauze is soaked, please replace it. If you have Steri-strips covering the incision, please try and keep those in place. If they happen to loosen or fall off don’t worry. No need to come in to have them replaced.
Is there any special care for the wound/s?
No. Just keep them clean and dry. Please don’t put any ointment on them.
When can I exercise?
You may exercise as soon as you feel comfortable. Ease into things and if you feel discomfort back off. For the first two weeks try to avoid direct pressure on any incision and avoid sudden, uncontrolled motions or contact sports.
When should I schedule a follow-up visit with Dr. Sternberg?
Generally in 2 weeks unless otherwise instructed. Seeing me earlier is usually not helpful.
What medications will I prescribe after surgery?
The majority of patients will be prescribed the following medications:
- Ibuprofen, a NSAID that relieves pain and decreases inflammation
- A narcotic pain reliever (typically Oxycodone)
All medications should be taken with food or they may induce nausea. The Ibuprofen is the more important of the pain relievers as it decreases inflammation. Ibuprofen should be taken 3 times a day for 10 days, while the narcotic should only be taken every 4-6 hours if needed (and discontinued once your pain is adequately relieved by the Ibuprofen). Also, narcotics may cause constipation, so you should only take narcotics if you need to.
Most insurance companies won’t pay for the stool softener prescription. Consider purchasing over the counter Docusate Sodium. This is a lower strength than I recommend. Please take 2 tablets of the over the counter variety twice a day for the period time you are taking the narcotic pain reliever.
Should you feel constipated (miss having a bowel movement for a day or two), please take 2 tablespoons of Milk of Magnesia (an over the counter laxative readily available at all pharmacies) 3 times a day until you have a bowel movement.
Please let Dr. Sternberg, or his office staff, know if you have any allergies or prior reactions to the medications listed above, well in advance of surgery.
WHAT ELSE SHOULD I KNOW?
Will I become constipated?
Not as a result of the procedure. But – taking a narcotic can definitely lead to constipation and the prescribed stool softener should be taken regularly. If you go for a day without a bowel movement please buy Milk of Magnesia. It is available over the counter. Take 2 tablespoons every 8 hours until you have a BM. Once you have a BM, STOP the MOM or you will have diarrhea.
What if I become nauseated after surgery?
Nausea for a day or so after surgery is common. On the day of the operation, it’s often due to the anesthetic. Oral anti-nausea medication is often not helpful and has many side effects, so I don’t like to prescribe it. Most commonly, nausea is due to the pain medications oxycodone or hydrocodone, or Ibuprofen. Please make certain that you never take any pain medication on an empty stomach.
Should you develop nausea please hold your pain medications for several hours and try and nap. Place a cool moist cloth on your forehead. You may resume the pain medications with food after the nausea subsides. Best to just take the ibuprofen and avoid the narcotic (oxycodone or hydrocodone). Remember; never take any of your prescribed medications on an empty stomach. A small amount of food such as bread or toast will help settle your stomach!
When can I return to work?
You may return to work whenever you feel comfortable. The only restriction is that you not return to work, make important decisions, or drive a motor vehicle or bicycle the day of your surgery or procedure. It’s also appropriate to take some time off and we can provide you with a permission letter. Just ask!
What if I notice bruising around the incisions?
Bruising is quite common and rarely concerning. If the area becomes “black and blue” it will diffuse and involve a larger area over time, then turn green, and finally dissipate.
Patient Instructions and Forms
Download a New Patient History Form, and post-operative instructions for Pilonidal Surgery and General and Colorectal Surgery.
Contact our San Francisco Office
To learn more about treating your Pilonidal Disease with surgery and the Cleft Lift procedure, contact our office staff for information or to schedule an appointment.
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American College of Surgeons, and Pilonidal Support Alliance