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3 4 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J A N U A R Y 2 0 1 5 W hat do your discharge instruction forms say about your quality of care? If your forms are faded and outdated copies of copies, their text slanting across the page, then clearly not much. In this digital age, we should be able to give patients clean, crisp copies, not the marked-up, dog-eared directions we've kept on file all this time. A few years ago, we created a discharge instruction website on our health system's intranet from which our PACU and day surgery nurses can print off instructions for every patient. The website is organized into folders for each surgical specialty, which contain electronic I D E A S T H A T W O R K I M P R E S S I V E I N S T R U C T I O N S Create an Online Library of Discharge Forms Division of General & Gastrointestinal Surgery INSTRUCTIONS FOLLOWING PARTIAL THROIDECTOMY DIET • You may have temporary throat discomfort or difficulty swallowing. This is due to the surgery around your larynx (voice box) and esophagus (swallowing tube). These symptoms will gradually improve over the course of several weeks. • Drink and eat foods that can be swallowed easily, e.g. juice, soup, gelatin, applesauce, scrambled eggs or mashed potatoes. • You may be able to return to your usual diet in a couple of days. ACTIVITY • Most patients are able to return to a full-time work schedule in 1-2 weeks; however this may vary according to your job. It may take longer to return to heavy physical or other demanding work, or shorter if you are feeling well. • Do NOT drive a car until you are able to turn the neck side to side, which may take 1-2 weeks. • Do NOT drive while you are taking pain medicines. PAIN MANAGEMENT • We will supply you with a prescription for a mild narcotic pain medication. You are not required to take it. If you do take it, please do not drive or drink alcohol as these in combination may make you drowsy. Most patients do not need strong pain medicine by the time you leave the hospital. You can take Tylenol (acetaminophen) or ibuprofen (e.g. Advil) as needed. HORMONES AND MEDICATIONS • Most of the time after only half the thyroid has been removed no thyroid hormone supplementation or additional calcium is needed. However, there are exceptions and if your physician/surgeon has asked that you take thyroid hormone or additional calcium please follow their instructions. • If you were taking thyroid hormone before one half of your thyroid was removed with this most recent surgery then take your thyroid hormone (e.g. Synthroid, Levoxyl, Cytomel) as prescribed when you go home. These medications are identical to the hormone made by the thyroid. Calcium and thyroid hormone should be taken 1-2 hours apart. Thyroid medication should be taken on an empty stomach. Please resume your pre-hospital medications. You should follow-up with your primary care physician regarding new prescriptions and refills Division of Vascular Surgery Michael T. Watkins, M.D. Tel: 617-726-0908 Fax: 617-726-2560 mtwatkins@partners.org Post-Surgery Instructions For Venous Procedures RETURN TO WORK The average time off work is approximately one day to one week. This may vary depending on your surgical procedure, the type of work you perform and how you tolerate the operation. If you identify after surgery that you need a little extra time, please call our office to discuss it with us. If you work and your employer requires paperwork to return to work, please contact our office to arrange this. We will complete a disability type form at no charge. Please allow five working days for disability forms to be completed. ACTIVITY You are encouraged to walk after every surgery and should increase it daily. For the first week or two after surgery you should avoid prolonged sitting and standing. When able, you should elevate your operative leg, above heart level to control swelling. You should expect to wear the compression hose for at least 1-2 weeks after the procedure for comfort. You may resume driving when you are comfortable enough to drive safely. You should not drive if you are taking pain medication. You may climb stairs as needed immediately after surgery. You may resume exercise such as aerobics, running, tennis or weight lifting approximately one to two weeks after surgery. We recommend you start slowly at one week and proceed as tolerated. Do not fly in an airplane for 1-2 weeks after surgery. For two to three weeks after surgery, if you have long car trips planned please stop and walk for a few minutes every hour. INCISIONAL CARE You will need to keep your incisions dry for 2-3 days. Your operative leg will be wrapped with an ACE bandage, or compression hose and you may be asked to continue to wear the bandage for one to two weeks (during the waking hours). If you have prescription support hose you can start wearing them in place of the ACE bandage, when your operative leg is comfortable and the bandages and steri-strips have been changed (1- 2 days post operatively). The steri-strips will fall off on their own in the first week, or you may remove them if they stay longer. You may shower after 1-2 days. After surgery you can expect bruising, swelling and hard knots on your leg(s). As your body heals the bruising will fade and the swelling and knots will subside slowly by themselves. MEDICATIONS You should avoid aspirin and ibuprofen products for 1 week before and 1 day following surgery to reduce bruising. You will receive a prescription for pain medication that you can fill after surgery at your local drug store to take if Tylenol is not sufficient. FOLLOW-UP If your surgery is scheduled on a Tuesday, you will return to the office on Thursday for a post-operative appointment to have your surgical dressings removed. The office doctor will examine you and the office staff will review your post-operative instructions with you. Your first post-operative appointment with your surgeon will be scheduled in approximately 4 weeks to 6 months after. If you have had an endovenous ablation, you may need to have a follow-up ultrasound at approximately 6 months to access the vein closure. This is also a good time to check in with your surgeon about any other concerns.