PATIENT INSTRUCTIONS – AMISURGERY

Dr. Bonheur believes that patients are better prepared for the challenges that they may face during their procedures if they are well informed of their procedure and post procedure requirements. For this reason, Dr. Bonheur has made a series of in-depth instructions available on this website to benefit his patients. Browse the pages below for more information.

Avoid Rescheduling

• How to Avoid Having Your Surgery Rescheduled
  In addition to the responsibilities of your surgeon, anesthesiologist, and the nursing staff, surgery involves certain obligations on the part of the patient to ensure a safe and uncomplicated experience. The following is a list of three guidelines before surgery that must be followed prior to your operation. While all may not apply to each patient, the pertinent ones will be confirmed by the nursing staff when you check in for surgery. If these are not followed, surgery will need to be rescheduled for your medical safety.
  1. Nothing to eat or drink eight (8) hours prior to surgery
  This is the most important criteria before surgery. It is a potential life and death issue. Food or even liquids in the stomach can be potentially vomited while being put to sleep, entering the lungs and causing a severe pneumonia or even death. For this reason, surgery is never performed without one having an empty stomach even if it is only a conscious sedation. This means even a few sips of coffee!
  2. You will need to be taken home by someone after surgery
  Unless you are having a procedure done under local anesthetic injections, the use of IV medication for sedation or general anesthesia requires that you be taken home by a responsible adult after surgery. It is simply not safe for you to drive home after an anesthetic. There are no exceptions. Taking a taxi home is also not permitted.
  3. If you are from out of town and staying in a hotel, someone will need to stay with you the night after surgery
  It is not medically safe for you to be alone in a hotel room after any surgery that required you to have a general or conscious sedation anesthetic. If you do not have someone, we can help make arrangements to stay overnight in the surgery center or for a caretaker to stay with you in the hotel or at your house. These arrangements will need to be made in advance.
  Surgery with Dr. Bonheur
  Dr. Bonheur and his staff treat each patient with a high amount of attentiveness and care. Our team works hard to ensure that each patient remains safe and comfortable throughout their visit and procedure. As a premier minimally invasive surgeon, Dr. Bonheur performs a wide range of sophisticated procedures and is considered a leading minimally invasive surgical specialist because of his ability to create results that appear natural.

Medications After Surgery

• For most patients, two medications will be prescribed for use after surgery- a pain medication and a laxative. Prescriptions will either be sent to you prior or just after your procedure/surgery.The pain medication we prescribe will be either VICODIN, PERCOCET, or LORTAB. If you know that one works better for you than another, please let us know. VICODIN and LORTAB can be called in over the phone to your pharmacy; PERCOCET requires a written prescription.When your pain prescription is filled by your pharmacy, please check carefully for the amount of acetaminophen (Tylenol) in each tablet. Tylenol is a standard part of most pain medications such as VICODIN and PERCOCET. Excessive amounts of Tylenol taken over a few days may cause liver damage / failure. The amount of Tylenol per tablet should be limited to 325mgs. At this dosage, it is safe to take up to 2 tablets every 4 hours for pain.

  All narcotic medications have the potential to cause nausea and vomiting. To best prevent this problem, pain medicine should be taken with a small amount of food. Should any nausea persist despite your precaution, please call our office.

  Another common side-effect of prolonged narcotic use following surgery is constipation. To avoid this problem, stay well-hydrated. Increasing your activity level with frequent walks can also be helpful. If you are prone to constipation, we recommend taking an over the counter laxative available at any drugstore or the prescription laxative we prescribe to you. If constipation persists, please call our office.

  Be very careful not to combine alcohol and pain medication. One increases the effect of the other, making for a potentially dangerous situation. Alcohol may also make medications
  (e.g. antibiotics) you are taking ineffective or may potentiate their effect.

  We recommend continuing the homeopathic treatment ARNICA MONTANA for one week following surgery. Please follow the dosage instructions listed on the packaging.

Medications To Avoid

• Aspirin and Aspirin-Containing Medications
  Dr. Bonheur requests that Aspirin and aspirin-related products not be taken for two (2) weeks before surgery because they can increase the tendency for bleeding. Even ‘heart-protective’ or low-dose daily aspirin can have the same effect. At the least, they will increase the amount of bruising you will have. For this reason, it is very important that the contents of any ‘over-the-counter’ medications be checked carefully prior to their use.
  Many headache, cold remedies, and sinus medications contain aspirin. The chemical name of aspirin is Acetylsalicylic Acid. Check for it on the label of the medications that you may be taking prior to surgery.
  Tylenol May Be Safely Taken For Minor Pain and Headaches
  The following is a partial list of some common medications to avoid prior to surgery:
  Advil
  Aleve
  Alka-Seltzer
  Anacin
  Anaprox
  Ansaid
  APC
  Arthritis Pain Formula
  A.S.A. tablets
  Ascriptin
  Aspergum
  Bayer tablets
  Bufferin
  Butazolidin
  Codimal
  Coricidin tablets
  Darvon
  Disalcid capsules
  Doan’s pills
  Empirin tablets
  Enacaprin
  Excedrin
  Feldene
  Fiorinal
  Indocin
  Meclomen
  Midol
  Motrin
  Naprosyn
  Norgesic tablets
  Nuprin
  Orudis
  Pabirin tablets
  Pepto-Bismol
  Rhinogesic
  Sinexin
  Synalgos capsules
  Talwin
  Tolectin
  Triaminicin tablets
  Trigesic
  Vanquish caplets
  Viromed
  Zorprin tablets
  Herbal Medications and Teas
  There are a wide variety of herbal medications and drinks (e.g., tea) that are now routinely taken by many patients. Many of these have been shown to affect the ability of blood to clot and have caused intraoperative and postoperative bleeding problems in some patients. It is difficult, if not impossible, to know exactly which ones can cause bleeding or what the interactive effects are when more than one is being taken or ingested on a daily basis. As none of them are absolutely critical for your health, they can be stopped for a short period of time. Dr. Bonheur advises that all herbal medications and regular tea drinking should be stopped two weeks prior to surgery.

  The safety, comfort and satisfaction of our patients are Dr. Bonheur’s primary concerns and he takes great strides to ensure that their experiences are positive ones.

Preparing for Surgery

• At AMISurgery we want you to have a positive and satisfying surgical experience. Through positivity the best possible outcomes can be achieved with a quick and uncomplicated recovery. While much of those results will come at the hands of Dr. Bonheur, there are numerous things you can do (or avoid) to help achieve those goals.
  Pre-Surgical Preparation
  Prescription medications, over-the-counter supplements and lifestyle habits can help or hurt your surgical results. To prevent the risk of bleeding or excessive bruising and to help tissues heal after surgery, here are some management guidelines:
  Medications to avoid two weeks prior to surgery:
  Discontinue use of any nicotine products. This includes cigarettes, cigars, nicotine gum, chews, and patches. Nicotine causes blood vessels to constrict, decreasing the amount of oxygen that is delivered to your tissues trying to heal. This is never a good thing and is one of the major contributors to healing problems after surgery.

  Stop using medications containing aspirin and NSAIDS (non-steroidal anti-inflammatory drugs) NSAIDS include such commonly taken over-the-counter and medications as Ibuprofen, Motrin, Alleve, and Advil. These medications can affect how blood clots and can cause bleeding and excessive bruising after surgery. Be sure to read the labels of any non-prescription remedies you regularly take as many of them may contain aspirin. (e.g., Alka Seltzer) For these same reasons, stop taking Vitamin E or drinking red wine before your surgery.

  Stop all herbal medications before surgery. The most common herbs used are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St. John’s Wort, and Valerian. They may adversely affect anesthetic drugs, prolong bleeding and impair healing after surgery. While there is some debate as to which herbs have negative effects on surgery, none of them are life-saving or essential so all should just simply be stopped before your surgery.

  Females: All osteoporosis drugs (e.g., Boniva) should be stopped. They have been reported to increase the risk of stroke after surgery
  Medications to start two weeks prior to surgery:
  Begin using an Arnica supplement 7 days prior to surgery and continue for one weeks afterwards. Arnica Montana (extract of the Mountain Lily flower) is a well known naturopathic remedy that has a positive effect on bruising. It not only helps prevent some of the bruising that would otherwise occur but also that which does appear to go away faster. Arnica is available in multiple preparations; oral tablets and topical gels and are available for sale in our office.

  Begin a multivitamin supplement at least two weeks, or more ideally one month before surgery. Vitamins and minerals, combined with a diet high in protein, provides the nutritional elements needed for good wound healing.
  Restrain from eating and drinking 8 hours prior to surgery
  This is the most important criteria before surgery. It is a potential life and death issue. Food or even liquids in the stomach can be potentially vomited while being put to sleep, entering the lungs and causing a severe pneumonia or even death. For this reason, surgery is never performed without one having an empty stomach even if it is only a conscious sedation. This means even a few sips of coffee!
  Expectations
  Elective surgery should not be a mystery. The procedures you are having are commonly done and what will occur both during and after surgery can generally be predicted. Being fully informed should make you more comfortable about what you are to experience and what the outcome of surgery will be.

  Sharing this information with the person who will be taking care of you for the first few days after surgery will make the recovery period easier and less stressful to you and your support team.
  Post-surgical planning
  Plan for the hours immediately after your surgery ahead of time: make trips to the pharmacy and grocery store; and arrange for child care. Plan your wardrobe for the day of surgery and a few days after. Loose-fitting clothing that can be unbuttoned or unzipped down the front is best. Designate an area in your home for yourself- such as a quiet bedroom or sofa away from busy family activities. Even if you are having a minor procedure, you will still need a minimum of 24 hours to fully recover from anesthesia, and will not be up to handling responsibilities by yourself.

  Rest and sleep, combined with a small meal and plenty of fluids are keys to making you feel better sooner after surgery. Fluid and electrolyte replacement is much more important than food and for that reason, Dr. Bonheur recommends you stay on a liquid diet the day of surgery and resume a normal diet the following morning, unless otherwise instructed.

  Allow yourself adequate time for recovery. The biggest mistake most patients make after surgery is shortchanging time for recovery. The number one cause of postoperative pain and complications is ‘over-doing it’ on your arrival home. Plan to take it easy for a few days, and be patient. Everyone is an optimist before surgery. Many patients become a realist afterwards.

  Schedule your follow up appointment. It is important that you follow up with Dr. Bonheur within 2-3 weeks of your procedure. We recommend you call the office and schedule visit. If you need to be seen before that time simply call the office and arrangements can easily be made.

Pre-Surgery Exams and Tests

• Depending on the type of surgery you will be having and your age, certain blood test, heart studies, x-rays and other radiological scans may be needed prior to undergoing anesthesia. These are necessary for your safety so that we can be sure there are no unknown or underlying medical issues.If you are a healthy patient, the following preoperative criteria apply:
  If you are 60 years of age or older, you will need an EKG and CBC (blood count)
  If you are a male aged 45 or older, you will need an EKG
  If you are a female aged 50 or older, you will need an EKG

  If you have a history of smoking you be required to have a chest x-ray

  If you have certain medical issues (such as high blood pressure, diabetes, heart conditions, on certain medications), other preoperative lab studies may be needed. Dr. Bonheur will make that determination in conjunction with your primary care physician if necessary.

  If any of these tests are necessary for your surgery, we may request you see your primary care physician or internist prior to undergoing surgery. In many cases, these studies may already be on file at your own physician’s office.

Post Operative Instructions

• Recovery after surgery varies from patient to patient. These instructions are designed to help you resume your normal activities as quickly as possible. Please make every effort to follow these instructions; but do not expect to be pain-free immediately. There will be some soreness – this is normal.
  ACTIVITY:
  • You may start showering the morning after surgery, the dressing are water resistant, NOT water proof, so NO swimming, baths, hot tubs or Jacuzzi until seen in follow up.

  • Walk a lot, go up/down stairs and stay active starting the day of surgery, (the more you walk, the quicker you will recover)

  • DO NOT engage in sports, heavy lifting or strenuous activity/exercises until seen in follow up.
  (avoid lawn work, hiking, shoveling snow, working out, Pilates, yoga etc.).

  • Lift no more than a gallon of milk until seen in follow up

  • Sleep in a bed, not a lounge chair/Lazy boy

  • DO NOT drive while taking narcotic pain medication (Percocet, Dilaudid etc.)

  • WORK: you may return to work when you feel physically able (approx. 1-2 weeks on average)
  WOUND CARE:
  • A small amount of blood on your dressing is to be expected. DO NOT BE ALARMED. If you feel the amount is in excess, please call our office.

  • You MAY place an ice pack on the affected area for 48 hours. Then place a WARM compress or heating pad thereafter.
  MEDICATIONS:
  • Take the prescribed pain medication as needed. To avoid constipation try an over-the-counter stool softener.

  • You may take Motrin, Advil, Tylenol or similar instead of the prescribed narcotics.

  • Resume all your pre-operative medications tomorrow.

  • WEIGHT LOSS PATIENTS: Start taking all your medications the day after surgery
  CAUTION:
  -Take 1 medication at a time over 10 -15 minutes to avoid blockage
  -Monitor your blood sugar and blood pressure as these may drop as you lose weight
  CALL THE OFFICE IF:
  You experience
  o Fever of 101.5 or greater, chills,
  o Increased pain, redness, swelling or discharge from the incision sites
  o Abdominal pain that does not go away with pain medication or if the pain becomes severe.
  o Abdominal distention, discomfort, nausea or vomiting.
  o Excessive/persistent bleeding from your incision sites.
  o Any concerns not already addressed
  CALL 911 IF: If you experience chest pain and/or suddenly have difficulty breathing.
  FOLLOW UP IN OUR OFFICE IN 1-2 WEEKS
  PLEASE CALL TO MAKE AN APPOINTMENT (203) 327 4444

Minimizing Scars After Surgery

• Surgical incisions and the scars they create are a concern for many patients. After surgery, most people ask how to take care of a scar so that it eventually looks as unnoticeable as possible. While time and the mature healing of wound tissue is a major element in the ultimate appearance of a scar, there are a variety of things that you can do to affect both the speed and final look of your scars.If your surgical incisions are left open at the end of the operation (usually occurring in facial procedures), keep them covered with Bacitracin ointment 2 to 3 times per day. Contrary to popular belief, the purpose of the Bacitracin is to keep the incision/sutures soft (for easier removal), not to decrease the risk of infection. Once the sutures are removed, apply a very light layer of Bacitracin ointment twice a day for an additional week.
  If the surgical incisions are taped (usually body procedures), leave the tapes on until Dr. Bonheur removes them. It is perfectly acceptable to get the tapes wet in the shower. They will not easily fall off as they are glued in place. When your tapes are removed for the first time, new tapes may or may not be put back to cover the incisions for another week.

  Scar management generally begins about three (3) weeks after your surgery. At this time, all sutures and tapes have been removed and the incision is sufficiently healed to start topical therapies.

  The best topical treatment to apply is SCARGUARD, a proprietary blend of Vitamin E, hydrocortisone (steroid), and silicone. These are the only three topical agents that are known to improve scars. Three weeks after surgery, apply SCARGAURD twice a day-in the morning and evening. It is easy to apply, and dries quickly and invisibly.

  Apply SCARGUARD between three weeks and three months after surgery. This is the most effective time to affect how the scar will eventually look.

  Scars that are exposed to direct sunlight in the first 6 months following surgery may have a tendency to darken and become rougher in texture. Exposure to UV rays does not have a positive effect on the final look of scars, so it is crucial to protect them during outdoor activities when prolonged exposure to sun may occur.

  SCARGUARD is available for purchase at our offices during your follow-up appointments.