HOW TO PREPARE FOR YOUR SURGICAL CONSULTATION.


Going to a surgeon would bring painful memories to most people, hence they postpone surgical care. But it doesn’t need to be that way. Today the technology in surgical care has advanced so much: It has reduced ‘invasive’ procedures to ‘minimally invasive’ ones.  With today’s research and excellent analgesic drugs to control post operative pain, your surgical care can become a pain-free experience. You can soon put behind an illness that has kept you worrying and had prevented  you from enjoying health.

Some preparation before your surgical consultation will help you get the best from it. The first question that will come to your mind is “ Is surgery is the only way to treat my ailment.”

  1. You could begin to read or access information from ‘reliable sources’ before you meet your surgeon. Not all that lay people say is gospel truth in spite of their good intentions. Get your information from qualified medical professionals, reliable publications or websites that are accessible to those who can use internet. Research has clarified illnesses that are best treated by surgery alone.
  2. Do not try to self diagnose.
  3. You could go to a surgeon (call: SURGICALCARE) directly if you have any of the following complaint.
       a.   A visible swelling or lump anywhere in the body - especially in the breast, neck, thyroid, groin, private parts.
       b.   Bleeding, protrusion or pain while passing stool or constipation.
       c.   Any abdominal pain – recent or old
       d.   Any mass felt anywhere in your body or in the abdomen
       e.   Any swelling that appears while coughing or straining- HERNIA
       f.   Any infective lesions on the body either or not secondary to diabetes
       g.   Any non-healing ulcers on the leg, foot or other areas
       h.   Any form of Injury to the abdomen or soft tissues ( bone and brain injuries are seen by other specialties)
       i.   You have been examined by a physician and was advised to meet a surgeon for opinion.
  4. Wear a dress that is comfortable to remove for the physical examination of the specific area.
  5. Be mentally prepared with questions you have (even if it means listing them on a paper) and also with your plan/ decision if a procedure is recommended to you.
  6. Try to ask yourself ‘what is the main complaint that is taking you to the surgeon ?’ and tell him specifically that it is your ‘presenting complaint.’ Or else, it  can result in an unsuccessful procedure where your ‘presenting complaint’ has not been addressed.
  7. Many a time investigations involve blood tests, urine tests and occasionally an Ultrasound scan examination. It is best if you plan ahead to avoid multiple visits to the medical centre and have all that done on one day. Ultrasound abdomen often is done on an empty stomach and sometimes they may want to hold your urine for few hours depending on the type of scan the surgeon orders.
  8. We at SURGICALCARE have maintained the openness for second opinions and give you the liberty to make informed choices concerning your health that is best for you
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HOW TO PREPARE FOR YOUR OPERATION.

  1. Always plan with your surgeon the exact date and time and hospital of your surgery, and when you need to check-in to the hospital.
  2. Make sure you are prepared with any advances that you may have to pay or get credit letters from your insurance or Offices or ‘Clearances’ so that there won’t be any last minute hitches that will be unpleasant to either you or the operating surgeon.
  3. It is preferable to get admitted minimum one day prior to surgery, except in cases of Day Care Surgery. (In the latter case you have to at least meet the surgeon in person and ensure all the pre-operative orders from him). There are many preparations like shaving, enema, medications re-investigations, control of Blood sugar, Blood pressure, Pre-anesthetic check-up etc., to be done, after admission.
  4. For Day Care Surgeries- (Non-admission Surgeries), unless the surgeon is sure of the safety, make sure the anesthetist sees you the day before you are taken for surgery and you are cleared for Day Care Surgery.
  5. A good night’s rest  and tranquility before the operation day and an calm unhurried morning  is essential for a pleasant anesthesia experience. (impossible, if you have to travel to the hospital in the morning.)
  6. Keep all your records, Pre-op investigations, X-rays, CT scans, Ultrasound scans, any past records of your illnesses, allergies etc with you when you get admitted – preferably in one FILE!
  7. Most surgeries are done on an empty stomach, at least 5-6 hrs.
  8. Preoperative breathing exercises and stopping of smoking at least 2 weeks  before surgery (best if possible to stop for 2months) helps in avoiding post operative lung complications.
  9. For major surgeries preoperative leg exercises by flexing and extending at the level of the ankle and knee joints, (prepares you to do so even after the surgical procedure) this helps prevent a serious complication of Deep Vein Thrombosis.
  10. Scrubbing the area of surgery well, with soap or antiseptic scrub, helps reduce wound infection following surgery.
  11. Do not be afraid of ‘spinal anesthesia’ or regional anesthesia if you are advised so. There is almost negligible pain during the procedure in experienced hands. It also avoids a lot of lung and heart side effects of General Anesthesia, in addition to being cheaper.
  12. Plan to avoid too many visitors as it increases infection and stress during the post-operative period.
  13. Keep your room/bed neat and tidy with the help of your attender. You could prepare in advance for an aesthetic atmosphere, like a flower bouquet or soothing music which are better ‘positive distractions’ than the blaring TV commercials during your recovery period after surgery.
  14. Contemplation and quietness drawing on spiritual resources helps one to know that ultimately one’s life is in the hand of a merciful God gives you a positive outlook to the procedure done. A positive outlook goes a long way in inspiring your surgeon to do his best for you. Most Surgeons get restrained by a patient who is skeptical.
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HOW TO RECOVER FAST AFTER YOUR OPERATION.

Much research has been directed to study the factors affecting healing and quick recovery following surgery. The metabolic responses following surgery is related to both nerve responses and hormonal responses. The healing is also quite dependent on another largely unknown areas of immune response and the psychological predisposition of the patient. There has been a lot of interest on ‘fast track surgery’ and ‘recovery enhancement programs.’ What is given below Is a summary of what most investigators agree as measures for fast recovery.
  1. Relaxing and deep breathing exercises before surgery (like pranayama).
  2. Carbohydrate rich diet (like fruits) the day before operation. (Diabetics to be cautioned)
  3. Good peri-operative analgesia.
  4. Minimal invasive technique surgery planned by your surgeon.
  5. Get out of bed as fast as you can after the surgery (or as fast as you are advised to). Use toilet with help, rather than the bed pan.
  6. Move your body parts that the muscles may not lose its mass due to inactivity on bed.
  7. Early food intake as advised by your surgeon
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HOW TO PLAN ‘SICK LEAVE’ FOR SURGERY.

You may be concerned about the leave from office/ work etc., during your surgical care. This is true even if you are a housewife or a student . Though it is desirable that you spend  the least amount of time possible in the hospital necessary, all depends on the type of your surgery, your health and your recovery time, and hence is not fixed. A few points to note are

  1. Avoid getting operated on week-ends, thinking that you can save 2 days of week-end leave. Most hospitals are understaffed on week-ends when you will be needing maximum care during your immediate post-operative period.
  2. Your sick leave will include few days in the hospital and few at home. Your surgeon can assess and predict, but only an approximate period of leave.
  3. Join work only when you are declared  fit by the surgeon. Especially if you are a businessman, there  are challenges due to the pressure of work may force you to hurry things up opening room for complications to set in.
  4. Your ‘sick leave certificate’ can be obtained from the surgeon, provided you present your discharge summary and records, along with the leave format filled by the receptionist/ coordinator of the hospital. You can even send any representative for the same
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HOW TO PLAN THE EXPENSES FOR YOUR OPERATION.

Medical care has become very expensive these days that it drains resources of even most middle class families. Often this question bothers patients “Now how much will this procedure cost me?” Many-a- time the surgeon is at a loss to tell you how much will it exactly cost. There are two reasons for this:

  1. There is always a cheaper way of doing things at the expense of some standards or on the other end an extravagant way of doing things, to give the best available options in a given procedure or treatment.  So you may have to give the surgeon a clue of what your expectation is and also understand the implications of your choice. (Always tell him in advance of what you can afford).
  2. He may not be able to assess the exact route, your treatment will finally take, due to the unpredictability of the disease condition. For e.g., It could be a complication needing ICU treatment, multiple consultations from other specialists, or a resistant infection needing expensive antibiotic.

Most hospitals take an advance not less than 50%-60%  of the total expenses estimated for the procedure and hospital stay. In some places the anesthetist’s fee is paid directly by you immediately after the surgery. The remaining is paid in installments as when demanded by the Public Relations Executive.

It is good to have a medical insurance these days. With so many policies and companies around, you could insure yourself to cover the costs of your surgery. It is the best way to obtain the most comfortable and hassle-free care, not only to you but also the care-givers.

In SURGICALCARE we have a classification of all surgical procedures into 5 classes to help you get the approximate expenditure expected. However, In most procedures, it is difficult to give a guarantee for a definite amount (as in other services) due to reasons mentioned above. Please look at SURGICALCARE PACKAGES for further information.
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WHAT TO DO ABOUT THE PROBLEM OF BLOOD?

  

Many surgical procedures require the need of blood transfusion either due to losses before or during surgery. There is an effort in medical practice to avoid or minimize  blood transfusions because of its various reactions and possible transmission of diseases. So when a surgeon is asking for blood, he has already weighed the benefits and has decided to go for it. Your task is now to arrange the blood.

  1. Most of the time you really do not have to worry getting the same group of blood as the blood is exchanged to match the recipients group anyway.
  2. Do not get all the blood units requested on paper, at one time, unless you have been asked by the surgeon (or his assistant) himself. Once blood is brought out of the bank it is not taken back if unused.
  3. It is OK for any healthy individual to donate blood. One can donate up to 3 times a year with no side effects to health.
  4. Donating blood will entitle you to have a ‘donor card’ from most blood banks which will be useful in times of emergency when you or your close family  or friends require it. It will save you from panic at the time of the medical treatment.
  5. Do not rely on professional donors. Blood banks reject them or they may also be carriers of disease.
  6. You cannot buy ‘blood’ as it is not a factory product. Human body is the only factory that produces it and hence donation is the only way to procure blood.
  7. Do not be frightened to donate blood for your family or friends. If you are afraid of the pain you can request the blood bank officer to use local anesthesia before the needle prick.
  8. After donation, it is good to drink good amounts of water, juices etc., in the first 24 hrs, to keep your blood volume and avoid any weakness
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HOW TO PREPARE FOR DAY CARE SURGERY/ AMBULATORY SURGERY.

What is day care surgery?
Day care surgery is surgical care that requires only one day admission in the hospital (24hrs). Ambulatory surgery means you are not admitted in the hospital and hence no overnight stay – you go home as soon as the surgery and recovery is over the same day.

Day care surgery has become increasingly popular all over the world for many reasons. Thanks to advances in technology, surgeons can now perform minimally invasive surgical (MIS) procedures instead of the previous invasive surgery. Newer drugs used for anesthesia allow patients to recover consciousness very quickly, so that they can go home soon after the surgery is over. And lastly, since modern painkillers are more powerful, patients experience much less pain after the operation and they can successfully relieve the pain themselves by taking these medications at home.

Day care surgery

  • Delivers the same high quality care as that given to hospital patients.
  • Is actually safer than hospitalized surgery.
  • Day care surgery is economical as well. (On an average, research conducted in the USA has shown that procedures at day care surgery centers cost 50 per cent less than those at hospitals).
  • Patients recover faster in the home than in an inconvenient atmosphere of a hospital.
  • Less inconvenience to relatives in the Indian setting.
  • Lesser nosocomial (hospital-acquired) infections

SOME SURGERIES THAT CAN BE DONE AS DAYCARE / AMBULATORY SURGERY

  • SKIN AND SOFT TISSUE LESIONS/ GROWTHS
  • BREAST LUMPS
  • STAPLER HEMORRHOIDOPEXY
  • LAS for FISSURES
  • INGUINAL HERNIA IN ADULTS AND CHILDREN
  • HYDROCELE
  • MALE STERILIZATION
  • EAR LOBE REPAIRS
  • SMALL EPIGASTRIC HERNIAS
  • DIAGNOSTIC LAPAROSCOPY
  • TRENDLENBERG OPERATION for VARICOSE VEINS
  • LAPAROSCOPIC VARICOCELE VEIN CLIPPING
  • LAPAROSCOPIC FEMALE STERILIZATION
  • CLEFT-LIP REPAIR

SOME GUIDELINES FOR THOSE UNDERGOING DAYCARE SURGERY

  • Make sure you have got all your pre-op investigations done and also checked by the surgeon at least a day prior to the surgery.
  • Confirm the time and location of your surgery in writing by the surgeon.
  • Ask for the DAYCARE SURGERY PATIENT INFORMATION SHEET prior to the surgery.
  • Confirm the area to be shaved and prepared for the surgery.
  • See if you have to take any enema previous night.
  • Mention beforehand any allergies you have had in the past.
  • Meet the Surgical Nurse at the appointed time and place and show her all the records.
  • Do not forget to get one change of easy ‘wear and remove’ dress when you are taken into the OT.
  • Void urine before going to the OT.
  • Do not leave the OT premises/ recovery room before the surgeon has signed your discharge and given you instructions.
  • Find out the warning signals you have to look out for before contacting the surgeon.
  • See that you have at least one person accompanying you to the hospital and drive you back home. It is preferable to have someone with you for a day at home.
  • You should be clear of what was surgeon’s recommendation of the mode of your travel back home if you are from a distant place. Some modes of travel are harmful for when you are recovering from surgery.
  • Join duty only after you have been declared safe by the surgeon who has operated you
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SPECIAL INFORMATION FOR THOSE UNDERGOING LAPAROSCOPIC SURGERY.

Laparoscopic surgery (or Minimal Access Surgery) is the modern day trend in surgery to do major operations through small holes (without traditional long incisions) thereby patients have minimal pain, less hospitalization, almost no scars and early return to work.

  • Laparoscopic surgery is done mostly for Abdominal and Thoracic operations. (For eg., a patient once asked me whether I could do laparoscopic surgery for Piles!)
  • There are some surgeries which are commonly done laparoscopically in all centers with good results. A list of them are discussed under the LAPAROSCOPIC SURGERY section of the Services. Much research is being focused on which surgeries are best done laparoscopically, and which are better by the open method.
  • You must understand, that all Laparoscopic surgeries have a potential to be ‘converted’ to open surgery in case of any danger perceived by surgeon. For eg., bleeding, anomalous anatomy, pathological abnormalities causing difficulty in surgery like adhesions, friable tissues etc., There are also times when the patient’s cardio-respiratory status is unable to cope with the high pressure in the abdomen during laparoscopic surgery. One should not be disappointed by this, but rather appreciate that the surgeon was taking this decision, on the patient’s best interests.
  • Laparoscopic surgery can be done only when you are declared fit for the same by the anesthetist or cardiologist.
  • After surgery you may experience a heaviness in the abdomen and pain in the right or in the left shoulder.
  • In conclusion, laparoscopic surgery is one advancement that has reduced post operative pain drastically, leaving almost no scars on the patient, with early return to home and work. It is truly a boon for patients these days
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