Post Op Instructions
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The following medication recommendations are generalized and may not apply specifically to you as medication allergies or certain medical problems may limit the use of some pain medications. You should have been given instructions about your pain medications when you were discharged. If you have specific questions about your medications, please call Dr. Jeffers.
IF YOU HAD ARTHROSCOPIC OR OUTPATIENT SURGERY: You were likely given a prescription for a narcotic pain medication. The usual dosage is 1 pill every 6 hours but you can take 1 pill every 4 hours if the pain is not controlled. If 1 pill is not controlling your pain, you may take 2 pills every 6 hours. However, DO NOT take more than 12 narcotic pills in a 24 hour period. Try to take the minimum amount of pills to keep your pain at a tolerable level. The less narcotics you take, the better. Minimizing the amount of narcotics you take will minimize the side effects from the narcotics (constipation, nausea, vomiting, dizziness, confusion). If you feel that the narcotics are too strong, you may use plain Tylenol (acetaminophen). Anti-inflammatory medications, like Motrin and Aleve, also work well but these may create an increased risk of bleeding.
If you find yourself taking both the narcotic and extra Tylenol (acetaminophen), please be aware that most narcotic pills are combination medications containing both Tylenol (acetaminophen) and the narcotic. The pill bottle will list the 2 medications on the label. (NOTE: Dr. Jeffers will sometimes prescribe straight oxycodone; this narcotic is not mixed with Tylenol. Your pill bottle label will tell you exactly what you are taking). You will need to monitor exactly how many milligrams of Tylenol you are taking. Taking over 4000 mg of Tylenol (acetaminophen) in a 24 hour period will damage your liver and potentially cause liver failure. Ideally, you should try to limit your intake of Tylenol in 24 hours to 3000 mg so you don't overly stress your liver. Most narcotic pills contain 325 mg of Tylenol and plain Tylenol comes in 250 mg, 500 mg, and 650 mg pills. Look the Tylenol package or bottle to figure out the strength.
IF YOU HAD MAJOR SURGERY SUCH AS A JOINT REPLACEMENT: You had pain before the surgery; there will be pain after the surgery as well. For the first few days after surgery, you should NOT expect that the pain medications will make you pain-free, The overall pain control goal is to make your pain tolerable and manageable. You were likely prescribed 3 different medications for pain, Tylenol, Ibuprofen, and Oxycodone. You should take take the Tylenol and Ibuprofen every 8 hours, even if you don't have a lot of pain. Continue the Tylenol and Ibuprofen for about 5 days or for as long as you are having significant pain. If you are not having much pain after 5 days, you can begin to take less of the Tylenol and Ibuprofen and just take them as needed. The Oxycodone is your rescue medication for when you have severe pain. Take 1 pill every six hours when the pain is severe. Take it only when the Tylenol and Ibuprofen are not controlling your pain. Ideally, you will not need to take any of the oxycodone. Please don't suffer though, take the oxycodone if you are having severe pain. If your pain is not controlled the maximum amount of the medications, please call Dr. Jeffers.
ICING: Cold therapy is often very helpful. You may place ice, cold packs, or a bag of frozen vegetables over the surgical site for as much and as long as you want but please be cautious of causing frostbite. It is recommended to place a towel between the ice and the skin to help protect the skin. The pain will likely vary in the days after the surgery but the overall intensity should decrease with time. If your pain continues to get worse and never improves, call Dr. Jeffers.
IF YOUR SURGERY WAS NOT A JOINT REPLACEMENT: You may remove the bandage the day after surgery unless you are told not to do so by Dr Jeffers. It is not unusual to see some blood on the gauze pad after removing it for the first time. If there is continued drainage, apply another clean dry gauze. There will a plastic bandage directly over the incision(s). Leave the plastic bandage on the skin and let it fall off on its own. If you are in a splint and it feels too tight, you may loosen the Ace wrap holding the splint in place but leave the splint on.
JOINT REPLACEMENT PATIENTS (Hip, Knee, Shoulder): You have 2 bandages protecting your incision but one is underneath the other and not visible until the outer one is removed. Both are waterproof. There is no need to remove either dressing until you follow up with Dr. Jeffers. It is best to leave both dressings in place if possible. Occasionally, you may note a little bit of bloody drainage on the outer dressing. If it has not soaked the entire bandage, it is OK to leave the dressing alone. If you think there is too much drainage, call Dr. Jeffers. If Dr. Jeffers gives you permission to do so, it is OK to remove and change the OUTER bandage ONLY. Leave the clear plastic bandage that is directly on the incision alone.
IF YOUR SURGERY WAS NOT A JOINT REPLACEMENT: Keep the incisions dry for at least 1 day. Unless told otherwise by Dr. Jeffers, it is Ok to get the incisions wet after the outer bandage has been removed. Leave the plastic bandage that is directly on the incision alone; it is OK to get it wet. Letting water run over the incisions in a shower is OK. Don't soak the incisions in either a bath or Jacuzzi until you are told it is safe to do by Dr. Jeffers - usually 4-6 weeks after the surgery.
JOINT REPLACEMENT PATIENTS (Hip, Knee, Shoulder): Both of your dressings are waterproof. You may start to shower and get your bandages wet 1 day after surgery. Do NOT soak your incisions in either a bath or a hot tub. Letting the water run over the dressings is OK. Gently pat the area dry after the shower and try not to disturb the dressings. The dressings are intended to stay in place for 2 weeks. Once the dressings have removed by Dr. Jeffers, it is still OK to shower and to get the incision wet. Don't soak the incision in either a bath or Jacuzzi until you are told it is safe to do by Dr. Jeffers - usually 4-6 weeks after the surgery.
Deep Venous Thrombosis Prevention (DVT or Deep Blood Clots)
DEEP VENOUS THROMBOSIS (DVT): One of the more concerning problems that can happen after surgery is the formation of a clot within the deep veins on the legs; a deep venous thrombosis or DVT. If the clot breaks loose, it can travel through the veins back to the heart and then the lungs. This is called a pulmonary embolism, or PE. If the clot is big enough, it can stop blood flow in your lungs and make it difficult to breathe. Rarely, the blood clots can be fatal. Luckily, most surgeries have a low risk of DVT formation but there are some types of surgery in which the risk is high. Unfortunately, there is no way to completely eliminate the risk of DVT formation after surgery.
THINGS YOU CAN DO TO PREVENT DVTS: While Dr. Jeffers does many things during the surgery to reduce your chance of DVT formation, there are actually many things you can do yourself to prevent the DVTs from forming, as they can occur even when you are at home. For most surgeries, the most important thing you can do is try to remain active and keep your legs moving. Walking, or even just moving your ankle and knee, activates the muscles in your legs and helps push the blood back to your heart. Try to get up and walk 3 to 4 times a day, even the day after surgery. You don't have to walk far. Staying hydrated also may help as well.
BLOOD THINNING MEDICATIONS: For most outpatient surgeries the risk of DVT is low and no additional medications are indicated to prevent DVTs. For certain surgeries though, joint replacements in particular, the risk of DVT formation is high. In addition to the walking, Dr. Jeffers most likely prescribed you a blood-thinning medication. For most patients, this will a baby aspirin but it may a different medication. The most important thing is to take the medication as prescribed. The medication, dosage, and length of time you should take will vary based on your particular medical problems. You should have been given instructions on how to take the medication on your discharge, but if you have questions, call Dr. Jeffers.
IF YOU SUSPECT YOU HAVE A DVT: If you suddenly develop chest pain or find it difficult to breath, call 911 or go directly to the Emergency Room. You may have developed a pulmonary embolus (blood clot in the lung) and you should seek urgent medical treatment. Luckily, pulmonary emboli are rare and so this is uncommon. A DVT that forms but hasn't broken loose yet also needs medical treatment sooner rather than later. Unfortunately, diagnosing a DVT based on physical examination alone is actually quite difficult. The most common symptoms of a DVT are pain in the calf and swelling. Trying to tell the difference between the pain and swelling from a DVT and pain and swelling that normally is present after surgery can be a challenge. While pain and swelling are completely expected after surgery, if you think the amount of pain and/or swelling is more that you would expect, call Dr. Jeffers. If you are unable to reach him quickly, consider going to the Emergency Room. There, they have the tools to quickly evaluate you for a DVT and also start treatment if needed.
Walker, Cane, Crutches and Sling Instructions
WALKER OR CRUTCHES: Unless you were given specific instructions not to, it is OK to place all of your weight on your legs. even the one that had the surgery. Use the walker or crutches until you regain your feeling of balance. If you feel unsteady, continue to use the walker or the crutches. Once you start to feel more comfortable, you can use the device less and less. Most knee arthroscopy patient will feel comfortable walking without crutches after 2-3 days but you can use them for a longer or shorter time. For joint replacement patients, you can transition to a cane from the walker when you feel comfortable to do so. If you don't think you need a cane, that is fine too. Most patients transition to starting walking without assistive devices in their house but will continue to use the device (just in case) when they leave the house. The key concept is a feeling of balance and stability...continue to use the walker, cane or crutches if you feel unsure of your stability.
SLING: Depending on the specific surgery you had, Dr. Jeffers will give you personalized instruction as to which shoulder and arm movements you should avoid. The sling is supposed to help with support and helps keep your arm close to your body. You may use your hand as much as you would like, even within the sling. You can use your hand and arm for feeding or personal care but don't lift anything heavier than a full coffee cup. It is recommended that you remove the sling 2 to 3 times a day so that you can fully stretch your elbow so it does not become too stiff. You don't necessarily need to wear the sling 24 hours/day and so you may remove it from time to time if it becomes uncomfortable. If you do remove it, keep your arm close to your chest and don't do the specific motions of your arm and shoulder that Dr. Jeffers told you not to do.
When to seek URGENT Medical Attention
If you have any of the following conditions below, please call Dr. Jeffers right away. If you can't get a hold of him, consider going to the Emergency Room.
Continuous, active bleeding or drainage from your wound
Pain that continues to increase and does not improve despite the use of pain medications
Most likely, you will not have any of the above problems. However, if you are concerned about something and you are not sure if the problem can wait until the follow up appointment, please feel free to call Dr. Jeffers at any time, day or night, 805 981-1788. If it during office hours, his secretary will pass the message along. If it is at night, or on the weekend, his Answering Service will contact him and he will call you back. If he does not contact you right away and you don't feel you can wait any longer, consider going to the Emergency Room.
Please call for an appointment for the week following your surgery. (805) 981-1788
If you have had a joint replacement (knee, hip, or shoulder), you should follow up 2 weeks after your surgery.
Common Concerns and Problems After Surgery
Click below to learn about some of the problems seen after surgery and how to make them better on your own and when to call for help!
If you have told that you can remove your dressing, it is not unusual to see some blood on the gauze pad after removing it for the first time. If there is continued drainage, apply another clean dry gauze. If you think you have too much drainage, call Dr. Jeffers.
You will very likely have some swelling in the affected area or limb but you may not see it until 1-3 days after the operation. Swelling is due to increased blood flow to the surgery site and is a natural and normal response to the surgery. The swelling will be increased when the affected body part is lower (closer to the ground) than your heart. This is due to gravity. You can minimize the swelling if you elevate the body part so that it is above the level of your heart but you will likely not be able to eliminate it completely. The swelling may last for weeks, or even months. Again, this can be normal. However, if you think you are having too much swelling, please call Dr. Jeffers.
Bruising and stiffness are very common after surgery. It usually looks dark purple or bluish-red. The bruising may not be seen until 3-7 days after the surgery. The bruising is due to bleeding at the surgical site at the time of the surgery and is caused by the the blood seeping into the surrounding tissue. Often, the bruising may be seen a distance away from the surgical site (for instance, bruising may be noted in the ankle after knee surgery). This is normal and due to gravity. The bruising will go away on its own after a few days. Occasionally, it may cause some itching.
You are expected to have some discomfort after the surgery. The goal of the pain medications is to make the pain tolerable. It is advisable to take the least amount of medications to bring your pain to an tolerable level. You can minimize the risks of side effects from the pain medications by taking only what you need. Cold therapy is often very helpful. You may place ice, cold packs, or a bag of frozen vegetables over the surgical site for as much and as long as you want but please be cautious of causing frostbite. It is recommended to place a towel between the ice and the skin to help protect the skin. The pain will likely vary in the days after the surgery but the overall intensity should decrease with time. If your pain continues to get worse and never improves, call Dr. Jeffers.
Constipation can be very common after surgery. Narcotics are a major cause as the medications slow down the normal bowel motion. When you can, try to stop taking the narcotics as soon as you can. Walking and staying active encourages bowel motion. Chewing gum can help stimulate the bowel to start moving again as well. Staying hydrated is very important as well. Dehydration can make the stool very hard. If you do have constipation, try prunes, Milk of Magnesia, fruits with fiber like apples, or milk and molasses. Constipation that lasts a more than a few days can feel very concerning but if you are passing gas daily, the constipation will resolve with time; usually when you stop the narcotic. If you stop passing gas or your stomach becomes increasingly bigger without going down, call Dr. Jeffers or consider going to the Emergency Room.
Nausea and Vomiting
General anesthesia (anesthesia where a tube is inserted in the mouth) is very common cause of nausea and vomiting right after surgery. Post-operative nausea is usually temporary; it usually gets better once all the anesthetic has left your body. This may take a few hours but occasionally may last longer, sometimes overnight. Dr. Jeffers prescribes medications to given around the time of surgery to minimize the risk of nausea but the medications do not always work. Strangely, sniffing rubbing ethyl alcohol, like an alcohol pad, is often very effective for relieving post-operative nausea (it only seems to work for post-operative nausea, not other types of nausea though!). Some patients say that eating ginger helps with nausea. After you have recovered from anesthesia, a very common cause of nausea and vomiting are narcotic pain medications so try to take the narcotics only if you really need to. Again, another good reason to try limit the of the narcotic pain medications as much as possible.
Loss of Appetite
Don't worry if you don't have much of an appetite for solid food after surgery and anesthesia; this is very common. As long as you keep up on your fluid intake and keep yourself hydrated, your appetite will soon return to normal. The most important thing is to stay hydrated. Water, clear broths, or electrolyte drinks like Gatorade are recommended right after the surgery until you feel more normal. Once you are tolerating clear liquids, you can try more complex liquids or regular food.