Topics of Interest

New Research on the Myths Regarding Instructions Doctors Give Following Surgery

Building the Evidence Base for Postoperative (and Postpartum) Advice

Dr. Parker’s Note: I have summarized most of the information from this paper in a new web page: Caring for Yourself After Surgery.

Authors: Minig, L; Trimble, E; Sarsotti, C; Sebastiani, M; Spong, C.

Journal: Obstetrics & Gynecology:  October 2009 – Volume 114, pp 892-900

Study from: National Institutes of Health, Bethesda, Maryland

Problem:  Following surgery, doctors give fairly standard instructions regarding what activities the patient can, and cannot, do.  Unfortunately, there is little science to back up these recommendations.

Study: The authors reviewed studies related to post-operative instructions from medical journals, medical textbooks in obstetrics, gynecology, and general surgery, the American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions and clinical guidelines of Royal College of Obstetricians and Gynecologists of the United Kingdom in order to evaluate current recommendations.

Authors’ Conclusions: Resumption of usual activities after gynecologic surgery helps integrate women back into their normal life. Available data do not support many of the recommendations previously provided. Restrictions on lifting and climbing stairs should be reconsidered. Guidance on driving should focus on the concern about driving while using narcotic medications rather than concern about opening the wound. Much more study is needed to better define all the above issues.

Dr. Parker’s Comments: As the authors state in the introduction to the article, “recommendations for activity after discharge remain based on tradition and anecdote”.  To the authors’ credit, they investigated current recommendations and came up with little evidence to support what we usually tell women.

The authors suggest that the new recommendations be fully tested by scientific study, but since this is unlikely to happen soon (or ever), it is best to discuss the new recommendations with your doctor.

Patients are often each others’ best resource for finding and sharing information about recovery after surgery. I encourage you to post comments on this post if you have something helpful to share.

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

5 Comments

  1. Claire
    Posted January 5, 2010 at 7:54 am | Permalink

    Dr Parker, per your request for post-surgery comments:

    I’m recovering from an ab myo (4″ incision) 12/19/09. I’ve found that I turned the corner yesterday and woke up feeling like my pre-surgery self. For me the hard recovery was appx. 6 days. Now it’s just waiting for all the swelling to subside and the incision to heal completely.

    I was told to lift no more than 10 lbs: seemed silly to me since I regular lift 50-70 lbs at my work gym and I don’t use uterine muscles to do so. I’m already appx. lifting 20 lbs post-surgery and will stop if I feel pain.

    Pain management: After 5 days stopped the prescription pain medication and went to o.t.c. aleve (8-12 hour, 1 x a day).

    Driving: instructions were to drive after stopping all narcotics. I drove on Jan 2 for the first time with no pain or problem; had not taken a percocet since the day before, and have not taken one since.

    Actvity: Was told to do whatever I felt up to. I will return to bikram yoga Jan 7, and self-monitor during the first 90 min session. But I’m feeling completely well enough to return.

    Climbing stairs: was not told I could not do so, but since my surgery wasn’t in my legs, I will. I’m walking 2 miles now.

    Return to work: I have a faculty meeting tomorrow and will be attending, with a return to teaching this semester on the 11th of Jan.

    I think being in excellent shape overall, carrying no extra weight may help.

  2. Posted January 5, 2010 at 7:09 pm | Permalink

    Claire,

    Thanks for posting your experience following abdominal myomectomy. You seem to be doing very well.

    For women who would like to make contact with other women about any and all issues related to fibroids, consider joining this excellent message board: http://health.groups.yahoo.com/group/uterinefibroids

    Bill Parker, MD

  3. Nina
    Posted January 6, 2010 at 11:02 am | Permalink

    This is an interesting topic, Dr. Parker. Thank you for your tremendous contributions to your field.

    My experience having an abdominal myomectomy in November of 2008 was that it was no where near the ordeal so many warned me that it would be. For the sake of a good recovery window, I scheduled the surgery 5 months from when I decided to have it. I used this time to prepare myself mentally and physically. I kept a notebook to keep track of my progress and to write down ideas for my hospital stay and subsequent time at home. Many ideas and much encouragement came from http://health.groups.yahoo.com/group/uterinefibroids I believe that the best preparation for surgery (or other treatment) will vary for each patient, according to her sensibilities. For me, it included getting acupuncture treatments and Maya Abdominal Massage, (both for the first time). These were invaluable both pre and post op. Here is the list I made of little comforts for my 2-night hospital stay: The asterisks denote the items I actually used.

    *Seabands (to prevent nausea)
    Ginger candies (ditto – but never felt nauseous)
    *Chewing gum (to help get guts moving again and relieve any aftertaste)
    *Small balsam pillow (for a pleasant, familiar scent)
    *Portable CD player and headphones (used in pre-op, during surgery and
    afterwards in my room)
    *CD’s of favorite music (of course you could substitute and i-pod)
    *DVD’s (watched movies in room)
    *Paperback book, magazines
    *Arnica (homeopathic remedy to reduce swelling)
    *Lip balm
    *Moisturizer (for scent and nice feeling for hands and face)
    Phazyme (for gas relief – didn’t need, but many strongly recommend)
    *Cotton, button-front nightshirt
    Slipper socks (used hospital’s instead)
    *Guest book (wanted to keep track of all my great caregivers and it
    ended up full of wonderful encouragement)
    Eyemask and ear-plugs
    *Comfy sweater, loose clothes, including oversize granny panties and pull-on
    pants and step-in shoes to go home in
    *Affinity thin maxi pads to wear home (hospital pads are huge)
    *Pillow for travel home (to hold against belly and cushion seat belt)
    *Acupuncture tacks (I had pre-and post-surgery treatments, including small
    semi-permanent tacks in my ears to reduce anxiety, boost my immune system and
    reduce my need for narcotic pain killers)

    Following the surgery, which went well, removing 13 fibroids, 1500 grams worth, I had a comfortable two nights in the hospital. My first walk on the evening after surgery was a bit wobbly, but after a good night’s sleep and removal of the catheter, I could do laps around the wing, no problem. The last dose of oxydodone that I took was an “insurance dose” for the 6-hour ride home. Once home, I used my prescription for Motrin; the oxycodone and colace were not needed. Although I got all the usual post-surgery instructions, my surgeon, (the fabulous Dr. Brian W. Walsh at the wonderful Brigham and Women’s Hospital in Boston) told me mainly to “listen to my body,” EXCEPT for abstaining from intercourse for 6 weeks; that was a rule I was to follow. I was also instructed to not delay a first post-op bowel movement beyond the first morning home, which did not present a problem to me.

    At home, I took Motrin dutifully and felt very comfortable. I could feel that it was getting to be time for a dose about a half hour ahead for the first week. By 13 days post-op I discontinued it, switching to the homeopathic Traumeel for its anti-inflammatory benefits. I also used a cold pack around the abdomen (chillee gear swelly belly band) twice a day. Early on it numbed the slight sting around the incision; later I believe it contributed to reducing swelling and getting me back that flat tummy we women all crave. Our house has steep stairs, which never posed a problem, and I was out walking daily right away. I eased back into yoga/Pilates/dance exercise as it felt good. At first I felt twinges in my abdomen if I jumped and I did avoid lifting anything heavy, stopping at whatever weight started that twinge. My job involves both desk and physical work; I certainly felt up to returning, at least to desk work, after 1 ½ weeks at home, but I had been forbidden to drive for 2 weeks, then I had a short trip for my post-op, so I did not go back for 2 ½ weeks. At my 2-week mark, I drove to my acupuncturist for a treatment; there on the table, free of the fibroids and healing smoothly from surgery, I felt the sensation of being half of my 52 years. On the ride to Boston for the post-op, I wrote in my notebook that I was “completely comfortable and pain-free.” When I expressed my amazement to Dr. Walsh about how easy recovery had been, he advised that it was “90% my positive attitude.” I had to argue, and still do, that he deserved more than 10% of the credit. With me feeling fine and frisky, I was reminded of the one rule to obey before heading home with my husband.

    A month after surgery, I was delighted to welcome the return of what I now call “cute little periods” – back to what I was used to in my twenties. At 6 weeks, I wasted no time in declaring myself “fully recovered” and indulging in all the benefits of being a happily married woman. By this time I could also do heavy lifting without any twinges, so there was no shirking shoveling duty after a big snowfall. I then turned my attention to cosmetic details and began massaging emu oil into the neat and very low 4-inch incision, which has all but disappeared. 3-months post-op, I resumed Maya Abdominal Massage and self-care, which have been of great benefit to this date. You can read about this specialized modality here: http://arvigomassage.com/

    While major surgery still isn’t to be entered into lightly, clearly there have been major improvements in surgical techniques, anesthesia, pain management and knowledge of other complementary treatments. It is good to see a corresponding update of recovery advice and expectations. Best of all it’s great to see the options to be freed of fibroid-related problems while preserving the uterus in women of any age. Thanks to all of the medical professionals who don’t just advise to throw the baby out with the bath water.

  4. Claire
    Posted January 8, 2010 at 8:48 am | Permalink

    Dr. Parker,

    Here’s an amended post with pre-and post surgery hints (I had an ab myo 12/29).

    Pre surgery, I followed doc’s instructions–no advil/NSAIDs for five days previous, avoid some supplements, etc. I was required to do a bowel prep–not fun, but not too hard. I did a half lyte, like a colonoscopy prep but with half the amount of liquid ingested. I would advise those who are doing this to start it at least in the a.m. or no later than 12 p.m. I was told to start at 2, and because I’m not a big eater and am really regular anyway (I go more than once a day) it took till 11 p.m. for this procedure to work. I had to get to the hospital at 5:30, so I had about 3 hours of sleep the night before.

    I believe in a combo of natural and conventional medicine (Dr. Andrew Weil-style). I made sure I had magnesium capsules ready for any constipation issues, bromelain, arnica, vit c and zinc for post surgery swelling and tissue trauma. By taking the mag as soon as I was able to swallow after surgery, I kept the constipation at bay completely.

    Today I’m 10 days post-op and I think the other supps helped tremendously as all abdominal swelling has gone down, I have no bruising, the incision is looking great, and I can wear all my clothes again (they are even somewhat loose).

    I took dandelion capsules for a week to cleanse my liver and flush out any excess fluid. If you are going to use all these supplements, get some info on them first. I see a naturopath, so I know what they do and how I react to them. I don’t know what they’ll do to you, so just inform yourself.

    Avoid bubbly drinks. Avoid any gas-producin foods. Some people think that bubbly drinks relieve gas by making you burp, but I think they make it worse. Take gas ex with you to the hospital and start taking it as soon as you can.

    The worst pain I had I think was from the gas. The gas-ex helped, but the magnesium, which kept me regular, helped me pass it all out.

    I didn’t want any special food; I mostly ate ice chips in the hospital. You won’t die if you don’t eat for a day or two, but keep the fluids moving. It will help with fatigue and getting out all the drugs from your body faster.

    Expect to be really uncomfortable for at least a few days. Don’t expect too much at first.

    I refused morphine because it doesn’t work for me (I feel the pain, I just don’t care about it). My doc gave me toradol in the hospital, which worked about as well as it could, with no groggy, stoned feeling.

    Left with 600 mg ibuprofen and percocet. I used the perco for the first two days after surgery. finished with the ibu for a day or so afterward, then switched to otc aleve. I’m not taking anything now.

    I asked to stay the first night even though they were ready to release me the afternoon of surgery. I wanted them to monitor my pain, and I wasn’t sure I could keep pain pills down because I was nauseated. I never threw up though. I did not feel like I had failed because I asked to stay one night.

    Hospitals are no place to recover; I had people coming in every hour, when I’d just drifted off to sleep. Get out of there as soon as you can.

    Sleep as much as you can.

    I ate comfort food the first few days b/c I had no appetite–chicken noodle soup, toast, saltines.

    Don’t be afraid of a catheter. I had one overnight, and the nurse filled it with sterile water when she took it out so that I would have the urge to pee and get things going in there sooner. She also gave me something to avoid a possible UTI. The catheter didn’t hurt (they put it in after I was out, and it didn’t hurt taking it out).

    Drink plenty of water as soon as you can. It wasn’t hard for me as I was really thirsty for a few days afterward.

    My spouse was invaluable so have a person around you can trust, and one that wont’ take offense if your emotions go crazy. My emotions did.

    Emotions: post-anesthesia depression, hormonal changes because of the fibroid removal, etc. all normal and they will pass. Mine are all gone now.

    Have some good books to read.

    I couldn’t sleep on my side for two days but eventually I was able to, which helped me sleep so much better.

    A heating pad helped me in bed at night because my back was so achy, like the flu. That is normal too.

    Expect some bleeding vaginally; I bled for about 5 days, tapering off a lot each day. My discharge is gone now and I’m going all day without a pad.

    Be nice to yourself but don’t wallow in your recovery. Sometimes you do have to push yourself a bit to get better. Baby steps, but keep stepping a bit further each day if you can.

    That’s all I can think of for now. Today is day 10, and in spite of a little ache in my lower abdomen b/c of the incision, I feel completely back to normal. I have bladder retention now! Still can’t do my crunches yet, but I’m going to test every day and eventually that last part of my recovery will come too.

  5. Ihenata Ordia
    Posted January 27, 2011 at 5:22 pm | Permalink

    l just had a fibroid surgery two days ago and already lm walking woobly doobly. the only thing is my feeling nauseous, pain in my back like crazy, and the urge to eat nothing but your mouth yelling for a spicy meal.
    l cant eat very well but my surgery was a success thanks to my god for placing me in good hands of beautiful doctors and aneathesia in parkland hopsital, dallas Tx.
    l will always be grateful to them because they took care of me with all the fibroid out, and ofcourse my husband who has being there for me, rubbing my leg, my back, helping to a take a step in order to walk well. it is only two days since my surgery and lm feeling better.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in Los Angeles, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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