PLEASE READ THESE INSTRUCTIONS CAREFULLY
Not everyone has the same response to surgery. Not all of these instructions may apply to you. In addition to good common sense, please follow these guidelines. Please call the office if you have questions or need clarification. We can be reached at (415) 397-1400.
AFTER HOURS CONTACT
If you are having a problem after regular office hours and need to speak with Dr. Rayher, please call (415) 397-1400. Please follow the prompts or wait on the line and an operator will assist you. The operator will take your name and phone number that will be forwarded to Dr. Rayher. He will return your call. Please turn off any caller ID blocking.
You will be leaving the office with a gauze pack(s) inside your mouth. Bite down on the gauze pack(s) with firm pressure to stop the bleeding. Change the gauze every 1-2 hours. Do not change it more than once an hour. Frequent gauze changes will prolong the bleeding. The amount of blood on the gauze should decrease with each change. When bleeding is minimal, do not replace the gauze. Ideally, you should be done with the gauze before bedtime.
You may experience a bloody nose following a sinus lift or upper jaw bone graft. This is completely normal and may persist for 24 hours. This can be controlled by compressing your nose for 5 minutes.
Your face will be swollen for about a week and possibly longer. The swelling can be severe in some patients and will usually reach a maximum at 72 hours. Use a cold compress on your face for the first 48 hours while awake. This will help reduce the amount of swelling. Use ice packs for 20 minutes at a time. Take a least a 20-minute break between icing sessions. Keep your head elevated (do not lay flat) for the first 48 hours.
You may turn black and blue on the face and under the eyes. This may look like a “black eye.” Bruising may extend down from the face onto the neck. Bruising varies from person to person. Bruising usually takes a couple of days to develop and typically resolves in about 2 weeks.
There will be multiple sutures in your mouth. You will feel them with your tongue. Leave them alone. The sutures are self-dissolving. They will loosen and fall out in 5-15 days. If a suture becomes very loose, you can carefully trim the dangling end with scissors.
Do not rinse your mouth or brush your teeth the first day as this will prolong the bleeding. The next day after surgery, if the bleeding has stopped, begin warm saltwater rinses. Use ½ teaspoonful of salt to a glass of warm water. Rinse after every time you eat or drink anything and at bedtime. If salt water is not available, use plain tap water.
You can resume tooth brushing with toothpaste the next day after surgery as you are comfortable. It is important to resume brushing your teeth as soon as possible. Do not use commercial mouth rinses such as Listerine or Scope. Use the medicated mouth rinse you have been given.
If you had sinus surgery, you will need to follow special instructions for 2 weeks to protect the sinus graft and to allow it to heal properly.
- Do not blow your nose. Wipe it gently.
- If you sneeze, sneeze with your mouth open.
- Do not use a straw to drink.
- Do not forcefully spit.
- Do not smoke.
You will be on antibiotics for 2 weeks. It is very important to take them as prescribed to prevent infection.
WHAT TO EXPECT WITH YOUR LEG:
You will leave the office with a bandage wrapped below your knee. The bandage will protect the underlying wound and apply pressure to minimize bleeding and swelling. The outer layer is an Ace wrap. You may loosen the Ace wrap if it is too tight. Under the Ace wrap, your leg is wrapped with white cotton gauze. Please leave this in place. If the cotton gauze wrap is too tight or comes loose, please wrap it again carefully. After 72 hours, remove the Ace wrap and white gauze wrap by unwinding both. Underneath is a clear plastic bandage. Do not remove the clear plastic dressing. It will be removed at the office. Do not be alarmed if there is blood under the clear plastic dressing. If you have problems or questions about the dressing, please call the office.
INCISION & SUTURES
You will have a small incision about 1-1 1/2 inches long on your lower leg below the knee. Sutures are placed to help it heal. The sutures will be removed at the office about 2 weeks after surgery. The incision will leave a scar. The final appearance of this scar can vary greatly. The scar will continue to change and mature for up to one year. Keeping it out of the sun and using sunblock will help minimize discoloration. After the initial healing period (after the sutures and all bandages have been removed), Vitamin E oil and gentle massage can help minimize the scar.
SWELLING & BRUISING
Your leg will swell and bruise. The black and blue may spread all the way down to your foot. Do not be alarmed. This is normal. To minimize the swelling and bruising, you will need to keep your leg elevated as much as possible for the first 72 hours. While sitting, prop your leg up on pillows. While sleeping, place pillows under your knee and foot. Minimize the amount of time you spend on your feet.
WALKING & ACTIVITY
You may walk immediately after surgery, but try to minimize being on your feet for the first 72 hours. Your leg will be sore and stiff. This will get better with time. Your leg will return to normal function in 8 weeks. No running or high impact activities for 8 weeks to prevent possible leg fracture.
You must keep the leg wound and dressing dry. You should take sponge baths only for the first 72 hours. After 72 hours, you may shower, but you must keep the wound dry. Wrap the area with Saran wrap and place a couple of rubber bands over the Saran wrap above the wound and dressing to provide a water-tight seal. If the wound or dressing accidentally gets wet, please call the office. Do not soak the leg in water for 2 weeks.
WHAT TO EXPECT IN GENERAL:
After surgery go directly home with your escort. Stay at home for the remainder of the day. IV anesthesia may cause prolonged drowsiness. You will need someone at home to assist you until you are sufficiently recovered. This may take up to 24 hours. You should not operate an automobile or any other equipment or machinery, nor should you plan to care for children or make important personal or business decisions. Be careful not to sit or stand quickly as this may produce dizziness and cause a fall.
The next day after surgery you may begin to resume your usual daily activities. Avoid over-exerting yourself. Use common sense in resuming your normal activities. Follow the instruction above on walking and activity with regards to your leg. Do not do any activities that will jar your head for 2 weeks. Do not fly in an airplane for 2 weeks. Do not swim for 2 weeks.
You will be on a limited diet after surgery. Following the diet instructions is very important. For the first 24 hours, you may have clear liquids and Jell-O only. Dr. Rayher may extend this restriction based on your surgery. Do not have anything hot. Warm is okay. Cold is okay. Examples of clear liquids are broth, apple juice, tea, and Gatorade. This does not include milk, protein drinks, etc. Drink plenty of fluids after surgery. This will help prevent an upset stomach and dehydration.
After 24 hours, you may begin to eat soft foods as you are comfortable. Examples of soft foods are yogurt, ice cream, eggs, pancakes, protein drinks, smoothies, mashed potatoes, and cream of wheat. Stay on soft food until you are instructed otherwise. Your restricted diet usually lasts about 2 weeks. No hard, crunchy, or chewy foods. It is helpful to do your shopping before surgery.
Keeping you comfortable during your recovery is very important to us. Proper use of pain medications is critical to help keep you comfortable. Please read this section carefully. If you have questions or concerns, please call us. If your pain is not controlled, please call the office or Dr. Rayher any time for help.
Please inform Dr. Rayher if you have had any previous problems or bad experiences with pain medication. Please inform Dr. Rayher of all prescription and non-prescription medicine that you take. Have all your prescriptions filled in advance and bring them to your surgical appointment. We will review them with you. Always take your medication as directed.
It is best to take pain medications before pain sets in. For most people, two different types of pain pills will be given. These are ibuprofen and a narcotic combined with Tylenol. (If you were not given these, the doctor will give you specialized instructions).
Take the ibuprofen first. It should be taken four times a day on a regular cycle (breakfast, lunch, dinner, and bedtime) until the swelling and pain have subsided.
The narcotic pain pill is for more severe pain. The ibuprofen and narcotic pain pill are two different classes of medication and can be taken at the same time. Take the narcotic pain pill only as you need to for pain. Follow the directions on the bottle. Do not stop taking the ibuprofen when you are taking the narcotic. They work very well together. Do not take more than 12 narcotic pain pills in one day. Do not take any other prescribed or non-prescribed pain pills besides the prescription you were given here. If you are already taking pain pills, you must tell Dr. Rayher. Also, do not take any other prescription or non-prescription medicine that contains Tylenol or acetaminophen while taking the narcotic pain pills as a life-threatening overdose may occur. Many over-the-counter cold and flu medicines and remedies contain Tylenol. If you are unsure, do not take anything without first discussing it with Dr. Rayher.
Do not drink alcohol or drive while you are taking narcotic painkillers.
You will be taking antibiotics for 1-2 weeks after surgery to prevent infection and graft failure. It is important that you take them on a routine schedule until they are gone. Some patients may experience loose stool or diarrhea while on antibiotics. Please notify the office or Dr. Rayher if this lasts more than 24 hours, is watery or bloody.
NAUSEA & VOMITING
After surgery, you may feel sick to your stomach. This can be from the IV anesthetic medications, narcotic pain relievers, or antibiotics. It is important to continue to drink plenty of fluids even if you are nauseated or vomiting to prevent dehydration. Dehydration can lead to serious illness. If you are unable to keep anything down, you need to call the office or Dr. Rayher for help.
It is not uncommon to develop a low-grade fever on the night of surgery. If this persists, or if you develop a fever after the first 24 hours, please call the office or Dr. Rayher.
Smoking is very detrimental to wound healing and increases the chances of surgical failure and complications. Do not smoke after surgery. If you are a current smoker, please talk to Dr. Rayher about how to best manage your smoking around your surgery. Moreover, Dr. Rayher encourages you to use your surgery as an opportunity to quit smoking. Please ask him or one of the staff for information on quitting.
If you should experience anything you don’t understand or that is not covered in this instruction sheet, please call the office. If you feel the issue is an emergency, please do not hesitate to call Dr. Rayher anytime. It is always better to err on the side of caution and call.
After your surgery, you will need to return to the office for evaluation and further instructions. It is very important that you come to these visits. Missing or delaying your scheduled visits may lead to problems and complications. If you should have any problems or questions after your surgery, you are encouraged to contact the office before your scheduled post-operative visit.