This information is designed as a guideline to assist you in a speedy recovery from your surgery. Please follow these guidelines unless your physician has specifically instructed you otherwise. Please call our office nurse if you have any questions. Dial 911 if you have any medical emergency.

POST-OP APPOINTMENT:

Please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are 8:30-5:30 Monday through Friday.

WOUND CARE:

If the metal clips or stitches closing your incision have not already been removed, they will be at your first office visit. If they have been removed, you may have small strips of tape over your incision. These strips will stay on for seven to ten days. They will fall off on their own, do not pull them off. You may shower using plain soap and water, no tub baths. Do not rub or scrub the incision, pat it dry. If you leave the hospital with a dressing in place you should continue dressing changes as instructed by your physician or the hospital nursing staff. If your dressing becomes wet or soiled, remove the dressing and reapply a clean dry dressing.

WHEN TO NOTIFY YOUR PHYSICIAN:

If your temperature is greater than 100.4 degrees more than six hours.

If you notice increased swelling unrelieved by elevation of your arm above your heart level.

If you have increased redness or drainage from your incision, or it begins to separate

If you have pain unrelieved by pain medication and rest

If you experience shortness of breath and/or chest pain

If you have discoloration of your hand or fingers, with numbness

If you cannot feel a vibration or "bruit" in your arm

Excessive bleeding that saturates your dressing

If you notice your access bulges out more than usual

ACTIVITY:

No driving until cleared by your physician. Walking is good for you. Take rest breaks as needed and elevate your arm above your heart level. Hand/arm exercises as directed by your physician. No heavy lifting greater than ten pounds. Remember that some swelling of your arm post-operatively is normal and may last for several weeks. You will experience pain in the post-op period. This is a normal part of the healing process. If you think that your swelling and pain is excessive, please call the office.

SPECIAL CONSIDERATIONS:

Do not wear tight clothes or watches/jewelry around your access.

Do not have blood pressures or blood draws on your access arm.

Keep your access clean and dry and protect it from being hit or cut.

MEDICATIONS:

You may resume taking medication you were on prior to your surgery unless specifically instructed otherwise by your physician. Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day.

If your physician has prescribed Coumadin (warfarin), please let the office nurse know what dose you are on and when you are expected to have your blood work (protime) done. The nursing staff will contact you during the course of your coumadin therapy. IF YOU ARE TAKING COUMADIN, PLEASE ASK TO SPEAK WITH THE OFFICE NURSE WHEN YOU CALL FOR YOUR FIRST POST-OP APPOINTMENT.

Name of Med
Your pharmacy phone number
Any allergies to any meds

Sue and Edie are our Tacoma office nurses at (253) 383-3325. Jeanne is our nurse in Puyallup at (253) 848-6693.