It is essential that you are prepared for what your surgery and recovery involves. Please read the below information carefully, it contains important information about what to do and expect before and after your surgery.
Procedure
I will have discussed the planned procedure with you, and explained what you can expect in the short, medium- and long-term following surgery. Please make sure that you understand the recovery process and have realistic expectations. It is especially important to be prepared for the limitations you may face in the period immediately after the surgery. Please clarify any uncertainties that you have with me before the surgery.
Consent
I will have asked you to read, consider, understand and sign the consent prior to your surgery. If there are uncertainties regarding the consent, please discuss these with me. If I find something unexpected during the surgery; the surgery performed may differ slightly from what we discussed and planned. I will ensure that you are clear on what rehabilitation is required before you leave hospital, particularly if this differs from what we discussed prior to surgery.
Authorisation
Seona or Kathy will provide you with the procedure authorisation details for your medical aid scheme. It is your responsibility to call your medical aid to get their permission (authorisation) to go ahead with the surgery.
Your medical aid scheme will provide you with an authorisation number and details. Please read through this carefully, paying particular attention to any exclusions or prosthesis limits. This may affect their financial coverage of your surgery and we may need to modify how we approach the surgery to avoid payment shortfalls.
Please send the authorisation through to Seona and notify us of any concerns or limitations.
Pre-op Info
On the day of your surgery you will be told what time to arrive at the hospital reception, usually 90 minutes to 2 hours prior to your operation. This allows time for you to be admitted via reception and by the ward staff. We do not want this process to be rushed. Please try to attend the Pre-Admission Clinic a few days prior to surgery, it makes the admission process easier.
You will also be told what time to stop eating and drinking before surgery, i.e. the time from when you must be nil per os. This includes any tea, coffee, juice or water.
For morning surgery, you are required to be nil per os from midnight the night before. For later or afternoon surgery, we may tell you to have an early breakfast and allow you to continue with fluid intake until a certain time. Please clarify with the anaesthetist if you are uncertain. It is important to have an empty stomach when you have an anaesthetic, otherwise you are at risk of serious complications.
I will give you an estimated time that your actual surgery will occur. You may have to wait longer than you expected due to emergencies or unanticipated delays. Please be understanding and patient, particularly with ward staff. We understand that this is a stressful time for you and your family. Bring earphones, a charger and something to do. A family member can wait with you in the ward before your surgery, but please be sensitive to the needs of other patients and listen to the instructions of the Ward Sister.
I will come to see you before your surgery.
CHRONIC MEDICATION
Please bring ALL your regular medication into hospital, including inhalers. If you have a list of medication, bring it along, it is helpful. You can usually take your chronic medication on the morning of surgery, with a mouthful of water, on an empty stomach. You may also brush your teeth and rinse your mouth.
BLOOD THINNERS
Blood thinning medications (Ecotrin or Aspirin) need to be stopped a week before surgery. If you use additional anti-coagulant medications, for example - Warfarin, Xarelto or Clopidogrel etc., these will also need to be stopped. Please ask us what alternative must be used in the lead up to surgery. We often need to discuss this with your cardiologist, and require a cardiology report.
GLP-1 INJECTIONS
If you are using the diabetic and weight control injections (such as Saxenda, Victoza, Ozempic, Wegovy, Mounjara or Trulicity), it is very important to let me or Seona know immediately once surgery is booked. We need to inform the anaesthetist in good time. You may need to stop the injection weeks pre-op.
SLEEP APNOEA
If you have obstructive sleep apnoea, please notify the anaesthetist. If you use a nasal CPAP machine at night, bring this to hospital. Anaesthesia can result in more frequent apnoea episodes for a time post-op.
SLING
If you have used a shoulder sling in the past, please bring it to hospital for repeat use post op. This will spare you the cost of a new sling. Please bring the sling to theatre with you on the hospital bed, don’t leave it locked up in the ward.
SPECIALISTS
If you regularly see a cardiologist or physician, please notify us of their details in order for us to obtain your reports.
ANAESTHETIC
The anaesthetist is usually Dr Rose Mulder, my wife. Rose will WhatsApp you the day before surgery to make contact, and she will see you in the ward pre-op or in the waiting area of the theatre complex (if you are booked later in the day).
If you have any concerns you would like to discuss with her, please feel free to contact her prior to surgery. She would prefer to talk through your concerns, fears, medical issues, and previous anaesthetic experiences with you prior to surgery to allay any anxiety.
If you have questions about which medication to take on the morning of surgery, Rose will be able to answer your questions.
Contact details:
e-mail: rosemulder74@gmail.com
WhatsApp: 083 661 0905
AFTER THE OP
Once we have completed the operation you will be taken through to the recovery area of the theatre complex. You will wake up here and once your pain is controlled and you have woken sufficiently from the anaesthetic, you will return to the ward.
I always try to phone a member of your family to let them know that you are waking up and that the surgery is complete. Please leave the number of the person you would like me to call with the staff or tell me directly.
BACK IN THE WARD
Once back in the ward you will be allowed to have something to eat and drink. The staff will monitor your vital signs and your pain levels.
I will visit you later in the ward once you are awake and explain how everything went. We will discuss if you are suitable to go home or spend the night in the hospital.
GOING HOME
I will outline what you may and may not do following surgery, we will also discuss whether you require physio prior to going home or not. If you require physiotherapy before discharge, I will arrange this. You may return to your own physio for follow-up after discharge, or you may continue to attend the hospital physio practice for the duration of your rehabilitation.
You will have dressings over the surgical area. I will explain how to handle these after the surgery. In most cases these are waterproof and left in place until you see me at your follow-up appointment when we will remove the stitches. If they do come loose before, you can replace them with waterproof dressings which you can buy from any pharmacy, or you can pop into the office and we can do so for you.
POST OP VISIT
Please note: You will be told when you to see me again, usually 10 - 14 days post-op. The ward staff might make your appointment for you before you are discharged. IF NOT, once you are home, please phone the rooms timeously to make your post-op appointment . Office Phone: 021 797 9141
DRIVING & AIR TRAVEL
I will inform you when you are likely to be able to drive following surgery, this is based on the type of surgery. You may not drive for 24 hours after the anaesthetic.
It is safe to fly 48 hours after the surgery but bear in mind that you are likely to be on painkillers during the early post-operative period and it is wise to defer any non-essential travel for at least a week.
AT HOME
It is common to feel very tired in the first few days after your surgery. Please try to clear your schedule so that you do not have too many commitments in the early days.
You may also feel that you have very little appetite, do not be distressed by this as it will return in time. You may only feel up to snacking on small meals. It is important that you keep a good fluid intake - drink plenty of water, cooldrink or warm beverages.
It is not necessary to eat prior to taking pain medication; these can be taken on an empty stomach. The pain medication will make you extremely sensitive to alcohol, be very careful when consuming this while taking the medication.
Ice is very useful in the first 3-5 days following surgery. An ice-pack from any pharmacy, or a plain bag of ice cubes in a towel will greatly assist with pain and swelling.
IN GENERAL
Please do not underestimate the impact that surgery may have on you. Many people, irrespective of age, feel very tired and drained in the first week after surgery. Please make provision for this and don’t plan many responsibilities in the first week at least.
If you or your family are concerned about your condition following surgery, please contact me via my rooms (during office hours). If outside of office hours, please contact me via my cell phone, or via WhatsApp (no voice notes please). While I endeavour to be available, sometimes I may not answer immediately and I will get back to you as soon as possible.
PAIN MED PROTOCOL
TARGINACT: 1-2 tablets twice daily taken in the morning and evening. Schedule these, for example, at 6am and 6pm.
This is a strong, long-acting, controlled-release opiate. You will most likely have received it in hospital if you stayed overnight.
AND
DOLOROL FORTÉ / NAPACOD: 2 tablets, taken every 4 - 6 hours.
This is a combination of Paracetamol (Panado) and Codeine. This is taken simultaneously with the Targinact and both are usually needed for at least a week after surgery.
NB: Please take BOTH Targinact and Dolorol Forté. They can be taken at the same time.
In addition to this we might provide you with a few OXYNORM capsules, depending on the surgery.Take 1-2 capsules in addition to the above meds, for breakthrough pain. In other words, continue to take both the Dolorol Forté tablets and Targinact Tablet regularly, but, if despite these, you still have significant pain and it’s not time for one of these regulars, then you take an Oxynorm as a rescue painkiller. Oxynorm capsules can be taken as required but must be spaced at least 4 hours apart. Oxynorm is a strong opiate and works quickly, but for a short time. The combination of all 3 together will probably make you feel drowsy.
Please take the pain medication regularly to control the pain in the first 2-3 days at the very least. Thereafter you can start to reduce the dose or skip doses according to your pain. Be careful of tapering off the medication too soon.
ADDITIONAL MEDS
ANTI-INFLAMMATORIES: Some patients will be prescribed anti-inflammatories in addition to the painkillers listed. These also provide good pain relief. They will be indicated on your script.
For example: Xefo, Celebrex, Exinef, Arcoxia etc.
If not, please omit any anti-inflammatories for 2 weeks post-op, to allow for healing.
MOVICOL: One sachet of granules dissolved in half a cup of water every evening, until your bowels work again. You can use a sachet up to 3 times a day, as needed.
Opiates and decreased general activity post-op cause constipation. Almost everyone has this side-effect, so please take the advice and use the Movicol. It is not a laxative, it is a stool softener. This will reduce strain once your bowels open, usually day 3-6 post-op. If your bowels have not worked,you may ask your pharmacist for a laxative after 3-4 days.
Please also ensure that your diet contains fresh or dried fruit and plenty of water to help prevent constipation.
ANTI-NAUSEA MEDS: For example - Zofer / Vomiz / Ondansetron, to counteract the nausea from the painkillers / anaesthetic. Please use this as needed. This tablet is dissolved under the tongue and works very quickly. These can be taken every 8 hours, if required.
SCHEDULE 6 MEDS
Targinact and Oxynorm are Schedule 6 Opiates. They work well to control pain. We are careful when prescribing them, as they can be addictive. We prescribe the lowest dose, and lowest number of tablets / capsules as possible. If you require more, you will need an original script, your pharmacy cannot accept a verbal or mailed prescription. Please inform me in good time if you need a new script, as you will have to arrange to collect the original script from my office.
Q: How long will it be before I can get back to “normal”?
A: The time frame varies from person to person, as every injury is as unique as the person who sustains it.
Injuries are frustrating and naturally patients are eager to know when they can expect a full recovery. The time it takes for the fracture and associated soft tissue or “non boney” injury to heal is influenced by a number of different factors.
In order to assess a patient’s individual progress, Dr Mulder will ask detailed injury-specific questions and perform an examination that is often supplemented by X-rays or other necessary scans. This information is then interpreted to inform and create a guideline for returning to day-to-day activities (personal hygiene tasks, driving, lifting), work related tasks and sporting activities.
Depending on the injury Mike may prescribe a rehabilitation programme that is supervised by a physiotherapist. Over the course of the treatment the therapist will provide ongoing feedback to him regarding the patient’s progress. The end goal: getting the patient mobile again as quickly and safely as a possible.
Given that no recovery programme fits all, it’s best to discuss specific agendas with Dr Mulder.
Whether acquired through injury or surgery, wound care is vital. A well cared for wound goes a long way to avoiding unnecessary complications that may negatively impact the healing process.
Before being discharged, our practice will give patients a set of instructions that detail how to care for their wound. One of the most important things they should know about their dressing is whether they can get it wet or not. Some dressings have to stay dry at all times.
FORGOTTEN YOUR INSTRUCTIONS?
If you’ve forgotten what you were instructed or are in any doubt about the specific “do’s and don’ts” of your wound care, please contact the practice. Sister Seona is able to answer most queries and if any doubt exists, she will contact Dr Mulder for clarification. Rather ask us than risk slowing your recovery process.
If you develop any of these following signs, please contact the practice for further evaluation. Early detection is important.
NOTE: if you suspect that there is an infection, do not start any antibiotics without first consulting Dr Mulder. Antibiotics may mask important signs and delay the appropriate treatment.
Depending on the type of the injury, smooth pins may be left sticking out of the skin or they may lie below it. Pins that stick out through the skin will be covered with a dressing and a splint or with a cast. It’s a very important part of the healing process to keep these coverings dry. If you’re at all worried about the site where the pins penetrate the skin, please contact Dr Mulder at the practice. He is only too happy to answer your questions.
NOTE: While these instructions are written for the care of children’s plaster casts, the guidelines below are relevant to adults too.
General instructions
Elevation: During the first 48 hours after the cast has been applied, keep your child’s arm raised (with fingers pointing up) and encourage your little patient to move the fingers which helps to reduce the swelling. When your child is sitting or lying in bed, prop the limb up on pillows. Slings are not routinely issued.
Possible warning signs
Please keep an eye out for the following signs – especially in the first 48 hours:
If any of the above symptoms occur, elevate the limb for 20 minutes, administer painkillers and encourage finger movement. If the symptoms don’t improve, contact Sister Seona at the Practice during office hours on 021 797 9141 or Dr Mulder via his cell phone. If you cannot reach Dr Mulder, please contact the nearest emergency unit
Skin care
Please don’t let your child push objects down the cast (e.g.: rulers, knitting needles, pens, etc.). These may damage the skin and lead to the formation of sores.
If you suspect that there is something under the cast, let us know. Signs that there may be a problem include liquid staining of the plaster or oozing – i.e. yellow or green fluid. It is normal for casts to develop a perspiration odour, particularly if they’ve been worn for a few weeks.
On that note, also resist the temptation to put talcum, or perfumed powders, down the cast to reduce the smell; nine times out of ten they only make it worse.
Plaster care
Please don’t cut, or try to modify, shorten or remove the cast yourself. If a section of the cast is irritating the skin, please give us a call at the practice and we will make a plan from there.
Repeat x-rays
In cases where fractures are unstable Dr Mulder may ask you to repeat x-rays to confirm the position of the bones. These can be taken through the cast.
NOTE: While these instructions are written for the care of children’s wet and dry limb casts, the guidelines below are relevant to adults too.
The purpose of a cast is to hold the bone in alignment while it heals (knits). The specific cast applied will allow safe movement of the limb, but will prevent movement of the fracture.
There are two main types of casts: those that can get wet and those that can’t. Depending on the type of cast your child has been fitted with – you will need to follow a set of very specific instructions. This is very important, as it will encourage a fast and trouble-free healing process.
If your child has been fitted with a cast that can NOT get wet, please follow these instructions very carefully. If you can’t remember whether your child’s cast may or may not get wet – please phone the practice for clarity.
Bathing
Wrap the arm in a plastic bag (sealed with adhesive tape) but do NOT submerge it in water.
Although the hard synthetic plaster shell won’t be damaged by water, the padding won’t dry and may lead to sores developing beneath the cast.
Q: What if the cast does get wet?
A: Let it dry in the sun or use a fan blowing cool air only. Do not heat the cast.
If your child has been fitted with a cast that can get wet, this means that the hard (coloured) synthetic plaster is waterproof and will not be damaged or deformed by water. The protective padding under the plaster is a non-absorbent synthetic material.
Bathing & swimming
Your child may bath, swim or completely immerse the cast in water 24 hours after the cast has been applied. Once wet, the water under the cast needs to run out. Let the arm hang by the side for at least 5 minutes until all the water has dripped out. This is important as any water trapped under the cast may cause damage to the skin.
