Your
Surgery

What to Expect (MTF)

Two-three days prior to surgery: Arrival in San Mateo, make yourself at home here. There is much to see and do. You might want to think about how you'll get to Dr. Bowers' office for your pre-operative visit and to the hospital for your surgery. Visit our Travel page for more information.

Once you get into town, you need to connect with Dr. Bowers' office at (719) 846-6300 or via email.

On the day of your pre-surgery visit: You will see Dr. Bowers today for a consultation and examination. You may also see someone at Mills Health Center for blood work, registration, etc.

On the day prior to your surgery: This may or may not be on the same day as your pre-surgery visit!) You MUST restrict yourself to a clear liquids diet only; absolutely no solid foods. Have nothing to eat or drink after midnight prior to surgery. You will be sent to a local pharmacy to pick up a bottle of bowel prep to drink the afternoon prior to surgery. We will tell you exactly when you should gulp this down (Yum!).

Clear liquids include:

• Strained fruit juices without the pulp (apple or white grape)
• Clear broth or bouillon
• Coffee or tea (without milk or non-dairy creamer)
• Carbonated or non-carbonated soda (Sprite, 7-up)
• Plain Jell-O (without added fruit)
• Ice popsicles
• Water
• Gatorade
• Kool-aid
• Ginger-ale

Please make sure that none of the clear liquids that you have are colored red, purple or caramel (example, Coke or Pepsi)

We recommend you return to your hotel room within 30 minutes of drinking your bowel prep, where the effects of the bowel prep can be managed - plan on regular bathroom visits. Admission will be the next morning although the time will vary if you are an AM surgery or PM surgery. We will let you know what time to be at the hospital prior no later than today.

Day of Surgery: Depending upon the time of your surgery, expect to arrive at the hospital early morning or later morning. Check in, get your bedside area set up for recovery. You will not be leaving the bed for 48 hours, so make sure things you want nearby are within reach. Valuables and cash should be left at home. You may meet with the anesthetist either in your room or in the OR prep area. Prior to surgery, you will be placed in compression stockings and given a tiny shot of heparin (to prevent blood clots). Once you have spoken with anesthesia, you may have medication for relaxation. Dr. Bowers will most likely say hello to you shortly before surgery.

You may wake up in the OR recovery area, in your room, or somewhere in transit. After surgery, you might be sore, but many patients report little pain or discomfort. There will be a full sensation, like needing a bowel movement, due to packing in the vagina. In addition, you will feel like you have to pee (catheter in the bladder). Use the pain medication liberally if you need it - the first 2 days could be quite foggy with the pain lifting shortly thereafter. If you cannot sleep, ask for medication; same for nausea; which is common after using the pain meds.

Throughout your recovery, you will want to drink plenty of water and be sure that your surgery site is well iced during the first 48 hours to reduce swelling. Any time a staff member comes through you should check your water and ice situation, as these constantly need replenishing. Advocate for yourself - and ask for these to be replenished when you notice they need it - the nursing staff has other duties and can not always notice.

Day After Surgery: Pain control and sleep are the main activities during the first 2 days following surgery. If there have been no complications and your nausea has gone down enough, try eating. This will give you something else to do! You may be switched over to oral pain medication today and your IV stopped. Also, start to exercise your legs in bed - they will be sore and you need to get the muscles moving. Keep drinking fluids!

Day Two After Surgery: If all goes well you will be out of bed today - perhaps not running a marathon but getting vertical with some assistance in any case. A shower is not out of the question, if you feel able. You can probably restart your hormones, but at a lower post-operative dose. You may request to use your own hormones or use the estradiol (2 mg per day) provided by the hospital.

Day Three After Surgery: The drain coming from your butt cheek is removed today. This is an odd sensation but normally not excruciating. You can take a pain pill ½ hour before they do this, if you need it. The retaining suture "Biber Button" (if needed) above your pubic bone is removed today. You will also be given a tube of triple antibiotic ointment which you should apply to your surgery site (labial incisions, clitoris, etc) to facilitate healing. You should have had a bowel movement by now. This is normally a major problem - between the constipating pain medication, the packing in the vagina and your lack of activity. We try to keep up on this by giving you stool softeners, mineral oil, and oral laxatives, but this often is not enough. An enema is another option that may be offered. Let us know about this! Rarely, we must remove the packing in order for things to happen but try not to. Warm prune juice at bedtime may provide another time-tested remedy. Don't panic - everyone poops eventually!

If everything goes as planned, you will be released today! You will be given a set of dilators at the hospital and then discharged. If you have chosen to stay at the Companion House, you will be picked up by Gwen. If you are staying at the Residence Inn, you will need to take a taxi or if you are traveling with a friend or family member they can give you a ride. Rest and relax!

Day Four After Surgery: Today is for resting and relaxing.

Day Five After Surgery: Another day for resting and relaxing.

Day Six After Surgery - Follow Up Visit: You will leave the Companion House today and get back to your hotel, or stay at the Residence Inn. Someone from the Companion House can help you get back to the clinic for your follow up visit. You will also see Melissa in Dr. Bowers' office today for packing and catheter removal, and to be taught how to dilate. (Be sure to bring your dilators.) Once in Dr. Bowers' office, the foley catheter is removed. There is often some bleeding (controlled by pressure) around the urethra or even a small clot passed, particularly when you first void. The vaginal packing will be removed and you will be taught about dilation of the vagina (see discharge instructions). Spend the night in a local hotel. Although you are released, we normally prefer that you spend another several nights in town, to make sure there are no minor problems that need addressing. Driving is possible although not while on pain medication. Taking advantage of friends or family, or taxi service for transportation is certainly preferred.

For those counting at home: If your surgery is on a Tuesday, you will be discharged from the hospital Friday. Unless you've made plans to stay additional days, you will leave the Companion House on Monday. Plan travel and accommodations, accordingly.

Day After Follow Up Visit: Spend today resting and relaxing in your hotel room. If you want to get out into the 'real world' again, go to lunch or do some light shopping, but plan on taking plenty of down time, also. Work on getting plenty of rest for your travel day tomorrow.

First Day You Can Travel Home: If possible, Dr. Bowers would like for you to continue your stay for a few more days, but if you would like, you can travel home today. Staying a couple of extra days is a good idea, just to help you heal a bit more before travel. You should contact our office or the after-hours numbers you will be given if you have any concerns.

Homeward Bound!: This will probably be a long travel day, so get plenty of rest the day before. Be sure to stay in touch with us with questions or concerns, and let us know how everything goes for you! We will call you about 2-3 weeks after your surgery to follow up, but again, stay in touch with us!

We'll hopefully be able to send you home with your Surgical Declaration Letter. One per customer, but additional copies (in case yours gets lost, destroyed, or ensnarled in red tape) are available for a fee of $25 each.

Please visit our Patients Page for links to some of our patients who have documented their experiences online.

There is also a Yahoogroup that some of Dr. Bowers' patients have set up to chat, trade notes, ask advice, etc.

Next: Post-Operative Care

©2010 Marci L. Bowers, MD
PO Box 1044 · Trinidad, CO 81082
Phone: 719-846-6300 / 877-439-2244 · FAX: 719-846-9500 / 877-439-9922
Email: mail@marcibowers.com

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