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Instructions For Hemorrhoidal Banding

INSTRUCTIONS FOR HEMORRHOIDAL BANDING

You have been booked to have internal hemorrhoids banded in my office on________________at
________________. No anesthetic is required for this procedure.

It is very important that you keep this appointment. We reserve the right to bill you for not showing up. Please phone our office 3 days before your appointment to confirm that you will be coming for the procedure.

HOW TO PREPARE FOR HEMORRHOIDAL BANDING?

1. Buy a Fleet enema to be used rectally two hours before the procedure.

2. Normally you may not need a ride going home but if you are very anxious about this procedure then
have somebody bring you here and take you home. Normally there is minimal discomfort during the
procedure.

An internal hemorrhoid is inside the lower part of the rectum near the beginning of the anal canal. An external hemorrhoid is a swollen vein further down at or just inside the anal opening. Usually there are three internal hemorrhoids at 3, 7 and 11 o’clock position. There may be other minor internal hemorrhoids as well.

Usually one to two internal hemorrhoids are banded at one sitting. Therefore you may need more than one appointment to complete the banding of all the internal hemorrhoids. Banding is not done for external hemorrhoids. If external hemorrhoids are bothersome then they need to be cut out under local anesthetic in the office.

WHAT TO DO AFTER HEMORRHOIDAL BANDING?

1. Take pain killers which you are familiar with if there is discomfort or pain.

2. Keep your bowels regular, soft and bulky with dietary fiber, oral fluids, fiber supplements, exercise
and stool softeners if required.

3. Sit in the hot bath for 20 – 30 minutes twice a day and this will relieve pain and provide comfort.

4. You can use hemorrhoidal ointment which has been prescribed to you.

ARE THERE ANY COMPLICATIONS ASSOCIATED WITH THIS PROCEDURE?

Usually the complication rate is very small. Except for some pressure and discomfort most of the time things go very well. Complications to look for are:

1. Delayed bleeding at 5 to 10 days (less than 1%)

2. Pain (less than 5% – may need to remove the band)

3. Discomfort (30%)

4. Thrombosis (clotting of the hemorrhoidal vessels – very rare)

5. Fissure (very rare)

6. Infection (usually rare but can be very serious). In case of persistent pain then please phone
my office.

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Instructions For Toenail Surgery

INSTRUCTIONS FOR TOENAIL SURGERY

You have been booked for toenail surgery to be done in my office on ________________ at ________________. This will be done under local anesthetic.

If you fail to keep this appointment, then we reserve the right to bill you for not showing up. Please phone our office three days before your appointment to confirm that you will be coming for the procedure.

PRE & POST SURGERY INSTRUCTIONS

1. Make sure your feet are clean before you come for the procedure.

2. Have somebody bring you here and take you home as you will have a bulky dressing and will be
unable to wear your shoes and unable to drive.

3. After the surgery you should keep your feet elevated above your hip line for 48 hours. This helps
reduce the swelling and pain and help the healing process.

4. Watch the tip of the toe for adequate circulation. If it is pale white or dusky and turns blue then
loosen the dressing to improve circulation.

5. If there is bleeding or pain which is persistent then call my office or in the evenings or weekends
see the doctor on call at the hospital emergency.

6. For pain – take painkillers which you are familiar with at home or ask for a prescription before you
leave the office after the procedure.

7. Take antibiotics if you have been instructed to do so after surgery.

8. After 48 hours you should change the dressings. It will be stuck to the skin so you
should soak it well and peel it off gently.

9. Apply polysporin and gauze and light dressing once or twice a day until
the pain is gone.

10. If you have stitches then have them removed from you doctor in 10 days.

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Looking Ahead To 2004

The best years of your life are the ones in which you
decide your problems are your own.
You do not blame them on your mother,
the ecology or the president.
You realize that you control your own destiny.
– Albert Ellis

Well, 2004 is here. And it is going to be here for the next 365 days. So, what are you going to do to stay healthy and happy and perhaps control your own destiny in areas of mental and physical health?

It’s a simple question. Can we find a good and a simple answer for you? Let us give it a try!

First, you need to take stock of your current situation. Then you need to have some idea of what you expect to achieve in the next 363 days (two days have already gone by!).

Do you have any risk factors – genetic, environmental, or lifestyle habits – which make you prone to mental and physical ill health? If yes, then you need to take actions to reduce these risks factors and if possible to eliminate them.

If you do not have any risk factors then you need to take actions which will keep you healthy and happy for many years to come.

As we know, our health is determined by many things. Our genes play an important role. So do our environment and the lifestyle we choose to pursue.

About hundred years ago, many lives were lost in infancy and childhood or before the age of 50. This was due to malnutrition and infection.

Since then we have made progress. Now a child born in Canada can expect to live to about 80 years. Many factors have contributed to our longevity – improvement in nutrition, public hygiene, discovery of antibiotics, introduction of immunization programs, newer and better methods of understanding, diagnosing and treating many illnesses.

Now we seem to take life for granted – especially in the industrialized and affluent countries we live in. Very few people die of infection or malnutrition. Instead we have an epidemic of obesity – which leads to diabetes, heart disease and other illnesses and disabilities.

The prevalence of diabetes in Canada is increasing. The proportion of Canadians with diabetes rose from 3.4 percent in 1994/95 to an estimated 4.5 percent in 2000/01.

Heart disease, stroke, cancer and lung diseases (most of them related to smoking) take its own toll. Use and abuse of alcohol costs our health care system billions of dollars. A British government sponsored report found that “average drinkers” today are consuming 150 percent more alcohol than their counterparts did 50 years ago.

Motor vehicle accidents and other types of accidents kill and disable many of our young people.

So, is this how life is going to be? Or can we change it? Or can we be selfish enough to keep ourselves and our families out of trouble?

We cannot change our genes. But we can make a contribution to improve our environment. We can try and reduce stress and make better lifestyle choices. Yes, lifestyle choices! Healthy lifestyle choices.

Here are few suggestions – eat right, exercise regularly, get enough sleep, quit smoking, wear a seatbelt, drive carefully, and watch your alcohol intake. Make time for laughter, meditation and family.

Making changes is not always easy. But one has to make a commitment and go for it. You may have to make some sacrifices but in the long run it will be a good investment.

It is estimated that if you live up to 80, then the last 10 years of your life will be spent fighting some sort of disease or disability. This burden may be reduced if we take care of our health during our better days.

So, 2004 is here. And you have to make some choices – yes, choices. Make sure they are healthy ones!

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Information/Instructions for No-Scalpel Vasectomy

Instructions for Vasectomy

1. You have been booked for bilateral vasectomy to be done in my office under local anesthetic. Phone us 2 to 3 days before your appointment to confirm that you will be coming for the procedure. We reserve the right to bill patients who do not show up for their appointments.

2. Have somebody bring you to my office and pick you up after the procedure. You should not drive for 24 hours. You will be here for about 1 hour. The procedure itself takes about 10 – 15 minutes.

3. You should shave the scrotum in the front at the junction of the penis and scrotum completely and trim the pubic hair the day before the procedure.

4. Bring an athletic supporter with you. Have a shower on the day of the procedure and wear clean underwear, socks and clothing.

5. Please take 2 tablets of Tylenol #3 with water and Ativan 2 mg sublingually (under your tongue) one hour before you come to my office for the procedure.

6. HAVE A VERY LIGHT BREAKFAST ON THE DAY OF PROCEDURE.

Information About Bilateral No-Scalpel Vasectomy

Vasectomy is an increasingly popular, simple method of sterilization. Complications are minimal. Studies comparing various methods of birth control show that couples relying on vasectomy, on the average, have sexual intercourse more frequently and find greater fulfillment and satisfaction in their sexual relations than couples using other methods of contraception.

Informed consent is essential. You should know that this is a permanent, irreversible procedure. Reversal procedures are being done, but they are expensive and the results are unpredictable. Therefore, vasectomy should not be used as a temporary contraception. You should remember that you are not considered sterile until a sperm count establishes that fact. At least two sperm counts, 2 months and 3 months after vasectomy should be obtained. Other methods of contraception should be used until a sperm count demonstrates sterility. Recanalization and failure of vasectomy occurs in about 1% of patients, usually within two months of the operation. There are reports of late failures as well. You will get an appointment to see me 2 months after vasectomy when instructions will be given to you regarding the sperm counts. Current evidence does not show that vasectomy would adversely affect your health in anyway.

Are there any complications after vasectomy?

Complications after vasectomy are rare – but there is no guarantee that nothing will go wrong. About 95 – 99% of the patients do very well with no complaints. A small percentage of patients do get complications like: bleeding, infection, swelling and pain. Pain usually starts after 3 to 5 days. If this occurs, then get in a hot bath 2 to 3 times a day and take Tylenol #3. If the pain does not get better within 24 -48 hours then see your doctor or come back and see me. Usual healing process takes about a week. So use common sense and be careful. If there are no complications then you should feel no pain.

Post-vasectomy pain syndrome: Sometimes patients have complained of pain in the testicular area long after the vasectomy. In some cases, the pain corresponds with ejaculation. This symptom is rare. The exact mechanism underlying this pain is not known, but it could be related to the active transport of sperms from the testicles to the surgically divided vas. Occasionally, you may get a swelling where the vasectomy is done and this is called sperm granuloma. Sometimes, this area gives pain and discomfort and this can be excised if it is a source of discomfort and concern.

Post-Vasectomy Instructions

1. Do not drive for 24 hours. You are legally impaired after taking Tylenol #3 and Ativan.

2. Rest at home until the day after surgery. Put ice-pack on the scrotal area as often as possible on the day of surgery. You may resume your normal activities after one or two days. But avoid work and strenuous exercise for at least 48 hours. This will help the wound heal.

3. You may shower day after surgery. You can get the incision wet, but do not rub anything in that area for 48 hours. Dab it dry. Apply polysporin and gauze for three days. The scrotal incision has no stitiches and takes about 3 days to heal. Sometimes pain starts after 3 days, then sit in hot bath 3 – 4 times a day and take Tylenol #3. If it is no better than see me or your family doctor.

4. Do not pull or scratch the wound while it is healing.

5. Wear a snug undergarment or scrotal support for at least one week after surgery. This will help you to be comfortable.

6. You may have sex with your partner as soon as it is comfortable for you. This is usually two or three days after the operation. Remember, vasectomy does not work immediately, and you can still get your partner pregnant. Sperms should be gone after 20 ejaculations. Use condoms, or ask
your partner to use another family planning method until you have two negative sperm counts – one after two months and second after three months. If there are no sperms then we will let you know that you are sterile.

7. You may have a little pain, bruising, or swelling where the wound is. Watch it to be sure that it does not get worse. A small amount of pain, bruising, or swelling that does not get worse is normal. Take the medication recommended. Be sure to follow the instructions given to you. An ice pack may help relieve the pain, bruising, or swelling. Hot bath also helps.

8. Call me:
-If you have fever within one week of surgery
-If there is any bleeding or pus in the wound
-If there is pain or swelling around the wound that gets worse or does not go away
-If your partner ever misses a period or thinks she is pregnant. This is very important. It may mean the operation has failed, and your partner may be pregnant.

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