Other Post-Op Esophageal Surgery Advice Make an Appointment Ask a Question Refer Patient Crush all Medications Crush all medications or take in liquid/chewable form for the first 2-4 weeks. Various pill crushers are available at your local pharmacy. Many people find it helpful to take crushed medications with applesauce or juice to dampen the taste. Ask your doctor or pharmacist if you have questions regarding the “crushability” of your medications. It is always helpful to have reviewed your medication list with your primary doctor or pharmacist before surgery as some medications cannot be crushed and will need to be stopped or changed temporarily. Activity Unless otherwise instructed, it is appropriate to walk, climb stairs, ride as a passenger in a car and perform tasks of daily living. Listen to your body, and don’t overdo it early on. Avoid heavy lifting (15 lbs. or more) for 6 weeks to allow most of the wound healing to occur. Major surgery and being in the hospital can disrupt sleep patterns. It is normal to feel fatigued after surgery and need more sleep than usual. This may last for several weeks and can be minimized by making sure you stay well hydrated. We do not routinely recommend sleep medication for home use. You may need to avoid driving for up to 2 weeks. Pain and use of the narcotic pain medication will impair your ability to drive safely. DO NOT DRIVE WITHIN 24 HOURS OF TAKING NARCOTIC PAIN MEDICATION. Unless otherwise instructed, sexual activity may be resumed as tolerated. Wound Care Most of you will have 4 – 6 small incisions. Most incisions are closed with absorbable sutures that do not need to be removed. Dressings vary. If you have a clear dressing over your incision(s), you may remove this 5 days after your surgery. If there is tape (steri-strips) over your incisions, leave the tape in place until it starts to come off on its own (usually 7 – 14 days). If you have skin adhesive over your incisions, leave it alone for 2 weeks. It is OK if it flakes off, but don’t pick or pull it off. In all situations (clear dressing, steri-strips, adhesive), it is OK to shower, but no baths until after your postoperative office visit. Do not scrub incisions; the soap and water can run over them to clean them, but do not scrub. Make sure to rinse your body well. Pat dry with a clean towel or gauze. You do not need to put additional dressings on the incision after showering, but occasionally you may want to place dry gauze or a bandage for comfort or to protect clothing if the incision has drainage. Do not put ointment, creams or lotions on incisions. If surgical staples or non-absorbable sutures are used, they will be removed at your follow-up visit. Minor drainage of clear yellow or red-yellow fluid from the incision is normal. Thick, opaque, dark yellow fluid or redness spreading beyond the incision site on skin can be associated with infection. Please call if this occurs. Bruising around the incision sites is normal, and it will resolve on its own with time. Most healing takes place within 6 weeks after surgery, but the scar will still soften over time. After 6 weeks, it is ok to massage firm scars with lotions or vitamin E oil to help them soften. The final appearance of the scar may not be apparent until one year following surgery. Protect your incisions from sunburn with sunscreen for the first year to avoid darkening of the color. Work Depending on the type of surgery, most patients take off between 10-14 days before returning to work. Please remember that upon returning to work, you should not lift more than 15 lbs. until 6 weeks after surgery. Please ask the surgeon or medical assistant about any forms needing to be filled out related to work, insurance or disability issues. Follow-Up Office Visit Please call the office when you return home from the hospital to schedule your follow-up appointment. Unless otherwise instructed, a follow-up appointment typically takes place about 3 – 4 weeks after discharge from the hospital. The National Jewish Health number is 303.398.1355. Telephone Advice Our surgeons are committed to providing you with the highest quality of care during your surgery and recovery. You can be assured that your surgeon will not be interrupted during your operation unless a matter is urgent. Therefore, our office staff has been extensively trained to answer many common questions you may have before or after your surgery. Your surgeon will review your call and make sure the information provided to you by the team is accurate and appropriate for your individual needs. In general, expect non-urgent phone calls to be returned within 2 business days. If the acuity of your problem/question requires more than approximately 10 minutes’ phone time, you may be redirected to appointment scheduling. This will allow you and your surgeon a face-to-face conversation to discuss concerns in a private setting. Above all, please do not hesitate to call if you are concerned or worried. Special Circumstances Gas Bloat: Feeling full sooner than you are used to and feeling bloated or gassy is common. This almost always settles down with time as the swelling decreases in your esophagus. Chewing slowly and taking smaller bites will help by decreasing the amount of air you swallow. Gas-X® with meals is also helpful. Certainly, avoid carbonation and foods that typically cause gas (beans, broccoli, sauerkraut, etc.) if you are feeling uncomfortable. Diarrhea: You may experience loose stools during the first weeks after your surgery as your body adjusts. This typically gets better with time as you continue to recover. Increasing fresh fruits and vegetables and decreasing the amount of sugar you consume will help a lot. (By sugar, we mean sugar, sucrose, fructose, lactose, sorbitol). If you are experiencing very watery stools for more than a few days or having loose stools several times each day, call your doctor. It may be sign of an imbalance of bacteria in the intestine, which can be easily treated with an antibiotic. Please call the office if this occurs. Otherwise, feel free to try over-the-counter Imodium® and Citrucel® supplements. Nausea: Many people experience nausea after stomach/esophageal surgery. Sometimes it is related to the anesthesia, is a side effect of the pain medication, or is related to gas bloat, but often it is simply a part of healing. Nausea related to any of these causes almost always improves with time. Please call if you are experiencing troublesome nausea, and we will be happy to give you a prescription for anti-nausea medication, if you didn’t get one at the time of hospital discharge. Gastroparesis: Some of you have been diagnosed with gastroparesis, sometimes called “lazy stomach.” Since liquids empty from the stomach most easily, you may feel pretty good during the first few weeks after surgery. If so, take notice of what you are eating/drinking so that you will have an “emergency backup diet plan” to go back to during flare-ups of nausea/vomiting in the future. Remember that your stomach feels best when you limit the amount of heavy fats and raw fiber. However, as discussed above, eating too many carbohydrates and sugars will likely worsen diarrhea. It can be difficult at first to find the right balance. Some tips: Cooked vegetables are easier to digest than raw. Most things that are liquid are OK, even fats and fiber. Avoid beans, whole grains, nuts/seeds, berries, peas and corn. Trouble with Urination: If you had a catheter (Foley) placed into your bladder at the time of surgery, it is not unusual to experience minor discomfort or frequency of urination for several days after the catheter is removed. This is usually a temporary problem that resolves with time. If you are urinating small amounts frequently (every hour or so), or if the discomfort persist or worsens, please call the office. Occasionally it is necessary to replace the catheter for a few days or take a short course of antibiotics. If you experience retching, worsening abdominal pain/bloating/nausea or if you are unable to swallow or pass gas, please call 303.398.1355 or go to the emergency room. This information has been approved by Emily Speer, MD (January 2017).