Instructions

The following information was created simply to make your operative experience as safe and comfortable as possible. Firstly, you will find general information applicable to any surgery planned as well as PDF files specific to your particular surgery. For “best results” as they say, I encourage you to read, print and otherwise repeatedly review these instructions! Feel free to call on us at any time (day or night) should you have questions.

This section includes net chapters:

Pre-Surgery Instructions
Post-Surgery Instructions
Instructions for Special Illnesses
Out of town guest information

General Advice: Do’s and Don’ts

PLEASE refer often to the instructions we have given you. They have been very carefully written to encourage the fastest, most comfortable recovery.

Before Your Surgery

Weeks or Months Before Surgery:

Do return to the office as often as necessary to have all your questions and concerns addressed. We are here for you and you only!
Do not radically change either your diet or exercise program before surgery. Your body and your immune system yearn stability to insure a safe surgery and quick recovery.
Do arrange for your physical examination, if ordered, as soon as possible after scheduling your surgery. This exam may include a blood test and EKG. Please arrange for the exam and lab and EKG results to be FAXED to Dr. Rosenfield at least 7 business days prior to your surgery. (FAX: 650-692-0110)

Two Weeks Before Surgery:

Do STOP smoking, if you are a smoker, for at least 2 weeks before surgery and 2 weeks after in order to prevent wound healing complications.
Do take ONLY Tylenol for pain relief for the two weeks before your surgery! (no motrin, advil, aspirin or other anti-inflammatories) (check with BJ about any other medications)
Do stop ALL of your routine herbs, vitamins and supplements at least 2 weeks before surgery, as they may thin the blood dangerously. (You may restart these 2 weeks after surgery)
Do not apply dye, tint, bleach or permanents to hair at least 2 weeks prior to surgery. You may do so again about 3 weeks after any facial surgery.

The Day Before Surgery:

Do pick up your prescription medication if you have not done so already.
Do keep your appointment, should you have one, with Dr. Rosenfield for preoperative markings.

The Night Before Surgery:

DO NOT EAT OR DRINK ANYTHING after MIDNIGHT (unless otherwise instructed by Claudette). You may take your essential medications in the morning with a sip of water.
Don’t be afraid to use the sleeping and anti-anxiety medications you have been prescribed! They have been ordered expressly to make your immediate preoperative experience as comfortable as possible.
Do take a shower the night before or morning of your surgery, as you wish. Just don’t scrub vigorously over any markings Dr. Rosenfield might have made. Also, after your shower, please do not apply any makeup, skin or hair products.

The Morning of Surgery

Do take any essential medications per your primary care doctor (particularly blood pressure or diabetic pills) with a SIP of water, the morning of surgery.
Do wear loose, comfortable, easy to wear clothes the morning of surgery: sweats and a button or snap shirt work best. NO pullovers! We’ll provide you with warm booties! And leave all your valuables with your ride or at home!
Do remove all makeup, contact lenses, and facial or body jewelry before leaving the house.
Do give the office ALL contact numbers to reach you postoperatively. (Particularly if you will be staying somewhere other than your own home).

After Your Surgery

Recovery

Depending upon the surgery performed, you will either recover at home or at the Mills Hospital Recovery Care Inn (RCI). The RCI is a private, full service recovery facility with lovely, large suites. There is also a pull-out couch for the convenience of a family member or friend. Should you not go to the RCI, we ask that you arrange for a friend or family member be with you at all times for the first 24 to 48 hours, for your safety. Our office can also arrange for a private nurse to assist you at home postoperatively. Just inquire with Claudette.

I. Activity

DAY OF SURGERY: The day of surgery, Do rest in bed primarily, except to go to the restroom. Apply an extra pillow if you have had facial surgery. Always get up and walk with assistance for the first 24 hours, as you may become lightheaded or dizzy at first.

THE NEXT DAY: The day after surgery Do try to sit in a chair and walk about your room 3 –5 times. Otherwise, you need to continue to rest in bed! For most surgeries you may shower once cleared to do so by Dr. Rosenfield.
UNTIL DAY 14: Do not try to exercise before 2 (two) weeks! Relax! The time off will do so much to prevent complications and encourage wound healing. Specifically, Do not try to lift anything heavier than a telephone book, exert to create a sweat, have sex or bend over to tie your shoes. You may resume alcohol consumption within 7 days and smoking, if you must, at 2 weeks.
WEEK 3 through 6: Do build up to your normal AEROBIC exercise routine over weeks 3 through 6, but still avoid true weight training, except for light toning weights. You may also resume sex after 3 weeks.
WEEK 6 through 12: Do gradually return to your regular WEIGHT training routine.

II. Wound Care

Do not use pure Vitamin E or Aloe Vera moisturizers on your wounds. They can be irritating to the wounds and scars. You can, instead, apply a moisturizer supplemented with Vitamin E and Aloe two weeks after surgery.
Do wash your wounds in the shower (avoid baths for the 3 weeks) with soap and water, pat dry and apply gauze sponge if you wish.

III. Pain Control

Do take the various medications ordered depending upon the DEGREE of pain you are experiencing: Do not wait for the pain to come back; be proactive!

USE a 1-10 scale:
For pain between 1-3: MILD : Use Tylenol extra strength or Vicodin
For pain between 4-6: MODERATE: Use Darvocet I – ii every 4- 6 hours or Vicodin or Percocet I – ii by mouth every 4-6 hours
For pain between 7-9: SEVERE: Use Percocet i-ii by mouth every 4-6 hours or one Dilaudid suppository every 4 – 6 hours
For spasm-like pain, or uncontrolled pain, or Breakthrough pain (pain between doses of regularly scheduled pain medicine), or anxiety:

DO take the valium prescribed: 5 mg by mouth. You may take the valium at the same time as your pain medication or any time between doses of your pain medicine. Valium will usually “break” the cycle of pain.

And / Or:

Do take a suppository of Dilaudid (you may cut it in half if less is needed) or if provided, one or two Codeine tablets.

But please do not take any more Tylenol, vicodin or percocet because this can result in the ingestion of too much of the drug acetaminophen (Tylenol).
3. Also, we will offer you in-office relaxing massage therapy as part of your care post operatively. We have found these treatments to significantly aid in the treatment and resolution of postoperative discomfort.

IV. Nausea Control

Do take the anti-nausea medications as ordered should you have nausea.
Do try to AVOID nausea by:

Staying in bed: REST if you are tired or dizzy or in pain!
Eating little, light and lean: let your stomach adjust after surgery and anesthesia.
Taking only the pain medication you need: unfortunately narcotics are a big reason for nausea…

V. Diet

Do start with clear liquids (Ginger Ale/7-up/apple juice etc) and light, soft foods (Jello, scrambled egss, clearer soups etc). Then, after 24 hours or so of this diet, if you do not have any nausea, you may increase your diet gradually to normal.
Don’t imbibe liquor for at least one week post operatively
Do ingest Gatorade or other “sport” drink if you feel light headed.
Do not take a lot of phone calls. Do not try to do any important work. Do not decide to re-arrange the furniture or organize your desk. This is your time. Take it and let yourself heal.

1. CONSTIPATION CARE:
Constipation after surgery is VERY common secondary to the anesthesia and narcotic medication which both slow down the bowels
To help prevent and otherwise treat constipation, we include the following medications for your use postoperatively:

Laxative: One capful of Mirolax with a full glass of water once per day
Then if still constipated after 5 days postoperatively, try MINERAL OIL four (4) tablespoons twice per day until effective. Of course, if you have your favorite “formula” for constipation, don’t hesitate to use it; just clear it with Claudette.

Do not hesitate, day or night, to call our office about any concerns or questions. Dr. Rosenfield and his entire staff are always available to facilitate your recovery period.

Postoperative OFFICE VISIT:
If you wish to avoid entering the main waiting room, you may use our private entrance (office door #406) for your postoperative appointment. (just knock to be admitted). Just mention your wishes to Mindy at the time of your appointment.
Reasons to CALL the office:
Please call the office immediately – day or night –if you have note any unusual swelling, discoloration, discomfort, pain or fever following your surgery.

Special Instructions For Special Illnesses

Due to the increased health risks, please inform us if you have diagnosis of ANY of the following:

Artificial heart-valve implant
Mitral-valve prolapse (MVP) or heart murmur
Hip/knee replacement implant
Asthma
Diabetes
Sleep Apnea
Gastric Reflux
Dry eye syndrome
History of cold sores
History of drug or alcohol abuse
History of blood clots or embolism

Or are taking ANY of the following:

Diet drugs: Tenfluramine

(with Phenfermine: fen-fen) or Redux (dexfenfluramine)

Blood Thinning drugs: Coumadin, Heparin, Aspirin of any kind, Advil, Motrin or other anti-inflammatory
Insulin or other diabetes drugs
Asthmatic medications: inhaler or pills

We may ask you to obtain medical guidance and clearance from your primary physician prior to any surgery.

Dear Out of Town Patients

Welcome to our office! We appreciate all our patients who choose to come from outside their zip code to have surgery with us. Our goal is to make your “stay” with us both convenient and safe. Our office is conveniently located one exit from the San Francisco Airport and a few minutes from the very quaint downtown area of Burlingame (http://www.burlingame.org/)

As a general rule, for most surgeries, Dr. Rosenfield desires that you stay close by the office for your immediate postoperative care. Often, Dr. Rosenfield will come visit you personally.

There are many accommodation options available to you:

1. One of our nurses, Ruth Lahde, offers superb postoperative care services in a bed and breakfast environment in the privacy of her home. Her services include pick up and delivery to and from the office both before and during your stay with her. For your convenience and comfort, whenever possible, Dr. Rosenfield will visit you at Ruth’s. Please see this link for more information: http://underthegreenwoodtree.com/index.htm

2. There are several local hotels located minutes from our office:

Westin Hotel San Francisco Airport
1 Bayshore Highway
Millbrae, Ca 94010
650-692-3500
http://www.starwoodhotels.com/westin/search/hotel_detail.html?propertyID=1007

Hyatt Regency San Francisco Airport
1333 Old Bayshore Highway,
Burlingame, CA 94010
650-347-1234
http://www.sanfranciscoairport.hyatt.com/hyatt/hotels/index.jsp

Marriott San Francisco Airport 1
800 Old Bayshore Highway
Burlingame, CA 94010
650-692-9100
http://www.marriott.com/hotels/travel/sfobg-san-francisco-airport-marriott/

Hilton Hotel San Francisco Airport
600 Airport Blvd
Burlingame, CA 94010
650-340-8500
http://www1.hilton.com/en_US/hi/hotel/SFOAPHF-Hilton-San-Francisco-Airport-California/index.do

Embassy Suites San Francisco Airport
150 Anza Blvd
Burlingame, CA 94010
650-342-4600
http://embassysuites1.hilton.com/en_US/es/hotel/SFOBGES-Embassy-Suites-San-Francisco-Airport-Burlingame-California/index.do

Best Western El Rancho Inns & Suite, Millbrae
1100 El Camino Real
Millbrae, CA 94030
650-588-8500
http://www.elranchoinn.com/

Travelodge SFO South
110 S. El Camino Real,
Millbrae, Ca 95030
650-697-7373
http://www.travelodge.com/Travelodge/control/Booking/property_info?propertyId=07046

Holiday Inn Express
1250 Bayshore Highway
Burlingame, CA 94010
650-347-2381
http://www.hiesfosouth.com/

ALOFT San Francisco Airport
401 East Millbrae Avenue
Millbrae, CA 94030
650-443-5500
http://www.aloftsanfranciscoairport.com/

Peninsula Plastic Surgery Inc. Lorne K. Rosenfield M.D. F.A.C.S