What happens at my first appointment?
Your first appointment is an excellent opportunity to ask questions. Your doctor will discuss your current medical condition and also about your past medical conditions. He may need to examine you. He will review your results and discuss the management plan.
Management could be either further investigations or surgical procedure. You may or may not elect to proceed with surgery however please arrive with as much history on your condition as possible. If you are going to proceed with surgery, your surgeon will go through the informed medical consent and will be advised steps leading up to your operation.
How do I schedule an appointment?
You can schedule an appointment by calling us in working hours.
Your GP will send us a referral letter in the name of your specialist. Once the referral is received, we will also contact you to facilitate your appointment.
How much is the Consultation Fees?
You will be required to pay out of pocket on the day of your appointment. Initial consultation fee is $150 and subsequent visit $80. Concession and Pension card holders (on presenting a valid card) initial fees will be $120 and subsequent visit $70. No fees will be charged for post procedure visit. Fees covered by Medicare will be credited to your account during the time of consultation.
What to bring for the appointment?
On the day of your outpatient appointment bring
- Referral
- Investigations
- Medication list
- Medicare card
- Private Health Insurance card (if any)
- Pension or Concession card
What if I am running late for my appointment?
We request you to kindly arrive on time to your appointment. If you are running late, please contact us on the phone, and we will try to accommodate you on same day or reschedule your appointment.
Appointment cancellation?
Please provide us with at least 48 hours notification upon cancellation or rescheduling of an appointment.
Privacy policy for my medical records?
Our practice collects, uses, discloses and stores your personal information in accordance with the National Privacy Principles under the Privacy Act 1988.
If you’re going to have surgery, it’s good to be prepared. You should find out about what your surgery will involve, your medicines, what you need to do before the surgery, how to get to and from the hospital, and your care when you go home after your surgery.
Do I really need this surgery?
It’s a good idea to know exactly how the surgery might help you. Be clear about what the benefits might be. Check how long the benefits should last. For many types of surgery, they should last a lifetime. For other types the benefits might be short-lived. Ask what the chances of success are.
What are the risks of surgery?
All surgery has risks. There are risks that are associated with the anaesthetic you will have. There are also the general risks of any surgery, such as bleeding from the wound, while each type of surgery also has its own risks.
What happens if I don’t do anything?
Is your condition likely to get better or worse if you don’t have the surgery?
Are there simpler, safer options?
Some conditions get better by themselves. Some conditions improve with alternatives such as exercise, physiotherapy, dietary changes or medicines. You could ask your GP and your surgeon:
- What are the alternatives to surgery?
- What might happen if I do nothing?
What are the costs?
Surgery and the time spent recovering from it costs money. You could ask your surgeon:
- How much will you pay overall — to the surgeon, to the anaesthetist, to the hospital?
- If your surgery is covered by Medicare, how much will Medicare pay? What will your out-of-pocket cost be?
- What will it cost you in time, effort and stress?
- How long will you take to recover?
- How long before you’re able to get back to your normal life?
If you have private health insurance, check how much of the surgeon’s fees, anaesthetist’s fees and hospital fees will be covered. Some policies have restrictions for some procedures and you may have some out-of-pocket costs.
What will recovery be like
There is a recovery period after all surgery. This can range from a few days to several months, depending on your age, condition, health and the type of surgery. It will be important to follow your surgeon’s advice carefully.
Getting a second opinion
You can also ask for a second opinion by asking your GP to refer you to another surgeon.
The days leading up to your surgery
Make sure you know exactly what your operation is for, what it is expected to do for you and the risks involved.
You might have a general anaesthetic, a local anaesthetic or light sedation. Be sure you know what your doctors plan to do and what you need to do to prepare. Ask your doctor about the anaesthetic — you might not meet the anaesthetist until the day of the operation.
If you take medicines regularly, discuss them with your doctor. It’s important to know whether or not you should take them as usual or delay them.
Tell your doctor about all the medicines you take, including over-the-counter and complementary or alternative medicines. You may need to stop taking some medicines.
Medications to be stopped prior to surgery?
As a general rule, you should take all your usual regular medications with a sip of water on the morning of your operation unless instructed otherwise.
BLOOD THINNERS
LOW DOSE ASPIRIN can be continued prior to most operations.
Warfarin (Coumadin) – stop for 5 full days pre surgery, you need to take bridging Clexane as a substitute before your surgery.
Plavix (Clopidogrel) – stop for 7 days prior to surgery
Brilinta (Ticogrelor) – stop for 5 days prior to surgery
Eliquis (Apixaban) / Pradaxa (Dabigatran) / Pradaxa (Dabigatran) – stop for 2 days prior to surgery
Please confirm when you are to resume the blood thinners.
Diabetic Medications
If you are a diabetic on oral medication or insulin medication to manage your blood sugar level, please seek instructions from your GP and endocrinologist and anaesthetist, as to when to stop these medications prior to your surgery and when to resume after your surgery.
If you smoke, quit if possible. Quitting will help your recovery and reduce your risk of problems with anaesthetic. Even quitting for a short period is helpful.
If you drink alcohol every day, drink less before surgery. It will help with your healing and your recovery.
The day before surgery
If you’re having a general anesthetic, you’ll need to avoid eating and drinking for some hours beforehand. Your anesthetist will tell you when to stop eating and drinking before surgery.
After surgery
Ask your doctor how long you’ll be expected to stay in hospital after the operation. Some people need only a few hours before they can go home while others will be in for a few days or more. A few will be told they’ll wake up after surgery in an intensive care unit. It depends on the type of surgery, the type of anaesthetic, and your health.
You should plan how you’re going to get to hospital and get home. It’s best to ask family or a friend to help you get home and to help you at home afterwards.
Pain can be a significant problem after surgery. Don’t be a hero. Tell your doctors and nurses if you have pain.
Some people will need rehabilitation after surgery, either to get their strength back or to help with the particular problem that the surgery has dealt with. You can have rehabilitation treatment at home or in a rehabilitation unit. Talk to your doctor.
Depending on the type of surgery, there might be some things you can’t do for a while. You might not be allowed to drive, you might find it hard to work, you might find it hard to look after yourself. It’s good to talk these things through with your doctor before the surgery so you can plan to solve problems in advance.
Getting back to normal life can take time. You might be more tired than you expect. Go easy on yourself and accept help that’s offered.
Wound care
You are able to shower within 12 hours after your surgery, avoid soaps and do not use lotions near the wounds.
The dressings are waterproof and will resist water from the shower. Pat the dressings dry with a towel and avoid rubbing the wounds.
Please keep the waterproof dressings in place for a week, replacing them if they loosen or peel off.
No baths, spa’s, sauna, swimming pools or swimming in the sea for three to four weeks after the surgery, until the wounds are well healed to avoid infections.
Your wounds are closed with dissolving sutures. You will not need to have any stitches removed.
Diet
Immediately after surgery, you will be commenced on a fluid diet. This will be upgraded to a normal diet as tolerated, you may gradually return to your normal diet. It is a good idea to take small multiple meals.
There is normally no dietary restriction in most elective operations but your surgeon will advise you in any particular circumstances.
Bowels
Avoid constipation and straining when opening your bowels. Take aperients morning and/or night (Movicol, Coloxyl with senna, Metamucil) to prevent constipation.
Driving
No driving for atleast a week, and only when you are no longer taking strong pain relief which may make you drowsy and less attentive to traffic conditions, and when comfortable to do an emergency stop, and moving your foot from the brake to the accelerator safely.
Work
As a general rule, return to work after one to two weeks, and longer if your work involves manual labour.
Physical Activity
Go slow! The first one to two days are the most uncomfortable. You may feel tired needing an afternoon nap. Increase your activity levels as you feel more comfortable with short distance walks and stairs. Participate in light activities from one to two weeks. No heavy lifting (above 5kg), strenuous activity (cycling, jogging, weight lifting) or competitive sport for six weeks. After this you may increase your activity levels gradually, as your level of comfort allows.
Clot prevention
Wear compression tights if supplied by the hospital for one to two weeks, until fully mobile. Early mobilisation is highly recommended in most operations.
Keep doing deep breathing exercises, leg exercises, and frequent little walks to keep the blood pumping in your legs.
If you notice any discomfort, pain, swelling in your calves and lower legs, or you notice you are short of breath or have chest pain, please present to your GP ASAP, or return to your nearest emergency department.
No flying is recommended for three weeks’ post operatively
Follow up appointment
Our reception will book a follow up appointment for you in 2 to 4 weeks after surgery unless otherwise specified.
Red Flag symptoms – post-operative
Please contact your surgeon or your GP or present to your nearest emergency department if any of these symptoms develop postoperatively:
Pain that is not relieved by pain relief medications provided
Worsening nausea and/or vomiting
Increased swelling or pain in abdomen
Difficulty passing urine
Unable to pass stools or gas
Ongoing bleeding
Chills and persistent fevers > 38C
Increasing redness or warmth around your incisions or any discharge from your incision
What are the benefits of pain relief?
Operations cause pain. If you have good pain control after the operation, you are less likely to have a heart attack, a chest infection and blood clots. You should also get up and about more quickly and may go home sooner.
Simple painkillers
You can use these on their own or combined with other painkillers. After the operation take simple painkillers such as paracetamol, anti-inflammatory painkillers such as ibuprofen. Although these painkillers may not completely treat your pain, if you take them regularly, they reduce the amount of other painkillers you might need.
What complications can happen?
- Paracetamol is exceptionally safe in normal doses.
- Anti-inflammatory painkillers can sometimes cause stomach irritation.
- Anti-inflammatory painkillers can make asthma worse but most people with asthma are not affected.
Morphine and similar painkillers
For more severe pain you may be given morphine or similar painkillers such as fentanyl, tramadol, codeine or oxycodone.
These painkillers can be given by mouth once you are eating and drinking normally.
They can also be given by injection either under your skin (subcutaneous), into the muscle (intramuscular) or directly into a vein (intravenous).
Intravenous delivery (using a drip)
The most common intravenous delivery is a technique known as patient-controlled analgesia or PCA. This involves connecting a pump, containing the painkillers, to a drip (small tube) in a vein. The pump has a button that you will be given to hold and when you press the button a small dose of painkillers will be given.
What complications can happen?
- itching
- constipation
- feeling or being sick
- respiratory depression, where your breathing slows down too much
- confusion
Local anaesthetic wound infusion
You may be given a local anaesthetic infusion to help control the pain in the area around your wound and to reduce the amount of other painkillers you need.
A balloon device delivers the anaesthetic through a catheter (tube) to your wound or to the nerves that supply the area of your wound.
What complications can happen?
- failure of the infusion
- the catheter moving out of place or leaking anaesthetic outside of your wound
- allergic reaction
- local anaesthetic toxicity
Epidural anaesthetic
An epidural involves inserting a fine catheter (tube) into the epidural space (an area near your spinal cord). Local anaesthetics and other painkillers are injected down the catheter into the epidural space to numb your nerves.
Sometimes the anaesthetic is injected continuously (an infusion). The dose can be varied by the healthcare team.
What complications can happen?
- low blood pressure
- difficulty passing urine
- headache
- respiratory depression, where your breathing slows down too much
- seizures
- unexpected high block
- allergic reaction to the equipment, materials or medication
- infection around your spine
- cardiovascular collapse (where your heart stops)
- nerve damage
- blood clot around your spine
- damage to nerves supplying your bladder and bowel
- paralysis or death
Peripheral nerve blocks
You may be offered a peripheral nerve block to give pain relief after an operation on your arm or leg. A nerve block works by temporarily numbing your nerves to give pain relief. This involves injecting local anaesthetics and other painkillers near the major nerves to your arm or leg.
What complications can happen?
- failure of the nerve block
- allergic reaction
- bleeding
- nerve damage
- local anaesthetic toxicity
Summary
Pain after an operation is common and there is no need for you to be in a lot of pain. Pain relief after surgery is usually safe and effective.