Patient Instructions

Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

Before and After Procedure Instructions

1. BIOPSIES AND SUTURED WOUNDS, care after procedure
The wound might have been covered after sutures were placed. If so, keep covered with the bandage for 24-48 hours. Some oozing of pinkish clear fluid can be expected. If the wound begins to bleed, apply pressure with a non-stick gauze for at least 10 minutes: brand names of such non-stick gauze include Telfa, Adaptic, and Xeroform.

Typically you can shower with the sutures in place after 24 hours. If your doctor or nurse recommended the use of a topical antibiotic ointment, we recommend Polysporin or Bacitracin. If the area becomes reddened, more itchy, or develops small blisters after applying an antibiotic ointment, wash it off and don't use any more, because you're probably allergic to this ointment. Some people are allergic to Neosporin, so typically we recommend avoiding it altogether. Vaseline can be used instead to help the healing process. Ointments typically should be used for about five days.

You should wash the wound lightly two or three times a day. Keep it covered, if possible, when sleeping. If steri strips were applied, leave them on until they begin to peel off at the edges, usually within a few days after they were applied. It’s OK to get them wet, but don’t soak them in a bath or Jacuzzi, and don’t scrub over them.

Use Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) for pain, unless you have another condition that doesn't allow these products to be used. Avoid aspirin for pain, since it may cause bleeding. If you were given an antibiotic, finish the entire prescription, even if your symptoms have improved.

Be sure to ask your doctors what kinds of activities you can do, and when you may start doing them. Sutures placed in mobile areas of your body (elbow, knee, finger, wrist, shoulder, jaw, etc.) can break or stretch under the stress of extra movement in those areas.

Whenever there is a break in the skin, germs may enter and cause infection. This typically happens within the first four days after sutures are placed. Signs of infection include increased redness, swelling, pain, tenderness, yellow drainage or pus, red streaks leading away from the wound, fever, or chills. If you think you may have an infection, call your doctor immediately.

Sutures should be removed after a certain time period, depending on when they were placed. Usually, if sutures were placed above the neck they should be removed in 5-7 days. On the arms, chest, back and abdomen: 7-10 days. On the buttocks, legs, and feet: 10-14 days. Call your doctor for specific instructions for when to return to remove the sutures. Generally, any sutured wound will have some scarring. Wound healing takes time, so you won’t know the final results for at least 10 to 12 months.

2. REMOVAL OF BLOOD FROM UNDER A TOENAIL OR FINGER NAIL
After the nail has been opened with a heated pointed instrument you should feel immediate relief of pain because the of pressure of blood underneath the nail has been reduced. Keep the wound elevated above your heart as much as possible for the next 24 hours to avoid swelling and throbbing pain. If pain or bleeding recurs, swelling worsens, or you notice pus drainage, contact your doctor immediately.

3. INGROWN TOENAILS AND FINGERNAILS
a) before procedure:
If your doctor prescribed antibiotics prior to your procedure, start them immediately. It is best to take them at least 24 hours prior to your procedure, if necessary. If your toe or finger is infected, soaking it in Epsom salts and warm water 20 minutes at a time, twice a day, will help reduce inflammation and pus. For an ingrown toenail, bring open toed sandals to the procedure to allow room for the bandage.

b) after procedure:
There may be minor pain and swelling after the procedure. It is best to limit your activities and keep your foot or hand elevated above your heart as much as possible to minimize these symptoms for 24 hours. Keep dry for at least 18 hours following the procedure, then wash with soap and water three times a day for the next five days. If fever, chills, increased swelling, redness, pus, or red streaks form within the first few days, call your doctor immediately.

4. CARE OF A CAST OR SPLINT:
It is very important to elevate your casted/splinted limb above your heart as much as possible over the next 72 hours, as rest and elevation greatly reduce pain and swelling. Contact our office immediately if you develop any of the following symptoms:

• Increased pain (this might mean the cast is on too tight).
• Numbness and tingling in the hand or foot outside the cast (could be caused by nerve pressure).
• Excessive swelling below the cast (may be caused by lack of blood circulation).
• Burning and stinging (might be caused by too much pressure on the skin).
• Loss of active movement of exposed toes or fingers (requires an URGENT evaluation).

It is important to keep your cast/splint in good condition. Keep it dry at all times, as moisture weakens the materials and damp padding next to the skin can cause the skin to breakdown, which increases the chance of infection and irritation. Use two layers of plastic over the cast/splint to keep it dry when you bathe. Do not run on a "walking cast," as too much pressure can break it down. Keep dirt, sand, and powder away from the inside of your splint or cast. Do not stick objects inside the splint to scratch itchy skin. Call your doctor if your itching becomes unbearable. Do not try to modify rough edges before speaking to your doctor. Call your doctor if the cast cracks or becomes soft.

5. INFANT CIRCUMCISION, care after procedure
After circumcision the tip of the penis will be red and moist, and it often becomes covered with a yellowish mucus-like substance. This normal healing process may last a week. Either petroleum jelly gauze will be applied to the penis to prevent it from sticking to the diaper, which should be replaced when the diaper is soiled; or a Plastibel plastic ring will be placed, which will typically remain for a week before it loosens and sheds off (do not try to remove this ring until it falls off on its own). Keep the area around the circumcision as clean as possible. Use a soft, warm washcloth with warm water for cleaning, and apply petroleum jelly around the head of the penis with each diaper change.

6. SPIDER VEIN INJECTIONS (Sclerotherapy)
a) before procedure:
• Inform your physician if you are taking birth control pills or estrogen.
• Do not take aspirin, ibuprofen (Motrin, Advil) vitamin E, gingko, Prednisone, or any anti-inflammatory drugs seven days prior to each injection session. These can all cause excessive bleeding after injections. Acetaminophen (Tylenol) is acceptable to use. Avoid aspirin for at least three days after treatment.
• Do not drink alcoholic beverages or smoke for two days before and two days after your treatment, since this may impair the healing process.
• Before your appointment, shower and wash your legs thoroughly with soap. Do not apply any cream or lotion to your legs.
• To avoid discomfort, do not shave your legs on the day of your appointment.
• Eat a light meal or snack one hour before your appointment.
• Bring loose-fitting shorts or a skirt to wear during the treatment.

b) after procedure:
• Immediately after the procedure you will be fitted with support stockings, and will be required to walk for 30 minutes. Be sure to have loose-fitting slacks and comfortable walking shoes with you. For the best possible results, it is imperative that you follow your doctor’s instructions regarding the use of support stockings, bandage dressings, and the length of time before discontinuing their use.
• If traveling over 30 minutes, have someone else drive so that you can move your feet and legs around.
• You will be able to do your normal activities, but avoid standing for long periods of time. Walk at least one hour every day—the more the better! Avoid strenuous physical activities such as high-impact aerobics or weight lifting for the first five days.
• Avoid hot baths and jacuzzis for two weeks. Cool your legs with cold water after each shower.
• Wear the compression hose as instructed. After healing, you may use them for long trips, or when your legs ache.
• You may be fitted with bandage dressings. The bandage feels tight when applied correctly. If it becomes uncomfortable, or you feel it is affecting your circulation, you may rewrap it a bit more loosely. When it is time to remove the bandage, dispose of it and bathe as desired.
• If you have been fitted with a pair of compression hose, put them on over the taped areas and wear them to bed the first night. Remove them in the morning, remove the bandages, and feel free to bathe. Then put the hose back on immediately, and wear them all day from early morning until bed time for the next two weeks. Follow washing and handling instructions carefully (never dry them in a dryer). If handled carefully and washed daily, they should last through several treatments and many months of wear. Some people purchase two pair; one to wear while the other is being washed.
• Bruising is common and generally fades after 10 days. Treated veins may look worse for a few weeks before they start to look better. Mild itching, redness, and the appearance of raised bumps may occur after treatment, and subside in a day or so.
• If veins feel lumpy or tender they may contain some trapped blood, which is part of the healing process. This will usually improve on its own, but it can be removed at your next visit. Call our office for any crampy leg pain that doesn’t improve after a day.
• Avoid sunbathing or tanning booths until your series of treatments is complete. Sun exposure can worsen spider veins and lead to darkened pigment. Protect your skin with sunblock.
• Please make a follow up appointment in 4-6 weeks, or as directed, for further evaluation. Remember, almost everyone requires a series of treatments to see good results, not just a single visit.
Compression (support) stocking instructions:
• Do not wear jewelry when touching stockings, as it can easily catch and rip them.
• Wearing rubber gloves when putting compression stockings on will give you a better grip as you pull them up.
• It is OK to wear thin panty hose or talcum powder under the stockings to smoothe the legs.
• To avoid damaging your stockings they should never been in contact with topical ointments, creams, or stain removers.
• Wash the stockings daily and line dry them (never place them in a dryer) to maintain their elasticity.
• If you have difficulty putting your stockings on, speak to your physician about renting a tool to help you with this issue.

7. SIGMOIDOSCOPY (colon cancer screening)
a) before procedure: There are several different ways to cleanse your bowels prior to the procedure. Follow the instructions provided by your doctor or nurse. Generally, you will need to stay on a clear diet free of fluids or foods with red dye for one to two days. Speak with your doctor regarding adjustments to your current prescription medications. Follow instructions provided in the cleansing kit, being mindful that you will need to take a Fleet enema 1½ hours prior to the procedure. The return from your enema should be clear. If it is not, a second, or possibly a third may be needed.
Clear liquid diet—the following foods/liquids are allowed; avoid all others.
Beverages: Carbonated beverages, coffee, tea.
Desserts: Gelatin (not strawberry, cherry, or other red-colored flavors), clear popsicles
Fruit juice: apple and grape Juice
Soups: Beef or chicken bouillon or clear broth
Sweets: hard candy or sugar

b) after procedure: You will be able to return to your normal activities and diet. Notify your doctor if you develop progressive abdominal pain, profuse rectal bleeding, or fever within 72 hours following the procedure.

8. VASECTOMY
a) before procedure: Shower the day of your procedure. Bring an athletic supporter, tight-fitting underwear or jockey-shorts. You may wish to have someone take you home afterward, especially if you use a sedative prior to the procedure. Have bags of ice, frozen vegetables, or another cold source prepared in advance for when you get home. Applying ice for the first four to six hours after the procedure reduces swelling. Please notify your doctor prior to the procedure if you have any allergies or intolerance to any medications or anesthetics, or if you become dizzy or faint easily. Be prepared to not work for at least two days after the procedure.

b) after procedure: Do not lift objects greater than 10 pounds for at least 2 days. Do not have intercourse nor masturbate the first week after the procedure. It is advised from the second week to the sixth week following the procedure to have 20 ejaculations. At the end of six weeks, you will need to provide a semen sample to the lab to ensure sterility. On the day of your procedure your doctor will provide you the necessary specimen bottle and lab requisition. You must use an alternative method of birth control until lab results show sterility. In some cases an additional semen test will be required after another six to twelve weeks if the sample has not cleared completely.

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