Postoperative instructions: gallbladder and appendectomy surgery

Postoperative Instructions: Gallbladder and Appendectomy Surgery 1. For the first 24 hours make sure your diet is a liquid diet. You may have any liquids that are the consistency of water, including tea and coffee, but try to avoid carbonated beverages for the first 24 hours. You may also have low-fat frozen and regular yogurts. Starting 24 hours following your surgery you may progress to a low-fat bland diet and continue to progress your diet as desired from there. 2. Make sure that for the first 24 hours following your surgery you have very sedentary activity. Do not do anything more strenuous than getting up to get something to drink or to go to the bathroom. You can take short walks around the house if you are comfortable and to relieve any gas pains. Starting 24 hours following the surgery, you may become more active. I would avoid lifting over 10 lbs. and I would avoid straining. You may, however, walk around as much as you would like and you may walk outside and ride in a car. Starting 72 hours following the surgery, if you are essentially pain free and are as alert and oriented as you normally are, you may begin to drive a car. You should not drive a car, if you are still having any discomfort, or any light headiness, or taking any pain medicines, or nausea 3. You have several small pieces of gauges and tape over incisions on your abdomen. Leave these bandages in place until 24 hours following the surgery. Twenty-four hours following the surgery you may remove these bandages, and you will not see stitches, but you will see small white tapes on the skin. These tapes should be left in place for 7 to 10 days. If they come loose, you may remove them at that time. Otherwise, I will remove them for you on your follow up visit in the office. You may shower and even tub bathe with these tapes in place, as they are waterproof, and will stay. If by chance they do come off, you need not worry. All of these wounds have stitches underneath the skin that will hold the skin edges together so the incisions will not come apart. If the tapes should prematurely come off, simply use a Neosporin ointment over the incisions to keep them from being irritated. Do not put Neosporin ointment over the tapes. 4. For 2 to 3 days following the surgery, it is not unusual to experience some pain in the abdomen and some pain in your incisions, some nausea and vomiting, and some fever as high as 101 degrees. However, after 2 to 3 days, these symptoms should begin to resolve, and any persistent pain, nausea, vomiting or fever should be reported to us. Certainly, if while you are at home during the first 2 to 3 days and you have an increase in your nausea and vomiting, pain or fever, or feel that your medication is not working, please call us. 5. You will be given prescriptions for pain medication and for nausea medication. You may actually take both medications together, as sometimes the pain medications can make you nauseated. Taking the nausea medication with the pain medication will also enhance the effect of the pain medication, making it stronger for you to get more relief. It will, however, make you more sleepy, so it is very important that you only take that combination while you are at home and able to rest. It is not unusual for one pain medicine to be less effective for different people and for different pain medications to have some side effects of nausea or itching. These are not allergic reactions, but normal side effects. Itching from your pain medication can be taken care of by taking Benadryl (25 to 50 milligrams) every 6 hours. You may purchase Benadryl, over the counter, in that dosage. The nausea can also be improved by taking the Benadryl, but is better improved by taking your nausea medication. If you find that the pain pills we have prescribed are not effective in controlling your pain, or giving you too much dizziness or nausea, please call us and we will adjust your pain Page 1 of 2
Postoperative Instructions: Gallbladder and Appendectomy Surgery 6. It is very common to have indigestion and constipation following the surgery. Both of these come from a slow down in your bowels, caused by the surgery itself, the anesthetic and the pain medication you are taking. It is very reasonable to take Mylanta or Maalox for any indigestion and to take a laxative of your choice, if you become constipated. The laxatives that you can buy over the counter that are very effective, include Milk-of-Magnesia, for which you may take up to 4 tablespoons as needed, Dulcolax tablets, for which you may take 2 and up to 4 if needed and Dulcolax suppositories. Our first preference is to have you take a Dulcolax suppository, because it works very quickly and effectively, and is probably the most effective in relieving any gas that you may have. The gas that you feel following the surgery is a combination of gas that is placed into your abdominal cavity, as well as an accumulation of gas within your intestine. This can be relieved by taking Dulcolax suppositories or Mylanta, and an also be relieved by taking the over-the-counter gas products such as Phazyme, Gas-X and Di-Gel. All of those would be reasonable to take 7. We would like to see you for a follow-up visit in our office in approximately 10 to 14 days following the surgery. Please call our office within a day or two of arriving at home, to make an appointment to see us in the following 10 to 14 days. Certainly feel free to call us at any time if you have additional questions or concerns, or if you feel you are not progressing as Page 2 of 2


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Biosci. Biotechnol. Biochem., 70 (7), 1794–1797, 2006Genetically Engineered Poly--glutamate Producerfrom Bacillus subtilis ISW1214Makoto ASHIUCHI,y Kazuya SHIMANOUCHI, Terumi HORIUCHI,Tohru KAMEI, and Haruo MISONODepartment of Bioresources Science, Kochi University, Nankoku, Kochi 783-8502, JapanReceived February 13, 2006; Accepted April 4, 2006; Online Publication, July 23, 2006The pgsBC

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