When you are a patient, surgery is tough. Scary. New. Nothing feels normal or “right.” How do you know when something in your healing is the “normal” amount of pain, swelling, and ick versus something bad?
This is a tough question. “Normal” healing after surgery varies a lot. Some people have a little swelling and almost no pain, while others have a lot. Both are normal, so how do you know?
I talk to and see my patients a lot. I do this because after being a surgeon now for almost 18 years, I have seen a lot. The best tool I have for making sure there is nothing to worry about is to see you. When I see my patients for follow ups, they likely think I am just chit chatting. But I am noticing everything. How do you move? Your pain level? Are you swollen? Bruised? How much? How do your incisions look? Do you have a drain? If so, what color and how much is coming out? I look at your skin. Is there any redness? Discharge? and overall, how are you?
I read a book recently by Atul Gawande called “Complications” (It was assigned for my book club–it was a fascinating read and threw me back into residency while I read it.) One vignette which struck me in his book was a story about when he saw a patient and everything seemed not so bad with her, but something tickled his mind. This tickle made him keep coming back to a different, unusual, but bad diagnosis. It was a story of a woman with a skin infection in the ER. He knew she didn’t have a fever….she didn’t look so sick…. her story wasn’t so bad….. she was young, BUT something tickled his mind–something seemed off, worse, different. And it was. His little tickle caused him to push further, and it saved her leg and maybe her life.
So, you the patient. When do YOU know? Clearly you haven’t had years and thousands of surgeries. When should you call the doctor?
- PAIN. Pain is a good indicator of hurt. Your doctor should be blunt and clear with you of how much pain to expect and how to treat it. If your pain cannot be controlled by the normal medication, it is a reason to call the doctor. Sometimes pain indicates something else going on- bleeding, infection, abnormal swelling. This is a place where we get a feel for patients and for their surgeries. How complex was your surgery? Did everything go well? Is there anything we are worried about? How high or low is your pain threshold?
- BLEEDING. Bruising is normal after surgery. A true bleed is not. If there is a drain in, how much and what color is coming out? If you have a bilateral surgery like a breast surgery or facelift, do the two sides look like each other? If one side is a lot larger and painful than the other, it could signify a bleed. You increase your risk of bleed if you have been on medications which thin your blood like aspirin, advil, vitamin E, fish oil, and many others- for many of my surgeries, my patients have to stop these 2 weeks before surgery and until their bruise is gone after surgery. Before your surgery, consult with your doctors about what medications you can take.
- INFECTION. This could be a skin infection, a urinary tract infection, a lung infection (take those deep breaths after surgery). One general sign of infection is fever (greater than 101.5 in my practice). Then it goes by area. For urine, it is pain with urination, frequent urination, did you get a catheter during or following surgery? For skin, you look at it. Is it red, warm, tender? Is there discharge?
- Bad smell.
- Discharge. A little bloody discharge along your incision is normal usually for the first 24 hours. If it is more, smelly, painful, looks like pus- call your doctor.
- DIFFICULTY BREATHING. This may be shortness of breath or pain when you breathe deeply. It could be a sign of a blood clot which started in your leg but ended up in your lung, called a “PE” or pulmonary embolus. If you have any signs of this, go to an ER immediately. They are not common. They require urgent treatment.
- ANYTHING WHICH TICKLES YOUR GUT. Just like we get a tickly feeling as doctors something is amiss, you get the same tickly feeling. Call and see your doctor. If you are really concerned, make sure you talk directly to the doctor. Be a little pushy. I do not have any nurses or assistants to handle my calls, but I have a secretary who answers the phone. If you are worried, make sure you talk directly to me.