Ascension Saint Agnes Maryland Surgeons

We at Saint Agnes Medical Group, Maryland Surgeons believe that the relationship between patient and surgeon is crucially important to providing top-notch and personalized breast care.

The relationship begins with an initial consultation in which the patient’s history is reviewed, the patient's risk for breast cancer is assessed, imaging studies are reviewed, and a physical examination is performed.  Considering all of this and other information, we generate a personalized recommendation regarding which, if any, diagnostic procedure is indicated.  If a diagnostic procedure is required, the patient's surgeon will explain it thoroughly, and we will assist with scheduling the procedure, be it a scan, a biopsy, or an operation.

If cancer is found and further treatment is necessary, the relationship between the patient and the surgeon will often, therefore, have already been established.  This is crucial in helping the patient make decisions required for successful treatment of breast cancer.  We will advise the patient on what further evaluation, such as a breast MRI scan, may be indicated, and will present the patient's case to the multidisciplinary breast-cancer tumor board.

We pride ourselves on discussing the options for surgical treatment thoroughly.  We will offer advice concerning referrals to the medical oncologist, radiation oncologist and plastic surgeon, as needed.  Whatever treatment is required, an established and excellent patient-surgeon relationship makes a difficult situation the best it can be.

We specialize in the following procedures:

• Diagnostic Procedures
• Lymph-Node Procedures
• Breast-Conserving Surgery
• Mastectomy

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

Frequently Asked Questions

Q. What is stereotactic (mammographically guided) core breast biopsy?
A. A core biopsy is a method of removing a specimen of breast tissue about the size of a pencil lead through a very small incision.  A stereotactic core biopsy uses a special biopsy table and mammography to precisely locate the coring needle into the area of the breast to be sampled.  It is a particularly useful technique for sampling areas of abnormal micro-calcifications.  The procedure is performed under local anesthesia and takes less than an hour.  The patient can drive herself to and from the procedure.

Q. What is sentinel lymph node biopsy?
A. Sentinel lymph node biopsy is a method of identifying the lymph node closest to the breast.  This lymph node has been named the sentinel lymph node.  The sentinel lymph node is the first lymph node that filters the fluid draining away from the primary tumor.  If cancer cells are breaking off and entering the lymph system, the first filtering node will be most likely to contain breakaway cancer cells.  If the sentinel node is cancer-free, the probability is high that the cancer has not spread to any other node.  This information is important in staging the cancer and individualizing the cancer treatment for maximum benefit.  Identifying the sentinel node and removing it for pathologic examination is a sentinel lymph node biopsy.

Q. What is a mastectomy?
A. Mastectomy is the surgical removal of the breast for the treatment or prevention of breast cancer.  There are three main kinds of mastectomy: modified radical, simple, and skin- and/or nipple-sparing. In each case, all of the breast tissue is removed.  In a simple mastectomy, the nipple is removed with all the breast tissue. In a modified radical mastectomy, the nipple is removed as well as the lymph nodes under the arm.  In a skin-sparing mastectomy, as much of the skin of the breast is left in place as possible to keep the original shape of the breast intact.  A nipple-sparing mastectomy is a skin-sparing mastectomy where the nipple is left intact.  The type of mastectomy chosen depends on the specific cancer being treated, the preoperative shape of the breast, and the wishes of the patient.

We at Saint Agnes Medical Group, Maryland Surgeons believe that when it comes to your cancer care the relationship between patient and surgeon is crucially important to providing top-notch and personalized care, and that a multidisciplinary approach is needed.

We will work with you the whole way from diagnosis to staging and treatment and will work with your other doctors to produce a tailored treatment plan that will provide the best treatment for your cancer.  We take a holistic approach and work with each patient and their families to educate them about their cancer and the role that surgery can have in improving outcomes.

Our oncology team is specialty trained to manage complicated cancers. We have developed strong relationships with many other physicians to produce a multidisciplinary team, which has been shown to improve outcomes.  Depending upon the cancer, minimally invasive surgery using laparoscopic or robotic techniques can be performed to reduce the size of the surgical incision and produce better cosmetic results, and easier recovery.

We specialize in the following procedures:

• Gastrointestinal (GI) cancer
• Pancreatic and hepatobiliary cancers
• Breast cancer
• Endocrine cancers
• Melanoma
• Soft-tissue sarcomas

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

Frequently Asked Questions – Oncology

Q. What is cancer?
A. Cancer is a disease of unregulated growth.  It can take over the body like a weed can take over a garden.  Our bodies are made up of trillions of tiny building blocks, called cells.  In general, these cells grow when they are supposed to grow, like when we need to heal a cut, and they stop growing when it's time to stop.  The body controls this process by sending signals to tell the cells exactly when to grow and when to stop growing.  In cancer, one cell may lose the ability to respond correctly to these signals and begins to grow out of control, usually because of a genetic mutation, or a change in the cell’s DNA.  Then, the cell continues this uncontrolled growth until it takes over the body.  Fortunately, there are many good treatment options to stop this uncontrolled growth, and one of the most important is surgery.

Q. What is the “multidisciplinary tumor board”?
A. Multidisciplinary tumor boards are weekly meetings at Saint Agnes that comprise clinicians from different disciplines, including surgical oncology, medical oncology, radiation oncology, diagnostic and interventional radiology, pathology, gastroenterology, and nursing.  This team evaluates patient records, imaging, and pathology to formulate a consensus regarding diagnosis and treatment.  The benefit of multidisciplinary teams is providing patients with the benefit of input from multiple different perspectives.  These weekly conferences are held for breast, GI, and other cancers, allowing clinicians to discuss complex cases.

Q. Is the Saint Agnes Cancer Institute accredited?
A. Yes. In fact, it is the only cancer center in Baltimore to have received three-year accreditation from the Quality Oncology Practice Initiative and Outstanding Achievement from the American College of Surgeons Commission on Cancer.

Q. What is Chemotherapy?
A. Chemotherapy is treatment using medicines to treat disease, generally cancer.  There are many different kinds of chemotherapy. Chemotherapy, like radiation therapy, is sometimes used in addition to surgery to treat cancers.

Q. What is Medical Oncology?
A. Medical oncology is the medical specialty in which physicians use medicines, chemotherapy, to treat diseases, most often cancer.  Physicians trained in this specialty are called medical oncologists.

Q. What is Radiation Therapy?
A. Radiation therapy is the treatment using radiation (a form of energy) from natural or artificial sources to treat disease, generally cancer.  There are several natural sources that produce or emit radiation, which is used like x-rays, an artificial source of radiation that is used in diagnostic radiology.  Radiation therapy, like chemotherapy, is sometimes used in addition to surgery to treat cancers.

Q. What is Radiation Oncology?
A. Radiation oncology is the medical specialty in which physicians use radiation therapy to treat diseases, most often cancer.  Physicians trained in this specialty are called radiation oncologists.

We at Saint Agnes Medical Group, Maryland Surgeons strive to have a strong relationship with our patients to offer the best treatment for colorectal diseases.

Our goal is to work together to help guide you through all the stages of your treatment.  We work with your gastroenterologist in a multidisciplinary approach to help optimize the care that is right for you.  When you meet with us we will talk with you about your condition and help to explain what is going on and how our services can help you and improve your quality of life.

We specialize in the treatment of many diseases and conditions of the gastrointestinal (GI) tract.  Each of our board-certified surgeons offers a compassionate and tailored approach to your needs.  Depending upon the patient and the disease we can offer minimally invasive approaches in many situations.

We specialize in the following procedures:

• Endoscopy
• Sphincter-Sparing Surgery
• Colectomy
• Surgery For Inflammatory Bowel Disease (IBD)
• Hemorrhoid Surgery
• Anorectal Surgery

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

Frequently Asked Questions – Colorectal Surgery

Q. What are the colon and the rectum?
A. The colon and the rectum are part of the gastrointestinal (digestive) tract and form a long tube called the large intestine, or the large bowel.  The colon begins at the end of the small intestine and travels about five feet around the abdomen to end at the rectum, which is a pouch-like structure, about 6 inches long, between the colon and the anus.

The colon absorbs water from the digested food and stores waste until it is ready to pass out of the body.  The rectum expands to hold the waste before it passes through the anus as a bowel movement.

Q. What is Inflammatory bowel disease (IBD)?
A. Inflammatory bowel disease is made up of two diseases: Crohn’s disease and ulcerative colitis.  Crohn’s disease can occur anywhere in the digestive tract from the mouth to the anus while ulcerative colitis occurs from the large intestine to the rectum.  Both diseases can have many complications that requires surgery to treat.  For example, patients can develop fistulas (where two organs fuse together and make an abnormal connection), blockages, and infections that require surgical intervention. In severe case, patients may require removal part of the intestines.

Q. What is a polyp?
A. Polyps are benign but precancerous growths.  They form on the inner wall (called the mucosa) of the colon or rectum.  They are common, especially in people older than age 50, and can cause bleeding, or, when very large, can block bowel movements.  Because some polyps may become or harbor cancer, they are generally removed by colonoscopy.

Q. What is a colostomy?
A. A colostomy is a surgical procedure, generally reversible, that creates an alternate way for stool to leave the body when it cannot leave, or it is not safe for it to leave, the usual way. This alternate way is through an opening, called a stoma, in the abdominal wall.  A low-profile bag equipped with an adhesive ring is applied to the skin and catches the stool. Many people live fully active lives with stomas. Typically, once it has healed the stoma is painless and should not even cause discomfort.  A special clinician called an enterostomal therapist can help a patient with a new stoma learn how to take care of it, and adjust to living well with it.

We at Saint Agnes Medical Group, Maryland Surgeons believe that the relationship between patient and surgeon is crucially important to providing top-notch and personalized endocrine care.

The endocrine system is essential for the regulation of numerous processes in the human body that includes our metabolism, blood pressure, and energy levels. When there is disease of one of the endocrine organs, these processes are often interrupted and their activity can be either lowered or become overactive.

Our surgeons will work with you to review your case and perform an evaluation for disease.  They will work with your endocrinologist in a multidisciplinary fashion to generate the best treatment plan for you.  We aim for our patients and their families to understand their disease clearly and how each treatment option will benefit them.

Maryland Surgeons offers specialty trained surgeons who perform endocrine surgery.  We perform surgery for the thyroid, parathyroid and adrenal glands.  We are often able to perform laparoscopic procedures in the treatment of adrenal gland diseases to reduce incision size, decrease the need for pain medication and lower the risk of infection.

We specialize in the following procedures:

• Thyroidectomy
• Parathyroidectomy
• Adrenalectomy

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help.

Frequently Asked Questions – Endocrine Surgery

Q. What are some symptoms of thyroid disease?
A. The thyroid gland is a small gland that sits in the front and next to the wind pipe, or trachea.  It is often hard to feel in many people due to its small size and soft texture.  The thyroid gland plays a role in metabolism and regulating your energy levels.  In overactive cases patients may feel hot and have a decrease in their weight.  In some cases, patients will notice a bulging of their eyes.  In cases of underactive thyroid, patients may report weight gain and decreased energy.

Q. What is a parathyroid gland? What is hyperparathyroidism?
A. Humans typically have 4 small parathyroid glands that secrete parathyroid hormone (PTH), which is a hormone that helps control calcium levels.   An overactive parathyroid gland is called hyperthyroidism, and can be caused by several different factors.  The most common cause is a benign tumor on one of the parathyroid glands, which is not cancerous.   Overgrowth of all glands can also cause hyperparathyroidism, and may be due to kidney disease, vitamin D deficiency, or inherited conditions. Hyperparathyroidism is diagnosed based on levels of calcium and PTH in the blood.

Q. What is a typical recovery after thyroid surgery or parathyroid surgery?
A. After surgery, most people have a sore throat, mild swelling, some difficulty swallowing, and mild discomfort at the incision in the lower neck, but should be able to eat, drink, and talk immediately.  Driving is allowed as soon as patients have stopped narcotic pain medications, and feel able to turn their necks for safe driving (usually a few days to a week).  Most patients are fully recovered and back to work within 1-2 weeks.  Strenuous activity and heavy lifting should be avoided during this time (1-2 weeks).

Q. What are the complications of thyroid surgery or parathyroid surgery?
A. Thyroid and parathyroid surgery (like all surgery) comes with standard risks of anesthesia, bleeding, infection, damage to nearby structures, and the risk of other complications related to any underlying health problems, such as heart, lung, kidney, or liver disease.  However, thyroid surgery is typically considered safe. Prior to any operation, the surgeon will carefully review the risks and benefits associated with the operation, as well as alternatives.

There are several complications that are specific to thyroid and parathyroid surgery.  The most common complication after thyroid or parathyroid surgery is low calcium.  This is usually temporary and may require taking extra calcium and a special form of vitamin D for a few days or weeks postoperatively.  Voice changes can also occur after thyroid or parathyroid surgery but are rarely dangerous or permanent.

We at Saint Agnes Medical Group, Maryland Surgeons believe that the relationship between patient and surgeon is crucially important to providing top-notch and personalized care.

We work closely with our patients to ensure that the best possible treatment is provided in a caring and compassionate setting.  We aim to ensure our patients clearly understand their disease and how each treatment option will affect them.

Maryland Surgeons is a highly skilled group of board-certified general surgeons and use state-of-the-art equipment and advanced techniques when they perform surgery.  Depending upon the patient and the disease, we can perform operations using laparoscopic or robotic surgery in many cases.  These surgical techniques offer precision and improved cosmetic and functional outcomes.

We specialize in the following procedures:

• Appendectomy
• Gastrectomy
• Cholecystectomy (Gallbladder Removal)
• Splenectomy
• Foregut Procedures
• Removal or drainage of lumps and bumps

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

Frequently Asked Questions – General Surgery

Q. Where will my surgery be performed?
A. While some small procedures are office-based, such as some breast biopsies, incision and drainage of abscess, and some hemorrhoids, most procedures require not just local anesthetics, but actual anesthesia by an anesthesiologist and are performed in the hospital’s operating room.  Most of our surgeons practice at both Saint Agnes Hospital, and also at Howard County General Hospital.

Q. How long will it be before my surgery is scheduled?
A. If your surgery is deemed an emergency, then it will be done immediately. Elective surgery is usually scheduled in as little as a few days and as long as a month, depending on the level of urgency and on how much preparation is required (eg, preop visits with your primary care provider and/or cardiologist, insurance approval, etc) to get you ready for your procedure.

Q. What do I do if I have problems at night or on weekends?
A. Just call our main office number of 443-574-8500 and follow the prompts. One of our physicians is on call 24 hours a day, 7 days a week.  Refill for prescription pain medicine should be requested during normal office hours.

Q. Can I drive myself home after my surgery?
A. No. Patients receiving anesthesia or those taking prescription pain medicine should not operate a motor vehicle.

We at Saint Agnes Medical Group, Maryland Surgeons believe that the relationship between patient and surgeon is crucially important to providing top-notch and personalized hernia care.

Hernias commonly form when there is a weakness within a wall of the body that holds a tissue or organ in it. There are many types of hernias but the most common occur in the abdomen.  Most hernias can be repaired with a minimally invasive (laparoscopic or robotic) procedure.  To help prevent recurrence many hernias are repaired with a mesh which strengthens the weakened wall.

We work closely with our patients to ensure that the best possible treatment is provided in a caring and compassionate setting.  We aim to ensure our patients clearly understand their disease and how each treatment option will affect them.

We at Maryland Surgeons are highly skilled in hernia surgery and use state of the art equipment and advanced techniques.  Depending upon the patient, we can perform laparoscopic procedures or robotic-assisted surgery.  These surgical techniques offer precision and improved cosmetic outcomes where small incisions are made in the abdominal wall to reduce the size of the surgical incision.

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help.

Frequently Asked Questions - Hernia Surgery

Q. What is a hernia?
A. A hernia is a bulge through a weak area, usually in the abdominal wall.  Imagine your belly as a wall. This wall keeps your insides inside of you.  If there is a weakness in the wall, then your internal organs can bulge out.  This bulging is the hernia. Sometimes you can see the bulge as a lump. Other times, it can cause pain.  Sometimes, if intestines are involved in the hernia, you can have nausea, difficulty with bowel movements, or even vomiting.

Q. What causes hernias?
A. All hernias are caused by a weakness in a wall that allows something to bulge through the wall, usually the abdominal wall.  We are born with areas of natural weakness in the abdominal wall. The most common hernias occur at the navel and are called umbilical hernias, and in the groin, which we call inguinal hernias.  Weaknesses in the abdominal wall can also result from surgical incisions, and we call these incisional hernias.

Q. What are the risk factors for getting  a hernia?
A. A combination of age, constipation, straining, coughing, and lifting heavy objects can cause these weaknesses to get larger, and as a result, a hernia forms.

Q. When should I get surgery for a hernia?
A. There is one situation where you simply must get your hernia repaired:  If you have intense pain that does not go away, nausea, vomiting, or difficulty having a bowel movement, a piece of intestine may be trapped in the hernia.  We call this an incarcerated hernia.  If this occurs, you must get the hernia repaired without delay.  If it is not repaired, it is possible for the entrapped intestine to lose its blood supply and begin to die.

More commonly, patients will have hernias that can be fixed electively.  If you have mild, intermittent discomfort or pain that gets better with rest, and a bulge that you can push back in, then you may have the a hernia that can repaired nonurgently.

Q. What does hernia surgery involve?
A. Currently there are three basic ways to repair a hernia.  First, a hernia can be repaired by an "open" approach, in other words with a single incision that is about the length of the hernia itself, anywhere from two inches to the entire length of the abdomen, depending on how large the hernia is.  Second, a hernia can be repaired laparoscopically, in which multiple small, Band-Aid-sized incisions are used to repair the hernia. Finally, a hernia can be fixed robotically.  Robotic surgery is one of the most recent techniques to be developed in surgery.  Similar to laparoscopic surgery, multiple small incisions are used, but instead of the surgeon using the surgical instruments by hand, robotic arms are attached to the instruments, and the surgeon operates the robot from a console.

In many cases, the hernia is repaired with mesh, also called a patch.  This is a usually synthetic screen that is implanted onto the abdominal wall muscle.  Mesh has been proven to decrease the chance of hernias recurring after repair and is considered the standard of care for many hernias.

Q. Which surgery option is the best?
A. There is no one best option.  Every patient is different, every hernia is different, and every surgeon is different.  Each surgeon has spent years perfecting his or her method of giving you the best result possible.  Your surgeon will take into account your medical conditions, the size and location of your hernia, and many other factors.  Based on his or her personal methods, and your particular case, your surgeon will arrive at the very best option for you. In some cases, your surgeon may feel the open approach is best; in others, the laparoscopic or robotic.

Q. What is the recovery like after hernia surgery?
A. Hernia surgery is often outpatient, depending on the size of the hernia.  This means that you will go home the same day of surgery. You can expect several days of pain, regardless of the method used to repair the hernia.  You should expect to walk immediately after your repair, and can resume normal activities as pain permits. Most surgeons will limit the amount of weight you should lift, for example 10-20 pounds.  This restriction will last anywhere from 2 weeks to 6 weeks, depending on the severity of the hernia, and how physically demanding your normal work and home activities are.

We at Saint Agnes Medical Group, Maryland Surgeons are committed to providing the best and most advanced care to our patients.  We are the most diverse surgical practice in the region to offer a variety of laparoscopic and robotic-assisted surgical procedures and we tailor care to each patient’s needs.

The term minimally invasive surgery (MIS) includes both laparoscopic surgery and robotic surgery.  MIS involves the use of several small, Band-Aid-sized incisions that are used to access the abdomen using access ports.  One of these ports always has a camera and the others allow laparoscopic or robotic instruments to be placed, which are then controlled by the surgeon.

Robotic surgery is one of the most recent techniques to be developed in surgery.  Similar to laparoscopic surgery, multiple small incisions are used, but instead of the surgeon using the surgical instruments by hand, robotic arms are attached to the instruments, and the surgeon operates the robot from a console.

The advantages of MIS are smaller incision sizes, less of a need for pain medicine, decreased risk of infection at the surgical site, and easier recovery.  Robotic-assisted surgery is very similar to laparoscopic surgery. The benefits of the robotic approach include precision of instruments, greater dexterity of instruments, and greater magnification.

We specialize in the following MIS procedures:

• Cholecystectomy (Gallbladder Removal)
• Hernia Repairs
• Appendectomy
• Colectomy
• Anti-Reflux Surgery
• Pancreas and Liver Surgery

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

The Da Vinci® XI Robot at Saint Agnes Hospital

Frequently Asked Questions – Laparoscopic and Robotic Surgery (MIS)

Q. What should I expect if I am having MIS?
A. Depending upon the procedure you will be having the result may vary.  In general, what you can expect during MIS is several Band-Aid-sized incisions, with one generally at the navel and 2-4 additional small incisions around the abdomen.  The operation is performed using the camera while you are under general anesthesia. When you wake up you may still feel pain or discomfort, for example at the incisions or shoulders, but this is generally quite tolerable and improved with pain medicine, either over-the-counter medicine alone or supplemented with prescription pain medicine (typically a narcotic).  Many patients will be able to go home the same day but others have to spend a night or two in the hospital for observation.

Q. What should I expect if I am having robotic surgery?
A. Robotic surgery, sometimes referred to as robotic-assisted surgery, has been a great technological advance.  Many surgeons feel that it is safer and easier to do robotic versus laparoscopic surgery, but the experience of the patient is very similar with either kind of MIS.

Pancreatic and hepatobiliary surgery is surgery of the pancreas, liver, and bile ducts, including the gallbladder.

We at Saint Agnes Medical Group, Maryland Surgeons believe that the relationship between patient and surgeon is crucially important to providing top-notch and personalized care.

Our surgeons work closely with our patients to ensure that the best possible treatment is provided in a caring and compassionate setting.  We aim to ensure our patients understand clearly their disease and how each treatment option will benefit them.

Saint Agnes Medical Group, Maryland Surgeons are highly skilled in pancreatic and hepatobiliary surgery and use state of the art equipment and advanced techniques when they perform surgery.  Depending upon the patient, our surgeons can perform minimally invasive (laparoscopic or robotic) surgery.  These surgical techniques offer easier recovery, increased precision, and improved cosmetic outcomes.

Saint Agnes is a high-volume pancreatic and hepatobiliary surgery center and both Dr. Patel and Dr. Cunningham are board-certified, fellowship-trained experts.

We specialize many pancreatic and hepatobiliary procedures, including the following:

Pancreatic procedures

• Whipple operation (pancreaticoduodenectomy)
• Distal (or left) pancreatectomy
• Pancreatic debridement and drainage

Liver procedures

• Major and minor partial hepatectomy
• Liver biopsy
• Drainage of liver cysts

Biliary procedures

• Bile-duct resection
• Simple cholecystectomy [ko-lee-sis-TECT-o-mee]
• Extended cholecystectomy

Please contact us at 443-574-8500 to set up an appointment or to get more information about how our surgeons can help you.

Diet

• Eat lightly the night after your surgery, avoiding heavy, greasy, spicy foods.
• Resume regular diet as tolerated with plenty of fruits and vegetables the morning after surgery.
• Take a fiber supplement 2-3 times per day. Reduce dosage if you have more than 2 bowel movements per day.
• Drink plenty of fluids.
• No alcohol, including beer/wine, for 24 hours and while taking narcotic pain medicine.

Activity

• Activity allowed guided by common sense and discomfort level. Walking and stairs are ok. Have someone with you until you feel secure.
• Take slow, deep breaths and cough to open lungs.
• Avoid lifting >15-20 lbs or strenuous activity until seen for your first postoperative visit.
• Do not drive while taking narcotics. Be sure you can twist/move comfortably before you drive.
• Rarely a patient can develop urinary retention after surgery. Try soaking in a hot sitz bath or standing in a hot shower. It this is not successful, contact your surgeon.
• Return to work when cleared by the surgeon. This is on an individual basis as determined by job duties.

Pain Control

• Purchase the following:
  • Tucks
  • Metamucil
  • Colace (stool softener)
  • Pain medicine
• A prescription for narcotic pain medicine will be given to you. Be judicious with its use, but do not wait until pain is unbearable before taking it. Narcotics are not completely effective so do not think that more is better.
• For milder pain, acetaminophen (Tylenol) may be used instead of the narcotic pain medicine. Some narcotic medicines, such as hydrocodone/APAP, already have Tylenol added to them.
• Avoid ibuprofen (Motrin) as this can make bleeding worse, unless your surgeon approves it.
• Narcotic pain medicine can be constipating. If you miss a bowel movement, take 2 tablespoons of milk of magnesia at bedtime. In the morning, drink prune juice and coffee if still feeling constipated.
• Apply an ice pack to the incision area for 20 minutes at a time for the first 24-36 hours after surgery. Place a cloth between the skin and ice pack.

Wound Care

• You may shower the next morning after surgery.
• The incision is closed with sutures under the skin. These will dissolve and do not need to be removed.
• You may notice bruising /skin discoloration around the incision area. It is normal to have a lump along the incision area. This will slowly resolve on its own.
• Use non-alcohol-containing baby wipes to clean after bathroom use.
• Hot sitz bath, or tub soaks, about 4 times per day and after each bowel movement. There is no need to add epsom salt to the water.
• Some blood will be noticed with your bowel movements initially. This usually stops completely when the wounds are healed. If the bleeding is excessive and does not stop, apply pressure and call the surgeon.

Call the office to schedule a post-operative appointment for 3 weeks after surgery.

Call the office at 443-574-8500 with any questions or with any signs of infection.

Diet

• Eat lightly the first night after surgery. Avoid heavy, greasy, spicy foods.
• Resume regular diet as tolerated in the morning.
• Drink plenty of fluids.
• No alcohol, including beer and wine, for 24 hours and while taking narcotic pain medicine.

Activity

• Activity allowed guided by common sense and discomfort level. Walking and stairs are ok. Have someone with you until you feel secure.
• Take slow, deep breaths and cough to open lungs.
• No driving while taking narcotics. Be sure you can twist/move comfortably before you drive.
• You may shower the morning after surgery.
• No tub baths, swimming or soaking for 2 weeks.
• After a sentinel lymph node biopsy, it is normal to have a greenish-blue discoloration of the urine.
• Wearing a good bra (support or sports bra) day and night, will provide more support for healing and may help with pain control.
• Return to work when cleared by the surgeon. This is on an individual basis determined by job duties.

Pain Control

• A prescription for narcotic pain medicine may be given to you. Follow directions and use as needed. Do not take pain medication on an empty stomach, as it may cause nausea/vomiting.
• For milder pain, acetaminophen (Tylenol) may be used, instead of the prescription pain medication. Some prescription pain medications, such as hydrocodone/APAP, contain Tylenol. Ibuprofen is ok if approved by your surgeon.
• Narcotic pain medicine can constipate you; drink lots of fluids, increase fiber in your diet, and you may use an over-the-counter stool softener or laxative if needed.
• Apply an ice pack to the incision area (30 minutes on, 30 minutes off) as needed while awake. Place a cloth between the skin and ice pack.

Wound Care

• The incision is closed with sutures under the skin. These will dissolve and do not need to be removed.
• You may notice bruising or skin discoloration around the incision or nipple area. It is normal to have a lump along the incision area. This will slowly resolve on its own.
• Remove the clear plastic gauze dressing by the 2nd day after surgery. You may shower with this bandage on. Remove the bandage if it gets wet under the clear plastic.
• Steri-Strips (white reinforced paper tapes) may be present over your incision underneath the outer dressing. Allow these to fall off on their own.
• You may shower with the Steri-Strips on. Do not scrub the area. Pat dry.
• If "skin glue" was used, you will NOT have a bandage. You may note some clear or white flakiness around your incision. Do not scrub this off. It will dissolve on its own.

Sign And Symptoms of Infection

• Fever above 100 degrees Fahrenheit.
• Redness and warmth at the incision site.
• Swelling extending out more than an inch from the incision site.
• Worsening pain from baseline pain level.
• Cloudy, yellow or green drainage from the incision site.

Pathology Results

We will call you with pathology results as soon as they are available. Please allow 5 working days.

Post-op Appointment

Please call to schedule your post-operative appointment for 2 weeks after your procedure, unless instructed otherwise by your surgeon.

Call the office at 443-574-8500 with any questions or with any signs of infection.

Diet

• Eat lightly the first night. Avoid heavy, greasy, spicy foods.
• Resume regular diet as tolerated in the morning.
• Drink plenty of fluids.
• No alcohol, including beer and wine, for 24 hours and while taking narcotic pain medicine.

Activity

• Activity allowed guided by common sense and discomfort level. Walking and stairs are ok. Have someone with you until you feel secure.
• Take slow, deep breaths and cough to open lungs.
• No driving while taking narcotics. Be sure you can twist and move comfortably before you drive.
• You may shower the morning after surgery.
• No tub baths, swimming or soaking for 2 weeks.
• Return to work when cleared by the surgeon. This is on an individual basis determined by job duties.

Pain Control

• A prescription for narcotic pain medicine may be given to you. Follow directions and use as needed. Do not take pain medication on an empty stomach, as it may cause vomiting. Eating saltines may help.
• For milder pain, acetaminophen (Tylenol) may be used, instead of the prescription pain medication. Some prescription pain meds, such as hydrocodone/APAP contain Tylenol.
• Narcotic pain medicine can constipate you; drink lots of fluids, increase fiber in your diet, and you may use an over-the-counter stool softener or laxative if needed.
• Apply an ice pack to the incision area (30 minutes on, 30 minutes off) as needed while awake. Place a cloth between the skin and ice pack.

Wound Care

• The incision is closed with sutures under the skin. These will dissolve and do not need to be removed.
• Remove the white gauze/clear plastic dressing by the 2nd day after surgery. You may shower with this bandage on. Remove the bandage if it gets wet under the clear plastic.
• Steri-Strips (white reinforced paper tapes) will be present over your incision underneath the outer dressing. Allow these to fall off on their own.
• You may shower with the Steri-Strips on. Do not scrub the area. Pat dry.
• If "skin glue" was used, you will not have a bandage. You may note some clear or white flakiness around your incision. Do not scrub this off. It will dissolve on its own.

Signs And Symptoms of Infection

• Fever above 100 degrees Fahrenheit.
• Redness and warmth at the incision site.
• Swelling extending out more than an inch from the incision site.
• Worsening pain from baseline pain level.
• Cloudy or yellow or green drainage from the incision site.

***For Inguinal Hernia Repair***

• You may notice bruising or skin discoloration around the incision and the genital area (labia or scrotum).
• It is common to have swelling in the groin area, and may extend to penis and scrotum.
• Placing a small towel roll under the scrotum may decrease swelling by elevating the scrotal area.
• It is normal to feel a lump or ridge along the incision area. This will resolve on its own.

Pathology Results

We will call you with pathology results as soon as they are available. Please allow 5 working days.

Post-op Appointment

Please call to schedule your post-operative appointment for 2 weeks after your procedure, unless instructed otherwise by your surgeon.

Call the office at 443-574-8500 with any questions or signs of infection.

Diet

• Eat lightly tonight. Avoid heavy, greasy, spicy foods.
• Resume regular diet as tolerated in the morning.
• Drink plenty of fluids.
• No alcohol, including beer/wine, for 24 hours and while taking narcotic pain medicine.

Activity

• Activity allowed guided by common sense and discomfort level. Walking and stairs are ok. Have someone with you until you feel secure.
• Take slow, deep breaths and cough to open lungs.
• No driving while taking narcotics. Be sure you can twist and move comfortably before you drive.
• You may shower the morning after surgery.
• No tub baths, swimming or soaking for 2 weeks.
• After a sentinel lymph node biopsy, it is normal to have a greenish-blue discoloration of the urine.
• If your surgery was to the arm/hand or leg/foot, it helps to keep that area elevated.
• Return to work when cleared by the surgeon. This is on an individual basis as determined by job duties.

Pain Control

• A prescription for narcotic pain medicine may be given to you. Follow directions and use as needed. Do not take pain medication on an empty stomach, as it may cause nausea/vomiting.
• For milder pain, Acetaminophen (Tylenol) may be used, instead of the prescription pain medication. Some prescription pain medication, e.g. hydrocodone/APAP, contain Tylenol.
• Narcotic pain medicine can constipate you; drink lots of fluids, increase fiber in your diet, and you may use an over-the-counter stool softener or laxative if needed.
• Apply an ice pack to the incision area (30 minutes on, 30 minutes off) as needed while awake. Place a cloth between the skin and ice pack.

Wound Care

• The incision is closed with sutures under the skin. These will dissolve and do not need to be removed.
• You may notice bruising or skin discoloration around the incision area. It is normal to have a lump along the incision area. This will slowly resolve on its own.
• Remove the clear plastic gauze dressing by the 2nd day after surgery. You may shower with this bandage on. Remove the bandage if it gets wet under the clear plastic.
• Steri-Strips (white reinforced paper tapes) will be present over your incision underneath the outer dressing. Allow these to fall off on their own.
• You may shower with the Steri-Strips on. Do not scrub the area. Pat dry.
• If "skin glue" was used, you will not have a bandage. You may note some clear/white flakiness around your incision. Do not scrub this off. It will dissolve on its own.

Signs/Symptoms of Infection

• Fever above 100 degrees Fahrenheit.
• Redness and warmth at the incision site.
• Swelling extending out more than an inch from the incision site.
• Worsening pain from baseline pain level.
• Colored drainage, yellow or green, from the incision site.

Pathology Results

We will call you with pathology results as soon as they are available. Please allow 5 working days.

Post-op Appointment

Please call to schedule your postoperative appointment for 7-10 days after your procedure, unless instructed otherwise by your surgeon.

Call the office at 443-574-8500 with any questions or signs of infection.