If you treatment involves surgery you will be given a date for surgery (depending on doctors availability and your
convenience unless it is an emergency). Dr Novikova operates at Mediclinic Cape Town on Monday mornings. She does her best to accommodate you in terms of the surgery date.You are expected to obtain an authorisation from your medical aid for the procedure and hospital admission. You will be given all necessary documentation to facilitate the authorisation process. Depending on your medical aid cover you may have to pay a co-payment for doctor’s fee. Our fees are payable on a day of the service provision.
Investigations before surgery
You may be asked to have blood tests, X-ray, ECG or other tests to assess your fitness for surgery.
You will be admitted to the hospital on the day of the procedure (unless advised otherwise). You will be advised on the time you need to come to the hospital (usually 6 am if surgery is planned in the morning and 10 am if it is planned in afternoon).
Depending on the procedure you may be able to go home on the same day or you may have to stay in the hospital for one or more days.
Diet Before Surgery
You should not eat or drink anything for 6 hours prior to your allocated surgery time. There is no need for a special diet or bowel preparation, unless instructed otherwise.
PLEASE NOTE: if you do not adhere to the diet prior to your surgery, your surgery will not proceed.
Your Regular Medications Before Surgery
It is very important to report all medications (including food supplements and herbal medicine) you take to Dr Novikova during your visit as some of them may thin or thick your blood and cause potential complications. Because of that, some medications have to be stopped before the operation.
Hormones are to be continued unless advised otherwise. Tamoxifen should be stopped 14 days before the procedure. Non-steroidal anti-inflammatory pain medications such as Nurofen, Ponstan, Voltaren, Aspirin, Clopidogrel need to be stopped 7 days before your surgery. If you are taking Clexane or Warfarine or any other blood thinning medication, please discuss with Dr Novikova regarding when to stop these prior to the surgery. Continue other medications (e.g. heart, diabetes, antihypertensives) – take with a small amount of water on the morning of your surgery. Herbal medicine and nutritional supplements such as omega-3, fish oil, echinacea, creatine, ginger should be stopped 7 days before surgery.
Dr Novikova works with the anaesthetist Dr Anthony Aubin and Dr Tim Kambarami, from the ACT Group . Please refer to their website at www.a-ct.co.za for more information on anaesthesia for surgery.
- Diet – You can eat and drink immediately following the operation. Start with small portions and light meals and gradually increase it to your regular diet. Keep well-hydrated with water, which will help to prevent clots.
- Medications – you can re-start your regular medications following surgery. You will be given pain-killers (may be as an injection initially, and as tablets once you pain is improved). Please note that strong pain medications generally cause constipation, therefore, we try to wean them off as quickly as possible.
- Pains after Surgery – it is common to have pain around the incision area as well as around the area of surgery inside of tummy, painful cramps, nausea, swelling in the tummy due to gas used in laparoscopy, pain in shoulders and upper abdomen especially with breathing. It is important to remember that the pain should be gradually getting better and not worse.
- Vaginal Bleeding – you may have vaginal bleeding for about a week following surgery. The bleeding should be getting lighter day by day. Your period after surgery may come at a different time to usual time.
- Bowel function / Constipation – it is common to develop constipation because of anaesthesia, surgery itself as well as opioid pain medications (codeine, panadeine, morphine, oxycodone) used following surgery. It is important to stay well-hydrated with water, eat healthy high-fibre diet with vegetables and yogurt, and start physical activity (walking) as soon as possible following surgery. Sometimes we use laxatives (movicol) to help with bowel function.
- Exercise -walking can be started as soon as possible and for as long as you are comfortable. Avoid high impact exercise for 4 weeks following surgery. If you would like to re-start particular type of exercise before 4 weeks please discuss the details with Dr Novikova to make sure it is safe.
- Going Home – you are usually discharged from the hospital on the same day or following day after laparoscopic or hysteroscopic procedure, and in 2 days after open / abdominal surgery. Your discharge will depend on your general condition, support at home, pain control (you should not need injections for pain when you are at home), bowel and bladder function. On some occasions, if you are unable to pass urine following surgery, you may have to go home with the catheter (tube in your bladder), which will be removed once your bladder function recovers usually in about a week.
- Driving – please contact your insurance company to find out when you are allowed to drive following surgery in terms of your insurance cover. General medical advise (not related to you individual insurance) is that you can drive when you have no pain, are not using any pain killers and able to press your foot hard on the floor without any pain in your body. If you had minor surgery (for example, hysteroscopy) you can re-commence driving 24 hours following anaesthesia.
- Sex – you can resume sexual activity as soon as you stopped bleeding and have no discomfort. If you are trying to fall pregnant you can resume trying to conceive following your menstrual period.
- Work – you will be able to return to work in 2 weeks following laparoscopic or vaginal surgery and in6 weeks following abdominal surgery. You can return to work following day after hysteroscopy, treatment of abnormal Pap smear. You should avoid heavy lifting, intense house hold duties for 4 weeks following surgery.
- Post-operative Care – Dr Novikova will see you in the hospital following surgery and will advise you on follow-up visit after surgery. You are welcome to contact her for any questions.
Please contact Dr Novikova if you develop any of the following symptoms after surgery
– pain in your tummy that is increasing in intensity and is not controlled by the prescribed pain killers
– persistent vaginal bleeding, which is becoming heavier
– smelly vaginal discharge
– pus, swelling, increasing redness around incisions
– pain or burning when you are passing urine or need to pass urine frequently
– inability to pass urine
– collapse, dizziness
– any concerns you may have about your surgery
If you are unable to get in touch with Dr Novikova please present to the hospital Emergency Department of Mediclinic Cape Town or any other hospital