1. What is surgical abortion?

Surgical abortion (Dilation and Curettage also known as D&C) is a commonly used method to terminate the first trimester of pregnancy. It is suitable for those who are less than 10 weeks pregnant. The procedure involves the extraction of pregnancy tissue (such as villi, sacs, etc.) from the uterus by surgical measure to terminate the pregnancy.

In order to facilitate the suction device and other instruments into the uterine cavity, the need to use a cervical dilator to gradually expand the cervix, plus the negative pressure suction process and the final curettage process, these will bring discomfort to you, even pain. During the operation, the patient’s relaxed mood and active cooperation with the surgeon can reduce discomfort to a certain extent. Many hospitals now have the option of performing a D&C under anesthetic analgesia, which can reduce discomfort but also increase the additional risk of anesthesia.

2. What is the effect of D&C on the body?

All operations have the potential for complications. Although the procedure is generally safe, it can lead to uterine damage in special circumstances, such as many time miscarriages, only a few months after the last delivery (or miscarriage), or excessive uterine forward flexion.

Artificial abortion too soon and too many, will cause greater damage to the endometrium, adverse impact on the future pregnancy. Therefore, unwanted pregnancies should be avoided as much as possible, and when they do occur, early termination is less damaging.

3. What should be paid attention to before the D&C?

Preoperative medical history should be truthfully provided, and necessary preoperative examinations should be completed to determine whether surgery can be performed and whether there are any high-risk factors (such as the presence of genital tract infection, lactation, etc.). You can ask your doctor about the operation and sign the informed consent form after you are fully informed.

The day before the operation should do a good personal hygiene, better take a bath, change clothes, wash perineum area. Do not have intercourse, pay attention to rest, appropriate nutritional diet.

If the patient is selected to receive D&C under anesthesia, on the date of surgery: before the operation, solid food (including milk and granular drinks) should be avoided for 6 hours, water should be forbidden for 2 hours, and empty your bladder.

4. Consider the contraceptive measures implementing after the operation to avoid another accidental pregnancy

Make full use of the time before the operation to communicate with the doctor, understand the various contraceptive options available after the operation and how to use them effectively;

• IUD can be placed at the same time of operation.

• or start taking short-acting oral contraceptives immediately after surgery;

• or use a condom when having sex again

Post-Surgical Abortion education

Will I have symptoms after a surgical abortion?

• Pain and cramping in the lower belly. This lasts for a few hours.

• Bleeding from the vagina. This is usually lighter than after a medication abortion. The bleeding can last for up to 2 weeks.

Should I call my doctor or nurse after an abortion?

Call right away if:

• Your bleeding is heavy enough to soak through 1 menstrual pad each hour, for at least 2 hours, and you are still bleeding

• Your pain is really bad (it makes you double over or makes it hard to move), and you don’t feel better with pain medicines, such as ibuprofen (sample brand names: Motrin, Advil)

• You have a fever higher than 100.4°F (38°C)

• Bad-smelling discharge comes out of your vagina

Incomplete abortion

In some cases, abortion does not work completely. In other words, they do not always get rid of all the pregnancy tissue. If that happens to you, you will need to take additional medicine or have a procedure to remove any leftover tissue. Signs that an abortion was not complete include:

• Not bleeding after a medication abortion

• Still having pregnancy symptoms, such as nausea and tender breasts, 1 week or more after your abortion

• Bleeding for more than 2 weeks after an abortion

• Not having a period in the first 6 weeks after an abortion

Is there anything I should do differently after an abortion?

Do not have sex or put anything into your vagina for 2 weeks after an abortion. If you do, you could get a very serious infection.

What if I want to get pregnant again someday?

Having an abortion does not make it harder to get pregnant again. Abortions do not harm your health, and they do not harm the health of your future babies.

Reference:
Shanghai maternal and child health center
UpToDate

Medical abortion is a non-operative approach to termination of pregnancy. This approach allows the pregnant woman to have an abortion with light pain and avoid the risk of surgery. However medical abortion still can do harm to your uterine membrane. Furthermore, about 10% patients will probably experience incomplete abortion or failed abortion. Therefore that follow-up after a medical abortion is helpful for recovery.

What respects should be pay attention after medical abortion?

Observation

One hour observation is necessary after the expelling of gestational sac, and can be discharged home if you are not having discomfort. If there is abdominal pain, vaginal bleeding more, your doctor will take appropriate measures to control it.

What may happen after leaving the hospital?

• Vaginal bleeding: A small amount of vaginal bleeding may occur for a period of time after a medical abortion, lasting longer than after a surgical abortion. If the bleeding is larger than the normal amount of menstruation (compared with the amount of bleeding on the same day of menstruation), or the time of vaginal bleeding is more than 2 weeks, you should go to the hospital in time.

• Abdominal pain: mild lower abdominal pain within a few days after the procedure. If there is more severe abdominal pain. Need to go to the hospital in time.

• Fever: there should be no fever under normal conditions. If you feel cold or uncomfortable, take your temperature. Such as a significant increase in body temperature, or accompanied by severe abdominal pain, or accompanied by a large number of vaginal bleeding, timely return to the hospital.

Follow-up visits:

• Those who did not discharge the pregnancy sac during observation should return to the hospital for further consultation 1 week after medication.

• If the pregnancy sac has been discharged during observation, the patient should return to the hospital 2 weeks after the procedure.

• All patients for medical abortion are expected to have a 6th week follow-up visit especially when your Menstruation did not recover in time.

Prevention of infection:

• Before menstruation returns back, do not have a sexual life, avoid the use of vaginal tampon, tub bath, etc., especially after a medical abortion.

• Keep the perineum clean, change sanitary pad and underwear frequently.

Back to normal life:

• Two weeks of rest is recommended after medical abortion.

• Pay attention to nutrition. Add foods rich in protein, iron and vitamins.

• Avoid early post-abortion intense exercise and heavy physical activity, so as not to increase abdominal pain and vaginal bleeding.

• If you plan to have another pregnancy, you should wait 6 months after the abortion to recover well. Because the endometrium after abortion by different degrees of damage, and need to have a recovery process, such early pregnancy is adverse to fertilized eggs implantation and development, easy to cause spontaneous abortion.

Implement contraceptive measures to avoid another unwanted pregnancy:

• There is no safe period after an abortion, and once sex is restored, another unwanted pregnancy may occur.

• After resuming sex, reliable contraceptive methods:

• Short-acting oral contraceptives: they can be used once the abortion is successful.

• Intrauterine device: can be placed after menstruation recovery.

• Condoms: can be used once sex resumes.

• Calendar calculate method, before menstruation did not restore regularly, or cannot be mastered correctly, is not recommended to use.

Reference:
Shanghai maternal and child health center

The recommendations that follow are intended as a general guide to you at home.

• Pain Control

It is common to have discomfort after surgery. You may have discomfort from the incision and muscle aches. Getting up and moving around can ease some of the discomfort. Take your pain medicine as ordered. Some medicine may upset an empty stomach. To prevent nausea, you should take the medicine with food.

Some of your pain medicine may contain acetaminophen. Acetaminophen can cause liver damage if you take too much. Do not take more than 3000mg in 24 hours. If you are taking narcotic pain medication or sleeping medication, do not drink any alcohol. You should not drive any vehicles while taking narcotics.

• Constipation

It is common to not have a bowel movement for several days after surgery. Some pain medications can also cause constipation. To help your bowels stay regular:

◦ Drink more liquids

◦ Eat more whole grains, fruits and vegetables

◦ Get regular exercise(a 15-minute walk is a good start)

◦ Take stool softeners

• Activity

The most important thing is to use good common sense in planning your activities. If it hurts, do not do it. Do not do anything to the point of exhaustion. Rest if you get tired. After minimally invasive procedures (such as laparoscopy, hysteroscopy, vaginal surgeries, and robotic procedures), you should be up and moving about freely soon after the surgery. Gradually increase your activities as follows:

◦ You are allowed to climb stairs, but try not to become too tired.

◦ Avoid heavy lifting, not more than a 4 liter bottle of water.

◦ Avoid strenuous exercise or sports for 6 weeks after major surgery.

◦ You should not drive for 24 hours after receiving general anesthesia. After that, do not drive until you can do so without discomfort and without using prescription pain medicine. This can take from 3 to 7 days.

◦ You may shower and wash your hair.

◦ No intercourse, douching, or tampons for at least 2 weeks. You may be restricted longer (6 weeks or more) if you had vaginal surgery or a hysterectomy.

• Caring for Your Incision

It is important to keep your incision clean and dry to prevent infection. Leave any covering over the incision in place for a week unless otherwise instructed. Call immediately if a large amount of fluid starts to drain or redness develops. You should wear comfortable clothing. Do not wear soiled or tight clothing over the wound. If you have paper strips of tape (Steri-Strips®) on the skin over your incision, leave them on until they fall off. These may offer extra support as your incision heals.

Once home, you may shower and care for the incision as follows:

◦ Always wash your hands before and after touching your incision.

◦ Soapy water can run over the incision.

◦ Rinse well.

◦ Pat the incision dry with a clean towel, rather than rubbing.

You may use a hair dryer on low heat to dry your incisions.

◦ Do not soak the incisions in a tub until you are told you may do so.

◦ Starting on the 4th day following surgery, restart washing the incision with CHG every day for 2 weeks unless instructed otherwise by your surgeon.

◦ Do not use lotions, cream or ointments on the wound unless they have been ordered by your doctor.

• Diet

You may eat and drink as tolerated. Go easy at first, with clear liquids, soup or broth, and crackers, before you progress to solid food. Eat foods that are easy to digest while avoiding fatty foods until your digestion returns to normal. Increase fiber and fluids if you get constipated.

• Follow-up Visit

Please plan to return for a postoperative check 1 to 2 weeks after your procedure. If an appointment has not been made for you, call your doctor’s office to be scheduled.

When to Call Your Doctor

Contact your doctor if you notice any of the following:

• Temperature over 38 ℃ (100.2℉), chills or sweats

• Drainage or fluid from the incision that continues or is foul-smelling

• Increased tenderness or soreness at the wound

• Wound edges that are no longer together

• Redness or swelling at the wound site

• Vaginal bleeding heavier than a period or foul-smelling discharge

• Difficulty urinating or urinary frequency, urgency, or burning

• Worsening pain

• Chest pain, shortness of breath, dizziness

• Pain in the calves or legs

• Nausea or vomiting

• Unable to drink fluids or keep fluids down

• If any symptom is getting worse with time

• If you do not feel well, or just aren’t sure whether your symptoms are normal

Dear Mr./Ms.                 :

Thank you for choosing the Ophthalmology Clinic of Jiahui Health for your eye surgery. We will give you a brief introduction to the preoperative preparations required, preoperative medications and postoperative precautions you need to understand for the purposes of promoting a smooth procedure and helping you understand the postoperative precautions to accelerate recovery.

1. What is vitrectomy:

• It is a method to treat diseases of the vitreous and retina under an operating microscope with the help of a vitreous cutter.

2. Preoperative preparations:
1）Preoperative irrigation of the conjunctival sac will be performed to remove intraocular foreign bodies and secretions and reduce postoperative infection.

2）Preoperatively, we will cut off the eyelashes for skin preparation to provide a better surgical field and reduce intraoperative and postoperative infections.

3. Medication instructions

1）Apply Tobramycin and Dexamethasone Eye Drops to the operative eye: 6 times daily for the first three days, followed by QID since the forth day, discontinuing two weeks later.

2）Apply Tobramycin and Dexamethasone Ophthalmic Ointment to the operative eye: QN, discontinuing two weeks later.

3）Additionally apply Gatifloxacin Eye Gel to the operative eye: QN, discontinuing two weeks later.

4）Apply Pranoprofen Eye Drops to the operative eye: TID two weeks later, discontinuing after it is used up

5）Apply Tropicamide Eye Drops to the operative eye: 6 times daily for the first three days, followed by 4 times a day since the forth day.

6）Each eye drop should be applied alternately, with an interval of more than 10 minutes. Eye drops should be applied at 1 drop/time. Intraocular water intake should be avoided within one month after surgery, and all drugs should be administered after the gauze is opened on the second morning of surgery.

7）Time for postoperative routine follow-up visit: one week, two weeks, one month, two months, and three months after surgery.

4. Postoperative precautions

1）Generally, absolute bed rest is not required for patients undergoing vitrectomy (without intraocular fillers); they may lie supine, but eyeball movements should be restricted in case of postoperative bleeding. Patients with intraocular fillers (gas or silicone oil fillers) pressing against retinal tears need to face down while resting for 8-10 hours daily for the fillers are lighter than water; the extent and specific position should be adjusted depending on the condition under the doctor’s guidance. Special emphasis should be placed on that: correct resting and sleeping postures directly affect the effect of surgery and can reduce the occurrence and exacerbation of postoperative cataracts. Please be sure to follow the doctor's guidance.

2）The eyelids are the lowest in prone position, so surgery-induced inflammatory edema is most evident in the eyelids, and the affected eye will be severely swollen, which gradually relieves 3-5 days after surgery when observation or cold compresses may be performed. A prone position should be maintained 1-2 weeks postoperatively, and it may be shifted as instructed by your doctor. Long-acting gas is generally absorbed slowly 1-2 months after surgery, while silicone oil often needs to be removed surgically.

3）Patients should apply eye drops regularly and correctly, take medicine in time, eat more vegetables, and avoid spicy, stimulating and hard food to keep bowels open. The medical staff should be informed of headache, nausea, vomiting, eye pain, eye distension, severe wound pain, insomnia, etc. (if any) in time. Eyes should not be touched or rubbed with hands casually; hands should be washed before applying eye drops, and at least 10 minutes of rest with eyes closed is required after applying eye drops. It is necessary to avoid strong light stimulation, keep indoor light soft, and possibly wear colored safety glasses when going out. Doctor’s instructions should be followed to adjust medication frequency or reduce dosage in time. There is no need to worry in case of increased intraocular pressure; please communicate with doctor timely, adjust medication and apply intraocular tension-lowering drugs.

4）Regular reviews are required to monitor visual acuity, intraocular tension, retinal fundus and visual field. Please seek medical attention timely to prevent recurrence in case of any abnormality. A review is required 1 week after gas filling, and the intervals between subsequent reviews are gradually extended after the gas is completely absorbed. For patients with silicone oil fillers, it takes 3 months to half a year before taking out the silicone oil in hospital. The specific time for oil removal should be recommended by the doctor according to ordinary follow-ups, and discussed with the doctor. Long-term retention of silicone oil in the eyes may induce emulsification, cataract, glaucoma, corneal zonal degeneration and other complications, but there are significant individual differences - some people develop significant complications in a relatively short period of time, while others, especially the elderly who are less active, may not develop significant complications for a long time. Please pay timely visits to hospital for examination in case of eye pain, significant decline of vision, and other symptoms, to prevent the vision from damage by silicone oil emulsification and other complications in the later stage.

5）Activities should be restricted: excessive activities should be restricted for half a year after surgery, and heavy physical labor should be restricted for one year. For patients filled with C3F8, before the gas is fully absorbed, they should avoid working at height, taking an airplane or traveling to the plateau, so as to avoid a series of complications such as central retinal artery/vein occlusion. Strenuous exercises such as running and jumping should be avoided in 3 months after surgery, and diving, boxing and other sports that may hurt the eyes are strictly prohibited; regular reviews are required.

6）Patients should keep optimistic and comfortable; be prepared to fight the disease for a long time. It is important to realize that if cataracts are not removed at the time of vitrectomy, they may appear earlier or worsen in your intraoperative eye.

7）Please seek medical attention timely in case of severe headache, nausea, vomiting, eye pain, severe wound pain, insomnia and other conditions, and call the hospital prior to your visits.

Dear Mr./Ms.                                :

Thank you for choosing the Ophthalmology Clinic of Jiahui Health for your eye surgery. We will give you a brief introduction to the preoperative preparations required, preoperative medications and postoperative precautions you need to understand for the purposes of promoting a smooth procedure and helping you understand the postoperative precautions to accelerate recovery.

1. Strabismus is a disease related to both eyes; thus, to correct the eye position, surgery is sometimes performed on both eyes, and sometimes only on either eye. A decision should be made by the surgeon depending on the patient’s specific condition and the preoperative and intraoperative examination results of eye position.

2. This surgery does not affect visual acuity and diopter. Patients with postoperative ametropia still need to wear glasses. The spectacle lens power may be adjusted according to the eye position.

3. It is normal to have strabismus after strabotomy without wearing glasses.

 
4. The following intraoperative and postoperative complications may occur, commonly including:

 
1) Pain and congestion of the operative eye

2) Postoperative diplopia

3) Inadequate correction or overcorrection of postoperative eye position

4) Poor healing of conjunctival wounds

5) Postoperative decline of short-term corrective effect

6) Partial non-concomitant strabismus (paralytic strabismus)

Eyeball movements cannot be recovered after surgery; diplopia does not subside or only partially improves

7) Some special types of strabismus require more than one operation

5. Systemic surgical complications: As with all surgeries, other complications may arise from anesthesia, drug reactions or other factors affecting other parts of the body, including the oculocardiac reflex and anesthesia accidents.

6. Since it is impossible to list all the complications of this surgery, the above list does not cover them all.

 
7. Due to undercorrection or overcorrection of the operative eye position, a second correction or training may be required after surgery.

 
8. Purpose of strabotomy: Not only for beauty, but more importantly, to create conditions for the establishment of normal binocular vision and stereoscopic vision. Therefore, postoperative comprehensive treatment and training are still necessary, and surgery is merely an important means of comprehensive treatment. Moreover, the eye position may change for a quite long time after strabotomy, so regular follow-up visits and doctor’s guidance are required.

9. Postoperative medication guidance:

1) For medication, please follow the discharge instructions in the discharge summary

2) Please apply appropriate ice compress within 2 days after surgery

Dear Mr./Ms. :                    

Thank you for choosing the Ophthalmology Clinic of Jiahui Health for your eye surgery. We will give you a brief introduction to the preoperative preparations required, preoperative medications and postoperative precautions you need to understand for the purposes of promoting a smooth procedure and helping you understand the postoperative precautions to accelerate recovery.

1. Purpose of entropion and trichiasis surgery:

1) To improve ocular surface irritation induced by entropion and trichiasis, and reduce the risk of ocular surface complications

2) To improve appearance

2. The following intraoperative and postoperative complications may occur, commonly including:

1) Postoperative overcorrection, undercorrection, angular deformity, aberrant lashes, conjunctival prolapse, etc., requiring re-adjustment under anesthesia

2) Postoperative recurrence of entropion and trichiasis, requiring re-operation

3) Postoperative scar hyperplasia

3. Systemic surgical complications: As with all surgeries, other complications may arise from anesthesia, drug reactions or other factors affecting other parts of the body, including the oculocardiac reflex and anesthesia accidents

4. Since it is impossible to list all the complications of this surgery, the above list does not cover them all

5. Postoperative medication guidance:

1) For medication, please follow the discharge instructions in the discharge summary

2) Please apply appropriate ice compress within 2 days after surgery

6. Please pay visits to the attending physician’s Ophthalmology Clinic for follow-up visit and stitch removal 1 week after surgery.

Preoperative Instructions for Cataract Surgery

Dear Mr./Ms.________________:

Sincerely thank you for choosing Jiahui International Hospital to provide you with cataract surgery. We provide this manual to help you understand what you need to prepare for this surgery. Proper preparation will help you cope with the surgery easily and facilitate your postoperative recovery. Please read this manual carefully and feel free to ask questions to learn more about surgical announcements.

Pre-operation

1）Instructions for Use of Preoperative Eye Drops:

Antibiotic eye drops should be applied to the operative eye 3 days before surgery, 1 drop/time QID.

2）Please refer to the figure below for the usage of eye drops

4）Please clean your eyes and avoid makeup on the day of surgery.

5）If local anesthesia is applied, normal food intake is allowed before surgery; fasting and water restriction are not required.

6）Attention should be paid to preoperative changes in blood glucose for diabetic patients: for vitreoretinal surgery, 2-hour postprandial blood glucose should be monitored on the day of surgery; if the blood glucose level is above 13mmol/dl, surgery will be rescheduled until it remains below 13mmol/dl.

7）Please inform your doctor or nurse in case of preoperative eye infection or inflammation.

8）Instructions for registration time: on the day of surgery, if you will undergo local anesthesia, please arrive at the front desk (next to the pharmacy) on the first floor of the Clinic one hour before surgery, and an operation room nurse will pick you up to the Operating 

Room; if you plan to undergo general anesthesia, please arrive at the front desk of the hospital 2 hours in advance since your surgical team needs to make some preparations for you and take notes for some documents before general anesthesia.

Postoperative Instructions for Cataract Surgery

1.Postoperative use of eye drops: apply eye drops for 2-4 weeks (as instructed), 6 times daily for the first three days and QID thereafter, or as instructed; use of mydriatics: 6 times daily for the first three days and QID thereafter, or as instructed; different eye drops should be applied at an interval of more than 10 minutes, 1 drop/time.

2.Within one month after cataract surgery, the doctor will prescribe hormonic and antibiotic eye drops for the affected eye to prevent adhesions of pupil after mydriasis. If you have been using hormonic eye drops for a long time, it is necessary to observe whether there is eye distension, eye pain and other signs of increased intraocular pressure; please inform your doctor in time if any of the above symptoms.

3.Postoperative symptoms or discomfort: please don't be panic if you have the following symptoms, which are normal phenomena:

Eyes may be photophobic and blurry after mydriasis

Postoperative eyes have foreign body sensation and mild hyperemia.

Within one month after surgery, if you need to go out, it is recommended to wear glasses or sunglasses in strong sunlight to prevent dust, sunlight and wind from getting into your eyes. Your eyes may feel itchy during recovery, but do not rub them with your hands.

4.Postoperative home eye care:

No water is allowed in the operative eye within one month after surgery (special attention should be paid when washing hair).

If there is a little secretion in the operative eye, please wipe it gently with a clean cotton swab.

Activities: Do not drive after surgery until a permission is obtained from your doctor; within three months after surgery, please avoid strenuous exercises, eye squeezing, eye rubbing and head movements, such as wagging your head.

Rest: If you feel tired, please take more rest.

5.Follow-up visits

Please visit the clinic on time as required by your doctor: follow-up visits are generally scheduled in 1 day, 1 week, 2 weeks and 1 month after surgery

6.Please contact your doctor or go to the nearest hospital immediately in any of the following cases:

Pain or vision loss persists for several weeks after surgery.

Postoperative symptoms of headache and nausea (increased intraocular pressure) persist for 2 hours, or sharp loss of vision occurs.

Eye pain, significant eye distension, loss of vision, increased secretion, and severe tearing occur postoperatively.

Postoperative Instructions for Cataract Surgery

1.Postoperative use of eye drops: apply eye drops for 2-4 weeks (as instructed), 6 times daily for the first three days and QID thereafter, or as instructed; use of mydriatics: 6 times daily for the first three days and QID thereafter, or as instructed; different eye drops should be applied at an interval of more than 10 minutes, 1 drop/time.

2.Within one month after cataract surgery, the doctor will prescribe hormonic and antibiotic eye drops for the affected eye to prevent adhesions of pupil after mydriasis. If you have been using hormonic eye drops for a long time, it is necessary to observe whether there is eye distension, eye pain and other signs of increased intraocular pressure; please inform your doctor in time if any of the above symptoms.

3.Postoperative symptoms or discomfort: please don't be panic if you have the following symptoms, which are normal phenomena:

Eyes may be photophobic and blurry after mydriasis

Postoperative eyes have foreign body sensation and mild hyperemia.

Within one month after surgery, if you need to go out, it is recommended to wear glasses or sunglasses in strong sunlight to prevent dust, sunlight and wind from getting into your eyes. Your eyes may feel itchy during recovery, but do not rub them with your hands.

4.Postoperative home eye care:

No water is allowed in the operative eye within one month after surgery (special attention should be paid when washing hair).

If there is a little secretion in the operative eye, please wipe it gently with a clean cotton swab.

Activities: Do not drive after surgery until a permission is obtained from your doctor; within three months after surgery, please avoid strenuous exercises, eye squeezing, eye rubbing and head movements, such as wagging your head.

Rest: If you feel tired, please take more rest.

5.Follow-up visits

Please visit the clinic on time as required by your doctor: follow-up visits are generally scheduled in 1 day, 1 week, 2 weeks and 1 month after surgery

6.Please contact your doctor or go to the nearest hospital immediately in any of the following cases:

Pain or vision loss persists for several weeks after surgery.

Postoperative symptoms of headache and nausea (increased intraocular pressure) persist for 2 hours, or sharp loss of vision occurs.

Eye pain, significant eye distension, loss of vision, increased secretion, and severe tearing occur postoperatively.

Tobacco use is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. Smoking cessation reduces risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancer. When coming into the hospital setting, one of the most important actions you can take to improve your health is to quit smoking, no matter how old you are or how long you’ve been smoking. Jiahui International Hospital is committed in building a hospital environment that is smoking-free.

2. How does quitting smoking help with surgical outcomes?
• Quitting cigarettes before surgery makes a huge difference. Patients can expect fewer complications if they stop smoking three to four weeks before other types of surgeries too, but even quitting a day or two before any surgery can make a tremendous difference.
• Just within a day or two after stopping, the body can bring more oxygen to cells and blood flow improves, making it easier for healing. Three to six weeks after stopping, the body’s defenses against bacterial infection improve.

3. When to quit smoking before surgery
• The sooner you can quit smoking prior to surgery, the better.
• With each passing smoke-free day, your overall risk of complications decreases. Quitting even 12 hours prior to surgery can make a difference, but quitting eight weeks before surgery can have a dramatic impact on your surgery and recovery.

• When you quit matters:
◦ 12 hours before surgery: improved oxygenation, blood pressure, and heart rate
◦ 2 weeks before surgery: less breathing problems during surgery
◦ 3 weeks before surgery: wound healing improves
◦ 8 weeks before surgery: decreased risk of clot-related problems (heart attack and stroke) and risk of infection; improved immunity and response to anesthetic medications

4. What is the policy of Jiahui International Hospital for smoking cessation?
• At our hospital, you will be advised not to smoke in doors.
• If you are a surgical patient, we recommend you start quitting smoking at least one week prior to your surgery to prepare you for the procedure and your recovery. This will be the best time for you to start quitting smoking while you’re taking care of by doctors and nurses.
• Any challenge through your quitting smoking journey, please call your health care providers (Call Center: 4008683000) to discuss any alternative method to do more to help you quit smoking.

5. What you should do if you want to quit smoke?
• It's a good idea to start by talking with your doctor or nurse. It is possible to quit on your own, without help. But getting help greatly increases your chances of quitting successfully.
• Here are some tips for you if you feel like you are ready to quit:
◦ Start by making a plan first:
  Set a quit date;
  Tell your family and friends that you plan to quit;
  Plan ahead for the challenges you will face, such as cigarette cravings.

References：
Global Burden of Disease [database].Washington, DC: Institute of Health Metrics;
2019. IHME,accessed 17 July 2021
https://www.who.int/news-room/fact-sheets/detail/tobacco
https://www.mgh.net/wellness/tobacco-cessation/
https://www.massgeneral.org/community-health/cchi/community-health-associates/living-tobacco-free
Smoking and Tobacco Use | CDC

Welcome to Jiahui International Hospital (JIH) located in 689 Guiping Road, Xuhui District, Shanghai. Our mission is to provide excellence in healthcare for our patients. We are dedicated to providing you with an experience that is efficient, high quality and as comfortable as possible. We have provided this set of instructions to help you learn what to expect and how to prepare for your upcoming procedure. Advanced preparation helps you relax, and may speed your recovery. Please read this brochure and feel free to ask questions to learn more.

Before Surgery
1. What to bring
• Please bring any test results not done at Jiahui Health when you check in on the day of surgery.
• Please bring all medication labeled containers or boxes if you currently take them regularly.
• Eyeglasses, contact lenses & case, Hearing aid(s) & case, denture case (if applicable).
• ID or passport, Chinese social security card, commercial insurance documents.

2. Preparing for surgery at home
Pre-operative Diet
• We recommend increasing the carbohydrates in your diet for 1 to 2 days before your surgery. This will help your body have the energy you need for surgery and recovery. Foods that are good sources of carbohydrates include: pasta, rice, cereals, bread, beans and lentils, milk and fruit.
• If you are diabetic, please discuss with your doctor about how to manage your diet.

Smoking and alcohol
• If you smoke and you are scheduled for surgery, we recommend that you take immediate steps to stop smoking at once. Do not smoke at least one week before your surgery. Smoking will not only increase your airway secretion, but also decrease blood flow making surgical wounds less likely to close, less likely to heal well and more likely to become infected.
• Please do not drink alcohol for 48 hours before your operation. Alcohol may change how your body reacts to medications during the operation.

Current medication taking
• Most medications should be taken on your usual schedule the day before your surgery. If you take medications listed below, please discuss with your doctor:
• Anticoagulant/blood thinning medication
Please discuss with your surgeon if and/or when you should stop the anticoagulation prior to your surgery.
• Blood Glucose Medication
Please follow your doctor’s instruction about holding or cutting down your morning diabetic medication dose.
• Antihypertensive medication
You may take your anti-hypertensive medication with a sip of water on the day of your surgery. If you are undergoing thoracic surgery, please stop taking anti-hypertensive medication that contains reserpine composition one week before the surgery.
• Hormonal Medication
You can continue to take your hormonal medication before surgery to avoid fluctuation of medication concentration (e.g. thyroxine sodium, female hormones). If you are currently taking steroids, please follow your doctor’s instruction. Your doctor may elect to substitute your oral steroids with an intravenous dose.
• Any medication you have been told to take before surgery, take it with small sips of water.

3. Arriving for surgery in the hospital
Arrive on time
Please arrive 2 hours before your scheduled surgery time. Every effort is made to ensure your surgery begins at the scheduled time. Your surgery might be delayed due to unexpected reasons, such as emergency or prolonged operation time for the first patient. We will inform you at the right time if this is the case.

Pre-operative assessment
A nurse will take you to the pre-operative area and complete a final checklist with you. You will be asked to change into a hospital gown. You will meet your anesthesiologist (the doctor who will provide your anesthesia) and other members of your surgical team who will answer any questions and ask you to sign or confirm the consent forms.

Information for families
• It is helpful to designate a family spokesperson, so the health care staff can update your condition to them during or after your surgery.
• We cannot share any medical information about you by phone to outside callers. Family or friends may wait for you in the surgical waiting area located on the 2nd floor of ambulatory building.
• COVID-19 negative test results are required within the required validated period (follow pre-surgery patient instruction by your nurse) for both you and any of your significant others accompanying you in the hospital.

During Surgery
1. Anesthesia:
• You will be receiving care from the anesthesia team who will keep you comfortable and pain-free. Inside the operating room, you will be introduced to your care team, you will be asked to participate in our safety checks, and then your anesthesia will be administered.
• Your anesthesiologist will use multimodal pain control regimens to help reduce your pain and discomfort. The multimodal pain control regimens will be adjusted according to its efficacy and if any adverse event occurs.
• Immediately after waking up, you may feel dizzy or sometimes nauseous. Your anesthesiologist will be by your side to provide further medication and treatment. This discomfort will gradually go away while you recover.

2. In the Operating Room
Staffing: Your Surgical Team usually includes the followingmembers:
• Surgeon, who is responsible for your overall care, leads your surgical team.
• A surgical assistant will be present when more than 1 doctor is necessary to perform your surgery.
• An anesthesiologist provides anesthesia or medication, and monitors vital signs.
• A scrub nurse sets up instruments and assists the surgeon.
• A circulating nurse prepares the OR, makes sure sterile methods are followed, and helps other team members.

The Equipment
• An IV (intravenous line) will be used to provide fluids to your body. When needed, medications and blood are also given through the IV. An IV feels like a pinprick when it is inserted.
• Monitors show your vital signs (blood pressure, heart rate, heart rhythm, etc.).
Electrocardiography records your heart functions. It is connected by wires to round, sticky patches that are placed on your upper body.
A pulse oximeter, placed on your finger, monitors your blood’s oxygen level.
Blood pressure cuff is placed on your arm to monitor your blood pressure.

There will be surgical lights overhead and other equipment around you in the room to help in your operation, and to make sure you are safe and comfortable.

After Surgery
1. In the PACU (Post-Anesthesia Care Unit)
After your surgery, you will wake up in the Post-Anesthesia Care Unit (PACU). Your nurse will check your blood pressure, pulse and incision frequently. The nurse will ask you about your pain and make sure you are comfortable. You will stay here for several hours until you are fully wake.
You may have:
• An oxygen mask over your face
• An intravenous line giving you fluids and medicine
• When you are ready, you will be discharged from the PACU to either go home or be admitted to a hospital room, depending on your level of recovery and the type of procedure that was performed.
• If you are discharged to go home, be sure to have an adult friend or family member drive you home after surgery.
• If you are admitted to the hospital for further observation, your family can visit you once you are in the ward.

2. Recovery in the Hospital
Pain Control
Most patients will experience some pain or discomfort after surgery, but it should never be unbearable. At Jiahui Health, your anesthesiologist manages pain relief during your surgery and afterwards. Our goal is for every patient to be comfortable enough to take deep breaths and move as needed because this helps your recovery process.
Your PACU nurse will ask you to describe your pain using a scale numbered between 0 to 10. 0 means no pain and 10 is the worst pain you can imagine. The goal is to keep your pain level below 3.
You may receive medicine through your IV or by mouth to help control your discomfort. Please let us know if you have uncontrolled pain.

Eating
Food may be hard to digest after surgery. So, you may have an IV for fluid and nutrition when you are in the hospital. You will start by drinking some water in PACU after you fully wake up. Usually your digestive function will return to normal 4-6 hours after surgery. Your doctor will give you specific orders about eating and drinking at home.

Discharge: You will be ready to go home when you have reached the following goals:
• Your pain is well-controlled.
• You are able to walk without assistance.
• You are able to drink water without too much nausea.
• You are able to use the bathroom on your own. If you have trouble to urinate please let your doctor or nurse know and they will help you.

3. Recovering at Home
Most patients improve each day following surgery. You will gradually feel stronger and become more active. It is important to keep your follow-up appointments with your doctor, even if you are
feeling well.

Pain Control
It is common to have discomfort after surgery. You may have discomfort from the incision and muscle aches. Getting up and moving around can ease some of the discomfort. Take your pain medications as ordered. Some medicine may upset an empty stomach. To prevent nausea, we recommend you take the medicine with food. If you are taking narcotic pain medication or sleeping medication, please do not drink any alcohol. You should not drive any vehicles while taking narcotics.

Diet
• Eat foods which are easy to digest such as clear liquids, soup or broth, and crackers.
• Slowly change to normal solid food and avoid fatty foods until your digestion returns to normal.
• Increase fiber and fluids if you get constipated.

Activity
Early activity such as walking, deep breathing, coughing, and turning can speed up your recovery and increase circulation to decrease complications such as blood clots, pneumonia and poor wound healing, etc. To avoid falling, ensure there is someone with you when you first start to exercise. You might experience dizziness if you move or change positions too quickly.

Gradually increase your activities as follows:
• Avoid heavy lifting, not more than a 4 liter bottle of water.
• Avoid strenuous exercise or sports for 6 weeks after major surgery.
• You should not drive for 24 hours after receiving general anesthesia. After that, do not drive until you can do so without discomfort and without using prescription pain medicine. This can take from 3 to 7 days.
• You may shower and wash your hair one day after surgery.

Caring for Your Incision
• It is important to keep your incision clean and dry to prevent infection. Wear comfortable clothing.
• Leave any covering over the incision in place for a week unless otherwise instructed.
• If you want to take a shower, it is better to wait until a day following surgery using a waterproof wrapper to cover your incision. When you have a shower, please care for the incision as follows:
◦ Always wash your hands before and after touching your incision.
◦ If the dressing is wet after the shower, please change the wet dressing. Pat the incision dry with a clean towel, rather than rubbing. You may use a hair dryer on low heat to dry your incisions.
◦ Do not soak the incisions in a tub till the wound is completely healed.
◦ Do not use lotions, cream or ointments on the wound unless they have been ordered by your doctor.
• Call immediately if a large amount of fluid starts to drain or redness develops.

Constipation
It is common to not have a bowel movement for several days after surgery. Some pain medications can also cause constipation. To help your bowels stay regular:
• Drink more liquids
• Eat more whole grains, fruits and vegetables
• Get regular exercise (a 15-minute walk is a good start)
• Take stool softeners

Follow-up Visit
• You will receive a phone call from the hospital within 24 hours after your surgery to make sure you are doing well. The nurse who calls you is available to answer any of your questions.
• Please come back for your follow-up visit on time as instructed by your surgeon.

When to Call Your Doctor
Please contact your doctor if you notice any of the following:
• Temperature over 38℃ (100.2°F), chills or sweats
• Drainage or fluid from the incision that continues or is foul-smelling
• Increased tenderness or soreness at the wound
• Wound edges that are no longer together
• Redness or swelling at the wound site
• Difficulty urinating or urinary frequency, urgency, or burning
• Worsening pain
• Chest pain, shortness of breath, dizziness
• Unable to drink fluids or keep fluids down
• If you do not feel well, or just aren’t sure whether your symptoms are normal

If you have any questions, you can call our 24/7 hotline number:4008683000

Lymphedema and Breast Cancer

People who have been treated for breast cancer are at risk for developing lymphedema (limf-ah-deema). This pamphlet will give you information about lymphedema and its treatment.

When does BCRL usually occur?

Breast cancer-related lymphedema may appear weeks, months, or even years after breast cancer surgery or regional lymph node radiotherapy, but most of them occur within 3 years after surgery. If you are experiencing or have experienced treatment, you should seek professional advice for prevention and treatment of lymphedema.

What is the lymphatic system, and what is its function in the body?

Lymph fluid, lymphocytes (white blood cells), lymph vessels, and lymph nodes are part of the body’s lymphatic system. The lymphatic system removes cell waste and protects the body from infections and disease. It does this by collecting extra fluid, proteins, and other substances from the body’s tissues. It is moved through the body in tiny vessels that are much smaller than veins. Bean-shaped lymph nodes filter the fluid to remove waste and bacteria. Other lymph vessels carry the lymph back to the bloodstream.

What is lymphedema?

Lymphedema is a breakdown of lymphatic refluxes leading to the accumulation of protein-rich fluids in the stroma. When the lymphatic vessel load exceeds the transport capacity of the lymphatic system, it will cause the accumulation of filtrate, which will lead to lymphedema. Surgical removal of lymph nodes (lymph node resection) and radiotherapy are the main causes of lymphedema in breast cancer patients, but Breast Cancer-Related Lymphedema (BCRL) can also be caused by lymphatic or lymph node obstruction or by tumor cell infiltration (cancerous lymphangitis)

Some early symptoms of BCRL：

•Puffiness or edema in the hands or arms

•Clothes, underwear or jewelry feel tighter than before

•Grooves or marks are left on the skin when taking off jewelry or clothing

•A feeling of swelling in the breast, chest or arm

•Arms feels heavy

What are the risk factors for lymphedema?

Breast cancer and related treatments are the most common causes of upper limb lymphedema. The main risk factors for BCRL include the diagnosis of invasive cancer, axillary lymph node dissection/destruction, radiotherapy, local infection, and obesity, but other factors may also play a role.

We recommend the following precautions to protect affected limbs:

•Monitor limb condition, including measuring and recording upper limb size. Measurements should be taken at the palms of the hands (if edema is present), the wrists, and 10 cm below and above the elbow joint

•Carefully maintain skin hygiene and nail care to prevent infections that may cause cellulitis

•Protect exposed skin, including using sunscreen and wearing gloves when participating in activities that may cause skin damage

•Wear suitable graded pressure sleeves

•Avoid medical procedures that require puncturing the skin of affected limbs (e.g., vaccination, acupuncture, venous bleeding, venous catheterization, venography)

•Manage your weight

BCRL prevention advice for daily life:

•Exercise

Adhering to proper exercise habits can not only help blood circulation and maintain your ideal weight, but also control edema. It is recommended that exercise be carried out under the guidance of a medical professional.

•Repeated actions

For most people, some repetitive movements will not be a big problem, such as mopping the floor, using a vacuum cleaner, painting, or training on a rowing machine. However, some patients can develop lymphedema due to these repetitive actions. When you perform repetitive activities, please pay attention to how your arms and hands react. If you feel swelling or pain during or after the activity, you should immediately stop the activity, reduce its intensity, or shorten its length.

•Take a hot shower/bath or use a sauna

For some people, lymphedema could be caused by taking a hot shower or bath, or using a sauna. If you want to do any of these activities, start by doing it for a few minutes, paying close attention to possible edema reactions in your body.
Traveling by airplane

Before boarding the plane, during the flight, and after landing, you should drink plenty of water. Stretch your arms from time to time while you are waiting for the plane and during the flight. If you do not have lymphedema, it is not necessary to wear a pressure sleeve, but you must wear pressure sleeves when flying if you already have lymphedema. The selection and wearing of pressure sleeves needs to be carried out under the guidance of a physiotherapist.

Our Rehabilitation services for BCRL：

•Breast cancer postoperative posture correction training

•Breast cancer postoperative rehabilitation exercises

•Prevention of complications after breast surgery

•BCRL Risk Factors Screening

•Assessment of upper limb range of motion and muscle strength

•Multilayer compression bandage wrapping

•Detumescence exercises

•Kinesio Tape

•Intermittent Pneumatic Compression

•Customized home exercise plan for lymphedema prevention