OUTPATIENT PROCEDURES

Minor Procedures and cyst or lumps and bumps removal
Minor procedures includes outpatient small surgeries which is done under local anesthetic. This is very similar to dental work. These surgeries include removal of cyst, lipoma or other superficial skin lesions.
Steps of this procedures usually are:
1- removal of hair (if it's necessary) and cleaning up the area with antiseptic solution.
2- Injection of local anesthetic around the lesion.( A few had previous reaction to local anesthetic notify the nurse and doctor)
3- Removal of the lesions and closing the wound with or without sutures.
4- There will be a discharged with instruction regarding wound care and follow-up appointment.
5- Most of these procedures did not need prescription medication for pain or antibiotics.
Minor Procedure Discharge Instructions:
- Please call to schedule an appointment in 2 weeks.
- If You have sutures or staples that need to be removed. You may have sutures that are    absorbable and do not need to be removed.
- Please remove Steri-Strips in 7-10 days.
Dressing: Remove the bulky dressing tomorrow. You may shower in 48 Hrs after your procedure but do not immerse incision site in water, (i.e. pool, Jacuzzi, or bath). You may wash the area daily with soap and water. Avoid using any cream or ointment unless it is instructed.
After the procedure resume your current regular medications, You can start taking blood thinners (i.e. Plavix, Aspirin, Coumadin, Pradaxa, etc.) in one day after the procedure.
If you have prescribed narcotics you may need a stool softener and these may be purchased over the counter (i.e. Miralax, Senekot X, or Peri-colace). Otherwise you may take over the counter Tylenol or Advil if it is necessary
You may have some numbness and bruising. If the incision oozing blood apply pressure for 20 minutes and if continues call my office or go to the ER.
You can expect some incisional pain but this should be minimal.

Call my office (416) 913-6457 or go to the emergency room if:

-          You notice fever or chills and have a temperature of over 38 degrees.
-          Your incision turns red and expanding and very painful
-          Your pain worsens after the surgery.
-          Tenderness or swelling in one or both calves.
-          Shortness of breath or chest pain.
-          Cloudy or foul smelling drainage.
-          Drainage that continues beyond 4 to 5 days.

Do Not Smoke: Smoking has been shown to slow the healing process and increase your chance of infection. Your primary care doctor can help with medications or patches.

Rigid sigmoidoscopy for assessment of anorectal disease

What is a rigid sigmoidoscopy?
Rigid sigmoidoscopy is a procedure done to look at the rectum and lower colon. The doctor uses a special tube called a scope. The scope has a light and a small glass window at the end so the doctor can see perianal area and insight the anus, rectum and lower part of the colon.
This procedure is done for many reasons. Some reasons are:
• to look for the cause of rectal bleeding • a tissue sample to test called a biopsy
The procedure takes about 5 minutes but plan to be at the hospital for ½ hour.
Are there any complications to this procedure?
Your doctor will explain the problems that can occur before you sign a consent form. Problems are rare but include:
􀂉 The scope can damage the lining of the rectum.

􀂉 The scope can cause severe bleeding by damaging the wall of the colon or after banding of hemorrhoids.

􀂉 You may have blood spotting if a biopsy is done or a polyp is removed.
Since the doctor and nurse are with you all of the time, they can manage any problem that may occur.

What do I need to do to get ready at home?
4 to 5 days before your procedure:
Taking medications:
Your doctor may want you to stop taking certain medications (like ASPIRIN or PLAVIX) 7-10 days before the procedure. If you need to stop any medications, your doctor will tell you during the office visit. If you have any questions, call the doctor’s office.
Buying a Fleet enema:
Your bowel must be clean and empty of waste material before this procedure. Your surgeon will ask you to use a rectal fleet enema. You will need to buy a Fleet enema at your pharmacy. The pharmacist can also tell you how to give yourself an enema.
The day of the procedure:
Giving yourself an enema:
During the office visit with your doctor, you will be told if you use the Fleet enema in the morning before you come to the hospital. To put the enema in, follow the instructions on the box.
If you think you may have trouble sliding the enema in, buy some K-Y jelly to put on the tube to lubricate the area.
Insert the fleet enema into your rectum up towards your belly button. You may need to ask someone to help you do this.
Eating and drinking before you come to the hospital:
Come fasting. He can it breakfast after the procedure..
Bring to the hospital:
• Bring your Ontario Health Card.
• Bring a person to translate for you if you do not understand or speak English well.
In the Hospital: Register on the main floor and go to the
outpatient department on the 6th floor and give your papers to the OPD receptionist.
There are many clinics going on at the same time in this area. You may see patients go in before you because they are going to a different clinic.
Plan to be at the hospital 30 minutes before your appointment

Excision of ingrown toenails
Ingrown nail ( onychocryptosis) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail skin.
Causes may include:
·        Shoes causing a bunching of the toes in the developmental stages of the foot (frequently in people under 21), which can cause the nail to curl and dig into the skin. This is particularly the case in ill-fitting shoes that are too narrow or too short, but any toed shoes may cause an ingrown nail.
·        Poor nail care, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across.
·        Broken toenails.
·        Trauma to the nail plate or toe, which can occur by dropping objects on or stubbing the toenail, or by the nail protruding through the shoe (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh.
·        Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases or a genetic susceptibility, increases the chance of an ingrown nail, but the ingrown cannot occur without pressure from a shoe.
·        A bacterial infection
Treatment:
The best first option is conservative management with soaking the toe in warm water as long as possible every day. Do not use salt or antibacterial solutions. Allow nail to grow and cut them straight.
If conservative management fails the next best option is excision of ingrown part of the nail. This can be done under local anesthetic in outpatient department. The procedure will take 10-15 minutes. Your nail will be slightly narrower than the other side and this will be permanent.

Instruction after removal of ingrown toenail

Ø Stay off your feet and keep them elevated as much as possible.

Ø You may see some bleeding through the bandage. This is normal and if this happens reinforce the area with bandage put pressure on it and keep your foot elevated. This should stop the bleeding.

Ø Take scheduled Advil or Tylenol for first 24 hours. The best is to keep the feet elevated to avoid throbbing sensation.

Ø After 48 hours, soak the toe in warm water with no salt or any other antiseptic solution. After a few minutes you can remove the dressing. Gently wash the toe with warm water and regular soap. Dry up and cover the toe with wide Band-Aids.

Ø Repeat this twice a day until the wound is healed completely and it is covered with skin. This may take a couple weeks. At the beginning the area looks very inflamed with scabs with yellowish-brown discharge. Continue washing with soap and water and keeping the toe dry.

Ø After a few days it is a good idea to leave the toe exposed to the air as much as possible when you are at home. You can wear open-toed shoes or sandals.

Ø Make a follow-up appointment for 2 weeks after the procedure by calling (416) 913-6457

Call my office (416) 913-6457 or go to the emergency room if:

- You notice fever or chills and have a temperature of over 38 degrees.

- Your toe and foot turns red and expanding and very painful

- Your pain worsens after the surgery.

- Cloudy or foul smelling drainage.

- Drainage that continues beyond 4 to 5 days.

“Do Not Smoke: Smoking has been shown to slow the healing process and increase your chance of infection. Your primary care doctor can help with medications or patches.”

OUTPATIENT PROCEDURES

Minor Procedures and cyst or lumps and bumps removal

Minor procedures includes outpatient small surgeries which is done under local anesthetic. This is very similar to dental work. These surgeries include removal of cyst, lipoma or other superficial skin lesions.

Steps of this procedures usually are:

1- removal of hair (if it's necessary) and cleaning up the area with antiseptic solution.

2- Injection of local anesthetic around the lesion.( A few had previous reaction to local anesthetic notify the nurse and doctor)

3- Removal of the lesions and closing the wound with or without sutures.

4- There will be a discharged with instruction regarding wound care and follow-up appointment.

5- Most of these procedures did not need prescription medication for pain or antibiotics.

Minor Procedure Discharge Instructions:

- Please call to schedule an appointment in 2 weeks.

- If You have sutures or staples that need to be removed. You may have sutures that are absorbable and do not need to be removed.

- Please remove Steri-Strips in 7-10 days.

Dressing: Remove the bulky dressing tomorrow. You may shower in 48 Hrs after your procedure but do not immerse incision site in water, (i.e. pool, Jacuzzi, or bath). You may wash the area daily with soap and water. Avoid using any cream or ointment unless it is instructed.

After the procedure resume your current regular medications, You can start taking blood thinners (i.e. Plavix, Aspirin, Coumadin, Pradaxa, etc.) in one day after the procedure.

If you have prescribed narcotics you may need a stool softener and these may be purchased over the counter (i.e. Miralax, Senekot X, or Peri-colace). Otherwise you may take over the counter Tylenol or Advil if it is necessary

You may have some numbness and bruising. If the incision oozing blood apply pressure for 20 minutes and if continues call my office or go to the ER.

You can expect some incisional pain but this should be minimal.

Call my office (416) 913-6457 or go to the emergency room if:

- You notice fever or chills and have a temperature of over 38 degrees.

- Your incision turns red and expanding and very painful

- Your pain worsens after the surgery.

- Tenderness or swelling in one or both calves.

- Shortness of breath or chest pain.

- Cloudy or foul smelling drainage.

- Drainage that continues beyond 4 to 5 days.

Do Not Smoke: Smoking has been shown to slow the healing process and increase your chance of infection. Your primary care doctor can help with medications or patches.

Rigid sigmoidoscopy for assessment of anorectal disease

What is a rigid sigmoidoscopy?

Rigid sigmoidoscopy is a procedure done to look at the rectum and lower colon. The doctor uses a special tube called a scope. The scope has a light and a small glass window at the end so the doctor can see perianal area and insight the anus, rectum and lower part of the colon.

This procedure is done for many reasons. Some reasons are:

• to look for the cause of rectal bleeding • a tissue sample to test called a biopsy

The procedure takes about 5 minutes but plan to be at the hospital for ½ hour.

Are there any complications to this procedure?

Your doctor will explain the problems that can occur before you sign a consent form. Problems are rare but include:

􀂉 The scope can damage the lining of the rectum.

􀂉 The scope can cause severe bleeding by damaging the wall of the colon or after banding of hemorrhoids.

􀂉 You may have blood spotting if a biopsy is done or a polyp is removed.

Since the doctor and nurse are with you all of the time, they can manage any problem that may occur.

What do I need to do to get ready at home?

4 to 5 days before your procedure:

Taking medications:

Your doctor may want you to stop taking certain medications (like ASPIRIN or PLAVIX) 7-10 days before the procedure. If you need to stop any medications, your doctor will tell you during the office visit. If you have any questions, call the doctor’s office.

Buying a Fleet enema:

Your bowel must be clean and empty of waste material before this procedure. Your surgeon will ask you to use a rectal fleet enema. You will need to buy a Fleet enema at your pharmacy. The pharmacist can also tell you how to give yourself an enema.

The day of the procedure:

Giving yourself an enema:

During the office visit with your doctor, you will be told if you use the Fleet enema in the morning before you come to the hospital. To put the enema in, follow the instructions on the box.

If you think you may have trouble sliding the enema in, buy some K-Y jelly to put on the tube to lubricate the area.

Insert the fleet enema into your rectum up towards your belly button. You may need to ask someone to help you do this.

Eating and drinking before you come to the hospital:

Come fasting. He can it breakfast after the procedure..

Bring to the hospital:

• Bring your Ontario Health Card.

• Bring a person to translate for you if you do not understand or speak English well.

In the Hospital: Register on the main floor and go to the

outpatient department on the 6th floor and give your papers to the OPD receptionist.

There are many clinics going on at the same time in this area. You may see patients go in before you because they are going to a different clinic.

Plan to be at the hospital 30 minutes before your appointment

Excision of ingrown toenails

Ingrown nail ( onychocryptosis) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail skin.

Causes may include:

· Shoes causing a bunching of the toes in the developmental stages of the foot (frequently in people under 21), which can cause the nail to curl and dig into the skin. This is particularly the case in ill-fitting shoes that are too narrow or too short, but any toed shoes may cause an ingrown nail.

· Poor nail care, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across.

· Broken toenails.

· Trauma to the nail plate or toe, which can occur by dropping objects on or stubbing the toenail, or by the nail protruding through the shoe (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh.

· Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases or a genetic susceptibility, increases the chance of an ingrown nail, but the ingrown cannot occur without pressure from a shoe.

· A bacterial infection

Treatment:

The best first option is conservative management with soaking the toe in warm water as long as possible every day. Do not use salt or antibacterial solutions. Allow nail to grow and cut them straight.

If conservative management fails the next best option is excision of ingrown part of the nail. This can be done under local anesthetic in outpatient department. The procedure will take 10-15 minutes. Your nail will be slightly narrower than the other side and this will be permanent.

Instruction after removal of ingrown toenail

Ø Stay off your feet and keep them elevated as much as possible.

Ø You may see some bleeding through the bandage. This is normal and if this happens reinforce the area with bandage put pressure on it and keep your foot elevated. This should stop the bleeding.

Ø Take scheduled Advil or Tylenol for first 24 hours. The best is to keep the feet elevated to avoid throbbing sensation.

Ø After 48 hours, soak the toe in warm water with no salt or any other antiseptic solution. After a few minutes you can remove the dressing. Gently wash the toe with warm water and regular soap. Dry up and cover the toe with wide Band-Aids.

Ø Repeat this twice a day until the wound is healed completely and it is covered with skin. This may take a couple weeks. At the beginning the area looks very inflamed with scabs with yellowish-brown discharge. Continue washing with soap and water and keeping the toe dry.

Ø After a few days it is a good idea to leave the toe exposed to the air as much as possible when you are at home. You can wear open-toed shoes or sandals.

Ø Make a follow-up appointment for 2 weeks after the procedure by calling (416) 913-6457