Questions & Answers

713.464.4111

Pre-Operative/Post-Operative  -  Q&A

How do I find out my benefits for surgery?

 

Our office will call your insurance to get an estimation of benefits for our services based on coverage. After obtaining this information, a nurse will contact you and will collect the amount owed per your insurance company. The surgery deposit can be paid with a credit card, personal check or cash. This payment is required before the date of your surgery.

Any benefits regarding anesthesia and hospital bills will be given to you by someone at the hospital. We do not have access to this information and, therefore, cannot provide you with a full estimation of coverage for all services rendered on the day of your surgery.

 

 

How do I schedule my pre-op labs?

 

Blood work must be done prior to your surgery. In order to schedule these labs, you can call 713-242-3880 and speak to a nurse to get an appointment. These labs are typically required within 1-2 weeks of surgery.

 

 

What medications must I stop before surgery?

 

Dr. Levin asks all patients who are on hormone replacement (estrogen, progesterone, etc) to stop these medications 1 week before surgery. Also, any aspirin-based products (i.e. Aspirin, Motrin, Advil, Ibuprofen, Aleve) must be discontinued 1 week before surgery to decrease potential post-operative bleeding.

Any other medications you may be on including blood pressure, thyroid or diabetes medications should be reviewed with the pre-op nurses in order to obtain dosing instructions based on anesthesia protocol.

 

 

When must I begin fasting for surgery?

 

In order to have general anesthesia you must have an empty stomach. In general, we ask patients to be fasting after midnight.

 

 

What time do I arrive at the hospital?

 

In general, we ask that you arrive 2 hours before your scheduled surgery start time. This will allow for you to get checked in by a nurse who will confirm medical information and prepare you for surgery. Please use the time our office gives you as the hospital nurse may not be aware of schedule changes.

 

 

How long will my hospital stay be after my surgery?

 

Robotic Hysterectomy - 1 overnight stay and discharge in the morning

Abdominal Hysterectomy - 2-3 days depending on recovery

Laparoscopy - outpatient procedure

Cold Knife Cone/LEEP/Laser - outpatient procedure

Bladder Repair - outpatient procedure

 

da Vinci Robot-Assisted Hysterectomy  -  Q&A

When will I be seen in the office following my hysterectomy?

 

Patients are seen at 1 week and 3 weeks after your surgery for a routine post-op exam. At these visits you will be instructed on what activities are allowed and what to avoid.  Some general guidelines are listed below.

 

 

When can I drive after my hysterectomy?

 

As long as your surgery was performed with the assistance of the da Vinci robot, you will be allowed to drive once cleared by your doctor at your 1-week post-operative appointment. You will need someone to drive you to your first post-op follow up appointment.

 

 

When can I have intercourse after my hysterectomy?

 

On average, patients are to avoid intercourse for a minimum of 6 weeks following surgery or until no discharge has been present for approximately one week. During the hysterectomy, the uterus, tubes, ovaries and cervix are removed through the vagina. As a result, the top of the vagina is sutured closed and takes approximately 6 weeks to heal.

 

 

When can I exercise after my robotic hysterectomy?

 

Light aerobic exercise is allowed 1 week after surgery. After your final post-operative visit at 3 weeks you will be released to activity as tolerated, though gradual introduction is recommended.

 

 

When can I return to work after my hysterectomy?

 

Most patients are allowed to return to work at 10-20 days depending on the type of job.  A work release can be provided by our office at your post-op visit.

 

 

What should I expect after my robotic hysterectomy?

 

Common post-operative symptoms/complaints include:

• Bloating occurs because gas is put into the abdomen during surgery to allow for optimal visualization.

 

• Constipation can result from intestinal irritation from the gas used in surgery as well as the post-operative pain medications taken.

 

• Vaginal bleeding and discharge is expected immediately after surgery and after surgery while the stitches are dissolving. This bleeding/discharge may last 6 weeks after your surgery. Notify the office if the bleeding is heavy or if it increases suddenly.

 

• Incisional pain is very common after surgery. The incision located by the left ribcage has been reported to be the sorest by most patients. Pain medications will be provided to alleviate the pain.

 

• Bladder spasms can occur after surgery because a catheter is placed in the bladder during surgery. These symptoms are more common if a bladder procedure was done in addition to the hysterectomy.

 

• Hot flashes/night sweats can occur if your ovaries are removed at the time of your hysterectomy. These symptoms are to be monitored during the immediate post-operative period. For the majority of patients, the symptoms improve once a few weeks out from surgery. In the event the symptoms do not subside or improve, hormone replacement options will be discussed at your final post-operative appointment.

 

 

Where can obtain additional information regarding the da Vinci Robot?

 

You can visit www.davinicisurgery.com for more information regarding the robot.  We encourage you to leave a testimonial about your surgery and recovery on their website!

 

Other Gynecology Procedures  -  Q&A

What should I expect after a cold knife cone (CKC) or Loop Electrode Excision Procedure (LEEP)?

 

• Vaginal bleeding is expected after this procedure and can last for up to 4 weeks. Commonly the bleeding can also increase at approximately 2 weeks. Pads are to be used, not tampons, for the bleeding.

 

• No sex until after your 1 month post-operative check up in the office.

 

 

What should I expect after bladder surgery?

 

• Bladder spasms commonly occur after bladder surgery. These symptoms usually resolve within 4-6 weeks.

 

• Driving is permitted once you feel able to do so. It is not advised if you are still requiring narcotic pain medications due to potential impairment.

 

• No heavy lifting or sex for 4-6 weeks after surgery. This is to protect the integrity of the bladder repair.

 

Pregnancy Related  -  Q&A

When should I make my first OB appointment?

 

Call the office when you have a positive home pregnancy test. You will be seen in the office at 6-8 weeks for your first OB appointment. This appointment will include an ultrasound to confirm your due date, blood work, cultures and a pap smear.

 

 

How often will I be seen during my pregnancy?

 

For an uncomplicated pregnancy you will be seen according to the schedule below

6-28 weeks: Every 4 weeks

28-36 weeks: Every 2 weeks

36-40+ weeks: Weekly until delivery

Postpartum visit will be at 6 weeks after delivery for both vaginal and cesarean deliveries

 

 

How many days will I be in the hospital after delivery?

 

Women who deliver vaginally will be in the hospital for 2 days after delivery. Those that have a cesarean section will have a hospital stay of 3-4 days after delivery.

 

 

How much will having a baby cost?

 

Our office calls and confirms your OB benefits at your first OB appointment. They will call you to inform you of what out of pocket expenses are due before delivery. The benefits we confirm through your insurance company only cover those services rendered by us and not anesthesia or your hospital stay.

 

 

What tests are performed during my pregnancy?

 

At your first OB appointment an ultrasound to confirm your due date is performed. In addition, blood work, cultures and a pap smear are done. The blood work includes a sexually transmitted disease panel, cystic fibrosis screen, rubella immunity, blood type and blood count. Cultures include a urine culture and gonorrhea/chlamydia culture. These results will be discussed with you at your next visit unless an abnormality is noted.

 

A first trimester screen is offered between 11-14 weeks. This screen includes maternal blood work and an ultrasound to evaluate the baby’s risk for Down Syndrome, Trisomy 13 and 18. This test is more accurate when done earlier in pregnancy and is an elective screening test done at an outside testing center. You will still require an office blood test around 16 weeks to test for spina bifida. If the patient opts out of doing this test, a maternal lab will be drawn between 15 and 20 weeks of pregnancy which will evaluate for the same chromosomal abnormalities in addition to the risk of a neural tube defect (i.e. spina bifida).  Once you know your estimated risk, you have the option of an amniocentesis which will provide a sample of DNA from the fluid surrounding the baby that is tested for those chromosomal abnormalities. There is a 1 in 200 risk of miscarriage following an amniocentesis. If a neural tube defect is suspected, a higher level ultrasound will be ordered to further evaluate this possibility.

 

An anatomy ultrasound will be performed at approximately 20 weeks gestation. At this time the heart, kidneys, spine, bladder, extremities, etc will be evaluated for any abnormalities so that further testing can be done early in the pregnancy. The gender of the baby can also be determined at this time if desired. There is no guarantee that any or all abnormalities will be identified on ultrasound.

 

At 24-28 weeks, a gestational diabetes screen is done via the 1 hour glucose tolerance test. This test will evaluate your body’s ability to metabolize sugar and is used to screen for gestational diabetes. If this screening test is failed, a 3 hour version will be done to definitively diagnose gestational diabetes. If you are diagnosed with this condition, you will be followed by an endocrinologist who will monitor your blood glucose levels and determine whether diet control or insulin is required.

 

At 35-36 weeks, a vaginal culture is done to look for Group B Streptococcus. If positive, antibiotics will be given to the mother at delivery to prevent an infection being transferred to the baby. This bacteria does not pose a threat to the mother or to the baby during pregnancy, but can increase the risk of pneumonia and meningitis in babies after delivery if exposed. According to a recent change in recommendations by the American College of Obstetrics and Gynecology (ACOG) it is now required that we offer patients a repeat HIV and gonorrhea/chlamydia test in the 3rd trimester. This test can be deferred by the patient if desired.

 

 

What does the screening for gestational diabetes involve?

 

Patients must be fasting after midnight the night before their appointment. You will be given a 50 gram glucose drink to consume within 5 minutes. One hour after the drink has been finished; blood work will be drawn to evaluate your body’s ability to metabolize the sugar in the drink. If this test is failed, this does not mean you have gestational diabetes but that you are at risk for it. As a result, a confirmatory three hour version is done following a special diet for three days. This three hour version will determine whether you are diabetic and the need for further evaluation by an endocrinologist. Click here for the 3 hour glucose tolerance test diet and instructions.

 

 

What are the signs of labor?

 

• Contractions that are regular and get closer together with time. They also increase in length and intensity as time passes. Once contractions are 5 minutes apart for at least one hour patients should go to labor and delivery on the third floor of the Memorial Herman Tower.

• Gush of fluid from the vagina. The fluid should be clear and odorless with blood potentially present as well. If your fluid has an odor or different color please inform the labor and delivery nurse once you arrive.

• Bright red bleeding.

 

 

Questions & Answers  Click on categories below for details.

Dr. Sherri S. Levin, M.D. & Associates located in Houston, Texas offers complete OB/GYN services featuring the latest state-of-the-art equipment including the da Vinci Robotic Surgical System which may be used to treat cervical and uterine cancer, fibroids, endometriosis, hysterectomy, pelvic prolapse surgery without mesh, excessive bleeding, laparoscopic robotic hysterectomy surgery and more.  All of our doctors are FACOG Board Certified.  We provide the highest quality adolescent and women’s health care services including: prepregnancy, pregnancy, postpregnancy, high-risk pregnancy, menopause, obstetrics, gynecology, aesthetics, pelvic health,  mammograms, papsmears, ultrasound, bone density testing, osteoporosis, infections, Essure Sterilization, annual check-ups, the latest, most effective bladder incontinence procedures, overactive bladder procedures, and infertility treatments. Patients can be seen in a relaxing office environment.

 

Surgical Affiliations: Memorial Hermann Memorial City Hospital.  We accept most insurance plans.

Dr. Sherri S. Levin, M.D. & Associates  929 Gessner Rd. Suite 2100  Houston, TX 77024  Phone: 713.464.4111 Fax: 713.464.3116

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