LEVEL OF ACTIVITY IS LIMITED

• Stair Climbing : Keep to a minimum the first week, try to limit to one time, every eight hours. 
• Exercise - Take it easy and slowly increase your activity over the next three to four days. While you will progressively feel better, you can anticipate a lack of energy and you should rest when you are tired.
• Shower - You may shower only for the next 7 to 10 days, and until groin puncture sites are completely healed. 
• Sexual Relations: You may have unrestricted activity, including sexual relations and exercise , seven days after the procedure.
• Date to return to work: You will need about one week off from work.
• Driving: Do not drive until you are no longer taking the prescription pain medications (Percocet or Dilaudid). These medications may make you sleepy. You should also not operate any machinery or kitchen appliances while you are on these medications.
• Other Limitations: No heavy lifting, pushing or pulling for 4 weeks.

DIET

• No Restrictions - Increase your fluids and fiber. Prune juice or mild laxative may be helpful to keep your bowels soft.

GROIN PUNCTURE SITES - Arterial puncture sites are at the top of both legs. Band Aids cover each of these sites.

• You may shower each day.
• After you shower, remove the wet Band-Aids and replace them with clean dry ones. Do this for the next two days and until the skin is closed.
• Observe the sites. Some bruising is normal and as this heals, the bruising may spread out over several days. This is the normal way for blood to be absorbed under the skin. 
• You may feel a small knot, about the size of a large pea, under the skin of the puncture site. This is normal and will fade in a few months.
• If you have continuing pain at the puncture sites, you may take Motrin or Advil and please contact our physicians at ___________. This is due to irritation of the nerve branch that passes by the puncture site.
• If you notice any swelling or active bleeding from the puncture sites: lie down flat, apply direct pressure with your fingers over top of the site for a minimum of ten minutes, call for help. This is very rare. Notify our physicians if there is any separation, drainage, redness, severe pain, swelling or active bleeding.

MENSTRUAL PERIODS, VAGINAL DISCHARGE OR SPOTTING

• It is normal to have a brown, or brownish red vaginal discharge or spotting after the embolization. This may continue for a few weeks or until your first period. Use a sanitary napkin until this resolves. Do not use tampons for at least one week after the procedure.
• Occasionally, patients can have a clear watery discharge for several weeks or months after the procedure. This does not indicate infection. However, a thick or foul smelling discharge, particularly accompanied by a fever or pelvic pain may indicate infection and you need to contact our physicians or your gynecologist.
• Your next menstrual period may start early or you may skip a period or two. The period may be better right away or some patients may not improve for 2 or 3 cycles. Don't be discouraged!
• You may have more discomfort with your first and possibly the second menstrual period. These increased cramps should resolve as the fibroids shrink over the next several months. 
• Fibroids are estrogen driven, and as they die you may have a sudden change in hormones that may cause mild depression to "hot flashes". This is usually self limiting and requires no treatment.

MEDICATIONS - Prescriptions given [ ] Yes [ ] No; Food and Drug Interaction Information given and explained [ ] Yes [ ] No

• Torodol ( Ketorolac) 10 mg - 1- every six hours for four days - Take with food.
• Ibuprofen ( Motrin) 800 mg - 1 - every six hours as needed . Do NOT take same day as Torodol - Take with food and full glass of water.
• Percocet ( Oxycodone) - 1 or 2 - every four hours as necessary for pain.
• Dilaudid (Hydromorphone) - 1 - every four hours as necessary for pain if Percocet does not work.
• Phenergan (Promethazine)12.5 to 25 mg - 1 - every six hours as necessary for nausea.
  

POTENTIAL PROBLEMS
Symptoms that may indicate problems include swelling or active bleeding from the puncture sites, pain that arises several days or weeks after the initial pain has resolved, an elevated temperature several days to weeks after the procedure, or an irregular vaginal discharge that may be foul smelling or copious. This may indicate either an infection or partial passage of a portion of the fibroid and may require gynecologic evaluation. If these symptoms occur, please contact our physicians at 610 275-8346 during the day or after hours phone 610 270-2000 and ask the operator to page the Interventional Radiologist on call.

FOLLOW-UP CARE -Make an appointment with your gynecologist:
Dr. _______________ @______________ in ________ weeks

Office # _______________________You will need a prescription from your gynecologist for an MRI of the Pelvis three months after this procedure. 

After your MRI of the Pelvis, please phone me at ____________to make an appointment for a follow-up visit to review your results. 

I have received a copy of the above information. I have no further questions at this time. 

Date _________________________

Patient or Patient Representative's Signature_______________________________ 

Nurses's Signature ______________________________

ADDRESSOGRAPH


3/11/06