Improving Surgery Discharge Instructions

My doctor gave me terrible and confusing instructions that I didn’t understand for a wisdom teeth extraction surgery, so I rewrote them to be easier to follow.

My doctor’s instructions make the classic mistake of being egocentrically aligned from the doctor’s perspective instead of from the patient’s perspective.

Also before we go on: hey, I’m not a doctor and this is not medical advice, I’m just practicing some human centered design.

Also #2: oh my god doctors get your shit together. How are people supposed to follow your logic puzzle discharge instructions while going through surgery? Come on now you can do better.

Before scheduling the surgery

  • If you’re pregnant, don’t

A week before

  • arrange for someone to drive you to and from surgery (you can’t drive yourself) and spend the rest of the day in the same room as you.
  • plan for two days of liquid food (soylent, smoothies, soup, ice cream, yogurt, mashed potatoes, pudding, jellow, or similar)
  • Get some gum
  • Get an ice pack and a heat pack
  • if you have fake nails or dark nail polish, get it taken off. The color of your nails is important for the anesthesiologist to make sure you’re not dying.
  • Don’t have any alcohol, smoke, vape, or use any recreational drugs because it could mess with your tolerance to the sedative medications and you might wake up in the middle of dental surgery which would be horrifying.

The day before

  • Don’t have any grapefruit because it messes with some medications (specifically, it interferes with drug metabolism via CYP450 enzymes in the liver. Weird, right?)
  • Don’t eat or drink anything (even water) after midnight. You need to have fasted for at least eight hours before your surgery to minimize the risk that you vomit and then choke on your own vomit while sedated, and what an embarassing way to die that would be.
  • Mix up a big bottle of salt water to rinse your mouth out for meals (but only after the first 24 hours—your mouth is going to be super delicate on the day of your surgery)
  • Plan some relaxing activities you can do while stationary tomorrow. Video games? Netflix binge?
  • Hey good job taking care of your health! Do one of those relaxing activities a few hours before bed.

The morning of your surgery

  • Hey good job taking care of your health! Remember to breathe.
  • Wear short sleeves so the doctors can access your arms to put in an IV for sedation drugs

Immediately after waking up from your surgery

  • What to expect:
    • You might feel uncomfortable, have swelling, bleed, and not be able to open your jaw all the way: that’s normal.
  • Do:
    • gently but firmly bite down on the gauze in your mouth to control bleeding

On your way home

  • Stop by a pharmacy to pick up your prescriptions for:
    • an antibiotic (amoxicillin or cindamycin)
    • a Medrol Dose Pack (an antiinflamatory steroid)
    • Zofran, but only if you feel nautious
    • Ultracet or Tylenol and Ibuprofen for pain

When you get home

  • change your gauze and let it stay in your mouth for up to one hour (so you’ve had gauze in your mouth for about two hours total).
    • if bleeding is excessive, check that the gauze is as far back in your mouth as possible. You may bite on tea bags to help stop bleeding.
  • lay down with your head elevated and take a nap. Blood pressure and bleeding decrease when sleeping.
  • Try not to talk or move excessively.
  • While your driver and post-surgery companion is hanging out in the same room as you for your nap, ask them to write out a schedule with checkboxes for when you’re going to take that medication for the next week. Plan to eat or drink something before taking any medication to avoid nausea.

Day 1 (the day of your surgery)

  • Don’t:
    • rinse your mouth—the blood clots in your mouth are delicate and might get dislodged with sloshing water
    • spit—pressure in your mouth might dislodge your blood clots and you could get dry socket
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
    • brush your teeth-a big stick in your mouth might, you guessed it, dislodge those blood clots
    • look in your mouth—ahh blood!
    • talk or move excessively—movement might… well, you can probably guess.
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rest, nap, netflix, and chill (but only if it’s actual chilling)
  • What to expect:
    • swelling will likely increase
    • you might have a little bleeding
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply ice for 20 minutes on and 10 minutes off
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If you feel nauseous:
    • take your anti-nausea Zofran as directed on the bottle
  • If you feel hungry:
    • it’s probably better to fast on this day, but if you absolutley have to eat, have liquid food like soylent, smoothies, soup, ice cream, yogurt, mashed potatoes, pudding, jellow, or similar
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 2

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rinse your mouth gently with salt water in the morning and evening
    • brush your teeth
  • What to expect:
    • swelling will likely increase from yesterday
    • you might have a little bleeding
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply ice for 20 minutes on and 10 minutes off
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • begin eating soft foods that require chewing so your jaw doesn’t get tight and cause pain: banana, pancakes, eggs, larger pastas, soft sandwiches, cooked veggies, and similar
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 3

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rinse your mouth gently with salt water in the morning and evening
    • brush your teeth
  • What to expect:
    • you’re at peak healing and swelling, so you might feel worse today than you have so far
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply heat
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • eat soft foods that require chewing so your jaw doesn’t get tight and cause pain: banana, pancakes, eggs, larger pastas, soft sandwiches, cooked veggies, and similar
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 4

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rinse your mouth gently with salt water in the morning and evening
    • brush your teeth
  • What to expect:
    • you’re at peak healing and swelling, so you might feel worse today than you have so far
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply heat
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • eat soft foods that require chewing so your jaw doesn’t get tight and cause pain: banana, pancakes, eggs, larger pastas, soft sandwiches, cooked veggies, and similar
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 5

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rinse your mouth gently with salt water in the morning and evening
    • brush your teeth
  • What to expect:
    • swelling should start gradually decreasing
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply heat
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • eat soft foods that require chewing so your jaw doesn’t get tight and cause pain: banana, pancakes, eggs, larger pastas, soft sandwiches, cooked veggies, and similar
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 6

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
    • chew hard food-it might dislodge those blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • rinse your mouth gently with salt water in the morning and evening
    • brush your teeth
  • What to expect:
    • swelling should be decreasing
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply heat
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • eat soft foods that require chewing so your jaw doesn’t get tight and cause pain: banana, pancakes, eggs, larger pastas, soft sandwiches, cooked veggies, and similar
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

Day 7

  • Don’t:
    • use a straw—pressure in your mouth might dislodge your blood clots
  • Do:
    • take your antibiotic (amoxicillin or clindamycin) as instructed on the medicine bottle
    • take your antiinflamatory steroid Medrol Dose Pack as instructed
    • use the provided syringe filled with warm salt water to keep the extraction site clean once a day at night
    • brush your teeth
  • What to expect:
    • swelling should start gradually decreasing
    • you might not be able to open your jaw all the way
  • If you feel pain:
    • apply heat
    • eat or drink something, then take 2 tablets of Ultracet or 1 tablet of Tylenol #3 or 2 over the counter 500mg Tylenol
    • if you’ve taken Ultracet or Tylenol and are still in pain 4 hours later, take 800mg Ibuprofen or 2 200mg over the counter Ibuprofen
    • if you’re still in pain 4 hours after that, you can take Ultracet or Tylenol again and keep alternating with Ibuprofen.
  • If your jaw feels tight: chew some gum
  • If you feel hungry:
    • you can start eating crunchy and small foods, like chips, rice, corn, and oatmeal
    • rinse your mouth gently with warm salt water after eating
  • If you feel thirsty: drink lots of water
  • If you experience rapid swelling in the eye/neck, fever, difficulty breathing, or excessive bleeding that cannot be stopped: visit the ER

After day 7

  • you can safely use straws, smoke, and vape again (well, as safe as smoking and vaping were before at least)
  • use the provided syringe filled with warm salt water to keep the extraction site clean once a day at night

Hey you did it! Good job taking care of yourself. I’m proud of you.