"There was absolutely no problem with climbing stairs the day after the procedure, and living alone, I had no problem taking care of myself – preparing meals and such. After two days, I felt good enough to drive and run short errands, and less than a week after the procedure, I was enjoying my favorite hobby, gardening, and lugging heavy bags of soil." -Jean
Puncture Sites The arterial puncture site at the top of your right leg has a Band-Aid covering it. You may shower but replace the wet Band-Aid with a clean dry one today and following two days. This action will promote healing at the site. You may remove the Band-Aid on the fourth day. If you notice any swelling or active bleeding from the puncture site, you should use direct pressure by placing your fingers and a clean cloth or paper towel over the site. Immediately call for assistance and report to the nearest emergency room for evaluation. This problem at the puncture site is very rare; occurring in less than 1 in 500 patients. Normally, some bruising at the puncture site is observed. The bruise tends to spread out and change colors from red-purple to yellow-blue-green over several days. This process is the normal way that a small amount of blood under the skin is reabsorbed and should not alarm you.
For most patients we deploy a plug under the skin, above the artery, that helps prevent bleeding. This plug absorbs over a few days which can cause some discomfort at the site. So if you ache a bit at the site that is most likely the plug absorbing or a small bruise.
The second puncture site either just above or below your navel is from the nerve block. You have a second Band-Aid at this location which you can discard when you take a shower. Don't worry about replacing this Band-Aid as long as the site is not bleeding.
Diet, Medications, Activity Resume your normal diet and medications. You should slowly increase your activity over the next three to four days. Do not drive if you are taking the prescription pain medicine Norco. Norco will make you sleepy and slow your response time, do not operate any machinery or kitchen appliances while you are taking it. You may have almost unrestricted activity, including sexual activity and exercise, but don't do an exercise that puts lots of strain on the puncture site at your groin for the first 10 days. And if some activity causes pelvic discomfort, stop and try again after a few more days.
Pain and Pressure You should expect to have pelvic pain and cramping over the next several days to two weeks. It is most intense the night following the procedure, but the nerve block will spare you from that part, converting the pain into a sensation of pressure. We use a long-acting medicine in the block that usually takes 2 to 3 days to wear off. So do not be worried that something has gone wrong if after 2 or 3 days you start having more pain, it is just the block wearing off.
You have been given a prescription for ibuprofen; the same drug that is in Motrin and Advil but at a higher dose. It is a very good drug for pain control and, at the higher dose you have, also keeps the inflammation caused by the embolization under control. It is important that you take the ibuprofen for the full week. Unless we tell you otherwise. After a week, you can use the left-over ibuprofen for pain control as you feel you need it.
You have also been given a prescription for the narcotic-containing drug Norco to assist with pain control, if needed. Many women don't wind up needing it, but you will have it available should you have pain that the ibuprofen is not helping with. Norco also contains Tylenol. You may take one or two tablets of Norco every 4 to 6 hours, but do not take more than 8 tablets in any 24-hour period (because that would be too much Tylenol)
Nausea, Heartburn, Constipation, Gas It is not unusual to experience nausea after UFE. You have been given a prescription for Zofran. You may take Zofran every 4 to 6 hours as needed for nausea. It may make you sleepy.
While taking ibuprofen it is important to protect your stomach from irritation. Try to eat some food with each dose.
A common side effect of the prescription pain medicine Norco is constipation and excess gas. Feel free to use Milk of Magnesia or a glass of prune juice prior to drinking your morning coffee. Or you can take Colace; a gentle laxative that you can purchase over the counter at your pharmacy. Phazyme is another over the counter medicine that can help relieve gas pain. Also, remember to drink at least 8 glasses of water a day.
Fever A mildly elevated temperature (less than 102°) is a common side effect of UFE, occurring in about one-third of patients. Fever can be treated with Tylenol. You may take 2 extra strength Tylenol tablets every 6 hours while the fever is present. Do not take more than 8 Tylenol in any 24-hour period. Remember each Norco tablet contains the equivalent of one extra strength Tylenol. So, the number of Tylenol + Norco you take should not exceed 8 per day.
I will give you an antibiotic to take for five days. Usually this is Cipro; which is effective against the bacteria I am most concerned about.
High temperatures, greater than 102°, are of some concern. Call the clinic as described at the end of this instruction set if your fever reaches 102° or greater. Fever is a side effect of the dying fibroids and does not necessarily indicate an infection. Infection is unlikely to occur, especially if you take the antibiotic as instructed, but if it happens it is more likely to develop in a week to several weeks after the procedure than in the first few days following UFE.
Summary of your medicines
Prescription, take these for the first week Anti-inflammatory Motrin Ibuprofen
Antibiotic Cipro Ciprofloxacin
Prescription, take these only if you need them
Pain relief, moderate-severe Norco Hydrocodone
Anti-nausea Zofran Ondansetron
Over the counter, take these only if you need them Laxative Colace Docusate
Anti-fever Extra Strength Tylenol Acetaminophen
Anti-gas Phazyme Simethicone
Discharge or Spotting A brown or reddish-brown vaginal discharge or spotting after UFE is considered normal. You may use either a tampon or sanitary napkin; whichever you prefer. Do not be alarmed if this discharge lasts a few weeks. Your menstrual cycle may begin just after the procedure; also considered normal. A foul-smelling discharge is abnormal. Please call us if this occurs.
Menstrual Periods Your first menstrual period may be heavier, lighter, or the same. It may also come sooner than usual. If abnormal menstrual bleeding is one of the primary reasons you had the UFE, do not be discouraged. Sometimes it can take 2 or even 3 periods before you see what your periods will be like going forward. Almost every patient will have improvement by the third month after the procedure.
The first and possibly second menstrual periods may be more uncomfortable than typical. Some patients have increased cramps during these periods. These symptoms resolve as the fibroids shrink. The fibroids take six weeks to three months to significantly shrink, so rapid results should not be expected.
Some patients may experience symptoms as a result of changes in their hormonal balance after the procedure. Fibroids are driven by estrogen. As the fibroids die, there may be a sudden change in hormones. Some women experience mild depression, which subsides in s few days. Others experience “hot flashes” and/or night sweats. In our experience we have found these symptoms resolve without treatment for most patients.
Signs of Potential Problems Symptoms that might indicate problems include pain that occurs several days or weeks after the initial pain resolved; a temperature several days to weeks after the procedure; an irregular vaginal discharge (particularly if foul smelling or profuse). These symptoms may indicate either an infection or partial passage of a fibroid and may require gynecological evaluation. If any of these symptoms occur, please contact the Radiology Department so that we can assess the symptoms and make further treatment recommendations.
Gynecologic Care You should continue your normal gynecologic care. This includes monthly self-breast exams and yearly pelvic exams with Pap smear as suggested by your gynecologist.
Follow-up Care with Interventional Radiology We will see you in three months for a post procedure visit at which time we will repeat the pelvic MRI to ensure all is well. Please call to schedule this visit. If your symptoms do not resolve in the expected time frame, or if your symptoms worsen or other questions develop, we can schedule an earlier return visit. Please tell us if you are developing symptoms, otherwise we have no way of knowing! We may contact you on occasion to check on your well-being but there is no routine scheduled follow-up beyond the three-month visit.
If you have a question or problem…
If at any time you have any questions regarding the procedure or any symptoms you might have, please feel free to call us. Call the STRIC nurse at (210) 617-9444, he or she can usually answer your question and if not knows how to reach your IR doctor.