Your Personal Surgery
Preparation Guide

Anesthesia is one of the most common sources of fear before surgery — often because people don't fully understand what it involves. Let's demystify it.

Types of Anesthesia

Type	What It Does	Common Uses
Local	Numbs a small area. You're fully awake.	Skin biopsies, dental work, minor repairs
Regional — Nerve Block	Numbs a larger area (arm, leg, abdomen). You may be awake or lightly sedated.	Hand/arm surgery, knee arthroscopy
Spinal	Single injection in lower back. Numbs from waist down for 1–3 hours.	C-section, hip/knee replacement, hernia
Epidural	Catheter in lower back for continuous medication. Can be adjusted.	Labor & delivery, major abdominal surgery
Sedation (MAC)	"Twilight" — you're relaxed and drowsy but breathe on your own.	Colonoscopy, minor cosmetic procedures
General	Completely asleep. Breathing tube or mask. No awareness.	Major surgery, any procedure requiring complete stillness

The Anesthesia Team

• Anesthesiologist (MD/DO): Physician who plans your anesthetic, manages your vital signs, and handles emergencies. Board-certified after 4 years of specialized training after medical school.
• CRNA (Certified Registered Nurse Anesthetist): Advanced practice nurse with specialized anesthesia training. May work independently or with an anesthesiologist depending on the facility.
• Anesthesiologist Assistant (AA): Works under the direct supervision of an anesthesiologist.

What Happens When You "Go Under"

1. You'll breathe oxygen through a mask for a few minutes ("pre-oxygenation")
2. IV medication is given — you'll feel warm and relaxed, then sleepy
3. You'll fall asleep in about 15–30 seconds
4. A breathing tube or airway device is placed (you won't feel this)
5. Throughout surgery, your anesthesiologist monitors: heart rate, blood pressure, oxygen, breathing, temperature, and depth of anesthesia

Waking Up

• As surgery ends, anesthesia is gradually reduced
• The breathing tube is removed (you may have a sore throat for 1–2 days)
• You'll wake up in the recovery room (PACU) — it may feel like only seconds have passed
• Feeling groggy, confused, cold, or emotional is completely normal
• Nausea can occur — tell your nurse immediately; they have medications ready

Common Anesthesia Side Effects

• Sore throat (from breathing tube) — 1–3 days, mild
• Nausea/vomiting — common, usually treatable (see Module 12)
• Shivering — common, resolves quickly with warming blankets
• Grogginess/confusion — 24–72 hours to fully clear
• Muscle aches — from medications used during anesthesia, resolve in 1–2 days
• Hoarse voice — usually resolves within a week

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Effective pain management is one of the most important factors in your recovery. The goal is not zero pain — some discomfort after surgery is inevitable and actually signals healing. The goal is manageable pain that allows you to move, breathe deeply, eat, and sleep.

The Multimodal Approach

Modern pain management layers multiple strategies together. Each one attacks pain through a different mechanism, so you get better relief with fewer side effects than relying on any single medication.

Step 1: Non-Opioid Foundation

• Acetaminophen (Tylenol): 1000mg every 6–8 hours. Take on a SCHEDULE, not "as needed." This is the single most important pain medication after surgery.
• Ibuprofen (Advil/Motrin): 400–600mg every 6–8 hours WITH FOOD. Only if cleared by your surgeon. Alternating with acetaminophen provides excellent coverage.
• Naproxen (Aleve): 220–440mg every 12 hours. Alternative to ibuprofen.

Step 2: Adjunct Therapies

• Ice therapy: 20 minutes on, 20 off. Wrap ice pack in a thin towel — never directly on skin or incision.
• Elevation: Keep surgical area elevated above heart level when possible
• Nerve blocks: If placed during surgery, may provide 12–72 hours of excellent pain relief. When the block wears off, start your oral medications BEFORE the pain arrives.
• Gabapentin/pregabalin: Sometimes prescribed to reduce nerve pain and opioid needs

Step 3: Opioids (Rescue Only)

Opioids (oxycodone, hydrocodone, tramadol) are reserved for breakthrough pain that non-opioid medications can't control.

• Use the lowest effective dose
• Most patients need opioids for 3–5 days or less
• Take with a stool softener (constipation is almost guaranteed — see Module 13)
• Do NOT drive, operate machinery, or make important decisions while taking opioids
• Do NOT mix with alcohol, benzodiazepines (Xanax, Valium), or sleep aids

Opioid Weaning Schedule

Don't stop opioids abruptly if you've been taking them for more than 3–5 days. A gradual taper prevents withdrawal:

• Days 1–3: Take as prescribed for breakthrough pain
• Days 4–5: Reduce to half dose, use only at night or for activity
• Days 5–7: Switch to acetaminophen + ibuprofen only
• If you're still needing opioids after 7–10 days, call your surgeon

Safe Storage & Disposal of Opioids

• Store in a locked location, away from children, teens, and visitors
• Count your pills — know how many you have
• Never share your prescription with anyone
• Dispose of unused pills at a pharmacy take-back program or mix with coffee grounds/cat litter in a sealed bag and throw away
• The DEA holds National Prescription Take-Back events twice a year

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Surgical site infections (SSIs) occur in about 2–5% of surgeries. The good news: many are preventable with simple, evidence-based steps that start before you even get to the hospital.

Pre-Op Showering Protocol

• Night before AND morning of surgery: Shower with chlorhexidine (Hibiclens) soap if instructed. Wash from the neck down. Let the soap sit on your skin for 2 minutes before rinsing.
• Do NOT shave the surgical area. If hair removal is needed, the surgical team will use electric clippers (not razors — razors cause micro-cuts that harbor bacteria).
• Do NOT apply lotion, deodorant, perfume, or powder after your pre-op shower
• Use clean towels and put on clean clothes

Preventing Staph Bacteria Before Surgery

Some surgeons prescribe a preventive nose ointment protocol (prescription antibiotic mupirocin ointment inside both nostrils, 2x daily for 5 days before surgery) to eliminate Staph bacteria. This is especially common before:

• Joint replacement surgery
• Cardiac surgery
• Spine surgery with hardware
• Any implant-based procedure

Blood Sugar Control

Elevated blood sugar significantly increases infection risk — even in patients without diabetes. If you have diabetes:

• Optimize your blood sugar control in the weeks before surgery
• Target A1C below 8% (ideally below 7%) before elective surgery
• Your surgical team will monitor blood sugar closely during and after surgery

Post-Op Wound Care

• Keep the dressing clean and dry for the first 24–48 hours (or as instructed)
• Wash hands thoroughly before and after touching near your incision
• Do not submerge your incision in water (no baths, pools, hot tubs) until fully healed (usually 2–4 weeks)
• Gentle shower is usually okay after 48 hours — let water run over the incision, pat dry. Do not scrub.
• Do not pick at scabs, Steri-Strips, or surgical glue — let them fall off naturally

Warning Signs of Infection

• Increasing redness spreading from the incision
• Warmth and swelling that worsens after day 3–5
• Pus or thick, cloudy, or foul-smelling drainage
• Fever above 100.4°F
• Red streaks extending from the wound
• The wound opening up (dehiscence)

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The PACU (Post-Anesthesia Care Unit) is where you'll wake up after surgery. Knowing what to expect removes one more source of anxiety.

What PACU Looks Like

The recovery room is usually a large, open area with curtained bays. It's brightly lit, and you'll hear monitors beeping. There will be nurses nearby at all times. It can feel disorienting at first, and that's completely normal.

What's Connected to You

• IV line: In your hand or arm for fluids and medications
• Pulse oximeter: Small clip on your finger measuring oxygen levels
• Blood pressure cuff: Will inflate automatically every few minutes
• Heart monitor: Small stickers on your chest with wires (no pain)
• Oxygen: Nasal cannula (small tubes in your nose) or face mask
• Urinary catheter: For longer surgeries (you may or may not have one)
• Surgical drain: Small tube near your incision (depends on surgery type)

The Waking-Up Process

You may feel:

• Confused or disoriented — "Where am I? Is it over?" This is extremely common.
• Cold — Operating rooms are kept cool. Warm blankets will be provided.
• Emotional — Crying, laughing, or feeling anxious upon waking is normal. Anesthesia affects the brain's emotional centers.
• Thirsty — Your nurse will start with ice chips, then small sips of water.
• Nauseated — Tell your nurse immediately. Anti-nausea medication works fast.
• Pain — Your nurse will ask your pain level (0–10). Tell them honestly so they can treat it.

How Long You'll Stay

• Outpatient surgery: 1–3 hours in PACU before discharge home
• Inpatient surgery: 1–2 hours in PACU, then transferred to your hospital room

Discharge Criteria

Before you can go home, the nursing team will confirm:

• You're awake, alert, and oriented
• Pain is controlled
• Nausea is managed
• You can keep fluids down
• Vital signs are stable
• You have a responsible adult to drive you home and stay with you
• You've urinated (sometimes required, depends on procedure)

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Post-operative nausea and vomiting (PONV) affects 30–50% of surgical patients and is one of the most common complaints after surgery — often rated by patients as worse than pain. The good news: there are excellent prevention strategies.

Risk Factors for PONV

You are at higher risk if you have:

• Female sex (2–3x higher risk)
• History of PONV or motion sickness
• Non-smoking status
• Younger age
• Use of opioids after surgery
• Certain surgery types (gynecologic, abdominal, ear, eye, laparoscopic)
• Longer anesthesia time

Prevention Strategies

During surgery (your anesthesiologist will manage these):

• Ondansetron (Zofran) — most common anti-nausea medication
• Dexamethasone — steroid with anti-nausea properties
• Scopolamine patch (behind the ear) — for high-risk patients
• Minimizing inhaled anesthetics when possible
• Adequate IV hydration

At Home

• Eat small, bland meals: Crackers, toast, rice, bananas, applesauce
• Stay hydrated: Small sips frequently rather than large amounts at once
• Ginger: Ginger tea, ginger chews, or ginger ale (real ginger, not just flavoring) — evidence supports its anti-nausea effect
• Peppermint: Peppermint tea or peppermint aromatherapy (inhaling peppermint oil)
• Fresh air and cool compresses: Open a window, use a cool cloth on forehead
• Avoid strong smells: Cooking odors, perfumes, cleaning products
• Acupressure: Press the P6 point (inside of wrist, 3 finger-widths below wrist crease) for 2–3 minutes. Sea-Band wristbands use this principle.

When to Call Your Doctor

• Can't keep any fluids down for 12+ hours
• Can't take your medications due to vomiting
• Signs of dehydration (dark urine, dizziness, dry mouth)
• Vomiting blood or dark "coffee ground" material

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Post-operative constipation is one of the most underestimated and uncomfortable recovery challenges. Nearly every surgical patient experiences it to some degree. Let's talk about why it happens and how to stay ahead of it.

Why It Happens

• Opioid medications: The #1 cause. Opioids slow your entire digestive system.
• Anesthesia: General anesthesia temporarily slows gut motility
• Reduced activity: Moving less = slower digestion
• Dehydration: Not drinking enough water post-op
• Dietary changes: Eating less, eating differently, or NPO (nothing by mouth) period
• Iron supplements: If prescribed, iron is notoriously constipating

Prevention Protocol

Start BEFORE surgery, not after you're already miserable:

• Docusate sodium (Colace): 100mg twice daily — this is a stool softener, not a stimulant. Start the day before surgery. Must-have if taking opioids.
• Senna (Senokot): 1–2 tablets at bedtime — this is a gentle stimulant laxative. Add if docusate alone isn't enough by day 2 post-op.
• Miralax (polyethylene glycol): 17g (1 capful) in 8 oz water once daily — osmotic laxative, safe for daily use

High-Fiber Foods to Add When Eating Normally

• Prunes or prune juice (the classic for a reason)
• Pears, apples (with skin), berries
• Oatmeal
• Beans and lentils
• Broccoli, spinach, sweet potatoes
• Whole grain bread
• Ground flaxseed (1–2 tablespoons in yogurt or smoothie)

Hydration

Aim for at least 64 ounces (8 cups) of water daily. Warm liquids (herbal tea, warm water with lemon) can be especially helpful for stimulating bowel activity.

When to Escalate

• No bowel movement for 3–4 days despite stool softeners and laxatives → call your surgeon's office
• Severe abdominal pain, bloating, or distension → call your surgeon
• Nausea/vomiting with inability to pass gas → could indicate bowel obstruction → seek urgent care

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To the caregiver: Thank you. You are an essential part of this recovery, and your role matters more than you might realize. This module is specifically for you.

Before Surgery: Home Preparation

At the Hospital

• Bring a notebook — write down everything the surgical team tells you. The patient will NOT remember post-anesthesia instructions.
• Ask questions — when can they eat? shower? drive? lift? What medications, and when?
• Take a photo of the discharge instructions
• Bring the car around when the patient is ready — a wheelchair will take them to the entrance
• Drive carefully — every bump will be felt. Bring a pillow for between the seatbelt and incision.

Medication Management

For the first 24–48 hours, YOU should manage the medications:

• Set alarms on your phone for each medication
• Use a medication log: write down what was given and when
• Never let the patient double-dose — anesthesia causes memory fog
• Keep opioids in YOUR possession (the patient should not self-manage opioids while groggy)
• Watch for signs of over-sedation: difficulty waking, very slow breathing

Wound Care

• Wash your hands before and after helping with dressing changes
• Know what the incision looks like now (take a photo at discharge as a baseline)
• Watch for changes: increased redness, swelling, drainage, warmth, or odor
• Help the patient follow the surgeon's wound care instructions exactly

Emotional Support

• Post-surgical depression and mood swings are common — be patient
• The patient may be frustrated with their limitations — validate their feelings
• Encourage small goals: "Let's walk to the kitchen today"
• Limit visitors if the patient is overwhelmed
• Watch for concerning signs: persistent hopelessness, withdrawal, not eating, mentioning self-harm

Self-Care for Caregivers

• Accept help when offered — let others bring meals, do laundry, or sit with the patient so you can rest
• Take 15–30 minutes daily for yourself (walk, read, shower in peace)
• Don't neglect your own medications or appointments
• It's okay to feel frustrated, scared, or overwhelmed — you're human

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Postoperative fatigue affects most surgical patients. After major surgery, about one-third of patients experience significant fatigue lasting throughout the first month. Understanding why it happens and what to do about it helps you recover more smoothly.

How Long Does It Last?

Surgery Type	Typical Fatigue Duration
Minor / day surgery	Mild by day 5
Major surgery	2–4 weeks
Very major (heart, cancer, transplant)	Several weeks to months

Why Does Fatigue Happen?

• Healing response: Surgery triggers inflammation; your immune system uses significant energy repairing tissues
• Anesthesia: Medications take 24–72 hours to fully clear; sleep patterns are disrupted
• Pain & opioids: Pain itself is exhausting, and opioid medications cause drowsiness
• Deconditioning: Even a few days of bed rest causes muscle weakness and reduced cardiovascular efficiency
• Poor nutrition & dehydration: Reduced appetite + increased calorie needs for healing
• Emotional stress: Anxiety, frustration with limitations, worry about recovery

The 6 Best Strategies to Fight Fatigue

1. Walk daily. Start short, increase gradually. Activity gives you more energy over time, even though it feels tiring at first.
2. Prioritize sleep. Keep a regular schedule, limit naps to 20–30 minutes, avoid screens 1 hour before bed, take pain medication as needed to sleep comfortably.
3. Eat protein at every meal. Small, frequent meals if appetite is poor. Drink at least 8 glasses of water daily. Limit caffeine after noon.
4. Manage pain proactively. Take medications on schedule (not just when pain is severe). Transition off opioids as soon as appropriate — they worsen fatigue.
5. Pace yourself. Plan activities when you have the most energy. Alternate activity with rest. Accept help.
6. Get natural light. Open curtains, sit by windows, spend time outdoors. Natural light regulates your sleep-wake cycle.

What to Expect Week by Week

Timeframe	What to Expect
Week 1	Fatigue at its worst. Sleep more than usual. Focus on rest + short walks.
Weeks 2–3	Gradual improvement. Can do more each day. May have good and bad days.
Weeks 4+	Steady improvement. Resuming normal activities. Full energy may take months.

When to Be Concerned

Contact your doctor if fatigue is getting worse instead of better, prevents basic activities, comes with fever/shortness of breath/chest pain, includes signs of depression, or shows no improvement after several weeks.

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“When can I get back to normal?” This depends on your surgery type, overall health, and how well you’re healing. These are general timelines — always follow your surgeon’s specific instructions.

Driving

Do NOT drive if you are taking opioids, unable to brake firmly, or unable to check blind spots.

Surgery Type	Typical Return to Driving
Laparoscopic / minor	1–2 weeks
Open abdominal / C-section	2–6 weeks
Total knee/hip (right side)	1–4 weeks
Total knee/hip (left side, auto trans.)	1–2 weeks
ACL reconstruction	3–6 weeks
Spine fusion	2–6 weeks
Rotator cuff / shoulder	2–3 months
Carpal tunnel release	1–2 weeks

Returning to Work

Job Type	Minor Surgery	Moderate	Major
Desk / sedentary	1–2 weeks	2–4 weeks	4–6+ weeks
Light physical	2–3 weeks	4–6 weeks	6–8+ weeks
Heavy / manual labor	4–6 weeks	6–12 weeks	3–6+ months

Consider a gradual return (part-time initially). Get a note from your doctor specifying restrictions. Communicate with your employer about limitations.

Exercise Progression

Phase	Timeline	Activities
1	Days–2 weeks	Walking (start short, increase gradually). Gentle movement only.
2	Weeks 2–6	Longer walks, gentle stretching, light daily activities. No lifting/twisting.
3	Weeks 6–12	Low-impact exercise (swimming, stationary bike). Light resistance training.
4	3+ months	Gradual return to full activity. High-impact/contact sports last.

Stop exercising immediately if you experience increased pain, worsening swelling, shortness of breath, chest pain, dizziness, or wound drainage.

Lifting Restrictions

Restriction Level	Max Weight	Reference
Light	5–10 lbs	A gallon of milk (~8 lbs)
Moderate	10–15 lbs	A bag of groceries
Standard	15–20 lbs	A laundry basket

Ask for help. Use a cart for groceries. Have children climb to you instead of lifting them.

Other Activities at a Glance

Activity	General Timeline
Showering	24–48 hours (pat incisions dry)
Bathing / soaking	2–4 weeks (after incisions fully healed)
Swimming	2–4+ weeks (chlorinated pools safer than lakes)
Sexual activity	1–6 weeks depending on surgery (off opioids first)
Light housework	Usually OK early (cooking, dishes, dusting)
Heavy housework	Wait until cleared (vacuuming, mopping, yard work)
Air travel	1–2+ weeks (wear compression stockings, walk aisle, hydrate)
International travel	4–6+ weeks after major surgery

Questions to Ask Your Surgeon

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Medical tourism — traveling to another country for medical or surgical care — is chosen for many reasons: lower costs, shorter wait times, access to specific procedures, or combining treatment with travel. While it can offer real benefits, it also carries unique risks that require careful preparation.

Important Risks to Consider

Infection Risks

Infection is the most common complication among medical tourists:

• Surgical site infections
• Blood-borne infections (hepatitis B, hepatitis C, HIV)
• Antimicrobial-resistant infections that may be more common in certain countries
• Infections from contaminated medications or equipment

Several outbreaks have been documented among medical tourists, including fungal meningitis from epidural anesthesia and surgical site infections from nontuberculous mycobacteria after cosmetic surgery.

Other Medical Complications

• Blood clots (deep vein thrombosis, pulmonary embolism)
• Wound healing problems
• Poor surgical outcomes
• Complications from anesthesia
• Death (rare but possible)

Travel-Related Risks

• Air travel after surgery increases blood clot risk
• Changes in cabin pressure can affect healing
• Long flights while in a hypercoagulable state are dangerous
• Limited access to follow-up care if complications occur

Timing Restrictions for Flying

• After chest or abdominal surgery: Wait at least 10 days before flying
• After facial, eyelid, or nose procedures: Wait 7–10 days
• After any major surgery: Consult your surgeon about safe timing

Before You Decide: Research Thoroughly

Evaluate the Facility

• Look for internationally accredited facilities (Joint Commission International, Accreditation Association for Ambulatory Health Care)
• Accreditation does not guarantee a good outcome, but it indicates certain standards are met
• Be aware that marketing websites may not provide complete information about accreditations or qualifications
• Local standards for facility accreditation may differ from those in the United States

Evaluate the Healthcare Professional

• Verify the surgeon is certified in their specialty through a process equivalent to American Board of Medical Specialties certification
• Organizations that accredit physicians abroad include the American College of Surgeons, American Society of Plastic Surgeons, and International Society of Aesthetic Plastic Surgery
• Request outcome data if available (though this may not be tracked in all locations)
• Ask about the surgeon’s experience with your specific procedure

Understand What’s Included

• Clarify exactly what services are included in the quoted cost
• Ask about fees for follow-up care, complications, or additional procedures
• Determine where follow-up care will occur
• Understand that pharmaceuticals, laboratory services, and medical devices may not be subject to the same regulatory oversight as in the United States

Essential Pre-Travel Steps

Arrange for Complications

• Discuss the plan for addressing complications with both your U.S. healthcare professional and the overseas provider
• Identify healthcare facilities at your destination that can handle emergencies
• Know how to contact the U.S. Embassy or Consulate
• Enroll in the U.S. Department of State’s Smart Traveler Enrollment Program (STEP)

Insurance Considerations

• Check your domestic health insurance carefully — most do not cover care received abroad
• Purchase supplemental medical insurance that covers international care
• Obtain medical evacuation insurance (essential for remote destinations)
• Understand that if complications develop, you may not have the same legal recourse as in the United States

During Your Trip

Before the Procedure

• Meet with your surgeon and anesthesiologist
• Ask all your questions and ensure you understand the procedure
• Confirm the plan for postoperative care
• Know the signs of complications and when to seek help

After the Procedure

• Follow all postoperative instructions carefully
• Avoid typical vacation activities during recovery:
  • No alcohol consumption
  • No strenuous activity or exercise
  • No sunbathing or swimming
  • No long tours or sightseeing
• Do not delay seeking medical care if you suspect any complication
• Request complete copies of your medical records in English before leaving

After Returning Home

Immediate Steps

• Schedule a follow-up appointment with a U.S. healthcare professional
• Provide complete information about your travel history, surgeries received, medications given, and any complications
• Share all medical records from your overseas care

Watch for Complications

Seek medical care immediately if you experience:

• Fever or chills
• Increasing pain, redness, or swelling at the surgical site
• Wound drainage or opening
• Shortness of breath or chest pain
• Leg swelling, warmth, or pain (possible blood clot)
• Any other concerning symptoms

Questions to Ask Before Committing

About the Facility

• Is the facility accredited by an international accrediting organization?
• What are the facility’s infection rates and complication rates?
• What emergency services are available on-site?
• How are medical records maintained and secured?

About the Surgeon

• What are the surgeon’s credentials and certifications?
• How many of these procedures has the surgeon performed?
• What are the surgeon’s complication rates?
• Can I speak with previous patients?

About the Procedure

• What exactly is included in the cost?
• What happens if I have a complication?
• Who will provide follow-up care?
• When will I be cleared to fly home?
• How will my care be coordinated with my U.S. healthcare team?

About Legal Protections

• What legal recourse do I have if something goes wrong?
• Is there malpractice insurance coverage?
• What are my rights as a patient in this country?

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Gynecologic surgery includes procedures on the female reproductive organs — the uterus, ovaries, fallopian tubes, cervix, vagina, and vulva. These surgeries may be performed for many reasons, including fibroids, endometriosis, ovarian cysts, abnormal bleeding, pelvic organ prolapse, or cancer.

Types of Gynecologic Surgery

• Hysterectomy: Removal of the uterus (may include ovaries and fallopian tubes)
• Myomectomy: Removal of uterine fibroids
• Oophorectomy: Removal of one or both ovaries
• Salpingectomy: Removal of fallopian tubes
• Procedures for prolapse: Repairs for pelvic organ prolapse
• Endometriosis surgery: Removal of endometriosis tissue
• Diagnostic procedures: Laparoscopy, hysteroscopy

Surgical Approaches

• Vaginal surgery: Through the vagina with no abdominal incisions
• Laparoscopic surgery: Small incisions with a camera and instruments
• Robotic surgery: Laparoscopic surgery assisted by robotic technology
• Open (abdominal) surgery: Larger incision in the abdomen

Minimally invasive approaches (vaginal, laparoscopic, robotic) generally have faster recovery times and fewer complications when appropriate for your condition.

Before Your Surgery

Preoperative Appointments

You will have appointments to:

• Discuss the procedure, risks, benefits, and alternatives
• Review your medical history and current medications
• Complete any necessary tests (blood work, imaging, EKG)
• Meet with anesthesia if needed
• Receive instructions for surgery day

Medications to Discuss

Tell your surgical team about all medications, including:

• Blood thinners (may need to be stopped before surgery)
• Diabetes medications (may need adjustment)
• Hormone therapy and birth control pills
• Herbal supplements (some increase bleeding risk)
• Over-the-counter medications

Fasting Instructions

Modern guidelines allow:

• Clear liquids (water, apple juice, black coffee, tea without milk) up to 2 hours before surgery
• Light solid foods up to 6 hours before surgery
• Heavy or fatty meals should be avoided for at least 8 hours

Follow your specific instructions — they may vary based on your procedure.

Bowel Preparation

For most gynecologic surgeries, especially minimally invasive procedures, bowel preparation is NOT routinely needed. Your surgeon will tell you if bowel prep is required for your specific procedure. The old practice of routine bowel prep has been abandoned for most gynecologic surgeries.

The Day of Surgery

• Arrive at the time specified (usually 1–2 hours before surgery)
• You will change into a hospital gown
• An IV will be placed for fluids and medications
• You will meet your surgical and anesthesia team
• The surgical site will be cleaned with antiseptic solution
• You will receive antibiotics before surgery to prevent infection

Preventing Blood Clots

• You may receive compression stockings or inflatable leg devices
• Early walking after surgery is encouraged
• Blood-thinning medication may be given depending on your risk factors

After Your Surgery

Modern Enhanced Recovery After Surgery (ERAS) protocols help you recover faster:

• Early eating and drinking: You can usually eat and drink soon after surgery
• Early walking: Getting up and walking as soon as possible helps prevent complications
• Pain management: A combination of medications (not just opioids) controls pain better with fewer side effects
• Early removal of catheter: If you have a urinary catheter, it will be removed as soon as possible

Pain Management

Your pain will be managed with multiple types of medications:

• Non-opioid pain relievers (acetaminophen, ibuprofen) are the foundation
• Opioid medications are available for breakthrough pain
• This “multimodal” approach provides better pain control with fewer side effects

Recovery at Home

Activity Guidelines

• Walking: Start walking right away and increase gradually
• Lifting: Avoid heavy lifting (usually >10–15 pounds) for 4–6 weeks
• Driving: Usually 1–2 weeks after laparoscopic surgery, longer after open surgery
• Work: Depends on your job and type of surgery
• Exercise: Gradual return as directed by your surgeon
• Sexual activity: Usually wait 6 weeks after hysterectomy; ask your surgeon for other procedures

Wound Care

• Keep incisions clean and dry initially
• You can usually shower 24–48 hours after surgery
• No soaking in tubs, pools, or hot tubs until incisions are fully healed
• Watch for signs of infection (redness, swelling, drainage, fever)

What to Expect

• Some vaginal bleeding or discharge is normal after many gynecologic procedures
• Fatigue is common and may last several weeks
• Constipation is common — use stool softeners as recommended
• Emotional changes may occur, especially after hysterectomy or removal of ovaries

When to Call Your Doctor

Contact your surgical team if you experience:

• Fever (temperature over 100.4°F or 38°C)
• Heavy vaginal bleeding (soaking more than one pad per hour)
• Increasing abdominal pain
• Redness, swelling, or drainage from incisions
• Difficulty urinating or inability to urinate
• Nausea or vomiting that won’t stop
• Leg swelling, warmth, or pain
• Shortness of breath or chest pain

Special Considerations

If You’re Taking Hormones

• Combined oral contraceptives and hormone therapy slightly increase blood clot risk
• However, stopping them before surgery is not routinely recommended
• If you have additional risk factors for blood clots, discuss this with your surgeon
• Blood clot prevention measures will be used during and after surgery

If You Have Diabetes

• Blood sugar control is important for healing and preventing infection
• Your diabetes medications may need adjustment before and after surgery
• Blood sugar will be monitored during your hospital stay

If You’re Overweight

• Antibiotic doses may be adjusted for your weight
• Blood clot prevention is especially important
• Minimally invasive surgery may still be possible

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A cesarean section (C-section) is a surgical procedure to deliver your baby through an incision in your abdomen and uterus. Whether your cesarean was planned or unplanned, understanding what to expect during recovery will help you heal well while caring for your newborn.

Immediately After Surgery

In the Recovery Room

• You will be monitored closely as anesthesia wears off
• If you had spinal or epidural anesthesia, your legs will be numb for a few hours
• You may feel shaky or cold — this is normal
• You can usually hold and breastfeed your baby soon after surgery
• Pain medication will be given to keep you comfortable

The First 24 Hours

• Your IV will provide fluids until you can drink well
• You can start drinking clear liquids soon after surgery
• You can eat a regular diet within 2 hours of surgery (unless your doctor advises otherwise)
• Your urinary catheter will be removed as soon as possible (often within 6–12 hours)
• You will be encouraged to get up and walk within hours of surgery

Pain Management

Multimodal Approach

Your pain will be managed with a combination of medications that work better together:

• Scheduled acetaminophen (Tylenol): Given regularly, not just when you have pain
• Scheduled NSAIDs (ibuprofen or ketorolac): Anti-inflammatory medications that are very effective for post-cesarean pain and safe while breastfeeding
• Opioids for breakthrough pain: Available if needed, but the goal is to minimize opioid use

What to Expect

• Some discomfort is normal, but severe pain should be reported
• Pain is usually worst in the first 2–3 days and improves steadily
• Taking pain medication on schedule works better than waiting until pain is severe
• All recommended pain medications are safe while breastfeeding

Your Hospital Stay

Early Mobilization

Getting up and moving is one of the most important things you can do:

• Helps prevent blood clots
• Improves bowel function
• Reduces risk of complications
• Helps you feel better faster

You will be encouraged to sit up in bed within hours of surgery, walk to the bathroom with assistance, walk in the hallway several times a day, and increase activity each day.

Eating and Drinking

• You can drink fluids soon after surgery
• You can eat a regular diet within hours of surgery
• Eating helps your bowels recover
• Stay well hydrated, especially if breastfeeding

Preventing Blood Clots

• Compression stockings or inflatable leg devices
• Early and frequent walking
• Staying hydrated
• Blood-thinning medication if you have additional risk factors

Breastfeeding

• You can breastfeed soon after cesarean delivery
• Pain medications used are safe for breastfeeding
• Nurses and lactation consultants can help with positioning
• Side-lying or football hold positions may be more comfortable
• Skin-to-skin contact with your baby is encouraged

Going Home

You may be ready to go home when your pain is controlled with oral medications, you can eat and drink normally, you can walk and care for yourself, you can urinate normally, and your incision looks healthy. Many women go home 2–3 days after cesarean delivery.

Recovery at Home

The First Two Weeks

• Rest when your baby sleeps
• Accept help from family and friends
• Walk regularly but avoid strenuous activity
• Don’t lift anything heavier than your baby
• Take pain medication as needed
• Eat nutritious foods and stay hydrated
• Continue stool softeners to prevent constipation

Incision Care

• Keep the incision clean and dry
• Shower daily — let water run over the incision
• Pat dry gently
• Wear loose, comfortable clothing
• No soaking in tubs, pools, or hot tubs until fully healed (usually 4–6 weeks)

Activity Guidelines

• Walking: Encouraged from day one; increase gradually
• Stairs: Use as needed, but take it slow
• Driving: Usually wait 2–4 weeks (until you can brake suddenly without pain)
• Lifting: Nothing heavier than your baby for 4–6 weeks
• Exercise: Gentle walking only initially; ask your doctor about returning to exercise
• Sexual activity: Usually wait 6 weeks until your postpartum checkup

Emotional Recovery

• “Baby blues” (mood swings, tearfulness) are common in the first 2 weeks
• Cesarean delivery can bring mixed emotions
• Talk about your feelings with your partner, family, or healthcare provider
• Seek help if you feel persistently sad, anxious, or unable to care for yourself or your baby

Warning Signs: When to Call Your Doctor

Incision Problems

• Increasing redness, swelling, or warmth around the incision
• Drainage from the incision (especially if cloudy or foul-smelling)
• Incision opening up
• Fever (temperature over 100.4°F or 38°C)

Bleeding

• Heavy vaginal bleeding (soaking more than one pad per hour)
• Large blood clots
• Foul-smelling vaginal discharge

Other Concerns

• Severe or worsening abdominal pain
• Pain, redness, or swelling in your legs
• Chest pain or difficulty breathing
• Painful urination or inability to urinate
• Severe headache that doesn’t improve with medication
• Signs of depression or thoughts of harming yourself or your baby

Long-Term Recovery

4–6 Weeks

• Most women feel significantly better by this time
• You will have a postpartum checkup
• You can usually resume normal activities, including exercise and sexual activity
• Your incision should be well healed

Full Recovery

• Complete healing takes 6–8 weeks or longer
• Some numbness around the incision is normal and may last months
• The scar will fade over time
• Future pregnancies are usually possible after cesarean delivery

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Labor pain is among the most intense types of physical pain. The good news: there are many effective options for managing it. Understanding your choices will help you make informed decisions and communicate your preferences to your healthcare team.

Epidural Analgesia

The most common method of pain relief during labor, used by more than 60% of women giving birth in the United States.

How It Works

• A thin catheter is placed in the epidural space near your spinal cord
• Local anesthetic and pain medication are delivered continuously
• Pain relief begins within 10–20 minutes
• You remain awake and alert
• Can be adjusted throughout labor

Important Facts

• Epidurals do NOT increase the risk of cesarean delivery
• Modern epidurals do NOT increase the risk of assisted vaginal delivery
• Epidurals do NOT cause long-term back pain
• Epidurals are safe for your baby
• Can be used for cesarean delivery if needed

Possible Side Effects

• Temporary drop in blood pressure (treated with fluids or medication)
• Itching (treatable)
• Fever (about 30% of women; usually not from infection)
• Headache (rare, less than 1% of women)
• Your legs may feel heavy or tingly

Combined Spinal-Epidural (CSE)

Combines rapid onset of spinal anesthesia with the ongoing relief of an epidural catheter. Popular choice that provides the benefits of both techniques.

IV Opioid Medications

Opioid pain medications given through your IV provide moderate pain relief.

• Common medications: fentanyl, morphine, remifentanil
• Available in almost all birth settings
• Allow you to remain mobile
• Less effective than epidural for pain relief
• May cause drowsiness or nausea
• Usually avoided close to delivery to minimize effects on baby

Nitrous Oxide (Laughing Gas)

• You control when and how much you breathe through a mask
• Provides mild to moderate pain relief and reduces anxiety
• Wears off quickly between contractions
• Safe for your baby
• Can be used while waiting for an epidural
• Not available at all hospitals

Non-Medication Methods

Many women use these alone or in combination with medications:

• Movement: Walking, birthing ball, position changes, rocking
• Water therapy: Warm shower, laboring in a tub, warm compresses
• Breathing & relaxation: Focused breathing, meditation, visualization
• Physical comfort: Massage, counterpressure, heat/cold packs
• Support: Continuous labor support from partner, doula, or nurse
• Other: Acupuncture, TENS, hypnosis (requires prior preparation)

Comparing Your Options

Method	Pain Relief	Mobility	Availability
Epidural/Spinal	Most effective	Limited	Most hospitals
IV Opioids	Moderate	May cause drowsiness	Almost universal
Nitrous Oxide	Mild-moderate	Full	Some hospitals
Non-medication	Varies	Full	Universal

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Your body needs extra nutrients to heal after surgery. Good nutrition helps repair tissues, fight infection, rebuild strength, restore energy, and reduce complications. Eating well after surgery is one of the most important things you can do.

Key Nutrients for Healing

Protein: The Building Block of Healing

• Most surgical patients need 1.2–1.5 grams per kg of body weight daily
• For a 150-pound person, that’s about 80–100 grams of protein per day
• Good sources: meat, poultry, fish, eggs, dairy, beans, lentils, nuts, tofu
• Aim for protein at every meal and snack

Vitamins & Minerals

• Vitamin C: Essential for collagen and wound healing — citrus, berries, peppers, broccoli
• Vitamin A: Supports immune function and tissue repair — orange/yellow vegetables, leafy greens, eggs
• Zinc: Critical for wound healing and immunity — meat, shellfish, legumes, nuts, seeds
• Iron: Needed for oxygen delivery to healing tissues — red meat, poultry, fish, beans, fortified cereals

Fluids

• Drink at least 8 glasses of water daily
• More if you have drains, fever, or are losing fluids
• Water, milk, and diluted juices are good choices
• Limit caffeine and avoid alcohol during recovery

Eating After Surgery: A Timeline

The First Few Days

• Start with clear liquids as directed, progress to regular foods as tolerated
• Eat small, frequent meals
• Focus on easy-to-digest foods

The First Week

• Gradually increase portion sizes
• Include protein at every meal
• Eat a variety of fruits and vegetables
• Take any prescribed supplements

Weeks 2–4 and Beyond

• Return to a normal, balanced diet
• Continue emphasizing protein
• Maintain good hydration

Tips for Common Recovery Challenges

If Your Appetite Is Poor

• Eat small, frequent meals (5–6 times per day)
• Choose nutrient-dense foods over empty calories
• Add protein powder to smoothies, soups, or oatmeal
• Drink nutritional supplements (Ensure, Boost) between meals

If You Have Nausea

• Eat bland, dry foods (crackers, toast, rice)
• Avoid greasy, spicy, or strong-smelling foods
• Sip clear liquids between meals
• Try ginger tea or ginger candies

If You Have Constipation

• Drink plenty of fluids
• Eat high-fiber foods (fruits, vegetables, whole grains)
• Prunes and prune juice are natural laxatives
• Take stool softeners as recommended

Foods to Emphasize

• High-protein: Chicken, fish, eggs, Greek yogurt, cottage cheese, beans, tofu
• Healing-supportive: Colorful fruits and vegetables, whole grains, healthy fats (olive oil, avocado), bone broth, fermented foods (yogurt, kefir)

Foods to Limit

• Alcohol (interferes with healing and medications)
• Excessive sugar (empty calories, impairs immune function)
• Highly processed foods (low in nutrients)
• Very salty foods (can cause fluid retention)

Sample Meal Ideas

Meal	Options
Breakfast	Scrambled eggs with cheese & toast • Greek yogurt with berries • Oatmeal with nuts • Protein smoothie
Lunch	Chicken salad sandwich • Lentil soup with crackers • Tuna salad • Bean and cheese quesadilla
Dinner	Baked salmon with vegetables • Chicken stir-fry • Beef stew • Pasta with meat sauce
Snacks	Cheese & crackers • Nuts • Yogurt • Hard-boiled eggs • PB on apple slices

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Surgery is one of the most important treatments for cancer. It may be used to remove a tumor, determine the extent of disease, relieve symptoms, or reconstruct areas affected by cancer. Preparing well can reduce complications, speed recovery, and improve your overall outcome.

Your Cancer Surgery Team

Cancer surgery involves a multidisciplinary team working together:

• Surgical oncologist: Specializes in cancer operations
• Medical oncologist: Manages chemotherapy and systemic treatments
• Radiation oncologist: Manages radiation therapy
• Anesthesiologist: Manages anesthesia and pain during surgery
• Pathologist: Examines tissue removed during surgery
• Dietitian, physical therapist, social worker, psychologist: Support your preparation and recovery

It is important that all team members evaluate your case before treatment begins.

Prehabilitation for Cancer Surgery

Just as athletes train before a competition, you can train your body before surgery. Studies show prehabilitation can reduce postoperative complications by up to 40%.

Exercise

• Aim for at least 30 minutes of moderate activity most days (walking, cycling, swimming)
• Even small amounts are better than none
• Your team can design a program tailored to your abilities

Nutrition

• Eat plenty of protein to maintain muscle mass
• If you’ve lost weight or have a poor appetite, tell your team
• Immunonutrition formulas (arginine, omega-3 fatty acids) may be recommended before major abdominal cancer surgery

Mental & Emotional Preparation

• Distress is highest around diagnosis and surgery — and gradually improves
• Deep breathing, meditation, guided imagery, and support groups all help
• Your cancer center should screen you for distress and connect you with resources

Quitting Smoking Before Cancer Surgery

If you smoke, quitting before surgery is one of the most important things you can do:

• Smoking increases risk of lung complications, wound infections, blood clots, and longer hospital stays
• Even quitting on the day of surgery has some benefit
• Four weeks of abstinence significantly reduces complications
• Nicotine replacement therapy (patches, gum) is safe before surgery and is NOT a reason to delay
• Quitting should never delay your cancer surgery

Medical Optimization

• Diabetes: Blood sugar control is critical for healing and preventing infection
• Heart/lung disease: May need evaluation before surgery
• Anemia: Low blood counts may need correction before surgery
• Dental care: Important before head/neck cancer surgery or radiation

Understanding Your Surgery

Surgical Approaches

• Open surgery: Larger incision for direct access
• Minimally invasive (laparoscopic/robotic): Smaller incisions, often faster recovery
• Endoscopic: Through natural openings

Lymph Node Surgery

• Sentinel node biopsy: Removing only the first node(s) where cancer would spread
• Lymph node dissection: Removing a group of lymph nodes
• May cause lymphedema (swelling) — your team will discuss prevention

After Cancer Surgery

Enhanced Recovery (ERAS)

• Early eating and drinking
• Early walking to prevent complications
• Multimodal pain management (not just opioids)
• Early removal of tubes and drains
• Blood clot prevention

ERAS protocols reduce hospital stays and lower complication rates across many types of cancer surgery.

Drains and Tubes

You may go home with surgical drains. Your team will teach you how to empty them, measure output, and recognize problems.

Pathology Results

After surgery, tissue is examined by a pathologist (takes several days to a week+). The report determines whether all cancer was removed, the exact type and grade, lymph node involvement, and what additional treatment may be needed.

Special Considerations by Cancer Type

Breast Cancer

• Lumpectomy or mastectomy; sentinel node biopsy common
• May go home with drains
• PT can prevent shoulder stiffness and lymphedema
• Discuss reconstruction options before surgery

Lung Cancer

• Breathing exercises before surgery are especially important
• Chest tubes after surgery
• Early mobilization is critical
• Pulmonary rehabilitation may be recommended

Colorectal Cancer

• May need a temporary or permanent stoma (ostomy)
• If a stoma is planned, you’ll meet with a stoma nurse beforehand
• Early eating and walking are especially important

Head & Neck Cancer

• Dental evaluation before surgery is essential
• Speech and swallowing therapy may be needed
• May need a temporary feeding tube

Preparing for Additional Treatment

Many cancer patients need chemotherapy or radiation after surgery. One of the goals of good surgical recovery is to be well enough to start additional treatment on time. Prehabilitation and ERAS protocols help ensure this.

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This module brings together everything you need to prepare for labor, delivery, and the early postpartum period — whether you’re planning a vaginal birth or a cesarean section. Think of this as your L&D home base.

Preparing for Delivery Day

When to Go to the Hospital

• Regular contractions: 5 minutes apart, lasting 1 minute each, for at least 1 hour (the “5-1-1 rule”)
• Your water breaks — note the time, color, and odor and call your provider
• Heavy vaginal bleeding (more than spotting)
• Decreased fetal movement — if your baby is moving less than usual
• Severe headache, vision changes, or upper abdominal pain — could be preeclampsia
• Scheduled C-section: Arrive at the time your OB team specifies (usually 1–2 hours before)

Understanding the Stages of Labor

Stage	What Happens	How Long
Early labor	Cervix dilates 0–6 cm. Contractions are mild to moderate, 5–30 min apart. You can usually stay home during this phase.	Hours to days (varies widely)
Active labor	Cervix dilates 6–10 cm. Contractions are strong, regular, 2–5 min apart. This is when most women go to the hospital and may request an epidural.	4–8 hours (first baby); shorter for subsequent
Pushing & delivery	Cervix is fully dilated. You push with contractions to deliver your baby.	Minutes to 2–3 hours
Placenta delivery	The placenta is delivered. Uterine massage and any repairs are done.	5–30 minutes

Your Birth Plan

A birth plan communicates your preferences to your care team. Keep it to 1 page and stay flexible — labor is unpredictable.

Anesthesia & Pain Management Options

Understanding your pain relief options before labor gives you the power to make informed decisions in the moment. Here’s a quick overview — for the full deep dive, see Module 20: Pain Management During Labor & Delivery.

Method	Pain Relief	Key Facts
Epidural	Most effective	Used by 60%+ of US births. Does NOT increase C-section risk. Safe for baby. Can be adjusted throughout labor.
Combined Spinal-Epidural	Most effective, faster onset	Rapid relief (minutes) + ongoing epidural. Popular choice.
IV opioids	Moderate	Available early in labor. May cause drowsiness. Usually avoided near delivery.
Nitrous oxide	Mild-moderate	You control it. Wears off quickly. Not available everywhere.
Non-medication	Varies	Breathing, massage, water therapy, movement, doula support. Can combine with any of the above.

If You’re Having a Planned Cesarean

For the full recovery guide, see Module 19: Cesarean Section Recovery. Key points:

• You’ll likely receive spinal or epidural anesthesia — you’ll be awake for the birth
• Your support person can usually be in the OR with you
• Skin-to-skin contact can often happen shortly after delivery
• Surgery takes about 45–60 minutes; you’ll feel pressure but not pain
• Recovery in hospital is typically 2–3 days
• All recommended pain medications are safe for breastfeeding

If an Unplanned Cesarean Becomes Necessary

About 1 in 3 US deliveries are cesarean. Sometimes a C-section is needed during labor for:

• Baby showing signs of distress (abnormal heart rate patterns)
• Labor not progressing despite adequate contractions
• Umbilical cord issues
• Placental problems

If you have an epidural in place, it can usually be used for the C-section — no general anesthesia needed. If not, a spinal is placed quickly. Your support person can typically stay with you.

Breastfeeding Basics

• First hour: Skin-to-skin contact and early breastfeeding are encouraged (even after C-section)
• Colostrum (the first milk) is small in volume but packed with antibodies — it’s all your baby needs at first
• Milk typically “comes in” 2–5 days after birth
• Breastfeeding can be uncomfortable at first — ask for a lactation consultant (most hospitals have them)
• C-section positions: Side-lying or football hold may be more comfortable than cradle hold
• All standard postpartum pain medications (acetaminophen, ibuprofen, most opioids) are safe while breastfeeding

Postpartum Recovery

What’s Normal

• Vaginal bleeding (lochia): Lasts 4–6 weeks. Starts heavy, gradually lightens. Use pads only — no tampons.
• Cramping: Uterine contractions as your uterus shrinks back. Worse during breastfeeding (oxytocin). Normal.
• Perineal soreness (vaginal delivery): Ice packs, sitz baths, and witch hazel pads help.
• Incision pain (C-section): Worst in first 2–3 days. Take pain medication on schedule.
• Baby blues: Mood swings, tearfulness, feeling overwhelmed — affects up to 80% of new mothers. Usually resolves within 2 weeks.
• Fatigue: Profound. Sleep when baby sleeps. Accept all help offered.
• Constipation: Very common. Start stool softeners before leaving the hospital.

When to Call Your Doctor

• Fever above 100.4°F (38°C)
• Heavy bleeding (soaking more than 1 pad per hour) or large clots
• Foul-smelling vaginal discharge
• Incision redness, swelling, opening, or drainage (C-section)
• Severe headache that doesn’t improve, vision changes, or upper abdominal pain (possible postpartum preeclampsia — can occur up to 6 weeks after delivery)
• Leg swelling, warmth, or pain (possible blood clot)
• Chest pain or difficulty breathing
• Painful, red, warm breast with fever (possible mastitis)
• Difficulty urinating or painful urination

Postpartum Mental Health

“Baby blues” vs. postpartum depression:

Baby Blues (Normal)	Postpartum Depression (Seek Help)
Starts within days of delivery	Can start anytime in the first year
Mood swings, tearfulness, irritability	Persistent sadness, hopelessness, numbness
Resolves within 2 weeks	Lasts more than 2 weeks and worsens
You can still care for yourself and baby	Difficulty bonding, caring for baby, or functioning
Comes and goes	Constant or worsening

OpWell’s mental wellness specialist, Stacey J. Floyd, MA, LPC, provides perinatal mental health support. Book a session →

Your L&D Preparation Timeline

When	What to Do
28–32 weeks	Take a childbirth class. Tour the hospital/birth center. Start your birth plan. Begin pelvic floor exercises.
32–36 weeks	Pack your hospital bag. Install the car seat. Discuss anesthesia options with your provider. Consider an OpWell L&D Consultation.
36–38 weeks	Finalize birth plan. Pre-register at the hospital. Stock freezer meals. Arrange help for after delivery.
38–40 weeks	Review when to go to the hospital. Have your bag by the door. Rest as much as possible.
After delivery	Focus on rest, feeding, bonding. Take pain meds on schedule. Accept help. Watch for warning signs.

Deep-Dive Modules

This guide covers the big picture. For detailed deep-dives, see:

• Module 19: Cesarean Section Recovery — complete C-section recovery guide (pain management, incision care, breastfeeding, emotional recovery, week-by-week timeline) Open Module 19 →
• Module 20: Pain Management During Labor & Delivery — detailed comparison of all pain relief options (epidural, spinal, CSE, IV opioids, nitrous, non-medication methods) Open Module 20 →

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