Anna Toker, MD

new address:120 N Miller, Mansfield 76063 Suite 200

Hemorrhoid Surgery

AnoRectal Surgery

Here at Anna Toker, MD in Mansfield, Texas, my treatments range from in-office to

extensive rectal reconstruction surgeries. Depending on your symptoms and anatomy, I

can offer you the simplest, least painful, and the best approach to anorectal surgery.

IMPORTANT: We are a NARCOTIC FREE practice, please read the instructions to

patients regarding post-operative pain medications and supplements. Opiods are

addictive and, for intestinal surgery, actually worsen outcomes. Please do not ask for a

triplicate prescription.

On this page I have several suggestions for supplements and products- you DO NOT need to use these specific products, they are suggestions that I find helpful. Some links will take you to outside pages whcih are associated with my wellness program which I do have a financial interest in.

There is an exciting new technology to consider for pain, stress, and sleep that does not involve medication and that does not need a prescription. It is called Superpatch and it uses a tactile code on the skin to neutralize certain neurologic communication controlling pain, your stress response, your immunity/blood flow and even sleeplessness. These 4 issues after surgery can be the difference between healing and struggling after an operation. It can be used on anyone at any age and does not interact with medication. It is safe for any age group and even in pregnancy. If you hate pills, these unmedicated technology pathches are an amazing solution. This can not replace proper nutrition, but is designed to replace medications. "GutCheck" at check out should get you a discount.

The REM sleep patch is applied at bedtime- anywhere on your skin- it will not make you feel sleepy, just apply when you want to sleep and then lay down to sleep. Remove the patch in the morning.
The Peace patch for stress can be placed anywhere on the skin and stays 24 hours at a time and then is changed daily.
The Freedom pain patch should be applied as close to your incisional pain as possible. This patch can work within 15 minutes when applied properly but may take several days to maximize results, but studies show patients use 80% less pain medications by day 4 with this patch
The Defend patch improves blood flow and immunity, critical components to healing an operation and preventing illness in the pre and post-operative timeframe. Wear 24 hours a day, change the patch daily

Super Patch

Video

My real advice to manage hemorrhoids without surgery

*Warning: This advice does not always work. *

If I have not yet examined you in the office, please start following this advice now while you wait for your appointment. Patients who fail this advice do frequently require surgery or at least further testing. If you do not have an appointment make one with me or your local colorectal surgeon for an actual exam to ensure there is no life threatening issue occurring.

Post-Operative Instructions

We go over a lot in the office and there just is not time for every little detail. Watch this video as many times as you need to-take notes! These types of surgeries are complex and can be hard to heal, but with the proper diet and activity, you can get through this process!

Surgery Instructions: Anal Surgery

Before the procedure

Recent evidence has shown that patients who use narcotic pain medications are slower to heal and have more complications than those who do not. We will not write for opiod medications! We will manage your pain using an alternative approach....

Proper nutrition is critical to healing and so from now until your surgery, please follow the link below to online purchase your enhanced recovery pack which will be mailed to you:
2 weeks prior to surgery and 4 weeks after surgery, you should be on a milk-free, gluten-free, and egg-free diet as well as:
1) avoid sugar, high fructose corn syrup, processed food, alcohol consumption and cigarette smoking. Use Stevia as a sweetener when possible.
2) You should be consuming at least 70 grams of protein per day,
3) You should be consuming 64 ounces of water daily unless you are on a water restricted diet by your physician.

Enhanced Recovery

Medications

Your post-operative medications have been sent to your pharmacy. There will be 2 prescriptions waiting for you.

1) a muscle relaxant (cyclobenzaprine)

2) a medication for nerve pain (gabapentin)

3) medication is an NSAID nasal spray. (It comes from an out of s tate pharmacy and you should call them at 1-844-977-7749 as so on as possible to confirm that they have the prescription and so that they can work with your insurance to cover the cost. This medication is an extremely effective non-narcotic anti-inflammatoy but is hard to find at a reasonable cost. This pharmacy can help. If you are allergic to NSAIDS please let the doctor know- you should not take this medicine.) If you are over the age of 60 I may prescribe Celecoxib or oral ketorolac instead

Avoiding constipation is critical after rectal surgery, but you must avoid diarrhea as well! Starting prior to surgery, you should take a fiber supplement (can do kiwi fruit, prunes, prune juice, or powdered supplements mixed in water like citrucel) You will want to continue these supplements after the surgery as well to improve your healing.

You may want to consider several holistic supplements as well- NOW brands has many of these items online...

1) n-Acetylcysteine (NAC) 600 mg daily. This is a good anti-inflammatory.

2) Inulin and Pectin supplements are prebiotic foods that can sup port the probiotic supplements suggested

3) L- Glutamine 500 mg is an amino acid your intestines like and c an promote more normal bowel function

4) Arnica montana, quercetin and zinc all help minimize bruising, take as directed on the bottle- Arnica is typically a topical cream, quercetin and zinc come in tablet form

5) Turmeric- a great anti-inflammatory- you can get at any grocery store, a medical grade version is made by Standard Process.

6) Boswellia can be found at many whole food groceries- Standard process has a medical grade boswellia which is combined with ginger and turmeric and is available online.

7) Stem cell support supplement called STEMREGEN take 2 capsules twice a day for 2 weeks after surgery

8) vitamin D/K2

9) whole food source of vitamin C such as kiwi fruit

10) Zive 7, digestive support including prebiotic and probiotic

Surgery Recovery

The night before your surgery you should do one fleet enema and then repeat the morning of surgery. You will need to be on an empty stomach for 8 hours.

After your surgery, you should spend time in a warm bath tub-unless otherwise directed. Do not sit on a donut pilow and avoid prolonged sitting on the toilet.

There are no food limitations after surgery, per se. Normal bowel habits promote healing so....avoid foods and medications that cause diarrhea or constipation!

The incisions should then be dried off and covered with dry non-woven gauze. If dry gauze is too rough, you can cut cott on t-shirts into small squares and use that as a topical patch over the incisions.

The incisions will have mild amounts of bleeding and even drainage until they are healed. There is a 1% chance of severe post-operative bleeding that occurs between days 7-15. Please call if this occurs for advice. Rarely, this type of bleeding requires operative intervention.

I typically inject a long acting local anesthesia during your surgery, this medication reacts negatively with topical lidocaine. If you need a topical medication, I suggest a post-operative topical ointment that contains 5% lidocaine, 0.2% nifedipine, 1% metronidazole and 1% cbd. This compounded medication Is made by Adams Pharmacy in DeSoto and is available in my office for purchase.

Alternatively, there is an over the counter lidocaine cream called Recticare which you can purchase at pharmacies such as Walgreens or CVS.

Rectal surgery hurts, but to heal you must have normal bowel function- avoid constipation and diarrhea. If you have had no BM in 24 hours after surgery, take milk of magnesium or Perdiem (an herbal laxative). These medications can be repeated 8 hours later if needed. If still no results, you can take magnesium citrate- 1 bottle. If still no luck, I suggest a dose of miralax every 15 minutes until it produces a bowel movement (this may be a large number of doses)

Any questions? Contact us at 214-942-3740 by leaving a voice message or text