Part 3: Preparing for Surgery

 

  • Preparing Your Body for the Best Outcome

  • Pre-operative Clearance

  • Medication Management Before Surgery

  • What to Expect on Admission

  • Personal Care Companion

  • After Surgery

  • Post-Operative Meal Plans

  • Discharge Planning

Preparing Your Body for the Best Outcome

 

There are several things you can do to promote a positive outcome before and after surgery. In fact, a properly prepared body offers the best chance of a speedy recovery. The following 7 things have been shown to make a difference in surgical recovery:

 

 

  • Smoking cessation. When a smoker stops smoking some amazing things begin to happen almost immediately, which include a drop in heart rate and blood pressure. Peripheral circulation is improved and in as little as 12 hours carbon monoxide levels begin to fall to normal.  After a day or taste and smell begin to return to normal which enhances food enjoyment.  After 3 days, the nicotine will be completely gone from the body. After two weeks breathing and lung function improve dramatically, along with exercise capacity. Although nicotine withdrawal can be difficult, it improves the body’s ability to heal after surgery and may be the single most important thing a smoker can do improve surgical outcome.

  • Adequate Hydration. Be sure to consume plenty of water (8-10 glasses) daily to ensure your body is functioning at its best for at least a couple weeks prior to surgery, and hopefully continue this habit long-term.

  • Feed your body nutrient-dense foods. The lining of the gut regenerates quickly and a whole-food diet can have a big impact on the health of the gastrointestinal tract. A whole food diet means single ingredient fruits and vegetables. Organic chicken and turkey are okay, as is wild-caught fish. Try to eat 3 solid whole food meals a day. Healthy snacks include nuts and seeds. Spices have natural healing properties and should be incorporated whenever possible.

  • Avoid processed foods. It is important to limit chemical exposures in order to allow the body to “detox” and function optimally prior to surgery. Avoid soft drinks, pre-packaged cookies, crackers, and pastries. It is best to avoid sugar and dairy if possible, with the exception of organic yogurt.

  • Eat plenty of fermented foods. Fermented foods offer many health benefits by supporting the gastrointestinal microbiome, which is the healthy bacteria living within our digestive system.

  • Exercise.  Exercise is a wonderful anit-oxidant and promotes detoxification throughout the body. Even a simple 30-minute walk every day gets the body moving enough to promote healing.

  • Guided imagery. Guided imagery is an excellent way to replace fears with positive thinking. Studies show that optimists actually have a healing advantage over worriers! An excellent guided imagery resource is Health Journeys, at healthjourneys.com.

 

Pre-Operative Clearance

 

Depending on unique factors pertaining to your age and medical history you may be sent for a pre-operative clearance to be performed by your primary care physician, cardiologist, or pulmonologist. Pre-operative testing usually consists of a physical examination, an EKG to check your heart, and a chest X-Ray to check your pulmonary status. If any of these tests are abnormal, additional tests may be ordered. It is important to discover any abnormalities before an elective surgical procedure. If you are on anticoagulant medications we will need authorization from the prescribing physician to stop these medications.

 

About one week prior to your procedure you will have lab work done in preparation for surgery. This includes routine blood work, and anything else specific to your procedure. It is important that this lab work is no older than 30 days.  A hemoglobin A1C will be checked for diabetes screening. A urinalysis will be performed. A nasal swab will be performed to check for methicillin resistant Staphylococcus auras, bacteria that you may unknowingly carry, that could adversely affect wound healing. If any of these tests are abnormal, you will be treated accordingly. In most cases treatment will not delay surgery.

 

During this appointment you will also be given Bactoshield, a specific antiseptic soap solution. The bottle will last 3 days. You will wash daily with the soap solution as part of your routine bathing. Ideally the last scrub should be early the morning of surgery prior to coming to the hospital.

 

Medication Management

​During the pre-operative period it is important to manage your medications in preparation for surgery. Be sure to communicate all medications and supplements. Some medications may need to be discontinued prior to surgery. Please review the following areas if they apply:  

 

The medication phenteramine must be stopped two weeks prior to any type of anesthesia.

If you are on any anticoagulants, including aspirin, they must be stopped a week prior to your procedure. Coumadin (warfarin) must be stopped four days prior to your procedure. You may be given clearance to stop Coumadin, or you may be given a prescription for Lovenox to use during this time. Here is a list of common anticoagulant Medications:

  • Coumadin (warfarin)

 

  • Plavix (clopidogrel)

 

  • Aggrenox (dipyridamole + aspirin)

 

  • Ticlid (ticlopidine)

 

  • Pletal (cilostazole)

 

  • Effient (prasugrel)

 

  • Brilinta (ticagrelor)

 

  • Pradaxa (dabigatran)

 

  • Xarelto (rivaroxaban)

 

  • Eliquis (apixaban)

 

 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) can also cause bleeding during surgical procedures and must be stopped one week prior to your procedure. Here is a list of Nonsteroidal Anti-inflammatory Drugs (NSAID's) that can increase bleeding:

  • Motrin/Advil (ibuprofen)

 

  • Orudis KT, Oruvail, Actron (ketoprofen)

 

  • Clinoril (sulindac)

 

  • Aleve, Naprosyn, EC-Naprosyn, Naprelan, Anaprox, Anaprox-DS, Vimovo (naproxen)

 

  • Lodine XL, Lodine (etodolac)

 

  • Nalfon (fenoprofen)

 

  • Arthrotec, Cataflam, Voltaren, Cambia, Voltaren-XR, Zipsor, Flector Patch, Voltaren Gel (diclofenac)

 

  • Ansaid (flurbiprofen)

 

  • Sprix, Toradol, Toradol IV/IM (ketorolac)

 

  • Feldene (piroxicam)

 

  • Indocin SR, Indocin (indomethacin)

 

  • Ponstel (mefenamic acid)

 

  • Mobic (meloxicam)

 

  • nabumetone (Relafen)

 

  • Daypro (oxaprozin)

 

  • Actron, Orudis KT, Orudis, Oruvail (ketoprofen)

 

  • Duexis (famotidine and Ibuprofen)

 

  • Meclofen (meclofenamate)

 

  • Tolectin (tolmetin)

 

  • Disalcid (salsalate)

 

  • Trilisate (choline magnesium trisalicylate)

 

  • Dolobid (diflunisal)

 

  • Celebrex (celecoxib)

Diabetes medications may be adjusted during the perioperative period. If you are diabetic you may need to check your sugar more frequently in the peri-operative period. If you need to drink juice do not hesitate to correct a low sugar. 

For patients with Type I diabetes, you will continue basal insulin without diminishing the dose. Do not take short acting insulin the morning of the procedure. If you are treated with an insulin pump, you may continue your usual infusion rate.

For patients with Type II diabetes do not take short-acting insulin the morning of the procedure. If you take glargine insulin (Lantus) at bedtime, take 1/2 your usual dose the night before the procedure. If you take glargine (Lantis) in the morning, take 1/2 your usual dose. For patients taking detemir insulin (Levemir) you may take your usual dose.

Oral medications like glucophage XR, and chlorpropamide (Diabenase) should not be taken the evening prior, or the morning of the procedure. Do not take Glipizide, Glyburide, Glimepride, Prandin, Starlix, Precose, Glyset, or Voglibose the morning of your procedure. Avandia or Actos should generally be held as well. Byetta, Symlin, Galvus, or Januvia should also be held the morning of your procedure. 

Vitamins and Supplements present an interesting challenge to physicians and surgeons. There are literally over 40,000 supplements and supplement combinations of varying doses on the market. The following supplements are known to possibly increase bleeding risks: Bilberry, Cayenne (Red Pepper), Dong Quai (angelica), Echinacea, Evening Primrose Oil, Feverfew, Fish Oil, Flaxseed Oil, Garlic, Ginger, Ginkgo Biloba, Ginseng, Hawthorne, Kava Kava, Licorice Root, Ma Huang, Melatonin, Red Clover, St. John's Wort, Valerian, Vitamin E, Yohimbe. Dr. Pennington recommends that you discontinue all vitamins and supplements a week prior to your procedure.

 

Bowel Preparation

 

You may or may not be required to do a bowel preparation.  If Dr. Pennington instructs you to do a bowel preparation prior to surgery, it will be a Moviprep as follows:

MoviPrep regimen: Around noon the day before surgery, take the first liter of MoviPrep solution over one hour (one eight ounce glass every 15 minutes), and then about two to three hours later, take the second liter of MoviPrep solution over one hour. In addition, take 1 L (approximately 32 ounces) of additional clear liquid during the evening before surgery. You should be finished with the prep by 6 pm. Do not eat or drink anything after midnight the day prior to your procedure. 

 

Antibiotics

 

You will also be given a prescription for two oral antibiotics to be taken the night before surgery:

1 g of Neomycin to be taken at 2 pm, 3 pm, and 10 pm

and 1 g of Erythromycin base to be taken at 2 pm, 3 pm, and 10 pm

Alternately you may be given:

Amikacin (2 g) and Metronidazole (2g) to be taken at 6pm and 10 pm. 

It is very important to complete your bowel preparation if required and take the recommended antibiotics. This is the best defense against post operative wound infection.

In preparing for surgery, do not wear make up or hair spray. Removed hearing aids, contacts, and dental partials. Be prepared to remove glasses and dentures in the preoperative area. Remove all jewelery and body piercings and leave them at home.

 

What to Expect on Admission

After arrival to the surgery center, you will be taken to the preoperative holding area to prepare for surgery. It is important that you know your past medical history, surgical history, and medications with daily doses. It may be helpful to write this information down carefully and bring it with you.

 

An IV will be started and you will be given IV antibiotics. You may have hair clipped from the abdominal area. Your abdomen will be wiped down with an antiseptic cloth. You will be given a shot of anticoagulant to prevent blood clots.

Just before surgery Dr. Pennington will come and greet you and answer any last minute questions. She will also offer prayer. If you are feeling anxious or distressed the anesthesiologist will give you an IV medication to help relieve tension and promote rest. 

 

Personal Care Companion 

 

It is helpful if a family member can stay with a patient during the entire admission. The postoperative period is a time when an extra set of hands is useful.  Dr. Pennington strongly encourages arranging for someone to stay with patients if at all possible.

 

After Surgery

You will wake up in the recovery room where you will be carefully monitored and attended. You will be given pain medications as needed. We generally use Dilaudid. You may notice that another IV was started in surgery. You will have blow up booties on your legs to prevent blood clots. You will have a urinary catheter in your bladder. You will have a clean sterile dressing on your incision that will remain undisturbed for several days. The dressing is attached to a small suction device and ensures a clean undisturbed wound. When a room is ready for you upstairs you will be transported to a private room for the duration of your hospital stay. You will be allowed to have non-carbonated clear liquids the evening after your procedure, if you desire. You will go to your room with a on-demand pain pump or orders for liberal pain management utilizing dilaudid and or morphine. If you experience nausea, IV medication can be administered as needed. The day of surgery is a day of rest. On the day after surgery, you will be required to sit up in a chair, and may begin clear liquids, and even a full liquid diet if you are doing well. You should not need antibiotics post-operatively and you will be given probiotics to aid in repopulating the intestines with healthy bacteria. You will be given anticoagulant shots daily to prevent blood clots. The catheter in your bladder will be removed in first or second post operative day. You will be encouraged to walk no later than the second post-operative day. Physical Therapist are available to assist you. As soon as possible you will wean off of IV pain medications, in favor of oral pain medications. We generally use Percocet or Lortab. During the post-operative period the average return of bowel function is 4 days. Bowel function is encouraged by walking, eating or chewing gum, and decreasing pain medications. Most people are discharged home in 3-4 days. A prescription for pain medication will be provided, and if you are at high risk for a blood clot, you may be given a prescription for anticoagulant shots to be taken for up to one month.

 

Postoperative Meal Planning

 

The very best meals postoperative are foods that are nourishing and also easy to digest.  Unfortunately the hospital may not be able to accommodate the best options, so a pre-prepared picnic-basket may be useful. Processed foods are not recommended.  Sugar and sugary juices are not recommended. Soft drinks or any carbonated beverage that promotes gas is not recommended. The following list is composed of good food choices:

 

  • Filtered water

  • Organic bone or vegetable broth

  • Bananas (the riper the better)

  • Watermelon, apricots, and peaches (whole food, not canned)

  • Cantaloupe and melons

  • Scrambled eggs

  • Organic chicken broiled or prepared as homemade chicken soup

  • Mashed potatoes, and cooked carrots, green beans, zucchini, and spinach

  • Fermented foods like yogurt, sauerkraut, and pickled beets

 

Discharge Planning

 

An important part of postoperative recovery is planning the first few days at home. Ideally a caregiver should be available. Home health nursing and physical therapy can be provided depending on insurance restrictions. Sometimes this service is short-term. A skilled nursing facility is another option as a bridge before going home. This is also insurance dependent. The patient and family need to plan for postoperative care at home for the first few days.