Chapter 7. Essential Preparation for your plastic surgery operation
Article by George Commons, MD
Palo Alto Plastic Surgeon
1. Do not eat or drink after midnight the night before surgery or anesthesia will cancel your surgery. If so instructed it is okay to take medicine with a sip of water only. Do not eat or drink after midnight. A little sip of water only is okay for a dry mouth.
2. Do not take anything that will hinder your clotting and cause you to bleed. The following must be stopped two weeds prior to your surgery and two weeks after your surgery : Aspirin, ibuprofen, cold or pain medication , Vitamin E, fish oil, herbs and food supplements. A good practice is to limit all medications to only Tylenol and prescribed medications approved by Dr Commons for the 4 weeks. Tylenol is acetaminophen and does not interfere with clotting.
3 .Please know your surgical date, directions to the center, and your arrival time.
4. Bring all of your medications to surgery with you in a secure bag for review
5. Please assure you have a ride to and from the operating room. You cannot drive after surgery. We are not allowed, by law, to let you drive or let a taxi take you home. You must have a caretaker - driver. You must have a caretaker for 24 hours and it is best to have one for 2 to 4 days. If no ride and caretaker we cannot do your surgery unless a hired caretaker is available. If you have problems with obtaining a caretaker, we can arrange one for you.
6 .Shower the day before surgery, the morning of surgery, and daily thereafter with baby shampoo.
7. Take no tub baths, sauna, jacuzzi , or steam baths for 2 weeks after surgery.
8. After surgery begin ambulating the night of surgery and progress thereafter for 2 weeks to normal activity. Walk and do not run. Avoid strenuous activity for 2 weeks. Avoid heavy lifting.
9. Pain medication causes constipation. On day 2 after surgery start Milk of Magnesia according to directions on bottle. If constipation persists a fleets enema may be indicated, call. You must have a bowel movement by Day 3. Mild laxatives do not correct pain medicine induced constipation.
10. Keep salt (Na+) below 2000 mg day for one week before and two weeks after surgery. Read labels. This decreases swelling. It is even a good idea to reduce salt the week preceding surgery. You will have less swelling and discomfort after your surgery if you reduce salt prior to surgery.
11. Wear loose fitting, easy entry clothes to surgery
12. No contacts, make up, jewelry, piercings, or valuables to the operating center. If questions, call. If you have a piercing in an area not near your surgical site it is usually not a problem.
13. Please be on time and bring phone numbers for your contact and ride home.
14. After your surgery, you will be in recovery for 1 to 2 hours. Your ride will receive time estimates. Please have ride on call and ready. We pick opportune times to send you home, and if this is delayed by your ride the trip is more difficult.
15. Take food and fluids slowly at home. Start ice chips, then water, then 7 up, then clear liquids, then ice cream, then gently add some solid food slowly to prevent nausea. If even a hint of nausea, go back to ice chips and water and take your anti nausea medication...Zofran (ondansitron) sub lingual tablets every 4 hours.
16. Pain pills can be taken with crackers and a sip of water. Take as prescribed. Take as directed, but if one does not work every 3 or 4 hours you can increase to 1 1/2 or 2 every 4 hours. If nausea is a problem take Zofran (ondansatron) with each pain administration.
17. No alcohol for one week. No alcohol with pain or sleep medication. Do not drink alcohol the day before surgery.
18. A wound at rest heals best. Walk to prevent blood clots but do not run. Be gentle with yourself. Take it easy.
19. There are no routine mandatory tests or studies prior to your surgery, but we do go over your health history carefully and may require a medical check up by your family doctor if you have problems. It is important that you share your entire health history with us. If you have had a recent check up and studies, I would like copies of lab work and EKG sent to my office. If you have ongoing issues with high blood pressure and are on medication, I like your doctor to do a check up. If you are on blood thinners that must be explored extensively with you doctor. Diabetes is another issues that needs some thought and study. If you are quite healthy, I require no blood work but I do require, via our anesthesiologists, an EKG for all males over 50 and for all females over 60. Please note that patients must be off all weight loss drugs for 3 weeks prior to surgery. Some of the weight loss drugs interfere with anesthesia.
20. Alcohol should never be taken at the same time as pain medication or sleeping medication. Avoid alcohol for the first week post op.
21. If laboratory work is required, please do this at least 10 days prior and assure it is sent to office .
22. When you come for your consultation bring a list of all medications you take please. Better yet bring the medication bottles themselves.
23. Do not smoke anything. Nicotine causes poor wound healing and skin death. Even nicotine from gum is dangerous. Coughing causes strain and bleeding and can mean a second operation to stop the bleeding. Stop smoking ideally a month before and after surgery. If impossible to stop, carefully review your amount of smoking and alternative avenues that will be safe for you. Few people seem to smoke in 2013 but if you do we will discuss it. We can work this out depending on type of surgery.
24. Call if any significant health change before surgery such as a severe cold, or broken leg, or appendectomy, or whatever.
25. Remember some degree of bruising and swelling are normal after surgery. Feel free to call. You will have the office number, home and cell numbers for your convenience. I make it very easy to call me and I do not mind being called about little things. In fact I love little things that we can easily solve over the phone. Solving little things prevents big things. I find giving patients all my numbers calms them. I have done this for over 20 years and I have never had anyone abuse the open nature of my practice. I want you to do well, be calm, be at peace, and be very happy throughout.
26. Take all of your medication I give you as prescribed and if it does not agree with you call me. Also take your routine prescriptions as we discuss. I will give you 4 prescriptions. Cephalixin or antibiotic equivalent, Percocet5/325 or other pain medication equivalent, Zofran (ondansitron) or other anti nausea equivalent, and Ambien or other sleeping medication equivalent. Take these as directed on your prescription and as I discuss with you. If a problem, call me and we will adjust.
27. Some bruising, swelling, pain, itching, and other sensations are normal after surgery but if not controlled with medication call me. Pain medication does not eliminate pain but does control it well.
28. THE BASICS ARE AS IMPORTANT IN EVERY SINGLE ASPECT OF SURGERY FOR BOTH PATIENT AND DOCTOR AS THEY ARE FOR PLAYERS IN BASEBALL, FOOTBALL, GOLF, OR BASKETBALL. Read and learn and remember the basics. Read, and read, and read again. To some extent these guidelines will assist in preparing for all types of surgery, not just plastic surgery.
29. If you have questions call me. Remember I want you to do well even more than then you want you to do well. I am extremely meticulous before, during, and after your surgery. I do 100% of your surgery myself. I do 100% of your post operative care myself. I do all consultations myself. I do all surgical preparations myself. I never place another between my patient and myself. I really care about you from both a scientific viewpoint, from an artistic viewpoint, and from a human viewpoint. I will be with you and there for you all the way.
31. Get prepared and enjoy every second of your surgical experience. It is one of life's great adventures and it will be a real joy for both of us.
My Best, Dr C