Preparing For Surgery

Dr. Roth Surgery Information Packet

 

Here are some guidelines that will help you in preparing for surgery and the immediate pre- and post-operative period.

Scheduling Your Surgery:

Dr. Roth’s surgical scheduler is Mallory (925-256-2182). She will be your main point of contact starting now through your surgery and will assist you in scheduling the surgery, getting insurance authorizations, booking your pre- and post-operative visits, and arranging your pre-operative medical evaluations, if required. Once you and Dr. Roth have decided that a surgery is the most effective treatment for you, Mallory will typically contact you within 5-7 business days.  It is important to note that some insurance carriers require prior authorization for surgical procedures. If authorization must be obtained prior to scheduling, Mallory will let you know. It may take 7-14 business days to obtain some authorizations. For some carriers it can take up to 30 days dependent upon the procedure recommended. Please also be aware that depending on the urgency of your surgery, it may take a few weeks to find a time that is convenient for both your and Dr. Roth’s schedule. While a specific surgical day can be requested, it may or may not be possible for Dr. Roth to accommodate exactly the day that you wish your surgery to take place.

PREOPERATIVE INSTRUCTIONS:

WITHIN A FEW WEEKS BEFORE SURGERY:

Dr. Roth or his Physician Assistant will see you in the office. He will perform a preoperative history and physical examination and complete the necessary paperwork. He will write preoperative hospital orders and if needed, he will order the appropriate pre-operative laboratory studies. Depending on your surgery, Dr. Roth may recommend doing preoperative exercises and/or physical therapy in order to help speed your recovery after surgery. He will give you prescriptions for post-operative physical therapy and pain medications at this visit. You will be contacted by Restore Motion if you need any post-operative equipment (ice machine, sling, braces, crutches) to discuss insurance coverage and to arrange for delivery.

SEVERAL DAYS PRIOR TO SURGERY:

All surgical patients, please purchase a 4% chlorhexidine gluconate antiseptic body cleanser at the drug store (Hibiclens is a brand name, but CVS and Walgreens both carry less expensive generic versions as well). For the two days prior to surgery, including the morning of surgery, wash your body from the neck down daily in the shower with the Hibiclens soap to decrease the risk of infection. BE CAREFUL AND DO NOT GET IT IN YOUR EYES OR PRIVATE PARTS – chlorhexidine is toxic to the eye.  Before using the Hibiclens wash, first wash your face and hair with your normal shampoo and face soap, and rinse those areas. THEN, step away from the shower stream and use the Hibiclens wash to wash the rest of your body from your neck down. Rinse and then dry yourself with a clean towel after you get out of the shower.

If you are having shoulder surgery, please also purchase a 10% benzoyl peroxide gel to wash the entire shoulder and armpit where you are having surgery. This will usually be found in the acne treatment section of the drug store. The primary bacteria that tends to cause infections in shoulder surgery lives in your armpit and is also a bacteria that causes facial acne, and therefore this type of wash is more effective against that particular bacteria.   You should use this wash for the two days prior to surgery including the morning of surgery, and can do this after you do your Hibiclens wash.

If you know you are allergic to either chlorhexidine gluconate or benzoyl peroxide, do not do the scrub with that product.  Similarly, if you have a reaction to either wash, discontinue that wash immediately and let Dr. Roth know.

The skin where the incision will be has to be in very good shape to prevent problems after surgery, so be careful not to get any scratches, cuts, sunburn, poison ivy, etc. in the area where the incision will be. Dr. Roth will always err on the side of safety over convenience, so if you have any skin problems that will put you at risk for infection on the day of surgery, Dr. Roth may decide to postpone your surgery. DO NOT shave your extremity the day of surgery. DO NOT put any lotions or creams or oils on the skin the 24 hours before surgery.

Blood Thinning Medications: You need to stop taking blood thinning products such as Aspirin for 7-10 days prior to surgery – please discuss this with Dr. Roth.

Other medications with blood-thinning qualities you may be asked to stop before surgery include: Advil, Motrin, Ibuprofen, Aleve, and Naprosyn.  For a more comprehensive list of medications, please see the list at the end of this document. There may be others on the list, including Celebrex and Mobic, which are prescription anti-inflammatories but also have slight blood-thinning qualities. Please check with Dr. Roth about these medications.

If you are taking a prescription blood thinner such as Coumadin, Warfarin, Plavix, Xarelto, Eliquis, Pradaxa or heparin, please discuss with Dr. Roth and your prescribing provider the options regarding surgery and briefly interrupting your prescription blood-thinner.  For a more complete list of blood thinning medications, please see the list at the end of this document. Sometimes an alternative medication, such as Lovenox, is prescribed as a bridge therapy during the days immediately around your surgery.

THE DAY BEFORE SURGERY:

  • A surgery nurse will call you one or two days before surgery to review your health history, confirm your arrival time and answer any questions you may have.
  • It is your responsibility to arrange in advance for a responsible adult (over the age of 18 years old) to pick you up at the center, drive you home and remain with you for the first 24 hours after surgery. You cannot drive yourself, take public transportation or a taxi, or be left alone.
  • Notify Dr. Roth before coming to the center if there is any change in your physical condition, such as a cold or fever.
  • A Preoperative Nurse may also contact you for an informational interview prior to your surgery. If you have not been contacted 12 to 48 hours before your surgery, please call the appropriate surgery center (phone numbers below) for specific instructions.

DAY OF SURGERY:

  • Prior to surgery you will meet with Dr. Roth, the anesthesiologist, the pre-operative nurse, and you will have an opportunity to ask any additional questions.
  • If you wear contact lenses or glasses, bring a case for their safekeeping. The Surgery Center provides containers for removable dentures and bridgework.
  • Do not drink or eat anything after midnight the night before your surgery - not even coffee or water. This will reduce the possibility of nausea and vomiting following anesthesia, and will be safer for you if you do vomit.  You may brush your teeth, but remember not to swallow anything.  Refrain from the use of mints, chewing gum or cigarettes.  Failure to follow these instructions may result in the cancellation of your surgery.
  • Please do not take any medication after midnight unless instructed by Dr. Roth or by the Surgery Center. If you are diabetic or on blood pressure medication, obtain specific instructions from the Surgery Center.
  • Please shower the morning of surgery with the Hibiclens body wash as described above, and if you are having shoulder surgery, please also wash the shoulder and armpit with the benzoyl peroxide wash as described above. When you finish your shower, dry yourself with a fresh clean towel.  Remove all make-up and do not use lotions, perfumes, or oils after bathing.
  • Wear loose, comfortable clothing, such as sweat suits and easy-to-button shirts or blouses that are big enough to accommodate a large bandage after surgery. Wear comfortable shoes, slip on shoes are best.
  • Leave all valuables, including jewelry, body piercings, and cash, at home.
  • Bring with you your photo ID, and insurance cards.
  • Please expect to have approximately 1 hour recovery time prior to being discharged home.

THE FIRST 24 HOURS AFTER SURGERY

  • Do not drive a car or operate any machinery that requires your full attention.
  • Do not drink any alcohol or take any recreational drugs.
  • Do not sign any legal papers or make any major decisions.

WHAT TO EXPECT AFTER SURGERY

  • Pain: You can expect some discomfort after surgery; the more complicated the operation, the more painful it might be. At your pre-operative appointment Dr. Roth will prescribe pain medication which will usually control pain very effectively; however, these medications can cause side effects such as dizziness, nausea and constipation.
  • Taking Care of Your Incision(s): Keep your dressing dry and clean. Depending on the type of surgery you have had and what/where your incision(s) are, Dr. Roth may ask you to leave your dressing in place or may allow you to remove it yourself. If you are unsure of what to do with your dressing, first check Dr. Roth’s website at KevinRothMD.com as most questions can be answered there. If you still are unsure, call Dr. Roth’s office at 925-939-8585 to find out if/when you may remove it. If you cannot get in touch with someone at the office right away (i.e. weekend), leave the dressing in place. You will not cause harm by leaving the dressing in place a few extra days, however, removing it too soon can be problematic.
  • When to Call: Call our office any time with concerns, but please notify us immediately of any of the following symptoms.  If your symptoms are increasing suddenly and you do not hear from us right away, report to the nearest emergency room for evaluation and treatment.
  • Increasing drainage from the incision
  • Increasing redness
  • Foul odor
  • Increasing swelling accompanied by pain
  • Fever over 101 (take your temperature twice to ensure accuracy)
  • Increasing pain not relieved with rest, elevation, ice and the pain medication
  • Coldness, numbness or a sustained blue color to your extremity
  • Blistering of skin
  • Sudden onset of calf pain
  • Sudden onset of shortness of breath
  • Chest pain

SURGERY LOCATIONS:

Dr. Roth operates at a number of different surgery locations. Please check with Dr. Roth’s surgical scheduler, Mallory (925-256-2182), to confirm at exactly which location your surgery is taking place.

OUTPATIENT SURGERY CENTERS:

INPATIENT HOSPITALS:

  • Alta Bates Summit Medical Center Ashby Campus in Berkeley
  • Alta Bates Summit Medical Center Summit Campus in Oakland
  • John Muir Hospital, Walnut Creek
  • San Ramon Valley Medical Center in San Ramon
  • Valley Care Medical Center in Pleasanton

BLOOD THINNING MEDICATIONS:

If you are taking any of these medications please discontinue 7-10 days prior to surgery.

Please Note

The following list may be used as a guide for use when your physician tells you to avoid aspirin, aspirin like compounds, ibuprofen, naproxen, and certain herbal supplements. When in question please consult with your pharmacist or primary care doctor to determine if you are taking any medications that thin your blood.

Products containing Aspirin &/ or Aspirin like compounds

A-C TABLETS BUFFEX MONO-GESIC TABLETS

ADPRIN BUFFINOL NIGHT-TIME EFFERVESCENT TABLET

ANACIN CAMA ARTHRITIS PAIN RELIEVER NORGESIC

ALKA-SELTZER PLUS COPE NORWICH ASPIRIN

ALKA-SELTZER TABLETS DARVON COMPOUND-65 P-A-C

ANODYNOS DISALCID CAPSULES/TABLET PAIN RELIEVER TABLET

ARTHRITIS PAIN FORMULA DOAN’S PILLS PEPTO BISMOL

ARTHRITIS STRENGTH BC POWDER EASPRIN PERCODAN

ASCRIPTIN ECOTRIN REGIPRIN ENTERIC COATED

ASCRIPTIN AD EMAGRIN ROBAXISAL

ASPERCREME EMPIRIN SALFEX

ASPERGUM EQUAGESIC TABLETS SINE-OFF

ASPIRIN EXCEDRIN

ASPERMIN EXCEDRIN MIGRAINE ST.JOSEPH LOW DOSE ASPIRIN

ASPIRITAB FIORINAL SYNALGOS

ASPIRIMAX 4-WAY STANBACK, ORIGINAL FORMULA

BACK-QUELL GENPRIN SUPAC

BAYER GENSAN TALWIN

BC GOODY’S HEADACHE POWDERS TORADOL

BUFFAPRIN HALFPRIN LOW STRENGHT EC TRIGESIC

BUFFASAL MAGNAPRIN TRILISATE

BUFFERIN MAGSAL URSINUS

BUFFETT ll MIDOL VANQUISH

MOBIGESIC ANALGESIC VICK’S DAY QUIL SINUS

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) COMMON HERBAL SUPPLEMENTS

THAT THIN THE BLOOD

ADVIL CAPLETS/TABLETS GENPRIL ANGELICA HERB

ADVIL COLD/SINUS HALTRAN BROMELAIN

ADVIL MIGRAINE IBU DANSHEN

ALEVE IBUPRIN DONG QUAI

ANAPROX IBUPROFEN EVENING PRIMROSE OIL

ARTHRITIS FOUNDATION LODINE FENUGREEK

BAYER MENEDOL FLAXSEED (INCREASES BLEEDING TIME)

CATAFLAM MIDOL IB GINGER

CHILDREN’S ADVIL MOTRIN GINKGO BILOBA

CHILDREN’S MOTRIN MOTRIN IB SINUS GINSENG (PANAX, SIBERIAN)

COADVIL NAPROSYN GOLDENSEAL (INHIBIT EFFECTS OF HEPARIN)

CRAMP-END NUPRIN GREEN TEA

DICLOFENAC PEDICARE FEVER GUARANA (PROLONG BLEEDING TIME)

DIMETAPP SINUS RELAFEN RED CLOVER (CONTAINS COUMARIN)

DRISTAN SINUS SINE-AID VITAMIN E

DYNAFED IB ULTRAPRIN

FELAFEN VALPRIN

FELDENE VOLTAREN

If you take Coumadin, Plavix, Pradaxa, Eliquis, Xarelto, Brilinta, Savaysa, or any other blood thinners, PLEASE INFORM YOUR SURGERY COORDINATOR. You will need prior approval from the prescribing doctor to stop the medication.