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CHAPTER 4 - GETTING READY FOR SURGERY
Details before Surgery
It is our policy for you return to the office within two weeks of your scheduled surgery, if it is to be performed under general anesthesia or intravenous sedation. At this time, we review the plan for surgery with you, and have you read the surgical consent forms and sign them after all your questions have been answered. This visit is also an opportunity to take standard "before" photographs to document pre-existing asymmetries and as a comparison for later use. Implants for chin, cheek, jaw and breast surgery are chosen and ordered and all garments that you will need after surgery are fitted including bras, upper and lower body compression girdles and chin straps. We give you prescriptions for antibiotics, pain medication, and muscle relaxants, if needed, so that you can get the prescriptions filled ahead of time and avoid stopping at a pharmacy on the way home from the surgery center or hospital.
A nurse or physician assistant will also spend time with you during the pre-surgery visit and cover other practical issues related to surgery such as the appropriate clothing to wear on the day of surgery, the best way to bathe afterwards, tips on sitting and sleeping and positions, instructions on bandages, and the best way to take pain medications. If surgical drains will be needed after the surgery, they will also show you what they look like and how to take care of them so that you know what to expect.
Medications
Like any surgical procedure, it is important that you tell your doctor about your complete medical history and all prescription and over the counter medications you are taking, including aspirin, Motrin, birth control pills, hormone replacement medications, vitamin supplements, diet pills and herbal remedies.
You will be advised not to drink alcohol, and to avoid taking aspirin and aspirin containing products, non-steroidal anti-inflammatory products, and vitamin E, as these medications and substances can disrupt the clotting process and lead to excessive bleeding. Women who smoke, have a history of varicose veins, or are more than 10% over their ideal body weight should stop taking birth control pills and hormone replacement therapy one month before surgery to decrease the chance of developing blood clots.
In general, if you are taking medications to treat problems such as high blood pressure or thyroid conditions, these should be continued up to the time of surgery. We may specifically prescribe antibiotics to be taken prior to surgery if you have a history of mitral valve prolapse, a heart murmur or have had previous joint replacement surgery.
Do I need Blood Work and Tests?
The pre-surgical testing requirements for in-office surgery are the same as if you were having surgery in a hospital setting. The requirements for blood work and other tests are based on your age, your general health and the type of anesthesia that you will be having. When necessary, blood tests are performed within two weeks of surgery and may include a blood count, electrolyte levels and/or a profile of the blood elements that regulate bleeding. If you are age 40 and over, an electrocardiogram is usually required. For women of childbearing age, a urine pregnancy test is requested. A chest x-ray may also be ordered, especially for people with a significant history of cigarette smoking.
We suggest that you get medical clearance by a family doctor or internist for any major surgery and it is required if you have a medical condition such as diabetes, high blood pressure or lung disease. If you are taking prescribed psychoactive medications, we recommend that your psychiatrist or other mental health professional provides clearance before surgery. Even with normal test results and medical clearance, a markedly elevated blood pressure or a common cold on the day of surgery, are grounds to reschedule your procedure.
Vitamin Supplements
There are a number of companies that have developed comprehensive pre and post-operative nutritional supplement systems specifically designed for people undergoing surgery. The vitamins and nutritional supplements can boost the immune system, help to prevent infection, minimize inflammation, reduce bruising and enhance wound healing and we highly recommended them. You are given the opportunity to learn about the vitamin programs at the pre-surgical visit.
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