Surgery can be intimidating and often is nerve racking if you are not prepared for it, but with the proper guidance and information, you can be prepared on your day of surgery. Make a list of questions and discuss them with your surgical team at your pre-operative visit. You should understand what your surgery will entail as well as the expectations after surgery. Bring a complete list of your medical conditions and medications (including prescription, over the counter, and herbal-nutritional supplements) with the dosage for each one.
Medical Testing before Surgery
Your health conditions and your planned surgery may require that you undergo testing before surgery. Testing may include blood work, radiographs, EKGs and in some cases medical clearance by your primary care provider or specialists such as a cardiologist.
Certain medications need to be stopped before/after surgery
Some medicines can be dangerous when taken just before or after surgery. Your surgeon will tell you which medicines must be stopped before or after surgery. Your surgeon may tell you to stop taking:
- Aspirin before surgery. This drug can increase bleeding during surgery.
- Non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil and Motrin), naproxen (Aleve), Celebrex, and Mobic. These drugs can increase bleeding during surgery by decreasing one’s ability to clot blood. They may also slow down bone healing after surgery.
- Certain steroids as they may slow down wound and/or bone healing after surgery.
- Hormone replacement therapy and/or birth control pills after surgery. These may increase the risk of having blood clots after surgery.
- Metformin or diabetic medications related to metformin at least 24 hours before surgery. These medications can cause a reaction to anesthesia.
- Certain over the counter (OTC) supplements and/or herbal preparations before surgery. Many of these agents can increase bleeding during surgery.
When you should stop eating and drinking
Typically, you will be instructed to not eat or drink after 11:59 pm on the night before your surgery. This means no coffee, chewing gun, or water in the morning. If your surgery is later in the day, you may be allowed to drink clear liquids until about 6-8 hours before your surgery.
Why is this important? You should have as little food, drink, or stomach acid in your stomach as possible at the time of anesthesia. After eating or drinking, it takes at least 6-8 hours for food and/or drink to leave the stomach and enter the intestines. If you do not eat or drink after 11:59 pm on the night before your surgery, your stomach should be empty be the time anesthesia is administered. This decreases the chances of nausea, vomiting, or an upset stomach, or an upset stomach with anesthesia or aspiration.
If you take certain medicines regularly in the morning, exceptions may be made to allow you to take the medication with small sips of water on the morning of surgery. It is highly recommended to review your medications with your surgeon and anesthesiologist before surgery.
What you should bring with you
While each center has different policies, it is highly recommended that you bring the following with you on your day of surgery:
- Medical insurance card
- Passport or driver’s license as legal identification
- List of medications that are regularly taken
- Immunization record if patient is a minor
- Credit card and small amount of cash
- Copy of pre-surgical test results. This is very important to have if these tests were done at a location different from the place of surgery.
- Assistive devices, such as crutches or a walker, to be used after surgery
- Small bag for personal belongings
Who you will be meeting with
As the leader of the team, the foot and ankle orthopedic surgeon will speak with you again about your surgery. Many surgeons will have already discussed what to expect from surgery, but this lets you ask any last-minute questions or express concerns to the surgeon. At this time, the surgeon will mark your surgical area with his/her initials via pen or marker and verify with you that it is correct. To ensure the entire team is aware of the plan, other members of the surgical team will check that the correct area on the patient has been marked for surgery.
You will meet with the anesthesia team before having surgery. This team includes the anesthesiologist who will make sure that the patient feels neither pain nor discomfort during surgery, nurse anesthetists (CRNAs), and possibly assisting anesthesiologists in training. Such assisting doctors are common at university or academic hospitals and are known as resident anesthesiologists. While you will meet with many people that are a part of the anesthesia team, it is important to recognize that the anesthesiologist is the leader of the team and will be administering the anesthesia. Nurses and residents assist the anesthesiologist and are an important part of the team providing patient care.
Your options for anesthesia during surgery
Some form of anesthesia is needed to safely receive any kind of foot or ankle surgery. Anesthesia options include general anesthesia, sedation, regional anesthesia, or local anesthesia.
With general anesthesia, you are completely asleep during surgery. You receive medicine through your IV to make you fall asleep. Once asleep, you receive a tube in your mouth (laryngeal mask airway or LMA) or windpipe (endotracheal tube or ETT) to protect your lungs and keep you breathing during surgery.
Regional anesthesia allows you to breathe on your own by numbing the surgical area. This may include a spinal or epidural where numbing medicine is injected into the back and spinal cord, near the spinal nerves.
It is also important to consider the post recovery process and what to expect. Post-surgery recovery is often a lengthy process and requires a lot of patience and care. Surgery can be a big stress to the body, so it is normal for you to experience the following symptoms after surgery:
- Pain, which will be worst in the first few days after surgery. As time passes and the body starts to heal, post-surgical pain lessens.
- Swelling of the surgical foot and/or ankle
- Bruising and discoloration of the surgical foot and/or ankle. Normal skin colors after surgery include blue, red, pink, purple, and brown. Skin colors that may be a sign of problems with circulation are pale white and dark black. Tell your surgeon immediately if you suspect circulation problems.
- Blood or fluid leakage from the surgical foot/ankle incisions. This tends to occur when one’s foot swells after surgery.
- Low-grade fevers (less than or equal to 100.5 degrees) during the first week after surgery. Low-grade fevers that last after one week or those that are above 100.5 degrees at any time after surgery may not be normal. The surgeon should know about this immediately.
These symptoms are to be expected, but if you are experiencing something abnormal, you should call your surgeon as soon as possible. Every foot and ankle surgeon has different instructions and protocols that they follow for patients after surgery to ensure the most effective care, don’t hesitate to give your surgeon a call.