Coming Clean
6 things to tell your doctor before surgery
By Anna Lockhart

You’ve binge-watched all the TV medical dramas and can now diagnose your friends’ ailments. But when it’s your turn to deal with a health issue, it’s best to admit the limitations of your medical expertise.

One of the most crucial pieces to receiving effective medical treatment has nothing to do with what you read online or see on TV, and everything to do with what you share with your doctor. Especially when it comes to undergoing surgery, what your doctor doesn’t know can harm you. Here are six topics to discuss with your surgeon – and when you do, be brutally honest.


1. The medications you take

You will be asked a lot of questions before any procedure about medications you take. Be prepared with the names and exact dosages. Doctors need such information to take into account how your medications, or their mix, will impact the operation or your outlook for recovery.

You may forget some of them, including the daily dose of aspirin you’ve been on for years to reduce the risk of stroke. But that aspirin is a blood thinner, which can be dangerous during and after surgery, says Roy Sandau, DO, a general surgeon at Jefferson Health New Jersey.

A rule of thumb: anything you put in your body should be disclosed, Sandau says. That includes all non-pharmaceutical medications, herbal supplements and even that daily vitamin.

“A lot of those things, even if they say they are regulated, may not be pharmaceutical grade, and the dosages may not be clear,” he adds.


2. Alcohol, smoking and drug habits

You could be tempted to under report your daily wine consumption, but Sandau warns that’s not in your best interest.

“The liver is in charge of stopping bleeding and clotting,” says Sandau. “Anything going near it should be discussed.”

Whether using cigarettes or vapes, smokers too need to be honest about their habit as well, as complications related to anesthesia could come up. Doctors typically recommend patients refrain from smoking for a minimum of 24 to 72 hours before and after most surgical procedures to increase the body’s ability to deliver oxygen to vital organs and tissues.

“Smoking is a big deal because, when you’re sedated, underlying breathing issues can show up,” Sandau says, noting that nicotine can lower the effectiveness of certain medications or interfere with the way drugs work. It can also impact healing and lead to infection and greater discomfort after surgery.

Be honest about drug use as well. “Marijuana usage can complicate surgery and recovery,” says David Lynch, MD, a general surgeon at Inspira Health. “It is associated with hypertension and, particularly for smokers, poor blood supply to the healing areas.”

Also, studies have found THC – the main compound in marijuana that gives the high sensation – can increase your tolerance for anesthetics. Doctors can adjust the dosing accordingly, but they first need to know if it’s in your system.

Be candid too if you have a history of drug use or abuse. As the number of people struggling with opioid addiction climbs, Lynch says, prescribing pain medication for legitimate reasons has become more complex.

“We always tell people we’d love for them to be able to manage pain with Tylenol or Motrin or Aleve, but a lot of times they may need a stronger pain medication,” he adds.

If you have a concern, tell your doctor. It’s their job to manage your pain safely. Lynch says he carefully monitors patients and weans them off medication as soon as possible. In addition, he’s always on the lookout for withdrawal symptoms.


3. Allergies

Like your medical history, allergic reactions and sensitivities are topics covered during the screening process. Your past reactions to antibiotics, latex and other adhesives are taken into consideration. If you know your skin is sensitive, it’s worth telling your doctor.

“We’re seeing more people reacting badly to the skin glue we use to heal incisions,” Sandau says.


4. Previous surgeries

Maybe your first surgery – say getting your tonsils removed as a toddler – has nothing to do with your current operation. But it’s still worthy of disclosure.

“If you’re having gallbladder surgery and you’ve had knee surgery before, there can still be a relationship between those,” Lynch says.

Every year, Lynch performs hundreds of hernia surgeries, an operation that sometimes has to be done multiple times. Scar tissue from a past surgery can significantly impact the current one, he notes.


5. Illness on the day of surgery

The reason for surgery may loom larger than anything else you’re experiencing, but even a head cold could affect the procedure. Your doctor may want to re-schedule your surgery if you’re congested.

“If you’re coughing and have post-nasal drip, that’s going to compromise recovery,” says Lynch.


6. Overall health conditions

Your overall health – what you eat, if you exercise, how well you sleep – is also important. It may have been your New Year’s resolution to eat healthier, but come clean to your doctor if it didn’t stick. “Your lifestyle,” says Sandau, “will directly affect the outcome of your surgery.”

A few extra pounds and a sedentary lifestyle can put you at a higher risk for complications and infections.
On the flip side, patients who get antsy when their fitness plans hit a snag often have a hard time accepting the limitations that come after surgery.

So if your idea of an everyday workout is akin to a US Marine bootcamp, discuss it with your doctor. Sandau assures his patients that they can still be active, and likely as active as they once were, but only if they give themselves time to heal. “You’re not a super hero,” says Sandau.

December 2019
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