PREOPERATIVE INSTRUCTIONS
You will have an appointment in advance of surgery to go through the details of your surgical day with you. However, reading about some of these instructions in advance may prepare you for what to expect. Certainly, if there is a discrepancy between these instructions and you are received instructions from preop clinic, feel free to contact the office for clarification.
Medications
Starting and stopping medications in advance of your surgery is a big part of the preoperative clinic. They will go in great detail about which medications to stop in which to continue, and if they are stopped, when they should be stopped. Particularly with respect to blood pressure medicines, pay attention to the instructions provided by your preoperative clinic visit.
Blood thinners: Medications such as Coumadin, Lovenox, Xarelto, and Eliquis need to be stopped in advance of surgery. If they are not stopped, your surgery will be canceled as it is too dangerous to operate while you are on these medications. You will have received instructions on when to stop these medications. Typically, Xarelto and Eliquis are stopped 2 to 3 days prior to surgery and held for 2 to 3 days after your surgery. Clarify exactly when these will need to be stopped with your surgeon. Coumadin is typically stopped 5 days prior to surgery. Depending on the indication for anticoagulation with Coumadin, you may need to be bridged with a medication such as Lovenox, which is typically stopped the day before surgery. If you cannot take Lovenox, you may need to be bridged with a medication called heparin which would require you to be admitted to the hospital, as this medication is administered through an IV.
GLP-1 agonists: This is a new class of medications used for diabetes and weight loss. This includes medications such as Mounjaro, Wegovy, Trulicity, Ozempic, and Victoza. New medications in this class may be emerging soon as well. These medications cause significant delay in gastric emptying which may lead to aspiration (vomiting) during intubation for general anesthesia. This is very dangerous and an unnecessary risk to you for an elective operation. If you are taking this medication, please make sure to note this during your clinic visit, surgical scheduling, as well as during your preoperative medical visit. You will need to be on clear liquids for 48 hours prior to surgery, with nothing per mouth overnight. We have found that this protocol allows for safe induction of general anesthesia and intubation.
Diabetic medications: If you take medications for diabetes regularly, you will receive instruction about which ones to continue in which to stop prior to surgery. Typically, these will be held the morning of your surgery, and any long-acting medicines may be held or decreased the night before surgery. If you are on an insulin pump, or are a type I diabetic, you will likely need to continue on your pump, but discuss an adjustment to your pump settings or an alternative medication regimen if your pump needs to be stopped with your endocrinologist.
Diet: There is no special diet to follow prior to surgery, unless you take a GLP–1 agonist. If you are taking one of these medications, you will need to be on clear liquids for 48 hours prior to surgery, and nothing per mouth from midnight prior to surgery.
Antithyroid medications: You should continue taking any antithyroid medications related to thyroid hyperfunction, particularly if you have a condition known as Graves’ disease. These medications include methimazole and PTU. Other medications that you may be taking for this condition include a beta-blocker such as atenolol or propranolol; bile acid binding salt such as cholestyramine; steroid such as dexamethasone or prednisone; and Lugol’s solution to help devascularized and shrink your thyroid. Typically, Lugol’s solution is taken 7 to 10 days prior to surgery 3 times daily. These days, this medication may not be carried by your local pharmacy and is best purchased independently through the following vendor:
https:/www.jcrowsmarketplace.com
J. Crows Lugols solution 5% 1 oz
Start 7-10 days prior to surgery
Take 6 drops by mouth three times daily x 7-10 days before surgery. Take in juice or other liquids.
POSTOPERATIVE INSTRUCTIONS
Pain: Following surgery, you will be discharged home with pain medications. Most patients will experience discomfort similar to a sore throat for the first night or two. The prescribed narcotic pain medication should provide sufficient pain relief for this type of discomfort. You can also take Tylenol or ibuprofen to help with pain relief.
Medications: After surgery, you may resume your home medications per your usual routine. The only exception will be the resumption of anticoagulation. Medications like lovenox, coumadin, Xarelto, Eliquis, etc., should not be resumed right away unless specifically told to do so by your surgeon. Typically, medications like Xarelto and Eliquis are resumed 2-3 days after surgery. Coumadin can often be resumed the day after surgery. Lovenox may or may not be resumed after surgery. Please double check with your surgeon and discharge instructions if any question about when to resume these medication before you take them.
– You may also be prescribed thyroid hormone following total thyroidectomy, and occasionally following thyroid lobectomy. This medication is best taken on an empty stomach, first thing in the morning, with no other medications or food. It is best to take this medication in a consistent manner. Your thyroid hormone levels will be checked, typically about 1 to 2 months after your surgery, to determine if additional adjustments need to be made.
– Also, you may be prescribed calcium and vitamin D to be taken after surgery. You will receive specific instructions about the dosing and frequency needed for your particular situation.
– Plan to pick up your medications at the pharmacy at Rex Hospital prior to your discharge.
Incision care: Please keep your incision clean and dry. If it gets a little bit wet during showering, that is okay. Blot your dressing to dry it off, do not rub as this may encourage the dressing to come off. Your dressing is waterproof. However, do not attempt to swim or submerge yourself in water, or subjected to prolonged exposure to water as it may come off prematurely. If the incision comes loose within 1 week of surgery, contact the office for instructions about what to do. If it begins to come off after 1 week, try to maintain the incision in place until your follow-up appointment, but but you can trim the incision up with some scissors and perhaps a Band-Aid to support it. If there are any questions, of course contact the office for further instructions.
Diet: There are no dietary restrictions following your surgery. You are free to eat and drink what ever you wish, although I would recommend abstaining from alcohol after your surgery as that may impair your judgment in combination with any anesthetic or pain medications that you received. For your first meal, try eating something relatively mild and easy to digest as you may experience some nausea from the anesthesia.
Driving: You may return to operating a vehicle when you are no longer taking any narcotic pain medication to help with pain relief. This is usually 1 to 2 days following surgery.
Smoking: I recommend abstaining from smoking at least 1 to 2 weeks prior to surgery and for 2 weeks following surgery as smoking can irritate the airways and promote coughing, which can lead to wound issues, bleeding, or formation of seromas. Additionally, smoking promotes constriction of microvasculature with his leads to abnormal and delayed wound healing. Also, it is just bad for you in general.
Weightbearing: Avoid heavy weightbearing following surgery as this can lead to increased venous pressure and promote bleeding in the neck. You should restrict your weightbearing to less than 10 pounds for the first week following surgery. Avoid extended neck postures, head down postures, physical exercise or exertion with the intent of raising your blood pressure or heart rate, running, jarring activities such as cycling, jogging, swimming, golfing, or jumping up and down. For the second week, you can increase your weightbearing up to 20 pounds. Typically, you can resume your normal physical activities after your 2-week follow-up visit, although if that includes heavy weightbearing activities with weights greater than 50 to 100 pounds, please discuss this specifically with your surgeon before resuming such activities.
Water: You can resume showering per normal routine the day after surgery. Leave your dressing intact. Avoid excessive wetting of your surgical incision, although if it gets a little bit wet when washing her face or hair, that is fine. The dressing is waterproof. Pat the dressing to dry it, rather than rub it. Do not swim or take a bath. Do not sit in a hot tub or sauna. If the dressing begins to come free before 1 week, contact the office for further instruction.
Work: If your job is mostly clerical and does not require heavy weightbearing, you can oftentimes return to work about 1 week following your surgery if you desire. If you have heavy weightbearing as part of your job position, you may not return to work with any of the heavy weightbearing responsibilities. Typically, you will need to stay out of work for 2 weeks, until after your follow-up appointment.