Surgery Instructions:

As a reminder prior to major surgery, please avoid overt the counter blood thinners such as aspirin, high doses of vitamin E and fish oil unless directed to stay on them by the doctor.

We do want you to continue to take your regular medications prior to the procedure with some exceptions. Diabetic medications will need to be altered during the period of fasting prior to the surgery. Blood thinning medicines may need to be changed as well- please contact the doctor to discuss the best course of action for these 2 issues if they apply to you.

Proper nutrition is critical to healing and so from now until your surgery, please:

1) avoid sugar, high fructose corn syrup, processed food, alcohol consumption and cigarette smoking. Use Stevia as a sweetener w hen possible.

2) You should be consuming 70 grams of protein per day.

3) You should be consuming 64 ounces of water daily unless you are on a water restricted diet by your physician.

I suggest the following supplements to improve intestinal health and promote healing intestinal surgery- NOW foods is a good source - available online, at health food stores and on Amazon

1) N AcetylCysteine (NAC) 600 mg

2) L-Glutamine 500 mg- an amino acid that supports GI nutritional health

3) Probiotic-10 + Inulin - this combines good gut bacteria plus the food they like to consume into one product

3) Vitamin C- 2 g daily

The day before your surgery you will start a clear liquid diet and drink one dose of magnesium citrate at noon. If you are having a colon resection, antibiotics have been called out to your pharmacy (Neomycin and metronidazole) to take in 2 separate doses the evening before surgery- follow the instructions on the prescription. I do not typically call these drugs out for hernia or perineal surgeries.

You will be on a clear liquid diet until 6 hours prior to surgery. To make sure your body has a good energy supply during the surgery, you should drink an 8 ounces of isopure protein clear (or equivalent clear protein drink) at bedtime and then at 6 hours before surgery. You will need to have an empty stomach for 6 hours prior to surgery.

The hospital will contact you for a pre-operative assessment which will be done several days prior to surgery. Labs may be drawn based on the anesthesiologist recommendations. They will also give you suggestions for an antiseptic soap to use prior to surgery and when to use it.

We will work with your insurance to ensure there is prior approval if time allows (some emergency surgeries do not allow enough time for this process). Both our office and the hospital will alert yo u to your financial responsibility based on your insurance contract.

Most patients undergoing robotic colon surgery are in the hospital 2-4 days. If we are worried about your mobility after surgery, we can coordinate home health to visit after surgery to track your progress. 

Pain management after surgery will avoid narcotic medications as studies have shown that narcotics worsen outcomes. But, we want to make sure your pain is managable, so we suggest the following:

1) Prescriptions will be written for a muscle relaxant (Cyclobenzaprine), an anti-inflammatory(ketorolac or celecoxib (unless contraindicated)), and a medication for neuropathy nerve pain (Gabapentin) which has been shown to augment the effect of the other medications.

2) over the counter medication, tylenol, can be used as directed on the bottle

3) holistic and herbal supplements can be used as well including- 

arnica montana (prevent bruising)

Turmeric (anti-inflammatory)

Boswellia (anti-inflammatory)

CBD oil supplements (anti-anxiety, anti-inflammatory)

For any urgent issues call 214-942-3740.

Remember, patients do best with surgery when they are hydrated, relaxed, and have proper nutritional intake. Get some rest, eat well, and we will see you the morning of your surgery.