Preparing for Surgery & Procedure

Surgery Timeline

Within days of your office visit, you will be contacted by Dr. Remy’s Surgery Scheduler to discuss scheduling and provide initial details. It is critical that you are reachable by both our office and the surgery centers. You will receive several important phone calls leading up to your surgery. If 3 attempts to reach you by phone are unsuccessful, a letter will be mailed to you. If the letter is not responded to within 1 week of expected receipt, you will forfeit your spot in the surgery schedule. To help prevent communication problems, please confirm your contact information is correct with our office, make sure the office phone number ((423) 578-1570) is saved to your contacts, and your voicemail is set up with space available.

Please Note: If you are being scheduled for a replacement you will need to obtain clearance from both your primary care provider and dentist. If you see a specialist, we may have to obtain clearance from them as well (e.g., Cardiology, Neurology, Pulmonology). All clearances will need to be obtained before you are put on the schedule.

2 Weeks Prior to Surgery

• Dr. Remy’s nurse will call to confirm details of your surgery including physical therapy location, pharmacy, and any necessary durable medical equipment (DME).
• Depending on your type of surgery, if you do not already have the recommended bracing, ambulatory aids, or cryotherapy a third-party company Kinex will reach out to you to schedule the DME to be delivered to your house. It is very important to bring these items with you to the hospital or surgery center!
• If any additional imaging is required, it will be scheduled about 2 weeks before your surgery.
• Check the list of medications to stop taking prior to surgery provided in this packet. A copy will also be mailed to you after scheduling. Call the office at (423) 578-1570 if you need clarification. If you are unsure if a medication can, safely be stopped, please reach out to the prescribing provider and ask how to proceed.

1 Week Prior to Surgery

• The surgery center or hospital will call to confirm and discuss your medical history. They will also call to let you know if you will owe anything financially at the time of service.

3 Days Prior to Surgery

• Do NOT shave or wax near the area where you will have surgery. Better hair than razor burn!

Day Before Surgery

• Pick up medications at your pharmacy!
  • If you will be on a narcotic, you should pick up an OTC stool softener of your choice.
• The surgery center will call you to let you know what time to arrive for surgery.
• After 6:00 pm follow the attached instruction sheet titled Getting your Skin Ready for Surgery

***Do not eat, drink, or use any tobacco products (such as chew, cigarettes, and vapes) after midnight leading into your surgery. You may take morning medications with a small sip of water only.***

Frequently Asked Questions

Q: I am being schedule for a Total Joint Replacement. Why do I have to obtain dental clearance?

A: Your oral health can make a difference in the outcome of your surgery! If you have any kind of infection (ex: cavity, abscess) it enters your blood stream and travel to your surgical site. We want you to have the best possible outcome long term and your dental health matters. Make an appointment if you have not seen your dentist in the past 6 months.

Q: How often am I supposed to use the ice machine?

A: Use as much as you can in the first 72 hours after surgery. The ice machine is based on cold water and therefore safe to use continuously. Regular ice packs, frozen peas, etc. should only be left on for 20 minutes at a time. The ice machine pad should not make direct contact with the skin; Dr. Remy typically places it on you in surgery in a safe manner. You can also use a hand towel in between the wrap and your skin. The cold will help with pain control and swelling.

Q: When can I take the surgical dressings off?

A: On day 3. Depending on what surgery you have you may need a waterproof bandage, a bag, or saran wrap to keep the incision dry. You can reference the post op packet Dr. Remy provided after surgery for more details.

Q: When can I drive?

A: After you are no longer taking narcotic medicine and adequate range of motion has been gained. Make sure you use your best judgement as it can take longer than expected for your reaction time to return to normal.

Q: Do I have to take antibiotics when I go to the dentist after a Total Joint Replacement surgery?

A: No. Current consensus guidelines indicate that this is not necessary. If you are having a major procedure or have a special risk factor that makes you feel they are indicated, Dr. Remy is happy to prescribe them but does not use them routinely.

Q: My employer needs FMLA/ Short Term Disability paperwork filled out. Can you help with that?

A: Yes! You can drop it off to the Bristol or Kingsport office or have your employer fax it directly to our office ((423) 392-6251). Because this paperwork takes office staff time and effort, the paperwork may require up to 7-10 business days. There is a $25 fee. * Once it is complete you will receive a phone call from our office, and they will ask you to stop by the office to pay the fee or over the phone with a credit card. It will be returned to your employer/insurer upon payment.

*The fee is good for 1 year regarding the same issue and all follow up requests can be sent directly to our office fax at (423) 392-6251.

Caregiver Help Sheet

Below are helpful tips and tricks to help you care for your loved one following surgery.

• Ice Machine
  • Freeze 4 to 8 plastic water bottles! Place the frozen bottles in the machine and add water. You can rotate the bottles as they thaw to keep the ice water flowing. This will also save you from having to buy ice. Make sure the bottles will fit height wise in the machine before freezing the bottles.
• Medication
  • The patient may be on several different medications after surgery to control pain in different manners. Check the prescription bottles for how often they are supposed to be taken and make a list. You can set alarms or keep a written log of when medications are taken. This is especially important for the pain medication in the first 48 hours following surgery. Making sure the patient takes pain medication on schedule helps with pain control.
• Pillows/Elevation
  • Knee: Elevate the operative leg above chest level to decrease swelling. Do not place the pillows under the knee unless specifically instructed to as this is an exception. It is typical to place them under the foot/ankle, so the knee is straight.
  • Shoulder: Sleeping may be difficult. Some patients prefer sleeping in a recliner or propped up with pillows in bed which keeps the shoulder elevated.
• Incision Maintenance
  • Follow the care guidelines in the Post Op Surgery packet provided by Dr. Remy at the surgery center. There are a couple of signs of infection to watch for. Call the office at 423-578-1570 if you are unsure. If it is afterhours, you can call the office and will be given an option to connect with an after-hours provider line. Some signs of infection are:
    • Worsening redness
    • Drainage from incision sites that continues for more than 5 days.
    • Fever >101.5
• Activity
  • Make sure the patient does not overexert themselves in the first week after surgery. Physical therapy will provide instruction for appropriate activity level.
  • Physical Therapy is a crucial part of a full recovery but is often frustrating to the patient in the beginning. Emotional and moral support will go a long way! Be patient and encouraging with your loved one.

Medications to Stop Prior to Surgery

14 Days Before Surgery

• Ticlid
• Semaglutides (Trulicity, Victoza, Saxenda, Byetta, Bydureon BCise)

7 Days Before Surgery

• Non-Steroid Anti-inflammatories (aspirin, ibuprofen, Motrin, Advil, Aleve, naproxen, Mobic/meloxicam, Celebrex)
• Omega 3/Fish Oil, Vitamin E, and other Herbals as many of these impact bleeding
• Plavix/Aggrenox
• Phentermine (diet pills)

5 Days Before Surgery

• Coumadin

4 Days Before Surgery

• Steglatro

3 Days Before Surgery

• Jardiance
• Brenzavvy
• Inuokana
• Farxiga

24 Hours Before Surgery

• Lovenox/Luveox

For some minor surgeries, you may be safe to continue aspirin and/or Plavix especially if you are prescribed this for your heart health. If you are unsure, please ask Dr. Remy.

If there are any OTHER medications you are concerned about, please contact your prescribing doctor/primary care physician. Inform them of your upcoming surgery date.

Let our office know if you are under the care of a pain management clinic and if they will be providing pain management after surgery or if they would like Dr. Remy to temporarily take control of pain management. The most common approach is for you to continue your chronic medication through surgery and Dr. Remy will prescribe a 3-5 day supply of breakthrough narcotic medication.

Please pick up your prescriptions the day before surgery!

This allows time for any issues to be addressed such as need for alternative medication, pharmacy shortages, etc and ensures you have adequate pain control immediately after surgery. Please also plan to pick up at over the counter stool softener to use while on narcotic medication after surgery.

Most lower extremity surgeries also require over the counter aspirin 81mg twice daily (unless you are on a different blood thinner like Eliquis or Xarelto). Please pick this up ahead of time as well.

Explanation of Dr. Remy’s commonly prescribed medications:

• Percocet 5/325 = oxycodone-acetaminophen 5/325
  • This is a narcotic medication with Tylenol included.
• ketorolac = Toradol
  • This is a very powerful anti-inflammatory and works wonderfully for surgical pain. It can be hard on the stomach, so take with food and for a maximum of 5 days. Do not use any other NSAID such as ibuprofen until after completing your 5 days of this medication.
  • Not prescribed for people over 65, with history of kidney failure, ulcers, or NSAID intolerance
• Hydroxyzine
  • As needed for itching (which is a common side effect of narcotics). Also works wonderfully for anxiety which can help keep pain well controlled.
  • Not prescribed to people over 65
• Promethazine
  • As needed for nausea
  • Use with caution if over 65 due to risk of urinary retention and sedation

Let our office know if you are under the care of a pain management clinic and if they will be providing pain management after surgery or if they would like Dr. Remy to temporarily take control of pain management. The most common approach is for you to continue your chronic medication through surgery and Dr. Remy will prescribe a 3-5 day supply of breakthrough narcotic medication.

Surgical Location List

Surgery location is dependent on availability, insurance, and health history. Surgical location is subject to change.

Getting Your Skin Ready for Surgery

This handout explains how to clean your skin before surgery. This is to help lower your risk for infection. Please review the step-by-step instructions below. It is important to give yourself enough time follow the steps carefully. For total joints, our office will supply you with Hibiclens® at your nurse preop visit. For all other surgeries you can buy it (or any other anti-microbial skin soap) at your local pharmacy. For shoulder surgeries, some evidence shows a benefit to benzoyl peroxide soaps as are marketed for acne. This can be used in addition.

Supplies Needed

• Hibiclens® CHG soap and a clean washcloth or new body sponge
• Clean towels, bedsheets, pillowcase, and pajamas

3 Days Prior to Surgery

• Do not shave or wax near the area where you will have your surgery.
• Use the specified antimicrobial soap as you would a normal body soap during your routine bathing or showering

The Night Before Surgery (after 6:00pm)

1. Shower and bathe using your usual soap and shampoo. Do NOT shave.
2. Turn off or step out of the stream of water.
3. Wet the clean washcloth and open CHG soap.
   • Do NOT apply soap directly to your face, head, or genital area.
   • Apply CHG soap to the washcloth and wash your skin from head to toe. Cover all skin areas one time.
   • Reapply the CHG soap as needed to the washcloth. Apply to your skin until all your skin is covered. Rinse
4. Repeat step 2. You should use half the volume in the bottle.
5. Leave CHG soap on skin for 1 minute (sing Happy Birthday two times, slowly), so it can absorb into your skin.
6. Rinse with warm water. Do not scrub. Minimal contact to the genital area during rinsing is fine.
7. Blot your skin dry with a clean towel.
8. Do not use lotions, creams, powder, perfume or makeup after the shower or bath.
9. Dress in clean pajamas and sleep on clean sheets.

Lindsay Remy, MD

Holston Medical Group Orthopedics and Sports Medicine

Perioperative Nutrition Advice

Management of nutrition should begin prior to surgery to optimize benefits and prepare your body for the demands of surgery. Evidence suggests that proper nutrition can reduce the risk of complications and improve surgical outcomes. Below are some ways that you can help support your body to be in the best position to heal after your upcoming procedure.

Increasing protein intake in the weeks prior to surgery can help to aid in recovery, reduce risk of infection, maintain muscle mass and allow for improved healing of your surgical site. Aim for 1g of protein for every pound of ideal body weight. High protein foods include:

• Eggs
• Lean meats and seafood
• Tofu/Soy
• Almonds
• Lentils and legumes

Providing support for your gastro-intestinal (GI) system in the weeks prior to and after surgery can benefit you in multiple ways, as well. Your GI system provides a barrier to infection and ensuring proper “gut health” allows nutrients in your diet to be properly absorbed. You can support your GI system by including the following foods:

• Dark, leafy greens such as spinach, kale or bok choy
• Fruits like berries, mango, and apples
• Yogurt
• Kombucha, Kefir and other probiotic beverages
• Whole grains such as oats and quinoa

Lastly, carbohydrates play an important role to help your body have the energy to heal after surgery. Including a higher carbohydrate diet and potentially even carbohydrate heavy beverages such as Gatorade and Ensure may be of benefit to include in the days immediately prior to surgery. This “carb loading” approach is similar to what athletes do before an endurance event. Beware of this if you are diabetic as high blood glucose would be harmful to your health.

There are many foods and supplements that help reduce inflammation. Both Vitamin D and Omega-3 fatty acids have been shown to support the body during the demands of surgery. These are found in fatty fish such as salmon, many nuts and seeds, or in supplement form. Many vegetables, particularly those with bright colors, are anti-inflammatory.

It is always a good idea to consult your primary care doctor with any questions or concerns regarding nutrition and diet. REMINDER: you are not to consume food, drink or supplements after midnight the night before surgery with the exception of clear liquids being allowed up to 2 hours prior to anesthesia for some individuals. No tobacco products on the day of surgery! Refer to preoperative instructions for medications and supplements to stop prior to your surgery.