There is a phone call two to six weeks before every surgery I do, and it is the most underrated appointment in my practice.
It is not with me.
It is with one of my nurses, it runs twenty to forty-five minutes, and patients keep telling me afterward that it was the call where everything finally made sense. So I had some of them transcribed. What follows is my nursing team in their own words, names removed and every patient detail with them.
One caveat before you read. This is how we do it. Another surgeon may do it differently and still be right.
“We’ll Be Sending You Written Instructions for Everything”
That sentence shows up in nearly every call.
Our pre-op nurse: “So your vitamins, I’m gonna explain them to you, but it’s a lot. But we’ll be sending you written instructions for everything.”
Our pre-op nurse: “The first one is gonna be with the clearance paperwork that you need to take to your PCP for everything that we need before your surgery. And then the second email is gonna be the email with the copy of your consent, pre- and post-op instructions.”
Two emails, and for body procedures a physical box by FedEx two-day that somebody has to sign for.
“Our Surgical Criteria Center Requires Everything That Is on the Clearance”
Your primary care doctor has to sign off in writing.
Our pre-op nurse: “We need everything that is on file. Just because sometimes you go to the PCP and they tell you, oh no, because of your age we don’t need to do some of the labs that are here. Our Surgical Criteria Center requires everything that is on the clearance. And then for the EKG, if you can just let them know that we need the actual EKG.”
No insurance is not a dead end. “Anybody that, you can go to urgent cares or any doctor, they’ll be willing to do it.”
We want it back at least ten days out.
“Nothing to Eat or Drink Since the Night Before After 12 Midnight”
Our pre-op nurse: “You do have to be completely, completely fasting. Nothing to eat or drink since the night before after 12 midnight, as well as both of your index fingers, no gel or acrylic, ’cause that’s the finger where we’re checking your oxygen level while you’re under surgery. And somebody has to come with you and stay with you wherever you’re gonna be staying for the first 48 hours. So that means you cannot be by yourself.”
Why fasting, in plain terms:
Our pre-op nurse: “It’s just so you don’t have anything in your system when you come into surgery and we intubate. The less stuff you put in your stomach, the less risk of aspiration.”
Your own prescriptions are a judgment call, and they draw the line clearly:
Our pre-op nurse: “It depends, because if it’s for blood pressure, I’d rather you take it than not take it. But if it’s something, vitamins, or if they’re hormone therapy, yes, those kind of stuff can hold off.”
“I Want That Soap to Be the Last Thing to Touch Your Skin”
Two Hibiclens packets: one the night before, one the morning of.
Our pre-op nurse: “Tonight I want you to shower, regular shampoo, regular conditioner. You’re going to rinse everything off, and then you’re going to use the first package of Hibiclens to all the areas we will be working with. So specifically, let’s work from the neck down to underneath the booty.”
Then the part people forget:
Our pre-op nurse: “I don’t want you to put any lotions, creams, or perfumes. I want that soap to be the last thing to touch your skin before you go to bed tonight.”
One concession, and I love that they give it:
Our pre-op nurse: “You can put a little bit of deodorant just so you’re not stinking during the night and you don’t feel uncomfortable.”
On what to wear:
Our pre-op nurse: “Most people show up in pajama tops and pajama bottoms. I mean, you’re going straight back home to recovery. It’s not like you’re going to go to Walmart afterwards.”
“You’re Gonna Stop All Vitamins, Supplements, Pre-Workouts”
Two weeks out, everything unprescribed stops and ours starts.
Our pre-op nurse: “You’re gonna stop all vitamins, supplements, pre-workouts, or anything that you take that is not prescribed. If you’re taking any prescribed medications, you continue taking them.”
Our pre-op nurse: “Our vitamins are called Recovery Support. They help you with the bruising, the swelling, and everything that you need to heal. It’s a month treatment that you start 2 weeks before, then you finish it 2 weeks after.”
Here is the arithmetic, verbatim, because this is the part people get wrong:
Our pre-op nurse: “The morning formula is gonna be 3 before breakfast. The evening formula, 3 before dinner. Then you’re gonna continue with the Bromelain, which is gonna be 3 days before the surgery. Bromelain is gonna be 2 capsules, 3 times a day. So that means 2 before breakfast, 2 before lunch, 2 before dinner, of course, plus the 3 in the morning and the 3 in the evening. So when you’re taking them all together, it’s a total of 12.”
Why bromelain: “Bromelain is what pineapple contains, a natural antibacterial and a natural anti-inflammatory.”
The arnica is hand-labeled tablet by tablet before it ships:
Our pre-op nurse: “That box is actually opened and taped because I labeled every tablet for you. You’re gonna start with the first tablet that is labeled pre-op, 24 hours before the surgery. Then you’re gonna continue with the post-op, that is gonna be 4 hours after surgery. And then at bedtime the day of the surgery. Day 2, morning, afternoon, evening. Day 3, day 4, and you’re done.”
“If You’re Taking Any of the GLP-1s, Two Weeks Before”
This one is newer and it catches people off guard.
Our pre-op nurse: “I’m gonna need for you to stop taking it 2 weeks before the surgery and 2 weeks after. The reason why, they slow down your intestinal motility, as well as the surgery, and we do need for you to have bowel movements right after surgery.”
“He Prefers Your Hemoglobin to Be High”
Liposuction and tummy tuck patients start iron two weeks ahead.
Our pre-op nurse: “The reason why, we do lose a little bit of blood during surgery. So if you lose a little bit of blood and it’s high, it’ll go to normal levels other than having it normal and dropping to anemia.”
And a detail I did not expect to hear on a phone call:
Our pre-op nurse (translated from Spanish): “The only difference with the iron we prescribe, we prescribe ferrous gluconate, and usually when you buy over the counter it is ferrous sulfate, and the sulfate causes a little constipation, the gluconate does not, and the gluconate has better absorption.”
“Two Pain Medications, One Antibiotic, One for Nausea, One for Constipation”
Five is the usual list. Seven or eight for a tummy tuck, because that adds iron and a blood thinner.
Our pre-op nurse: “For pain medication, we prescribe Journavx. Journavx is a new pain medication, and it’s as strong as an oxycodone, but it doesn’t have the narcotics. So you avoid the constipation, the drowsiness, everything that comes when we take narcotics.”
You take it before you ever feel pain: “You’re gonna take 2 pills 30 minutes before your surgery, because what Journavx does, it blocks the pain receptors.”
The pharmacy warning is one of the most practical things my team does:
Our pre-op nurse: “Sometimes they tell you that it is not covered by insurance or that the cost is $400. We don’t want you to purchase it. In the email I’m going to send you, I’m going to send you a copy of the coupon. So it’s only $30. If they still tell you that they don’t accept the coupon, don’t purchase them. Once you get here to El Paso, we’ll go ahead and guide you to a pharmacy where they know how to run it with the coupon.”
“Nicotine Closes Our Blood Vessels”
Our pre-op nurse: “He wants you to stop smoking 2 weeks before the surgery and 2 weeks after. The reason why, nicotine closes our blood vessels. If your blood vessels are blocked, you will not have enough oxygenation to the scars and we can create a problem called necrotic tissue, which means that the skin will die.”
An offer, not a lecture: “If you need help, you can just let us know so we can send you some Chantix as medication to help you stop smoking.”
“You Cannot Be by Yourself”
Somebody stays with you for forty-eight hours. If you fly in alone, there is a path, and it is not improvised.
Our pre-op nurse: “If nobody is coming with you, there is another way. You will need to stay in our office, you will need to pay for the overnight stay, and then the next day we can arrange for a driver to take you to the hotel or the Airbnb. Because we cannot release you right after surgery because you’re still loopy and drowsy.”
Our pre-op nurse: “In recovery we go over all the medications and all the post-op instructions with your husband. You’re not going to remember any of it because you just had anesthesia. However, the nurse will be going to your house or your Airbnb or your hotel the next day, and she’ll pretty much reiterate all of the discharge instructions to you.”
That home visit is a real visit: “She just goes to the hotel and stays with you for a couple of hours, and she checks all your vital signs. She checks to see if you’re not anemic, and if she sees that you’re really low, she’ll give you a little bit more of IV fluids.”
“We Don’t Put the Garments Until Your First Massage”
This one surprises almost everyone.
Our pre-op nurse: “Your package comes with two full body suit garments, but the garments, we don’t put them right after surgery. We’ll put them on at your first massage. The reason why, there’s some circulation compromised during surgery, so we want to let circulation start working again in order for us to constrict you.”
Our pre-op nurse: “Once we put the garments on, you’re gonna wear them 24/7 for 4 weeks. The only time you’re gonna take it off is to shower, which you have to shower right the next day after surgery. And it’s only showers, no baths. Nothing you can submerge, no hot tubs, no baths, just regular showers.”
“He Does Not Want You to Be Bed Confined”
Our pre-op nurse: “He wants you to be up and walking right the next day, every hour for 5 to 10 minutes. And that’s to help prevent DVTs as well as, the more active you are, the better you’re gonna start feeling sooner.”
The limit, and the honest test for whether you are cheating:
Our pre-op nurse: “It’s gonna be no lifting, carrying, pulling, or pushing objects greater than 15 pounds for 4 weeks after surgery, as well as nothing that is gonna make your breasts bounce. If your breast is bouncing, that means you’re doing too much for the recovery.”
“A Total of 8, Two a Week the First Month”
Our pre-op nurse: “Dr. Agullo strongly, strongly recommends lymphatic draining massages. The lymphatic massages help break the scar tissue that the liposuction creates, the fluid retention, and for the drains to come out faster. He wants you to get at least 2 a week, a total of 8 the first month.”
Our pre-op nurse: “The person that comes with you can go in there and see the massages so they can see how they do them and help you when you’re back at your hometown. Remember, they have to be lymphatic massages done by hand.”
“Scratching Creates Stretch Marks”
Our pre-op nurse: “Every time you go under anesthesia, and especially after lipo, your body becomes very dry and itchy. We don’t want you scratching because scratching creates stretch marks, so we want you to use the body moisturizer at least twice a day. But not on the incision.”
Scar products wait: “The Skinuva and the scar tape, they’re for you to start 3 to 4 weeks after surgery, once we’re completely sure that all the incisions are completely closed.”
The Part Nobody Warns You About
This is the best thing on any of these calls, and it is not clinical at all. It comes up on face cases.
Our pre-op nurse: “For the face procedure recovery, that one is more like a psychological healing. The reason why, because the face is something that we can’t hide. When we do our body, we just put the garment and loose clothes and nobody notices. The face we can’t. So the majority of our patients, around week 3 to 4, they’re regretting what they did. I like to let you know, because once you remember what I tell you when you’re healing, you’re like, okay, she did tell me.”
And the reassurance in the same breath: “You might be one of the lucky ones that don’t swell up a lot, you might be one of the not so lucky that swell up a lot. It varies per patient. Just remember, if you’re very, very swollen, you’re not gonna stay like that.”
Why I Let My Nurses Do This Call
I could do it myself. I do not, and that is deliberate.
By the time a patient reaches this conversation the decision is already made. What they need now is not more surgical explanation. It is a person with unlimited patience who will tell them the bromelain math three times and then mail them the written version anyway. My nurses are better at that than I am, and they are the ones answering the phone at week two when something looks strange.
I am a double board-certified plastic surgeon with a Mayo Clinic fellowship, and I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center. A good result is not one person. The forty minute phone call is part of the operation.
Ready to Talk?
If you want to know exactly what the preparation looks like before you commit to anything, let’s talk. Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.
#StayBeautiful
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