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� %i-a6fb153865"%i-02ce79eb29!%b-f488b77c.1 %b-f488b77c.0%b-f442d5fe.1%b-f442d5fe.0%b-e4fe2d92.1%b-e4fe2d92.0%b-c42fe7cc.1%b-c42fe7cc.0%b-c02f5508.1%b-c02f5508.0%b-b73d4712.1%b-b73d4712.0%b-aef5acd2.1%b-aef5acd2.0%b-a9bc9bbf.1%b-a9bc9bbf.0%b-81b4db5e.1%b-81b4db5e.0%b-5864bade.1%b-5864bade.0
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%b-30159879.0 %b-2146192c.1%b-2146192c.0%b-19fdcaf6.1%b-19fdcaf6.0%b-0979084d.1%b-0979084d.0.master .data _satisfied":"Were you satisified with the procedure?","msg_helpful":"Was this guide helpful?","msg_comment":"Tell us about your experience","msg_footer":"Please share what you liked about this app, and what you did not, so we can continue to improve. Since this is completely anonymous, you will not receive a reply.","btn_caption":"Send Feedback","cap_success":"Thank You","cap_error":"Error","msg_ok":"Your feedback was sent successfully","msg_err1":"Your feedback was not submitted. The error is: %s","msg_err2":"Please select a rating, or enter a comment"},{"type":"block","size":10,"text":"<b>Author:</b> Dr. Christopher P. Miller, MD, MHS. Instructor of Orthopaedic Surgery, Harvard Medical School<p><b>Author:</b> Dr. Jeremy T. Smith, MD. Assistant Professor Orthopaedic Surgery, Harvard Medical School<p><b>Series Editor:</b> Joseph P. DeAngelis MD MBA Associate professor of Orthopaedic Surgery, Harvard Medical School<p><b>Powered by:</b> PatientApps Inc., Boston"}]}],"infolink":"https://patientapps.com/home/info?id=121237","careteam":[{"type":"text","text":"The advice contained in this Procedure Guide is based on current best practices. Your Primary Care Provider will be able to answer any questions you may have. ","extra":null},{"type":"text","text":"If you encounter an error within this guide, please contact PatientApps on <a href=\"tel:+1.888.808.8007\">1.888.808.8007</a> or email <a href=\"mailto:support@patientapps.com\">support@patientapps.com</a>. ","extra":null},{"type":"text","text":"PatientApps support staff cannot offer medical advice.","extra":null},{"type":"container","icon":"user-alt","children":[{"type":"title","text":"Physicians","extra":null},{"type":"blank","text":"Christopher P. Miller, MD"},{"type":"blank","text":"Fernando Raduan, MD"}]},{"type":"container","icon":"user-md","children":[{"type":"title","text":"Clinic","extra":null},{"type":"address","text":["BIDMC - Shapiro Building - 2nd Floor","98 Binney Street","Boston MA 02215"]},{"type":"phone","text":"+16176673940","extra":null,"caption":"Phone"},{"type":"oncall","text":"+16176677000","extra":null,"caption":"Off Hours"},{"type":"map","text":"Online Map","extra":null,"target":"https://maps.app.goo.gl/gbyVCJs1Dm3ZMCWG8"}]},{"type":"container","icon":"user-md","children":[{"type":"title","text":"New Clinic Location","extra":null},{"type":"address","text":["HMFP Foot & Ankle Center","40 Allied Drive, Suite 104","Dedham MA 02026"]},{"type":"phone","text":"+17814538550","extra":null,"caption":"Phone"},{"type":"oncall","text":"+16176677000","extra":null,"caption":"Off Hours"},{"type":"map","text":"Online Map","extra":null,"target":"https://maps.app.goo.gl/feBDjR5P3t7twsQ48"}]},{"type":"container","icon":"clinic-medical","children":[{"type":"title","text":"Surgery","extra":null},{"type":"address","text":["BIDMC - Shapiro Building - 2nd Floor","98 Binney Street, 3rd Floor","Boston MA 02215"]},{"type":"phone","text":"+16176673940","extra":null,"caption":"Phone"}]},{"type":"text","text":"Hospital parking, transportation, etc.","target":"https://www.bidmc.org/patient-and-visitor-information/visiting-bidmc"},{"type":"text","text":"Check-in Instructions","target":"https://www.bidmc.org/patient-and-visitor-information/visiting-bidmc"},{"type":"container","icon":"clinic-medical","children":[{"type":"title","text":"New Surgical Location","extra":null},{"type":"address","text":["NE Baptist Outpatients","2nd Floor, 40 Allied drive","Dedham MA 02026"]},{"type":"phone","text":"+16177545000","extra":null,"caption":"Phone"}]},{"type":"text","text":"Hospital parking, transportation, etc.","target":"https://nebsurgerycenter.com/contact-directions/"},{"type":"text","text":"Check-in Instructions","target":"https://nebsurgerycenter.com/contact-directions/"},{"type":"text","text":"<b>If, at any time, you have questions, or the solutions suggested in this guide do not work, please either contact the hospital, or go immediately to the Emergency Department.</b>","extra":null}],"branding":{"layoutType":0,"showPAIlogo":1}}}],"version":"2024.04.10","theme":2,"expiry":1744296183} scribed everything hour-by-hour, day-by-day.<p>If you have any questions or concerns during the non-surgical treatment, or the at-home recovery phase, please check out our signs and symptoms section, which will help you determine whether your symptoms require medical attention. If the app says that you need help, you just click the button and you will be connected with the physician on call, our office, or you could send an email to us.<p>Finally, we can bring you the support and tools you deserve \u2013 24 hours a day \u2013 and on every device you and your caregivers have. We are doing this together. It\u2019s not quite like having us by your bedside, but you get the idea.<p><b>If, at any time, you have questions, or the communications solutions suggested in the app do not work, please either contact the hospital, or go immediately to the Emergency Department. For contact information on your physician please click on the Care Team icon, bottom right of your screen.</b>"},{"type":"divider","caption":null,"hash":"516c763798a3b1b6","title":null},{"type":"block","size":8,"text":"<i>Content provided by this app does not contain or constitute, and should not be interpreted as, medical advice or opinion. No doctor-patient relationship is created. The authors, editors, reviewers, and publishers of this app are not responsible for errors, omissions, or the consequences from application of the information in this app. If any information you obtain from using this app is inconsistent with the advice from your health care provider, you should follow the advice of your health care provider.</i><p><i>This app is for the issuer\u2019s patients and their caregivers. All other uses are prohibited. Content cannot be used or copied without the permission of PatientApps Inc.</i>"}]},{"type":"header","caption":"Table of Contents","hash":"a5a8203b893c223f","is_toc":true,"title":"Table of Contents","children":[{"type":"banner","hash":"ed173a62b0a9a65de01b6df91a783dd5","name":"b-f488b77c.1","size":10},{"type":"block","size":16,"text":"Table of Contents"},{"type":"link","size":12,"target":"5496f60fdd1671d6","text":"Hello"},{"type":"link","size":12,"target":"c2de672a3159f132","text":"About Diagnosis"},{"type":"link","size":12,"target":"606e14e4a493bcad","text":"About Procedure"},{"type":"link","size":12,"target":"18886e9eb68e4799","text":"Pre-Procedure"},{"type":"link","size":12,"target":"bee7646507081261","text":"Day of Surgery"},{"type":"link","size":12,"target":"069667e87a9328a6","text":"Recovery"},{"type":"link","hint":"- Self-Care","size":12,"target":"3126ac78575962c9","text":"At Home"},{"type":"link","size":12,"target":"a420ea0a7decdf87","text":"What to do If"},{"type":"link","hint":"Feedback and Credits","size":12,"target":"be05914d81766466","text":"Feedback"}]},{"type":"subheader","caption":"Hello","hash":"5496f60fdd1671d6","icon":"happy","title":"Hello","children":[{"type":"banner","hash":"53f05723f7bd87de7e71a026a9a44ab5","name":"b-45785fb3.1","size":10},{"type":"block","size":10,"text":"Hello, and Welcome to \u201cThe Patient Guide to Bunion Correction\u201d.<p>The first metatarsophalangeal (MTP) joint connects the first metatarsal bone to your big toe. This joint is a common site of problems, including the site of a bunion deformity.<p>A bunion is an angular deformity where the first metatarsal bone deviates one direction and the toe goes the other. This creates an angular deformity that can be the source of pain and problems with wearing shoes.<p>We want to help you deal with your diagnosis in the best way possible. To Orthopedic surgeons this means finding non-surgical treatments wherever possible. We have described the best treatments here for you to follow.<p>If, despite your and our best efforts, the treatments fail to solve your problems, then we will propose a surgical solution for you.<p>We will guide you through just about everything you need to know before, during, and after your surgery. From the time you get ready at home until you have completely recovered.<p>Unfortunately, we cannot make the surgical process painle ss. However, we <i>can</i> provide guidance and answer most questions you may have, decreasing your physical and emotional stress level throughout the process.<p>During the important at-home recovery phase, our signs and symptoms section will help you determine whether you require medical attention.<p>If this app suggests that you need to see a medical professional or if you find yourself in a situation where the app does not address one of your questions or concerns, we can help!<p>With the simple click of a button, our app allows you to directly communicate with either your surgeon\u2019s office or an on-call physician\u2014via email or telephone. We think that you will find this resource to be extremely valuable and reassuring, as you recover.<p>We are fully prepared for you and want you to experience a full recovery with all the help that both modern surgical techniques and the latest technology can provide.<p>Finally, you can use the app on any browser enabled device that\u2019s connected to the Internet \u2013mobile phones, tablets or\u00a0computers. \u00a0Please use this app as a reference throughout your peri-operative process and\u00a0feel free to share the app with your family or your caregivers."}]},{"type":"subheader","caption":"About Diagnosis","hash":"c2de672a3159f132","icon":"doctor","title":"About Diagnosis","children":[{"type":"banner","hash":"e6c0383d0f1050d6d6f419c65222c225","name":"b-30159879.1","size":10},{"type":"tab","caption":"What\u2019s yours?","hash":"20dc74e659d47003","title":"What\u2019s yours?","children":[{"type":"block","size":10,"text":"A bunion deformity is an angular deformity located at the first metatarsophalangeal (MTP) joint of the foot. This is the joint at the base of the big toe.<p>A bunion is actually an angular deformity that results from the first metatarsal bone deviating one direction and the big toe deviating another. This often creates a prominence at the inside of the foot where the joint is.<p>It is important to understand that the prominence is not usually a bone spur since the problem really is an angular one. You can see a clinical photo of a patient with a bunion before and after surgical correction.<p>Bunions can cause pain in a variety of different ways. Sometimes, the deformity itself will cause pain deep within the joint. This can result in pain that is spread out throughout the first MTP joint.<p>You may also have pain localized mostly to the bony prominence at the inside part of the foot. This prominence can be painful due to the soft tissue being stretched and can be particularly problematic when it comes to shoes. Many shoes will rub on the bump, which can create pain due to friction and pressure.<p>You may have tried a variety of different treatments. These treatments typically involve adjustments to your shoes, such as wearing wide shoes, avoiding shoes with a heel because this puts more pressure on the front part of the foot, and stretching your shoes so they do not rub on the inside part of the foot as much.<p>In addition, a toe spacer that you wear between your big toe and second toe can help minimize the bump on the inside of the foot. A bunion sleeve, which is a soft pad that protects the inside part of the foot, can be helpful as well.<p>It is important to know that none of these treatments are going to cause the toe to straighten out permanently, but rather are used to help minimize your pain.<p>There are <i>many </i>different types of bunion surgery. It is estimated that there are over 120 different bunion surgeries. These can involve just soft tissue (ligament) correction and also bone cuts and joint fusions. The specifics of your bunion will guide us as to what is the best surgical treatment.<p>The basic principles of bunion surgery are to correct the angular deformity of the toe. This is why it is so important to understand that the problem is an angular deformity; it is often not successful just to \u201cremove the bump\u201d. Bunion surgery is truly a reconstruction of a complex foot deformity."}]},{"type":"tab","caption":"Available Treatme nts","hash":"5bb4385f6c256539","title":"Available Treatments","children":[{"type":"block","size":10,"text":"The goal of bunion treatment is to minimize pain. With some minor shoe adjustments, bunion deformities can often be managed without surgery. It is important to know that non-surgical treatments are very unlikely to permanently straighten out your toe To do that, you would need to undergo surgery. That said, you may do just fine without needing surgery with some simple adjustments to your shoes and activities.<p>The specific treatment depends on:<ul><li>What prior treatments you have had</li><li>The degree of deformity at the joint</li><li>Whether arthritis is present</li><li>Your age, occupation, activity level</li><li>Your overall general health</li></ul><br><p><b>We will suggest one or more of the treatments described below. Depending on the results, we will know whether we need to take further action, or not.</b>"},{"type":"lineitem","bold":true,"depth":1,"group":10006,"index":1,"size":12,"subsize":10,"text":"Non-operative Treatment","children":[{"type":"block","size":10,"text":"The goals of treatment, whether you have surgery or not, is to minimize your pain. Since shoes often pose a big problem for bunions, due in part to rubbing, you may have success by making some adjustments to your shoes. Wearing wider shoes or stretching the front part of your shoe may minimize rubbing on the bunion.<p>Avoiding wearing heels is also helpful, as heels put more pressure on the front part of your foot when standing. There are also a number of devices that you can wear that may help with your pain, including a toe spacer and a bunion splint.<p>Toe spacers sit between your big toe and your second toe. They work by pushing the big toe to the inside, which helps to decrease the bump on the inside part of the foot.<p>Bunion splints are small pads that cushion the inside part of the foot. These treatments will not permanently change the shape of your foot, but if they minimize your pain then they have achieved the treatment goals."}]},{"type":"lineitem","bold":true,"depth":1,"group":10006,"index":2,"size":12,"subsize":10,"text":"Surgery","children":[{"type":"block","size":10,"text":"The goal of surgery for bunions is to minimize your pain. It is important to understand that surgery is not typically pursued to improve the appearance of your foot. We hope that your toe will be straighter after surgery, but surgical treatment really is to help with your pain and function.<p>There are many different procedures than can be used to treat a bunion deformity. Which specific surgery is right for you depends on a lot of factors, including importantly the degree of bunion deformity.<p>Some treatments involve just balancing out the soft tissues around the joint, while others involve cutting and straightening out the bone, or even fusing the joint to maintain the deformity correction."}]}]},{"type":"tab","caption":"Treatment Results","hash":"76500c5c84780012","title":"Treatment Results","children":[{"type":"block","size":10,"text":"Your doctor will do a physical examination and often obtain x-rays. The x-rays should show the extent of the bunion deformity. The location and severity of your pain helps to determine what the best treatment might be.<p>The ultimate goal of treatment is to provide you a painless and well-functioning foot. If possible, it is preferable to manage your bunion deformity without surgery since this avoids some of the risks associated with surgery.<p>If surgery is necessary, then you should know that the treatments do have good outcomes. Most patients experience a lot of pain relief after healing post-operatively, with improvements in the appearance of the foot as an added benefit.<p>This typically allows for wearing a broader variety of shoes, although we continue to discourage heels and narrow shoes in order to minimize the risk of the bunion coming back."}]}]},{"type":"subheader","caption":"About Procedure","hash":"606e14e4a493bcad","icon":"patient","title":"About Procedure","children":[{"type":"banner","hash":"fdc bd384cb60eea6545578af7ed90166","name":"b-19fdcaf6.1","size":10},{"type":"link","size":12,"target":"e79a3c92d1020775","text":"Briefing"},{"type":"link","size":12,"target":"e9d3ad6099121ede","text":"What will happen if I don\u2019t do this?"},{"type":"link","size":12,"target":"ea47bc64e3b58ab5","text":"Alternatives?"},{"type":"link","size":12,"target":"01f2af556999ae8f","text":"Risks?"},{"type":"link","size":12,"target":"d16f0335957d62f1","text":"Contact information"}]},{"type":"page","hash":"e79a3c92d1020775","title":"About Procedure","children":[{"type":"banner","hash":"0a4a87c380138a72196f37e46ad4f4ba","name":"b-f442d5fe.1","size":10},{"type":"block","size":16,"text":"Briefing"},{"type":"block","size":10,"text":"You, dear patient, are reading this section either because you and your doctor have elected to proceed with surgery to correct your bunion deformity..<p>Here are some things to consider, and the different surgical solutions we can use.<p><b>Timing</b><p>The decision of when to proceed with a bunion correction depends a lot on how much pain you have. When you decide to proceed with surgery, you will need to ensure that you have enough time and help at home to safely recover.<p><b>Anesthesia</b><p>Surgery can be done with a general anesthetic or a regional nerve block. Nerve blocks are commonly used and put your leg to sleep with an injection of local anesthetic (like Novocain when you go to the dentist). With your leg asleep, we can ensure that you are comfortable during the procedure. Sometimes we can avoid needing to place a breathing tube entirely, but this is ultimately up to the Anesthesiology team.<p><b>Outpatient vs Inpatient</b><p>Usually these surgeries are done as an outpatient. You may need to stay overnight if you are on blood thinners, if your general health is poor, or if you do not have adequate support at home, but this is quite rare."}]},{"type":"page","hash":"e9d3ad6099121ede","title":"About Procedure","children":[{"type":"banner","hash":"483192e8afabf26929bacd53e93c036f","name":"b-b73d4712.1","size":10},{"type":"block","size":16,"text":"If I don't do this"},{"type":"block","size":10,"text":"If you chose not to undergo surgery, you will likely continue to have the deformity and experience the same pain in your foot. The deformity may gradually worsen over time, although this is not a guarantee. You should plan to continue to manage your pain with adjustments to your shoes and the toe spacers and bunion splints."}]},{"type":"page","hash":"ea47bc64e3b58ab5","title":"About Procedure","children":[{"type":"banner","hash":"2b5abfadc3a645e6d5c134347d316924","name":"b-c02f5508.1","size":10},{"type":"block","size":16,"text":"Alternatives"},{"type":"block","size":10,"text":"There are many different techniques for correcting bunion deformities, in fact there are more than 100 different operations. These operations address the bony prominence at the inside part of your foot, most by correcting the angular deformity.<p>Some procedures achieve this by balancing the ligaments around the joint while others involve performing an osteotomy (bone cut). The osteotomy allows me to straighten out the bone.<p>Lastly, some procedures involve fusing the joint to help maintain the correction."}]},{"type":"page","hash":"01f2af556999ae8f","title":"About Procedure","children":[{"type":"banner","hash":"e7732c3c94d50f53394b4a5b1ef62c71","name":"b-aef5acd2.1","size":10},{"type":"block","size":16,"text":"Risks"},{"type":"block","size":10,"text":"All procedures have risks, but this is usually a straightforward procedure.<p>Serious risks from bunion correction do exist, but the likelihood of having a complication is relatively low. Early complication rates are usually less than <b>5.0%</b>. The likelihood of experiencing any one of the following complications is dependent upon your individual clinical scenario. Long term the highest risk is developing recurrence of the bunion. This is estimated to be 10-15% of cases, but even if the bunion does partially recur, it is often much less symptomatic.<p>However, we must be comprehe
nsive. The risks include:<ul><li><b>Damage </b>to nearby structures like blood vessels and nerves.</li><li><b>Infection</b> of the incision.</li><li>Postoperative complications requiring <b>further surgery.</b></li><li><b>Fever.</b></li><li><b>Localized numbness.</b></li><li><b>Complications from anesthesia.</b></li><li><b>Foot swelling.</b></li><li><b>Continued pain.</b></li><li><b>Blood clots.</b></li><li><b>Recurrent bunion.</b></li><li><b>Angular deformity of the toe deviating the opposite direction.</b></li></ul>"}]},{"type":"page","hash":"d16f0335957d62f1","title":"About Procedure","children":[{"type":"banner","hash":"e355357c2070a0f412d6c0fc2de32854","name":"b-a9bc9bbf.1","size":10},{"type":"block","size":16,"text":"Contact Information"},{"type":"block","size":10,"text":"Click on the people icon at the bottom of each page."}]},{"type":"subheader","caption":"Pre-Procedure","hash":"18886e9eb68e4799","icon":"numbers","title":"Pre-Procedure","children":[{"type":"banner","hash":"d2dc05bc30692089aa0ec4f0d78ccd29","name":"b-2146192c.1","size":10},{"type":"tab","caption":"Surgery Description","hash":"b4794c35dba2be14","title":"Surgery Description","children":[{"type":"warning","header":"Please complete your checklist","iconname":"cb-boxcheck","iconsize":14,"message":"Check when task is completed","subheader":"Be sure to complete your checklist so the hospital team knows you are ready"},{"type":"block","size":10,"text":"We make an incision over the dorsum (top) or medial (inside) aspect of the first MTP joint. This incision is usually about 4 cm long. This gives us access to the structures around the joint, allowing us to balance the ligaments. This typically involves lengthening the tight ligaments on the outside of the joint and tightening the ligaments on the inside.<p>We also shave off some of the bony prominence that is part of the head of the first metatarsal bone, which we call the medial eminence.<p>Many bunions are also best corrected by performing an osteotomy of the first metatarsal bone and sometimes the big toe. An osteotomy is a controlled cut of the bone, typically done with a small saw.<p>We cut the bone in a particular way which allows us then to shift the bone and straighten the toe out. The osteotomy is typically held with metal screws. When the osteotomy has healed, then the new alignment of the bone helps to maintain the correction (see images of bunion corrected with an osteotomy of the first metatarsal bone).<p>With certain deformities, we may choose to fuse either the first tarsometatarsal joint or the first metatarsophalangeal joint. With these procedures, the correction is gained through the joint.<p>We do this by removing any remaining cartilage from the joint and then drilling holes into the bone at the joint to encourage the healing process. Sometimes we will place bone graft into the joint to help with the healing.<p>We then place a few screws or a small metal plate across the joint to hold it in the corrected position. Fusions do have the downside of removing the joint, and thus eliminating motion at that joint. The good news is that most of the time, people do not feel limited by the loss of motion.<p>During the procedure, x-rays are taken in the operating room to ensure that the correction is adequate. When we are satisfied, we irrigate the wound(s) and then then close the surgical incision(s) and place a sterile dressing."}]},{"type":"tab","caption":"Weeks Before","hash":"a4100672279067a8","title":"Weeks Before","children":[{"type":"warning","header":"Please complete your checklist","iconname":"cb-boxcheck","iconsize":14,"message":"Check when task is completed","subheader":"Be sure to complete your checklist so the hospital team knows you are ready"},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10018,"hash":"9c0d8d4bf3a7847d","index":1,"size":12,"subsize":10,"text":"Pre-operative appointment:","children":[{"type":"block","size":10,"text":"<b>Interview</b><ul><li>If you are having outpatient surgery, you will most likely meet with your surgeon.</li><li>These are like ly topics and questions you may have:</li><li>Your major medical problems.</li><li>Any surgeries you have had.</li><li>Your current medications (including all vitamins, herbs, and supplements) along with their dosage and frequency of use.</li><li>Any allergies.</li><li>Common questions to ask your surgeon include:</li><li>Will I be staying overnight?</li><li>How will my pain be controlled after my procedure? What alternative solutions are there other than opioid pain medication?</li><li>What expectations should I have for my recovery?</li><li>How much time will I need to take off from work while I recover?</li></ul>"}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10018,"hash":"8470b90e96f4211a","index":2,"size":12,"subsize":10,"text":"Physical examination & possible tests.","children":[{"type":"block","size":10,"text":"<ul><li>Electrocardiogram (ECG) to assess your heart function may be helpful if you have a history of heart problems.</li><li>Blood tests are not usually necessary unless you are on a blood thinner.</li><li>Urine test might be done if you could be pregnant.</li><li>X-rays will be obtained to look at the foot. In some cases, a CT or MRI may also be obtained.</li></ul>"}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10018,"hash":"efb879f620ba67e8","index":3,"size":12,"subsize":10,"text":"Recovery period planning.","children":[{"type":"block","size":10,"text":"Depending on your overall health, recovery duration can vary. Total recovery time for a bunion correction is about 3-4 months."}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10018,"hash":"e04d00e1100c79af","index":4,"size":12,"subsize":10,"text":"1 week before or after your initial visit.","children":[{"type":"block","size":10,"text":"<ul><li>Attend your <b>pre-admission testing</b> appointment - if scheduled. Most of the time, the pre-admission assessment will be done through a phone call.</li><li><b>Discontinue </b>Aspirin, non-steroidal anti-inflammatory (NSAIDs) or arthritis medications, vitamin E supplements, and blood thinners (e.g. warfarin) if necessary, as instructed by your doctor. If you are on a blood thinning medication for a coronary or vascular stent, the decision to discontinue your blood-thinning medication needs to be made by your cardiologist or prescribing physician. If you did not receive instructions on what to do, please call our office.</li><li><b>Pharmacy</b>: Know where you will be picking up your prescription medications after surgery and check to make sure they have the appropriate postoperative pain medications you will require.</li><li><b>Antibiotic soap</b>: Make sure you have the special antibiotic soap (see section on \u201cevening before surgery\u201d) you will use at home prior to your surgery.</li><li><b>Home-care team ready?</b> You will not be allowed to leave the hospital on your own after receiving anesthesia or opioid pain medication, so you need a responsible adult to help. You are also encouraged to have an adult stay with you for your first day home.</li></ul>"}]}]},{"type":"tab","caption":"Day Before","hash":"aa7420e01ef9e313","title":"Day Before","children":[{"type":"warning","header":"Please complete your checklist","iconname":"cb-boxcheck","iconsize":14,"message":"Check when task is completed","subheader":"Be sure to complete your checklist so the hospital team knows you are ready"},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10023,"hash":"a6ecde84c117478b","index":1,"size":12,"subsize":10,"text":"Day before surgery","children":[{"type":"block","size":10,"text":"<ul><li>Stop all pain medications. If you require pain relief, acetaminophen should be OK.</li><li>Abstain from smoking and nicotine use.</li><li>Follow the plan for your diabetes medications so that your blood glucose is in the desired target range.</li><li>Review all surgical preparation materials.</li></ul>"}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10023,"hash":"6ee769accfe521d3","index":2,"size":12,"subsize":10,"text":"Evening bef ore procedure","children":[{"type":"block","size":10,"text":"<ul><li><b>Overnight stay possibility</b>. Although it is rare, there is a possibility that you will be required to stay overnight if there are unexpected complications, or your surgery was delayed.</li></ul><br><p>Just in case, <b>pack the bare essentials</b> you would need for an overnight stay. These \u201cessentials\u201d are obviously patient-specific. For example, if you have sleep apnea, you should bring your CPAP or BiPAP sleeping machine. If you have asthma, you should bring your inhalers.<ul><li><b>Surgical soap.</b> You need to shower with preoperative surgical soap twice before coming to the hospital. This soap is called chlorhexidine gluconate antiseptic soap (CHG).</li></ul><br><p>The first shower should take place the evening before your surgery. The second shower occurs the morning of your surgery. This soap has antibacterial properties and decreases your risk of infection after surgery. Briefly, use this soap on all areas of your body below your chin EXCEPT for your genital area if you are a woman. DO NOT use on your head and avoid using it over non-intact skin or open wounds. Avoid this soap if you have an allergy to CHG.<p>Do not use your regular soap after using this antiseptic soap, and no skin lotions or deodorants either.<ul><li>DO NOT use on your head and avoid using it over non-intact skin or open wounds. Avoid this soap if you have an allergy to CHG.</li><li>DO NOT use your regular soap after using this antiseptic soap.</li><li>DO NOT use any skin lotion.</li></ul>"}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10023,"hash":"f522c12643cc1731","index":3,"size":12,"subsize":10,"text":"Midnight and morning before surgery:","children":[{"type":"block","size":10,"text":"<ul><li><b>New eating rules.</b>Rules are more relaxed. You should <b>not</b> eat heavy/fatty meals 8 hours before your surgery. You <b>may</b> have a light snack, such as toast, up to 6 hours before your surgery. <b>You</b> <b>may</b> drink clear liquids (e.g., water, electrolyte drinks, cranberry juice, and even ginger ale) up to 2 hours before your surgery. <b>This means drinks that you can see through \u2013 no pulp</b>. If you break these rules, your surgery may be cancelled.</li></ul>"}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10023,"hash":"244288f5266badc5","index":4,"size":12,"subsize":10,"text":"Medications.","children":[{"type":"block","size":10,"text":"You should take the medications that your Physician has instructed you to take with small amounts of water at the approved times."}]},{"type":"lineitem","bold":true,"checkbox":true,"depth":1,"group":10023,"hash":"6f5686447ef747a3","index":5,"size":12,"subsize":10,"text":"Morning of surgery","children":[{"type":"block","size":10,"text":"<ul><li><b>Smoking</b>DO NOT SMOKE ON THE DAY OF YOUR SURGERY.</li><li><b>Shower</b>.Take your second shower with the preoperative surgical soap. Nothing else on your skin.</li><li><b>Medications</b>Bring a list of current medications.</li><li><b>Clothing & other wearables</b>You should wear loose clothing that is easy to take off. You will be changing into a hospital gown soon after you arrive.</li><li><b>You must remove contact lenses/glasses, hearing aids, dentures, hair accessories, and any piercings. Either keep these at home or have a safe way to store them during your operation.</b>If you have to bring valuables, make sure you have a trusted friend or family member with you who can assume responsibility for them during your surgery.</li><li>Do not wear make-up.</li></ul><br><p>If possible, remove all nail polish, including gel or acrylics, prior to surgery."}]},{"type":"block","size":10,"text":"<b>Be Calm & Relax: It\u2019s OK.</b>We encourage you to remain calm. Surgery is a stressful event for every patient, but you are in capable hands and will be well taken care of by your surgical team, anesthesia team, and the nursing staff."}]}]},{"type":"subheader","caption":"Day of Surgery","hash":"bee7646507081261","icon":"scalpel","