The harsh reality is that, wherever you live, there are not enough organs to accommodate those in need. Nationally, about 8% of patients die while waiting for a liver; in New York, that rate is nearly double, according to Sander S. Florman, MD, Director of the Recanati/Miller Transplantation Institute, and the Charles Miller, MD Professor of Surgery at the Icahn School of Medicine. Many of us in the transplant community are working to come up with a more equitable system.
David A. Greenwald, MD, Director of Clinical Gastroenterology and Endoscopy, The Mount Sinai Hospital
Each year, more than 50,000 Americans die from colon cancer, the second leading cause of cancer deaths in the United States. David A. Greenwald, MD, Director of Clinical Gastroenterology and Endoscopy, The Mount Sinai Hospital, explains why the vast majority of these deaths are preventable, simply by identifying and removing polyps, or small growths, that occur on the lining of the large intestine, also known as the colon.
Medications can have an impact on the anesthesia that will be used for your surgery and even on your recovery, says Ram Roth, MD, board certified anesthesiologist at Mount Sinai Queens. That is why it is very important to talk with your surgeon and anesthesiologist about all the medications you are currently taking or have recently taken. Even though someone may have asked you and written down your medications, I usually will ask you again. Whether you have a surgery scheduled or not, it is good practice to have a ready list of medications you are taking, and to make your health care professionals aware of them, especially when you receive care. Your list should include:
Drug name and dosage
How often you take the medication
How long you have been taking the medication
Be sure to include over-the-counter medications; vitamins, herbs, and supplements; and even recreational drugs. Remember to update the list when changes are made by your doctor. In addition, you should keep, and share with all healthcare professionals, a list of any medications that have caused an allergic reaction.
Some routine and maintenance medications merit special consideration prior to your procedure. A good example is insulin. Insulin-dependent diabetics need to continue their medication to maintain normal blood sugar. Prior to surgery, patients are asked to fast after midnight, which may affect the way insulin needs to be taken. If this situation applies to you, discuss it with your endocrinologist or ask your surgeon for his or her recommendations.
Anticoagulants, or blood thinners, are another type of medication that requires special consideration. This includes medications like ibuprofen and vitamin E, which thin the blood even though that is not their express purpose. Based on your medical history, your cardiologist, surgeon and/or anesthesiologist will determine the optimal timing for discontinuing some or all of your blood thinners. In some situations, you will be told that continuing your medication is important even prior to surgery. Decisions like these are based on the risk of bleeding related to surgery versus the risks of stopping the medication. The primary care or specialty physician who knows your medical history is the best person to help you and the surgical team decide. I include you, because as a participant in your healthcare, you should be informed and understand how the decision is made.
Patients should not discontinue medications that control high blood pressure or anti-seizure medications. While patients must avoid food and drink starting at midnight on the night before the scheduled surgery, it is permissible to have a small sip of water with your medication.
Click here for a comprehensive list of medications to avoid prior to surgery. Remember, this information is not a substitute for direct medical advice.
Ram Roth, MD
Assistant Professor, Anesthesiology, Perioperative & Pain Medicine, Mount Sinai Queens
Guest post by Ram Roth, MD, a board certified anesthesiologist at Mount Sinai Queens. Please remember that this information is not a substitute for direct medical advice.As...
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Edward Yang, MD, Chief of Orthopaedics, Mount Sinai Queens
Pre-surgery efforts can influence the success of the surgery and recovery, says Edward Yang, MD, board certified orthopedic surgeon and Chief of Orthopaedics at Mount Sinai Queens.
When orthopedic surgery is part of your care plan, there are many steps you can take to help optimize results. Communication is key. Surgery can be overwhelming; it is important to talk with your surgeon about how to best prepare.
Dr. Yang has compiled a “to do” list to help patients take an active role in their surgery and recovery.
Be clear on your diagnosis and the procedure you are about to undergo. In addition, be sure to know:
What the surgery is meant to accomplish
Exactly which body part is being operated on and why
Is this the best option to achieve your health goal? Will the procedure result in the reduction of pain, improvement of function, or prevention of further deterioration or damage?
In addition to direct questions, ask your surgeon for literature or online resources to learn more about what to expect.
Set a date that is convenient for you and a friend or family member.
It is reassuring to have an advocate at the hospital with you. For outpatient surgery, you will need someone to help you get home, and if possible, stay over at your home the night of the surgery.
Find out about the recommended physical therapy for before and after the surgery.
In some cases, physical therapy before the surgery is imperative. For example, with a knee procedure called an anterior cruciate ligament (ACL) reconstruction, pre-surgery physical therapy is needed to reestablish full range of motion and strengthen the quadriceps (the muscle on the front of the thigh). Physical therapy before surgery often decreases recovery time and improves results.
What are the pre-surgical instructions? Are there medications you need to stop taking before the surgery?
Over-the-counter medications that thin the blood, like aspirin and ibuprofen, and prescription blood thinners, like warfarin and clopidogrel, should be stopped seven days prior to surgery. It is important for you to discuss your medication regimen and what changes may be needed before and after surgery.
Find out ahead of time what to expect after the surgery. Specifically, it is important to know:
How much pain you will experience
What medications you will be given
How long before you can return to work or school
If any medical equipment will be needed to aid in recovery. For example, machines that apply cold and compression therapy are useful for decreasing inflammation and pain post-surgery.
When your first post-surgical office visit is scheduled
You will almost certainly have other questions. Write them down and ask your surgeon or the office staff. Being ready both physically and mentally will almost certainly aid in your recovery.
Dr. Yang often conducts pre-surgery workshops to ensure his patients are best prepared for the surgery and recovery. For more information, or to register, click here.
Future posts will detail Dr. Yang’s perspective on orthopedic surgery, how to best prepare for orthopedic surgery, and the surgical services offered at Mount Sinai Queens. Please remember that this information is not a substitute for direct medical advice.
Scott H. Sicherer, MD, Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology, left and Hugh A. Sampson, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute
Scott H. Sicherer, MD, Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology and Chief of the Division of Allergy and Immunology in the Department of Pediatrics at The Mount Sinai Hospital, served on the National Institute of Allergy and Infectious Diseases-sponsored panel that developed new guidelines on preventing peanut allergies in young children, along with Hugh A. Sampson, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai. He explains the new guidelines.
“It is important for parents to speak to their pediatrician or an allergist to find out if the new recommendations for preventing peanut allergy apply to their child. The hope is that these guidelines will reduce a major health burden by helping to prevent peanut allergies altogether. And if your child already has peanut allergy, be sure to talk to your doctor about the best ways to manage it,” he writes in the Huffington Post.
A new tool is giving orthopedic surgeons an innovative view inside the body. “It’s an instrument that has a digital camera at the tip of it so that once you put it in the joint you can look around,” says James N. Gladstone, MD, Co-Chief, Sports Medicine Services, Orthopedics at The Mount Sinai Hospital. “It’s giving you a review that’s more or less equivalent to what you have in the operating room. If you think you have a meniscus tear, you go in, you look, and either there is a meniscus tear there or not, and all within the same visit you have an answer. The patient leaves with the treatment plan in place. You can obviate the need for the MRI altogether.”
The harsh reality is that, wherever you live, there are not enough organs to accommodate those in need. Nationally, about 8% of patients die while waiting for a liver; in New York, that rate is nearly double, according to Sander S. Florman, MD, Director of the Recanati/Miller Transplantation Institute, and the Charles Miller, MD Professor of Surgery at the Icahn School of Medicine. Many of us in the transplant community are working to come up with a more equitable system.
