Surgery Information

Dear Patient,

Thank you for entrusting me with your care. We will contact your insurance company to authorize the anticipated surgical procedure. We will also contact you to decide on a date for surgery.

You will receive a letter by email (or mail if you so choose) to confirm. This letter will ask that you call the number provided for the hospital or surgery center where your procedure has been scheduled to pre-register. Pre-registration typically requires an appointment at the facility with a pre-admission nurse and may involve lab work and other testing depending on your age, medical history, and planned procedure. The pre-registration nurse will also review your list of regular medications.

The letter will confirm your pre-operative appointment with me or one of our Physician Assistants (PAs) at which time we will review the details of your surgery and sign a consent if it wasn't already done. You will also be scheduled for a post-operative appointment 10-16 days following surgery to review the details of your procedure, make brace adjustments, remove your sutures or staples, and review your postoperative instructions. Following that appointment, you will also be scheduled for your 6 week and 3-4 month post-op appointments to assess your progress.

The contents of this packet provide you with general information about your recommended surgical procedure.

Feel free to contact our team if you have any questions during this process.

Surgery Coordinator: Jenn at or email [javascript protected email address]

Clinical Staff: Sarah at or email [javascript protected email address]

I appreciate your trust and confidence in me and look forward to helping you improve your quality of life.

Sincerely,

Brian B. Gilmer, MD

PREPARING FOR YOUR SURGERY

• Pre-registration at hospital of surgery center:
  • Once you have been given a surgery date and facility, please call or register online. The facility will determine if any labs or tests are needed prior to your surgery based on the anesthesia protocol.
    • Quail Surgery: Call https://quailsurgery.com/
    • Surgery Center of Reno: Register Online: surgerycenterofreno.com
      • Click "Patients Start Here", enter SCOR775NEW
    • Renown South Meadows: Call
    • Northern Nevada Medical Center: Call

• Medical Clearance: If you have been asked to obtain Medical Clearance from your primary care provider or specialist, please make this contact as soon as possible. You will not be able to schedule a date for surgery until we have received the Medical Clearance form indicating that you are safe to proceed with surgery. This primarily applies to joint replacement patients.

• Oral medications:
  • The American Society of Anesthesiologists has issued a warning that certain herbs and supplements could pose a danger if taken prior to surgery due to interactions with medication used during and after surgery. If you are taking any of the following...
  • Discontinue use 2 weeks prior: St. John's Wart, Gingko Biloba, Feverfew, Ginseng, High doses of supplemental garlic, Vitamin E, Ephedra, Kava Kava, Valerian, Dong Guai, Goldenseal
  • Discontinue use 5 days prior to surgery: Ibuprofen, Advil, Celebrex, Meloxicam, Diclofenac, Aspirin
  • If you are on prescription anti-coagulants, communicate with your PCP, surgeon, and the surgery center to have a plan to discontinue or bridge your medication leading up to your surgery and how/when to resume it after surgery.

• Purchase Aspirin: If you are having surgery on the lower body, we would like you to take 325 mg Aspirin twice daily for 2 weeks AFTER surgery.

• Cold Therapy: Ice and compression is strongly recommended after surgery to decrease swelling and help control pain. A flyer is at the end of this packet for the "Wave".

• Immunizations (flu/COVID/pneumonia): Please do not have any vaccines two weeks before or after your surgery.

• Skin Health: The health of your skin is extremely important and can delay your surgical case if there are cuts, rashes, scrapes, or bug bites, etc. anywhere near your surgical site. If you get a wound within 1 week of your surgical date, email a picture to [javascript protected email address] so the staff can determine next steps if necessary.
  • Hibiclens- Hibiclens is an antiseptic/antimicrobial soap to use in your last shower prior to surgery. If you have a known sensitivity to chlorhexidine gluconate, please use Gold Dial Antibacterial Soap.
    • To use:
      • Do your normal routine in the shower.
      • Apply Hibiclens to your surgical area and gently wash from neck down, avoiding face, genitals and open wounds. Focus on the surgical site and more dirty areas like armpits, back of knees, etc.
      • Rise thoroughly and dry off normally
      • Do not apply lotions, perfumes, etc. prior to surgery.

• Nutrition: Trauma, injuries and surgeries can lead to a decrease in lean muscle mass, skin health, and the function of your immune system. Building your body nutritionally 7-14 days prior to surgery can promote adequate protein stores for recovery and carbohydrate (CHO) loading to improve insulin sensitivity (surgical stress may result in insulin resistance which can lean to postoperative hyperglycemia that is associated with poor outcomes.)
  • So what can you do for your nutrition?
    • 5-7 days prior to surgery start drinking a Pre-Surgery Immunonutrition Supplement
      • See product examples below
    • The night before surgery drink a Complex Carbohydrate CHO (maltodextrin) supplement if available
      • Benefit- may reduce perioperative discomfort, including anxiety
      • See product examples below
    • Start now
      • Include protein in every meal and snack
        • Quarter of your plate (lean meats, nuts, beans, eggs, dairy, legumes)
        • Protein prevents break down of healthy tissue and helps fight infection
          • For the average person, 1.2 - 2.0 g/kg of body weight of protein per day.
            • An elderly person is going to be closer to that 1.2 while a fit and healthy person is on the 2.0 end of the scale.
          • Post-operatively 1.5 - 2.0 g/kg
        • Drink enough water, milk and flavored water that your urine is faint yellow to clear. (30 - 35 mL/kg/day
        • Increase your fruits and vegetables (1/4 plate fruit & 1/4 plate vegetables)
        • Increase whole grains (1/4 of your plate)
          • 100% whole wheat bread, brown rice, whole wheat pasta, cereals, quinoa
        • Take a probiotic supplement of at least 1 million active bacteria daily.
          • Increase probiotics to improve your "gut health" can decrease the risk of surgical site infection, increase bowel motility, and decrease risk of postoperative pneumonia.
        • Easy tips and tricks: Easy Protein options:
          • If you can tolerate dairy, milk and yogurts to eat/drink, make smoothies. You can use a dairy alternative with protein.
          • Lean meats (chicken, fish, lean beef and pork)
            • If you can't cook, purchase precooked single portions of chicken in the freezer section and throw in the microwave.
          • Premade shakes ex. Ensure Immononutrition, Ensure Plus, Premier Protein Shake, Nestle Impact.
          • Fresh Fruits- can get pre-cut in deli
          • Vegetables
            • Don't overthink. Fresh is best but is cooking is a struggle, you can buy frozen steamer bags or canned
          • Whole grains-loaf of 100% whole wheat bread, quinoa and brown rice.
          • Snacks- hummus, peanut butter, nuts, string cheese, whole grain crackers, dried fruit.
        • Example of products:
          • Immunonutrition Shakes:
            • Ensure Surgery Immunonutrition Shake- surgical immunonutrition
              • Designed to support immune health and recovery from surgery
              • Drink 2-3 shakes/day for 5-7 days before and after surgery
              • If immunocompromised- minimum 7 days.
            • Nestle Impact Advanced Recovery
              • Designed to reduce risk of infections and help with recovery
              • 3 cartons a day for 5 days before and after surgery
            • Ensure Pre-Surgery Clear Nutrition Drink- CHO loading
              • Helps reduce insulin resistance after surgery and improve patient outcomes
              • Contains complex CHO and is low is osmolality
              • Drink two bottles the night before and one as soon your stomach will tolerate after your surgery

PRE-OPERATIVE VISIT

• Pre-operative visit: You will be scheduled a pre-operative office visit within 30 days of surgery if needed. Specifics of your procedure and medications will be reviewed.

• Physical Therapy prescription: We will place your physical therapy order to your location of choice. Swift Physical Therapist work closely with Dr. Gilmer and are one good option. However, the most important factors regarding physical therapy are that your like and trust your therapist and that the location is convenient. We recommend that you contact a physical therapy facility approved by your insurance plan and schedule your initial visits. Let us know where to send the referral then call to schedule at least 6 weeks of sessions following your surgery. Physical therapy is typically prescribed to start 3-5 days following surgery and extend 6 weeks to 3 months post op and sometimes beyond.

• Pain medication prescription: A prescription for pain medication will be sent to your pharmacy of choice. If you are under contract with a pain management clinic, please communicate with your pain management provider that you are having surgery so your prescription can be adjusted as necessary.

• Post- op office visit: You will be scheduled for a post-operative appointment 10-21 days after surgery. Sutures and staples will be removed at that time. Arthroscopic photos and/or imaging will be reviewed if applicable.

DAY OF SURGERY

• Arrival to Surgery: You will arrive 2 hours before your scheduled surgery time to begin your pre-surgical prep, you will meet with the anesthesiologist and Dr. Gilmer prior to going to the operating room. If you have any significant concerns regarding your options for anesthesia, please inform the surgery center when you register for your surgery.

• More questions? If you have questions about the surgery itself, please contact Dr. Gilmer's office before the day of surgery. This discussion can take time and we want to make sure all your major questions are addressed ahead of time.

• Ride Home: You will need someone to provide you a ride home. Your ride will be notified by phone when you are ready after your surgery to be discharged home.

• First Night: Please plan to have someone with you the first night following surgery to aid in your comfort and in care of any emergencies.

• Eating/Drinking: Please do not eat anything solid after midnight the night before surgery. You may have clear liquids up to 2 hours prior to surgery check-in time.

• Clothing: Please wear loose fitting pants or shorts to your surgery and athletic type shoes that are easy to put on.

AFTER SURGERY

• Nerve Block: The effects of the nerve block may last from 12-60 hours depending on the medication used.

• Dressings/shower: Keep your bulky knee dressings clean and dry following surgery. You can remove your post-operative dressings on the 4^th If you shower before day 4, please use a plastic covering over the entirety of your dressing and brace. After day 4, and you remove your post-operative dressing, please cover the incisions with adhesive band-aids which can be changed as needed to keep your incisions covered until sutures are removed at your first post-operative visit.

• Baths/Pools/ Hot Tubs: Please do not submerge your incision in a hot tub, pool, or bath until your incision is completely closed. This may take 3-6 weeks depending on your healing time.

• Ice: Use of ice or cold therapy to your knee as you feel necessary to help alleviate pain and swelling.

• Brace: Please remain in your brace as directed by your post-op instructions. If you have concerns about your brace, contact us at .

• Pain medication: Take your pain medication as prescribed, only as needed. Do not drive or operate machinery while taking opioid pain medication. You may supplement with acetaminophen as needed, to not exceed 3000 mg per day. Please take medication with food as this will help avoid stomach upset.

• Aspirin: If directed, please take 325 mg, daily, for 2 weeks following surgery.

• Driving: You may drive when you are no longer taking pain medication and your leg no longer has to be supported by a brace. Please practice in a safe environment to determine if you are comfortable and safe to return to driving.

We are here to help you navigate these next few weeks. Please let us know if you have any questions. Please direct any questions regarding your surgery including scheduling and clearance to Jenn:

Surgery Coordinator: Jenn at or email [javascript protected email address]

If you have questions regarding clinical needs, brace, crutches, physical therapy, medications, FMLA paperwork, notes for work or school, DMV placard, etc. Please contact Sarah.

Clinical Staff: Sarah at or email [javascript protected email address]

Surgery Information

You will need the Adobe Reader to view and print these documents.