Dr. Robert Whitfield walks through his pre-op appointment: timing (1-2 weeks before surgery), the medications you'll take the night before (Zofran, gabapentin, Celebrex, and a scopolamine patch), photo documentation, and what recovery looks like. He tracks brain fog with EEG at multiple checkpoints and recommends 1-1.5 grams of protein per kilogram of body weight daily.
Questions this video answers
Typically 1–2 weeks before surgery.
The day before surgery.
Between 6:00 and 7:00 AM.
About 60 to 90 minutes before the designated start time.
Zofran (ondansetron), gabapentin, and celecoxib (Celebrex).
Welcome to the Holistic and scientific podcast with board Certified plastic surgeon Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments.
Today we're talking about our pre op appointment for patients who live in or near Austin. This appointment typically happens between one to two weeks before surgery. For my patients traveling from out of state or further away, we'll do this the day before. I always have an in person appointment with my patients pre op. It's incredibly important to have an in person appointment. If you're always doing things virtually, you lack the ability to do a physical examination. Our preoperative appointment in general is to propose to go over to reiterate our surgical plan again based on our initial consultations, our virtual discussions, and then answer questions regarding the plan. So we'll go over specifically about why I do that, why I choose a particular type of lift and I will typically take a picture with my iPad and draw on it for them. Then I'll insert it in their file which goes into their Simplast EHR chart and they can access at any time. If not, we can simply email it to them if they're having difficulties. Typically, what we do for each and every patient is running ERAs protocol. ERAs protocol means enhanced recovery after surgery. What does that entail? There's medications you take the night before surgery. You'll say, why are we taking stuff the night before? Because we want to avoid problems with nausea, increase pain and inflammation and then nerve pain the night before. I have everybody take Zofran, which is for nausea, Gabapentin, which is to help to reduce nerve pain and make it so the anesthesia provider has an easier time getting you off to sleep. And then the Celebrex is the anti inflammatory I prefer to use and that's obviously decreased inflammation. So those are taken the night before. And then you bring all of your medications to the surgery center the day of. We'll provide you obviously with the location that we're using for your case and then your arrival time. I like to start really early in the morning. I've been doing it for 20 years. Typically we start between 6 and 7 o', clock, so your arrival time is always an hour to 90 minutes. Before that, designate start time, the medications, and if you're going to need more of them, you'll have them with you. We also place a scopolamine patch, which is for motion sickness. Once again, we're trying to do everything preemptively. We don't like to react to situations we Want to avoid them by being proactive. Here are some of the most common questions I get asked at pre op appointments. People ask a lot about what should I wear prior to surgery? So easy things to get in and out of. Kind of like a jumpsuit, zip down, top down shirts, things that you don't have to pull on and off over your head are always easy. And then comfortable, like sweatpants, comfy pants. Those are things that are warmer. Those are what we want you to wear the day of surgery. People often ask when will they see me again after surgery? So I have the same protocol in place for each patient, regardless of its outpatient nature or in office surgical nature. I touch base with a patient via phone the day after surgery. I then see them in person at a week, one month, three months, six months, nine months and a year. Obviously, any of these appointments can be virtual if necessary. So what I'd like to have, if at all possible, is that one week and that three month appointment in person. I'm always happy to see folks more frequently if needed, but that's my protocol. And then a big, big component of all of the process is making sure you have great before pictures. There can be no great after pictures if they're not great before pictures. So we make sure that our backgrounds are consistent, our clothing's consistent. So we provide all that for you. For my Austin based patients or patients flying in that I can do an EEG for, we do this to evaluate brain fog. We're doing this at the preoperative appointment or one week post op appointment, our one month and our three month appointments. It's a very valuable tool in looking at brain fog and hopefully seeing improvements right away. Other things we'll go over really are related to what to expect in the days after surgery. So on the day after surgery, I will give you a phone call as early as I can that next day if I'm not operating. Just to reiterate my findings so that you understand exactly what I found. The other thing I want to do is answer any questions. Invariably there'll be some question regarding either how they're feeling, what I expect in terms of mobility. On the day after surgery, I expect everybody to get up and walk around. I would prefer that you walk. That's the best form of exercise after surgery. In fact, once you're filling up to it, if you could walk a mile or two, whether it's on a treadmill or gently on a recumbent bike or even seated bike, that would help you from a exercise or cardiovascular standpoint. We want everybody to honestly get the best sleep they can, eat the best they can. So diet is a huge thing for me. We're big advocates here of food sensitivity testing so we make sure that your really understanding what works well in your system. Specifically, I always like to put everybody on a gluten free, dairy free diet and increase their protein intake to one to one and a half grams of protein day per kilogram of body weight. So for really small folks that's like 100 grams. For larger folks it could be up to 200 grams. And we discussed this and go over this because you need the amino acids and protein in order to heal from any surgical procedure or anything like an infection or inflammation or an injury from trauma or something. So surgery, same thing, you need to have amino acids, you need to be able to absorb them. So knowing your sensitivities can help with that as well. So my best case scenario would be somebody who's taken our genetic testing, gotten food sensitivity testing, blood work that reveals any hormone levels that we treat holistically with supplements or with hormone replacement therapy, which we do so that patient's more prepared to have a better outcome. On our next episode, we'll talk about the day of surgery, what happens at the surgery center and what to expect there.
Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas, near 360 and Walsh Tarleton in Westlake. To learn more, go to Dr. Robert Whitfield whitfitfield.com or follow Dr. Robb on Instagram at doctorrobertwitfield links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the show Notes. The holistic and scientific podcast is a production of the Axis T H E A X I S I.
