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Please read Dr.Rezniks’s newest AAOS Ortho-pinion article, “What to tell your MD and why to help reduce your risks of complications during surgery”

Please read Dr.Rezniks’s newest AAOS Ortho-pinion article, “What to tell your MD and why to help reduce your risks of complications during surgery”
Monday, October 15, 2018

If you are about to have surgery consider making this simple ABCD list on paper based on your own medical history and bring it to your pre-op appointment. It will help you and your doctor avoid unwanted complications.


Think of ABC and D:

“A” is for Airway and Allergies:

“B” is for Bleeding or forming Blood clots too easily.

“C“ is for Cardiac and Circulation

“D” is for Drugs and Diet, the drugs you take every day even if “over the counter” or “natural” supplements and your overall nutritional status.


“A” Airway and Allergies:

Airway: We must also remember asthmatics often don’t think themselves as being sick, sleep apnea patients often don’t like using their CPAP machines and smokers are not aware how that effects post-op healing, infections or lung complications. Your doctor needs to know if you have any of these issues.

Allergies: Make sure you tell your doctor exactly what happens with a medication you think you may be “allergic to.” Remember reactions and allergies are not the same. Total body hives and difficultly breathing are commonly a result of a true allergy; stomach upset, dizziness, being tired and constipation are not. For example, one patient had written down they are allergic to calcium. The reason was they get constipation after taking it. At the same time, there is calcium in every bone in your body making it very unlikely that this is a true allergy.

When we ask for a history of allergies, answers range from none to a good number of medications, foods and other items. For your doctor’s purposes, we are interested in those things our immune system reacts to strongly. The reason for our concern is the body’s ability to release factors that can close your throat, block breathing and put you in real danger. A medication that gives you an upset stomach or a yeast infection is an important fact. These are adverse reactions and they are not true allergies.

Another common complaint is a Novocain allergy. The reaction is palpitations (an increased heart rate) after use at the dentist office. There is epinephrine in the preparation the dentist uses to make the Novocain last longer. The epinephrine will increase your heart rate if injected near a blood vessel. Epinephrine is the same as adrenaline and can be used to save your life if your heart stops or your pressure drops during surgery. Here too, for good reason, it is important to distinguish between a reaction like palpitations with adrenaline use and a true allergy.

“B” do you have a history of Bleeding problems both clotting and not clotting especially during a prior surgery.

A family history of easy bleeding or forming too many blood clots can be equally important. There are genetic disorders like hemophilia and Von-Willebrand’s disease that prevent clotting. There are also disorders like Factor V Leiden and Protein S deficiency, both conditions cause people to be at an increased risk of developing blood clots. Surgeons tend to lump bleeding problems and risk of blood clots together. This confuses some patients. We always worry about the more common problem blood clots, vein clots in the legs and preventing fatal embolisms and, as a result, we often spend less time on the history of too much bleeding than talking about too much clotting; your doctor needs to know both. Patients with a history of cancer or are under cancer treatment also have bleeding issues both excessive bleeding and easy clotting.


“C” Cardiac and Circulation problems and medications including treatment for high blood pressure, abnormal heart rhythms, heart failure, prior cardiac surgery, various veins or phlebitis.

To confuse things more, many times your MD may ask questions that has two meanings. For example, if we ask, “Do you have high blood pressure?” The patient says no because their pressure is normal. We notice Lopressor is in their history intake form. When asked again they will say, “I used to have high blood pressure,” my doctor has treated it, so “I don’t have it now.”

“D” Drugs and Diet: the drugs you take every day including “natural” products, hormones, insulin, steroids and thyroid replacements and your nutritional status.

As strange as this sounds, in my office patients have written down that they are diabetic on their medical history form and don’t indicate they need insulin daily. At the same time, asthmatics use inhalers for breathing don’t think that the contents of the inhaler are medications since they are not in pill form. Thyroid replacement is just a hormone to some. To these patients, and many others with chronic diseases, using “natural” substances like thyroid replacement and insulin are just part of routine life.

Diet represents a window into your overall ability to heal. Patients with poor nutrition and

low body weight do not make all the proteins necessary for healing and are at higher risks for

infection. Similarly, those with high body weight are also at risk for more complications.


So, my advice to patients before surgery is to take some time out of the doctor’s office before your pre-op exam and think about some simple ABC’s and D for good measure. Look at the list and write the answers down. Bring it to the appointment and share it with your surgeon and the medical staff. The small changes your doctor may make by knowing something important on this list can make a difference.

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