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Renown’s team of nurses and respiratory therapists discuss what you need to know before undergoing surgery, including fasting guidelines and how to improve recovery. There are several things to know before you undergo surgery, including steps to prepare at home in advance of your procedure.   Fasting Guidelines: No solid foods eight hours prior to surgery You may have clear liquids three hours before your surgery. Clear liquids include water, apple juice and lemon or lime-flavored soda water (not cola). In addition, do not chew or smoke tobacco (regular or e-cigarettes) after midnight the night before your surgery, unless instructed by your doctor or anesthesiologist.

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At 85, James Domingos is still enjoying life as a cowboy, thanks to a transcatheter aortic valve replacement. Always rolling with the punches when it comes to life, 85-year-old James Domingos faced his health issues with the same grit. For many years, he roped cattle for friends and rounded up horses for the Bureau of Land Management. In recent years, a pacemaker controlled the rhythm of his heart, but didn’t slow him down. “We used to be able to take walks for 15 minutes in one direction and take the dog,” says Domingos’ wife, Joy. “Then it got to be less and less.” Tests at Renown Health revealed a heart valve was nearly closed. His heart doctor, Jake Ichino, MD, FACC, FSCAI, suggested a transcatheter aortic valve replacement, known as TAVR, which repairs a heart valve without removing the damaged valve. The procedure is recommended for patients who are at high risk for open heart surgery.

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If you’re having surgery on your shoulder, why does it matter what’s in your stomach? We asked Dr. Matthew Hoberg to explain more about pre-surgery directives, including fasting. If you have an upcoming surgery, your care team likely gave you instructions to fast before your procedure. But why? We asked Matthew Hoberg, M.D., medical director of Renown Surgical Services, to explain why it’s important to forgo food and drinks before surgery. Why are patients instructed to fast before surgery? Regardless of surgery type or site, we want the stomach to be empty before having anesthesia, because anesthesia can reduce your body’s ability to protect and prevent food or acids from the stomach from entering the lungs. Normally, your body is able to prevent this, but anesthesia medicines make it harder for your body to do so. When food or liquids from the stomach get into the lungs, doctors call it “aspiration.” This is rare, but can be dangerous if it does happen. Solid foods and liquids leave the stomach at different rates too. Solid food takes longer to empty from the stomach than liquids, so the time to stop eating solids (eight hours) is longer than that for clear liquids (two hours). The body has energy reserves to produce needed nutrients and fuel during fasting. Recently, studies have shown it is important to stay hydrated and have some carbohydrates in clear liquids up to two hours before surgery, so clear liquids are allowed until two hours before surgery. There are also special rules for babies and young children who need surgery. For example, you may give breast milk up to four hours before surgery. If your baby drinks formula, you should stop six hours before surgery, and all solid foods you should stop eight hours before. Your child’s doctor or nurse will give you exact instructions. What if you show up for surgery and have broken the no-eating rule? Will surgery be re-scheduled? If patients have not followed the fasting guidelines, surgery will be postponed or rescheduled due to the possible increased risk associated with not having an empty stomach. The exception would be emergency surgery that cannot be delayed in which case special precautions are taken to help prevent anything from getting into the lungs. What other pre-operative rules should be followed to the letter? All instructions given to patients before their surgery or procedure should be followed. There are specific medical reasons behind all the instructions and they are designed for safety — to minimize risks, lower complications like infections and enhance the recovery process to help patients get back to normal as quickly as possible. Also, many patients ask if they should continue taking medications before surgery. The answer is: It depends. Your doctor or nurse will tell you which medicines you should take and when. Some medicines need to be stopped before surgery. But for others, it’s important you keep taking them as usual. You may also get new medicines to take before surgery. You may be asked to take some medications before surgery as part of advanced pain management protocols. If you need to take medicine right before your surgery, you can take it with a sip of water.

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To be on the move is a scary concept when you’re recovering from surgery. But did you know getting up and at ’em could be the key to a quicker recovery, post-surgery? Here’s some expert insight from Renown Surgical Services. The team at  has some news for you: Rest and movement are important to prevent serious complications. Here are some tips about how to get mobile after your procedure — and why it’s fundamentally important. Tip 1: Start Simple While you’re in bed, move your legs and feet up and down. Be sure to ask the nurses to help you get out of bed and into the chair for all your meals, or walk to the bathroom when needed. If you feel up to it, take a walk in the hallways with the nursing staff. Tip 2: The Sooner, the Better This may be surprising, but too much rest is not necessarily a good thing. The old saying “You use it, or you lose it” rings very true to maintaining the strength needed to get yourself out of bed. Beginning the mobility process early in your hospital stay will not only help you maintain strength and function, it may also help you get home sooner. Though it may seem counter intuitive, lying in bed all day can delay your healing time and cause serious complications to arise, including pneumonia, deep vein thrombosis or blood clots, pressure ulcers and sometimes constipation. Tip 3: Mobilize Your Support System Getting out of bed, sitting in a chair for meals and walking around your room or hospital unit can help reduce your risk of complications. The nursing staff will help you out of bed the same day of your surgery if it’s cleared by your doctor. Tip 4: Safety First The nursing staff is here to keep you safe, so make sure you call them for assistance getting out of bed. Even if you think you can do it yourself, use your call light to notify the nursing staff you are ready to get up and move. In addition, new medications can sometimes impair our judgment, balance and safety, so it’s always better to have help even though you may not need it. This is also why you may have a “bed alarm” on, to remind you to call for help and keep you safe while you are recovering. Tip 5: Move, But Manage Your Pain Many people find that getting up and moving actually helps their pain, rather than making it much worse. Taking the right amount of medication at the right times will minimize your pain and help you to get moving. Your care team will work with you on how much pain medication is right to manage any postoperative pain, with the goal for you to be comfortable enough to be able to move and gradually increase your activity each day. Tip 6: Maintain that Momentum at Home Mobility doesn’t end once you’re discharged from the hospital. It’s key to keep moving to maintain health and function. When you first arrive home, it’s crucial to take frequent movement breaks throughout the day. Increase activity as it becomes more comfortable, and be sure to ease back into an active daily routine. If you have concerns about your mobility once home, be sure to discuss this with your doctor at your follow-up appointment. Renown Surgical Services | 775-982-3993 Ask your doctor if you have any questions about your medical condition or the specific surgical procedure planned, or contact the team at Renown Surgical Services. Learn More

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Breast milk. It's often referred to as liquid gold. And fortunately, it can be safely refrigerated or frozen for later use, which can allow you to be a bit more flexible in your new routine with baby. Whether you're getting ready to return to work, planning for the chance date night out or just exclusively pumping, it's crucial to understand the guidelines for proper breast milk storage. Storing Breast Milk Use clean bottles with screw caps, hard plastic cups that have tight caps or nursing bags (pre-sterilized bags meant for breast milk). Be sure to label each container with the date the milk was pumped and your baby's name if the milk is going to childcare providers. You can add fresh, cooled milk to milk that is already frozen, but add no more than is already in the container. For example, if you have two ounces of frozen milk, then you can add up to two more ounces of cooled milk. For healthy full-term infants, milk can be stored as follows: Room temperature - six to eight hours (no warmer than 77°F, or 25°C). Refrigerator - up to five days at 32°-39°F (0°-3.9°C). Freezer– Varies depending on freezer type. Up to two weeks in a freezer compartment located within the refrigerator. Three to six months in a freezer that is self-contained (standard kitchen fridge/freezer combination) and kept at 0°F (-18°C). Breast milk should be stored in the back of the freezer and not in the door. Six to 12 months in a deep freezer that is kept at -4°F (-20°C). Be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes. Thawing Breast Milk Place frozen breast milk in the refrigerator to thaw (about 24 hours) then warm by running warm water over the bag or bottle of milk and use it within the next 24 hours. If you need it immediately, remove it from the freezer and run warm water over it until it's at room temperature. Never microwave breast milk and do not refreeze it. Once your baby has started to drink from the bottle, you should use it within one hour. You may find that different resources provide different recommendations about the amount of time you can store breast milk at room temperature, in the refrigerator and in the freezer. Talk to your doctor or lactation consultant if you have any concerns or questions.

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