Consultant Orthopaedic Foot & Ankle Surgeon
Guy’s and St Thomas’ NHS Foundation Trust
1st Floor, 29 Tooley Street, London SE1 2PR
T: 0207 234 2167, 0207 234 2719 F: 0207 234 2030
Email: [email protected] Website: www.samsingh.co.uk
Frequently asked questions about surgery When and where do I perform surgery? I operate every alternate week at London Bridge on a Tuesday afternoon and Wednesday afternoon/evening. I also operate at the Lister Hospital in Chelsea on Thursday afternoon/ evening. Lorna or Teresa will schedule surgery and they can advise you on available dates. What type of Anaesthetic will be used? Most operations are performed under general anaesthesia administered by a Consultant Anaesthetist. They will see you on the day of surgery. The anaesthetists I work with are recognised by all insurance companies. Any queries about their charges or concerns you may have about the anaesthesia should be raised directly with them; if you email Lorna or Teresa they can give you their contact details closer to the date of surgery. How will my post-operative pain be managed? With larger foot and ankle operations, you will be offered a local Anaesthetic nerve block, which is administered in the Anaesthetic room to minimise post-operative pain. The loss of sensation by blocking the nerves reduces the pain you feel but leaves you with a numb foot for 24 hours. If the block lasts for more than 48 hours, it doesn’t mean there is a problem but it is worth contacting us and we will ask some simple questions to check all is OK. The hospital will dispense a combination of simple and stronger painkillers such as Tramadol and morphine tablets for use after surgery. The ward nurse will go through the medication with you before discharge explaining how and when to take it. Will I see Mr Singh before and after surgery? On the day of your operation I will see you to check details, answer any questions you have about your surgery and recovery, take consent and mark your limb. This is a good opportunity for you to ask questions. I will also review you after the surgery. It is not uncommon for you to not remember what was said after the procedure due to the hangover effects from the anaesthesia. Do not panic - I will go over the surgical findings with you again when you come for follow up in the clinic. Do I need a separate authorisation code for surgery? Before authorising surgery, your insurance provider will ask you for a procedure code. I may have already given this to you in the clinic; otherwise it can be obtained from my Medical Secretaries Lorna or Teresa. Once you have spoken to your insurance company to authorise the surgery, please call/email my Medical Secretary with the authorisation number. Confidential
Does the surgery require an overnight stay or can it be done as a day-surgery procedure? Many Foot and Ankle operations are safely and comfortably performed as Day Case operations with you going home later on the same day. It is advisable that a family member or friend stay with you that evening, if this is not possible then speak to your insurance company about staying the night. How long do I need to stay fasted for before surgery? This is always a little confusing so hopefully this will help make things clear
1. Most surgeries are performed in the afternoon so do not eat anything after 08:30am. This is to ensure
your stomach is empty to make the anaesthetic safe.
2. No Juice, gum, Coke, Milk Tea or Milk Coffee after 08:30am. 3. You can however drink clear fluids until 1130am but no later than that. Clear fluids are water, black coffee
4. Even if you do not normally have breakfast please do try and eat something before 0830 on the day of
5. Even if your procedure is under local anaesthetic procedure we still use the above regime. This is simply
so that in the rare event that you do not tolerate the local anaesthetic we can proceed to a general anaesthetic and complete the procedure.
Will I receive reporting instructions before surgery? My Medical Secretary will contact you closer to the time of your surgery to tell you where to report to and details as to when you should start to fast. If you have not heard anything closer to the time of surgery then please contact Lorna or Teresa. What time will my operation be? At London Bridge Hospital on a Tuesday you will usually go down between 1330 and 1600 for your procedure. If your operation is on a Wednesday at LBH or Thursday at the Lister I operate a double session so you may go down anytime between 1330 and 1930. Even if you are later in the day I still need to see you at 1300 as for it is not easy to leave theatre once the operating list starts. The overnight stay cases are usually done later in the day. Bring a book, relax and unwind! At Chelsfield Park Hospital you will usually go down between 1800 and 2030 for your procedure. What about my scans and x-rays? If you have had these done at London Bridge or the Lister then they will already be available on our central radiology server. If your scans/ x-rays have been done elsewhere then you must bring them with you to surgery. Do I have to remove my nail varnish? Yes, even clear varnish needs to be removed from the foot we are operating on as once the dressings are on we need to check the colour of the toes. How important is managing swelling after surgery? With larger operations or surgery on the toes, swelling after the surgery is a serious problem that can cause pain, affect wound healing and slow down rehab. The most effective way of avoiding swelling and managing pain is elevation. This does not mean resting the leg on a footstool or pouf; the heel needs to be at the level of your heart so the armrest of the sofa or a stack of pillows on a footstool is preferred. Pillows under the heel when sleeping are a good idea but the leg can roll off. A simple trick is to raise the feet of the bed with wooden blocks or telephone directories. If your sofa has removable seat cushions they form a useful platform also. A pillow under the knee keeps the knee slightly bent, which takes the strain off your hamstrings.
Do keep exercising your knee and hip even while you are elevating the leg by most easily pretending to be riding a bike. Am I at risk of a DVT (clot in the vein) or Embolus (clot in the lung)? Any surgery is a risk factor for this, partly due to the relative immobility. At present there is no evidence for use of routine daily injections after foot and ankle procedures to thin the blood as DVT/ PE are rare after such procedures. Blood thinning injections do cause increased oozing of the wounds making the risk of wound complications higher.
Treat your postoperative relative immobility similar to a long-haul flight- do not sit in one position for too long and keep the other joints moving. If you are in a plaster cast, it is worth taking 150mg of Aspirin a day, as this can thin the blood without causing as much oozing. Obviously don’t take aspirin if you have a history of gastritis or ulcers and stop it if you develop any stomach pain or indigestion. If you are considered high risk for DVT you will be given a course of injections.
How much time do I need off from work after surgery?
This obviously depends on the type of surgery, your commute and the nature of your work. Almost all operations require you to be off work for a minimum of 5 working days. As mentioned, control of the swelling is critical and with the best of intentions it is hard to do this at work. It is a good idea to see if you could work from home for some of this period, especially for the first 2 weeks.
What do I do about dressing changes, showering and crutches?
Your dressings do not need to be changed and should not be disturbed unless you are having problems or unless I advise you otherwise until I see you in the clinic. It is OK to shower with protection but you must not get the dressings wet. Ask on the ward for a ‘shower cap’ for your leg. If you wish to obtain one independently I can suggest “Sealtight cast bandage protector”. Can Google it or try Physiosupplies.com on 01775 640972. You will need the half leg cover. If the dressings inadvertently get soaked contact us. The physiotherapist will dispense and teach you how to use your crutches and check that you are safe before your discharge from the ward. They will also dispense and fit you with a canvas sandal that goes over your dressings. If you have a pair of crutches or a walker boot then bring them along with you. The main role of physiotherapy in the first two weeks is to check you are safe on the crutches. I will provide more detailed instructions for the outpatient physiotherapist to follow at the 2-week check.
What type of dressing will I be given after the Operation and what type of clothes should I bring to go home after the Op?
The initial dressing is bulky running from your toes to above the ankle. You are given a sandal to wear over it. For the other foot try and bring some sensible shoes such as trainers, shoes with a good grip or sandals (not flip flops!). Also bring loose clothing that can fit over the bandage.
When do I need to see Mr Singh after discharge from the hospital?
He will personally see you at 10– 14 days after surgery in the clinic. At this appointment, the wound is checked, your pain evaluated and if non-dissolving stitches are used these are removed. I will explain the findings at surgery to you again. If your condition requires a plaster cast then a lightweight fibreglass cast is applied at this appointment. If you require physiotherapy then we arrange it at this appointment.
To book your follow-up appointment at London Bridge, call Lorna on 0207 234 2167 or Teresa on 0207 234 2719 or email them on [email protected] For a follow up appointment at The Lister call them directly on 0207 730 8298
A letter can be issued stating the date of surgery, suggested return to work time and total recovery time. Most employers are satisfied with this. It is sometimes easier to backdate this from the date of the operation when we meet at the 2 week follow-up. This way we can gauge if you need extra time.
This varies with the surgery. If you have an automatic then left leg surgery is not a problem though I do not advise driving in the first 2 weeks as the leg swells as it remains in the dependent position in the foot well. If you are restricted in your weight bearing then driving is not advisable, as you cannot do an emergency brake. These are guidelines only and always check with your motor insurer.
The main concern is DVT and in severe cases a clot to the lung. After one foot surgeries, I usually allow short-haul after 2 weeks, with both feet surgery 3 weeks. If you have a plaster cast on the leg then this is a definite risk factor so you may need to take blood thinning injections which I can arrange. With a plaster cast or aircast boot it is safer to avoid flying.
You have read this leaflet but still have concerns about the procedure and recovery?
The key thing here is not to rush into any decisions as a lot of things are discussed during the consultation. It is not uncommon that you will have additional questions. The easiest is to email them on: [email protected] or call on 0207 234 2167 making sure you always leave a mobile/contact number.
For a swifter response, include a gentle reminder of what has been discussed/what surgery is proposed. Otherwise I will reply but only after I have reviewed your notes when I am next in the office. I am always happy to discuss your concerns with you.
Why are we screened for Methicillin resistant Staphylococcus Aureus (MRSA)?
In order to maintain very low infection rates, we require that all patients who are to be admitted for a procedure are screened for MRSA before coming in to hospital. Once your doctor has agreed that you are going to be admitted, nose, throat and skin swabs may be taken. The results will be sent to us. If you do prove to be positive, please do not be alarmed – the carriage of MRSA is very common in the general population. You will be prescribed a simple regime, which will help to prevent the possibility of a more serious wound problem developing.
Patients having their operation done at the London Bridge Hospital, go to the 1st Floor Emblem House to see the nurses at least 2 weeks before your operation. Patients having their operation done at The Lister Hospital please call the Argyll Floor on 0207 881 4029 to book an appointment at least 2 weeks before your operation.
Please do note: there is no charge to either your insurance company or yourself for this service.
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