Planning Before Your Surgery

General Medical Check-up

For patients with a history of certain medical conditions (for example heart ailments or lung disease), a visit to a primary care physician may be recommended.

Herbal Supplements/Weight loss products

The use of any weight loss products or herbal supplements must be discontinued 1 week prior to surgery. These products can interfere with bleeding control and anesthetic medications.

The Night Before Surgery

You should not eat or drink anything after midnight.
This is a precaution to avoid anesthetic complications.

The MOI will call you the day before your surgery to let you know what time to arrive for surgery the next day.

Your Surgery

Missouri Orthopaedic InstituteMissouri Orthopaedic Institute
1100 Virginia Avenue
Columbia, MO 65212
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You will have to register at the MOI. The specific time will not be given to you during your office visit. You will receive a phone call the afternoon prior to surgery. Try to be prompt, as this may result in delays or cancellations. You will be asked to arrive early to allow for the registration process, preoperative testing, and consultation with the anesthesiologist. After you have registered, a nurse will check you in to the holding area. You will be asked several questions about your medical history, they will take your vital signs, and you will be asked to change into a hospital gown.


The nurse will start an intravenous (I.V.) line which will be used to deliver medications to your bloodstream during and after surgery. Immediately before surgery the anesthesiologist will discuss the details of your anesthetic. Any questions you have regarding anesthesia should be addressed to the anesthesiologist.


After you have been prepared, the nurse from the operating room (O.R.) will take you to the surgery area. You will be asked to wear a surgical cap to cover your hair. After being checked in a second time you will be wheeled into the operating room. You will be asked many of the same questions on several occasions. This is to prevent any important information from “slipping through the cracks”.

The surgical team is composed of your surgeon (Dr. Sherman), his assistant (Tammy), 2 or 3 nurses or surgical technicians and the anesthesiologist. The temperature in the room is typically lower than normal and warm blankets will be provided. Once the anesthesiologist is prepared, he or she will administer medicine which will make you feel relaxed. Afterwards, more medicine will cause you to fall asleep. Surgical time varies from case to case but we will make a time estimate for your family so they can prepare appropriately. After surgery Dr. Sherman and Tammy will talk with your family members about the surgery and the rehab after surgery. Please make sure that family members are available at this time.

Post-Anesthesia Recovery Unit (PACU)

When you awaken from the anesthetic, you will be in the PACU. A nurse will be assigned to monitor your progress and address your needs. After you have stabilized, you will be transferred to your room or the second stage recovery area in preparation for discharge. It is only at this time that your family members will be able to see you. Family members are usually not allowed in the main recovery room because of the need to maintain privacy of the other patients.

Medications and Pain Management

Immediately after surgery, your family members will be given your post-operative prescription for pain medication. Remember for the first 24 to 48 hours to stay ahead of your pain with the medication. Don’t be too timid or proud to take your medication regularly during this time.

The following is a list of common medications prescribed:

Narcotic pain relievers (i.e. Vicodin, Percocet, Norco).

These medications alter your perception of pain. They can make you feel sleepy therefore you should not drink alcohol, drive, or operate machinery with taking them. Narcotic pain relievers can cause nausea, particularly if taken without food. Always take your medications with food. Additionally, some patients will notice constipation. To minimize this be sure to drink plenty of fluids, especially fruit juices. Once your pain has reached a more manageable level, you may switch to using an over-the-counter medication as directed.

Anti-inflammatory medications (i.e. Ibuprofen, Naprosyn, Relafen).

These medications help with swelling, stiffness, and pain. They can cause stomach upset and rarely ulcers. They too should be taken with food. If stomach irritation occurs, Pepcid AC or Prilosec OTC can be taken in conjunction with the medications. If stomach irritation persists, or if you notice blood in your stools, immediately discontinue the medication and call our office.

Wound Care

In surgery, we apply a sterile dressing sealed with a plastic protective covering. You do not need to change the dressing. Leave the dressing on until you return for your first visit after surgery. You may shower with this type of dressing; however, you may not submerge it in a bath tub or a pool. If your dressing should accidentally come off or get wet, call our office. In many cases, a small amount of blood will be soaked up by the gauze resulting in a red spot. This is normal. If the dressing is saturated with blood, however, you should call our office.

Physical Therapy

At some point, you will be given physical therapy exercises, which will be individualized based on your type of surgery and any special circumstances. Therapy is every bit as important to your recovery as the surgery itself. Be sure to perform your exercises diligently as instructed. If you are scheduled to stay overnight, a physical therapist may be assigned to see you the next morning to do therapeutic exercises at your bedside. Otherwise, you will see a physical therapist on the same day as your first post-operative physician visit.


You may notice trouble getting comfortable at night, with can last several weeks. You may sleep on the operated side; this will not damage anything repaired during surgery. However, you should not try this for a while because it will be uncomfortable. If you had shoulder surgery, you may find it more comfortable to sleep in a recliner chair for the first week after surgery.

Common Problems


Some degree of pain is anticipated with any surgery. Once you have begun to experience the pain, treat it promptly and stay ahead of the pain by regularly taking pain medication. A common mistake is to wait too long between doses because the pain level seems reasonable. The medicine works much better to prevent pain than treating the pain once it has occurred. Take it regularly for the first 24-48 hours.

Remember some pain is normal. However, your pain should diminish day to day. If you notice worsening pain after several days, call the office.

Nausea and Vomiting

Nausea and vomiting can occur for several reasons. In the first 24 hours, the anesthetic agents you received during surgery can make you nauseous. The anesthesiologist typically administers anti-nausea medications, however, patients can still become nauseated. If you experience nausea at home it may be related to one of your pain medications. All of the narcotic medicines (i.e. Vicodin, Percocet, Norco) can cause nausea particularly if you taken them on an empty stomach. Never take your pain medicine on an empty stomach. Once you become nauseated, you may not be able to take oral pain medications.

Change in Appetite and Bowel Habits

A temporary loss of appetite is observed in some patients. This is typically short-lived and improves as you recover. Constipation is commonly associated with a decrease in your activity and your pain medications. The narcotics can be especially constipating. You should drink more fluids than usual, especially fruit juices.

When to Call the Doctor


A low grade fever below 100ºF is common. A temperature above 101ºF, especially if it persists after the first 48 hours should be reported.


Pain is expected after surgery. Your pain can be aggravated if you fail to take your medicine as directed or if you are overactive after surgery. If your pain is steadily increasing over consecutive days despite normal pain control measures, please call our office.

Wound Care

You should expect some minor bloody drainage to be visible on the dressing. The dressing acts as a wick, therefore, a small amount of blood can make a moderate sized spot on the dressing. If your dressing becomes soaked with blood, or if you notice any pus drainage, please call our office.

Important Numbers

Remember, Tammy typically will call you the day after surgery and Dr. Sherman, the second day after surgery to answer any questions and discuss any problems you may have had in the first few days after surgery. If you have problems before or after that time, please call our office at the Missouri Orthopaedic Institute. You will talk to Tammy or leave a message and she will return your call as soon as possible.

  • Department of Sports Medicine at the MOI – (573) 884-4767 (Tammy),
  • After Hours (University Hospital) – (573) 882-4141

Important Points

  1. Stop any herbal supplements and dietary aids 1 week before surgery.
  2. Stop any blood thinners and anti-inflammatories 5-7 days prior to surgery (aspirin, Plavix, Coumadin, ibuprofen, Aleve, Celebrex, etc).
  3. Don’t eat or drink anything after midnight the night before surgery.
  4. Please wear shorts or loose fitting pants for knee surgery and a button down shirt for shoulder surgery.
  5. You MUST have a driver for you will be unable to drive yourself home.
  6. After surgery, we ask that you take your pain medication with food, as prescribed by Dr. Sherman. Stay on top of your pain. Some pain is normal.
  7. Perform the exercises given to you after surgery.
  8. Don’t submerge the dressing under water.
  9. Call our office if you are having problems (884-4767).