Surgery Check List

Surgery Check List

Once you are scheduled for surgery, please take a few moment to read through the checklist here to reduce the risk of adverse events. Please let us know if any additional information needs to go here. This is constantly updated.

Before the surgery

  1. Vacuum the house; Mow the lawn; Rake leaves or do any chores you normally do. You may be out of action for a week. So get this done now. Also vacuuming the house has added benefit in reducing risk of infections.
  2. Create a safe room in the house.  This room must have a door that can be secured. Especially useful if you have a pet who has a habit of jumping on you to show affection. You do not want your pet to jump on you when you have drains sticking out of you.
  3. Create a sterile dressing kit.  This should have all the dressing, alcohol wipes, iodine and a few medicines at one place. Keep some space in the kit for the bag of medicines you receive after the surgery.
  4. Safe room preferably must have large windows with ample sunlight. Sunlight is a good disinfectant. However the windows must also have curtains so that you can sleep peacefully.
  5. Make sure house has no loose carpets or other furniture that can make you trip and fall. 
  6. Safe room can get air purifier with  HEPA filter. You just do not want any secondary infection.
  7. Talk to your family and friends and make a duty roster for them. They will take turns to care for you.
  8. Make sure safe room as well as whole house is hygienic. Make sure all the linen on the bed is fresh. 
  9. If a TV needs to be moved make sure it is moved now. After surgery you do not have strength to do these things. 
  10. Talk to the surgeon's nurse to understand what kind of drains if any will be used post surgery and how to operate them. Get a sample drain and understand how to operate it now. And make sure the family member/friend caring for you knows this as well.
  11. Make a list of all the medications; Get a pre-op physical done at our office  so that we can flag any big misses; Just before the surgery some medications may be stopped and new medications may be started. Make sure you have complete list in the Pre-Op note. 
  12. Talk to the surgeon's office and get their cell number to contact them in the case of any emergency.
  13. Talk to the surgeon's office and get the list of instructions for post operative care following surgery. If you need dressings changed, make sure your home nurse/ care giver is able to do that. 
  14. It is important to know who is going to do the surgery. Avoid non physicians and residents. Insist on getting physicians to care for you. Be shameless. This is your life. You do not want any compromise.
  15. Provide information to your insurance that certain procedure is planned and they will be getting bills from various entities and ask them to validate if the hospital is in network and ask them to make sure every body who treats you are paid fairly so that the claim can be processed as in network. If insurance pays very poorly that they are not able to find an in network physician ask them to pay usual and customary rates  for out of network physician and ask physicians to waive off charges above usual customary rates. (Physicians never harm the patients and will be glad to work with you .. but not your insurance. So inform the insurance early and often so that they can plan and assist you) 
  16. Meet the hospital administration and provide them a letter saying you have asked your insurance to pay the UCR rates for out of network claims and you are requesting hospital to agree for UCR rates. 
  17. Make a list of medications you will need after the surgery and if needed get your insurance to agree. Many times we have seen insurance companies denying medicines that are needed. 
  18. Book appointment for Post Operative Visit to your primary care. These visits must be done within 7 or 14 days after the hospital discharge so that they can effectively manage your discharge.  During these visits, your primary care can go through your surgery notes and address any emerging situation.  They can also prevent complications by watching the progress and change medications. 
  19. Plan your drive back from the hospital to home.  You will not be able to drive. Even if the procedure is small, you may still have difficulty due to anesthesia. So you must have a designated driver to drive you back from the hospital.
  20. Plan your car to be trouble free for the ride. Having a flat tire or dead battery that will prevent you from using your car, can spoil your safe journey back home.
  21. Clean your car. Use generous disinfectant to clean the seat, sides of the doors.  Remove all the trash from the car. 
  22. Plan the route your driver takes while driving you home. As the anesthetics wear out even a small bump can be really painful. So plan on the route that has less acceleration and deceleration and also less bumps. 
  23. Buy some Miralax and keep it in your dressing kit ( You can ask if the front office can provide you free of cost during your Pre Op Visit); Pain medications can cause severe constipation and this helps.
  24. Get some protein shakes and stock them up (  Front office can provide you coupons if available ). Immediately after surgery for a few days you may not be able to eat regular food and these shakes can be lifesaver.

After the surgery

  1.  Follow up with surgeon's office on pre-planned visits.
  2. Maintain a picture of sutures or dressing. It helps to see if there is any problem later on. Any infection must be immediately reported.
  3. When you are called to surgeon's office for suture removal, make sure a physician or someone designated by the physician removes the sutures.  We know a world class surgeon in Denver who does amazing surgery but hospital where he worked had mid level who  used to yank the drains without cutting a knot the surgeon was putting.  So always make sure only physicians are around you even after the surgery. Mid levels working on their own are not safe.
  4. Within 7 days or within 14 days, sooner the better, see your primary care physician and ask for a hospital discharge visit. You will be asked to fill a form and we will go over the procedure notes and address all the open issues. Please remember this visit is really important. We can see many more things what a patient cannot. We have access to surgeon's notes as well we know how to read it. So we fix glaring issues at this stage, all the time. 
  5. Ask your surgeon's office for surgery notes and give a copy of the note to your primary care. 
  6. If a tumor is removed, ask your primary care to provide an assessment on how efficiently it was done. Many time your primary care can read the surgery notes and see if the margins were correctly taken. 
  7. Your medications may need to be reconciled. Please visit your primary care. 



Pre Op Visits

One of the important aspect of having a primary care in your care team is reduction of risk of adverse events during and after the surgeries.  We provide Pre Op Visits to our patients approximately three to four weeks before the planned date of the surgery. 

It is very important to have this Pre-Op visit with your primary care. We monitor 14 different subsystems and hence are well equipped to asses the risk and then mitigate it through medicine changes, control of lab levels and management of the care plan post surgery.


What happens before the Pre Op?

  1. Please book an appointment that is at least three weeks prior to your surgery.
  2. Ask your surgeon to send a pre-op request to us (your primary care) ; This request can specify the procedure planned and labs expected.
  3. Show up for your Pre-Op appointment. Please let the front office know you are here for the Pre-Op. Do not discuss your other problems during this visit.

What happens during your Pre Op visit?

  1. Your primary care physician will assess the procedure planned and agree for the procedure. You can discuss about the procedure and risk and benefits.
  2. Our office will do certain labs as requested by the surgeon or your primary care physician
  3. We may also send additional referrals if your condition warrants
  4. We collect all the information from lab, imaging and consults and your primary care physician assesses if procedure is safe given your condition. Your physician communicates her decision along with risk score for the surgery (calculated if enough data is available)
  5. We also make you read our surgery check list so that you can plan a safer surgery and a safer care giving at home
  6. You also book an appointment to see us after your surgery (Post Op Visit)

If you need any additional care giver help, we will provide you signed orders so that you can set up additional care (home health, physical therapy) 

Why Pre Op should be done at your primary care ?

  1. Your primary care physician knows more about your other conditions than the surgeon who is operating.
  2. Your surgeon's office knows less about what primary care is. 
  3. Certain medications need to be stopped for adverse events during surgery. They need to be restarted after the surgery. 
  4. After the surgery you need more primary care intervention to ensure healing. 
  5. Hospital discharges you to a primary care and we need to be prepared to ensure care coordination that may be required.

Can I discuss my regular chronic conditions during pre-op visit?

  1. You must not discuss your chronic conditions during your pre-op. Your pre-op is a special appointment to focus on the procedure planned and get risk mitigation done for the procedure.
  2. Typically your provider has to spend half an hour going over your procedure plan and make suggestions to reduce the risk. 
  3. By keeping your pre -op focused on pre-op you are making sure your procedure has no adverse effects.
  4. Pre-op visits also need a coordination work to get your imaging, lab work, EKG etc. So there is hardly any time left to address anything else. 

How can I improve my pre-op visit?

  1. Schedule your pre-op from the link below approximately 3 weeks before surgery.
  2. At the time of scheduling please have your surgeon write you note describing what procedure is planned and what surgeon wants done.
  3. Please upload this note in your visit. When you book appointment online and specify you need a pre-op you will be asked to provide surgeon's request.


Antibiotics are used to treat or prevent certain types of bacterial infection. Antibiotics are effective only against bacteria. They do not work for viral infections. Also we have increased resistance to common antibiotics in our community, so this post.

We do not prescribe antibiotics in following cases.

  1. Mild bacterial infections which are likely to get better on their own.
  2. Viral infections

This policy has many positives. 

  1. By not taking antibiotic when it is not necessary, you are protecting your gut biome. 
  2. If you take antibiotic when it is not necessary, in future antibiotics may not work for you. (Antibiotic resistance)
  3. Body's immune system can fight small infections and using less antibiotic drugs means your immune system gets a chance to fight infections  



We prescribe antibiotics only when

  1. There is strong evidence that your infection is not likely to clear up without antibiotics
  2. You are actively infecting others
  3. You carry a risk of other serious complications

Please trust our judgment. When we say antibiotics are not required most likely they are not.

When we prescribe antibiotics 

  1. We do not shoot in the dark. We get a lab culture done to identify which is the strain of bacteria and we call medicine that works the best for that strain. These days we are using PCR tests to quickly identify the strain and we can often get the results next day itself.
  2. We ask you take a probiotic , so that your gut can repair itself. Many a time we prescribe probiotics. However home made yogurt is as effective as probiotic pills. So help yourself to large servings of yogurt. 

If you are on antibiotics,

You may notice side effects such as:

  • being sick
  • feeling sick
  • bloating and indigestion
  • diarrhea

Sometime you may develop very serious allergy (anaphylaxis) and may need immediate medical care. So if you are taking antibiotic for the first time, please plan time to watch out for any serious symptoms. 

Elevated Lipase

This is another true story of a great save. Patient set up care with us because his insurance wanted a letter for annual physicals.  We did annual physicals and noted all the baseline values in the chart and told the patient to see us for health issues. Patient subsequently booked appointment with us following an ER visit for worsening abdominal pain. During this visit, we noted the tell tale signs of something very serious but missed out by the ER. Patient had elevated Lipase in thousands! But ER nurse practitioner forgot to connect the dots for elevated lipase and abdominal pain. 

We insisted that patient go back to same ER and get tests done and provide differential diagnosis so that ER nurse practitioner can fix the earlier miss. They were reluctant to repeat the imaging (Earlier imaging said ulcers) ; When imaging was repeated after we provided the differential diagnosis, the radiologist confirmed pancreatic cancer. 


If you have elevated Lipase make sure you get checked for Pancreatitis. After ER visit or hospital visit, book a follow up appointment with your primary care.


Good primary care treats you for most of the issues. Great primary care puts your interest above that of the third parties  who have infested healthcare in America.  Patient was very reluctant to go back to ER  for talking to them about elevated lipase. But we are glad he changed the mind after our persistence and pancreatic cancer was not missed. 

We are getting reports on the progress of the patient through chemo and surgery and we are glad that our patient is safe. 

Angular Cheilitis

Angular cheilitis, also known as perlèche, is an acute or chronic inflammation of the skin and contiguous labial mucosa located at the lateral commissures of the mouth. It typically presents with erythema, maceration, scaling, and fissuring at the corners of the mouth. Lesions are most often bilateral and may be painful.

Angular cheilitis is caused by excessive moisture and maceration from saliva and secondary infection with Candida albicans or, less commonly, Staphylococcus aureus . Angular cheilitis may occur at any age without sex predilection but is especially common in older individuals wearing dentures. Predisposing local factors include wearing orthodontic appliances or ill-fitting dentures, sicca symptoms (dry mouth), intraoral fungal infection, poor oral hygiene, and age-related anatomic changes of the mouth due to reduced vertical facial dimensions 


Dr. Kamat will do the clinical diagnosis after looking at your skin. In some instances to rule out candida or other infections, we may take a swab and send it to the lab.



In our community we have observed that one of the contributing factors is vitamin deficiency. So we ask patients to take multivitamins. Patients must also avoid smacking the lips. Patient can also  start using topical aloe vera, sun protection (hat),  topical hydrocortisone. If drooling is a contributing factor, please use vaseline before going to bed. Typically your inflammation must resolve in a week of treatment.



  1. Continue taking multivitamins
  2. Improve oral hygeine
  3. Use moisturizer to avoid dry lips
  4. Improve denture  fit and cleaning(if using) 

Patient Questions:

  1. Where do I find a good Aloe Vera?

There are many Aloe Vera creams in the market. Look for something that has purer Aloe Vera and no fancy chemicals or mineral oils. Aloe vera is a moisturizer. Alcohol dries the skin. So if the product lists out alcohol along with Aloe Vera, it may not be very effective.   

You can get Aloe Vera at H-Mart in Aurora. You may also get this from other Asian and Mexican Markets.

If you buy Aloe Vera you can make Aloe Vera Gel at home following instructions from WellnessMama. (We have requested permission to share this link)


At the time of office visit, please present your insurance card.  We bill your visit to the insurance card you present. 

In the event of an error in your insurance, please let our front office staff know.

We are in network with most insurances. However individual plans may vary and not known till a claim is adjudicated.

We are a smoke free facility.

We need every patient to finish all the forms online and check in online if possible. 

Most visits start on time, so please plan to be at the office, fifteen minutes before your appointment.

Habitual no show patients are terminated from the patient panel.

We charge a no show fee.

If you are not able make the commute, or take time off for commute , explore tele medicine available now.