Stop blood thinners and pain relievers (as directed)

Aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), and prescription blood thinners like warfarin or apixaban (Eliquis) all increase your risk of bleeding during surgery. Your care team will give you specific instructions, but generally:

• Over-the-counter anti-inflammatory pain relievers (like ibuprofen and naproxen): stop 7–10 days before surgery
• Aspirin (for patients not taking it for a heart condition): stop 7 days before
• Prescription blood thinners: follow your care team's exact instructions — do not stop these on your own

Stop certain supplements

Many patients don't realize herbal supplements can significantly affect surgery. Stop the following at least 1–2 weeks before your procedure:

• Fish oil, vitamin E, ginkgo biloba — increase bleeding risk
• St. John's Wort — interferes with how your body processes anesthesia drugs
• Garlic supplements — can thin your blood
• Echinacea — can trigger unwanted immune responses while you're under anesthesia
• Kava, valerian — can interact with anesthesia drugs and affect your brain and nervous system

Prepare your home for recovery

You will not be yourself for several days after surgery. Set up your recovery space now, before the procedure:

• A comfortable resting area on the main floor (minimize stairs the first night)
• Ice packs or gel cold compresses in the freezer
• Stool softeners on hand — constipation from pain medications is extremely common and entirely preventable
• Easy-to-digest foods: broth, crackers, applesauce, yogurt
• Phone charger and medications within arm's reach of your resting spot

Follow fasting instructions exactly

Going under anesthesia with a full stomach is dangerous. If you vomit while unconscious, food or liquid can get into your lungs — which can cause a serious, life-threatening lung infection. Here are the standard fasting rules:

• No solid food after midnight (or as directed — some centers allow a light meal up to 6 hours before)
• Clear liquids (water, apple juice, black coffee, plain tea) are typically allowed up to 2 hours before anesthesia
• Milk, cream, pulpy juices, and alcohol count as solids

Shower with a germ-killing surgical scrub

Your skin naturally carries bacteria. Showering with a special antibacterial wash the night before — and morning of — surgery greatly lowers your risk of infection at the surgical site. Use Hibiclens (a widely available antibacterial wash) from neck to toes. Let it air dry on your skin; do not rinse it off with plain water.

• Take only the medications your anesthesiologist specifically told you to take, with a small sip of water. Typically: blood pressure, seizure, and thyroid medications
• Do not take diabetes medications the morning of surgery without your doctor's specific approval — dangerously low blood sugar while you're under anesthesia is a serious risk
• Remove all nail polish, acrylic nails, and jewelry — the oxygen monitor on your finger needs bare nails to work, and surgical instruments that use electrical current can cause burns near metal
• No makeup, lotion, or perfume — these interfere with monitoring equipment and sterility
• Bring photo ID, insurance card, and a written list of all current medications and dosages
• Arrange a responsible adult to drive you home — you will not be cleared to drive yourself

"Surgery is a team sport. The more prepared you are when you arrive, the more we can focus our energy on giving you the safest possible experience."

OpWell's Surgery Preparation service is a personalized pre-surgical consultation with a board-certified anesthesiologist. We review your full medical history, optimize your medications, walk you through exactly what will happen on your surgical day, and create a customized preparation protocol — including a post-op recovery plan — before you ever go under.

Most patients have never had this conversation with an anesthesiologist before surgery. We believe every patient deserves it.

Induction is the transition from awake to unconscious. In most cases, it's done with an IV medication called propofol (the most commonly used anesthesia drug). Within seconds of the drug entering your IV line, you'll feel a brief warmth or mild burning sensation in your arm. The ceiling will seem to shift. Your eyes will feel heavy. Within 10–30 seconds, you'll be unconscious.

What you won't notice: your anesthesiologist placing a breathing tube or mask to protect your breathing passages and deliver oxygen and anesthesia gas throughout the surgery. You won't feel any of it.

Once you're unconscious, your anesthesiologist switches from the IV medication to inhaled anesthesia gases — typically sevoflurane or desflurane (special gases designed to keep you asleep). These flow continuously through a breathing tube or mask, keeping you in a steady, controlled state of sleep for the entire procedure.

What we monitor while you're under:

• Blood pressure (measured every 1–5 minutes, or continuously through a small artery monitor for more involved cases)
• Heart rate and rhythm (continuous heart monitor tracking)
• Oxygen levels (the small sensor clipped to your finger)
• Carbon dioxide in your breath (tells us your lungs are working properly)
• Body temperature (your temperature can drop during surgery, so we watch it closely)
• How deeply asleep you are (a small forehead sensor reads your brain waves to make sure you stay at the right level of sleep)
• Fluid balance and estimated blood loss

Every number on our screen tells us something about how your body is doing — and we respond to changes in real time, adjusting how deeply asleep you are, giving medications, and keeping your heart and blood pressure stable as needed throughout the surgery.

As surgery wraps up, we begin lowering the anesthesia gases. We may give medications to reverse any muscle-relaxing drugs used during the procedure. As the anesthesia leaves your system, you'll begin breathing on your own again — which tells us it's safe to remove your breathing tube or mask.

Some patients wake up quickly, feeling alert within minutes. Others take longer, especially after longer procedures or if they are older or have certain health conditions. You won't remember anything. The combination of anesthesia drugs — including medications that prevent memory formation — ensures you have no memory of anything from the moment you fell asleep until the moment you woke up.

• Nausea and vomiting after surgery: Affects roughly 20–30% of patients. Your risk is higher if you're a woman, a non-smoker, have a history of motion sickness, or had a longer surgery. We preventively give anti-nausea medications to higher-risk patients before you even wake up.
• Sore throat: From the breathing tube or airway device. Usually resolves within 1–2 days. Ice chips and throat lozenges help.
• Grogginess and brain fog: Normal in the first 12–24 hours, especially in older patients. Do not drive, sign documents, or make major decisions the day of your procedure.
• Shivering: Your body temperature drops during surgery. A warming blanket in the recovery room helps bring it back up quickly.
• Muscle aches: Can happen from certain muscle-relaxing medications used during surgery. Usually mild and goes away within 24–48 hours.

"What if I wake up during surgery?"

Anesthesia awareness — being conscious but unable to move during surgery — happens in about 1–2 out of every 1,000 surgeries. Your anesthesiologist monitors how deeply asleep you are throughout the entire case to prevent this. If you have concerns or this has happened to you before, bring it up with your anesthesiologist during your pre-surgery visit so they can take extra steps to protect you.

"What are the chances I won't wake up?"

For a healthy adult undergoing elective surgery, anesthesia-related mortality is extremely rare — estimated at approximately 1 in 200,000. The vast majority of surgical deaths are related to the underlying procedure or patient's health condition, not the anesthesia itself.

"Will I say embarrassing things?"

Propofol is not a truth serum. It can briefly lower your filter in some patients as you're waking up, but the dramatic stories about people confessing secrets or behaving wildly are mostly exaggerated. What is true: you may say something silly as you come out of anesthesia. You won't remember it.

Most patients never speak to their anesthesiologist until the morning of surgery — often just minutes before heading into the operating room. That's a big gap. A consultation with your anesthesiologist well before your surgery date gives you the chance to ask every question, understand every step, and walk into the operating room feeling informed and calm instead of anxious and uncertain.

That's exactly what OpWell's Surgery Preparation service provides.

Once you're home, your only job is to rest. Ideally, you set up your recovery space before surgery so you don't need to make decisions tonight. Sleep in an accessible location, have someone stay with you — this is non-negotiable the first night after general anesthesia — and keep phone, medications, and water within reach.

Pain management: Take your prescribed pain medications on schedule, not just when pain becomes severe. Pain is much easier to control when you stay ahead of it. Set an alarm if needed.

Constipation prevention — start tonight: Opioid pain medications slow your gut significantly, and constipation after surgery is one of the most common patient complaints — and one of the most preventable. Start stool softeners (MiraLax or Colace) from day one. Don't wait until you're uncomfortable.

Many patients feel worse on day 2 than day 1 after surgery. This is normal and expected. The numbing medication your surgeon injected near your surgical site during the procedure starts wearing off around 12–24 hours after surgery, and swelling from the surgery peaks around 36–48 hours.

Wound care: Unless your surgeon gave specific instructions, leave your original dressing alone on day 1. On day 2, if cleared to shower, you may gently clean the incision as directed. Do not soak the wound in a bath, pool, or hot tub.

Swelling and bruising: Keeping the affected area elevated and using ice (20 minutes on, 20 off) are your best tools for reducing swelling in your arms or legs. Never apply ice directly to bare skin.

Hydration: Dehydration is common after fasting and surgery. Aim for 6–8 glasses of clear fluids. If nausea makes water difficult, try small sips of ginger tea, broth, or electrolyte drinks.

By day 3, most patients begin to feel incrementally better. Your goal today is gentle, deliberate movement.

Short walks — 5–10 minutes around your home, every 2–3 hours — are critically important for:

• Preventing blood clots in your legs (a condition called deep vein thrombosis, or DVT)
• Getting your digestive system moving again and preventing your bowels from "shutting down" after surgery
• Improving blood flow, your mood, and oxygen delivery to your healing tissues

You should not drive, lift more than 10 lbs, or make important decisions while taking opioid pain medications.

Do not wait to seek care if you experience any of the following:

• Fever above 101.5°F (38.6°C)
• Wound edges that are separating, gaping, or not holding together
• Wound discharge that is green, yellow, foul-smelling, or cloudy
• Increasing pain rather than gradually improving pain after day 2
• Calf pain, swelling, or warmth in one leg — this could be a blood clot (DVT)
• Sudden shortness of breath or chest pain — this could be a blood clot that has traveled to your lungs, which is a medical emergency — call 911 immediately
• Inability to urinate within 6–8 hours after surgery
• Any symptom that feels wrong and is getting worse — trust your instincts

Pre-surgical anxiety often isn't a single fear — it's a cluster of specific ones:

• Loss of control: Being unconscious, unable to direct what happens to your body
• Mortality: The thought, however small, that you might not wake up
• Body image and disfigurement: Changes to appearance, function, or identity after surgery
• Pain and suffering: Anticipating discomfort you can't yet measure or prepare for
• The unknown: Not knowing who will be in the room, what you'll feel, or how long recovery will take

Naming your fear is the first step to addressing it. When a fear remains unnamed, it grows. When it's acknowledged and understood, it becomes something you can actually work with.

Cognitive Behavioral Therapy (CBT)

CBT is a type of talk therapy that helps you notice and change worst-case-scenario thinking. Multiple studies have shown that doing CBT in the weeks before surgery reduces anxiety, lowers pain levels after surgery, and shortens recovery time. Even just a few sessions can make a real difference.

Learning what to expect before surgery

Simply knowing what's going to happen — the sights, sounds, sensations, and timeline of your surgical care — significantly reduces anxiety. Not knowing what's coming is one of the biggest things that fuels fear. Good information is one of the most powerful anxiety-reducing tools available.

Controlled breathing techniques

Box breathing (inhale for 4 counts, hold for 4, exhale for 4, hold for 4) activates your body's built-in calming system and physically lowers your heart rate and stress hormones. It works, it's free, and you can do it anywhere — even on the stretcher right outside the operating room.

Talking to your anesthesiologist before surgery day

Most patients never speak to their anesthesiologist until the morning of surgery — often just minutes before heading into the operating room. A consultation well before your procedure gives you the chance to ask every question, understand every step, and replace fear of the unknown with real understanding.

"You should feel like a participant in your care — not a passenger. Informed patients have better outcomes. That's not just our opinion — the research backs it up."

OpWell is one of the few pre- and post-surgical concierge practices in the country that treats mental health as a clinical priority alongside physical preparation — not as an afterthought.

Our partnership with licensed therapist Stacey Floyd, MA, LPC gives patients access to specialized mental health support before surgery that works hand-in-hand with our anesthesiology team. Stacey specializes in surgical anxiety, mental health evaluations for weight-loss surgery, and mental health during pregnancy and postpartum — using proven therapy approaches including CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), EMDR (Eye Movement Desensitization and Reprocessing, a trauma treatment), and Trauma-Focused Therapy.

You don't have to go through this alone. Real, clinical, coordinated support is available — and it can start before your surgery date.

This is the step most medical tourists skip — and it may be the single most important one.

Before you travel, a US-based physician (ideally with anesthesiology or pre- and post-surgical expertise) should review your complete medical history, current medications, lab work, and surgical plan. The goals:

• Identify any medical conditions that could increase your surgical risk
• Adjust or hold medications before surgery — blood thinners, diabetes medications, herbal supplements
• Confirm that your body is ready for general anesthesia (full sedation) or regional anesthesia (numbing a specific area)
• Make sure you have proper follow-up care lined up before you return to the US
• Create a handoff plan so your US doctors can smoothly take over your care when you get back

This is precisely what OpWell's Medical Tourism service provides.

Blood clots in the legs — a condition called deep vein thrombosis (DVT) — are one of the most serious risks for patients who have surgery abroad. Long flights mean sitting still for hours, getting dehydrated, and dealing with lower cabin pressure, all of which raise your clotting risk. When you've recently had surgery, that risk goes up even more.

Before your return flight, your medical team should address:

• Whether you should receive a blood-thinning injection before your flight (a common preventive measure for post-surgical travelers)
• Knee-high compression stockings — medical grade, not fashion
• Hydration and movement protocol: stand and walk the aisle every hour; flex your calves frequently while seated
• Whether your procedure timing is appropriate for a long-haul flight at all (some surgeries require a minimum recovery window before flying)

"Medical recovery villa" is not a regulated term. Anyone can call their property that. Do your homework before booking.

You should not be recovering from major surgery in a standard hotel, a vacation Airbnb, or a resort environment. You need a facility or arrangement that provides:

• Access to a licensed nurse or medical professional on-site or reliably on-call
• Appropriate post-op wound care supplies and medication management
• Nutritionally appropriate meals and adequate hydration support
• Proximity to a JCI-accredited hospital if complications develop
• No stairs if you're having orthopedic, abdominal, or lower-body procedures

Before you travel, write down and store in your phone and in a physical card in your wallet:

• The address and phone number of the nearest JCI-accredited emergency hospital to your recovery location
• US Embassy contact information for the country you're visiting (they can assist with emergency medical evacuation referrals)
• Your travel insurance policy number and 24/7 emergency claims number — and specifically confirm your policy covers medical evacuation, which can cost $50,000–$200,000 without coverage
• Your surgeon's direct emergency contact — not just the clinic's general number

Before you leave the hospital to return to the US, ensure you have copies of every document related to your procedure:

• Your surgery report — what was done, how it was done, and what technique and materials were used
• Lab reports on any tissue that was removed or tested during surgery
• Your discharge paperwork including post-surgery instructions and prescribed medications
• Imaging studies: X-rays, CT scans, MRI — on a disc or digital format you can share
• Any blood work or lab tests done before and after surgery
• Name, credentials, and direct contact information for your treating surgeon

Your doctors back home need these records to take proper care of you. Without them, they're making medical decisions without the full picture.

Do not board your return flight without a confirmed follow-up appointment with a US physician who knows you had surgery abroad. This means:

• Your primary care physician — informed in advance, with your records in hand
• A specialist related to the type of surgery you had (for example, an orthopedic doctor for joint surgery)
• Access to urgent care or an ER that has your surgical records and knows your history
• A telehealth provider — like OpWell — who can see you quickly if something doesn't feel right in the days after you land

"The procedure abroad is only half the story. The other half is what happens when you get home — and that's where most medical tourists are completely unprepared."

OpWell is one of the only concierge pre- and post-surgical practices in the country offering physician-led pre- and post-surgical support specifically designed for patients having procedures abroad. We review your case before you leave, help you prepare medically and logistically, and are here when you return — ensuring your recovery doesn't fall through the cracks between your international surgeon and your US providers.

You've made a significant investment in your health. Protect it with the same level of care.