*IF YOU WERE PRESCRIBED A DAILY ASPRIIN BY YOUR PRIMARY CARE DOCTOR OR CARDIOLOGIST, DO NOT STOP THE ASPIRIN UNTIL YOU HAVE CONSULTED THEM FIRST.

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1 Unless otherwise specifically instructed by Dr. Holovacs or another physician, STOP taking the following medications ONE WEEK before your scheduled surgery date: Anti-inflammatory medications such as: o Ibuprofen o Motrin o Advil o Aleve o Naprosen o Naproxen *Aspirin (if you were instructed by your physician to take aspirin for a cardiovascular reason, see below) *IF YOU WERE PRESCRIBED A DAILY ASPRIIN BY YOUR PRIMARY CARE DOCTOR OR CARDIOLOGIST, DO NOT STOP THE ASPIRIN UNTIL YOU HAVE CONSULTED THEM FIRST. It may not be safe for you to be off of the Aspirin. Your doctor will tell you how many days it is safe for you to stop taking the Aspirin prior to your surgery date. IMMEDIATELY FOLLOWING YOUR SURGERY IT IS VERY IMPORTANT THAT YOU RESUME TAKING YOUR DAILY ASPRIIN.

2 IF YOU ARE TAKING A BLOOD THINNER SUCH AS COUMADIN OR HEPARIN.. Make and appointment with the doctor that prescribes it to you to discuss how to manage this medication around your surgery date. Your doctor will be the one to decide how to manage this mediation NOT Dr. Holovacs. DO NOT STOP TAKING THE BLOOD THINNER WITHOUT CONSULTING THIS PHYSICIAN FIRST!!!!!!!!!! If you are taking the following medications/supplements you should stop taking them TEN DAYS before your scheduled surgery date: Herbal supplements HEALTH HISTORY FORM ONE MEDICAL PASSPORT (online) Fill it out as soon as possible. IF YOU DO NOT FILL THIS FORM OUT, YOUR SURGERY WILL NOT TAKE PLACE!!!!!!!!!!!!!!!!!!!! You will receive a phone call from an anesthesiologist the week before your scheduled surgery date. During this phone conversation they will then go over this health history form with you to ensure your safety for the upcoming procedure. If you are 50 years old or older, or if you are younger than age 60 years and have a history of heart disease, you will need to get a recent EKG. Christine will provide you with the paperwork necessary to get this done prior to your surgery.

3 Set up your first physical therapy appointment for about 4-6 days after your surgery date. Please set up your post-operative appointment BEFORE YOUR SURGERY. This appointment will be with Aimee Mulkern the nurse practitioner (not Dr. Holovacs) and should be scheduled for 7-10 days after your scheduled surgery date. You should use a Benzoly Peroxide wash in the shower and thoroughly cleanse your affected side every time you shower for one week prior to your scheduled surgery: If you are having LEFT shoulder surgery cleanse your entire LEFT arm, and the LEFT side of your upper body (neck, chest, and stomach). Be especially

4 thorough when you cleanse your LEFT shoulder and armpit. If you are having RIGHT shoulder surgery cleanse your entire RIGHT arm, and the RIGHT side of your upper body (neck, chest, and stomach). Be especially thorough when you cleanse your RIGHT shoulder and armpit. If you are having knee surgery (right or left) cleanse your entire affected leg. Be especially thorough when you cleanse your affected knee. THE MORING OF YOUR SURGERY YOU SHOULD TAKE A SHOWER AND USE THE BENZOLY PEROXIDE WASH AS INSTRUCTED ABOVE ACCORDING TO THE TYPE OF SURGERY YOU ARE HAVING (SHOULDER OR KNEE). *If you are the first case you may take your shower the night before just prior to going to bed. Here is a picture of a type of wash that you can buy at CVS. (This is an Acne Control Cleanser that contains 10% Benzoyl Peroxide Acne Medication.) *You do not need to buy this particular wash, but the wash should contain Benzoyl Peroxide, and 10 % is ideal.

5 Christine O Connor will call you the Thursday or Friday before your surgery date to confirm an arrival time. Your arrival time will not be confirmed before this. Report to the Ambulatory surgery center in Waltham 2 HOURS PRIOR TO YOUR SCHEDULED SURGERY TIME. REMOVE ALL NAIL POLISH DO NOT put any deodorant on the morning of your surgery (if you are having shoulder surgery).

6 The Orthopaedic Ambulatory Surgery Center at Mass General West is located at: 40 2 nd Avenue, Suite 200 Waltham, MA Their phone number is (781) Their website is: DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE NIGHT BEFORE YOUR SCHEDULED SURGERY!!!!!!!!!!!!!!!!!!!!!!!!!!!! (ALSO, NO CHEWING GUM AFTER MIDNIGHT) You MUST have someone to accompany you and wait at the facility while you are in surgery so that they can drive you home after you are discharged. If you should have any other questions regarding your pre-operative instructions, please give us a call at (617) OR you can the nurse practitioner, Aimee Mulkern at amulkern@partners.org Thomas F. Holovacs, MD Christine O Connor Aimee Mulkern, NP Karen Kelly