My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Gregg Gayre

Gregg Gayre, MD

Ophthalmology: Oculoplastic

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

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Blood Thinners to avoid prior to surgery

A word about Blood Thinners

All prescription or over-the-counter medications that increase the risk of bleeding must be avoided without exception prior to surgery near your eye. These medications include aspirin, non-steroidal anti-inflammatories, coagulants, antiplatelets and many common vitamins and herbal medications.

Did you know that even ONE TABLET of ASPRIN taken within 2 weeks before surgery or 5 days after surgery, can result in severe bleeding that might result in permanent vision loss?

Avoid using any of these medications unless you are specifically instructed to continue using them by your doctor. Because most anti-inflammatories and pain relievers contain blood thinning agents, these medications should be avoided. The exception is Tylenol (acetaminophen) For pain control, Tylenol is a safe alternative that can be taken at any time before surgery.

If you are taking warfarin (COUMADIN), HEPARIN or Lovenox, it is very important to discuss this with your doctor before surgery. Typically Coumadin must be discontinued for 5 days prior to surgery. Heparin and LOVENOX must be discontinued 24 hours prior to surgery. However, do not discontinue these medications before consulting your primary care provider or the pharmacists in the Warfarin clinic. Please, contact the warfarin clinic at 866-454-4917 for guidance. 

Medications to stop prior to surgery:

Vitamins:  

  • Vitamin E 
  • Chondroitn
  • Fish Oil (Omega Fatty Acids) 
  • Glucosamine

  Hold these vitamins for 14 days prior to surgery


Herbals:   

  • Dong quai 
  • Ginseng 
  • Ephedra 
  • Garlic 
  • Green Tea 
  • Feverfew 
  • Ginkgo Biloba 
  • Tumeric 
  • Ginger

Hold these herbals for 14 days prior to surgery

AntiPlatelet Drugs:  

  • Agrylin (Anagrelide) 
  • Cilostazol (PLETAL)
  • Clopidogrel (PLAVIX)  
  • Dipyridamole (AGGRENOX or PERSANTINE) 
  • Ticlopidine (TICLID) 
  • Pentoxyphylline (TRENTAL)

Hold these antiplatelet drugs for 7 days prior to surgery

Non Steroidal Anti-Inflammatories:

  • Ibuprofen  (MOTRIN, ADVIL, MIDOL, NUPRIN)
  • Naproxin  (NAPROSIN, ALEVE ANAPROX)
  • Celecoxib  (CELEBREX)
  • Diclofenac  (VOLTAREN, CATAFLAM, ARTHROTEC)
  • Diflunisal  (DOLOBID)
  • Etodaolac  (LODINE)
  • Fenoprofen  (ANSAID)
  • Ibuprofen  (MOTRIN, ADVIL, MIDOL, NUPRIN)
  • Indomethacin  (INDOCIN)
  • Ketoprofen  (ORUDIS, ORUVAIL)
  • Ketorolac  (TORADOL)
  • Meloxicam  (PONSTEL)
  • Nabumetone  (RELAFEN)
  • Naproxen  (NAPROXYN, ALEVE, ANAPROX)
  • Oxaprozin  (DAYPRO)
  • Piroxicam  (FLEDANE)
  • Pletal   (CILOSTAZOL)
  • Rofecoxib  (VIOXX)
  • Sulindac  (CLINORIL)
  • Tolmetrin  (TOECTIN)
  • Valdecoxib  (BEXTRA)

Hold these non-steroidals for 7 days prior to surgery

Aspirin Products (including “Baby Aspirin”):

  • BAYER
  • EXCEDRIN
  • BUFFERIN
  • ANACIN
  • ALKA-SELTZER

HOLD ALL ASPIRIN FOR 14 DAYS PRIOR TO SURGERY

Anti-Coagulants:

  • Enoxaparin (LOVANOX)
  • Heparin
  • Warfarin (Coumadin)

HOLD THESE MEDICATIONS AS INSTRUCTED BY WARFARIN CLINIC

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.