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I'm going with my brother to the surgeon tomorrow to discuss the type of surgery he's going to have for an infected wrist joint. He is HIV positive and an alcoholic, so as a family we are concerned he gets the right care. He doesn't seem able to make decisions for himself based on sound logic and reason right now. What should I be prepared to ask the surgeon if anything?

It's always a good idea to have a family member or friend attend the patient's preop visit with the surgeon. Even the most well-informed patient can become nervous and anxious and miss all of what is said or fail to ask important questions. In the case of potential complicating risk factors like being positive for the human immunodeficiency virus (HIV) and/or having a history of alcohol use, it's important that the surgeon has all of the information needed to make decisions on behalf of the patient. For example, the procedure could be done with a traditional open incision -- or it might be performed using small openings and inserting an arthroscope inside the joint. The scope allows the surgeon to see inside the joint to perform any necessary procedures. Arthroscopic surgery does have some limitations and there are a few contraindications (reasons why it shouldn't be used). Previous surgery on the same wrist, bone infection called osteomyelitis, or the spread of infection to other parts of the wrist that can't be seen or reached with an arthroscope limit the use of arthroscopy. The surgeon must always be aware of the potential for arthroscopic surgery to miss areas of infection or bone osteomyelitis. Failure to remove even a tiny portion of these infected areas will mean the infection can continue to spread and cause more problems. If fixation was used to hold the wrist in place during a previous surgery (metal plate, screws, pins), infection can get under, around, or on the hardware. The arthroscope can't show the surgeon these areas. And if surgery was already done on that same wrist, scar tissue and altered anatomy can prevent the surgeon from inserting the scope correctly without damaging nerves, blood vessels, bones, or soft tissue structures that have shifted from their normal anatomic location. Anything you can do to provide a complete and accurate health history will be a benefit to both the surgeon and your brother. Go prepared to listen carefully, take notes, and assist your brother in understanding his treatment choices and responsibilities after surgery to assure the best result possible.

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