Surgery Instructions
Stop Smoking
It is strongly advised that you dramatically decrease the amount you smoke or stop smoking completely. Research has shown that smoking hinders healing of surgical incisions.
PreOperative Testing
Preoperative testing, including blood work, EKGs, etc. will be required prior to surgery. It should be completed 1 to 2 weeks before your surgery date at the hospital where you will have surgery. You will be interviewed by a nurse and also meet with a member of the anesthesia staff during this visit.
During this visit, the nurse will give you additional instructions both verbally and in writ-ing to tell you what to do the night before and the day of surgery. These instructions will include how to take or stop taking your home medications, what to eat, and what time to arrive the day of surgery.
At Doctors Hospital: Free valet parking is provided if you pull your car under the shelter in front of the main entrance. You will need to report to Day Surgery registration (next to the Emergency Department) for your tests. Our surgery coordinator will fax over the or-ders for testing so they will be there when you arrive. At the pre-op visit, you will be given a special soap, called Triceptin to use the 2 days before surgery. Cleanse your entire body, paying special attention to the area where you will have surgery. In the sur-gical area, use a wash cloth, cleansing for 5 minutes. This will minimize the incidence of infection.
At University Hospital: Go to the second floor of the outpatient testing center. No ap-pointment is necessary. You may go between the hours of 9 A.M. and 4 P.M., Monday through Friday one to two weeks before your surgery. Your preop orders will be there when you arrive. You will be interviewed by a preop nurse and be given instructions on what medications you take the day of surgery and what time to arrive.
If you are required to wear a brace after surgery, get fitted for it and pick it up at least 48 hours before surgery. The doctor will give you a prescription for the correct brace and recommend a location to pick it up. The brace company will file your insurance. YOU MUST BRING YOUR BRACE TO THE HOSPITAL ON THE DAY OF SURGERY.
If you have heart problems, you will need medical clearance from your cardiologist before you can have surgery. Make an appointment to visit your cardiologist to get clearance BEFORE your preop date. Bring your clearance letter with you to the preop visit and give it to the nurse who interviews you.
Medications:
If you are taking Plavix, Coumadin, Asprin or medications for high blood pressure, be sure to tell your doctor and his staff. Please bring a complete list of medication you are taking with you.
Night Before Surgery:
Review the written instructions that you received during your preop visit to remind you when to stop eating, how to take your medications, and when to arrive at the hospital the next day. Get a good night’s rest. You will be asked to arrive at the hospital 2 hours before your surgery, which could be as early as 5:00am, in order to allow plenty of time to get your preoperative antibiotics.
Day of Surgery:
Do not apply lotion or make up. You may wear deodorant.
Arrive at the hospital at the assigned time with a responsible adult. Leave your suitcase, and your brace in the car. After your surgery is complete and you are in your hospital room, the adult can bring these things to your room. Do not bring jewelry or money to the hospital.
Your family can wait in the surgery waiting room while you are in surgery. Afterwards, Dr. Volcan will go to that area to talk with them about the surgery.
When you are taken into the preop area to be prepared for surgery, you will change into a hospital gown and an IV will be inserted in your arm. A nurse and anethesiologist will briefly interview you again. Many of these questions are repetitive, but they are an important part of the steps that we take to make sure that your surgery is performed accu-rately and safely. You will not be put to sleep until you are in the operating room.
Following surgery, you will be taken to the recovery room. Visitation by family is very limited and very brief in this area because it is a busy time for nurses taking care of you and because it is important to maintain sterility, confidentiality, and your safety at this time. You will be transferred to a regular hospital room when you have recovered, and you may have more visitors at that time.
What to Expect After Surgery:
Coming soon: Click for a patient care map if you are having a cervical fusion, cervical disc, or lumbar laminectomy. (pdf. of care map)
Coming soon: Click for a patient care map if you are having a spinal fusion. (pdf. of care map)
Home Instructions:
Be sure and keep your scheduled follow-up appointment.
When to Call Your Doctor:
- Fever above 100 degrees.
- Pain in your calf muscle, NOT relieved by medication.
- Unusual redness, heat or drainage from your incision site.
- Chest pain.
- Hoarseness is normal, but difficulty swallowing or breathing requires immediate attention.
- Blood in your urine.
- Continuous headaches.
If you had back surgery, it is common to have a reoccurrence of leg discomfort during the first week. This is temporary. You may call your physicians office if it doesn’t seem to improve over the next 1-2 days to see if medication is indicated for relief.
Incision Care:
- Your incision should remain dry.
- You may remove the outer dressing 48 hours after surgery.
- Keep your incision clean by wiping it with alcohol or peroxide daily and dry it afterwards. You will either have staples or
Steri-strips. If you have Ster-strips, you may dry them afterwards with a warm hairdryer. Leave them in place as long as possible, but if they start to fall off, you may gently remove them.
- You do not have to cover the incision after removing the dressing. If irritation occurs due to the Steri-stips or staples catching on clothing or bed linens, you may cover it with dry 4x4 and gauze with tape.
- Do not put any creams on your incision unless otherwise directed by your physician
- Notify your physician if you experience an increase in redness, draining or swelling at the incision site or if it extends past the staple line.
- Avoid touching your incision
Showering
You are permitted to shower (but not take a bath) once your dressing is removed. If your wound gets wet, gently pat dry with a clean towel. You may blow dry Steri-strips. A tub bath is not permit-ted until your wound is completely healed.
Activity
Please walk a minimum of 30 minutes each day. There is no maximum limit to the amount that you can walk.
Wear your collar or brace as instructed. For back surgery, minimize sitting to 15 minutes at the time, then get up and move about. For neck surgery, wear your collar at all times except for short periods in a chair or bed when your neck is well supported. Your collar will become soiled with skin oil, makeup, and sweat. You may cut the toes out of then cotton socks and slip the sock over the collar to keep it clean.
You may resume sexual activities 2 weeks after surgery.
Dr. Volcan will tell you when you can resume driving. Avoid long car rides.
Do not lift over 5 pounds (a full gallon of milk weighs 5 pounds). Avoid bending and twisting.
Pain Control and Medications
Pain Management – You may be given narcotic pain medication either prior to or following your surgery. These medications are controlled substances, and cannot be called into a pharmacy. Refills of narcotic prescriptions must be done by mailing the prescription to your home. You will need to hand-carry the prescription to the pharmacy. You need to allow 5 days for renewals. Often the mail works more quickly than this, but should not be relied on.
Upon discharge, you will be given a prescription for pain medicine to take at home. Most pharmacies do not carry narcotic pain medicine. Once you have been given prescriptions for pain medication to take home, call your pharmacy to see if they carry those medications and in the correct quantity.
During your surgery you may be given pain medication directly in your spinal canal. This medicine will help with pain management during your first 24 hours of surgery. Once you are feeling more comfortable, you may given pain medicine by mouth.
The length of time you will be on pain medication varies considerably from patient to pa-tient. Some patients need pain medications for only a brief period of time.
Dealing with Constipation
This is a common problem for patients who have recently undergone spine surgery. Both pain medications which contain narcotic medication, and iron pills can cause constipation. The following interventions will help relieve constipation:
Drink 6 – 8 (8) ounce glasses of water per day. Use Fiber One (16g fiber per ˝ cup) or Allbran Fiber Extra Fiber (14g per ˝ cup) breakfast cereal each morning. These are the breakfast cereals with the most amount of dietary fiber to help achieve regularity. Regular Allbran has less fiber, but may work also.
Use a stool softener (Colace, Docusate sodium). The dosage should be 50mg three times per day. This medicine can be purchased over the counter. It works by bringing an in-creased amount of fluid into your intestine. Thus, back to rule one drink 6 – 8 glasses of water per day.
Use a “bulk” laxative. Bulk laxatives provide increased roughage for the colon without chemical stimulants. These substances are in powder form and need to be mixed with water or juice. Konsyl is the best product (6 grams of fiber per teaspoon). Metamucil and Benefi-ber have 3 grams of fiber per teaspoon. They are best mixed in a container with a top so that the material can mix well with the fluid used. Metamucil has wafers as well. These bulk laxatives come in pill form as well, but they have very little fiber, and are not suggested for use.
If the above noted measures do not relieve your constipation, you will need to use a chemi-cal laxative. In general, it is not a good practice to use chemical laxatives over a long period of time because they adversely effect the natural movements of the colon, and one can eventually become dependent upon them. However, in the short term, Senokot or Dulcolax tablets may be needed occasionally while you are taking pain medication. These are over-the-counter medications and can be purchased in most pharmacies. If the methods above do not relieve your constipation, you may need to use Dulcolax sup-positories. If one or two Dulcolax pills at noon do not produce a bowel movement by the evening, use the suppositories as well.
If constipation still persists, you may need to use a Fleets enema.
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