You have decided to have surgery. This brochure walks you through what to expect along the way.

Desert Spine Institute Shawn Hermenau, MD 2851 South Avenue B Suite 2401 Yuma, AZ 85364 Phone 928-247-9714 Fax 928-247-9718 You have decided to have surgery. This brochure walks you through what to expect along the way. Pre-Operative Care - Spine Surgery Before Surgery Pre-admission testing When we schedule you for surgery our office will also schedule you to be seen for your pre-admission testing. You will report to the hospital on that day to be seen by the anesthesia department. At that time they will review your medical records and discuss with you your anesthetic plan for the surgery along with risks/benefits of different anesthetics. Please arrive 15 minutes prior to your scheduled time and bring with you the following information: Patient s full name, address, phone number Driver s license Social Security Card Medical Insurance Card Any co-pay that your insurance requires Your medical records will have been transmitted ahead of time by our office and you will not need to bring your copies with you. Pre-operative Exercises Many patients with arthritis favor their joints and thus become weaker. This interferes with their recovery. It is important that you begin an exercise program before surgery. It is not completely up to your surgeon to heal your back. You must partner with him for optimal results. It is important to be as fit as possible before undergoing surgery. This will make your recovery much faster. You should begin the exercise program now and continue until your surgery. Your doctor will give you an exercise instruction sheet and you should do this for 15-20 minutes twice a day. It is not harmful for you to do them more and twice a day should be considered a minimum prior to surgery. Also, remember that you need to strengthen your entire body, not just your spine. It is very important to strengthen your arms by doing chair push-ups. You will rely on your arms to help get you in and out of a chair, to walk, and to do your post-operative exercises. Home Preparation for return from the hospital

Have your house ready for your arrival from the hospital. Clean. Do the laundry and put it away. Put clean linens on your bed. Prepare meals and freeze them in single serving containers. Cut the grass, tend to the garden or other yard work. Pick up throw rugs and put them away. Also tack down any loose carpeting. Remove electrical cords or other obstructions from walkways. Install night lighting in the bathrooms, bedrooms, and hallways. Arrange for someone to collect your mail and care for pets or other loved-ones. Week Before Surgery All areas of the body to be operated on will be pre-treated with the cold laser. This will require a short visit to our office and a non-invasive treatment of the skin to be operated through. This aids in the postoperative swelling and reduces peri-operative pain and leads to decreased infection rates. Night Before Surgery Do not eat or drink anything after midnight, unless instructed to by the physician. You make take medications with a sip of water unless otherwise instructed not to by the physician. You will also be given a special soap bar to use the morning of surgery. You will need to shower with this soap prior to arriving at the hospital. What to bring to the Hospital Your physician provided you a brace to have after surgery - please bring your brace with you the day of surgery. In addition to the items mentioned above (Driver s License, INsurance card, etc.), personal hygiene items (toothbrush, deodorant, combs, electric razors, hand-held mirror etc.) are recommended along with a set of loose/comfortable clothing. Shorts, large t-shirts, slippers, or sweats are great things to have for the post-operative period. These will make you more comfortable and less patient-like. Small hand-held electrical items such as ipods, laptop computers, DVD players or phones are acceptable and helps the time pass more enjoyably. Please leave jewelry, valuable items and large amounts of money at home. All make-up must be removed prior to arriving at the hospital as well as nail polish. Page # 2

Hospital Care - Spine Surgery Day of Surgery What to do Report to the hospital or surgical center as instructed. The staff in the pre-operative department will assist you in getting ready for surgery. You will have showered the morning of surgery with the special soap provided by the surgeon prior to arrival. The nurses will ensure all your paper work is correct and assist you with assessing your medical condition that morning. They can help answer any questions you may have forgotten to ask until that point. Your family will be with you and they can meet the anesthesia team and surgeon at that time. Please make sure you bring your brace with you the day of surgery, the preoperative nurses will take it from you as well as gather your other personal items for you while you are in the operating room. What to expect You will be prepared for surgery by a peri-operative team of professionals. They will ask you many questions about your medical condition and the procedure you are about to undergo. In the holding room your surgeon and anesthesia team will greet you. At that point an IV will be placed, blood work maybe taken and your preoperative antibiotic will be given. Nurses will also place devices on your legs to prevent blood clots during and after the surgery. The team that will be monitoring your nerves during the procedure will meet you and place wires on your extremities. They will explain what they do and how they will be involved in your case. From the holding area you will say goodbye to your family and will be escorted into the operating room. Your family can wait in the waiting room and they will be updated throughout the case as to your condition and afterwards the surgeon will come out and let them know that you are doing well and any details about the procedure. After the surgery Following the surgery you will be taken to the recovery room until you are awake, safe and comfortable from your anesthetic. Depending on your procedure and your medical condition you will be transferred to the ICU or the surgical floor to begin your rehabilitation. You will likely be very tired and may not remember much about the day of surgery. Your surgeon will visit you after surgery in your room and answer any questions you have and educate you on the success of your procedure. You will be given a hand held machine to help keep your lungs inflated, this will be very important to use very frequently throughout the rest of your hospital stay. Post-op Day 1 On day 1 after the surgery you will be helped out of bed and seated in a chair in your room. The physical therapist will assess your abilities and assist you with walking. You will have any visitors during this period of people who are there to improve and quicken your recovery. It may be overwhelming at first and you may still be tired. You will be allowed to rest as needed but be prepared to work. Everyone is there to help you and will not let you hurt yourself. Depending upon your surgery your IV pain medications maybe Page # 3

transitioned to longer lasting oral pain medications. Your family and visitors are always welcome. You will see your surgeon at least once a day during your hospital stay and he is always available to answer your questions through the nursing staff. Post-op Day 2 (if needed) You will continue your rehab and walk with the physical therapists, your nurses and your family. Additionally, you will be helped to get dressed into your loose fit clothing. Shorts and loose fitting t-shirts are best along with slippers. Most of your time will be spent in a chair or walking, but you will be allowed to take short naps during the day. Patients undergoing anterior lumbar procedures will be allowed to begin taking liquid diets as their bellies start to wake up. Many patients leave for the rehab center or home on this day. Post-op Day 3 (if needed) All dressings will be removed and you will be allowed to shower today. A dry/clean dressing may be place over the incision after the shower. It is important to maintain good personal hygiene particularly during the peri-operative time period. Showers are ok, no baths or emersion in water can occur for the next month as the incisions need to heal. You will continue to work with the therapists and preparation for going home or to the rehab center will be in full swing. Expect to be discharged or transferred on this day. Discharge Instructions If you are going home Since you will not be permitted to drive for some time after surgery, you will need to make arrangements for someone to drive you home. You will receive written instructions at the time of discharge concerning medications, therapy, activity, etc.. We will arrange for any special equipment you may need. Most patients go directly home to continue therapy as an outpatient, though some patients may require home health services. If these are required we will arrange this for you. Please be aware that transportation issues do not qualify for home health services. If you are going to a sub-acute facility The decision to go home or to a sub-acute facility will be made collectively by you, your surgeon, the therapist, the nursing staff, the social workers, and your insurance company. Every attempt will be made to have this decision be finalized in advance but may be delayed until the day of discharge. Please keep in mind that our patients do well and may not qualify for sub-acute rehab. Also know that the insurance company do not become involved in social issues such as lack of caregiver, animals, etc. These are issues you will have to address before admission. Page # 4

Post-Operative Care - Spine Surgery Caring for yourself at home When you go home there are a variety of things you need to know for your safety, your speedy recovery, and your comfort. Control you discomfort Take your pain medications at least 30 minutes before therapy Gradually wean yourself from prescription medications to tylenol Change your position every 45 minutes throughout the day. Avoid prolonged sitting. Use Ice for you pain control. You can apply ice packs briefly (no more than 15 minutes at a time) to your surgical site. This will help with pain. A bag of frozen peas wrapped in a kitchen towel makes an ideal pack and can be reused many times. Body changes Your appetite may be poor. Drink plenty of fluids and make yourself eat small meals regularly. You may have difficulty sleeping, this is normal. Avoid too many naps during the day and try and return to a regular sleep schedule. Your energy level will be decreased for the first month, this is normal and it will return. Pain medication that contains narcotics can cause constipation. Use stool softeners or laxatives as necessary. Stockings and/or compression stockings You may be asked to wear special white stockings to help prevent excessive swelling in your legs and blood clots. Wear them at all times and only take them off for two hours twice a day. You may be asked to wear these for the first three weeks after surgery. Recognizing & Preventing Potential Complications Infections Signs of infection can be Increased swelling or redness at the incision site Change in color, amount, or odor of surgical drainage Increased pain at surgical area Fever of 102 for longer than 24 hours. You can take tylenol to decrease your temperature. Call your surgeon if any of the above signs occur Page # 5

Blood Clots Surgery may cause the blood to slow and coagulate in the veins of your legs, creating blood clots. This is why you may take a blood thinner after surgery. If a clot occurs despite these measures you may need to be admitted to the hospital to receive blood thinners. Prompt treatment usually prevents the more serious complication of pulmonary embolus (blood clot into the lung). Signs of Blood Clot Swelling in the thigh, calf, or ankle that does not go down with elevation Pain or tenderness in the calf Prevention of Blood Clot Walking Compression stockings, mechanical squeezers, ankle/foot exercises and blood thinners Pulmonary Embolus A pulmonary embolus occurs when a blood clot breaks away from the vein wall and then travels to the lungs. This is an emergency situation and you should call 911 immediately. Signs of a Pulmonary Embolus Sudden chest pain or shortness of breath Difficulty breathing and/or rapid breathing Sweating Confusion Prevention of Pulmonary Embolus Prevention of blood clot in leg Recognize a blood clot and contact your surgeon immediately Constipation Symptoms of Constipation Having a very hard time pushing out your stool (may be hard and dry) Pain or bleeding during a bowel movement Having the feeling of needing to have a bowel movement but cannot Prevention of Constipation Drink 6-8 (8 oz) glasses of water a day Increase your fiber intake in a well balanced diet Take a stool softener as directed by your physician Walking Caring for you incision Your incision will be closed with either staples, sutures or steri-strips. Staples and or sutures need to be removed in 7-10 days following surgery. You can shower 72 hours after surgery. You should keep your incision clean and dry with soap and water. Let the soap and water run over your incision but DO NOT scrub or rub your incision vigorously. Gently pat the incision dry after the shower. DO NOT immerse yourself in a bathtub, pool, jacuzzi, or ocean for one month after your surgery. Page # 6

Steri-strips will often be placed over the incision closed with absorbable sutures under the skin. You may shower as above. Do not take the steri-strips off, instead let them fall off over the next 1-2 weeks. Durable Medical Equipment (DME) Special equipment may be needed when leaving the hospital and going home. These items will be given to you or delivered to your home. The staff will arrange for you to get them. These items include walkers, canes, elevated commode, or reacher/grabber. Braces Your surgeon will prescribe a brace for you to wear following surgery. This brace will be given to you prior to your admission to the hospital. In general the brace is for your comfort and need not be worn at all times. Your surgeon will give you specific instructions if you are to wear it at all times, such as patients with fractures. Self-Care The best thing to do is think before you act. Ask yourself if the activity you are about to perform can be done safely without affecting your back or neck. Allow plenty of extra time to perform your normal activities and do not hesitate to ask for help. Bathing Walk-in showers are best. Place your bathing items in a shower caddy over the nozzle to keep everything in easy reach. Sometime a shower seat maybe helpful or necessary. Be careful of wet surfaces or slippery areas. Remove all throw rugs that may cause you to trip. Allow lots of time to shower and dress. See above for care of incision. Toliet During the first few weeks folllowing surgery, you may need a raised toliet seat or bedside commode. A regular toilet seat may be too low and cause you back to hurt or you may not have the strength in your legs to get up and down from it. Getting in and out of bed Rolling onto your side and using your hands to push you to a seated position is recommended. Sit on the edge of the bed. Using the arm closest to the pillow for support, lower your upper body sideways while gently swinging your legs and feet onto the bed is best. Reversing this works well for getting out of bed. Resting/Sleeping Use a firm mattress or couch. Soft pillows can provide support for your neck and legs (under the knees) while lying on your back. Do not use pillows that cause your neck to misalign your back. Comfort and support will assist with your ability to sleep and heal well. Remember that when you sleep your muscles may have tightened so take your time getting out of bed. Dressing Allow yourself plenty of extra time to dress. Hurrying or anxiety may cause you to use improper body posture or movements. Loose-fitting clothing such as sweats or shorts with elastic waists and slip on shoes are recommended. You may want to purchase a long handled shoehorn to assist you putting on your shoes. Page # 7

Your therapist will instruct you on putting on socks. Underwear, slacks, and socks should be put on while lying flat on your back. Sitting Sitting puts more pressure on your back than standing or lying flat. At first you may want to sit for meals only. Pillows that support your back may be beneficial in conjunction with a high back chair to assist with your sitting ability. Take care getting in and out of chairs and use your arms as directed by your therapist. Also a high seat will make this process easier and more comfortable to sit for extended periods of time. Driving a car Please do not drive until you receive your surgeons approval. You may wish to get a lumbar support pillow for riding in cars. You can return to driving when you can safely get in and out of the car, use all your mirrors safely/timely, and have the physical ability to react safely and timely. Remember if you drive too soon and you are involved in an accident you will be sited, potentially have your driving privelages revokes and potentially hurt yourself or others. Kitchen Activities Whenever possible, have frequently used items placed on the counter top. This may include pans, bowls, storage containers, and spices. You may not like the way the counter looks, but it will be back to normal in to time. The use of the grabber is highly recommended to reach items above or below the counter. When loading the dishwasher, place all items on the counter above the dishwasher. Drop to one knee or and load one item at a time. Reverse this procedure to unload the dishwasher. Lifting Avoid lifting as much as possible and ask for assistance. Do not lift over 5 lbs the first 4 weeks (1/2 gallon of milk) and then no more than 10 lbs (a gallon of milk) for the next 4-6 weeks. When lifting objects keep them close to your body and avoid twisting or pivoting. If lifting a child, bend down on one knee and place the child on your thigh. Bring the child close into your upper body and slowly push up to a standing position. If possible have the child stand on a chair before pick him/her up. Do not carry a child for more than a few moments at a time. Avoid gaining weight after surgery Weight gain is not uncommon after spine surgery. Between decreased activity levels, boredom associated with immobility, depression and back pain, those extra pounds can creep up on you before you know it. Unfortunately, excess weight only fuels the vicious cycle of increased pain, immobility, and depression. These suggestions may be helpful in preventing excessive eating and weight gain: Drink at least 2 quarts of water each day. This will make you feel full and you will eat less. Fill your refrigerator and cupoards with healthy foods. Look on the internet and library for healthy recipes and ways to eat more filling meals Eat slowly Keep your mind and hands busy Spine Precautions Do s logroll out of bed perform only exercises explained or approved by therapist or doctor Walk frequently Page # 8

Change positions frequently to avoid stiffness Try to limit stair climbing Dont s No twisting No Bending No lifting greater than 5-10 lbs Avoid sitting on low surfaces Decreasing your risk of falls Have good lighting - put night-lights in bedroom, bathrooms and hallways. Always have a flashlight handy at bedside. Remove throw rugs or loose carpets Have electrical cords or telephone cords taped up or moved out of walkways Put bathmat in shower/tub Wear low healed shoes with good traction. Keep pathways free of objects Maintain your health Get your vision tested regularly Take good care of your feet Consult your physician regarding any side effects from medications Use your assisted devices When getting up from the bed, sit on the edge of the bed briefly before standing up. Sexual Activity You and your partner can continue a sensual, loving, healthy sex life after surgery. Consult your physician about when it is safe to return to sexual activity. Use certain positions that keep the spine aligned properly. There are also certain positions to avoid. Speak with your physician about specific information regarding these do s and don ts. Depression and Motivational Healing It is normal to feel discouraged and tired for several weeks after your surgery. These feelings may be your body s natural reaction to the cutback of extra hormones it provided you with to handle the stress of surgery. Although emotional let-down is not uncommon, it must be not allowed to get in the way of the positive attitude essential to your recovery. If you were particularly energetic, on the go and/or kept your body in good shape before surgery, having to take it easy may be a blow to your active, independent lifestyle. You may resent the fact that you didn t plan on this happening to you. Feeling this way is entirely normal. You are going through a type of loss - a loss of controlling the lifestyle that you have been leading up until this time. In a sense, you are grieving - grieving for a you that you do not have right now. You may experience emotions you not use to feeling...sadness, frustration, anger and resentment to name a few. Some patients lose the definition of who the are. Grief can show up in numerous ways...loss of appetite, being withdrawn from friends and family, and insomnia to name a few. This grief is normal, but you must be careful not to get so caught up in it that it dictates your life. You must focus on the positive results. Granted, you may not be the same person you Page # 9

were before, but you have to re-direct your energies into things you choose, as opposed to things you did. Use this down time to reflect on what you want in the future and not dwell upon the past. If you didn t like your lifestyle before surgery, you can choose a different lifestyle for your future. Page # 10