Operative Instructions and Expectations

(THINGS TO DO BEFORE YOUR OPERATION)

Make pre-op medical clearance appointments with your:

• Pre-admission clinic as instructed
• General Practitioner, if applicable
• Cardiologist, if applicable
• Medical Specialist as recommended
• Obtain all medical imaging and blood test as recommended
• If further tests are requested, contact Dr Nair’s office as this will allow us to continue to facilitate the perioperative course

DIABETIC PATIENTS:

Specifically discuss pre-op diet and insulin/medication requirements.

HYPERTENSIVE PATIENTS:

Specifically discuss medication regimen prior to, the morning of, and after surgery.

STOP SMOKING:

We will gladly facilitate referrals to supportive programs.

MEDICAL IMAGING:

Hard copies of all medical imaging especially those of the spine are paramount. You are encouraged to organise these and bring them on the day of surgery

2 WEEKS BEFORE SURGERY:

• Stop taking aspirin
• It is advised you cease any herbal/oriental remedies as these sometime have blood-thinning properties which may cause undue haemorrhage during surgery
• Make appropriate social arrangements (i.e. staying with a relative or friend or have one stay with you). This often facilitates a smoother transition to independence and ultimately the desired quality of life
• Call your health fund to advise them of your upcoming hospitalisation and surgery.

Item numbers can be obtained from my staff regarding your treatment.  All patients will receive a financial consent prior to surgery relating to fees and charges .If applicable determine which rehabilitation facility suits your needs.

10 DAYS BEFORE SURGERY:

Stop taking:

• Anti-inflammatory medication (Voltaren, Ibuprofen, etc.
• Vitamin E and multi-vitamins.
• Any herbal supplements
• Plavix/Clopidogrel with approval from Cardiologist.

3-5 DAYS BEFORE SURGERY:

Stop taking:

• Coumadin/Warfarin 5 days prior with approval from the prescribing physician.

DAY BEFORE SURGERY:

• Contact admissions department at the relevant hospital in the early afternoon to confirm time of surgery.
• You will be required to fast, therefore NOTHING to eat or drink after midnight the night prior to your surgery.  Take essential medication as discussed at the pre admission review with sips of water.
• Arrive at the Hospital at leat 2 hours prior to your scheduled surgery. It is difficult to predict exactly when your surgery will take place if you are not first on the schedule.

PRE ANAESTHESIA:

After checking in at Admissions you will be asked to change into a hospital gown and taken into to the Pre-op area where others will be waiting for their surgeries. Significant others my wait with you in the Pre-op area right up until the time when you go back to the operating room. In the Pre-op area you will have an IV cannula inserted and you will be given IV fluids (which will help with the thirst a bit) and an antibiotic. You will meet with the Anaesthetist and Dr. Nair. Please advise Nurses, Anaesthetist and Dr Nair if you have allergies. Often you are given medication the IV to relax you in the holding area and make you more comfortable. Once you are rolled back to the operating room you will be given medicine through the IV that will put you asleep (most find it a very relaxing experience). You are asked to breathe oxygen through a mask at the same time. If the surgery is anticipated to be long in duration, a urinary catheter will be placed after you are asleep (i.e. Painless). During the surgery you will be asleep and it will not be painful. I have NEVER had a patient remember anything during surgery.

RECOVERY:

You usually don’t wake up until after a short time in the Recovery room. There you will have a nurse by your side to attend to any need. After approximately an hour, you will be taken to your room. You will be in some pain but it should not be more than tolerable. If so, call the nurse immediately and she will give you more medicine. The amount of pain varies greatly between patients due to sensitivity to pain, emotional factors, and the amount of pre-operative narcotics they may have been taking. Typically you will be drinking shortly after surgery.

POST-OPERATIVE PAIN RELIEF

Some people come round from the anaesthetic and feel an immediate relief of their arm or leg symptoms. Pain often settles fairly quickly. Numbness and tingling sensations usually take longer to settle though – this may be days, weeks or months. It varies considerably from person to person. Some people may have an area of numbness that never fully recovers. Do not worry if your arm or leg pain is still present – it is not a sign the surgery has failed. Nerves take a long time to recover from being squashed. They also have a tendency to ‘remember’ what’s happened to them. Also, consider the surgical incision. Bruising and swelling will be present which will settle, but can also irritate the delicate nerve tissue initially.

POSTOPERATIVE HOSPITAL STAY

Depending on the surgery you may be assisted out of bed by the therapist on the day of surgery. The therapist will walk with you 2 times a day. The first couple times out of bed is the hardest. The first day after surgery is the roughest. The more you walk the quicker you will go home and the less chance you have of developing a blood clot. Compressive stockings that are like small inner-tubes that wrap around your legs and inflate and deflate will be used while in bed to further prevent blood clots. You will be seen daily by your anaesthetist, a physician and Dr Nair. Your anaesthetist will martial your post operative pain regime. It is very rare to have a complication related to the spine. Dr. Nair will attend to any spinal problem. At any time during your stay you may speak with Dr. Nair (just let the nurse know so she can make the connection). Often the time from surgery until home is divided between the hospital and the rehabilitation hospital. Most patients enjoy their time at the rehabilitation hospital more than the hospital. There are several reasons not to stay the whole time in the hospital. The rehab can better focus on the physical therapy and is a gentler transition to a home environment. You will be transported to the rehab facility and will be able to make a choice as to one that is closest to your home. Essentially, you may go home once you can get out of bed by yourself, walk by yourself, and able to use the bathroom facilities by yourself.

You may or may not have pain from:

1. Incision pain

2. Muscle spasms or cramping

MEDICATIONS

You will be sent home with:  pain medications. If you do not get relief from these medications, please contact the office during office hours. It usually takes half an hour for medicines to start to work. Decrease the frequency of the pain meds and muscle relaxants as necessary. The pain is usually the worst the first day or two and then rapidly decreases.

FIRST POST OPERATIVE VISIT:

Should be 10-14 days post surgery. If you did not make an appointment prior to surgery, please call to make an appointment.

SPECIFIC INSTRUCTIONS

Bending

Try to avoid bending at the waist as much as possible for 3 months after surgery. Bend at the knees.

Driving

The Roads and Traffic Authority recommend no driving for 6 weeks after spinal surgery. You are usually able to drive when you can safely operate the pedals and are not requiring strong pain-killers, which may impair reaction times.

Travel

Flying short distances is generally safe as long as you do not have any blood clots. Long flights are best avoided for the first 2 months but should you need to fly for a long distance (> 2 hours), we recommend you wear above knee TED stockings, mobilise during the flight and stay hydrated. Please consult your GP or Dr Nair before a long flight

Housework

Light housework permitted after 2 weeks

Lifting

No lifting anything greater than 3 kg for 2 weeks

Showering

No showering until 2 days after surgery. Your incision will initially be covered with a clear, sticky dressing. It should stay on until you return to the doctor. You may shower with this dressing on, but do not let water run directly over the dressing. Should the clear, sticky dressing come off or be removed prior to your visit with Dr. Nair, replace it with the dressings provided on discharge. Do not attempt to shower if you feel lightheaded, weak, or dizzy.

Standing

Start with 10 minute periods and gradually increase to tolerance.

Sex

You can have sex whenever you feel ready, although it is advised to adopt a passive stance.

Walking

Start with a block in the morning and a block in the evening, gradually increasing. Try to walk outdoors if possible. Do not overdo and try to walk in the heat of the day. Do not walk so far from home that you are too tired to walk back. Walking is an important part of your rehab. Ideally, you should walk 2 km a day by one month after your surgery and 3 km a day by two months after your surgery

Physical Therapy/gym

Physical therapy is commenced day 1 post op. You are encouraged to mobilise with the aid of a therapist however rigorous activity is to be avoided until bony union.  If rigorous activity is started to soon the hardware may loosen which causes pain.  You may get into a pool or the ocean (in light surf conditions) after 1 month.

The second aspect to long term care is maintaining spinal fitness. This includes weight loss, core strengthening and on-going exercise. The best exercises are those which are non impact such as swimming and cycling. All patients are normally taught core-strengthening exercises. These should be continued independently by the patient at home indefinitely.

Hydrotherapy

Patients are encouraged to engage in hydrotherapy provided surgical incision(s) are well healed, usually after 1 month.

Sitting

Start with 10 minute periods and gradually increase as tolerated.

Braces

If you were fitted for a brace, you may wear your brace for comfort or for traveling in a car. Most feel better with a brace but it’s for your comfort and you don’t have to wear it. I would like you to wear it very infrequently or not at all after a month.

Return to work

If work is office based, you may return as soon as you feel that you are able to carry out your duties, this is typically after 2 week review.

Assistive devices

Once you are home, you may or may not require a hospital bed, walker, raised toilet seat or grabber. These items can be obtained through the hospital therapist

Diet

As tolerated unless other instructions are given after your surgery. Be sure to increase your diet slowly. Pain meds cause constipation thus a high fluid, high fibre diet is strongly encouraged and if necessary Coloxyl and Senna or other over-the-counter stool soft softener.

Contact the office if: you experience worsening numbness or loss of strength or you develop a temperature over 38 degrees Celsius, have increasing amounts of drainage from your incision; develop redness that spreads from the incision site, swelling and/ or yellowish drainage from the incision site. It is expected to have drainage from the incision but this should decrease with time.

Questions or concerns:

If you have any questions or problems not addressed above, please call our office on (02) 8488 9950 or email info@sydneyspinedoc.com.au  Alternatively call the hospital where you had your surgery performed and they will be able to contact Dr Nair and his practice staff. If you had your surgery in Norwest Private Hospital the Emergency Department is open 24 hours a day, should you require emergent care.