Post-Op Surgery Instructions
You can find Discharge Instructions for the Amulatory Surgery Center by clicking here.
Dr. Fisher, Christiana Spine Center
Christiana Hospital
Dr. Fisher, Christiana Spine Center
PRE- AND POST-OPERATIVE INSTRUCTIONS
IMPORTANT – PLEASE READ CAREFULLY!
DO NOT THROW AWAY UNTIL AFTER YOUR POST-OP VISIT
- Surgery Date:___________________________ Time:___________________________
- Patients may have NOTHING TO EAT OR DRINK after MIDNIGHT prior to surgery. If you eat or drink, your surgery will be cancelled.
- Your surgery will be performed at Christiana Hospital. You will receive two phone calls from Christiana. The first call will be from admitting to obtain insurance information. The second call will be from a nurse who will take your medical/surgical history and health status. The nurse will also give you instructions regarding medications prior to surgery. It is important that you have a list of medications ready for the nurse at the time of the call.
- Arrive at the hospital 2 hours prior to your scheduled surgery. You will need to go to the first floor – Surgery and Procedure Unit. If you are not sure where to go, check with the receptionist in the main lobby of the Hospital.
- It is impossible to know every patient’s insurance coverage and policy information. Please check with your insurance company regarding coverage for surgical procedures. Some require a second opinion and/or pre-surgical certification. Some have a pre-existing clause or waiting period.
- You will need to be seen six weeks after surgery. Your appointment is scheduled for ______________________ at ___________________. It is important that you keep your six week appointment. Due to limited office hours, rescheduling can be difficult.
Please be sure to have your x-ray taken at Christiana Care Health Services, Medical Arts Pavilion I, Suite 107, prior to the above appointment (if your insurance allows).
CERVICAL FUSION POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS: Resume your usual daily activities as you can tolerate them. You should limit pushing heavy items (like the vacuum) and lifting above shoulder level. It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
DIET: We recommend a mechanical soft diet until your sore throat resolves.
Foods like pasta, eggs, soup, etc.
SPECIAL INSTRUCTIONS: Leave the steri-tape(s) on your incision(s) until they fall off. Under them is skinglue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments).
You may have been given a cervical collar to wear. Dr. Fisher will advise you and your family on how long to wear it, based on the extent of your fusion.
If you have been set up with a bone growth stimulator (usually for diabetic patients or multi-level fusions) you will use this daily for 6-9 months.
FOLLOW UP CARE: You should have a post-operative appointment scheduled with Dr. Fisher in 6 weeks. You can call us before that if you have questions or concerns. Also, call if you have a fever over 101, or wound drainage.
MEDICATIONS: You have been given a prescription for narcotic pain medicine. It is for a two week supply. Please call the office at least two days in advance for either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics. ** NO ANTI-INFLAMMATORIES FOR 3 MONTHS.
SPECIFIC TO YOUR SURGERY: It is not unusual to experience different sensations in your upper extremities after surgery. This is from the nerve roots being decompressed and settling down. You may also experience neck and shoulder stiffness, this will settle down with time.
CERVICAL DISC REPLACEMENT POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS:
Resume your usual daily activities as you can tolerate them.
It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
DIET:
We recommend a mechanical soft diet until your sore throat resolves.
Foods like pasta, eggs, soup, etc.
SPECIAL INSTRUCTIONS:
Leave the steri-tape(s) on your neck until they fall off. Under them is skin
glue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments). You will be given a soft cervical collar to wear for your comfort. It is not mandatory that you wear it.
FOLLOW UP CARE:
You should have a post-operative appointment scheduled with Dr. Fisher in
6 weeks. You can call us before that if you have questions or concerns.
Also, call if you have a fever over 101 or wound drainage.
MEDICATIONS:
You have been given a prescription for narcotic pain medicine. It is for a
two week supply. Please call the office at least two days in advance for
either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics.
SPECIFIC TO YOUR SURGERY:
It is not unusual to experience different sensations in your upper extremities after surgery. This is from the nerve roots being decompressed and settling down. You may also experience neck and shoulder stiffness, this will settle down with time.
LUMBAR FUSION POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS:
Resume your usual daily activities as you can tolerate them. You should limit lifting, extreme bending or twisting and pushing heavy items (like the vacuum). It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
DIET: Resume your regular diet.
SPECIAL INSTRUCTIONS:
Leave the steri-tape(s) on your incision(s) until they fall off. Under them is skin glue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments). Call the office if you have concerns about your incision, or if it drains anything. Also call for fevers over 101.
You may have been set up with a back brace and / or a bone growth stimulator. Wear the brace when you are not in bed. If you have been set up with a bone growth stimulator (usually for diabetic patients or multi-level fusions) you will use this daily for 6-9 months.
FOLLOW UP CARE:
You should have a post-operative appointment scheduled with Dr. Fisher in
6 weeks. You can call us before that if you have questions or concerns.
Also, call if you have a fever over 101 or wound drainage.
MEDICATIONS:
You have been given a prescription for narcotic pain medicine. It is for a
two week supply. Please call the office at least two days in advance for
either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics.
** NO ANTI-INFLAMMATORIES FOR 3 MONTHS.
SPECIFIC TO YOUR SURGERY:
It is not unusual to experience different sensations in your lower extremities after surgery. This is from the nerve roots being decompressed and settling down. Tonic water and B Complex vitamins can help this.
LUMBAR HARDWARE REMOVAL POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS:
Resume your usual daily activities as you can tolerate them. Limit lifting, pushing heavy objects or prolonged sitting. It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
DIET:
Resume your regular diet.
SPECIAL INSTRUCTIONS:
Leave the steri-tape(s) on your incision until they fall off. Under them is skin
glue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments).
FOLLOW UP CARE:
You should have a post-operative appointment scheduled with Dr. Fisher in
6 weeks. You can call us before that if you have questions or concerns.
MEDICATIONS:
You have been given a prescription for narcotic pain medicine. It is for a
two week supply. Please call the office at least two days in advance for
either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics.
SPECIFIC TO YOUR SURGERY:
After hardware removal, it is a waiting game to see how your back settles out and/or “declares itself”. Each patient is different, and hopefully Dr Fisher has told you his expectations.
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LUMBAR DISC REPLACEMENT POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS:
Resume your usual daily activities as you can tolerate them.
It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
Dr Fisher does want you back in physical therapy in 10-14 days. Motion is being restored at your disc replacement and PT will help with that.
DIET:
Resume your regular diet.
SPECIAL INSTRUCTIONS:
Leave the steri-tape(s) on your incision until they fall off. Under them is skin
glue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments).
FOLLOW UP CARE:
You should have a post-operative appointment scheduled with Dr. Fisher in
6 weeks. You can call us before that if you have questions or concerns.
Also call the office if you have a fever >101 degrees or wound drainage.
MEDICATIONS:
You have been given a prescription for narcotic pain medicine. It is for a
two week supply. Please call the office at least two days in advance for
either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics.
SPECIFIC TO YOUR SURGERY:
It is not unusual to experience different sensations in your lower extremities after surgery. This is from the nerve roots being decompressed and settling down.
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LUMBAR MICRODISCECTOMY OR DECOMPRESSION POST-OPERATIVE INSTRUCTIONS
ACTIVITY/LIMITATIONS:
Resume your usual daily activities as you can tolerate them. Limit lifting, pushing heavy objects or prolonged sitting.
Dr Fisher does want you back in physical therapy in 7-14 days. This helps prevent scarring around the nerves and helps them settle down faster.
It is okay to shower (no baths), walk and climb stairs. You may drive when your not taking narcotics (pain medicine).
DIET: Resume your regular diet.
SPECIAL INSTRUCTIONS:
Leave the steri-tape(s) on your incision until they fall off. Under them is skin
glue, and under that are dissolving sutures. Do not apply anything to incision unless instructed to do so by Dr Fisher (this includes antibiotic ointments). Call the office if you have concerns about your incision, or if it drains anything. Also call if you get a fever over 101.
FOLLOW UP CARE:
You should have a post-operative appointment scheduled with Dr. Fisher in
6 weeks. You can call us before that if you have questions or concerns.
MEDICATIONS:
You have been given a prescription for narcotic pain medicine. It is for a
two week supply. Please call the office at least two days in advance for
either refills, or a less strong narcotic or other medication. Keep your bowels moving daily with Colace stool softener and laxatives while on narcotics.
SPECIFIC TO YOUR SURGERY:
It is not unusual to experience different sensations in your lower extremities after surgery. This is from the nerve roots being decompressed and settling down. Tonic water and B Complex vitamins will help this.
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Christiana Hospital
A Guide to Prepare You for Your Surgical Procedure
Thank you for choosing Christiana Care for your health care needs. We have developed this guide to help you prepare for your surgical procedure.
Pre-registration/Insurance verification
What to expect: A representative from Christiana Care’s Admitting Department will contact you by phone to preregister you for your procedure. Please be prepared to provide your health insurance information. During this preregistration, you will also be scheduled or a telephone interview with a nurse from the Perioperative Evaluation and Preparation (PEP) team. This interview is a REQUIRED part of your surgical preparation and will take about 30 minutes. The PEP nurse will review your medical history and give you instructions for the day of your surgery. Please make every effort to schedule this interview and keep the scheduled appointment. The nurse will call within 15 minutes of the scheduled time.
What you can do to be prepared: Be sure to make a list of your medications including dosages and when you take them. Please include any vitamins, herbal supplements and medications you take without a prescription. Have a list of previous surgeries and your medical history information available also. You will need a pen and paper to write down instructions from the nurse. You will be asked to repeat back your instructions. This phone call is a good time for you to ask any questions you might have. If you have any questions regarding your instructions after your telephone interview please call us at 302-327-7700 and ask to speak with one of the PEP nurses.
A helpful source of general information regarding your anesthesia can be accessed at www.christianacare.org/anesthesia.
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Presurgical testing
What to expect: The type of procedure you are having and your medical history will determine what pre-surgical testing you will need. If your doctor gives you a form listing the tests you will need, please bring it with you for pre-surgical testing.
Note: A parent, guardian or authorized adult must be present when a minor patient has presurgical testing.
What you can do to be prepared: Please check with your insurance carrier to determine where you can have your presurgical testing. If you come to Christiana Care for your testing, bring all forms the doctor may have given you.
Christiana Care offers pre-surgical testing at Christiana and Wilmington hospitals.
- New, extended hours at Christiana Hospital are weekdays from 7:30 a.m. to 4:00 p.m.
- Wilmington Hospital lab hours are weekdays from 7 a.m. to 4:30 p.m.
- Saturday hours are no longer available.
Please report to the Heart and Vascular Center at Christiana Hospital
No appointment is necessary. All testing needs to be completed within 30 days of the procedure, but no later than 7 days before your procedure. If you have your lab work completed at a facility other than Christiana Care, please notify the selected lab that all lab results must be faxed to Christiana Care - PEP at 302-327-7574.
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The day of your procedure
Please follow all instructions provided by your surgeon and the PEP nurse.
Please arrive at the hospital at the time instructed by the doctor. If you are having your procedure in Christiana or Wilmington hospitals, you should arrive 2 hours prior to your procedure start time. If you are scheduled in one of our surgicenters, you should arrive 1 ½ hours prior to your procedure start time. Please do not arrive any earlier than 5 a.m. at Christiana Hospital or 6 a.m. at any other site.
Leave all valuables and money at home. Christiana Care is not responsible for personal property, valuables or assistive devices brought to the hospital and left with the patient.
A family member or friend may stay with you until you are taken to the operating room. They may then wait in the surgical waiting lounge. The surgeon or nurse will come there to update your family member or friend on your condition. A parent or guardian must accompany any patient under 18 to the hospital or Surgicenter and may not leave the facility while the child is in the operating room.
Please check with your nurse after surgery to learn about visiting policies. Please discuss any problems or concerns with your nurse.
Note: If you will be spending the night, private rooms are available for an additional charge over semi-private room rates (subject to availability).
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Directions
Christiana Hospital
- Park in designated lots near the hospital entrance. Look for the pink Junior Board shuttle for a quick, comfortable ride between the parking lots. The shuttles run weekdays from 9 a.m. – 4 p.m.
- Valet parking service is available at the main hospital entrance Monday – Friday, 6 a.m. – 7 p.m. Cost is $2 for one hour or $3 for the day. Please see the attendant at the information desk on off hours.
- Go to the information desk and they will give you directions to the Surgery and Procedure Unit.
- Please follow the signs on the Christiana Hospital campus.
Important phone Numbers |
(all 302) |
| Admitting |
327-3437 |
| Patient Relations – Christiana |
733-1340 |
| Patient Relations – Wilmington |
428-4608 |
| Presurgical Testing |
733-3151 |
| PEP team |
327-7700 |
| PEP team fax |
327-7574 |
Post Operative Information
Medications: A prescription for your medications will be given to you at the time of discharge. A pharmacy is located in the lobby of the Christiana Hospital where you may fill your prescriptions.
Please follow closely the interval and dosage for your medication. All antibiotics should be taken until the bottle is completed. Please remember that all non-steroidal anti-inflammatory (NSAIDS) should not be taken for at least three months after all neck and back fusion surgeries. Non-steroidals include aspirin as well as its related products including Advil, Aleve, Celebrex, Daypro, Feldene, Ibuprofen, Mobic, Motrin, Naprosyn, Relafen, Vioxx and Voltaren. Non-steroidals do not include acetaminophen (Tylenol). With regard to pain medication, please refer to Dr. Fisher’s specific narcotic policy at that end of this sheet.
Follow-Up Appointments: Unless otherwise indicated by your physician, your first post-operative appointment will be approximately 6 weeks following your surgery. At your preoperative appointment prior to surgery, you were given surgery instructions that included a date and time for this post-operative appointment. If for some reason you do not have an appointment, please call the Christiana Spine Center immediately upon discharge from the hospital at (302) 623-4144 between the hours of 9:00 to 4:00, Monday through Friday, to schedule your follow-up appointment. It is important that you keep this post-operative appointment. Due to limited office hours, rescheduling can be difficult.
Incision Care: Check your incision at least twice daily for the first two weeks for any sign of infection. These signs include increased warmth or redness to the area, swelling, drainage or unexplained increasing pain in the incision not relieved by bed rest or local application of ice, 5 to 10 minutes, 3 times a day. Your skin is glued closed over dissolving sutures under the skin. Small, punctate irritation or inflammation at the ends of the wound is most likely a reaction to the suture material. These reactions are benign and will resolve as the wound heals. For cervical operations, vitamin E oil may help fade the scar. Apply vitamin E (200 IU or 400 IU) directly to your cervical incision once or twice daily. Vitamin E oil can be applied directly from the capsule onto the neck wound. Please give the wound at least one week to heal prior to the first application.
Dressing Changes: You may change the dressing 3 days after surgery. A small amount of reddish-brown drainage is not unusual for 1 to 2 days. Please report any other type or amount of drainage to our office. We may begin you on an oral antibiotic if the drainage persists. The dressing may be discontinued 24 hours after the incision stops draining or spotting. Showers may begin two days after the drainage stops. You may take tub baths 2 weeks after surgery or 4 weeks after large fusion surgery.
Steri-strips (adhesive skin closures): These should be kept on the incision until 5 to 7 days following surgery. You may shower as the protocol for your particular surgery permits, remembering to gently dry the incision area and Steri-strips. It is common for the edges of the strips to loosen and curl. Simply clip the frayed edges but leave the strips on for 5 to 7 days unless they are so loose they are obviously no longer functional. In this case, you may gently lift off the strips but do not pull or jerk to remove them. Apply vitamin E oil to neck wounds, otherwise keep the incision clean without the use of other creams or ointments.
Pain Expectations: After a lumbar fusion, you will have soreness and stiffness for 3 to 6 months with gradual resolution. After cervical surgery, you will have predictable muscle pain for up to 6 weeks post-operatively. A sore throat often occurs after intubation for anesthesia. After all surgeries, inflammation is a natural process of healing. We cannot and do not want to block this process. Please know we can take the “edge” off your pain, but we cannot stop all your pain. With each day that passes, you will get stronger and oftentimes must simply be patient as the healing process begins. You need to be encouraged by the “good days” as the “bad days” get further apart.
Neuropathic pain resolution is unpredictable. Some patients experience immediate resolution, others it resolves over time, and yet others require additional medications or further injections to help their nerves settle down.
Remember: Call our office immediately if you:
- Have drainage and/or odor from your wound.
- Have increased redness/swelling at the incision site, or unexplained increasing incisional pain not relieved by bed rest.
- Have fever greater than 101º with sweats or chills.
- Have new or unfamiliar pain or weakness in the arms or legs.
- Have difficulty with urination or bowel movements.
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Narcotic Policy
Narcotics are both good and bad. The use of narcotics is very efficacious for acute pain control. Appropriately used, narcotics control the pain while the body’s natural healing process occurs. Unfortunately, narcotics do not work for chronic pain. The mechanism of action of the narcotic is to stimulate the opiate receptors within the body. With chronic use, these receptors are down regulated. It thus requires more narcotic to sustain the same degree of pain relief. This is how patients develop a “tolerance” to narcotics. It is also a very easy path to narcotic addiction.
We at the Christiana Spine Center are dedicated to understanding the pathology of the spine. Spinal pain can be very devastating. This is especially true with patients with neurogenic pain. As much as we would like to be generous with our narcotic use, it is truly not in the patient’s best interest.
The guidelines we have outlined below will help us better in controlling your pain. It also allows us to gain some handle on your steady improvement through the healing process. So long as there is a decline in narcotic use, we will continue with the refills. If the narcotic demands increase, we then need to reconsider our options in the management of your pain.
The policies set forward for the Christiana Spine Center are listed below:
For medication refills for the first three months after surgery, please call the medication refill line at (302) 623-4144 (option 3, then press 2) for Dr. Fisher’s patients. All requests will require a minimum of 24 hours to process. Refill requests left on Friday will be addressed the following Monday. Please try to anticipate your narcotics use to help us with this refill policy. When leaving the information for prescription refills, please include your name, the medication you are requesting and the pharmacy number, including area code.
- There will be no narcotic refills over the weekend or after office hours. This is necessary to ensure that your refills are checked with your current office medical record.
- After the first three months following surgery, we will no longer refill medications by telephone. All medication refills must be done in person at a scheduled visit with our Physician Assistant. We will schedule these visits on Wednesday, Thursday and Friday. The only exception to this rule will be for physical therapy prescription refills.
- We will be very strict with the “one physician, one pharmacy” rule. If we learn that medications are being refilled by other physicians, we will discontinue refills from our office.
- Please do not change the frequency of narcotic use. The pharmacist will notify us if refills are occurring sooner than the prescription calls, and we will not refill any sooner. Medication is to be taken as directed.
- Be sure to safeguard all medications from loss or theft. We cannot replace medications that have been lost or stolen.
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Thank your for understanding our policy on narcotic use. We are here to help you with your pain control and are willing to further discuss any issues on pain management.
General Information during your first 6 weeks after surgery:
- Activity, especially walking around your home, is encouraged. Try to do so at least 2 to 4 times daily.
- We encourage you to try to get back to your regular daily activities as soon as you can tolerate them
- Do not do heavy housework, such as bed making, vacuuming or laundry.
- If using stairs is necessary, go slowly and use the handrail.
- Do not twist, bend or lift anything over 8 pounds (a gallon of milk). If you return to a sedentary job, you must abide by these restrictions. A letter can be faxed from our office stating these restrictions.
- No special exercises are necessary. Continue the abdominal and leg isometrics you were doing in the hospital.
- An increased intake of water, 6 to 8 glasses per day, will help clear your body of anesthetics and excess pain medication, and will increase the ease of bowel movements.
- With the use of narcotic pain medications, simple constipation is common. Increasing your intake of fiber with a daily supplement such as Metamucil is often helpful, as is Colace, a stool softener. Avoid extended use of stimulant laxatives.
- If you have a lumbar fusion, wait until after the first post-operative office visit (6 weeks) before having any sexual activity. Otherwise, you may resume normal activity after 2 weeks.
- Do not drive while you are taking narcotic pain medicine. In most cases, you can begin driving two weeks after surgery, but this is individually determined per patient and surgery. Riding in the car is acceptable, but long car rides (>2 hrs.) are discouraged.
- Spine fusion patients cannot smoke for 6 months after surgery. You must also avoid nicotine products (smokeless tobacco, gum and patches) and avoid exposure to smoke from other smokers.
REMEMBER, spine fusion patients are to avoid use of NSAID’s (arthritis medications) for at least 3 months after surgery. Consult your physician prior to resuming these medications.
- Braces or corsets are to be worn at all times when out of bed. Remember to change and clean the cervical pads daily. At your first post-operative visit, you will be given further instructions.
- If your surgery included the use of spinal implants (rods, plates, screws, etc.,) be sure to inform any physician planning other surgery for you in the first 6 months. This includes any dental surgery or deep dental cleaning. We suggest that your physician or dentist use the American Heart Association Guidelines for antibiotic prophylaxis.
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