• Get Yourlife back

  • Have yourspine problem treated the right way…. the first time

  • The only practice inthe region focused only on spine care

Pre and Post-Operative Instructions

 
  • Surgery Date: _____________________ Time: ________________ Arrive: ____________________
  • Patients may have NOTHING TO EAT after MIDNIGHT prior to surgery. If you eat anything after midnight, your surgery will be cancelled.
  • You are allowed to drink WATER OR GATORADE ONLY 4 hours prior to surgery and 2 hours prior to arrival. If you have any questions, please call your doctor.
  • Arrive to the hospital two 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.
  • You will need to be seen six weeks after surgery. Your appointment is scheduled for ______________________ at ___________________. It is very important that you keep your six week appointment. Due to limited office hours, rescheduling this appointment can be difficult.

Preparing for Surgery

Preoperative Phone Calls

    • A representative from Christiana Care’s Admitting Department will contact you by phone to pre-register you for your procedure. Please have your insurance information available for this phone call.
    • You will also be scheduled for 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 including instructions about taking your medications the morning of surgery. The nurse will call within 15 minutes of the scheduled time. For this phone call please have the following ready:
      • A list of all medical conditions
      • A list of all previous surgeries
      • Current medications (prescription and non-prescription) and the dose that you take
      • Any allergies that you have
      • A pen and paper to write down instructions given to you by the nurse
    • If you have any questions regarding your instructions after your telephone interview please call the PEP team at 302-623-7700 and ask to speak with one of the PEP nurses.
    • A helpful source of general information regarding your anesthesia can be found at www.christianacare.org/anesthesia.
    • If you DO NOT RECEIVE a call from a representative from Christiana Care’s Admitting Department seven (7) days prior to your surgery please call 302-327-3437 immediately.

Insurance

  • It is impossible to know every patient’s insurance coverage and policy information. Please check with your insurance company regarding coverage for surgical procedures. Our staff will contact your insurance company prior to surgery to initiate or verify prior authorization and coverage details.

Pre-surgical Testing

  • You are required to have pre-surgical testing before any procedure at the Christiana Hospital. This includes bloodwork and a urinalysis. Depending on your medical history you may also be required to have a chest x-ray and/or an EKG (EKG required for patients over the age 50).
  • Please check with your insurance carrier to determine where you can have your pre-surgical testing completed. You may have your testing done at any location; however, patients often find it convenient to go to a Christiana Care facility as both the hospital and our office have immediate access to your results. If you have your testing completed anywhere other than at a Christiana Care facility, please notify the selected lab that all results must be faxed to both Christiana Care at (866) 360-7822 and our office at (302) 623-4289.
  • All testing must be completed WITHIN 30 days of your surgery. Your testing should be completed, if possible, prior to your pre-operative appointment at our office. One purpose of your pre-operative appointment is to review your test results.

Medical Clearance

  • All patients over the age of 50 as well as those under the age of 50 with certain medical conditions are required to obtain medical clearance from their family physician prior to surgery. Certain patients with other past medical conditions such as cardiac or pulmonary conditions will require additional clearance from their specialist.
  • This must be completed WITHIN 30 days of your surgery.
  • Please keep in mind that when scheduling this appointment with your family physician or specialist you must mention that the appointment is for clearance for surgery.

The Day of Your Surgery

  • Please follow all instructions provided by your surgeon and the PEP nurse.
  • Please arrive to the hospital 2 hours prior to your procedure start time. Please do not arrive any earlier than 5 a.m.
  • 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.
  • ONE family member or friend may remain 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 and may not leave the facility while the child is in the operating room.

Christiana Hospital Parking/Arrival

  • Please park in designated lots near the hospital entrance.
  • Valet parking service is available at the main hospital entrance Monday – Friday, 6 a.m. – 7 p.m. The 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 main entrance of the hospital. The information desk will give you directions to the Surgery and Procedure Unit.

Important Phone Numbers

Dr. Fisher’s & Dr. Murray’s Office (302) 623-4144
Dr. Fisher’s & Dr. Murray’s Fax (302) 623-4289
Christiana Hospital Main Number (302) 733-1000
Christiana Care Admitting (302) 327-3437
Christiana Care Patient Relations (302) 733-1340
Presurgical Testing (302) 733-3151
PEP Team (302) 623-7700
PEP Team Fax (866) 360-7822

Post-Operative Information

Medications

  • A prescription for pain medication will be given to you at the time of discharge. You may also receive additional prescriptions (steroid, antibiotic, muscle relaxant, etc). Please take your medications exactly as prescribed.
  • For your convenience, a pharmacy is located in the lobby of the Christiana Hospital where you may fill your prescriptions.

Follow-Up Appointments

  • Unless otherwise indicated by your physician, your first post-operative appointment will be 6 weeks following your surgery. Please refer to the first page of this packet for your appointment date and time.

Incision Care

  • Check your incision(s) at least twice daily for the first two weeks following surgery.
  • Your incision(s) is/are closed with dissolvable sutures which are below the surface of your skin.
  • Monitor your incision(s) for any signs of infection. These signs include: increased warmth or redness to the area, swelling, cloudy or foul smelling drainage or unexplained increasing pain in the incision.
  • It is common to have small, punctate areas of irritation at the ends of your incision(s), this is usually from a benign reaction to the suture material and will resolve as the incision heals.

Dressing Changes

  • You may remove any large dressings 24 hours after surgery.
  • Please leave steri strips (white pieces of tape) on. If your steri strips haven’t fallen off after 14 days following surgery you may remove them.
  • A small amount of reddish-brown drainage is not unusual for the first 1 to 2 days following surgery. You may place a piece of gauze over your steri strips if needed. Please report any other type or amount of drainage to our office.

Showering

  • You may shower 24 hours after your procedure. Please do not scrub your wound. You can let soapy water run over your wound and then pat it dry with a clean towel. If you have been prescribed a cervical collar, please wear your cervical collar in the shower unless otherwise instructed. No baths, pools or hot tubs for 6 weeks after surgery.

Pain Expectations

  • There is no way to predict a patient’s post-operative pain as everyone handles pain differently.
  • Our goal is to help you to be at an acceptable pain level both during your hospitalization and once you are home.
  • You will be sent home from the hospital with a prescription for pain medication. If the medication you are taking isn’t giving you adequate pain relief it is important that you let us know.
  • Neuropathic pain resolution is unpredictable. Following surgery, some patients experience immediate relief while with others it takes longer and often requires additional medications or further injections.
  • It is NORMAL to have soreness and stiffness for 3 to 6 months following surgery.
  • It is important to keep in mind that as each day passes you will get stronger and feel better. You need to be encouraged by the “good days” as the “bad days” get further apart.

Constipation

  • A very common side effect of narcotic pain medication is constipation. After surgery, constipation can become quite an issue for patients and can lead to increased pain.
  • It is STRONGLY recommended that you purchase the following over the counter medications PRIOR to your surgery so that you may begin taking them once you are home from the hospital.
  • Our recommendation for prevention and treatment of constipation is the following regimen:
    • Colace (docusate sodium): Take 100mg (1 capsule) three times daily (morning/noon/night)
    • Senokot (sennosides): Take 8.6mg (1 tablet) twice daily (morning/night)
    • Dulcolax (bisacodyl): Take 5mg (1 tablet) daily at bedtime
  • Once you begin having regular bowel movements after surgery, stop taking the Dulcolax.
  • If after stopping the Dulcolax you are continuing to have regular bowel movements you should stop taking the Senokot.
  • It is recommended that as long as you are taking narcotic pain medication you should continue taking the Colace.
  • Increasing your fluid intake will also help with constipation.
  • If you have any questions regarding this, please do not hesitate to contact our office.

Dental Procedures

  • If you plan to have a dental procedure within the first THREE months following your surgery AND you had hardware placed (i.e. fusion, Coflex, disc replacement) you will need to call our office in advance to obtain a prescription for an antibiotic which is to be taken 60 minutes prior to your dental procedure. A simple cleaning is not considered a dental procedure. Dental procedures done after 3 months from your date of surgery DO NOT require an antibiotic unless requested by your dentist. If you do not have hardware placed during your surgery (microdiscetomy, simple decompression) you do not need antibiotics prior to dental procedures even within the first three (3) months following surgery.

Physical Therapy

  • Depending on what surgery you are having you may be discharged home from the hospital with a prescription to start physical therapy 10-14 days post op. If you are given a prescription for physical therapy it is recommended that once you are home from the hospital you call to schedule your initial physical therapy evaluation. For some surgeries (i.e. fusion) we will not have you start physical therapy until you are 6 weeks post op. If this is the case you will be given a prescription for physical therapy at your 6 week post-operative appointment. Please keep in mind that not all patients require physical therapy following surgery.

Special instructions for SPINE FUSION patients ONLY

  • Please remember that all non-steroidal anti-inflammatories (NSAIDs) are not to be taken for at least three months following surgery.
  • Non-steroidal anti-inflammatories include the following: Aspirin, Advil, Aleve, Celebrex, Daypro, Feldene, Ibuprofen, Mobic, Motrin, Naprosyn, Relafen, Vioxx and Voltaren.
  • If you take aspirin for your heart it is OK to resume taking it following your spinal fusion, however, only a baby aspirin (81mg) is allowed.
  • You may take Tylenol (acetaminophen) as it is not an NSAID.
  • It is imperative that you DO NOT SMOKE or use nicotine products (vapor cigarettes, gum, patches, smokeless tobacco, etc.) for AT LEAST six months after surgery as this will inhibit your bones from fusing. You should also take special care to avoid exposure to smoke from other smokers.
  • You will be given a prescription to start physical therapy at your 6 week post-operative visit.
  • No sexual activity until cleared by your doctor at your 6 week post-operative visit.

Driving

  • No driving while taking narcotic pain medication
  • No driving until you are cleared to do so at your 6 week post-operative appointment if you are wearing a cervical collar (neck brace).
  • Car rides are ok but long distance travel (>2 hours) is discouraged for the first few weeks following surgery.

Activity

  • Restrictions vary depending on the type of surgery you had.
  • All patients should try and walk a short distance every 30 minutes during the day.
  • All patients should avoid lying in bed other than for sleeping at night. Prolonged periods of being in bed can lead to complications such as blood clots and pneumonia.
  • You may resume normal sexual activity 2 weeks after surgery EXCEPT for spinal fusion patients.
  • Stairs are ok but it is recommended that you minimize the number of times you go up/down them during the course of the day. Please be sure to use the handrail for added safety.
  • If you were given a prescription for physical therapy upon discharge from the hospital, please begin therapy 10-14 days after your surgery.

Contacting Our Office

  • You are encouraged to call our office with any questions or concerns that you may have following surgery.
  • If it is outside of normal business hours and your call is of urgent nature, you may leave a message with our answering service who will contact your doctor.
  • Please note that leaving a message with our answering service is the ONLY way to get in contact with our office outside of normal business hours.
  • Voicemails, emails, or patient portal messages will not be received until the next business day.
  • Call our office immediately if you:
    • Have pain that is uncontrolled by rest and pain medication.
    • Have abnormal drainage and/or odor from your wound.
    • Have increased redness/swelling at your incision site(s), or unexplained increasing incisional pain not relieved by pain medication, ice or rest.
    • Have fever greater than 101º.
    • Have new or unfamiliar pain or weakness in the arms or legs.
    • Have difficulty with urination or bowel movements.
    • Think that you are having an allergic reaction on the skin surrounding your incision(s)

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.

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. As 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 forth 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 then follow the prompts for Dr. Fisher’s refill request line. All requests will require a minimum of 48 hours during normal business days 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, date of birth, the medication you are requesting, how you are taking the medication and the pharmacy number, including area code. Please note that most narcotic medications require a written prescription that will have to be picked up in the office during office hours. Whoever is picking up the prescription must bring their photo ID. No prescriptions can be mailed via the US postal service.

  • 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.
  • 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.

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.

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