Microsoft word - planning before your surgery.doc

Planning Before Your Surgery

Special Tests
It is most likely that you have already had x-rays by your family doctor or in our clinic. If
necessary, you may have to undergo other tests such as an arthrogram, MRI (magnetic resonance
imaging), EMG (electromyography), etc.
Pre-Operative Physical Therapy
Many patients have had a trial of physical therapy as part of their prior treatment. For certain
surgical procedures we may recommend a visit to the physical therapist to learn specific exercises
which are to be performed after surgery.
General Medical Check-Up
For individuals who have a history of certain medical conditions (for example heart ailments or
lung disease), a visit to a primary care physician may be recommended. This gives your doctor an
opportunity to identify any potential health risks and correct them prior to surgery. In some cases
surgery needs to be postponed while further testing or treatment is initiated.
Herbal Supplements/Weight Loss Products. The use of any weight loss products or herbal
supplements must be discontinued 1 week prior to surgery. These products can interfere with
bleeding control and anesthetic medications.
The Night Before Surgery
You should not eat or drink anything after midnight
. This is a precaution to avoid anesthetic
Your Surgery
Check In
You will have to register at the hospital on the day of surgery. The specific time and location will
be given to you during your office visit or by mail. Please be prompt! Failure to arrive on time
unnecessarily delays not only your surgery but those who are having surgery after you. If you are
significantly late your surgery will be canceled. You will be asked to arrive at least 2 hours before
the actual surgery time to allow for the registration process, pre-operative testing, and
consultation with the anesthesiologist. After you have registered a nurse will check you into the
surgical holding area. She (he) will ask you several questions relating to your past health and take
your temperature, blood pressure, etc. You will then be asked to change into a hospital gown.
The nurse will start an intravenous ( I.V.) line which will be used to deliver medications to your
bloodstream during and after surgery. Immediately before surgery the anesthesiologist will
discuss the details of your anesthetic. Any questions you have regarding anesthesia should be
addressed to the anesthesiologist.
After you have been prepared, the nurse from the operating room will take you to the surgery
area. You will be asked to wear a surgical cap to cover your hair. After being checked in a second
time you will be wheeled into the operating room (Please note that you will be asked many of the
same questions on several occasions. This is merely to prevent any important information from
“slipping through the cracks”.)
The surgical team is composed of the surgeon, his assistant(s), 2 to 3 nurses or surgical
technicians and the anesthesiologist. The temperature in the room is typically lower than normal
and warm blankets will be provided. Once the anesthesiologist is prepared he will administer
medicine which will make you feel relaxed. Afterwards, more medicine will cause you to fall
asleep. Surgical time varies from case to case but we will make a time estimate for your family so
they can plan appropriately. After surgery your physician will talk to family members to update
them on your surgery. Please make sure that family members are available at this time.
Post-Anesthesia Recovery Unit (PACU)
When you awaken from the anesthetic you will be in the PACU. A nurse will be assigned to
monitor your progress and address your needs. After you have stabilized you will be transferred
to your room or the second stage recovery area in preparation for discharge. It is only at this time
that your family members will be able to see you. Family members are not allowed in the main
recovery room because of the need to maintain the privacy of other patients.
Medications and Pain Management
Remember for the first 24 to 48 hours it is wise to stay ahead of your pain. Don’t be too timid or
proud to take your medication regularly during this time.
The following is a list of the common medications prescribed:
Narcotic pain relievers (ie: Vicodin, Lortab, Darvocet) alter your perception of pain. These
medications can make you feel sleepy therefore you should not drink alcohol, drive, or operate
machinery while taking them. Narcotic pain relievers can cause nausea, particularly if taken
without food. Always take your medications with food. Additionally some patients will notice
constipation. To minimize this be sure to drink plenty of fluids, especially fruit juices. Once your
pain has reached a more manageable level you may switch to using an over-the-counter
medication as directed.
Anti-inflammatory medications (ie: Relafen, Toradol, Naprosyn, Celebrex) will help with
swelling, stiffness, and pain.
These medications can cause stomach upset and rarely ulcers. They too should be taken with
food. If stomach irritation occurs Pepcid AC can be taken in conjunction with the medication. If
stomach irritation persists or if you notice blood in your stools, immediately discontinue the
medication and call our office.
Wound Care
In surgery we apply a sterile dressing sealed with a plastic protective covering. You do not need
to change the dressing. Leave the dressing on until you return for your first visit after surgery.
You may shower with this type of dressing, however, you may not submerge it in a bath tub or a
pool. If your dressing should accidentally come off or get wet call our office. In many cases a
small amount of blood will be soaked up by the gauze resulting in a red spot. This is normal. If
the dressing is saturated with blood, however, you should call our office.
Physical Therapy
At some point, you will be given physical therapy exercises, which will be individualized based
on your type of surgery and any special circumstances. Therapy is every bit as important to your
recovery as the surgery itself. Be sure to perform your exercises diligently as instructed. If you
are scheduled to stay overnight, a physical therapist may be assigned to see you the next morning
to do therapeutic exercises at your bedside. Otherwise, you will see a physical therapist on the
same day as your first post-operative physician visit.
You may notice trouble getting comfortable at night, which can last several weeks. You may
sleep on the operated side; this will not damage anything repaired during surgery. However, you
probably should not try this for a while because it will be uncomfortable.
Common Problems

Some degree of pain is anticipated with any surgery. Once you have begun to experience the pain
treat it promptly and stay ahead of the pain by regularly taking pain medicine. A common mistake
is to wait too long between doses because the pain level seems reasonable. The medicine works
much better to prevent the pain rather than treating the pain once it has occurred. Take it regularly
for the first 24-48 hours.
Remember some pain is normal! However, your pain should diminish day to day. If you notice
worsening pain after several days call the office.
Nausea and Vomiting
Nausea and vomiting can occur for several reasons. In the first 24 hours the anesthetic agents you
received during surgery can make you nauseous. The anesthesiologist typically administers anti-
nausea medications, however, patients can still become nauseated. If you experience nausea at
home it may be related to one of your pain medicines. All of the narcotic medicines (i.e. Lortab)
can cause nausea particularly if you take them on an empty stomach. Never take your pain
medicine on an empty stomach.
Once you become nauseated you may not be able to take your
medicines and it may be necessary to take rectal suppository anti-nausea medicine.
Change in Appetite and Bowel Habits
A temporary loss of appetite is observed in some patients. This is typically short lived and
improves as you recover. Constipation is commonly associated with a decrease in your activity
and your pain medications. The narcotics are especially constipating. You should drink more
fluids then usual, especially fruit juices.
After two or three days you may notice significant bruising in your upper arm and sometimes into
your chest. This is normal. The blood from the time of surgery slowly leaks out of the deep
tissues and takes the path of least resistance under the skin. Because of gravity it ends up going
down the arm. Swelling is also expected. Swelling in the shoulder and arm is typical and
occasionally the hand and fingers can be effected. The Cryo/Cuff minimizes swelling.

When to Call The Doctor

A low grade fever below 100° F is common. A temperature above 101 ° F, especially if it persists
after the first 48 hours after surgery should be reported.
Pain is expected after surgery. Your pain can be aggravated if you fail to take your medicine as
directed or if you are overactive after surgery. If your pain is steadily increasing over consecutive
days despite all of the normal pain control measures call our office.
Wound Care
You should expect some minor bloody drainage to be visible on the dressing. The dressing acts as
a wick, therefore, a small amount of blood can make moderate sized spot on the dressing. If your
dressing becomes soaked with blood or if you notice any pus drainage call our office.
Important Numbers
Methodist Sports Medicine Center office hours are from 8:00am to 5:00pm Monday through Friday and 8:00am to
10:00am Saturday. The clinic is closed for official holidays.

General clinic telephone number:

Indianapolis: 317-817-1200
Toll Free: 800-867-9250
FAX number: 317-817-1220
Answering Service: 924-8636 - After hours call the answering service and ask for your
Physical Therapy: 817-1200 (North)
Clinic billing department: 317-817-1236 (Rose Ambs)



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