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Surgical Patients

Navigating the Surgery Process

Surgery Discussion

At this visit, Dr. Hasan discusses surgical options for the treatment of your condition and a treatment option is recommended. The authorization of the procedure is requested from your insurance carrier.

Medical Clearance

Depending on your age, activity level and co-existing medical problems, you may need pre-operative clearance and labs prior to your surgery. Our surgery coordinator will help in making sure you are ready for your surgery.

Pre-Operative Visit

During the pre-operative surgery appointment, we will go over any questions you have about your surgery and obtain written consent. We may also provide you with:

  • post-operative prescriptions
  • brace (depending on surgery)
  • misc. post-operative equipment
  • informational packet

2 Weeks Prior to Surgery

Avoid Blood Thinning Medications / Supplements (7-10 days before surgery)

  • Please STOP any nonsteroidal anti-inflammatories (NSAIDs):
    • Ibuprofen (Advil, Motrin), Naproxen (Aleve), Celebrex, Meloxicam, Indocin, Diclofenac etc.
  • Please STOP any anticoagulants / blood thinners:
    • Please STOP Aspirin for 5-10 days prior to surgery
    • Please STOP Coumadin, Plavix®, Lovenox®, Arixtra®, Xarelto®, Pradaxa®, and Eliquis® – please discuss stop timeline with your primary care provider and Dr. Hasan.
    • Please avoid natural supplements like St. John’s Wart, Garlic, Ginseng, Gingko Biloba, Vitamin E and Vitamin C – as these tend to thin your blood

Check About Special Medications

Sometimes you may have a medication you take weekly such as for rheumatoid arthritis or osteoporosis. Please check with your doctor if you take have any questions about stopping any of your medications prior to surgery.

Stop Smoking

If you are a current smoker, we advise that you quit smoking tobacco products at least 30 days prior to surgery. Nicotine and smoke negatively affect the body’s ability to heal and can increase your likelihood of complications. Please check with our staff regarding smoking cessation programs to help you.

Eat Healthy

It is important you eat healthy a few weeks prior to your surgery. This will boost your immune response and help you heal faster. Try increasing vegetables, berries, nuts and fish; try to decrease fried foods, carbs and red meats. Natural remedies involving turmeric, ginger, honey and green tea are rich in anti-oxidants that help decrease inflammation.

Wean off Narcotics

It is important to slowly discontinue any opioid medications (Norco, Percocet, Vicodin, etc.) prior to the surgery. This is because these medications can make pain medications used during and after the surgery less effective. The safest medication to take for pain before surgery is Tylenol.

Pre-Surgery Checklist

  • Don’t eat / drink anything after midnight the night before surgery.
  • Pack some reading materials (there is a lot of waiting before surgery)
  • Pack a few personal items if there will be an inpatient stay (comfy clothes, toothbrush, glasses, laptop/ipad)
  • Make sure you have a form of ID and any informational packets we have provided.
  • Make sure you bring your brace if you were given one.
  • Arrange a ride for the morning of the surgery.
  • Arrange a ride for pickup after discharge.
  • Fill your prescriptions that were given at your pre-operative visit
  • Get a good night’s rest
  • Plan to arrive at surgery location 2 hours prior to your scheduled surgery time. (Delays affect everyone!)

Evening Before / Morning of Surgery

  • Do not drink or eat anything after midnight - not even coffee or water. This will reduce the possibility of nausea and vomiting following anesthesia. You may brush your teeth, but remember not to swallow anything. Refrain from the use of mints, chewing gum or cigarettes. Failure to follow these instructions may result in the cancellation of your surgery.
  • Please do not take any medication after midnight unless instructed by Dr. Hasan or by the hospital / surgery center. If you are diabetic or on blood pressure medication, obtain specific instructions from the hospital / surgery Center.
  • Please bathe or shower prior to surgery. Remove all make-up and do not use lotions, perfumes, or oils after bathing.
  • Wear loose, comfortable clothing, such as sweat suits and easy-to-button shirts or blouses that are big enough to accommodate a large bandage after surgery. Wear comfortable shoes.
  • Leave all valuables, including jewelry, body piercings, and cash, at home.
  • Bring with you your photo ID, and insurance cards.
  • Please expect to have several hour recovery time prior to being discharged home (unless there is a planned inpatient stay).

At the Hospital / Surgery Center

  • Check In
    • Please arrive ~2 hours prior to scheduled surgery time and check in with the assigned facility at the pre-surgical front desk.
  • Pre-operative Holding
    • You will meet with the anesthesiologist, the pre-operative nurse, and you will have an opportunity to ask any additional questions.
    • If you wear contact lenses or glasses, bring a case for their safekeeping. Ask a nurse to provide containers for removable dentures and bridgework.
  • Post-operative Recovery Unit (PACU)
    • You will be taken to the PACU immediately after surgery where you will recover from anesthesia.
    • Occasionally we use special monitoring equipment during the surgery which may leave small bruises on your head, arms and legs.
  • Inpatient Admission
    • Dr. Hasan will discuss whether your surgery requires an inpatient stay at the pre-operative visit. This can typically vary from 1 to 5 days depending on many factors.

Discharge

Discharge home after a surgery depends on a number of factors. Occasionally, larger surgeries may entail transfer to a rehabilitation facility after the hospitalization. The four main factors that determine discharge are:

  1. Pain levels are reasonably controlled
  2. Ability to stand/walk with minimal assistance
  3. Ability to tolerate food/drink by mouth
  4. Ability to urinate / pass stool without issues

The First 24h After Surgery

  • Do not drive a car or operate any machinery that requires your full attention.
  • Do not drink any alcohol or take any recreational drugs.
  • Do not sign any legal papers or make any major decisions.

What to Expect Immediately After Surgery

  • Pain
    • You can expect some discomfort after surgery; the more complicated the operation, the more painful it might be. At your pre-operative appointment your doctor  will prescribe pain medication which will usually control pain very effectively; however these medications can cause side effects such as dizziness, nausea and constipation.
  • Nerve Symptoms
    • Nerves are the way your body conducts signals such as pain, sensation and movement. Any surgery involving nerves can results in inflammation around the nerves resulting in temporary numbness, tingling and weakness. These symptoms improve with time and anti-inflammatory medications and special nerve medication (gabapentin, lyrica etc.) can be useful in the post-operative period.
  • Nausea / Vomiting
    • It is common for some people who are sensitive to anesthesia and narcotic medications to experience nausea / vomiting after surgery. If you know you are sensitive to anesthesia and narcotics, please ask your doctor about prescribing you anti-nausea medication post-operatively (Zofran).
  • Throat soreness
    • Spine surgery typically requires anesthesia with a breathing tube; this can result in some throat soreness following surgery. Additionally, during some cervical procedures, the throat is gently manipulated which can result in inflammation which manifests as difficulty swallowing or a hoarse voice. This typically improves with time and can recover faster with the use of anti-inflammatory medication.
  • Miscellaneous
    • During some procedures, we may use a special head holding device as well as place needles in your arms and legs to make sure your nerves are safe during surgery. It is not uncommon to have small cuts or bruises in the head, arms or legs. Do not worry, these are not unattended injuries during surgery, but a minor inconvenience to ensure you undergo surgery safely.
    • During longer surgeries, you are placed in certain positions which may cause the head, arm, legs, chest to feel sore temporarily.

When Should You Contact The Office

Call our office any time, but please notify us immediately of any of the following symptoms. If your symptoms are increasing suddenly and you do not hear from us right away, report to the nearest emergency room for evaluation and treatment.

  • Increasing drainage from the incision
  • Increasing redness
  • Foul odor
  • Increasing swelling accompanied by pain
  • Fever over 101 (take your temperature twice to ensure accuracy)
  • Increasing pain not relieved with rest, elevation, ice and pain medication
  • Coldness, numbness or a sustained blue color to your extremity
  • Sudden onset of calf pain
  • Sudden onset of shortness of breath
  • Chest pain

The Road To Recovery

Road to RecoveryRoad To Recovery

Managing Pain

Depending on the type of surgery performed, it may take a few days to a few weeks before you become completely comfortable following surgery. It is important to know how and when to use pain medications following surgery. You should seek to have a goal of 3 or less on a pain scale from 0-10. It important you be diligent about pain medication use following surgery and keep a diary of which medications to take and when to take them. Understanding what medications help the most and when to take them will make your post-operative recovery smoother. Only you will know what works best for you and although we will provide guidelines here, the best medication regiment for you will require trial and error.

PAIN MEDICATION ALGORITHM

1st Line: Anti-inflammatory medications: these medications are meant to help reduce inflammation following surgery and have the least side effects and should be the first medication to try

  • Tylenol (acetaminophen): 500mg every 6-8 hours
    • These are generally safe to take unless you have a history of liver problems. You can use these medications in conjunction with the other medications listed as a first line. Often narcotics (Norco, Percocet, Vicodin etc.) have a small amount of Tylenol in each pill (325mg); keep track of how much Tylenol you are using please DO NOT take more than 4000mg of Tylenol in one day.
  • Strong anti-inflammatories: Naproxen, Meloxicam, Celebrex, Ibuprofen, Diclofenac
    • These medications are stronger and we generally only recommend taking only one type from this category (whichever has worked best for you in the past).
    • Overtaking this class of medications can result in GI side effects and it is, therefore, helpful to take an antacid medication (Omeprazole, Prilosec, Pepcid etc.) to help protect your stomach. Avoid these medications if you have a history of kidney problems.
    • It is OK and encouraged to take Tylenol with these medications.
    • If you have had a fusion procedure, avoid taking these medications for greater than 2 weeks after surgery as it may interfere with bony healing.

2nd Line: Nerve and Muscle Medications: Use if continued pain despite 1st line

  • Nerve Medications (Gabapentin / Lyrica)
    • These medications are meant to affects how nerves conduct signals and may help in relieving post-operative nerve related pain, numbness and tingling. These medications can make you fatigued and drowsy, so it important to avoid driving vehicles and operating heavy machinery. It is helpful to take these medications at night if the nerve pain affects your ability to sleep.
  • Muscle Relaxants (Flexeril, Robaxin, Skelaxin etc.)
    • These medications are helpful if you are experiencing muscle spasms and have general tightness in your muscles following surgery. These medications can make you fatigued and drowsy, so it important to avoid driving vehicles and operating heavy machinery.
  • Steroids (Medrol dose pack, Dexamethasone pack)
    • Occasionally we may prescribe a short course of steroids to take if your nerves are very inflamed. If we prescribe these medications to you, please avoid taking any other strong anti-inflammatories as they can cause GI problems. These medications can increase your blood sugar if you have diabetes and can affect your ability to sleep.

3rd Line: Narcotics: use if continued pain despite 1st and 2nd line

  • Weak Narcotics (Tramadol)
    • Tramadol works by blocking some pain receptors and should be used if you are sensitive to stronger narcotics. They are beneficial as they have less addictive potential. These medications should be used if the 1st and 2nd line medications are not working. These medications can cause nausea, vomiting and constipation. These medications can make you fatigued and drowsy, so it important to avoid driving vehicles and operating heavy machinery.
  • Strong Narcotics (Norco, Percocet, Vicodin etc.)
    • These opioid narcotics work by completely blocking pain receptors. They are very effective but they also have the most additive potential and the most side effects. These medications often also contain Tylenol, so monitor the amount of Tylenol you are taking per day.
    • These medications can also cause nausea, vomiting and severe constipation. We may also prescribe a stool softener which is highly recommend if you are taking these medications.
    • It is important to try to wean off narcotic use following surgery to prevent unintended addiction. For most endoscopic surgeries, you will not need to use these medications. For fusion surgeries, your goal should be to completely off narcotics by 6 weeks post-operatively.

Nerve Recovery

Nerve recovery depends on a variety of factors. Typically, the longer amount of time the nerve was compressed, the longer it will take for complete nerve recovery. Nerve recovery can take anywhere from a few days to over a year. Occasionally, some nerves have been so compressed that they may never fully recover. It is important to be patient and take the anti-inflammatories and take any prescribed medications to help the nerve recover.

Incision Care

Keep your dressing dry and clean. Dr. Hasan uses a waterproof dressing and will allow you to shower a few days after the surgery. You can let water run over the dressing briefly, but do not scrub the incision area. Do not take any baths or use a sauna until you discuss with Dr. Hasan. Please leave the dressing on as is until you see Dr. Hasan at the first post-operative visit. If your dressing does come off prior to seeing Dr. Hasan, please use clean gauze and waterproof dressing (Tegaderm) to cover the incision. If you notice your incision is opening, drainage, foul odor from the incision, please contact the office immediately.

Bracing

Dr. Hasan may provide a post-operative brace or collar to use after surgery at the pre-operative visit and provide specific instructions regarding length of bracing post-operatively.

Posture is Everything

It is important after all surgery to focus on maintaining a neutral posture. A neutral posture is the normal “S” shaped curvature of the spine. It is critical for overall spine health to maintain this neutral posture when sitting at a desk, standing, walking and performing activities of daily living. It is a good idea to avoid any excessive bending, heavy lifting and twisting for some time in the post-operative period. Dr. Hasan will give you instructions on how long you should follow these restrictions depending on the type of surgery performed.

Stay Active

It is important to not lay bed bound after any surgical procedure. You should make effort to sit with correct posture and increase your activity as you feel better every day. It is a good idea to gradually increase your walks every day with a goal of 10,000 steps per day when possible. It is good to start on even surfaces and try incline/decline walks as you feel more comfortable.  Dr. Hasan will provide some gentle stretches to start around 2 weeks post-operatively and will prescribe a more structure physical therapy program around 6-weeks post-operatively.

Diet

A healthy diet is critical to healing look and recovering faster. Try to increase leafy vegetables (spinach, kale) and foods with plenty of anti-oxidants (nuts, broccoli, carrots, berries, fish, avocados, mushrooms, whole-wheat bread, green tea etc.) during the post-operative recovery period. Avoid overloading on carbs and foods that may cause increased inflammation in the body (processed foods/drinks/meats, fried foods, processed sweets, saturated fats, red meat). Some supplements and superfoods that are also a good idea (and a great addition to a smoothie) include turmeric, acai berries, lucuma powder, chia seeds, hemp seeds, maca powder, cacao powder, mesquite powder etc. It is also very important to stay hydrated in the post-operative period; you should have a goal of drinking 2L of water per day (eight 8 oz. glasses). You should also take a daily multi-vitamin (including iron and folate) ensure you have adequate Vitamin D (minimum 400–800 IU/day) and calcium supplementation (1,000-1,200mg per day) for bone health. Sunlight is an important natural way of activating Vitamin D in your body (aim to get 10–30 minutes of midday sunlight, several times per week).

Special Contact information

Contact information

  • Dr. Hasan:
    • Reach Dr. Hasan via email at [javascript protected email address]
    • Please be careful when emailing Dr. Hasan any personal protected health information via email. Email should be used to answer any urgent questions if you are unable to get ahold of the office and to arrange phone calls to discuss any post-operative issues.
  • Dr. Hasan’s Medical Assistant:
  • Dr. Hasan’s Surgical Coordinator:
  • Webster Orthopedics: