Dr. Garges Surgery Instructions: Pre- and Post- Operative Patients

Preparing for Surgery - Pre-Operative Instructions
Pre-operative testing (i.e. blood work, urinary analysis, chest x-rays, EKGs) will be required prior to surgery. All testing should be completed one to two weeks prior to surgery.

Antibacterial Soap - To minimize the incidence of infection you should use an antibacterial soap, for 2 showers prior to surgery. This is usually the night before and the morning of the surgery. Cleanse your entire body, paying special attention to the area where your surgery is going to be performed. In the surgical area, use a wash cloth, cleansing for 5 minutes.

Your level of fitness and nutrition prior to surgery should be maintained to the best of your ability. Maintain a healthy balanced diet.

If you smoke cigarettes, it is strongly advised that you decrease the amount you smoke or stop smoking completely. Research indicates that smoking adversely affects bone healing. Also, inhalation of smoke irritates the breathing passages which can affect recovery.

Any errands (i.e. house cleaning and grocery shopping) should be completed prior to surgery. The fewer concerns you have upon discharge, the easier your transition home will be.

Refrain from yard work or any outside activities that may cause lacerations, breaks in the skin or insect bites the week before surgery. These may increase your risk for infection and could potentially result in cancelled surgery. Also, avoid contact with pets as though scratches or bites will result in cancellation of surgery.

MEDICATIONS TO DISCONTINUE BEFORE SURGERY
Please do not take any of the following medications for at least seven (7) days prior to surgery. If you have spinal fusion surgery, you will NOT be able to take NSAIDS for about 3 months (until your doctor tells you that your fusion appears solid). The list below may not be a complete list of NSAID's, and aspirin containing products. If you are on aspirin for your heart or circulation, call your physician who prescribed the aspirin to see when to discontinue. If you have any questions, call our office.

†† † † † †
Advil Aleve Anaprox Ansaid Arthrotect Bextra Celebrex Daypro
Diclofenac Feldene Ibuprofen Indocin Ketoprofen Lodine Mobic Motrin
Naprosyn Naproxen Oruvail Relafen Toradol Vicoprofen Voltaren
Medications containing Aspirin:
Alka-Seltzer Aspirin Anacin Bayer Arthritis Bufferin Darvon Compound Ecotrin Excedrin
Fiorinal Pepto-Bismo Percodan
Anticoagulants and Antithrombotics: (You will need to consult your physician regarding plans for stopping these medications.)
Aggrenox Coumadin Ecotrin Fragmin Halfprin Heparin Lovenox Orgaran
Persantine Plavix Ticlid
MAO Inhibitors: (Consult your physician regarding stopping these medications.)
Nardil (Phenelzine) Parnate (Tranylcypromine)
Herbal Medications and Supplements: In general all herbal products and vitamins should be discontinued before surgery. Some herbal and vitamin supplements increase bleeding during surgery.
Acetyl- l- carnitine Alpha-lipoic acid Appetite depressants Chamomile Cinnamon
CreatineEchinaceaEphedraGarlicGinger
Gingko bilobaGinsengGlucosamine- ChondroitinGlutamineGoldenseal
Fish OilKava kavaL-carnosineLicoriceLovaza
Milk thistleMultivitaminsMa HuangOmega-3Resveratrol
SkullcapSaw PalmettoSt. Johnís wortValerianVitamin E (14 days before)


CONTINUATION OF THESE MEDICATIONS MAY RESULT IN CANCELLATION OF YOUR SURGERY.
 
IF YOU ARE IN DOUBT ABOUT ANY MEDICATION, PLEASE ASK!

 
(This list of medications to discontinue is not complete. Please check with your physician if you are taking other medications.)
 
Preparations for your Hospital Stay
Abstain from alcohol 48 hours prior to surgery.
Eat lightly the day before surgery.
Have nothing to eat or drink after midnight prior to your surgery.
If you have young children or a family member for whom you are the primary care-giver, arrange for alternative care for them after your surgery. This will allow for a restful recuperation period.
Suggested items to bring to the hospital:

  • Two comfortable loose fitting outfits (i.e. jogging suit, nightshirts, bathrobe etc.). Comfortable shoes and socks and slippers.
  • Comb/brush, and any other personal grooming items that you normally use daily.
  • Personal items of your choice
  • Please leave valuables at home.


Going Home - Post-operative Instructions

When arranging for transportation home, you will need a driver. Make sure you use a car that is easy to get in and out of. Once you arrive home, please call our office to arrange for a follow-up appointment. This appointment should be approximately 14 days from your date of surgery.
 
In the days and weeks following surgery, it is important to remember that you will need to make some modifications to your normal daily routine.

  • Keep your wound clean and dry. In most cases, you may shower 3 days after surgery. When showering, remove bandage and wash directly over the wound (see below). The bandage should be changed daily at home. For surgeries on the back or back of neck, you will apply an antibiotic ointment at each dressing change.
  • Showering: anterior cervical surgery - keep the steri-strips on the wound but remove the outer dressing when showering.
  • After 3 days you may get the suture line wet when showering. Pat dry gently. Bathing in a tub or swimming in a pool or ocean is not permitted until your wound is completely healed (about 6 weeks - ask your doctor first).
  • If you notice your wound becoming increasingly red, swollen and hot, or any drainage, please call your physician.
  • You may sit, stand and/or walk to your tolerance. Walking can be divided into short time periods if necessary.
  • You will experience some degree of discomfort after spinal surgery, which varies from individual to individual. Unless under the care of a pain management physician, you will receive a prescription for pain medicine prior to discharge. Please take your medication as directed. Do not take more than the prescribed dose unless approved by your physician. If you feel a need to increase the medication, call the office first for approval.
  • Outpatient physical therapy, if prescribed, will not begin until approximately 2-6 weeks following surgery. Only some patients require structured physical therapy programs.
  • Sexual activity may usually resume at six weeks following surgery. This varies however. Ask the office for a booklet on sexual activity with back problems.
  • You may resume driving when you feel comfortable driving and the medicines you are taking do not affect your reaction time and alertness. You may not drive in back brace or hard cervical collar.


Things to Avoid:

  • Lifting in excess of a gallon of milk. **When lifting light objects less than 8-10 lbs, hold items close to your body.
  • Movements that include twisting motion.
  • If you have had herniated disc spine surgery, sitting for extended periods of time (no longer than 30-45 minutes). **Alternate standing, walking, sitting and lying down throughout the day.
  • Smoking (if at all possible) for 3 months and alcoholic beverages while taking pain medication.
  • Straining to have a bowel movement should be avoided. Constipation is a common side-effect of some of the pain medications you will be taking.
  • If you have had a spinal fusion, please do not use any NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Advil, Motrin, or Aleve for the next 3 months. Refer to the medication list included in this packet for a list of NSAID medications. You may, however, take Tylenol.
  • **After surgery, you may not lift anything above your shoulders or below your waist until you are told to do so by your surgeon. You may not put on your own shoes and socks or do any activities below your waist that involves bending.


Pain Medicine
Pain Management - You may be given narcotic pain medication either prior to or following your surgery. These medications are controlled substances and should not be taken in excess of the prescribed amount unless discussed with the physician. Upon discharge, you will be given a prescription for pain.
 
Constipation
This is a common problem for patients who have recently undergone surgery.
Anesthesia during surgery, narcotic pain medications, and iron pills all cause constipation. The following interventions will help relieve constipation: - Drink 6-8 (8) ounce glasses of water per day.
- Use high fiber products. Consume fruits and vegetable.
- Use a stool softener such as Colace or Docusate sodium three times a day. (over the counter)
- You may use a "bulk" laxative such as Konsyl, Metamucil, etc.; or use MiraLax or Milk of Magnesia which are osmotic laxatives.
If the above noted measures do not relieve constipation, you will need to use a laxative. In general, it is not good practice to use chemical laxatives over a long period of time. However, in the short term Dulcolax tablets or Dulcolax suppositories may be needed while you are taking pain medication. These are over-the-counter medications and can be purchased in most pharmacies. Follow the directions on the package.
 
Follow-up visits after surgery:
Every patient needs to follow-up approximately 14-20 days after surgery and 4 to 6 weeks after surgery. You may have follow-up 3 months, 6 months, and 12 months and in some instance afterwards depending on the type of surgery. Please make sure to come back as instructed by your surgeon.
 
To reach our office after hours, you should call 281-333-2727 and leave a message you will get a return Phone call. If this is an emergency go to the nearest emergency room.