Going Home

When arranging for transportation home, you will need to be accompanied by another adult. 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 10 days from your date of surgery. (Scoliosis patients usually do not need to return for their first visit until 3 weeks post surgery.) At this appointment we will examine the sutra line and take out any non-absorbable stitches.

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Tips After 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. Here are a few tips:

• Keep your wound clean and dry. Remove any dressings that are covering your incision the day after you come home (but not the small white “steri-strips”). In most cases, you may shower upon returning home from the hospital. However, avoid letting the water run directly on your wound for the first 5 days. You can cover the wound by taping a plastic baggie around the wound area. If the wound area becomes wet, gently pat dry.
  
• After 5 days you may get the sutra line wet when showering. Pat dry gently. Bathing in a tub is not permitted until your wound is completely healed (about one month).
  
• Despite great care, any incision can become infected. If you notice your wound becoming increasingly red, swollen, hot or draining, please call your physician immediately.
  
• Please walk a minimum of 30 minutes each day. This can be divided into shorter time periods if necessary. There is no maximum limit to the amount of time you can walk.
  
• You will experience some degree of discomfort after spinal surgery, which will vary from individual to individual. You will receive a prescription for pain medicine prior to your discharge. Please take your medication as directed.
  
• Outpatient physical therapy, if prescribed by your surgeon, will not begin until approximately 6 weeks following surgery. Only some patients require structured physical therapy programs.
  
• Sexual activity may resume at two weeks following surgery.
  
• You may resume driving when you feel comfortable driving.

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Things to Avoid:

• Lifting in excess of 5 pounds. When lifting, hold items close to your body.
  
• Movements that include severe twisting motion.
  
• If you have had lumbar spine surgery, sitting for extended periods of time (no longer than 30-45 minutes). Alternate standing, sitting and lying down throughout the day.
  
• Smoking (if at all possible) for 3 months and alcoholic beverages (especially while taking pain medication).
  
• Straining to have a bowel movement should be avoided. Constipation is a common side-effect of spine surgery because of both the surgery itself and the 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 Alleve for the next 3 – 6 months. Refer to the medication list included in this packet for a complete list of NSAID medications. You may, however, take Tylenol.

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Pain Medicine

Pain Management – You may be given narcotic pain medication either prior to or following your surgery. These medications are controlled substances, and cannot be called into a pharmacy. Refills of narcotic prescriptions must be done by mailing the prescription to your home. You will need to hand-carry the prescription to the pharmacy. You need to allow 5 days for renewals. Often the mail works more quickly than this, but should not be relied on.

Upon discharge, you will be given a prescription for pain medicine to take at home. Most pharmacies do not carry narcotic pain medicine. Once you have been given prescriptions for pain medication to take home, call your pharmacy to see if they carry those medications and in the correct quantity. If they do not carry the medications you need, it is best to have the prescriptions filled near the hospital. There are several pharmacies in the immediate neighborhood of the hospital that carry narcotic pain medicine.

During your surgery you may be given pain medication directly in your spinal canal. This medicine will help with pain management during your first 24 hours of surgery. In addition, following surgery you may be connected to a PCA pump. This is a form of pain medicine given through an intravenous line. You can administer this medication yourself, as needed, by pressing on a device at your bedside. The length of time you will need this medicine will be variable.

Once you are feeling more comfortable, you will begin taking pain medicine by mouth. You will not be discharged to go home until you have good control with pain medicine by mouth. Additionally, in many cases, we have the Pain Management Service visit you and assist with your pain management.

The length of time you will be on pain medication varies considerably from patient to patient. Some patients need pain medications for only a brief period of time. Others may need pain medicines for several months. Generally, most patients have finished using pain medications by 3 months following surgery. If pain medication is needed past this point, we will refer you to a pain management specialist, who will take over this roll.

Pain medications should be reduced gradually, not stopped suddenly. Suddenly stopping pain medications can make you feel very uncomfortable. Symptoms may include nausea, vomiting, chills, and diarrhea. If you gradually decrease your medications before stopping, these symptoms will not occur.

If you need an adjustment in the amount of medicine you are taking, or if additional pain medicine is needed prior to your first post-surgery office visit, call the nurse practitioners at our office. The phone number for our Nurse Practitioners, Gilda Forseter and Laurin Howell, is 212 844-8649.

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Constipation

This is a common problem for patients who have recently undergone spine surgery. Both pain medications which contain narcotic medication, and iron pills can cause constipation. The following interventions will help relieve constipation:

Drink 6 – 8 (8) ounce glasses of water per day.
Use Fiber One (16g fiber per ½ cup) or Allbran Fiber Extra Fiber (14g per ½ cup) breakfast cereal each morning. These are the breakfast cereals with the most amount of dietary fiber to help achieve regularity. Regular Allbran has less fiber, but may work also.

Use a stool softener (Colace, Docusate sodium). The dosage should be 50mg three times per day. This medicine can be purchased over the counter. It works by bringing an increased amount of fluid into your intestine. Thus, back to rule one drink 6 – 8 glasses of water per day.

Use a “bulk” laxative. Bulk laxatives provide increased roughage for the colon without chemical stimulants. These substances are in powder form and need to be mixed with water or juice. Konsyl is the best product (6 grams of fiber per teaspoon). Metamucil and Benefiber have 3 grams of fiber per teaspoon. They are best mixed in a container with a top so that the material can mix well with the fluid used. Metamucil has wafers as well. These bulk laxatives come in pill form as well, but they have very little fiber, and are not suggested for use.
Green tea – One to two cups per day help naturally stimulate the colon.

If the above noted measures do not relieve your constipation, you will need to use a chemical laxative. In general, it is not a good practice to use chemical laxatives over a long period of time because they adversely effect the natural movements of the colon, and one can eventually become dependent upon them. However, in the short term, Senokot or Dulcolax tablets may be needed occasionally while you are taking pain medication. These are over-the-counter medications and can be purchased in most pharmacies.
If the methods above do not relieve your constipation, you may need to use Dulcolax suppositories. If one or two Dulcolax pills at noon do not produce a bowel movement by the evening, use the suppositories as well.

If constipation still persists, you may need to use a Fleets enema.

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Occupational Therapy and Return to Independence

An occupational therapist at the hospital will help you get back on your feet and doing your daily activities. Your doctor or therapist may alter your therapy program according to your individual needs. After your surgery, the occupational therapist at the hospital will:

• Help you with proper body mechanics for getting in and out of bed and comfortable positioning.
• Help you become independent with your basic activities of daily living.
• Help you become comfortable walking and climbing stairs safely.
• Provide gentle progressive mobility and endurance building exercises.
• Provide deep breathing exercises.
• Educate you regarding precautions and “back sparing” techniques to prevent re-injury.
• Help you and your doctor determine the appropriate discharge plan and date.

You will be scheduled for occupational therapy daily, and an individualized care plan will be developed for you based on your own needs. Occupational therapy will begin on the day of surgery or on the morning after surgery, depending on your doctor’s orders.

You will be discharged from the hospital once your doctor has cleared you medically and once you are able to get in and out of a bed and a chair, get up and down from a toilet seat, take care of your own basic needs, walk and climb stairs independently.

Contact Information:

If you have an emergency and you need to reach our offices after the office has closed for the day, you can call 212 844-8680. You will reach our answering service. They will forward a message to the covering physician.

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