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- Why can't I take my arthritis medicine, or NSAIDs?
- Why do I have a brace?
- Why is my activity restricted and why can't I drive?
- What determines how long my fusion is?
- How will my pain be managed?
- Will I get addicted?
- Why do I need a different chair not my recliner?
- Will I need a hospital bed at home?
- Why do you want me off my walker?
- Do I need a special car or ambulance to go home?
- When can I go out to eat or go to church?
- Why do I get fatigued mentally and physically?
- I've heard certain metal implants are better, how do I choose?
- When can I go back on my home medicines?
- What about nutrition and calcium supplements?
- Will I set off alarms at the airport?
- Should I put antibiotic cream on my incision?
- How can I make my scar look better?
- When can I exercise?
- I have terrible constipation from the narcotics, what can I do?
- Can you refill my pain medicines?
- What if I wake up in terrible pain?
- Can I call on weekends?
- What do I do if my incision starts draining?
- Do I get a handicapped parking permit?
- Do I need 24 hour home care?
- Why can't I smoke?
Why can't I take my arthritis medicine, or NSAIDs?
Preoperatively these medicine after blood clotting and may cause excess bleeding during surgery. Post operatively they also affect bone healing and fusion results.
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Why do I have a brace?
Typically most internal fixation is good but in certain individuals with softer bone due to osteoporosis a brace will help stabilize the spinal implants. For most individuals the brace is a good reminder to not do excessive motion as well as help support the muscles while they are healing.
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Why is my activity restricted and why can't I drive?
As above any spinal fusion is at risk for not healing. Restriction of activity takes stress of the implants and lessens non unions. Sometimes individuals may feel like they are ready to perform certain tasks but experience shows that more often then not when they have exceeded our recommendations they have regretted it. Driving can involve the quick and sudden movements and strength required to avoid a collision. This is not a safe activity before the first post op visit. Also many individuals are still taking narcotic medication and would be driving illegally.
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What determines how long my fusion is?
The goal of any spinal surgery for correction of deformity or treatment of degenerative processes, involve fusing the minimum number of motion segments to stop progression of the deformity or fuse the degenerative segments. The fusion will be as long as needed to achieve these goals to minimize later surgery.
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How will my pain be managed?
Patients are given a PCA (patient controlled analgesic) pump post operatively. They use this to give themselves doses of a morphine like drug which has lockout times and maximum dosing schedule placed into the computer chip in the pump. This allows the patient to medicate themselves rather than wait for a nurse. Ideally patients should use this to drift in and out of sleep to help with pain control. Patients that hurt significantly post operatively rarely use the pump to the degree they need to. Later patients are transitioned on to oral narcotics and sent home on these.
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Will I get addicted?
The short answer is no. If you previously have a medication problem then surgery and narcotics will not help this problem. We make sure that our patients receive adequate pain medicine but also make sure to begin tapering them before problems exist.
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Why do I need a different chair not my recliner?
That is related to the limitation of motion allowed post op. We want to avoid excessive flexion in the lumbar spine as this may put stress or loosen the implants. Sofas and chairs that are low or soft make it difficult to get up without bending forward to shift the center of balance over the legs to get up easily. Also many sofas and recliner chairs while appearing comfortable tend to flex the lumbar spine as you sink in to the cushion. A firm chair with arm rests is best.
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Will I need a hospital bed at home?
No! Hospital beds are designed for the individuals taking care of the patients. If a patient is essentially bedridden they are fine, but not for ambulatory patients. If you have a very low full wave water mattress or the old climb up 4 steps into bed - "granny bed" - then alternate bedding would be appropriate.
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Why do you want me off my walker?
Some of our older and weaker patients do go home for a short time with a walker. The goal of surgery is to position the spine in an upright posture. When patients lean forward over a walker there spines are not upright and the muscles that need to start strengthening to hold the upright posture are not working.
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Do I need a special car or ambulance to go home?
An ambulance is almost never required. We recommend a larger car not a subcompact for travel home. Patients should sit in the front seat and be belted. This facilitates ease of getting in and out as well as safety. Patients should never travel lying down in the back of a van on a mattress. If the trip home is more than about 75-90 minutes we recommend that you stop every 45-60 minutes or so for a short walk around break so as to not be so stiff on arrival home.
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When can I go out to eat or go to church?
This answer is variable depending on how extensive the surgery is and how you feel. Generally patients with spinal fusions may feel like they are ready to go out fairly soon but experience tells us not. Usually 4-6 weeks is a reasonable time to consider short trips. Sometimes if patients are feeling very well, off pain medicine entirely and going crazy at home short trips may be appropriate.
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Why do I get fatigued mentally and physically?
The physical part is easy. You have been through a rather extensive surgical reconstruction and your body is devoting lots of energy to healing. The muscles are not up to speed yet and fatigue comes quickly. Mentally the above physical part also takes its toll on your concentration powers. Any narcotic medication may also make concentration short and spotty at best.
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I've heard certain metal implants are better, how do I choose?
The answer is easy, we choose. All metal implant have their inherent advantages and disadvantages. Some have slightly better strength characteristics and better imaging qualities while others have much better characteristics to correct deformity. Any implant can adequately do the job it was designed to do. All metal implants can break if fusion is not achieved and micro motion over time causes metal fatigue. We choose the metal implant that best suits your case.
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When can I go back on my home medicines?
You will be told this when you leave the hospital. Generally things for heart, blood pressure and other general medical conditions are fine. Hormones, osteoporosis drugs and non steroidal anti-inflammatory meds like aspirin and ibuprofen will be held.
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What about nutrition and calcium supplements?
Nutrition is an important part of healing. Generally appetite is poor for a while but it is very important to eat as much as possible. Calorie needs for healing can double or triple the normal metabolic requirements. That is if you normally eat 2000 calories a day your caloric needs might be 4000-5000 cal per day initially. A high protein diet is best. Adequate calcium is also important. Most adults do not get adequate calcium in their diets. If you are not a milk drinker, cheese and ice cream eater then supplements would be beneficial. A multivitamin is important to get Vitamin D to absorb the calcium. The cheapest way to get added calcium is to use chewable over the counter anti-acid medicine containing calcium carbonate. Three or four of these per day with a multivitamin should suffice.
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Will I set off alarms at the airport?
Possibly depending on how high the sensitivity is set. Our nurses can supply you with a card stating you have metal implants but this is not a free pass through security. They will still take you aside and wand you but generally it's less hassle than you might think.
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Should I put antibiotic cream on my incision?
NO!! Most antibiotic cream found in the medicine cabinets contains Neomycin to which 15 percent of the general population is allergic to. A nasty dermatitis can then occur making the incision look red and irritated. No antibiotics or creams are needed.
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How can I make my scar look better?
Initially there is nothing. We attempt to give you the best scar possible and use the same technique as the plastic surgeons use. Each individual scars differently depending on the type of collagen you have, nutritional status and other factors. On you first post op visit sometimes we may suggest some things to improve the scar but those things need to wait until the scar is mature.
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When can I exercise?
For those individuals who exercise regularly taking time off is sometimes difficult. Until the first post op visit we want you to just increase your general activity and walking distance. After your visit we may allow some increased exercise.
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I have terrible constipation from the narcotics, what can I do?
We recommend continuing the stool softeners for several weeks until off the narcotics. There are several available over the counter medicine to help with a laxative effect. Milk of magnesia, Dulcolax suppositories and tablets, and as a last result use Magnesium Citrate which comes in a bottle and is a much stronger stimulant.
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Can you refill my pain medicines?
We ask that you call early for refills. Do not wait until late Friday afternoon to call that you are taking your last pill. PLAN AHEAD! Refills will not be done at night or over the weekend! If you go home and feel that the stronger medication is too strong as you feel better, we can call in a weaker narcotic but refills on Percocet require a written script.
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What if I wake up in terrible pain?
Everyone has a bad day. Generally if you look back on your activities from the day before you may find that you substantially increased your activities or did something you probably should not have done. If that is the case back off your activities and work back up. If you have two bad days in a row give us a call.
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Can I call on weekends?
There is someone available 24 hours a day for emergencies. If you have a routine type question, call during normal office hours to talk to someone on our staff.
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What do I do if my incision starts draining?
Some spotty drainage as you knock off the scab over the incision is common. This should only be a drop or two. If you develop drainage that wets and soaks clothing then the incision should be covered, your temperature monitored and your nurse should be notified.
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Do I get a handicapped parking permit?
Generally we don't give them. We prefer our patients to do as much walking as possible as since you're not driving initially someone can let you out at the door if you do go out. Save the space for someone who is truly handicapped.
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Do I need 24 hour home care?
Each person and their home situation are unique. Upon going home our patients are fully independent with walking, can dress and bathe themselves and fix a light meal. Some people are more comfortable with someone around initially but someone only needs to be available by phone. Obviously, cooking, cleaning and grocery shopping need to be done by someone else, but not necessarily a live in person.
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Why can't I smoke?
Science has clearly shown that smoking slows or prevents bone healing. Depending on the study you read this effect can reduce union or fusion rates by up to 100 percent. Because we want the best results for our patients, it is the policy of the Emory Spine Center not to perform fusions on smokers. Nicotine patches or nicotine gums are also not acceptable. We do check urine nicotine levels to verify there has not been any exposure to cigarettes or nicotine products. Call the toll free Georgia Tobacco Quit Smoking Assistance Line at 1-877-270-STOP.
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