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Preparing for Surgery

You may wish to consider some of the following:

  • Look at your current level of function, observe and note down your personal activities of daily living and domestic activities of daily living and what they involve
  • Think about your current level of mobility and how this will differ after your operation
  • Find suitable accommodation for after your operation, or prepare your home such as making arrangements for sleeping downstairs, and make sure you have a support network for after the operation
  • Talk through any worries you may be having with a friend, or if you are especially worried, speak to a professional to help you mentally prepare for surgery

On our support group we have a resident counsellor in Thalia Crane, if it helps, contact her and have a chat.

For those living alone, a friend of mine (Denise Vanderbush who has been through 5 surgeries) has suggested some top tips as she lives alone with her daughter and from previous experience she suggests - stocking up on canned goods and easy to make meals, frozen foods, over the counter pain meds, toiletries for when you get home. Having postage stamps on hand is a big plus. Plan to winterize the car (of course if it is winter) because it will probably be sitting for six to ten weeks and it will be pretty cold before you can get out to drive again. Also, planning for yard care, such as snow removal or if it was Summer someone to mow the lawn. Get the toilet seat raise before you leave, the one with arm handles on it, and is a huge help.

Cutting your hair if it is long could be a bonus being flat on your back for five days many patients learned it was the best thing to do. Denise says "The back of my hair was a rat's nest by the time I got up and we had to cut most of it out because it wouldn't brush out". Also, while you are recovering from surgery it is really tough to wash your hair anyway and if it is long it is twice as hard. As well as you need to keep your incision clean and dry, it is nearly impossible to do that in the shower while washing your hair. You may find it difficult to lean over a sink or anything else to wash your hair so it has to be done while sitting in the shower.

A bath/shower stool, or something for the shower is always a great bonus and I personally use one of these all the time as it helps when I want to shave my legs. One thing that most don't realise is after the revision surgery you have a really hard time taking care of yourself and bathing is one of those things most people struggle with.

Basically you need to think of anything that will make your life as easy as possible, obviously the hospital will provide most of your care whilst there, I was on the Stryker Frame for 2 weeks so cleaning was a non starter really, it was very difficult to wash me, but my Mother always gave it a good go.

Before Surgery

Don’t stop exercising. The stronger you are the faster you will heal. If you’re having muscle spasms and getting out of breath doing your normal sports, try a stationary bike or an elliptical for cardio, and do some strength training. You need to stretch your ham strings and strengthen your core muscles (the ones that support your belly and back. Pilates is excellent for strengthening the core muscles, and yoga is great for stretching.

Try your best to get enough sleep before surgery, although it is really tough because you’re nervous. Make sure you take your iron and multi-vitamin. DO stop iron supplements a day or two before surgery and have light meals the last day so you don’t have problems with constipation after surgery.

Make sure to eat plenty of fruits and vegetables, especially right before surgery. That first BM can be brutal, and if you have been good about getting your fiber before surgery, and minimizing red meat and dairy, it can make your first few days after surgery much more pleasant.

Don’t take any aspirin, Nuprin, Aleve or ibuprofen for two weeks before surgery. Also, stop St. John’s Wort, vitamin E, Ginkgo Biloba, garlic pills, or anything else that thins the blood.

On admission to the hospital the nurses will explain the general situation. You will have some routine tests if they have not been done beforehand and you will be shown around the High Dependency Unit, where you will stay for 36-48 hours after surgery, after which you will return to your hospital room. The physiotherapist will teach you breathing exercises, and foot, and toe exercises (to prevent blood clots forming in the leg) and turning (log rolling).

Bring to the Hospital (for the patient):

  • I-pod or portable music device
  • A couple of mushy familiar pillows
  • Laptop or portable DVD player
  • A couple of photos of friends and family
  • Comfort object like a childhood bear (you're never too old!)
  • Slipper socks (the fuzzy ones with sticky bumps on the bottom
  • Plastic cup with a lid and straw
  • Rinse free soap like Cetaphil. The soap the hospital has can be nasty
  • Body lotion
  • Face care stuff (wipes, lotion, zit cream)
  • Toothbrush and favorite toothpaste
  • Feminine supplies (even if you just got your period, you'll probably get it again. This always happens to women/girls after surgery)
  • Soft loose PJ's or sweats for after the catheter comes out and for the ride home (zip or button front, in case it hurts to lift your arms over your head)
  • Lots and LOTS of pillows for the ride home (sometimes the hospital will give you a bunch)

The hospital will give you these lemon glycerin swabs to wipe your mouth when you aren't allowed to drink. Don't use them, they feel good for a minute, but then they make your mouth feel sticky. Wet a paper towel, and wipe your lips and tongue and suck on it a little. It's enough moisture to make your mouth feel better, and wet your mouth and throat a little, but not so much water it will hurt you.

If your hair is long, put it in two braids (like Pippy Longstocking) and get your family to brush it out every day when PT makes you sit up. Bring covered bands to fasten the braids. If your hair is short, consider trimming it even shorter to minimize the "bird's nest".

For your Caregiver:

A Journal is absolutely essential! It helps your care giver stay on top of the nurses as far as when to administer pain meds. It will also help them to remember the names of doctors and nurses who administer care. Keeping a journal is also nice, because as a patient, you will forget most everything from the first few days because of all the drugs. It’s nice to be able to look back and realize what you have overcome.

Your care giver will need to have some loose soft clothes or pajamas for sleeping in the room with you. They should bring sweats as well as a t-shirt and boxers, as the temperature in the room could vary quite a bit. They should also bring slippers and basic toiletries.

Your care giver should bring several books, maybe a craft like knitting, and music or movies to watch. There will be lots of time when you the patient will be sleeping, and your care giver will be bored.

Bring bottled water (the hospital air is VERY dry) and healthy “high energy” snacks like trail mix, nuts, and dried fruit. The whole hospital experience is extremely stressful for your care giver, and they need to take care of themselves and take in enough healthy calories to maintain their energy and keep their immune system strong. The candy bars in the machine get old pretty quick.

Your care giver MUST have a respite plan. They can not sit by your bed 24/7. It is critical that they plan regular breaks to take a walk, step outside, eat a meal outside the hospital, etc. Your care giver must take care of themselves so they can take care of you. Tell friends you don’t need flowers, you need visits so your primary care giver can take a break.

Pain Management in the Hospital:

You will have physiotherapy in the hospital. You will be log rolled in bed for the first 48-72 hours or so until you can turn over by yourself. About 48-72 hours after the operation the drips may be removed. On the fifth postoperative day you will be transferred from your ward bed onto a special electric bed, which will help you to stand up for next 2-3 days. On the seventh or eighth postoperative day you may be fitted with a lightweight fibreglass jacket, which you will wear continually for 2-3 months. Patients are usually able to go home 6-9 days after surgery.

If you start to feel anything other than mild discomfort (3-4 out of 10) insist on paging the pain management team, day or night. Even if you’re on the pump, they can come and give you a little extra zap. There is always a way to make you comfortable, so don't take "No" for answer. Pain slows healing and there is no reason for you to suffer.

Donating Blood: All patients will lose some blood during surgery, and sometimes it is necessary to get transfusions during or after the operation. There are several different options for donating blood.

Autologous Donations: You will donate your own blood for transfusions after surgery. The first unit of blood must be given within five weeks of the surgery, and the last, not less than seven days before the surgery. It is important to eat a nourishing meal 2-4 hours prior to donating blood. The blood donor center is located in the Gray Building on the first floor at Mass General Hospital. The nurse will check your blood counts before any donation. If patients are donating their own blood before surgery, they will often be given a prescription for iron pills. Iron may cause constipation, so it is a good idea to increase the fluids, fruits, and vegetables in your diet. Since the body replaces blood very quickly, healthy patients can donate and still be ready for surgery soon after.

Aspirin and Other Medications: Aspirin, bufferin, and non-steroidal anti-inflammatory medications such as Advil, Motrin, Naprosyn, or Aleve may cause extra bleeding at the time of surgery. These medications should be stopped three weeks prior to surgery. Tylenol (Acetaminophen) can safely be used for pain relief prior to surgery. You should always check with your surgeon about drugs.

Pre-Admission Testing: One to two weeks before surgery, you will need to have pre-admission testing. Please plan on being at the hospital for four to five hours on this day. You will meet with a physician or nurse practitioner that will perform a physical examination, and make sure you are in good shape for surgery. The nurses and doctors will ask you and your parents some questions and answer any questions that you may have. Please call the orthopaedic office if your child is sick the week prior to surgery. While at the pre-admissions testing center, urine and blood samples will be obtained. In addition, you will meet the anesthesiologist (the doctor who will be putting you to sleep). He/She will explain how you will be put to sleep for the operation, as well as how pain will be controlled post-operatively. Be sure and tell the nurses or doctors about any allergies to medication, foods, tape, or latex (rubber products). After your visit at the Pre-Admission Clinic, you will need to go to the Pediatric Orthopaedic Office. Here you will visit with your spine surgeon who will answer any questions that you or your family may have relating to the surgery. The surgeon or nurse practitioner will complete a history and physical, obtain surgical consent, and obtain additional x-rays if necessary.

The Night Before Surgery: You must remember not to eat or drink anything after midnight. This includes water, chewing gum, and candy. Your stomach needs to be empty when you go to sleep. This will help keep your stomach from getting upset afterward. It will also help you avoid aspiration which is a potentially life threatening problem, avoid salty foods so you do not get thirsty so much.

The Operating Room: A nurse will greet you as you arrive in the operating room. The room can sometimes be cool and noisy. Soon after arriving, the anesthesiologist will give you medicine though the IV line to help you relax and fall asleep. You may be asked to breath through a mask, which is also used to help you fall asleep. After you are asleep, the anesthesiologist will put a small tube in the back of your mouth and throat and into your airway. This tube will deliver oxygen to your lungs, and will usually be removed before you wake up after surgery. Sometimes it can cause a sore throat after surgery, but usually you never realize it was there. Because your stomach is empty and asleep from the anesthesia, you will need a nasogastric tube (NG tube) to prevent you from becoming nauseous. The NG tube will usually stay in until your third postoperative day. The nurse will place a tube, called a Foley catheter, in your bladder while you are asleep. The Foley drains urine from your bladder so that it can be measured, and keeps track of how well your body is eliminating fluids. The catheter is also usually removed on postoperative day three. After the Foley is out, you will be able to use the bathroom normally.

The Recovery Room (PACU): When you wake up from anesthesia, you will be lying on your back in the recovery room or post-anesthesia care unit. You may feel still from being in one position for a long time. You may not even remember the PACU, because you will still feel sleepy and groggy from the surgery. Your nurse and anesthesiologist will be checking your vital signs frequently, and they will also make sure that you are comfortable. If you are having any pain, the PACU nurse will give you pain medicine through the IV. You will be receiving oxygen through your nose or mouth, and you will be encouraged to cough and deep breath to help clear your lungs. You will still have the IV, nasogastric tube, and Foley catheter. A large dressing will be placed over your incision. Occasionally, you will have an X-ray in the PACU to check the rods and hooks in your back. Usually, patients will stay in the recovery room for 2-3 hours while they wake up from the surgery. It is possible to have a parent visit in the PACU after they have met with the spine surgeon.

The Pediatric Intensive Care Unit [PICU]: You will most likely spend one night in the intensive care unit after your spinal fusion. In the ICU, you will still feel quite sleepy from the anesthesia and pain medications. You will continue to receive pain medications through your IV. It is important to let your nurse know if you are having any pain or nausea. The doctors and nurses will be touching your hands and feet, and asking if you have any numbness or weakness in your arms or legs. You will have your blood checked periodically and will receive blood transfusions if necessary. You will be monitored very closely while in the ICU.

Pain Medication: Your nurse will check your vital signs and assess your pain frequently on the floor. The Pediatric Pain Team at MGH is available for acute and chronic pain management. You will usually need to have pain medication through your IV for three to four days. Once you begin to drink and eat small amounts of food, you will be able to take pain medications by mouth. You will be given a stool softener or laxative to prevent constipation, which is a common side effect of pain medications.

Activity: It is common to feel quite tired following spinal surgery, and you may need help turning from side to side initially. You will meet with a physical therapist usually on the second post-operative day. The physical therapist will assist with deep breathing, coughing, mobility, and endurance. After your surgeon says it is okay, you may get out of bed and sit in a chair. The physical therapist will work with you to teach you the correct way to get out of bed and walk without twisting your spine. You will then progress to walking short distances on the floor. Some patients get up the day after surgery, and others have to wait a few days. Your individual pace of recovery is unique, and depends on the type and extent of spinal surgery. You will be given additional information about specific activity restrictions at your six-week follow up visit. As a general rule, however, no contact sports are allowed for six months after a spinal fusion surgery.

Eating: Your IV will remain in place so that your body receives enough fluids while you are unable to eat or drink very much. The IV will be removed when you no longer require IV pain medications or transfusions, and you are drinking enough fluids. After your digestive system is working again and your NG [nasogastric] tube is removed, you will be allowed to have clear fluids. Examples include water, chicken broth, and jelly. It is important to advance your diet very slowly to prevent nausea and vomiting! It may actually take two or three weeks for your appetite to return to normal.

Showering: The large dressing on your back will usually be changed to a smaller bandage on post-operative day two. Usually, the stitches used to close your incision are under your skin. They are absorbable, so they will not have to be removed. It is important to keep your incision clean and dry after surgery to avoid infection. You will need to take sponge baths for the first 7-10 days after surgery. After this, you can shower normally as long as your incision is well healed and has no drainage.

Going Home: Most patients will remain in the hospital for about 5-7 days after surgery. When your pain is well controlled, you are able to eat and drink without nausea, and you are able to walk around on the floor, you will start to think about going home. Usually your surgeon will tell you when you can expect to go home about a day in advance. During your hospital stay, your parents will be taught how to take care of you. You and your family will be instructed on what problems to look for, as well as how to manage your diet and medications prior to discharge. Generally, no special equipment is needed at home following a spinal fusion.

You will be given prescriptions for pain medication before you go home. Plan to take a dose of pain medication prior to leaving the hospital, as the ride home can sometimes be uncomfortable. If you still have pain after taking the medication, please call the orthopaedic office and let us know. It is possible to make an adjustment to your pain medications to make you more comfortable.

Also, if any of the following problems occur after surgery, please let your spine surgeon know right away:

  • Fever, chills, redness, warmth, or foul smell from the surgical site
  • Increase in pain
  • Numbness, tingling, or weakness in your arms or legs
  • Change in bowel or bladder control

You will not be able to return to school or work right for the first few weeks after surgery. Please arrange for a home tutor through your school system if possible, as most patients typically miss between four-six weeks of school. Before you leave the hospital, please schedule a follow-up visit with your spine surgeon. Usually, the first post-operative visit is scheduled six weeks after surgery.