You have taken the first step to improving your quality of life and lifestyle. In anticipation of your upcoming surgical procedure, there are several items I would like you to keep in mind. Our goal in providing health care is to make your surgical experience as pleasant as possible. If you follow these simple do’s-and-don’ts before surgery, I believe this will substantially improve your satisfaction.
1. There are many medications, both prescribed and over-the-counter, that can increase your risk of bleeding.
These medications, and herbal supplements include aspirin, Advil, Aleve, and most prescribed anti-inflammatory (arthritis) medications, and herbal supplements such as Ginkgo biloba and Ginsing; Vitamin E; and over the counter dietary supplements containing Ephedra. These medications should be discontinued 10 to 14 days prior to surgery to minimize the risk of bleeding associated with them. If you are on Celebrex, you may continue to take this medication. If you develop an increase in your pain levels while off these medications, we would be happy to supply you with a prescription for pain medication prior to your procedure. Kindly contact us during office hours for such. If you are taking prescribed anticoagulant medication for a medical condition, you must inform us of this if you have not already done so.
This medication will be discontinued in a controlled fashion prior to surgery, generally in concert with your prescribing physician, to ensure that the risk of complications is minimized.You should start taking 1000mg of Vitamin C every day for two weeks prior to your surgery. You can purchase Vitamin C over the counter at the pharmacy or discount stores. You should continue to take the Vitamin C once you get home. If you do not normally take this supplement you may discontinue it after you six week follow with Dr. Mead.
2.Your skin is an extremely important structure.
While most of us take our skin for granted, it is the primary barrier between the outside world and the internal workings of our body. Compromised skin in the area of a proposed surgical incision can increase the risk of infection. Even a small abrasion or scrape can dramatically increase the bacterial count in this area. For this reason, if you are considering joint replacement surgery or arthroscopic surgery about the knee, it is most important that, for the week prior to surgery, you abstain from working in your garden or on your lawn, wear long pants, and keep animals, such as pets, off your lap or from scratching you in the area of proposed surgery.
Do not shave the skin anywhere near where your surgical incision will be made. Furthermore, prior to surgery do not undergo any dermatologic procedures on the extremity you are scheduled to have surgery and until cleared to do so after surgery. It has been my experience that patients tend to present within several days of a surgical procedure with a new area of scraping. In most instances, this will not cancel surgery, but in the case of a knee replacement, if the scrape is near the incision, the surgery will have to be cancelled until things have healed. This usually takes two to three weeks for the abrasion to heal completely, so that there is completely unbroken skin. The best way to prevent delays in surgical management is to be proactive in protecting your skin in the aforementioned manner.
3. If you have any significant medical problems that have changed since we last spoke to you, or you have not had an evaluation by your regular medical doctor, please let us know.
This is particularly important for patients who are considering joint replacement surgery. If you are having any cardiac complaints, namely shortness of breath, chest pain on exertion, or history of coronary artery disease, the sooner you let us know of any proposed testing to be done, the greater likelihood that your anticipated time of surgery will be less interrupted.
4. Another important factor that we need to know is any sensitivity or allergy to any metals.
If there is any question, we have the ability to test for allergies to the metals that make up the components of the prosthesis that we will be implanting if you are having a total joint replacement.
Embarking on a surgical experience can sometimes be challenging. If you experience any significant anxiety, or if questions arise, please do not hesitate to contact us. Our goal is to make this experience as pleasant as possible for you, with a minimization of problems and a maximization of outcome.
Leon Mead, MD
Frequently Asked Questions (General)
1.When do I start fasting? Nothing to Eat or Drink after midnight the night before surgery. If you take prescription medications, you must take any Blood Pressure and Thyroid medications the morning of surgery with a small sip of water (If you normally take them in the morning). You will not take any diuretic (water pill) medications the morning of surgery, unless instructed to do so. This will be reviewed during your pre-operative and pre-admission visits.
2.Do I need to bring a list of medications? YES, YES, and absolutely YES. The first thing you should do is go over your medications with your Internist or Family Physician and make sure every medication is necessary and accounted for. Please make a new/updated list of every medication, vitamin, supplement, herb, and/or remedy and bring it with you to our office for you pre-operative visit and pre admission visit.
3.Do I need to do any Surgical Site Preparation? Wash the leg with the special liquid soap (Triseptin, dispensed in our office), starting two days prior to surgery. Do this during your daily shower, using a washcloth and starting at the waist working your way down the leg to include the foot and toes. Scrub lightly for about 2 minutes, be careful not to scratch your skin. Thoroughly rinse after you are done. Wash the leg two days before surgery and the day before surgery. Do not use the soap for your whole body. The soap is only to be used on the operative extremity. Do not rinse your head or face after you have used Triseptin, the alcohol based soap can burn your eyes. Do not shave the extremity that will be operated within two weeks of surgery. Also, wear long pants and protect the surgery site from any scratches or abrasions.
4.What should I do the day of surgery? No matter what time your surgery is set to start, you should be ready to come in earlier. Sometimes the operating room will run ahead of schedule or behind schedule secondary to cancellations and emergencies. You need to be available throughout the day to come into the hospital with short notice. If you are making transportation arrangements, please make sure they are flexible. Anyone who cannot come in will be bumped (“rescheduled”) to the end of the day to allow the operating room to run efficiently.
5.How and when do I return to Normal Activities? Everyone recovers differently, but here are a few guidelines. You may re-start driving once you have reached 3 weeks following surgery, but you must feel you can control the vehicle. We recommend that you practice in a parking lot prior to driving in routine traffic. You can restart golfing, tennis, and swimming after the 4 week point if you feel up to the activity. (Chipping and putting after 2 week point as tolerated as long as you are off ambulatory aids.) Please remember, start all activities slowly and work your way up to pre-operative activity levels or better. Do not rush into any activity.
- Skiing – 3 to 6 months after surgery
- Bicycling – 2-3 weeks after surgery, Start on stationary. You may start on a stationary bike at any point when you feel up to it.
- Gym – 3 weeks after surgery.
- Tennis – 6 weeks after surgery, as tolerated. Doubles only.
6.When do I restart my prescription medications? When you are discharged from the hospital. Do not re-start Aspirin. Only after you have stopped taking coumadin (Warfarin) can you re-start Aspirin. Unless specifically told not to restart a medication, you should continue your prescription medications when you are discharged. Please be aware the your internist or family physician may have added or deleted a medication while you were hospitalized, pay close attention to the discharge instructions given to you by the hospital nurse.
7.How long will I be on Pain Medications? Usually 2-6 weeks.
8.How long will I be on Blood Thinners? 6 weeks.
9.When will my staples be removed? 2 weeks after surgery by the Home Health Nurse. (+/- one day depending on schedules and holidays)
10.When can I shower and/or use the bathtub? You can take a shower about 10 days after surgery if incision is dry and there is no drainage. You should wait until 4 weeks after surgery before going in a bathtub or swimming as long as the incision is completely healed.
11. Home Health vs. outpatient physical therapy, which is better? A common question, but not an easy answer. It all depends on how you progress after the surgery and how much help you have at home. If you a doing well, Dr. Mead prefers for his patients to go home with home health for a short period of time, then start outpatient physical therapy. All these arrangements will be taken care of by our office.
12.Will I get better results in the long term if I go to inpatient Rehab as opposed to going home? NO. Many patients recover better at home.
13.When can I Fly or Drive a long Distance? You can travel by plane or go on relatively long car trips 3 weeks after surgery. Although, this may vary on individual circumstances. Always ask Dr. Mead prior to making plans within 6 weeks of surgery. It is wise to stretch every half-hour or so and do foot/ankle pump exercises.
14.How long will I use Ambulatory Aids? The physical therapist’s will advance you as you progress. Safety and endurance are key factors. Also, your walking (gait) without a limp is important and may take some time to work through.
15.How well will my knee bend after the surgery? This depends on how stiff the knee was before surgery. If your knee is limited before surgery it will be limited after the surgery. There is potential for improvement but individual results vary based on self discipline, pain control, and degree of swelling.
16.How long do I keep the Hip Precautions? There will be strict temporary precautions which will be reviewed in the hospital. Six weeks after surgery those precautions will be relaxed but you will have some permanent restrictions that will be reviewed in the office on multiple visits.
17.Will my replacement set off the Metal detector at the airport? Yes. Please use common sense with regard to travel. You will be given an implant card, but this is not required nor is it useful when traveling. Airport Security will not pay any attention to implant cards. They will allow you to board when they are satisfied that you are not a terrorist threat.
18.Will I get a handicapped parking sticker? Usually not. Most patients do not qualify for temporary handicapped permits. After surgery we want you to walk and get the exercise.
19.When will I be able to walk normal again? The answer to this question varied depending on your pre-operative walking pattern. A person who limps before surgery will need to learn to walk without a limp. This will take time and depends on the individuals self discipline.
20.When can I remove the surgical stockings? TED Stockings or surgical compression stockings are not needed but may decrease swelling in the lower extremities. If you were given stockings in the hospital wear them if you have swelling and they are helping.
21.When can I return to work part/full time? This depends on the type of work you do. A walking support like a cane may be used for a few weeks after surgery. Many times, a trial of part time work at two to four weeks is wise. Remember that every person is different in terms of recovery and rehabilitation rate, and employers need to respect this.
22.How often a day can I climb stairs? Climbing stairs is stressful on knees. Slowly increase this activity as tolerated. Your progress will depend on how limited you were before surgery.
For Knee Surgery:
1.Do I need to do any Surgical Site Preparation? Wash the leg with the special liquid soap (Triseptin), starting two days prior to surgery. Do this during your daily shower, using a washcloth and starting at the waist working your way down the leg to include the foot. Scrub lightly for about 2 minutes, be careful not to scratch your skin. Thoroughly rinse after you are done. Wash the leg two days before surgery and the day before surgery. Do not use the soap for your whole body. The soap is only to be used on the operative extremity. Be very careful not to get the soap in your eyes. Do not shave the extremity that will be operated within two weeks of surgery. Also, wear long pants and protect the surgery site from any scratches or abrasions.
2.What should I do the day of surgery? No matter what time your surgery is set to start, you should be ready to come in earlier. Sometimes the operating room will run ahead of schedule or behind schedule secondary to cancellations and emergencies. You need to be available throughout the day to come into the hospital with short notice. If you are making transportation arrangements, please make sure they are flexible. Anyone who cannot come in will be bumped to the end of the day to allow the operating room to run efficiently.
3.Do I need a bowel prep? No bowel or colon preparation is needed prior to hip or knee replacement.