Pre & Post Procedure Instructions - PLEASE READ IN FULL
Pre-Procedure:
You will need to complete a medical clearance and/or lab work prior to surgery. Specific instructions will be given to you by our scheduling coordinator. You should get your lab work done PRIOR to your medical clearance appointment so your PCP can review the results during the appointment. If you require your PCP to order the labs that is OK. Just make sure you call your PCP’s office and have them review and send the labs to us ASAP.
You must discontinue the following medication seven days prior to surgery: Aspirin, Aspirin-related products, NSAIDS such as Advil, Ibuprofen, Aleve, Feldane, Nuprin, Motrin, Celebrex, Darvon, Ecotrin, Endodan, Excedrin, Florinal, Norgesic, Orphengesic, Percodan, and Pravigard, etc.). This medication may be resumed as soon as possible when deemed safe by your surgeon.
You MUST discontinue ALL blood thinners, such as Plavix (Clopidogrel), Coumadin (Warfarin), Eliquis, Pradaxa, Brillinta, Fish Oil, Aggrenox, Vitamin K, Vitamin E, and Vitamin B6 seven days prior to surgery. This medication may be resumed as soon as possible when deemed safe by your surgeon.
FOR WOMEN AND MEN: Hold Estrogens and gender-affirming hormone therapy (Cenestin, Estratest, Estropipate, Menest, Ortho-Est, Premarin, Premphase, Prempro, etc.) and on the day of surgery and resume when instructed by your physician.
Hold ALL herbal supplements SEVEN (7) days before surgery. These supplements can be resumed one week after surgery.
Discontinue any and all WEIGHT LOSS MEDICATIONS ONE (1) week prior to surgery: Trulicity (Dulaglutide), Bydureon BCies (Exenatide ER), Byetta (Exenatide IR), Saxenda, Victoza (Liraglutide), Adlyxin (Lixisenatide), Wegovy, Ozempic, Rybelsus (Semiglutide), Mounjaro, Zepbound (Tirzepatide) etc.), These medications can be resumed one week after your surgical procedure.
Please discontinue all diet pills including Phentermine TWO (2) weeks prior to your surgical procedure.
DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE DAY BEFORE YOUR SURGERY, AND NOTHING ON THE MORNING OF YOUR SURGERY, UNLESS OTHERWISE ADVISED BY YOUR PHYSICIAN. You may take essential medications, such as blood pressure medications, with JUST a sip of water.
The surgery center/hospital will provide you with instructions on when to arrive and specific directions (one to two days beforehand) on when to get there and what to bring. However, it is VERY important that you bring your most recent imaging with you (CT scan/MRI disk if not available on our portals for example; BAYCARE).
We highly encourage bringing a friend or a family member to the surgery center with you, so that we can explain the post-operative rules and instructions to them, as well.
After your procedure, you will recover in the PACU, where nursing staff will provide you with post-operative care and inform you of how the procedure went.
If you are prescribed opiate pain medication by another physician (such as a pain management physician) MAKE SURE you see them prior to surgery so you are covered for post-surgical pain. Pharmacies will not fill prescriptions from another provider. If you do not take opiates at home, we will prescribe you a seven-day course to cover your post-operative pain. After that prescription we DO NOT give any more narcotic scripts.
After surgery, you will most likely require physical therapy. This has been proven to lead to optimal outcomes. If you prefer a physical therapist, please tell your provider before or during your post-operative appointment.
If you develop nausea easily or have had reactions of nausea with anesthesia before, please let us know prior to your procedure so we can send in nausea medication.
Post-Procedure:
Refrain from strenuous activities and follow post-operative instructions.
Pain can increase in your treatment areas TWO (2) to FIVE (5) days after your procedure. It may take up to TEN (10) to FOURTEEN (14) days for symptoms to improve. Symptoms may fluctuate during the healing process, which occurs over FOUR (4) to EIGHT (8) weeks. You likely will not feel fully back to “normal” for about THREE (3) months.
You may have some difficulty swallowing and a sore throat for several days after your procedure. This is very common and will typically go away on its own. We recommend getting cough drops or numbing throat spray prior to the procedure. If it does not go away, please call the office. If you have difficulty with breathing, please go to the emergency room as you will likely require IV steroids.
You should apply ice around places of discomfort for 20 minutes on and 20 minutes off. Please place a barrier between your skin and the ice. Heat is ok to apply to your back or neck muscles BUT not over the incision site.
You may experience a low-grade fever after treatment. Call if your temperature is above 100.4.
No anti-inflammatory medication (Celebrex, Advil, Mobic, Motrin, Aleve) should be used for TEN (10) days after surgery.
Light exercise or physical therapy is OK to start TWO (2) weeks after treatment.
Pain medication prescriptions may say to take TWO (2) tablets every six hours. If your instructions say this, JUST TAKE ONE (1) tablet every FOUR (4) to SIX (6) hours as needed for pain. WE DO NOT REFILL NARCOTIC PAIN MEDICATIONS AFTER SURGERY. If you continue to have pain, you will need to see a pain management doctor for narcotics.
If you were prescribed a brace, you must wear it when out of bed. If you are sleeping, sitting down, relaxing, or eating, you may remove your brace. You will be in your brace between FOUR (4) to SIX (6) weeks, depending on the type of surgery you had. If you had a cervical disc arthroplasty “replacement,” you will only require a soft collar for two weeks.
Do not drive until you can stomp your feet on the ground and do not feel pain.
Wound care: You will have stitches buried underneath your skin. They will dissolve on their own. On top of the wound there are usually two different types of closures depending on your surgery. DO NOT USE additioanl ointments unless instructed by your provider.
Anterior Cervical or MIS surgeries you will likely have skin glue and steri-strips (which look like little pieces of white tape). PLEASE INFORM YOUR PROVIDER PRIOR IF YOU HAVE ANY ALLERGIES TO SKIN GLUE OR ADHESIVE PRODUCTS. Do NOT remove or peel off steri-strips; these will fall off on their own. We know they get itchy and annoying but please refrain from the human natural tendency to touch them. If they start to peel off, you may trim them with a small pair of scissors. On top of the steri-strips, you will have gauze and tape. The gauze and tape are what you will be able to remove in THREE (3) days. Do not wet the dressing at all during those three days. On day three, you may remove the top layer of your dressing in the morning and shower as you normally would. DO NOT SUBMERGE wound in water for THREE (3) weeks (bathtub, jacuzzi, beach, etc.).
Open lumbar, posterior cervical, SCS implants you will likely have staples, and a special antimicrobial dressing called Silverlon. This dressing should not be removed for one week. When you shower, you will want to use a waterproof dressing over the dressing or avoid getting the area wet. You should follow up in clinic for a wound check in TWO (2) weeks after your procedure. If it starts to peel off, you should reinforce it with medical tape. DO NOT SUBMERGE wound in water for FOUR (4) weeks or until the wound is completely healed (bathtub, jacuzzi, beach, etc.).
Besides narcotic medication for pain, you may use Tylenol (acetaminophen) to optimize pain control. You may take up to 3,000mg a day, unless contraindicated due to allergy or liver issues. Make note that some narcotics are mixed with Tylenol (for example, Percocet has 325mg of Tylenol per pill), so dose accordingly. Please make sure to take pain medications on a regimen. Do not wait until your pain is elevated to a 6/10. Take medication to keep the pain stable. It is much harder to control if you let it get to a higher level.
You may walk if you are stable. We do want you out of bed as much as possible unless otherwise instructed. NO BENDING, TWISTING, OR LIFTING OVER TEN (10) LBS FOR four WEEKS.
You will need to follow up in the clinic for a post-operative evaluation in FOUR (4) weeks if you have had any hardware placed. Depending on your procedure, you may be required to have an X-ray done prior to the appointment. PLEASE BRING THE CD OF YOUR IMAGES or you can upload your imaging via our website. You call the office prior, if you had imaging done at an outpatient center, to check if we have access to their online portal to avoid having to bring the CD. Your X-ray script will be provided to you from our clinical nurse. She usually calls you 1-3 days after the procedure to check on you, set up your post op appointment, and provide you with your imaging script. If you do not receive it or lose it, please call for a new script.
You may have a drain after surgery. Do not be alarmed. The reason we place drains is becasue you may have been a little “oozy” upon completion of the procedure. This means that there is a litte more blood and fluid than desired. We place them so the extra blood and fluid can drain out of your wound easily. They are typically removed the next day by your home healthcare nurse. If you do not have home healthcare set up, call the office for an appointment to remove the drain.
For questions regarding surgical scheduling, please call Chris (Scheduling Coordinator) or Lisa (Scheduling Coordinator Assistant) at 727-605-1770 (1003). For any pre- or post-procedure questions or concerns, please call Maria (Clinical Nurse) at 727-605-1770 (EXT 1007). If she does not answer right away, please leave a message with your name, DOB, and reason for calling.
Chris and Maria will return your call (if a voicemail is left) as soon as possible and typically within the same day.
If there is an emergency, please call 911.
If you have post-procedural symptoms, call the office before closing at 5:00 pm or wait until the office opens the next day. For urgent after-hour requests please send a text message to the main line 727-605-1770. For emergencies or uncontrolled pain post op please go to the emergency room as we are limited in the medications we can provide for pain and sometimes patients may require IV medication to control the pain.
Thank you for trusting us with your care!
Sincerely,
Premier NeuroSpine Institute Surgical Team
Office: 727-605-1770
Fax: 727-350-6005