Billing & Insurance
What do I bring on the day of surgery?
- Your current valid insurance information card and photo identification.
- Any medications you normally take including inhalers or a CPAP machine (if you use them), a walker (we have walkers, but some patients prefer their own), and an incentive spirometer. If ordered by our surgeon, compression stockings are measured and provided to you on the day of surgery. If you are having an injection (and not surgery), please check with your doctor to see if it is necessary to bring any of these things.
- A smart phone or tablet is a great way to pass the time during your stay, but please respect the privacy of others if your device also functions as a phone or camera. Minimize phone calls in the patient care areas. There is a strict “No Photo” policy once you are checked into the Center.
What time do I show up on the day of surgery?
Proliance Center for Spine and Joint Surgery staff will call you two days before your surgery with the details regarding what time to be at the Surgery Center on the day of surgery. Remember, your arrival time on the day of surgery will be before your anticipated surgery start time. If you have not received a call from the staff by 3:00pm on the day before your surgery, please call (425) 673-3900. You will be asked to arrive 90 minutes before your anticipated start time.
What do I wear on the day of surgery?
- We recommend wearing loose fitting clothing that will accommodate bulky dressings, soft goods, and possibly casting materials that will increase the size of your limb. These items should be easy to put on and take off, for example, shirts that button up the front or loose-fitting slacks/sweatpants.
- Please leave all valuables at home.
- If you wear contact lenses, glasses, or hearing aids, bring a case or container and solution for contacts, to protect them while you are in surgery.
- We recommend wearing shoes that provide support and will not be a tripping hazard. Do not wear flip-flops or slip-on sandals.
What can I eat or drink on the day of surgery?
- You will be instructed not to take anything by mouth (food, gum, candy, etc.) after midnight prior to the day of surgery (for example, if your surgery is on a Wednesday, you will be asked not to eat or drink anything after midnight Tuesday). (See the next FAQ for information about what to do with any medicines you take.)
- The morning of surgery, you may brush your teeth and rinse your mouth with water (but do not swallow the water or use mouth wash).
What about any medicines that I normally take?
- The one exception to the “nothing by mouth” rule is any medication you are told by your surgeon or the nursing staff to take with a sip of water on the morning of surgery (you will be informed at your pre-operative visit which medicines, if any, you should take). If you have Diabetes, you will also be counseled on an individual basis according to your needs and your scheduled surgery time.
- For any blood-thinning medicine (anti-inflammatories, supplements like fish oil, coumadin, Plavix, etc.), you will be instructed by your doctor how to manage these around the time of your surgery. We will ask for guidance from your prescribing doctor for certain medicines (like coumadin, Plavix) and will not schedule your surgery until we have this information. We do this to minimize the risk to you after your surgery.
Do I need a ride home after surgery?
Yes! You are required to arrange for a responsible adult over the age of 18 to drive you home from surgery. Your escort’s name and telephone number are obtained at the time of surgery. You will also need to have a responsible adult stay with you for at least the first 24 hours after surgery (check with your surgeon for additional after-surgery requirements specific to your surgery). If you do not make these arrangements, we will cancel your surgery and reschedule it for when you are able to meet these requirements. This is done solely out of concern for your safety after surgery.
Joint Replacement Questions
Which medications/supplements can I take prior to my surgery? Which should I stop and when? Are there any I should take the morning of my surgery?
(Note: Your surgeon will instruct you specifically with respect to your medicines, What follows is a general guideline for your information.)
In general, medications that thin your blood shouldn’t be taken for 5 days prior to your procedure. This includes medications like NSAIDS such as aspirin, Aleve or ibuprofen, but also supplements such as fish oil, garlic pills, coQ 10, and turmeric. Anticoagulants such as Coumadin, Xarelto, or Plavix also need to be stopped prior to surgery, but you will need to check with your prescribing physician to determine how to do this safely. In some cases, you will need to use a bridging medication before resuming your regular anticoagulant.
Most other medications can be taken up until surgery, but we will ask that you hold them the morning of surgery before resuming them postoperatively. This includes most blood pressure medications, thyroid supplements, statins for cholesterol management, antidepressants, and pain medications.
There is one type of medication, however, that we do want you to take the morning of your surgery with a sip of water, and that is the class of medications called “beta blockers.” Typically, these medications end in the suffix “-lol.” A few examples are propranolol and labetolol.
Last, medications for diabetes need to be managed prior to surgery because you will be fasting. Our anesthesiologists ask that you stop your metformin 12 hours prior to your procedure. In addition, those of you taking insulin may need to lower your dose to accommodate for your fasting status. Coordinating your insulin dose with your prescribing physician is recommended.
Sleeping has been difficult for me after my surgery - what strategies can I use to help?
When do I have to stop eating before my surgery? Can I drink liquids on the day of my surgery? If so, when should I stop?
In general, you will be asked to fast for your surgery. This is for your own protection, as stomach contents are at risk for being aspirated into your lungs during general anesthesia. In most cases, you can eat and drink normally up until midnight the night before your surgery, and then fast afterwards. We ask that you refrain from drinking alcohol the night before your procedure. If you take a beta blocker medication, you will be asked to take that with a sip of water on the morning of your operation. If your case is later in the day, you may be allowed to have clear liquids up until 4 hours prior to your scheduled procedure time. Clear liquids includes black coffee (no creams or proteins), water, tea, soft drinks, sports drinks, apple juice…etc. No proteins means no coffee creamers or milk, broths, and the like. If your case is scheduled to be performed under local anesthesia, you may not be required to fast. Check with your surgeon during your preoperative visit or call the office to confirm what is recommended for you.
What can I expect postoperatively? Will I be in terrible pain? How do I manage my symptoms?
With very few exceptions, most of you will have had some type of local anesthesia during your procedure – even if you had a general anesthetic. As a result, when you awaken, your pain should be manageable. The recovery room nurses are there to monitor your pain level and give you medication as you require it. Some of you will have had a dedicated regional block and will be densely numb afterwards. Blocks last variable amounts of time, but most wear off within 12-24 hours. Anticipate this! This means you may want to consider taking a dose of your pain medication at bedtime, even if you’re not hurting. During the period you are numb, try not to “overdo it” as this can make the pain worse as the numbing agent wears off. Once the numbing agent wears off, there may be more discomfort, but try not to worry because we expect this to happen.
In order to help you manage your pain postoperatively, we recommend multimodal pain management. This simply means addressing your pain from multiple angles. We do use medication – both oral and injectable – but we also use ice and elevation and compression and rest. You might have a pain pump or a regional block. We ask that you also take a role in your pain management. This means being resilient and believing you will get through this because you will. Try not to “catastrophize” your pain. It will improve, sometimes sooner than seems possible.
A brief word about narcotics. First, most of us are aware of the opioid addiction crisis in this country. In the last twenty years, it is no secret that they have been over-prescribed. There are now rules in place limiting the number of pills we can prescribe and the frequency with which we can issue these prescriptions. That said, they do play their role early in your recovery to help you get on top of your pain. You may need to take a full dose of your prescribed narcotic regularly to help with the pain initially. Once you are able to get on top of your pain, then you will be able to decrease your dose and frequency. Opioids are addictive – and can cause wicked constipation, among other unpleasant side effects – but if you use them judiciously, and wean off them as you no longer need them, your risk of addiction is minimal. So use them, early.
What are things I should look out for after my surgery? What are possible complications?
Complications are an unfortunate possibility following any surgery. The type and severity of the possible complication varies depending on the location and magnitude of your procedure. More complex, longer operations tend to have a higher complication rate. However, there are ways to minimize the risk of a complication happening to you. The types of complications that we tend to consider include blood clots, infection, nerve damage, stiffness, recurrence of the injury, or failure of a repair. Prevention of a complication can take several forms. For instance, we may ask you to take aspirin after your surgery and stay hydrated to reduce the risk of blood clots. Additionally, we may give you antibiotics prior to (and sometimes after) your procedure to help prevent infection. Keeping your dressing and wound clean and dry after surgery for a variable period of time is also typically advised. We often will give you gentle exercises to perform postoperatively to prevent stiffness. Alternatively, we may ask you to refrain from certain activities, even basic tasks such as actively moving the operative extremity, in order to prevent damage to your repair. We will discuss this with you prior to your surgery and afterwards as well. If you have any questions about what you should or shouldn’t do postoperatively, please ask us. Similarly, if you have a concern about how you’re healing or feel you may be developing a complication, we are available 24/7 to answer your questions.
How do I take care of my splint or dressing? How should I manage my wound? When do sutures come out? Do I need to wear my sling all the time (if you have one)?
In general, after your surgery you will be asked to keep your dressing or incision clean and dry for some period of time. If you have a plaster splint, you will very likely be asked to keep it in good repair until your first postoperative visit, during which it will be removed. Those of you having arthroscopic procedures are typically asked to keep your incisions (or portals) clean and dry for a week. Waterproof band-aids work well for this. In between showers, wearing a regular band-aid will allow your incisions “to breathe” which aids in healing. After a week, you can typically get your small incisions wet in the shower, provided they’re healing uneventfully. Joint replacement patients are typically given an occlusive dressing that contains an antiseptic that can stay on for 2 weeks before being changed. These dressings are water resistant but not waterproof, so it is advised you cover them in the shower with a plastic wrap. As a general rule, any time you change a dressing or come near your wound, make sure you wash your hands well first. Antibiotic ointments and creams are not necessary for healing. Sutures are typically removed at your first postoperative visit, usually at around 10 days following surgery.
Regarding your sling (if you have one), we will want you to wear it most of the time, at least initially, coming out of it to perform your range of motion services or to bathe. It serves as a reminder to you not to overuse your extremity and as a warning to others that you’ve recently had surgery. The small pillow that is part of the sling brings your arm slightly away from your body, which takes tension off of your repair, aiding the healing process. If you must take your sling off, it is advised you rest your arm on a pillow to help with healing. Tucking a dry wash cloth under your arm can help prevent a “heat rash” from forming. As time goes on and the healing process proceeds, you will be allowed out of your sling more and more. In the meantime, please bear with your surgeon as there is a reason we are asking you to wear your sling.