​WHAT DO I NEED TO BRING WITH ME THE DAY OF SURGERY?
Photo ID and insurance card
Dress appropriately:
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Loose fitting front closure shirt/blouse/sweater or a front zip so you can easily change into a hospital gown
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Warm up jacket, coat, or sweater
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If you wear glasses, bring them. Do not wear contacts lenses to surgery.
​​​Friend or family member who is able to drive you and help get you home
Pillow for comfort/sleeping on your way home
Crutches or a walker if you have them already
If you are having a joint replacement: you should bring any personal items that will keep you comfortable for the 1-2 days if we expect you to stay in the hospital overnight after surgery.
WHAT SHOULD I LEAVE AT HOME?
Jewelry: especially valuable jewelry such as wedding bands
Valuables such as tablets and laptop computers.
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HOW LONG WILL SURGERY TAKE?
Surgery is an all day event: please do not make other appointments, work or errands on your surgery day. Surgery times can vary depending on the procedure being performed and the complexity involved. Our office can provide an estimate for the surgical time prior to your surgery, however, your case will take as long as necessary to achieve the best possible outcome. Discuss with Dr. Pashuck how much time you should take after your surgery to rest and recover before returning to work or activities.​
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SKIN ABRASIONS/RASHES
Notify our office immediately if you have any new skin issues including abrasions/rashes on the operative extremity before surgery. These skin issues can sometimes increase the risk of infection and therefore your surgery could be cancelled on the day of surgery. Notifying our office ahead of your surgery will allow us to appropriately assess the situation, determine whether surgery needs to be delayed and reschedule your surgery (if needed) to avoid any cancellations.
CHECK-IN
The specific time will not be given to you during your office visit. You will receive a phone call the day before your surgery with your surgery time. Try to arrive at or before your scheduled time the day of surgery, as any delays could result in cancellation. You will be asked to arrive before your actual surgery time to allow for the registration process, preoperative testing and consultation with the anesthesiologist. After you have registered, a nurse will check you in to the holding area. You will be asked several questions about your medical history, they will take your vital signs, and you will be asked to change into a hospital gown.
ANESTHESIA
The nurse will start an intravenous (I.V.) line which will be used to deliver medications to your bloodstream before, during and after surgery. The anesthesiologist will discuss the details of your anesthetic while you are in the preoperative holding area. Any questions you have regarding anesthesia, including nerve blocks available for pain control, should be addressed with the anesthesiologist.
SURGERY
After you have been prepared, a member from the anesthesia team and a nurse from the operating room will transport you to the surgery area. You will be asked to wear a surgical cap to cover your hair. After being checked in a second time you will be wheeled into the operating room. You will be asked many of the same questions on several occasions. This is performed to prevent any important information from “slipping through the cracks."
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The surgical team is composed of your surgeon, Dr. Pashuck, 2 or 3 nurses or surgical technicians and the anesthesiologist/nurse anesthetist. The temperature in the room is typically lower than normal and warm blankets will be provided. Once the anesthesiologist/nurse anesthetist is prepared, they will administer medicine through your IV which will make you feel relaxed. Afterwards, more medicine will cause you to fall asleep. Surgical time varies from case to case but we will make a time estimate for your family so they can prepare appropriately. After surgery Dr. Pashuck will talk with your family members about the surgery and the rehabilitation protocol after surgery. Please make sure that family members are available at this time.
POST-ANESTHESIA RECOVERY UNIT (PACU)
When you awaken from the anesthetic, you will be in the PACU. A nurse will be assigned to monitor your progress and address your needs. After you have stabilized, you might be transferred to a second stage recovery area in preparation for discharge or hospital room if you are staying overnight. Your family members will be able to visit once the sleeping medicine has worn off and you are in an area that protects patient privacy.
MEDICATIONS AND PAIN MANAGEMENT
Your post-operative prescription medications will usually be prescribed electronically to the preferred pharmacy that you previously listed by the morning of your surgery day. Pain as well as response to pain medications are different for everyone and there is no exact science for the optimal type or amount of pain medication for each person. In general it can be helpful to try to stay ahead of your pain during the first 24 to 48 hours and take the pain medication on a scheduled (regular) basis as long as you are not experiencing significant side effects. Do not take any additional narcotic pain medication than was prescribed as taking additional narcotic pain medications can be very dangerous. If you received a regional block by the anesthesiologist, you might have minimal pain until the block wears off. The time until the block wears off can vary depending on multiple factors including the medication used for the block and body location. Once the block wears off you will likely experience a noticeable increase in pain. It can be helpful to start taking the pain medications before the anticipated time for the block to wear off to minimize this increased pain.
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The following is a list of common medications prescribed:
NARCOTIC PAIN MEDICATIONS (I.E. VICODIN, OXYCODONE, PERCOCET, HYDROCODONE, NORCO)
These medications alter your perception of pain. Narcotic pain medications should only be taken as prescribed. Taking higher amounts of these medications can lead to respiratory depression and even death. Narcotic pain medications can make you feel sleepy therefore you should not drink alcohol, drive or operate machinery when taking them. Narcotic pain medications can cause nausea, particularly if taken without food. Always take your medications with food and fluids. Additionally, some patients will notice constipation. To minimize this be sure to drink plenty of fluids, especially water and fruit juices. Once your pain has reached a more manageable level, you should stop taking the narcotic pain medication and switch to using over-the-counter medications (Tylenol, Ibuprofen) as directed.
ANTI-INFLAMMATORY MEDICATIONS (I.E. IBUPROFEN, NAPROXEN, TORADOL, MELOXICAM)
These medications help with swelling, stiffness, and pain. They are a more safe medication compared to narcotic medications but they can can have side effects including but not limited to upset stomach and rarely gastrointestinal ulcers. Anti-inflammatory medications should also be taken with food and fluids. NEVER take multiple anti-inflammatory medications (i.e. Ibuprofen and Toradol) at the same time. If stomach irritation occurs, Pepcid AC or Prilosec OTC can be taken in conjunction with the medications. If stomach irritation persists, or if you notice blood in your stools, immediately discontinue the medication and call our office.
BLOOD THINNERS (I.E. ASPIRIN, LOVENOX, ELIQUIS, XARELTO)
These medications help to prevent blood clots including deep vein thrombosis (DVT) and pulmonary embolism (PE). Any prescribed blood thinner needs to be taken as prescribed unless there is a medical reason to not take the medication. Make sure to notify Dr. Pashuck of any potential issues with taking these medications prior to your surgery. If you are already taking a blood thinner we prefer that you stop taking the medication 10 days prior to surgery. You should check with your primary care physician before surgery if you are taking Plavix, Coumadin, Xarelto, Eliquis or other blood thinning medication. You will often restart taking your blood thinning medication the day after surgery. Mobilizing as much as possible after surgery will also help to prevent blood clots.
NAUSEA MEDICATION (I.E. ZOFRAN, ONDANSETRON)
You may be given a prescription for Zofran if you are prone to nausea or have a known reaction to one of the pain medications. You can take this medication on an as needed basis if you are having nausea after surgery. Please call our office if you have persistent nausea after surgery.
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STOOL SOFTENER (I.E. DOCUSATE/COLACE, SENNAKOT/SENNA)
You may be given a prescription for a stool softener depending on your surgery. This medicine is meant to be taken while you are taking narcotic pain medications in order to prevent constipation. You no longer need to take this medication when you are no longer taking the narcotic pain medications and you are having more regular bowel movements. You should take an over-the-counter stool softener if you experience constipation after surgery and you were not prescribed a stool softener.
​POSTOPERATIVE CARE IMMEDIATELY AFTER SURGERY
WOUND CARE
In surgery, we apply a sterile dressing or skin glue that is sealed with either a plastic protective covering (Tegaderm) or tape bandage. You can shower with the Tegaderm without additional covering. If you have a tape bandage, typically after an arthroscopic procedure, you will need to cover the bandages with Saran Wrap or other means to avoid getting the dressing wet. You should never submerge your incision under water until the incision is fully healed, typically around 3 weeks after surgery. You will be given instructions on specific wound care management and dressing changes in your discharge instructions after your surgery.
ICE
It is normal for you to have swelling after surgery. Ice and elevation are the easiest and best ways to decrease swelling. It is important for you to use ice several times a day during the first week after surgery. Make sure to use plenty of ice to cover the entire area that is painful. Here is a simple, inexpensive way to make extra lightweight ice bags.
1. Wet some towels (hand or kitchen sized work well)
2. Ring the towels out slightly
3. Fold each towel into a small square (6 inches works well)
4. Place each folded wet towel into a quart size zipper type kitchen baggie
5. Pour ½ to 1 full bottle of rubbing alcohol onto each towel (alcohol freezes as a gel, not rock hard) and zip shut
6. Put into freezer
These can be refrozen many times. You can also use a bag of frozen fruits/vegetables, special ice machines that circulate cold water or other methods. Remember do not place the ice directly against uncovered skin as this can damage the skin. Always have a barrier between your skin and the ice such as an Ace wrap or dry towel.
PHYSICAL THERAPY/HOME EXERCISES
At some point, you may be given physical therapy or home exercises, which will be individualized based on your type of surgery and any special circumstances. Therapy is every bit as important to your recovery as the surgery itself. Be sure to perform your exercises diligently as instructed. If you are scheduled to stay overnight, a physical therapist may be assigned to see you the next morning to do therapeutic exercises at your bedside.
SLEEPING
You may notice trouble getting comfortable at night after surgery. This can last several days to weeks. You may sleep on the operated side: this will not damage anything repaired during surgery. However, you should try to avoid this for a while because it will be uncomfortable. If you had shoulder surgery, you may find it more comfortable to sleep in a recliner or upright chair for the first week after surgery.
COMMON POSTOPERATIVE PROBLEMS
PAIN
Some degree of pain is anticipated with any surgery. Once you have begun to experience the pain, treat it promptly including ice, elevation and try to stay ahead of the pain by regularly taking pain medication, especially the anti-inflammatory medication. A common mistake within the first couple days after surgery is to wait too long between doses because the pain level seems reasonable. The pain medications can work better to prevent pain than treating the pain once it has occurred. Once again make sure to not take more pain medication than was prescribed. Your pain should decrease day to day. If you notice worsening pain after several days, call the office.
NAUSEA AND VOMITING
Nausea and vomiting can occur for several reasons. In the first 24 hours, the anesthetic agents you received during surgery can make you nauseous. The anesthesiologist typically administers anti-nausea medications, however, patients can still become nauseated. If you experience nausea at home it may be related to one of your pain medications. All of the narcotic medicines (i.e. Vicodin, Oxycodone, Percocet, Norco) can cause nausea, particularly if you taken them on an empty stomach. Never take your pain medicine on an empty stomach. Once you become nauseated, you may have difficulty taking oral pain medications. An anti-emetic (nausea medicine) may be given to you with your other prescriptions. If so, try to take it as directed should you develop nausea or vomiting.
CHANGE IN APPETITE AND BOWEL HABITS
A temporary loss of appetite is observed in some patients. This is typically short-lived and improves as you recover. Constipation is commonly associated with a decrease in your activity and your pain medications. The narcotics can be especially constipating. You should drink more fluids than usual, especially water and fruit juices, to help prevent this condition. You may also take a stool softener.
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WHEN TO CALL THE DOCTOR
FEVER
A low grade fever below 100ºF is common after surgery. If your temperature goes above 101ºF, especially if it persists after the first 48 hours, please notify our office.
PAIN
Pain is expected after surgery. Your pain can be aggravated if you are not icing/elevating the operative site enough, are unable to take your medicine as directed or if you are overactive after surgery. If your pain is steadily increasing over consecutive days despite normal pain control measures, please notify our office.
WOUND CARE
You should expect some minor bloody drainage to be visible on the dressing. The dressing acts as a wick, therefore, a small amount of blood can make a moderate sized spot on the dressing. If your dressing becomes soaked with blood, you have continued drainage after 4 days, or if you notice any purulent/foul smelling drainage, please notify our office.
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IMPORTANT POINTS
1. Stop any herbal supplements and dietary aids 10 days before surgery.
2. We prefer you stop any blood thinners and anti-inflammatories 10 days prior to surgery (Aspirin, Plavix, Coumadin, Ibuprofen, Aleve, Celebrex, etc). You should check with your primary care physician before surgery if you are taking Plavix, Coumadin, or other blood thinning medication.
3. Do NOT eat or drink anything after midnight the night before surgery. This also means NO gum or cough drops.
4. Notify Dr. Pashuck's office if you have any new skin abrasions or rashes on the operative extremity. These can sometimes lead to an increased risk of infection and your case might therefore be cancelled on the day of surgery.
5. Please wear shorts or loose fitting pants for knee surgery and a button down shirt for shoulder surgery.
6. You MUST have a friend or family member to drive you home after your surgery as you will be unable to drive yourself home.
7. After surgery, we ask that you take your pain medication, as prescribed by Dr. Pashuck, with food and fluids. Stay on top of your pain. Some pain is normal.
8. Perform the exercises given to you after surgery.
9. Do NOT submerge your postoperative dressing under water.
10. Call our office at 727-372-6637 if you are having problems.