Understanding Your Spine Surgery

Understanding Your Spine Surgery
patient education
Understanding
Your Spine Surgery
PATIENT EDUCATION
Your name
Surgery date
Your follow-up appointment with your surgeon is:
Date Surgeon Please bring this book to:
all appointments
your pre-surgery education class
the hospital on the day of surgery.
Time
Phone number
Understanding Your Spine Surgery
Fifth edition
© 2017 Allina Health System
The publisher believes that information in this manual was accurate at the time
the manual was published. However, because of the rapidly changing state of scientific
and medical knowledge, some of the facts and recommendations in the manual may be
out-of-date by the time you read it. Your health care provider is the best source
for current information and medical advice in your particular situation.
All rights reserved. No part of this book may be reproduced in any form or by any means, electronic
or mechanical, including photocopying, without permission in writing from the publisher.
Disclaimer
This publication is for general information only and is not intended to provide specific advice or recommendations for any
individual. The information it contains cannot be used to diagnose medical conditions or prescribe treatment. The information
provided is designed to support, not replace, the relationship that exists between a patient and his/her existing physician.
For specific information about your health condition, please contact your health care provider.
Before Your Surgery
Checklist
ˆˆContact your surgeon’s office if you are planning to visit
the dentist within 1 month before your surgery.
ˆˆSchedule your health history and physical exam.
You can read more about this on page 21.
ˆˆSchedule your pre-surgery education class or watch the
pre-surgery video if your hospital does not offer the class.
You can read more about this on page 21.
ˆˆReview the care map on pages 55 to 58.
ˆˆReview and complete any paperwork you received.
ˆˆMake a list of your current medicines. You can use
“My Medicine List” on page 121 to do this.
ˆˆFill out the insurance coverage worksheet on page 24.
Call your insurance provider if you have questions.
Did You Know?
Your care circle is your
family, friends and others
close to you. This term will
be used throughout this
book.
ˆˆSelect a member of your care circle (family, friends and others
close to you) to be your personal support coach. This person
will provide support and encourage you to meet milestones
during your recovery. You can find more information about
your personal support coach on page 22.
ˆˆTalk with your care circle about your needs after surgery.
You can find more information about planning for leaving the
hospital on pages 62 to 63.
ˆˆContact your surgeon’s office if you have any health changes
(sore throat, cold, fever, dental problem, urinating problem)
or skin changes (rash, cuts).
2
Table of Contents
Chapter 1: Welcome……………………………………………………………… 9
Chapter 2: Understanding Your Back……………………………………… 13
The Normal Spine………………………………………………………… 13
Spine Disorders and Conditions………………………………………… 15
Spine Surgeries……………………………………………………………… 17
Chapter 3: Before Surgery…………………………………………………… 21
Your Health History and Physical Exam………………………………… 21
Pre-surgery Education Class……………………………………………… 21
Personal Support Coach………………………………………………………22
Preparing Your Mind and Body for Surgery………………………………22
Insurance Coverage……………………………………………………………23
Determining Your Health Insurance Coverage……………………………24
Hospital Pre-registration……………………………………………………25
Advance Care Planning………………………………………………………25
Medicine Use Before Surgery…………………………………………………26
Diabetes…………………………………………………………………………26
Blood Levels Before Surgery…………………………………………………26
Tobacco Use……………………………………………………………………27
Quitting Tobacco Use…………………………………………………………27
Chapter 4: Preparing for Surgery………………………………………………31
Strengthening Program Before Surgery……………………………………31
Before Surgery Exercise Program……………………………………………32
Walking…………………………………………………………………………33
Breathing Exercises (Respiratory Exercises)………………………………35
Progressive Muscle Relaxation………………………………………………36
Affirmations for Surgery……………………………………………………38
Preparing Your Home for Your Needs After Surgery……………………39
Arrange for Help with Household Tasks …………………………………40
What to Bring for Your Hospital Stay………………………………………41
Preparing for Surgery…………………………………………………………42
The Day Before Surgery………………………………………………………42
Cleansing Your Skin for Your Surgery………………………………………43
Food and Liquid Restrictions Before Surgery………………………………46
The Morning of Surgery………………………………………………………46
Chapter 5: Surgery, Hospital Stay and Beyond………………………………49
What to Expect the Day of Surgery…………………………………………49
Anesthesia: What You Need to Know………………………………………50
How to Manage Your Pain After Surgery…………………………………51
Walking in the Hospital………………………………………………………54
Patient Care Plan………………………………………………………………54
Preventing Problems (Complications)………………………………………59
How to Use an Incentive Spirometer………………………………………60
Ten Tips to Prevent Falls While You Are in the Hospital…………………61
Discharge Planning……………………………………………………………62
Questions for My Health Care Team Before Discharge……………………64
Chapter 6: Home Exercise and Walking Program……………………………69
After Surgery Home Exercise Program……………………………………70
How to Start a Walking Program……………………………………………72
Walking Program Chart………………………………………………………73
Returning to Daily Activities After Surgery………………………………74
Chapter 7: Care After Surgery…………………………………………………77
What to Expect During Your Recovery……………………………………77
Commonly Asked Questions…………………………………………………79
Questions to Ask at My Follow-up Appointment…………………………85
Pain Relief………………………………………………………………………86
Pain Medicine: What You Need to Know…………………………………87
Nutrition: What You Need to Know…………………………………………88
Chapter 8: Posture and Movement (Body Mechanics)………………………93
Lifestyle Changes You Need to Make………………………………………93
How to Maintain Good Posture……………………………………………93
How to Get In and Out of Bed………………………………………………95
Tips for Lying Down…………………………………………………………97
How to Get In and Out of a Chair……………………………………………97
How to Use the Toilet…………………………………………………………99
How to Take a Shower or Bath………………………………………………99
How to Get Dressed……………………………………………………… 101
How to Go Up and Down Stairs………………………………………… 101
How to Get In and Out of a Car………………………………………… 102
How to Reach………………………………………………………………
How to Lift Correctly………………………………………………………
How to Push…………………………………………………………………
How to Pull…………………………………………………………………
How to Carry………………………………………………………………
103
104
106
106
106
Chapter 9: House and Yard Work……………………………………………
How to Do Laundry………………………………………………………
How to Clean and Dust……………………………………………………
How to Clean the Floors……………………………………………………
How to Shop for Groceries…………………………………………………
Arrangements for Child Care……………………………………………
How to Do Yard Work………………………………………………………
Chapter 10: Resources…………………………………………………………
Medical Equipment…………………………………………………………
Community Resource Directory…………………………………………
Other Resources……………………………………………………………
Know Your Care Team……………………………………………………
My Medicine List……………………………………………………………
109
109
110
110
111
111
111
115
115
117
119
120
121
Welcome
Chapter 1:
Welcome
In This Chapter:
„„
Welcome
Chapter 1: Welcome
Tip
Please bring this education
book to the hospital with
you.
Did You Know?
Each member of your
health care team at the
hospital will wear a different
color, depending on his or
her role. Turn to page 120 to
learn how to identify which
color represents each type of
care.
How do you make your surgery a positive and meaningful
experience? Many patients and their care circles (family, friends
and others close to you) find it helpful to learn as much as they
can before surgery.
This book was created to help you prepare for surgery and
guide you through your recovery. The information is not meant
to replace advice you receive from your health care team.
Please try to read the entire book before your surgery. Read it
at your own pace and write your questions in the margins.
Bring this book with you when you come to the hospital
for your surgery. Your health care team will work with you
and your care circle to create a recovery plan that is right for you.
They will be available to answer any questions you have.
Your health care team looks forward to caring for you!
9
In This Chapter:
„„
The Normal Spine
„„
Spine Disorders and Conditions
„„
Spine Surgeries
Understanding
Your Back
Chapter 2:
Understanding Your Back
Chapter 2: Understanding Your Back
The Normal Spine
Your back is made up of a spinal column, discs, spinal cord,
spinal nerves, ligaments and muscles. A back injury, spine
disorder or disease may affect one or more of these parts.
Spinal column (vertebrae)
Your spinal column is an S-shaped chain of vertebrae (bones).
Your spinal column serves three basic roles:
protects your spinal cord and nerve branches
supports your body
lets your body move (twist, bend, run or jump).
The flexible vertebrae start at the base of your skull and end
at your hips (pelvis). These spine bones are linked together and
protect the spinal cord and nerves, which run through the center
of your spinal column.
They have bony knobs on each side and connect to other
vertebrae or muscles and ligaments. When stacked, they form
your spinal column.
© Allina Health System
Labeled parts of your spinal column.
13
There are 24 individual vertebrae from your neck to your low
back that move:
cervical: Located in your neck, these seven are the lightest
and smallest of your vertebrae. They support the weight
of your head and give your neck the ability to move.
Your cervical vertebrae have a slight inward curve
(called lordosis). They are numbered C1 to C7.
thoracic: Located in your midback, these 12 vertebrae are
larger than the cervical vertebrae. They support the weight
of your chest and upper body. Your ribs connect to your thoracic
vertebrae. Your thoracic vertebrae have a slight outward curve
(called kyphosis). They are numbered T1 to T12.
lumbar: Located in your low back, these five are the largest
of your vertebrae. They support most of your body weight and
the stress of your spinal column. Your lumbar vertebrae also
have a slight inward curve (lordosis). They are numbered L1
to L5.
There are nine joined (fused) vertebrae that do not move:
sacrum: These five fused bones are located between
your hips.
coccyx: These four fused bones are located at the end
of your spinal column. They form your tailbone.
The vertebrae are connected by facet joints. These are located
on both sides and on the top and bottom of each vertebra.
They allow the vertebrae to move. A special fluid (synovial)
helps lubricate the facet joints so they move with ease.
Discs
Discs are thick pads of soft tissue (cartilage) between the bones
that let the bones move and provide “shock absorption” when
you move.
Spinal cord and nerves
Your spinal cord contains nerve bundles that carry messages to
and from your brain. You also have 31 pairs of nerves that branch
out from your spinal cord. The roots of those nerves leave your
spinal column through vertebral holes (foramen) and branch
out to your body. These nerves provide sensation and functional
ability to your spine’s discs, muscles and joints.
14
Ligaments and muscles
Ligaments are stretchy bands of tissue that support your spine
by keeping the vertebrae from slipping out of place and
protecting your discs. By supporting your spine, ligaments help
keep your back in a natural alignment.
Muscles help keep your back strong. By exercising your back
and abdominal muscles, you will be able to move and keep your
spine in its natural alignment.
Vertebral body
Superior facet
Transverse process
Spinous process
Transverse
process
Mammillary process
Inferior facet
Accessory
process
Spinous process
© Allina Health System
The labeled parts of a vertebra (from side).
The labeled parts of a vertebra (from top).
Spine Disorders and Conditions
Many different spine disorders can lead to surgery. Your health
care provider will explain your specific condition to you. Some
of the spine disorders include:
scoliosis: This is an abnormal side-to-side curve of the spine.
When looking at the back, the spine should look like an “S”
or “C” shape. There can also be an abnormal curve to the lower
back (lordosis). Scoliosis is usually easy to spot, either by the
curve or by uneven shoulders.
fractured (broken) vertebrae: This may happen from a fall or
other accident. A fracture to a vertebra may be treated with a
brace or surgery.
herniated (ruptured) discs: The spine’s shock absorbers have
a hard outer layer and a soft inner layer. When the outer layer
is damaged (torn or broken), some of the soft inner layer may
spread into the opening for the nerves (spinal canal) or toward
a nerve root. This causes pain and pressure on the spinal cord
and nerves. A disc can tear or break (rupture) anywhere along
the spine due to injury or aging.
15
spinal stenosis: This occurs when your spinal canal becomes
more narrow due to injury, aging or arthritis. These changes
narrow the spinal canal. This results in pressure on the spinal
cord and nerves. This can lead to pain, numbness, tingling or
weakness in your legs.
spondylolisthesis [spon-dee-low-lis-thesis]: This occurs
when one vertebra slips forward or backward on another.
It may cause back or leg pain.
spondylosis (spinal osteoarthritis): This is a disorder that
causes a breakdown of the spinal cartilage in the neck,
midback, low back or all of these areas. How quickly this
occurs varies from person to person. Age is usually the main
cause.
ankylosing spondylitis: This is a form of arthritis, mostly
affecting the spine.
cauda equina syndrome: This is a serious condition that
requires medical attention right away and in most cases,
surgery. In cauda equina syndrome, the bundle of nerve
roots at the end of the spinal cord (cauda equina) is squeezed.
This syndrome may be associated with bowel and bladder
problems as well as tingling or a loss of sensation and feeling
to the lower pelvic area and the legs.
disc degeneration: The aging process may cause the discs
to break down. The discs can also bulge (or become herniated).
If arthritis is affecting the spine, tiny bone growths (spurs) may
form on the vertebra. These disorders can occur on any part of
the spine and put pressure on the spinal cord.
16
Spine Surgeries
Your health care provider will explain your specific surgery
to you. Some of the most common spine surgeries include:
decompression: This surgery eases pressure on the nerves
by removing discs, bone or both. A spinal fusion may be done
after decompression to keep the spine stable.
discectomy: This surgery is done to remove the bulging
(herniated) part of the disc that is pressing on a nerve.
endoscopic: This surgery is done with ½-inch tubes inserted
into the spinal area. A tiny camera and magnifying lens on the
end of the tubes let the surgeon watch the surgery on a screen.
Instruments can be passed through the tubes to do the surgery.
This type of surgery may also be referred to as a “minimally
invasive surgery” (MIS) or “micro” surgery.
foraminotomy: This surgery is done to relieve the pressure
on nerves that are being compressed in the spine.
laminectomy: This surgery is done to remove a piece
of bone from the back of one or more vertebrae to release
pressure around the spinal cord.
microdiscectomy: This surgery uses a smaller incision to
remove the disc.
spinal fusion: This surgery is done to stabilize the spine by
fusing two or more vertebrae. This is done with a bone graft, a
metal implant or a combination of the two. It can be done from
the front (anterior), the back (posterior) or both.
spinal implants (instrumentation): Implants are used during
surgery to help stabilize the spine to keep it from moving while
fusion occurs. Types of implants include rods, plates, hooks,
screws or cages. Some implants are attached to the spine while
others are placed between the vertebrae.
thoracoplasty: This surgery is done at the chest level on your
side, to shorten or remove a part of the ribs to prevent a rib
hump from forming. This is done in some scoliosis surgeries
to correct a curve, especially in the upper back.
17
Chapter 3:
Before Surgery
In This Chapter:
Your Health History and Physical Exam
„„
Pre-surgery Education Class
„„
Personal Support Coach
„„
Preparing Your Mind and Body for Surgery
„„
Insurance Coverage
„„
Determining Your Health Insurance Coverage
„„
Hospital Pre-registration
„„
Advance Care Planning
„„
Medicine Use Before Surgery
„„
Diabetes
„„
Blood Levels Before Surgery
„„
Tobacco Use
„„
Quitting Tobacco Use
Before Surgery
„„
Chapter 3: Before Surgery
Your Health History and Physical Exam
Important
Your health history and
physical exam needs to
be done within 30 days
of your surgery.
It is recommended to
have the exam done 2 to
4 weeks before surgery.
Before your surgery, your primary care provider should do a
health history and physical exam. Call your primary care
provider to schedule your appointment.
During the exam, your primary care provider will:
assess your current health status
review and perform any tests needed before surgery
make sure you are ready for surgery.
Reminder
If you currently take any medicines, make sure your health care
provider gives you directions for:
Tell your primary care
provider if you are getting up
frequently at night to empty
your bladder or if you are
having trouble urinating.
taking your medicines the morning of surgery
stopping any prescription medicines before surgery
stopping any over-the-counter medicines before surgery,
including herbal medicines.
See page 26 for more information about medicine use before
surgery.
Pre-surgery Education Class
A pre-surgery education class for spine surgery may be offered
to you, depending on the hospital at which you are having your
surgery. Talk to your surgeon about options available to you for
pre-surgery education. If your hospital does not offer the class,
you will be able to watch a video about the surgery.
Staff specialized in the care of the spine will be at the pre-surgery
education class to answer your questions and help guide you
through your surgery.
It is strongly recommended that you bring a member of your
care circle to this class. This person should also be available to
act as a “coach” during your hospital stay and recovery.
At the pre-surgery education class, you will learn:
how to get ready for surgery
what to expect during your hospital stay
how to go home safely after surgery.
21
Personal Support Coach
You are encouraged to select a member of your care circle
to be your personal support coach. He or she will support
and encourage you to meet milestones during your recovery.
Recommended qualities in a coach
C – Caring and compassionate cheerleader
O – Offer comfort and support during your recovery
A – Available to actively participate and help with
your rehabilitation
C – Communicate with you and your health care team
H – Help, listen and encourage your return to normal activity
Coach’s responsibilities
Go to the pre-surgery education class with you.
Be available during your hospital stay.
Help you in your recovery when you leave the hospital.
Preparing Your Mind and Body for Surgery
Tip
Call 612-863-3333 or
visit allinahealth.org/
pennygeorge for more
information about the
Penny George Institute.
22
Studies have shown that if your mind and body are ready for
surgery you may sleep better and have less anxiety and pain.
Your hospital stay may also be shorter.
The Penny George™ Institute for Health and Healing
The Penny George™ Institute for Health and Healing offers
services to help you as you prepare for and recover from surgery.
Call 612-863-3333 or visit allinahealth.org/pennygeorge for more
information, or ask your health care team which services are
offered at your hospital.
Insurance Coverage
Health care benefits change and differ from plan to plan and
provider to provider. It is important for you to understand your
health care benefits before your surgery.
Now is a good time to call your insurance provider to find out
exactly what is and is not covered under your plan, and how
much you have to pay yourself. You can use the worksheet on
the next page to help you.
23
Determining Your Health Insurance Coverage
Questions to ask your insurance provider before your hospital stay
Insurance coverage for spine surgery is different from plan to plan. You need to know what your health
plan covers. To learn about your specific coverage, call your insurance provider at least 2 weeks before
your surgery. Look for the telephone number on your membership card. Use this worksheet as a guide
to help you get a clear idea of your coverage.
Insurance provider phone number: __________________________________________________________
Policy number: ____________________________________________________________________________
Date/time of call: ___________________________
Person spoken to: __________________________
1. I am scheduled for the following spine surgery: ______________________________________________
2. How long is the typical hospital stay for my surgery? _________________________________________
3. Does my hospital stay need to be pre-approved? r yes r no
If yes, who should pre-approve my hospital stay? ___________________________________________
What do I need to do to receive the pre-approval? ___________________________________________
3. Will more hospital days be covered if there are problems (complications)? r yes r no
If yes, how many extra days are covered and at what rate of coverage (percentage)? ______________
Using the table below, review the possible needs and financial concerns with your insurance provider.
Ask specific questions to help you get a clear idea of your coverage. Be prepared to share this
information with your health care team.
Type of service
Number of
days or hours
covered
Preferred
vendors/facilities
Amount
insurance
pays
Amount
I pay
Other
Short-term rehab*
Home health care
Occupational and
physical therapy
Medical equipment
Back or neck brace
Transportation**
(Medi-Van, stretcher)
Other
*Short-term rehab is also referred to as transitional care. It takes place in a skilled nursing facility such as a
transitional care center or transitional care unit (TCU).
**Transportation services are usually not covered by insurance companies. Plan ahead and arrange for a member
of your care circle to drive you home in a comfortable vehicle after you leave the hospital.
24
Hospital Pre-registration
After your surgery has been scheduled, you may be contacted by
the hospital 1 to 2 days before your surgery for pre-registration
information. Please have the following information ready when
you are contacted:
full legal name
home address (including county)
phone number
date of birth
marital status
Social Security number
name of insurance policyholder, his or her address, phone
number, work address and work phone number (if insurance
is through an employer)
name of your insurance company, mailing address, policy
and group numbers, and copy of insurance card (Note to
Medicare beneficiaries: Medicare requires an additional series
of questions.)
your employer, address, phone number and your job title
name, address and phone number of the nearest relative
or spouse if applicable
name and phone number of someone to notify in case
of an emergency (can be the same as nearest relative).
Advance Care Planning
How to Get Started
Allina Health offers three
ways to help you get started:
1. Sign up for a free
advance care planning
class. Call 612-262-2224 or
1-855-839-0005 to register.
2. Fill out a free, secure health
care directive online. Go to
account.allinahealth.org to
create an account.
3. Print out a health care
directive at allinahealth.
org/acp.
Planning for your future health care
Advance care planning is the process of giving information to
others about your health care choices in case illness or injury
prevents you from telling them yourself.
Talk with members of your care circle about your health care
choices. This is a time for you to share:
what kind of care and treatment you do or do not want
your wishes, goals and values and how they relate to your
health care choices for the future.
You can put your health care choices in writing by creating a
health care directive. Members of your care circle and your
health care providers will use this document to interpret and
understand your wishes, goals and values for your future health
care needs.
25
Medicine Use Before Surgery
Important
Do not take aspirin or
medicines that contain
aspirin before surgery.
If you take aspirin on a
regular basis, talk with your
health care provider about
when to stop taking it.
Certain medicines can cause problems (complications) with your
surgery unless you stop taking them before surgery.
Talk with your health care provider about all of the medicines
you take (including prescriptions, over-the-counter medicines,
herbals, vitamins or other supplements) at least 10 days before
surgery. Ask your health care provider for directions.
Important: It may be important to take certain medicines the
morning of surgery. Be sure to follow any directions your health
care provider gives you.
Diabetes
If you have diabetes, it is important to have good blood glucose
levels before and after surgery. This will help you heal better
after surgery and lower your risk of infection.
Talk with your health care provider who manages your diabetes
about having good blood glucose levels before your surgery. It is
recommended for you to have an A1c level lower than 8 percent
within 3 months before your surgery.
The stress of surgery can sometimes increase your blood glucose
level after surgery. While you are in the hospital, you may be
given insulin to control your blood glucose. If you take diabetes
pills, you will usually start taking them again when you leave
the hospital. Be sure to follow any directions your health care
provider who manages your diabetes gives you.
Blood Levels Before Surgery
Did You Know?
Hemoglobin is the most
important part of a red
blood cell. The protein
carries oxygen from your
lungs to your tissues.
Hemoglobin also takes
carbon dioxide from the
tissues to the lungs. You
breathe out the carbon
dioxide when you exhale.
26
It is important to have normal blood (hemoglobin) levels before
your surgery. This will help you handle surgery better and lower
your risk of needing a blood transfusion while you are in the
hospital.
Before your surgery, talk with your primary care provider about
your blood levels. If they are low before surgery, your surgery
may need to be rescheduled. This will give your primary care
provider time to find out why they are low and give you any
treatments needed to get your blood levels back to normal.
After surgery, your blood levels may be low. This is common.
It may take a few months for your blood levels to go back to
normal. You and your health care team will work together to find
the best way to make sure your blood levels return to normal
after surgery.
Tobacco Use
Did You Know?
Smoking can delay your body’s healing process. Smoking:
Tobacco use is the most
preventable cause of death
in the U.S.
makes your blood vessels become smaller (constrict), which
reduces the amount of oxygen-rich blood in your bloodstream
Cigarette smoking is the most
common form of nicotine
addiction in the U.S.
causes your blood to clot faster, which can lead to heart and
blood flow problems
causes your blood pressure and heart rate to rise.
It is important to quit smoking before surgery.
Quitting Tobacco Use
Did You Know?
Nicotine has effects like
both caffeine (“upper”)
and alcohol (“downer”).
Quitting may be difficult but it is not impossible. Talk with a
member of your health care team to get help quitting.
Need help quitting?
Talk with your health care or insurance provider about which
way(s) to quit may help you the most.
Call Allina Health Class Registration at 612-262-3333 or
visit allinahealth.org/classes to learn about support groups.
Did You Know?
In 1 year of quitting smoking,
your risk of heart disease is
reduced by more than half.
Quitting also reduces the risk
of a second heart attack if
you have already had one.
Call QUITPLAN® Services at 1-888-354-PLAN or visit
quitplan.com.
(Source: National Institutes
of Health)
27
Chapter 4:
Preparing for Surgery
In This Chapter:
„„
Strengthening Program Before Surgery
„„
Before Surgery Exercise Program
„„
Walking
„„
Breathing Exercises (Respiratory Exercises)
„„
Progressive Muscle Relaxation
„„
Affirmations for Surgery
„„
Preparing Your Home for Your Needs After „„
Arrange for Help with Household Tasks
„„
What to Bring for Your Hospital Stay
„„
Preparing for Surgery
„„
The Day Before Surgery
„„
Cleansing Your Skin for Your Surgery
„„
Food and Liquid Restrictions Before Surgery
„„
The Morning of Surgery
Preparing
for Surgery
Surgery
Chapter 4: Preparing for Surgery
Strengthening Program Before Surgery
You may have discovered you have been less active because of
your spine discomfort. When muscles are not used, they become
weak and do not perform well in supporting and moving your
body.
Important
Talk with your primary care
provider about starting your
exercise program.
Having your spine surgery can help to correct the problem, but
you will need a regular exercise program to strengthen your
muscles and properly support your body.
Beginning an exercise program before surgery can greatly help
your recovery.
The following pages list several exercises for you to work on
before your surgery. Because everyone responds to exercise
differently, you need to be the judge of how much exercise you
can do each day. If an exercise causes an increase in discomfort,
stop doing that exercise.
Tip
You should try to exercise 1 to 2 times a day, every day, before
surgery. Do 5 repetitions of each exercise.
Turn to chapter 8 for
information about body
mechanics (posture and
movement).
If you are comfortable with the exercise, increase the repetitions
by five each week until you reach 20 repetitions (week one: 5 to
10 repetitions, week two: 10 to 15 repetitions and week three: 15
to 20 repetitions).
For the most comfort, do the exercises lying down. Your bed is
an excellent place to do your exercises.
31
Exercises — before surgery
ˆˆAnkle pumps
ump your feet up and down by pulling your feet up toward
P
you, then pushing your feet down away from you.
© Allina Health System
ˆˆThigh squeezes (quadriceps sets)
ighten the muscles on the top of your thigh by pushing the
T
back of your knee down into the bed. Hold for 5 seconds and
relax.
© Allina Health System
ˆˆButtocks squeezes (gluteal sets)
Tighten your buttocks muscles by squeezing the muscles
together. Hold for 5 seconds and relax.
© Allina Health System
ˆˆAbdominal sets
Tighten your stomach muscles by pulling your belly button
in toward your spine. Do not move your spine. Hold for
5 seconds.
© Allina Health System
ˆˆChair pushups
Sit on a sturdy chair with arms. Hold the arms of the chair.
Push down on the chair arms, straightening your elbows so
you raise your buttocks off the seat of the chair. Lower yourself
slowly back into the chair. If your arms are weak, use your legs
to help raise your buttocks off the seat of the chair.
© Allina Health System
32
ˆˆStraight leg raises
Bend your leg with your foot flat on the bed. Raise your
leg up about 12 inches, keeping your knee straight. Hold for
5 seconds. Slowly lower your leg down and relax. Repeat with
the other leg.
© Allina Health System
ˆˆMini squats
Stand facing a counter. Place your hands lightly on the edge
of the counter to help you keep your balance. Bend your knees
slightly. Hold for 5 seconds. Straighten your knees to stand up
and relax.
© Allina Health System
Walking
Tip
See chapter 6 for information
about starting a walking
program.
Walking before and after surgery can help you have a successful
recovery. Regular exercise can also help to:
prevent constipation
make you feel better
manage your weight
improve muscle tone
keep your joints flexible
promote blood flow (circulation)
improve healing
promote sleep.
Try adding walking before or after your exercises, or you can set
a time of day such as morning or evening to add a walk.
33
34
Walking
Mini squats
Straight leg
raises
Chair pushups
Abdominal sets
Buttocks
squeezes
Thigh squeezes
Ankle pumps
Exercise
M
T
W
Th F
Week 1
S
S
M
T
W
Th F
Week 2
S
S
M
T
W
Th F
Week 3
S
S
M
T
W
Th F
Week 4
S
Check the box under the appropriate day and week after you perform the exercises selected for you. If you feel comfortable
doing 10 repetitions of each exercise, increase the repetitions by 5 each week until you get to 20 repetitions.
Before surgery exercise program
S
Breathing Exercises (Respiratory Exercises)
Tip
An incentive spirometer is a
hand-held breathing exercise
device to help you inflate
your lungs after surgery.
This will help keep your
lungs healthy after surgery.
You can read about how to
use an incentive spirometer
in chapter 5.
Performing respiratory exercises will help you prevent
respiratory system complications. Deep breathing, coughing,
and incentive spirometer exercises may speed your recovery
and lower your risk of lung problems such as pneumonia. Learn
the following exercises and practice them every day before your
surgery.
Deep breathing
To deep breathe correctly, you must use your abdominal muscles,
as well as your chest muscles.
Breathe in through your nose as deeply as possible.
Hold your breath for 5 to 10 seconds.
Let your breath out through your mouth, slowly and
completely. As you breathe with pursed lips (like blowing out a
candle), your stomach should be going in. Exhale twice as long
as you inhale.
Rest and then repeat these steps with 10 repetitions.
Coughing
To help you cough:
Take a slow deep breath. Breathe in through your nose and
concentrate on fully expanding your chest.
Breathe out through your mouth and concentrate on feeling
your chest sink downward and inward.
Take a second breath in the same manner.
Take a third breath. This time hold your breath for a moment,
then cough vigorously. As you cough, concentrate on forcing all
the air out of your chest.
Repeat this exercise two more times.
35
Progressive Muscle Relaxation
Progressive muscle relaxation is a short and easy exercise
to help you relax and relieve some of your pain.
Getting started
Find a relaxing position. You may sit down or lie on your back
in bed. Be sure your legs and hands are not crossed.
You may close your eyes. If you prefer, you can keep your eyes
open but focus on one spot in front of you.
Bring your attention to your breathing. Think about where your
breath comes in and out of your nose or mouth. Think about how
your chest moves up and down with each breath.
Imagine a gentle, safe wave of relaxation that will slowly and
warmly flow through your body. The wave can help you find
those places that need to relax and give them permission to relax.
You can also imagine this wave in any way you find most
comfortable. You may see it as light, water or just a feeling.
If your mind wanders, gently bring it back to your breathing.
36
Relax from your head to your feet
Bring your attention to the top of your head and begin
to imagine a wave.
With your next breath out, feel it flow through your head.
Feel your jaw soften and relax.
Breathe in.
With your next breath out, focus on the back of your neck.
Let it soften and relax.
Breathe in.
With your next breath out, imagine the wave moving through
each arm all the way to your hands. Feel your hands become
slightly heavier where they are lying.
Breathe in.
With your next breath out, imagine the wave of relaxation roll
gently and safely down your spine. Let all of your back muscles
relax and soften.
Continue to breathe. Feel the wave flow as you breathe out.
Let the wave flow through your pelvic area and hips into your
upper legs and thighs.
Breathe in.
With your next breath out, allow the wave to find those areas
in your legs and knees that need to relax. Give them permission
to relax.
Breathe in.
With your next breath out, feel the wave move into your calves,
then your feet. Feel your feet become a little heavier.
Take two deep breaths. Imagine any remaining stress gently
flowing out the bottoms of your feet.
Take a moment to observe the still place you created.
With practice, relaxation will become easier.
37
Affirmations for Surgery
Affirmations are positive statements. They can help change negative situations into ones that are
positive. Affirmations can help you feel in control and help you get ready for your surgery.
Examples of affirmations
I am relaxed and calm as I get ready for this surgery.
I will wake up easily and feel refreshed after surgery.
My surgery will be successful.
My body will work quickly to heal after my surgery.
When I wake up after surgery my pain will be at a realistic goal.
I am strong and will gracefully adapt to the lessons my body may be teaching me through this
process.
I trust in my body’s ability to welcome in and use what is helpful and healing to me. I also trust my
body to reject what is unhealthy and not needed in my healing journey.
My blood loss will be minimal and my body will quickly replace any blood or fluids.
I trust my health care providers to use their skills for my good and to promote healing.
My affirmations
Create three to five of your own affirmations or choose from the examples above.
Write them down below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Read them out loud to yourself every day until your surgery. Take a slow, deep breath before you
read each one. Use your affirmations before surgery and during your recovery.
38
Preparing Your Home for Your Needs After Surgery
To help prepare your home for your recovery, use the following
guidelines. Check each item box as you complete that item.
Outside your home
ˆˆMove items you use a lot in the garage or workshop
to tabletop-height surfaces or to middle shelves.
ˆˆCheck stair railings to make sure they are secure.
It is best if all stairs have railings.
ˆˆBe aware of uneven ground around your home and in your
yard.
ˆˆ Be sure your driveway and walking paths are uncluttered.
Inside your home
ˆˆHave clear pathways and remove clutter around your home.
ˆˆMake a path that an assistive walking device such as a walker
(if needed) will fit through.
ˆˆPick up all throw rugs in your walking or standing path.
Consider using double-sided tape to secure carpet edges.
ˆˆCheck stair railings to make sure they are secure.
It is best if all stairs have railings.
ˆˆMake your phone accessible to your main sitting area and bed.
Cordless phones or cell phones are helpful. Carry a cordless
phone or cell phone when you are home alone in case of an
emergency.
Living room
ˆˆMove low-height tables away from the couch and chairs.
ˆˆPick out a chair to sit in when you come home.
—— A good chair is firm with arms.
—— The seat height of your chair should be at the level of the
back of your knee or higher.
—— Do not sit in overstuffed chairs and sofas, or chairs with
wheels or gliders. A firm chair with a straight backrest is
best.
Kitchen
ˆˆMove items you use a lot in the kitchen to tabletop-height
surfaces or to middle shelves.
ˆˆPrepare and freeze a few meals before your surgery.
39
Bedroom
ˆˆMove items you use a lot in the bedroom to tabletop-height
surfaces or to middle shelves.
Bathroom
ˆˆMove items you use a lot in the bathroom to tabletop-height
surfaces or to middle shelves.
ˆˆConsider putting grab bars in the bathtub, shower or both.
Also consider other key areas for grab bars such as by the toilet.
(Grab bars should be installed into wall studs to ensure they
are secure. Using a towel bar or rack for a grab bar is not a safe
option.)
ˆˆApply adhesive slip strips or a bath mat to the tub or shower
floor.
ˆˆConsider a hand-held shower head.
ˆˆConsider using a soap dispenser with liquid soap in the
bathtub or shower rather than using hand-held soap.
Otherwise, place a bar of soap in a nylon stocking and tie it
onto a soap dish.
Arrange for Help with Household Tasks
You will have spine precautions for several weeks or longer.
Make plans to have someone help with the following household
tasks. Check off each box once you have arranged for help with
that task.
ˆˆFind someone to do your yard work and snow removal.
ˆˆHave your paper and mail delivered to your door instead
of curbside.
ˆˆHave someone drive you to the grocery store (or ask him or
her to do your shopping for you), community events, family
activities and appointments.
ˆˆFind someone to help care for your children or pets if needed.
ˆˆFind someone to do your house cleaning, vacuuming and bed
changing.
40
What to Bring for Your Hospital Stay
Important
Please do not bring any
of the following:
valuables
medicines
(pills, inhalers)
large amounts of money
jewelry (wedding ring)
electrical items (batteryoperated items are OK).
Reminder
Please have a member of
your care circle bring your
belongings into the hospital
after your surgery is done
and you have been assigned
a room number.
Please bring the following to the hospital.
ˆˆthis education book
ˆˆa current list of your medicines
(The “My Medicine List” is on page 121 for you to fill out.)
ˆˆa copy of your health care directive (if you have one)
ˆˆdriver’s license or photo ID
ˆˆyour insurance information (insurance card, Medicare card,
work compensation information or all three)
ˆˆyour brace (if you have one)
ˆˆpersonal care items such as a toothbrush, toothpaste, denture
cleaner, comb, skin care products, deodorant, make-up and
shaving kit
ˆˆclothing you intend to wear, including loose-fitting pants
(sweat pants, pajama pants, shorts or lounge pants)
—— If you will be wearing a brace, choose lower body clothing
that will fit over the brace and a fitted shirt for under the
brace.
—— If you will be staying more than 1 night in the hospital,
please bring two to three sets of clothing.
ˆˆflat shoes or athletic shoes (comfortable, supportive with
nonslip soles)
ˆˆglasses or contacts (if you wear them) and storage containers
Did You Know?
ˆˆhearing aides (if you wear them), storage container and extra
batteries
You can ask your health care
provider about getting a
temporary disability sticker
for parking.
ˆˆCPAP machine (if you use one)
ˆˆreading materials (All rooms have a television and telephone.)
ˆˆphone numbers of family and friends
ˆˆa rolling walker with front wheels (if you have one) so it can
be correctly fitted to you (Be sure to label the walker with your
name.)
ˆˆblank check or credit card. Ask a member of your care circle to
bring this to you if you need to purchase any equipment to take
home.
41
Preparing for Surgery
You will receive information from your surgeon’s office, which
will include the date and time of your surgery and the time you
need to arrive at the hospital.
You will be asked to come to the hospital at least 2 hours before
your scheduled surgery. This will give the health care team
enough time to prepare you for surgery.
It is important to arrive on time. Your time of surgery could
start earlier than expected. If you are late, your surgery may be
delayed or it may need to be canceled and scheduled at a later
date. Please call your surgeon’s office if you have any questions.
The Day Before Surgery
Tell a member of your health care team if you have any
changes in your health (sore throat, cold, fever, dental problem,
urinating problem) or skin condition (rash, abrasions).
You may need to schedule your surgery at a later date.
If you take diabetes medicine, ask the health care provider
who is managing your diabetes if you should take your
medicine before surgery.
Remove artificial nails and nail polish if you have your
fingernails or toenails painted.
Bathe or shower using the “Cleansing Your Skin for Your
Surgery” directions on the next pages or as directed by your
surgeon.
42
Cleansing Your Skin for Your Surgery
Important
If you did not receive Sage®
skin cleansing cloths from
a pre-surgery education
class or your health care
provider’s office, please
contact your surgeon.
Before surgery, you have an important role in reducing your risk
of infection at the surgery site. You can reduce the number of
germs on your skin by gently cleansing your skin with the Sage®
2% Chlorhexidine Gluconate Cloths. Do not to use these cloths
if you have an allergy to chlorhexidine gluconate.
Important: Do not shave your body below your neck 7 days
before your surgery.
The night before surgery, take a bath or shower. Wait 1 to 2 hours.
Wipe your skin well with the Sage cloths. They have a special
antiseptic solution. Use both of the cloths in each of the three
packages.
Please do not follow the instructions on the Sage packages
when cleansing your skin. Follow the instructions below.
Night before surgery
(at least 1 to 2 hours after taking a bath or shower)
Gather your supplies: three packages of Sage 2% Chlorhexidine
Gluconate Cloths, scissors, and clean clothes or sleepwear.
Open all three packages. Remove the cellophane wrapper
and throw it away. Use scissors to cut open the packages.
Cut straight across the top of each package.
Reach into one of the three open packages. Take out two cloths
at one time with the foam holder and put them on a clean
surface. Repeat for the second and third packages.
After you start using the cloths, do not touch your eyes, ears
or mouth.
Follow the skin cleansing steps on page 45.
Tip
—— Gently cleanse your skin using a back-and-forth motion.
If you cannot wash the
surgery area yourself, have
a member of your care circle
help you.
—— Be sure to completely cover each area. You may need help
wiping some areas of your body.
After you gently cleanse each area, let your skin air dry for 1 to
3 minutes. It is normal for your skin to feel tacky or sticky for
several minutes after you apply the solution.
Do not rinse or rub off the solution.
Do not apply deodorant, perfume, lotions, moisturizers, gels,
powders or make-up after cleansing your skin.
43
Throw away the used cloths. Do not flush them down the toilet.
Wash your hands with warm water and soap.
Put on clean clothes or sleepwear.
Put clean sheets on your bed. Make sure pets stay off of your
bed to keep it clean.
44
Chlorhexidine wipes
warning
Do not use chlorhexidine
wipes or liquid if you:
Skin cleansing steps
11.
Using the first cloth, wipe your neck and chest.
22.
Using the second cloth, wipe both arms. Start at your shoulder
and end at the fingertips. Be sure to wipe well under each arm
and in the armpit areas.
33.
Using the third cloth, wipe your right and left hip, then your
groin. Be sure to wipe any folds in the stomach and groin
areas.
44.
Using the fourth cloth, wipe both legs. Start at the thigh and
end at the toes. Be sure to wipe the front and back of each leg.
55.
Using the fifth cloth, wipe your back. Start at the base of your
neck and end at the buttocks.
66.
Using the sixth (last) cloth, rewipe the surgery area.
are sensitive to surgery
skin preps
know you have an allergy
to chlorhexidine.
If you notice your skin is
irritated while using the
chlorhexidine wipes or
liquid, remove it gently with
a wet washcloth. Tell your
pre-surgery nurse you had
a reaction so he or she can
make a note of your allergy
history and tell others on
your health care team.
There are rare cases of this
product causing a serious
allergic reaction. This can
occur within minutes of use.
Call 911 if you have any of
these:
1
wheezing or difficulty
breathing
5
2
2
swelling of the face
3
3
3
hives
severe rash
shock.
6
6
4
4
4
4
© Allina Health System
The numbered areas in the illustration show where to cleanse your
body using each of the cleansing cloths. The numbers in the text
above give you more details on how to cleanse your body.
45
Food and Liquid Restrictions Before Surgery
You may eat up to 8 hours before your surgery.
Important
Call your surgeon’s office
if you have questions about
how to prepare for your
surgery.
—— Eat light meals such as oatmeal or toast.
—— Avoid foods that are heavy or high in fat such as meat
or fried foods.
Do not use chewing tobacco 6 hours before your surgery.
You may have clear liquids up to 2 hours before your surgery.
—— Drink water, fruit juice without pulp, tea or black coffee.
—— You may also have hard candy and gum.
—— Do not drink milk or alcohol, or eat yogurt.
Take your regular medicine(s) with a small sip of water, unless
your health care provider gives you other instructions.
The Morning of Surgery
If you were given instructions by your health care provider
to take medicines the morning of your surgery, take them as
directed with a small sip of water.
Do not take a bath or shower the morning of your surgery.
Put on clean, comfortable clothes to wear to the hospital.
Arrive at the hospital 2 hours before your surgery.
Allow extra time for walking, bad weather and traffic.
46
Chapter 5:
Surgery, Hospital Stay
and Beyond
In This Chapter:
„„
What to Expect the Day of Surgery
„„
Anesthesia: What You Need to Know
„„
How to Manage Your Pain After Surgery
„„
Walking in the Hospital
„„
Patient Care Plan
„„
Preventing Problems (Complications)
„„
How to Use an Incentive Spirometer
„„
Ten Tips to Prevent Falls While You Are in the Hospital
„„
Discharge Planning
„„
Questions for My Health Care Team Before Surgery and
Beyond
Discharge
Chapter 5: Surgery, Hospital Stay and Beyond
What to Expect the Day of Surgery
When you arrive at the hospital
Go to the surgery registration area.
After you check in, you will be directed to the pre-surgery
care area.
Pre-surgery care area
Go to the waiting room.
You will be brought back to a pre-surgery care suite.
A member of your health care team will meet with you to
complete your care plan.
After you are settled, the person with you on the day of surgery
will be invited back to join you.
A member of your health care team will review what you can
expect before and after your surgery.
Your anesthesiologist will also meet with you.
Your anesthesiologist and surgeon will work with you to
choose the right type of anesthesia for your surgery.
Your surgeon will visit with you. He or she will mark the
surgery site on your body and answer any questions you may
have.
You will be asked to sign a consent form.
Information for your care circle
While you are in surgery and recovery, your care circle can wait
in the surgery waiting room.
Your surgery time will vary depending on the type of surgery
you are having. Your surgeon will talk with your care circle
when your surgery is over.
49
Anesthesia: What You Need to Know
Anesthesia is medicine that blocks the feelings of pain and
sensation during surgery.
An anesthesiologist (doctor) or a certified registered nurse
anesthetist (CRNA) is usually responsible for giving you the
anesthesia. This person evaluates your medical status and talks
with you to decide which anesthesia is best for you.
General anesthesia will be used, which puts you to sleep during
surgery. It is given to you by shot (injection). A breathing tube
helps you breathe oxygen while you are under anesthesia. Side
effects of anesthesia include sore throat, headache, hoarseness,
upset stomach (nausea) drowsiness and dry mouth.
Post Anesthesia Care Unit (PACU)
After surgery, you will be taken to the recovery room or
Post Anesthesia Care Unit (PACU).
Most people stay about 1 to 3 hours in the PACU. Your time
in the PACU will depend on your surgery and how fast you
recover from the anesthesia.
A member of your health care team will monitor your vital
signs and help if you have any side effects from the anesthesia.
You may have some discomfort and pain when you wake up.
Everyone reacts to pain differently. A member of your health
care team will work with you to make you as comfortable as
possible.
You may have a back or neck brace for extra support and
protection.
An X-ray may be taken of your back or neck in the PACU.
Post-surgery care area
You will be taken to a post-surgery care area when:
—— you are fully awake
—— your medical status is stable
—— your room is ready for you
—— your nursing staff is ready for you.
When you are in the post-surgery care area, it is important to:
—— do ankle pumps, buttocks squeezes and thigh squeezes.
These will help to prevent blood clots from forming in your
legs.
50
—— use your incentive spirometer and do deep breathing
exercises. See page 60 for instructions for how to use your
incentive spirometer.
How to Manage Your Pain After Surgery
Types of pain
Pain can last less than 3 to 6 months (acute), last a long time
(chronic) or be severe and intense (breakthrough). Pain can be
constant or it can come and go with injury, illness or surgery.
Important
Your right to pain management
Having no pain while in the
hospital is not realistic, but
pain can be controlled.
You have the right to have your pain managed. Proper treatment
of pain is necessary for you to achieve the best results during
your recovery.
Your health care team will
work closely with you to help
manage your pain during
your hospital stay and when
you return home.
If you do not think that your pain is being treated well, please tell
a member of your health care team. He or she will talk with you
about your pain and your pain management needs.
You and your health care
team will establish a “pain
goal” – the amount of
acceptable pain you can
handle during your
hospital stay.
Using a number scale (0 to 10) to rate your pain will help the
health care team members know how severe your pain is and
help them make decisions about how to treat it.
Pain scale
You will have pain. Your
pain goal will be to have a
pain level that balances pain
control with your ability
to do physical therapy and
daily activities.
51
Your role in managing pain
After surgery, it is common to have pain. A member of your
health care team will monitor your pain level often and help you
manage the pain.
Since you are the only one who knows where and how severe
your pain is, you have a key role in managing your pain. Tell a
member of your health care team if you have pain.
All of the following information will help your health care team
prescribe the right medicine and therapy for your pain, and
prevent serious side effects (complications). Tell a member of
your health care team:
where you feel pain and how much pain you have
(Use words to describe how the pain feels.)
what makes your pain better or worse
what methods of pain control have worked or have not
worked well in the past
if your pain starts to get worse or you have new pain
if you take pain medicine(s) on a regular basis
if you have allergies or reactions to pain medicine(s)
your goals for managing your pain
what vitamins, herbal and natural products you are taking
if you smoke
if you drink more than two alcoholic drinks each day
if you take illegal (street) drugs
if you are in a methadone maintenance program.
Treatments to manage pain
Important
You can expect your pain
to lessen as you heal.
Your health care team will
work with you to help
manage your symptoms
with medicines and other
methods. Please talk with a
member of your health care
team if you have concerns.
Keeping your pain managed is more than taking prescription
(opioid) pain medicine. Your health care team will work with you
to manage your pain. Your options may include:
medicines
physical therapy
cold (ice packs)
integrative therapies: acupuncture, relaxation techniques,
massage therapy or music
psychological therapies
shot or infusion in the spinal canal
transcutaneous electrical stimulation.
52
Quitting smoking may also help to decrease pain.
Tip
Pain medicine side effects
Take pain medicine when
pain first begins. If you know
your pain may get worse
with activity, take your pain
medicine before the activity.
All medicines have possible side effects, but not everyone gets
them. When side effects occur, it is usually within a few hours
after taking the medicine. Most side effects can be managed and
go away in time.
Do not wait for pain to
get worse before taking
medicine. Tablets or pills
may take up to 30 minutes
to begin working. Timing of
when to take medicines is
important.
Talk to a member of your
health care team about how
to time your pain medicines
before therapy or activity.
Tell a member of your health care team right away if you have:
constipation
sleepiness
dizziness
itching, a rash or both
upset stomach (nausea) or throwing up (vomiting)
slowed breathing
confusion.
Ways to give pain medicine
There are many ways to give medicine for pain. Your health care
team will help you decide which way might be best for you:
tablets or pills
into a vein (intravenous)
patient controlled analgesia (PCA) pump
through the skin (transdermal)
shot (injection)
shot or infusion in the spinal canal.
Pain control can help you
The right pain control can help:
you be more comfortable
you get back to your normal routine
you participate more completely in your exercises and therapy
promote healing.
53
Before you go home
A member of your health care team will give you directions for
managing your pain at home. Be sure to have written instructions
with a health care provider’s name and number who will manage
your pain after you go home.
It is important you follow any directions you receive for taking
pain medicine. Ask a member of your health care team if you
need help.
Call your surgeon or primary care provider if you have concerns
or side effects from pain medicine.
Walking in the Hospital
Did You Know?
Your physical therapist may
give you instructions and tips
about:
While in the hospital, your goal will be to walk at least four times
a day. Your health care team will:
help you follow your patient care plan
encourage you to go for walks (with help from staff, a member
of your care circle or on your own when you are ready)
when to use your walker
remind you to maintain good posture during your walks
how to develop your home
walking program.
help you track how many times you go walking each day.
Remember to maintain good posture during your walks.
It is important that you:
keep your head up
wear shoes with good support (no heels)
relax your shoulders
do not lean forward.
Patient Care Plan
A smooth and speedy recovery depends on your help
and cooperation. Your participation is essential in reaching
your goal to return home and prevent complications.
Many people wonder how long they will need to stay in the
hospital after surgery. Your health care team will work with you
to determine your discharge and home care needs.
The care map on the following pages will tell you what to expect
during your hospital stay.
54
55
Activity
‰ You may see a physical therapist (PT),
occupational therapist (OT) or both.
‰ Use the logroll technique at least
every 2 hours and when you get
in and out of bed.
‰ Follow your precautions.
‰ If you have a brace, wear it as
directed.
‰ Your activity goals are to:
‰ Eat meals sitting in your chair.
‰ Walk in the hallway 4 to 5 times.
r1 r2 r3 r4 r5
‰ Wear your leg compression wraps
to prevent blood clots.
‰ Do 10 ankle pumps every hour while
you are awake.
‰ You may take a shower if your
surgeon says it’s OK.
Date: _______________
Second and Third Days After Surgery
In general, this Care Map is what you can
expect during your hospital stay of 2 to
3 days. Your health care team will make changes
unique to your recovery. You will be discharged
by__________. You and your nurse will fill this out
as you work on discharge planning together.
‰ You may see a physical therapist
(PT), occupational therapist (OT)
or both.
‰ Use the logroll technique at least
every 2 hours and when you get
in and out of bed.
‰ You may be fitted for a brace.
Wear it as directed.
‰ Your activity goals are to:
‰ Eat meals sitting in your chair.
‰ Walk around your room and
then progress to the hallway
with walker or assistive device,
if needed, 4 times a day.
r1
r2
r3
r4
‰ Follow your precautions.
‰ Wear leg compression wraps
to prevent blood clots.
‰ Do 10 ankle pumps every hour
while you are awake.
Date: _______________
Date: _______________
‰ Use the logroll technique at least
every 2 hours and when you get
in and out of bed.
‰ If you were fitted with a back
brace, the nurse will help you
put it on. Wear it as directed.
‰ Wear leg compression wraps to
prevent blood clots.
‰ Your activity goals are to:
‰ Sit on the edge of your bed.
‰ Stand and take a few steps.
‰ Take a short walk if you
are able with help from your
nurse.
‰ You will learn how to do ankle
pumps while in bed. Do 10 of
them every hour when you are
awake.
‰ Follow your precautions.
Avoid forward or side bending,
twisting, pushing, pulling, lifting
and reaching. Do not lift more
than 5 pounds or as instructed
by your surgeon.
First Day After Surgery
Day of Surgery
Lumbar Spinal
Fusion Surgery
(Lumbar Fusion)
Food
Comfort
‰ You will receive pain medicine.
‰ Talk with your nurse about your
pain goal and how to manage
your pain.
‰ Tell your nurse if your pain is
getting worse or if your pain
medicine isn’t giving you relief.
‰ Medicine is available to treat
nausea (upset stomach), if needed.
‰ Ask your nurse about
non-medicine ways to treat
pain and nausea.
‰ Use cold packs on your surgery
site for comfort.
‰ When the bed is flat, use 1 pillow
under your knees. When lying
on your side, use 1 or 2 pillows
between your knees.
‰ After surgery, you may have
small sips of water.
‰ You will have an IV (intravenous)
line in your arm or hand to give
you fluids.
Date: _______________
Day of Surgery
‰ You will receive pain medicine.
‰ Talk with your nurse about your
pain goal and how to manage
your pain.
‰ Tell your nurse if your pain is
getting worse or if your pain
medicine isn’t giving you relief.
‰ Medicine is available to treat
nausea (upset stomach), if needed.
‰ Ask your nurse about
non-medicine ways to treat
pain and nausea.
‰ Use cold packs on your surgery
site for comfort.
‰ When the bed is flat, use 1 pillow
under your knees. When lying
on your side, use 1 or 2 pillows
between your knees.
‰ If you can keep liquids down,
drink 6 to 8 glasses of water.
‰ Your IV fluids may be stopped
if you drink enough water.
‰ You may eat foods if you have
active bowel sounds, are passing
gas and do not have an upset
stomach.
Date: _______________
First Day After Surgery
‰ You will receive pain medicine.
‰ Talk with your nurse about your
pain goal and how to manage
your pain.
‰ Tell your nurse if your pain is
getting worse or if your pain
medicine isn’t giving you relief.
‰ Medicine is available to treat
nausea (upset stomach), if needed.
‰ Ask your nurse about
non-medicine ways to treat
pain and nausea.
‰ Use cold packs on your surgery
site for comfort.
‰ When the bed is flat, use 1 pillow
under your knees. When lying
on your side, use 1 or 2 pillows
between your knees.
‰ Drink 6 to 8 glasses of water.
‰ You may eat foods if you have active
bowel sounds, are passing gas and
do not have an upset stomach.
Date: _______________
Second and Third Days After Surgery
56
57
‰ Use the incentive spirometer
every hour while you are awake.
‰ Take deep breaths and cough
often.
‰ You may receive extra oxygen.
Breathing
the surgery area to remove extra
fluid.
‰ If you still have a bladder catheter,
it will be removed.
‰ Your nurse will make sure you are
emptying your bladder by doing
a bladder ultrasound.
‰ Tell your nurse if you have
problems passing urine.
‰ You will have medicine to
help prevent constipation.
Date: _______________
Second and Third Days After Surgery
removed today.
‰ Your dressing may be changed
or removed.
‰ You may have blood tests.
‰ If you had a drain placed near
the surgery area, it will be
removed today.
‰ Your dressing may be changed
or removed.
‰ You may have an X-ray.
‰ Use the incentive spirometer every ‰ Use the incentive spirometer every
hour while you are awake.
hour while you are awake.
‰ Take deep breaths and cough often. ‰ Take deep breaths and cough often.
‰ Your nurse may remove your
bladder catheter. He or she will
also help you to the bathroom or
bedside commode.
‰ Your nurse will make sure you are
emptying your bladder by doing
a bladder ultrasound.
‰ Tell your nurse if you have
problems passing urine.
‰ You will have medicine to
help prevent constipation.
‰ You may have blood tests.
Tests, Labs ‰ A dressing will cover your
incision.
and
‰ If you had a drain placed near
Procedures ‰ You may have a drain placed near
the surgery area, it may be
‰ You may have a catheter in your
bladder. If not, you will be helped
to the bathroom or bedside
commode.
‰ Your bladder catheter will be
taken out once you are walking.
‰ If you do not have a catheter
in your bladder, your nurse
will want to make sure you’re
emptying your bladder by doing
an ultrasound.
‰ You will have medicine to
help prevent constipation.
‰ Tell your nurse if you had any
problems with your bladder or
bowels before surgery.
Date: _______________
Date: _______________
Bladder/
Bowel
First Day After Surgery
Day of Surgery
Date: _______________
Day of Surgery
Date: _______________
First Day After Surgery
Date: _______________
Second and Third Days After Surgery
Education Before You Leave the Hospital (Discharge)
What are your needs at home:
Discharge Plan
Planning ‰ Talk with members of your health ‰ Talk with members of your health
care team about your discharge
care team about your discharge
for
plan.
plan.
Discharge
(Leaving the ‰ Make plans for who will pick you ‰ Talk with members of your health
up from the hospital at discharge.
care team about your equipment
Hospital)
needs after discharge.
‰ After your hospital stay you
may go:
‰ Make plans for who will pick you
up from the hospital at discharge.
‰ home
‰ home with home care
‰ to a short-term rehab facility.
‰ activity and precautions to follow
‰ how to wear your brace
‰ how to care for your incision
‰ how to take your medicines
___________________________________________________________
‰ Review your discharge plan and
equipment needs with your health
care team.
‰ You may be able to leave the hospital
when you can:
‰ eat and drink without problems
‰ take pain medicine by mouth
‰ pass urine
‰ meet your activity goals.
‰ Tell your nurse if you need your
pain medicines filled before you
leave the hospital.
Did You Receive
Other: ____________________________________________________
Who is taking you home: ____________________________________
___________________________________________________________
Who will help you at home:
‰ patient education book and materials
‰ After Visit Summary
‰ prescriptions
‰ adaptive equipment, brace or both
‰ other ___________________________________________________
ortho-ah-86481 (5/16)
© 2016 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.
OTHER TRADEMARKS USED ARE OWNED BY THEIR RESPECTIVE OWNERS
THIS CARE MAP DOES NOT REPLACE MEDICAL OR PROFESSIONAL ADVICE; IT IS ONLY A GUIDE.
58
Preventing Problems (Complications)
Your health care team will do many things to reduce your chance
of a developing a complication after surgery.
Tip
Ask a member of your
health care team if you have
any questions about the
activities to help prevent
complications.
Your blood pressure, temperature and pulse will be taken often
after surgery.
You will do thigh squeezes, buttock squeezes and ankle pumps
to improve circulation and strength.
You will do deep breathing exercises and use an incentive
spirometer to help protect your respiratory system.
Your dressing may be changed or removed during your
hospital stay.
You may have a small tube that is connected to a wound drain
or collection container. It will draw out excess blood and fluid
from the area around your incision. This small tube will be
removed 1 to 2 days after surgery.
You may have an intravenous (IV) line for 1 to 2 days.
It is important to drink 6 to 8 glasses of liquid each day.
Your inactivity and pain medicine combined can cause
constipation. To help prevent this:
—— Drink plenty of liquids.
—— Eat foods with plenty of fiber including whole-grain bread,
bran cereals, fresh fruit and vegetables.
—— Increase your activity as you are able.
Talk to a member of your health care team about a bowel
program if you are uncomfortable and the actions above
are not working. You may receive a stool softener or laxative
medicine to help prevent constipation.
Ask a member of your health care team if you have questions
about these care activities.
59
How to Use an Incentive Spirometer
Incentive spirometer
After surgery, it may be difficult to breathe as you normally do.
You may notice your breathing changes to small, shallow breaths.
This can cause fluid and mucus to build up in your lungs,
increasing your risk for respiratory system complications.
An incentive spirometer is a hand-held breathing exercise device
to help you breathe deeply. Taking deep breaths allows air to
inflate your lungs, opening your airways to prevent fluid and
mucus buildup.
Using an incentive spirometer may speed your recovery and
lower your risk of lung problems such as pneumonia.
How to use the incentive spirometer
1. Sit upright in a chair with your feet flat on the floor.
(If you are not able to sit up in a chair, sit as upright as
possible.)
2. Place the spirometer on your bedside table or hold it in an
upright position.
3. Place the mouthpiece in your mouth. Seal your lips tightly
around the mouthpiece.
4. Inhale as slowly and deeply as possible through the
mouthpiece. Your health care provider will work with you to
set a breathing goal, which will be marked with small arrows
on the incentive spirometer. As you inhale, the small square
should stay between the arrows.
5. Hold your breath for 3 to 5 seconds. Then exhale slowly
through pursed lips. (Pursed lips are in the shape of blowing
out a candle.)
6. Repeat 10 times, resting between each time.
7. It is important to cough to clear any secretions. Coughing
(clearing your airway) will make breathing easier. It will also
strengthen your muscles after each use.
How often you need to use the incentive spirometer
At the hospital: You will need to use the incentive spirometer
10 times every hour you are awake after surgery.
60
At home: You will need to use the incentive spirometer
10 times every 2 hours for your first 7 days at home.
Ten Tips to Prevent Falls While You Are in the Hospital
Remember: Certain medicines, general weakness and new
surroundings during your hospital stay can increase your risk
of falling.
Tips to prevent falls
1. Use the call light when you need help.
2. Ask a member of your health care team for help to and
from the bathroom. This is very important if you are unsteady.
The call light in the bathroom may be located on the wall.
3. For your safety, a member of your health care team may stay
with you in the bathroom.
4. If you take medicines that cause you to go to the bathroom
often, ask for help when you need to get up. Consider using a
commode or urinal.
5. Some medicines may cause you to feel dizzy or sleepy.
Take your time getting out of the bed or chair. Sit at the edge
of the bed for a few seconds before you get up.
6. Wear nonslip footwear or slippers when you are up.
7. Wear your eyeglasses, hearing aid(s) or both when you are
awake.
Tip
See chapter 10 for more
information about special
equipment you may need
after your surgery.
8. Walkers and canes can provide support. Other items do not.
Do not lean on the bedside table, furniture, IV pole or other
items to steady yourself.
9. Ask a member of your health care team to place the call light,
phone and personal items within your reach before he or she
leaves the room.
10.Tell a member of your health care team if you have any
concerns about your safety.
61
Discharge Planning
Did You Know?
A discharge plan is
something that you, your
care circle and health care
team can begin working on
even before your surgery.
Planning for leaving the hospital
Making plans for when you leave the hospital is a very important
part of your recovery. Your health care team will work with
you and your care circle to help develop your discharge plan.
By using this plan, you and your care circle can make most
arrangements for leaving the hospital before your surgery.
A discharge plan is one of the following:
Home
You can return to your home if you can do the following at the
time of discharge:
You can get in and out of bed and a chair with little help.
You can walk independently or with your walker.
You can walk the distance from your bedroom to your
bathroom and kitchen.
You can go up and down stairs safely if needed.
You also need to have help from your care circle on a regular
basis until you regain your independence and self-confidence
in walking and daily living activities.
Home with home care
Most people can return home at discharge. Your care circle will
need to provide the majority of your care after you leave the
hospital. Home care providers are available to make home visits
but are not responsible for caring for your day-to-day needs.
The home care providers can be physical or occupational
therapists, home health aides or nurses. You can schedule a time
for them to come into your home to help you with special care
such as walking, strengthening exercises, safety and monitoring
your medical condition.
A social worker will talk to you while you are in the hospital to
see if you qualify for visits from home health providers.
62
Tip
Transitional care unit (TCU) or short-term rehabilitation center
Talk with your social worker
or care coordinator to find
out if you qualify for a stay at
a transitional care unit (TCU)
or short-term rehabilitation
center.
Some people need more help and services than what can be
reasonably provided at home. Such services can include daily
skilled nursing care, additional rehabilitative therapy or both.
In a transitional care unit (TCU) or short-term rehabilitation
center, you can continue your rehabilitation program and have
your medical needs monitored until you can safely return home.
Therapy sessions focus on building strength, endurance and
self-care skills. You will be cared for by a team of health care
providers who will work with you and your care circle so you
can return home as soon as possible.
Your health care team can help you identify a facility with the
extended care services you may need after your hospital stay.
To prepare for your stay at a TCU or short-term rehabilitation
center, there are a few things you can do before your surgery.
Choose more than one facility where you would be comfortable,
that have the rehab services you require after surgery and are
approved by your insurance company. If possible, you may visit
or call each of these facilities before your surgery.
63
Questions for My Health Care Team Before Discharge
1. If you have a brace:
When should I wear my brace?
Is it OK to take the brace off to shower?
2. When will I be able to resume all of my regular medicines?
3. If you were asked to stop taking your blood-thinning medicines, supplements or both before
surgery:
Ask your surgeon when you can resume taking them.
4. How many pounds can I safely lift? How long do I need to be careful with how much I lift?
5. Is the outside of my incision covered with:  Steri-Strips®  Dermabond®  sutures  staples
If you have sutures or staples: When do they need to be removed?
Do I wear a bandage at home?
When can I shower and get my incision wet?
6. When will I follow up with my surgeon?
64
7. When will I follow up with my primary care provider (if needed)? Any other follow-ups needed?
8. How long should I continue to use the incentive spirometer (breathing device)?
9. When can I resume my regular activity?
10. I have a trip planned for ________ (date). Will I be able to travel?
Ask your health care team to offer some suggestions to make your trip more comfortable and safe.
11. Do I have all the equipment I will need for at home? Do I need more information?
12. When can I drive?
65
In This Chapter:
„„
After Surgery Home Exercise Program
„„
How to Start a Walking Program
„„
Walking Program Chart
„„
Returning to Daily Activities After Surgery
Home Exercise
and Walking
Chapter 6:
Home Exercise and
Walking Program
Chapter 6:
Home Exercise and Walking Program
Tip
You also need to balance
physical activity with rest.
Plan on resting at least once
or twice a day.
Once you return home, it is important to follow your home
exercise and walking program. Regular physical activity
can help to:
prevent constipation
promote circulation
improve healing
promote sleep
prevent complications
Important
The rate at which you
increase your everyday
activities after surgery is
unique to you. It may take
up to 1 year before you
can resume your previous
activity level.
Here are some tips for getting
back to your everyday
activities:
Start with small tasks first.
Move slowly and carefully
to keep from bending and
twisting.
Lift no more than
5 pounds (or as instructed
by your surgeon) until
your surgeon says it is OK
to lift more.
See chapter 8 for information
about proper body
mechanics.
make you feel better about yourself
manage your weight
improve muscle tone
keep your joints flexible
increase your activity level to what it was before surgery.
Your muscles probably feel weak because you did not use them
much before surgery. Your home exercise program will help you
strengthen your muscles and increase your flexibility.
Your success with rehabilitation largely depends on your
commitment to follow the home exercise program (on the
following pages) developed by your therapists.
Ideally, you should do your exercises two times a day, every day,
after surgery. Do 10 repetitions of each of your exercises.
If you are comfortable with the exercises, increase the repetitions
by five each week until you reach 20 repetitions (week one:
10 repetitions, week two: 15 repetitions and week three:
20 repetitions).
For the most comfort, do your exercises lying down.
Your bed is an excellent place to do your exercises.
69
Exercises — after surgery
ˆˆAnkle pumps
Pump your feet up and down by pulling your feet up
toward you, then pushing your feet down away from you.
© Allina Health System
ˆˆThigh squeezes (quadriceps sets)
Tighten the muscles on the top of your thigh by pushing the
back of your knee down into the bed. Hold for 5 seconds and
relax.
© Allina Health System
ˆˆButtocks squeezes (gluteal sets)
Tighten your buttocks muscles by squeezing the muscles
together. Hold for 5 seconds and relax.
© Allina Health System
ˆˆAbdominal sets
Tighten your stomach muscles by pulling your belly button
in toward your spine. Do not move your spine. Hold for
5 seconds.
© Allina Health System
ˆˆSitting nerve floss
Sit on a sturdy chair. Straighten your knee as much as you can
without pain. Bend your ankle up, pulling your toes toward
you. Then bend your ankle down, pointing your toes away
from you. Repeat with the opposite leg.
© Allina Health System
70
Important: This exercise should only be done if instructed by
your surgeon. It should not be painful. If you feel pain or a
pulling sensation, do not straighten your knee as much. Work
toward straightening your knee more each time you do the
exercise.
71
Sitting nerve floss
Abdominal sets
Buttocks squeezes
Thigh squeezes
Ankle pumps
Exercise
M
T
W
Th F
Week 1
S
S
M
T
W
Th F
Week 2
S
S
M
T
W
Th F
Week 3
S
S
M
T
W
Th F
Week 4
S
Check the box under the appropriate day and week after you perform the exercises selected for you. If you feel comfortable
doing 10 repetitions of each exercise, increase the repetitions by 5 each week until you get to 20 repetitions.
After surgery home exercise program
S
How to Start a Walking Program
Besides your exercise program, you must leave time for walking.
Walking can keep your back healthy and strong, and build your
strength and endurance. Walk around your home at least four
times each day. (Trips to the bathroom or kitchen are not enough.)
Work toward walking outside and around your community.
Once you are able to walk comfortably, your goal is to increase
your walking each day.
Walking program guidelines
Buy comfortable walking shoes that provide good support.
Wear your brace if you are given one.
If your symptoms return when you walk or stand for a long
time, stop and correct your posture. Do not continue the
activity if it causes you pain or discomfort.
Do not walk outdoors in hot or cold weather or when the
ground is icy. Instead, go to a shopping center or mall,
community center or school to walk.
Try to walk on level surfaces.
If you are having trouble at any point, slow your pace and
remain at that pace until you can do more with ease.
Plan to walk daily. Work it into your schedule as a permanent
walking program.
If you are planning to walk for more than 15 minutes, warm up
and cool down by walking at a leisurely pace.
Use the chart on the next page to keep track of your walking.
72
Walking Program Chart
Date
Time/Distance Walked Number of Walks/Day
73
Returning to Daily Activities After Surgery
Tip
It takes time to recover from
surgery. Expect to feel tired
and to have some trouble
concentrating. It is OK
to ask for help with your
daily activities during your
recovery.
Important
Do not do any bending,
lifting or twisting activities.
Your daily activities are important in your recovery. The rate at
which you increase your activities after surgery is unique to you.
It may take a few months before you can resume your previous
activity level.
Start with small tasks first. Move slowly and carefully to keep
from bending, lifting and twisting. See chapter 8 for information
about proper body mechanics.
Ask your care circle for help when you need it. Some people need
home care assistance for bathing needs and light housekeeping.
Others may need more help than their care circle can provide
and will stay at a transitional care unit (TCU) or short-term
rehabilitation center for 1 to 2 weeks until they are more
independent.
Sexual activity
You can resume sexual activity when you are ready.
More Information
Visit recoversex.com for more
information about resuming
sexual activity after surgery.
Right after surgery, it may be necessary to take pain medicine
before having sex.
A firm mattress is recommended.
Wear your back or neck brace during sexual activity.
Be the passive partner for the first 6 weeks after surgery.
Use the missionary or less-dominant position.
74
In This Chapter:
„„
What to Expect During Your Recovery
„„
Commonly Asked Questions
„„
Questions to Ask at My Follow-up Appointment
„„
Pain Relief
„„
Pain Medicine: What You Need to Know
„„
Nutrition: What You Need to Know
Care After
Surgery
Chapter 7:
Care After Surgery
Chapter 7: Care After Surgery
After your surgery, there is a variety of things you need to know
for your safety, recovery and comfort.
This chapter includes information about what to expect during
your recovery, a list of commonly asked questions, a list of
questions to ask at your follow-up appointment, and information
about pain relief, pain medicines and nutrition.
Ask your health care team if you have any questions. They want
your recovery to be as smooth as possible.
What to Expect During Your Recovery
After surgery, it may take a while before you feel like your
normal self. Recovery is different for each person. The following
are a few things you may have after surgery and some ways to
manage them.
You may have discomfort for the first several weeks or months
after your surgery. To help manage discomfort or pain after
your surgery:
Tip
—— take your pain medicine as directed by your health care
provider
See the section “Pain
Medicine: What You Need
to Know” in this chapter
for more information about
taking pain medicine.
—— rest between activities as needed.
—— put a cold pack to your incision several times each day.
Place a clean, dry towel on your skin before you place the
cold pack. Leave the cold pack on for 15 to 20 minutes
at a time.
—— lie down to raise (elevate) your legs several times
during the day.
You may have trouble sleeping. To help get a better night’s
sleep after surgery:
—— try not to sleep or nap too much during the day
—— sleep on your back or your side (not on your stomach)
• When lying on your back, a pillow should be placed
under your knees. Keep your toes pointed straight up
or slightly outward. Place a thin pillow along each side,
just under your shoulders down to your hips. This will
lessen the pressure on your incision.
• When lying on your side, place one to two pillows
between your legs. The pillows hold your body in proper
alignment.
77
Important
—— make your bedroom (or where you sleep) comfortable
Talk with your health care
provider if you have trouble:
• Make sure your mattress provides good support.
falling asleep
• Wear loose-fitting pajamas or night clothes.
staying asleep
• Make sure your room is quiet. You may need to close
the door, wear ear plugs, play soft music or listen to a
relaxation tape.
staying awake during the
day.
• Keep the room temperature comfortable.
—— try to create a routine of going to bed and waking up at the
same time each day
—— try not to drink too many liquids right before going to bed
Tip
If you cannot fall asleep or
get back to sleep, do not stay
in bed. Go to another room
and do a quiet activity such
as reading for a while until
you get sleepy. Then go back
to bed.
—— avoid stress before bed.
Your energy level will be low for at least the first month after
surgery. To help manage your energy level after surgery:
—— try to take your pain medicine at the same time each day
—— rest between activities
—— try to get up and move around each hour you are awake.
You may not have much of an appetite.
—— Your desire for food will slowly return.
—— Be sure to drink plenty of liquids to stay hydrated.
Try to drink six to eight 8-ounce glasses of liquids
each day.
You may have constipation. This can be caused by taking
pain medicine. For more information on how to manage
constipation after surgery, see pages 81 to 82.
78
Commonly Asked Questions
Important
Call 911 right away if you
have:
sharp chest pain that
may get worse with deep
breathing or coughing
shortness of breath
confusion
sweating.
When should you call your surgeon or primary care
provider?
Call your surgeon if you have:
a temperature of 101.6 F or higher
problems or signs of infection at your incision site such as:
—— pain
—— swelling
—— redness
—— odor
—— warmth
—— green or yellow discharge
any change in your ability to move such as new weakness,
or not being able to move your arm or leg
any change in sensation such as new numbness or tingling
severe pain not relieved by medicine, rest or ice
any problems, questions or concerns related to your surgery.
Call your primary care provider if you have:
any unusual bruising or bleeding
feelings of being dizzy or lightheaded
an upset stomach (nausea) and throwing up (vomiting) that
will not stop
any bowel problems such as constipation or bloody stools
any problems urinating such as burning, urgency or frequency
any other problems, questions or concerns.
Call 911 or have someone take you to the nearest hospital
Emergency Department if you have any chest pain, trouble
breathing, shortness of breath, confusion or sweating.
79
What are signs and symptoms of an infection?
Signs and symptoms may include:
increased redness, swelling or warmth at the incision site
change in color, amount, odor of drainage
increased pain
temperature higher than 101.6 F.
Call your health care provider if you have any of the above signs
or symptoms.
What are signs and symptoms of a blood clot?
Signs and symptoms may include:
swelling in one or both legs
pain or tenderness in one or both legs
warmth of the skin in the affected leg
redness or discolored skin in the affected leg
leg fatigue.
Call your health care provider if you have any of the above signs
or symptoms.
What are signs and symptoms of a pulmonary
embolism?
Signs and symptoms may include:
shortness of breath
sharp chest pain that may get worse with deep breathing
or coughing
confusion
sweating
signs of shock.
Call 911 right away if you have any of the above signs or
symptoms.
80
Important
Please read your discharge
instructions for more
information about incision
care.
How do you take care of your incision and change
the dressing?
You should look at your incision every day and keep it clean
while it heals.
Do not put any creams, salves or ointments on the area.
If thin paper strips (Steri-Strips®) were used on the incision,
they will fall off as the incision heals. They do not need to be
replaced.
If staples were used, they will be removed at your follow-up
appointment 10 to 14 days after surgery.
Tip
If a special glue was used on the incision, the glue will loosen
from your skin on its own as the incision heals.
It is important to wash your
hands before starting the
dressing change and again
after you are finished.
Your dressing will likely be removed before you leave the
hospital. If you are sent home with a dressing, change it as
directed by your surgeon.
Do not take a tub bath until your surgeon says it is OK. (This
also includes swimming in pools or lakes and using hot tubs.)
How do you manage constipation after surgery?
Constipation is common after surgery, especially while you are
taking pain medicine and your daily activity level is decreased.
Signs of constipation include:
fewer number of bowel movements
small, hard stools that are difficult to pass
feeling bloated and uncomfortable
gas
abdominal cramping.
How to prevent constipation
Drink six to eight 8-ounce glasses of liquids each day.
Liquids add moisture to stool, making them easier to pass.
Water is your best choice. Caffeine or alcohol can make
constipation worse.
Eat foods with plenty of fiber including whole-grain bread,
bran cereals, fresh fruit and vegetables.
Be as active as you can each day. Walking around your house
or apartment will help. Follow your health care provider’s
directions for exercise.
Try to have a bowel movement when you feel the urge. Do not
ignore the urge. Try to set aside some time after breakfast or
dinner to sit on the toilet.
Take less pain medicine if possible. Follow your health care
provider’s directions for taking pain medicine.
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Tip
Use of constipation medicines
Laxatives and stool
softeners can be purchased
at most local grocery
stores, drugstores and
large retailers.
You may need to take a laxative to prevent constipation as long
as you are taking prescription pain medicine. Common products
include:
Read the label carefully
and follow package
directions. Talk with your
pharmacist if you have
any questions.
Stop taking a laxative or
stool softener when your
bowel movements are
back to normal.
stimulant laxatives. These cause the colon to have a bowel
movement. This is the best choice when your constipation is
caused by a prescription pain medicine. Examples include
senna (Senokot®) and bisacodyl (Dulcolax®, Correctol®).
Follow package directions.
stool softeners. These add moisture to the stools to make the
stool softer and easier to pass. These may not be enough to
prevent constipation while you are taking a prescription pain
medicine. An example is docusate (Colace®). Follow package
directions.
When to call your health care provider
Call your health care provider if:
your constipation does not improve after you have:
—— made changes to what you are eating
—— made exercise changes
—— tried laxatives or stool softeners
you have not had a bowel movement in 3 days
you have a severe, sudden onset of abdominal pain
you have blood in your stool
you have an upset stomach (nausea) or are throwing up
(vomiting).
When can you return to eating the foods you
normally do?
As soon as you are able, eat well-balanced meals and snacks
to help you recover more quickly and feel your best. What you
eat after your surgery affects your well-being. You need to eat
healthful meals and drink lots of liquids. For more information
about nutrition, see pages 88 to 90.
What precautions should you keep in mind?
Tell health care providers and dentists of your spine surgery
before having any surgery, podiatry procedures, dental work,
X-rays, or other tests or procedures. You may need to take
antibiotics.
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Tip
Will you set off metal detectors in airports?
For more information about
metal detectors and traveling:
If your spine implants have metal, they may set off the metal
detectors in airports. It is recommended to tell the security officer
that you have a metal implant and where it is located before you
go through security screening. The security officer may offer you a
private security screening
visit tsa.gov
type “medical conditions”
in the search box at the top
and click the search icon
click on Disabilities and
Medical Conditions in the
search results.
Do you need to take preventive antibiotics before
dental work?
Germs (bacteria) that can cause infections in your teeth or gums
can be released into your bloodstream during some dental
procedures.
To help prevent an infection, you may need to take antibiotics
before dental work if you have:
a weak immune system caused by medicines, radiation,
or a disease or condition
type 1 diabetes
inflammatory arthritis such as rheumatoid arthritis
blood that does not clot normally (hemophilia).
Important
Ask your surgeon when it is
OK to resume having routine
dental appointments or any
dental work done.
Be sure to also tell your dentist about all of the surgeries you
have had.
If you need to have any of the following dental procedures,
you may also need to take antibiotics.
gum disease treatment
one or more teeth removed
root canal
anesthetic injections in gums
having artificial teeth (implants) placed
any treatment that could cause bleeding such as cleaning.
Your dentist and surgeon will work together to decide which
type of treatment is right for you.
When can you drive a car?
Talk with your surgeon about when you can resume driving.
Do not drive while taking pain medicine because it can impair
your judgment and ability to operate the car safely.
83
When can you return to work or your hobbies?
Discuss returning to work and hobbies, and any physical
restrictions you may have with your surgeon.
When do you need to have your first follow-up
appointment with your surgeon?
Call your surgeon’s office for a surgery follow-up appointment
if you do not already have one or if you have any questions or
concerns. See the worksheet on the next page about questions
to ask your surgeon at this appointment.
84
Questions to Ask at My Follow-up Appointment
1. If I am still taking pain medicine, how much longer should I take it? ____________________
Should I make any changes to the amount of pain medicine I am taking? ____________________
2. When can I resume taking my blood thinner medicine? ____________________
3. Can I take anti-inflammatory medicines? ____________________
If I cannot now, when can I start? ____________________
4. Do I need to start physical therapy?  yes
 no
5. Can I do the following:
 take a tub bath
 start driving a car again (if I am not driving already)? ____________________
6. If I have a brace or corset, how long do I have to wear it? ____________________
7. When can I lift more than 5 pounds? ____________________
8. When can I increase my leisure activities such as traveling, golfing or dancing? __________________
9. When can I return to work or school? ____________________
Should I return full time or part time?  full time
 part time
If I should return part time, when can I work full time? ____________________
10. What restrictions will I have at work or school? ____________________
How long will I have these restrictions? ____________________
11. Are there any other restrictions I should follow? ____________________
Other questions:
85
Pain Relief
For More Information
Keeping your pain managed
continues when you leave
the hospital.
For more information on
keeping your pain managed,
visit allinahealth.org/
painvideos to watch a series
of four short videos on pain.
The topics are:
pain expectations
how to use the pain scale
how to treat pain in the
hospital
how to keep your pain
managed at home.
You can watch the videos as
often as you would like.
Important
Do not apply heat to your
incision until your surgeon
says it is OK.
86
Your pain should lessen every week. There are many ways you
can ease your pain:
Go for a walk a few times each day.
After activity (exercises or walking) lie down and apply a cold
pack to your incision. This can help reduce swelling and pain.
—— Use a clean, dry towel on your skin before you place the
cold pack. Leave the cold pack on for 15 to 20 minutes
at a time.
—— Use cold packs on your back several times throughout
the day.
You may feel some discomfort in your back. You may also have
swelling after surgery. This is normal and will gradually go
away.
Take your prescription pain medicine as directed.
Muscle spasms
Having a sudden tightening of the muscle (muscle spasms) is
common after surgery. You can treat this with ice by applying
cold packs to the area for 15 to 20 minutes at a time. Do not apply
heat to your incision until your surgeon says it is OK.
Pain Medicine: What You Need to Know
Tip
Change positions every
45 to 60 minutes or more
often for comfort.
What to remember when taking pain medicine
Many pain medicines (like Tylenol®) have acetaminophen.
Pharmacists advise that you take no more than
4,000 milligrams (4 grams) of acetaminophen in 24 hours.
More than that could damage your liver. Acetaminophen
is also found in cough and cold medicines.
Do not drink alcohol while taking prescription pain medicine.
Do not drive any motor vehicles while taking narcotics or pain
medicines that make you sleepy, or affect your judgement or
reaction time.
Eat a variety of healthful foods and drink six to eight
8-ounce glasses of water each day. Eat a lot of fresh fruit, raw
vegetables and other foods high in fiber. This will help prevent
constipation. Talk with your health care provider or pharmacist
about what you can do if you are constipated.
Taking your pain medicine with a small amount of food may be
helpful to control stomach upset.
How to cut back your use of pain medicine
Take the medicine as directed. Take the medicine at the same
time the first few days you are home.
Cut back on the pain medicine when you think the pain is
under control. You can go for longer times between doses or
only take one pill instead of two. Take the medicine at the time
of the day when you most often feel pain. This may be:
—— when you wake up in the morning
—— before you start certain activities
—— when you are ready for bed.
When to call your health care provider or pharmacist
Call your health care provider or pharmacist right away if you
have any of the following.
—— Take less of the pain medicine and call your health care
provider if you have unusual feelings after taking it. This
includes feeling dizzy, itchy or nauseous.
—— Make sure your health care provider knows what you are
taking if you take several medicines. Some medicines can be
harmful when taken with others.
—— Call your health care provider’s office several days before
the weekend if you need a narcotic pain medicine refill close
to the weekend.
87
Nutrition: What You Need to Know
Tip
According to the United
States Department of
Agriculture, you should:
eat smaller portion sizes
make half of your grains
whole
make half of your plate
vegetables and fruits
drink fat-free or low-fat
milk
eat lean proteins.
Good nutrition is essential for your recovery. Eating wellbalanced meals and snacks will help you recover quickly and
help you feel your best. What you eat after surgery affects your
well-being.
If you do not eat enough of the right foods, you will become tired
and less able to take care of yourself. Be sure you make time to
eat — even if you do not feel hungry.
Try to think about what your plate should look like when you are
planning your meals and snacks.
For meals:
(9-inch plate)
fruit
Visit choosemyplate.gov
for more information about
nutrition.
protein
nonstarchy
vegetables
Important
starch
If you have questions about
your nutrition and recovery,
please ask your health care
provider.
Tip
Be sure to drink six to eight
8-ounce glasses of liquids
(especially water) each day.
88
For snacks:
protein
fruit
nonstarchy
vegetables
grain
Here are some examples of well-balanced meals and a snack.
At breakfast:
At lunch:
At dinner:
For a snack:
Nutrients important for your recovery
Tip
Eat foods high in vitamin C
to help absorb the iron that
comes from plants such as
spinach.
For instance, drink a glass
of orange juice with an ironfortified cereal.
Good sources of vitamin
C are oranges, broccoli,
tomatoes, kiwi, strawberries,
peppers, potatoes and
cabbage.
Eating foods rich in the following nutrients are important
for your recovery.
Protein:
Protein helps repair and build healthy tissue.
Iron:
Iron works in each of your body’s cells to help make energy.
Vitamin C:
Vitamin C helps your body repair damaged tissues, keeps your
bones and teeth strong, and helps your body absorb iron.
Calcium:
Calcium helps build and maintain your bones, your muscles
move, your blood clot and your nerves send messages.
Fiber:
Fiber helps your body produce regular bowel movements.
Use the chart on the next page to help you choose foods
for building well-balanced meals and snacks.
89
90
Peas
Raisins
Steak
Bran flakes
Beans and legumes
Chicken
Tofu
Eggs
Peanut butter
Salmon
Grapes
Bell peppers
Berries
Oranges
Watermelon
Vitamin C
Broccoli
Sardines
Green beans
Yogurt
Milk
Calcium*
Whole-grain wrap
Whole-grain bread
Whole-grain pasta
White potato
Brown rice
Fiber**
*If you cannot tolerate milk products, you can also drink calcium-fortified juices such as orange juice. Choose low-fat or fat-free milk
products.
**Choose whole-grain varieties.
Iron
Protein
The following chart shows examples of foods to put on your plate.
Chapter 8:
Posture and Movement
(Body Mechanics)
In This Chapter:
Lifestyle Changes You Need to Make
„„
How to Maintain Good Posture
„„
How to Get In and Out of Bed
„„
Tips for Lying Down
„„
How to Get In and Out of a Chair
„„
How to Use the Toilet
„„
How to Take a Shower or Bath
„„
How to Get Dressed
„„
How to Go Up and Down Stairs
„„
How to Get In and Out of a Car
„„
How to Reach
„„
How to Lift Correctly
„„
How to Push
„„
How to Pull
„„
How to Carry
Posture and
Movement
„„
Chapter 8:
Posture and Movement (Body Mechanics)
Lifestyle Changes You Need to Make
Your posture and how you move, bend and lift are not only
important for your recovery, but for the rest of your life.
You will have to make this lifelong commitment to change.
Keep your body in good alignment and use proper movements
every day to help prevent spine pain and injury.
Important
Do not do activities that
require bending, lifting
or twisting.
Please use the following guidelines every day until your
follow-up appointment with your surgeon. Use these in all
of your work, leisure and home activities.
Do not do any twisting of your upper body.
Do not do any bending from your waist.
Do not lift anything heavier than 5 pounds (or as instructed
by your surgeon). One gallon of milk is about 8 1/2 pounds.
Limit reaching above your head (top shelves or closets).
Limit pushing, pulling or squatting.
Maintain all the normal curves of your spine. Curves are lost
when you bend forward or arch backward.
How to Maintain Good Posture
Tips for good standing posture
Keep your head high and chin tucked in.
Keep your shoulders back.
Let your arms hang free.
Keep your stomach in.
Keep your knees straight with your feet slightly apart.
Keep a small arch in your lower back.
Shift your weight from one foot to the other when standing
for a long time. Or, put one foot on a stool and switch positions
with your other foot once in a while. This will lower the stress
on your spine.
93
Did You Know?
Tips for good posture when you sit
A lumbar roll is a small
pillow shaped to support
your low back area.
Sit upright with your head facing forward.
Keep your shoulders back and relaxed. You may want to use
a lumbar roll to support your lower back.
Keep your knees slightly lower than your hips. Do not cross
your legs.
Keep your feet flat on the floor.
Tips for how to reach above your head
Limit any reaching to an arm’s length with your elbows
slightly bent.
Tips for how to do computer, desk and table work
Tip
Alternate tasks and change
positions often. This will
reduce fatigue and muscle
tension. Be sure to take rest
breaks.
Check your desk and chair height. Both of your feet should
be flat on the floor. Your knees should be slightly lower than
your hips. Your arms should rest on the tabletop with your
shoulders slightly raised.
Your ideal work height is no more than 3 to 4 inches below
your elbow level when you stand and at your elbow level
when you sit.
Always face the work area. Do not do any extreme twisting of
your upper body. Position your work so you will face forward.
Do not do any bending, especially with twisting, when you are
sitting such as reaching for something in a lower desk drawer.
When you talk on the phone, always use your hand to hold
the receiver. Do not cradle the receiver between your neck and
shoulder. You can also use a headset or speaker phone.
Arrange your desk or table to make sure your phone, pens
and other work items are within an arm’s length.
Use a chair that gives you full back support.
Add a footrest and a lumbar roll (for your lower back)
as needed.
Hold reading material in a tilted position.
Tips for returning to school
Your surgeon will give you instructions for when you can
return to school and physical activities.
Have one set of books at home and one at school so you do
not have to carry them back and forth. Many books can also be
found online.
94
Sit in the back or on the side of the classroom and limit sitting
to 45 to 60 minutes. You can stand up and walk as needed to
stay comfortable. Get up and take a short walk, pace the back
of the classroom or just stand.
Carry your backpack with the straps over both shoulders
to spread the weight to your entire back. Do not use backpacks
on wheels.
Pack you backpack with the heaviest items closest to your body
(books in the back, folders in the front).
You may want to return to school for a few classes or half days
at first. Increase to full days as you are able.
You may want to get out of class 5 minutes early to prevent
getting bumped by other people.
Your only exercise will be walking.
How to Get In and Out of Bed
How to do a logroll (to help you get out of bed)
To roll to the left:
Lie on your back. (Step 1)
Bend your right knee or both knees and reach your right arm
across your chest toward the side of the bed. (Step 2)
Roll all in one movement to your left. (Step 3)
Reverse this for rolling to the right.
Be sure to always move as one unit (together).
Your eyes and toes should face the same direction.
© Allina Health System
Step 1
© Allina Health System
Step 3
Step 2
Final position
© Allina Health System
© Allina Health System
95
How to get out of bed
Lie on your back.
Do a logroll toward your side.
Slide your body close to the edge of the bed.
Make sure your hip is pointed straight up or rolled forward.
Do not allow your hip to roll back.
Swing your legs over the edge as you push your upper body
up with your arms. It will be easier to get up if your elbow is
10 to 12 inches from the edge of bed.
Keep your back straight and legs aligned with your upper
body.
Move forward until both feet are flat on the floor.
Stand up slowly, pushing off with your hands on the edge
of the bed.
How to get into bed
Lower yourself slowly to a sitting position on the side
of the bed. (Step 1)
Scoot back onto the bed until the back of your knees touch
the bed.
Use a stool or platform if the bed is too high.
Lie down on one side by bending your knees and raising your
legs and lowering your head at the same time. (Step 2)
Use your arms to help lower yourself without twisting your
back. (Step 3)
Do a logroll onto your back. Bend both knees to roll.
Keep your back in a straight line with your legs. (Step 4)
Use a nightstand or heavy chair next to your bed in place
of a side rail. Do not push heavy furniture by yourself.
Ask a member of your care circle to do it for you.
Step 3
© Allina Health System
Step 1
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© Allina Health System
© Allina Health System
Step 2
© Allina Health System
Step 4
Tips for Lying Down
When lying on your back, place a thin pillow along each side,
just under your shoulders down to your hips. This will lessen
the pressure on your incision.
When lying on your side, place a pillow or two between your
knees.
How to Get In and Out of a Chair
A straight-backed chair with arms will be the easiest for you
to use when you first return home.
Choose a chair with a seat that is level from front to back.
You will have trouble getting out of a chair that has a seat higher
in the front than the back. Always sit with your buttocks as far
back into the seat as you can. Using one or two small pillows
between your hips and shoulders (cradle) may provide support
and comfort.
Be aware of your posture when you sit. Keep your knees bent and
at the same level as your hips or keep your knees slightly below
your hips. You may need to use a stool to adjust the knee height
if the chair is too high. Raise the height of the chair by putting a
cushion on the seat.
Tips for how to sit down in a chair with arms
Back up until you feel the chair against the back of your legs.
Reach back with both hands. Scoot your buttocks to the back
of the chair. Grip the arms of the chair and slowly sit down.
Tips for how to get out of a chair with arms
Keep your back in good alignment while you slide forward
or walk your hips to the front edge of the seat.
Keep both feet flat on the floor.
Put both hands on the arm rests.
Use your legs as much as possible to push you up to standing.
© Allina Health System
How to sit in a chair with
arms.
97
Tips for how to sit down in a chair without arms
Approach the chair from the side instead of the front.
Back up until you feel the chair against the back of your legs.
Use the back of the seat as an armrest for one hand.
Bend your knees and slowly lower yourself down to the chair
seat. Keep your back in the proper alignment.
Reach for the seat with your opposite hand as you sit.
Rotate your body to the front by keeping your hips and
shoulders in alignment and pivoting on your buttocks.
© Allina Health System
How to sit in a chair without
arms.
If possible, do not sit in chairs without arms.
Tips for how to get out of a chair without arms
Rotate your body to the side of the chair by keeping your hips
and shoulders in alignment and pivoting on your buttocks.
Keep both feet flat on the floor.
Put one hand on the seat of the chair and push up while placing
your other hand on the back of the chair for support.
Stand up while keeping your back in proper posture.
If you are sitting at a dining table or desk, you can use the table
or desk for support as you stand up.
Tips for how to sit in reclining chairs
Recliner chairs are OK to use if they give firm support to your
back.
If the chair has a manual recline option, have someone help
you with reclining the chair and returning it to the upright
position.
Do not sit fully upright with legs fully extended.
98
How to Use the Toilet
How to use a toilet with or without a raised seat
Tip
You may need medical
equipment to help you
use the toilet. Ask your
occupational therapist if you
have questions about which
ones may be most helpful.
You may need to consider using a raised toilet seat or a portable
commode if you need extra height. Keep both feet flat on the
floor.
Wear your brace while you use the toilet.
Keep your back in the proper alignment as you sit or stand up
from the toilet.
Anything you use for support in lowering or raising yourself
should be next to the toilet, not in front of the toilet. Make sure
the support is not too high.
It may be difficult to wipe after surgery, especially with a brace.
—— Lean to the side away from the hand you are going to use
for wiping.
—— Consider using toilet tongs (your occupational therapist
can show you an example of this) to help you reach without
bending or twisting. Important: Be careful to keep your
incisions clean during toileting.
—— Wet wipes are helpful.
How to Take a Shower or Bath
Tips for bathing in a shower or bathtub
Tip
Washing your hair may be
difficult to do by yourself,
depending on the location
of your surgery. Ask a
member of your care circle
for help washing your hair.
Do not wash your hair over
the tub or sink.
For the first 10 to 14 days, you may allow water to run over
your incision without direct water pressure or scrubbing.
Pat dry with a clean towel.
Do not take a bath until your surgeon says it is OK. Use the
shower instead.
Have someone available with you the first few times you
shower.
Use grab bars and nonslip strips or a bath mat.
Store soap and shampoo at a level between your hips and
shoulders.
If you need to wear a brace during bathing, follow the
instructions given to you by your health care team.
Try to stand to bathe. If it is not safe to stand, please use a chair.
If you do not have a shower, use a portable spray hose that
attaches to the water faucet in the tub to wash your hair.
Bend your knee and bring your leg up to wash and dry your
legs.
99
To keep from twisting or bending while in the shower, use a:
—— dispenser-type liquid soap bottle that hangs
—— long-handled scrub brush or sponge.
How to get in a bathtub using a tub chair
Back up to the tub and approach the tub chair from the side.
Reach for the back of the tub chair or use grab bars on the wall
or edge of the tub.
Bend your knees and lower yourself to the edge of the chair.
Keep your back straight and bend only at your knees and hips.
Slide back on the chair and swing your legs over the tub.
If you are not using a tub chair, you can use grab bars on the
wall or edge of the tub for support as you step over the tub.
How to get out of a bathtub using a tub chair
© Allina Health System
How to sit in the shower.
Slide forward on the chair.
Swing your legs over the tub edge.
Push up from the chair with both hands or use the grab bars
to help yourself up. Be sure you are rotating on your buttocks
and not twisting your back.
100
How to Get Dressed
Get all of the clothes you need, including socks and shoes.
Put them in one spot. This will keep you from going to your
dresser or closet often.
Wear loose-fitting, comfortable clothing. You may wear shirts
over your head. Do not wear tight pants and belts.
Do not use bottom drawers or closet floors to store your
clothes. Put your shoes on top of the dresser or chair when you
take them off.
Put the clothes you take off or plan to wear somewhere above
waist height such as the top of a dresser, back of a chair or hung
in the closet.
If you wear a brace, wearing a form-fitting cotton t-shirt or tank
top under the brace works best.
© Allina Health System
How to use a sock aid.
Do not twist or bend.
Do not bend over to dress your lower body. Bring your foot up
to your opposite knee. If you are not able to do this, consider
using a reacher or sock aid.
Wear supportive nonslip shoes or athletic shoes (no heels).
How to Go Up and Down Stairs
Your physical therapist will review stair climbing with you
in the hospital.
Important
It is OK to go up and down
steps at home, but do not
stair climb for exercise.
Remember to go up the step with your least painful (strongest)
leg first, then bring your painful (weak) leg up to the same step.
“Up with the good.”
Also remember to go down the step with your painful (weak)
leg first, then bring your least painful (strongest) leg down to
the same step. “Down with the bad.”
101
How to Get In and Out of a Car
How to get into a car
Put the car seat back all the way. Back up to the car seat.
Reach for the back of the seat with one hand, the dashboard
with the other.
Slowly bend your knees and lower yourself onto the edge
of the car seat. Keep your back in proper posture. (Step 1)
Step 1
© Allina Health System
Bend forward at your hips (not your back) as you slide back
on the seat. A plastic bag or sheet placed on the seat may make
sliding easier. (Step 2)
When you are far enough back, bend your knees and pivot on
your buttocks to bring in your legs. Do not twist your body.
(Step 3)
How to get out of a car
Rotate your buttocks until your feet are resting on the ground.
Scoot your hips to the edge of the seat.
Use the back of the seat and the dashboard to push up with
your arms for stability while you use your legs to stand up.
Step 2
© Allina Health System
If you had neck surgery, be careful not to hit your head on the
frame of the car when backing in or coming out. You may need
to roll your hips back to get your head into the car. Do not tilt
your head to the side.
Your physical therapist will review these steps with you in the
hospital.
Tips for comfort in the car
Wear your back or neck brace if directed by your surgeon.
Sit in the front passenger seat.
Step 3
© Allina Health System
Adjust your car seat for proper posture.
Always wear a seatbelt.
Important
Do not sit too upright or bend your knees more than 90 degrees
during long car rides to promote good circulation in your legs.
Do not pull or lift yourself
from the door frame or grab
bar.
If your car has a reclining seat, you may want to use this to be
more comfortable.
You may want to use a towel roll or pillow(s) to support
(cradle) your lower back.
Use cold packs as needed.
Do ankle pumps often as you ride.
102
Important
Do not drive until:
When you are driving or riding in a car for a long time, stop and
stretch every 60 minutes. You may need to stop and stretch more
often, especially right after surgery.
your surgeon says it is OK
you are no longer taking
pain medicine.
How to Reach
Be sure to start reaching only when your surgeon says it is OK.
Reaching can challenge your body posture. To reach, follow these
guidelines:
Work within your comfortable reach range — the top of your
head to your fingertips — and do not stretch as you reach.
Use a step stool instead of standing on your toes to reach
overhead items. Learn to tighten (contract) your pelvic muscles
to keep your low back stable if you cannot use a step stool.
Place your feet shoulder-distance apart with one foot forward
to reach across a table surface. Use one hand to balance yourself
on the table or counter.
© Allina Health System
Limit reaching over your head.
Use a sturdy support such as a countertop or table when
squatting to get to low cupboards or items.
Rearrange your home and office so you do not do repetitive
bending and reaching above your head and below your knees.
Sort laundry on a table.
Do not use low drawers.
103
How to Lift Correctly
Lifting Tips
To lift from the floor:
Squat down and bring the
item close to your body as
you lift.
To keep from twisting:
Pivot by using your feet.
Take small steps.
Lifting can challenge your body posture. Lift no more than
5 pounds (or as instructed by your surgeon) until your surgeon
says it is OK to lift more. To lift, follow these guidelines:
Figure out if the load is too bulky or heavy. Have someone help
you or use a pushcart or dolly to move the load.
Do not twist or turn.
Use your legs to supply most of the force you need to lift.
Bend your legs, not your back.
Keep your elbows close to your body at elbow height.
Do not hold your breath.
Get close to the object and straddle it between your knees
if possible.
Keep your back straight. Bend your knees and hips at the same
time. Put one knee on the floor if you need more stability.
Lift by straightening your knees and hips. Keep your
abdominal muscles and buttocks tight.
How to lift and move an object
Tip
Always assess the weight of the object before you try to lift it.
Ask for help and have others
lift when possible. Coordinate
your movements when lifting
together. Be sure to keep the
curve in your lower back.
Have someone help you if a load is too heavy.
Bend your knees and keep your back straight when you lift an
item that is below your waist level. Be sure to keep the curve
in your back and keep your feet apart.
Try to lift from under the object and keep the load close to your
body. Stand up and lift with your legs.
Do not twist your body when you lift or put the load down.
Move your feet and turn your entire body. Keep your body
straight.
Do not lift heavy items over your head. Use a step stool to raise
your body closer to the object. Or, put one foot in front of the
other and shift your weight from the front foot to the back foot
as you lift the object. Keep your back straight.
Do not carry unbalanced loads (objects that are heavier
on one side than the other).
Kneel on one knee and bend the other knee when you kneel
to lift an object.
Slide objects instead of lifting. Keep your back straight and use
your leg muscles by putting one foot in front of the other and
shifting your weight.
104
How to lift an object off the floor
Use a reacher to get objects from the floor if squatting is too
hard.
Hold the object close against your upper body with both hands
before you stand up. (Step 1)
Tighten your stomach muscles without holding your breath
while you stand up. (Steps 2 and 3)
Use smooth movements to keep from jerking.
How to set an object on a lower shelf or floor
© Allina Health System
Step 1
Use a reacher to get objects to the floor if squatting is too hard.
Hold the object close to your body at waist level.
Squat down or kneel with one leg on the floor.
Lower the object to the shelf or floor by sliding it down your
thigh.
Use smooth movements to keep from jerking.
© Allina Health System
Step 2
© Allina Health System
Step 3
105
How to Push
Be sure to start pushing only when your surgeon says it is OK.
Pushing can challenge your body posture. Always push rather
than pull when you have the option. To push, follow these
guidelines:
Bend at your knees and hips. Use your leg muscles, not your
back muscles, to push.
Put one leg behind the other for better leverage.
Incline your body to the object being pushed slightly higher
than the object.
Apply force squarely to the direction of the object being
pushed. Do not twist.
How to Pull
Start pulling only when your surgeon says it is OK. Pulling can
challenge your body posture. To pull, follow these guidelines:
Face the object.
Bring both hands around the sides instead of over the top
of the object.
Pull short distances and use your body weight and legs as a
counter balance.
If you are opening a door, get close to the door and put both
hands on the handle to pull it.
How to Carry
Carrying can challenge your body posture. Carry no more than
5 pounds (or as instructed by your surgeon) until your surgeon
says it is OK to carry more. To carry, follow these guidelines:
Carry the object at waist level with your elbows slightly bent
and close to your sides.
Try not to carry an object on one side of your body. Always
carry items in front of you. You can set the object down once in
a while if needed.
Try to use a rolling cart to push heavy, hot or breakable items.
106
Chapter 9:
House and Yard Work
In This Chapter:
„„
How to Do Laundry
„„
How to Clean and Dust
„„
How to Clean the Floors
„„
How to Shop for Groceries
„„
Arrangements for Child Care
„„
How to Do Yard Work
House and
Yard Work
Chapter 9: House and Yard Work
Doing regular work around the house can be hard on your back.
If possible, have someone else do household chores until you
have fully recovered. Do not do house or yard work until your
surgeon says it is OK.
How to Do Laundry
Tip
How to load laundry into a top-loading washer
Do your laundry more than
once a week. This puts less
stress on your spine and
spreads the work out over
a few days.
Place your clothes in a laundry basket. To lift the basket,
squat and hold the basket close to your body. Stand up.
Use your leg muscles, not your back, to do the work.
Put the basket on a table or chair near the washer. Use a
long-handled reacher to keep from bending and twisting
if needed.
To unload a top-loading washer, put one leg back and use
the opposite hand to lift the clothes out. You may also use a
long-handled reacher to lift out clothes. Lift only one or two
items at a time.
How to load laundry into a front-loading washer
If you can, use a front-loading washer because you can do this
from a kneeling position, squatting position or a low stool.
Unload a few pieces of clothing at
a time.
Place the laundry basket in front of the washer. You may kneel,
squat or use a low stool. Unload the clothes from the basket a
few items at a time. Use a long-handled reacher to keep from
bending and twisting.
How to unload laundry from a dryer
To unload a dryer, squat down to reach into the dryer.
Use a long-handled reacher to keep from reaching into the
dryer yourself.
Put small items into a large zip-close mesh bag to keep from
reaching several times.
Lift and carry the basket using the guidelines in “How to
Lift Correctly” on pages 104 to 105 and “How to Carry” on
page 106.
Fold clothes on a table that is at least waist height.
Use a long-handled reacher to load
and unload laundry.
Drawings © Allina Health System
109
How to Clean and Dust
Tip
Place yourself as close to the
work surface as possible so
you do not have to reach.
To reach high spots, keep one foot on a step stool or use a
stepladder. Keep your feet at different levels. Reach with one
arm at a time.
To reach lower spots, kneel and keep your back straight.
Keep a water bucket and your cleaning materials on a chair
or a stool so you do not have to bend. Consider using a spray
bottle filled with cleaning solution.
How to Clean the Floors
Do not clean floors until your surgeon says it is OK.
Ask a member of your care circle to help instead.
Use these guidelines when your surgeon says it is OK to resume
mopping, sweeping or vacuuming.
Use equipment with handles that are long such as a
long-handled dust pan so you do not have to stoop.
Dry cloth sweepers are lightweight and do not require twisting.
Face the material or area being cleaned. Do the work in front,
not to the side, to keep from twisting. Keep your knees slightly
bent while you work.
Stand straight to vacuum.
Do not bend to vacuum.
Drawings © Allina Health System
110
Vacuuming is very stressful on your back. Do not vacuum.
Ask a member of your care circle to help instead. When you
are ready to resume vacuuming, hold the vacuum cleaner
with your arms at your sides. Step back and forth to move the
vacuum. Do not push the vacuum back and forth with your
arms. Keep your head up and do not twist.
How to Shop for Groceries
Do not reach for items above your head. Ask for help
if an item is too high.
To reach items that are low, squat or put one leg back
and use the opposite hand to reach.
Pack your grocery bags light.
Put your legs shoulder-width apart, get close to the grocery
bag, grasp it with both arms and lift. Carefully put it into the
trunk or on the seat. Do not twist or bend. If possible, have
someone from the grocery store carry out your bags.
When you get home, use “How to Lift Correctly”
on pages 104 to 105 and “How to Carry” on page 106.
Try to store items you use often in easy-to-reach areas
(between waist and shoulder height) when you are putting
your groceries away.
Consider using an online grocery service or ask someone
to go with you to the grocery store.
Arrangements for Child Care
Make arrangements for members of your care circle to help with
taking care of your child(ren). You may not be able to lift more
than 5 pounds (or as instructed by your surgeon) during the first
several weeks or months of your recovery.
How to Do Yard Work
Yard work can be very stressful on your back. It may be several
months until your surgeon says it is OK for you to resume doing
yard work.
Tips on how to do yard work
Alternate tasks and take a lot of short rest periods. This will
keep you from becoming tired.
Use special medical equipment such as extended handles
to keep from bending.
Do not do unnecessary motions and tasks.
Do not bend forward when you weed, plant or pick flowers.
Keep your back straight. Do not twist.
111
Chapter 10:
Resources
In This Chapter:
„„
Medical Equipment
„„
Community Resource Directory
„„
Other Resources
„„
Know Your Care Team
„„
My Medicine List
Resources
Chapter 10: Resources
Medical Equipment
Did You Know?
If you did not need the
support of an assistive
walking device before
surgery, you may not need
one after.
Your physical or occupational
therapist will assess your
safety in the hospital and
make recommendations for
when you leave the hospital.
Front-wheel walker
or cane
To ensure a safe recovery after your surgery, you may need to use
some special equipment. This page and the following page show
and describe the equipment.
It is recommended to wait until after surgery to buy equipment.
If you can borrow equipment, it is helpful to make arrangements
before surgery.
Insurance will usually only cover the purchase of a walker or
cane. You most likely will need to purchase or borrow any other
equipment you need.
See page 117 for information about places that loan or sell
equipment.
Raised toilet seat/
commode
Toilet safety frame
A raised toiled seat may make
it easier for you to get on and
off the toilet. Your feet should
touch the floor when using the
toilet.
A toilet safety frame may make
it easier for you to get on and
off the toilet.
A walker or cane may help you
walk after surgery.
115
Grab bars
Tub chair
Tub transfer bench
Installing grab bars around
your toilet, bathtub or shower
will increase your safety
during transfers.
A tub chair lets you sit while
taking a shower or bath.
A tub transfer bench can help
you get in or out of the shower
or tub. You can also sit on it
while taking a shower or bath.
Hand-held shower head
Long-handled sponge
Reacher
A hand-held shower head
allows you to control the spray
of water while sitting.
A long-handled sponge can be
used to wash your feet when
you cannot bend and to wash
your back so you do not twist.
A reacher helps you get things
from higher and lower levels.
It can also help you put clothes
on the lower part of your body.
Sock aid
Tongs
Elastic laces or longhandled shoe horn
A sock aid helps you put on
socks without bending.
Tongs can be used in place of
a reacher. Or they can help you
with your hygiene care after
you use the toilet.
All illustrations © Allina Health System
116
Elastic laces let you slip in and
out of your shoes easily while
keeping them tied. The longhandled shoe horn helps you
guide your foot into an alreadytied or slip-on shoe.
Community Resource Directory
Medical equipment
After your surgery, certain equipment can make your recovery
go easier and increase your independence. The following is a list
of resources to help you find the equipment you need.
Allina Health Home Oxygen & Medical Equipment offers
items to purchase. Call 651-628-4800 or 1-800-737-4473 for
information about medical equipment, supplies and services.
Call your local American Legion, VFW or Lions Club.
They often have equipment you can borrow if you are a
member.
Call your local pharmacy to see what selection of equipment
that store carries.
Look in your Yellow Pages or go to yellowpages.com and look
under “handicapped services or equipment” or “home care
services.”
WisTech can connect you with resources for medical equipment
in Wisconsin. Visit wisconsinat4all.com to find equipment in
your area. You will need to create an account to view available
items. Once you have an account, you can buy, rent or get free
items from state agencies, private businesses, lending programs
or individuals. Each group or individual has different criteria
for using their equipment. Contact information is listed for
each item.
117
Grocery delivery
Store To Door®
This program shops for and delivers groceries to anyone
age 60 and older who cannot shop for and carry groceries.
This program uses volunteers to serve the seven-county
metro area of Minneapolis and St. Paul. You pay for your
groceries and a service fee. This fee is based on your income.
Go to storetodoor.org or call 651-642-1892 for more information.
Twin Cities Metro Area Meals on Wheels
Volunteers deliver ready-to-eat meals to homes in most
of the Minneapolis and St. Paul metro area. You can sign up
for short- or long-term meal delivery if you are recovering
from surgery or illness. The price is based on your need.
Call 612-623-3363 or visit meals-on-wheels.com for more
information or to sign up for this service.
Home-delivered Meals (Meals on Wheels)
Wisconsin’s Elderly Nutrition Program offers meals to anyone
age 60 and older. Meals can be delivered to your door Monday
through Friday. Visit gwaar.org to learn more about homedelivered meals. Click For Seniors and Families and then Elderly
Nutrition Program. Select Contact someone to find your local
agency and its contact information.
Many grocery stores and organizations offer services that will
deliver healthful meals to your home. Ask a member of your
health care team for more information.
118
Other Resources
Allina Health resources
Allina Health Care
Navigation Help Desk
Call 612-262-2200 or
1-855-227-5111 if you have
questions about community
resources, medical
equipment, home care, a
transitional care unit (TCU)
or a short-term rehabilitation
center.
Allina Health Care Navigation Help Desk
If you have questions about community resources, medical
equipment, home care, a transitional care unit (TCU)
or a short-term rehabilitation center call 612-262-2200 or
1-855-227-5111.
Allina Health Financial Assistance
For help in paying for Allina Health services, please call:
612-262-9000 or 1-800-859-5077
Allina Health Interpreter Services
You have a right to a medical interpreter at no cost to you.
Please let a member of your health care team know if you
would like to have an interpreter available during your visit.
Allina Health Spiritual Care
Chaplains, Catholic priests and a Jewish liaison are available
to you and your care circle. If you have questions about
spiritual care, please ask a member of your health care team.
Penny George™ Institute for Health and Healing
The Penny George™ Institute for Health and Healing
offers services to help you as you prepare for and recover
from surgery. Call 612-863-3333 or visit allinahealth.org/
pennygeorge for more information, or ask your health care
team which services are offered at your hospital.
Helplines
National Suicide Prevention Lifeline
If you are or someone close to you is in crisis, call the free,
24-hour lifeline at 1-800-273-TALK (1-800-273-8255).
United Way 2-1-1
For information about about food, housing, employment,
childcare, transportation, health services, senior services and
more, please call 211 or visit unitedwaytwincities.org.
119
Know your care team
We are committed to providing our patients and their families high-quality,
compassionate and professional care.
As part of that commitment, we’ve made it easier for you to identify
members of your care team and how they may help you.
Your care team wears the following colors:
Navy
Blue
Registered Nurses
Dark
Teal
Laboratory Services
Green
Clerical Support
Pharmacy
Royal
Blue
Therapy Services
Respiratory Therapy
Purple
Licensed Practical
Nurses
Maroon
Olive
Green
Black
Khaki
Dark
Brown
Patient Care Support
Nutrition Services
Gray
Radiology
Environmental Services
and Linen Services
Khaki
Materials/Supplies
S411102F 14518 1212 ©2012 ALLINA HEALTH SYSTEM. ®A REGISTERED TRADEMARK OF ALLINA HEALTH SYSTEM.
120
Teal
121
Other:
Allergic To: (Describe reaction)
NAME OF
MEDICATION
www.mnpatientsafety.org
START
DATE
DOSE
(How do you take it? When? How often?)
DIRECTIONS
DATE
STOPPED
Page ______ of ______
(Reason for taking?)
NOTES
List all medicines you are currently taking. Include prescriptions (examples: pills, inhalers, creams, shots), over-the-counter medications
(examples: aspirin, antacids) and herbals (examples: ginseng, gingko). Include medications taken as needed (example: nitroglycerin, inhalers).
Flu vaccine(s):
Hepatitis vaccine:
Date of Birth:
Immunization Record (Record the date/year of last dose taken)
Pneumonia vaccine:
Tetanus:
Pharmacies, other sources:
Doctor(s):
Emergency Contact/Phone numbers:
Name:
My Medicine List
Fold this form and keep it with you
1. ALWAYS KEEP THIS FORM WITH YOU. You may want
to fold it and keep it in your wallet along with your driver’s
license. Then it will be available in case of an emergency.
Directions for My Medicine List
•
•
•
It provides your doctors and other providers with a current list of
ALL of your medicines. They need to know the herbals,
vitamins, and over-the-counter medicines you take!
This form helps you and your family members remember all of
the medicines you are taking.
How does this form help you?
2. Write down all of the medicines you are taking and list all of
your allergies. Add information on medicines taken in
clinics, hospitals and other health care settings — as well as
at home.
For copies of the My Medicine List and
a brochure with more tips, visit the Minnesota
Alliance for Patient Safety’s Web site at
www.mnpatientsafety.org or call (651) 641-1121.
With this information, doctors and other providers can prevent
potential health problems, triggered by how different medicines
interact.
3. Take this form with you on all visits to your clinic,
pharmacy, hospital, physician, or other providers.
4. WRITE DOWN ALL CHANGES MADE TO YOUR
MEDICINES on this form. When you stop taking a certain
medicine, write the date it was stopped. If help is needed, ask
your doctor, nurse, pharmacist, or family member to help you
keep it up-to-date.
5. In the “Notes” column, write down why you are taking the
medicine (Examples: high blood pressure, high blood sugar,
high cholesterol).
6. When you are discharged from the hospital, someone will
talk with you about which medicines to take and which
medicines to stop taking. Since many changes are often made
after a hospital stay, a new list may be filled out. When you
return to your doctor, take your list with you. This will keep
everyone up-to-date on your medicines.
(1/06)
122
ALLINA HEALTH
Get better communication and faster answers online with your
Allina Health account.
Health is a journey that happens beyond the walls of your clinic or hospital and we will be there to help you – whether
it’s a question that pops into your head at midnight or recalling the date of your last tetanus shot. When you sign up for an
Allina Health account online, you get better communication with your clinic, hospital and provider; faster answers and your
(and your loved one’s) health information organized and at your fingertips anytime.
receive
lab results
sooner
email your
care team*
schedule
appointments*
read visit notes
and follow-up
instructions
manage a child’s
or another
adult’s care
do an online
visit for common
conditions
Rx
refill a
prescription
write a health
care directive
view
immunizations
and medications
set and track
health goals
l
Schoo
form
view and
pay bills
Sign up for your account at allinahealth.org
*Availability varies by location. Ask your clinic or hospital if this service is available.
S410726A 162301 1016 ©2016 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.
Your account is a free service
of Allina Health
Nondiscrimination in
Health Programs and Activities
Affordable Care Act – Section 1557
Allina Health complies with applicable federal civil rights laws and does not discriminate on the basis of race,
color, national origin, age, disability, gender identity or sex. Allina Health does not exclude people or treat
them differently because of race, color, national origin, age, disability, gender identity or sex.
Allina Health:
• provides free aids and services to people with disabilities to communicate effectively with us, such as:
◊ qualified sign language interpreters, and
◊ written information in other formats (large print, audio, accessible electronic formats, other formats)
• provides free language services to people whose primary language is not English, such as:
◊ qualified interpreters, and
◊ information written in other languages.
If you need these services, ask a member of your care team.
If you believe that Allina Health has failed to provide these services or discriminated in another way on the
basis of race, color, national origin, age, disability, gender identity or sex, you can file a grievance with:
Allina Health Grievance Coordinator
P.O. Box 43
Minneapolis, MN 55440-0043
Phone: 612-262-0900
Fax: 612-262-4370
[email protected]
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Allina Health
Grievance Coordinator can help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for
Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.
hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
S415075A 248931 1116 ©2016 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.
English:
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Call 1-877-506-4595.
Spanish:
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Laotian:
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ີ ພ
French:
ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1-877-506-4595.
Polish:
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer
1-877-506-4595.
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KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në
1-877-506-4595.
Tagalog:
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang
walang bayad. Tumawag sa 1-877-506-4595.
Cushite:
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama.
Bilbilaa 1-877-506-4595.
Amharic:
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ
1-877-506-4595.
Karen:
1-877-506-4595.
Mon Khmer:
ប្រយ័ត្ន៖ បរើសិនជាអ្ន កនិយាយ ភាសាខ្មែ រ, បសវាជំនួយខ្នន កភាសា បោយមិនគិត្ឈ្ន ួល គឺអាចមានសំរារ់រំប រ ើអ្ន ក។ ចូ រ ទូ រស័ព្ទ 1-877-506-4595។
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© 2017 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.
OTHER TRADEMARKS USED ARE OWNED BY THEIR RESPECTIVE OWNERS
THIS BOOKLET DOES NOT REPLACE MEDICAL OR PROFESSIONAL ADVICE; IT IS ONLY A GUIDE.
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