Spine care

Hello and welcome to the Allina Health Spine Program Pre-Surgery Education class. It is recommended that you watch the spine pre-surgery education videos, one or two weeks before your surgery. Is also recommended to have a member of your Care Circle watch this video with you. If your surgery is scheduled within less time, please watch the video as soon as possible.

Your surgeon's clinic may have provided you with a spinal surgery education book. If not, this is available at allinahealth.org. You will have a specific book based on your surgery. Everything you need to know about your surgery is located in the book. We will reference important highlights from each chapter. It may be helpful to bookmark or highlight areas as we go through each section. If you think of questions during this video, please write them down and contact your surgeon's office.

As you watch the video, you will get information about, how to prepare for surgery, what to expect the day of surgery and during your hospital stay, developing a pain plan, activity after spine surgery, making plans for leaving the hospital, and your follow up care. We will begin reviewing the first few chapters of your spine book and discussing how to prepare for your surgery.

Open your spine book to the first few pages where you will find a checklist. Please complete the checklist before your surgery. Be sure to review all information given to you from your surgeon one to two weeks before your surgery. The information given to you may include a patient education book, pre-surgery instructions, and other materials to help you prepare for your surgery.

Schedule and keep all of your appointments to make sure your surgery could take place as scheduled. This includes your preoperative history and physical appointment with your primary care provider. This exam needs to be completed within three days of your surgery date. It is recommended to have the exam two to four weeks before your surgery.

Discuss all medicines you are taking with your health care provider. Be sure to discuss any prescription, and over-the-counter medicines, including herbals or vitamins you are taking. It's important for you to know whether you need to stop taking your medicine before surgery and which medicines are safe for you to continue taking. Review this section in your book with your primary care provider at your health history physical exam.

Our goal is to discharge you home safely following surgery. If discharge needs are identified after your surgery, a social worker will be able to meet with you following your surgery to establish a discharge plan. It may be helpful to call your insurance company to find what is, and is not covered under your plan. You can fill out the worksheet in your patient education book to help you.

You are encouraged to select a loved one or close friend to be your personal support coach. The recommended qualities in a coach are to, be a caring and compassionate cheerleader, offer you comfort and support during your recovery, be available to actively participate and help with the rehabilitation, communicate with you and your health care team, and encourage your return to normal activity.

Your coach's responsibilities include reviewing the pre-surgery education and video with you, being available during your hospital stay, and helping you in your recovery when you leave the hospital.

In the one to two weeks before your surgery, please review all pre-surgery instructions. You'll receive a telephone call in one to three days prior to surgery from preoperative nurse regarding details and further information about your surgery and medications. Please check your voicemail during this time. If you haven't already done so, please begin the strengthening program found in the preparing for surgery section of your patient education book.

Walking before surgery is also important and can help you to have a successful recovery. Talk with your primary care provider or surgeon about starting your exercise program. It is recommended that you practice body mechanics or posture movements you will be using after your surgery.

You'll move a little differently after your surgery as your spine heals. Practicing these body mechanics before surgery will help you to be more successful using them after your surgery. We will discuss activities following your spine surgery later in this video. Our goal is to get you back home after surgery. Preparing for help with your care needs and household tasks before surgery is very important.

Arrange your help with household tasks, including child and pet care, if needed. You may also need help with grocery shopping, laundry, house cleaning, and yard work or snow removal. Is important to prepare your home for your needs after surgery, to have a safe and successful recovery. Review the checklist in your patient education book for more information.

Move items you use a lot, to tabletop-height-surfaces or to middle shelves. Remove clutter and rearrange furniture to create clear walking paths in your home. This can help to prevent falling or tripping. Pick out a chair to use during your recovery.

A good chair supportive and with firm arms. Avoid overstuffed chairs or sofas. Check and secure all stair railings. It is best if all stairs have railings. Make sure your bathroom is safe, considering installing grab bars and applying adhesive slip strips or a bathmat to the top of your shower floor.

If you use any tobacco products such as cigarettes, or e-cigarettes, vaping, cigars, pipes, or chewing tobacco, it is recommended that you quit before your surgery. Tobacco use after surgery may interfere with the healing of your spine.

Ask for support from your family, friends, and health care team, to help you quit using tobacco products before your surgery. For more information about smoking cessation, please review your book or visit allinahealth.org. Please keep in mind that your surgery will be canceled if chewing tobacco is used the morning of surgery.

Now, we will talk about what to bring to your hospital for your hospital stay. You can review the complete list of items in your education book. We will highlight a few of those items. If you receive the book, bring this with you to the hospital. Or you may ask your nurse after surgery for a book. We encourage you and your care team to use this as a tool during your hospital stay.

When you check in on the day of your surgery, please have your insurance card, photo identification, ID, and a copy of your health care directive. If you would like information associated with health care directives, resources are available on allinahealth.org to assist in completing this or you can speak to your primary care physician. Bring a list of the medicines that you take.

Be sure to include any prescription, and over-the-counter medicines, including burbles or vitamins. Do not bring your medicines with you, for your safety medicines will be provided for you during your hospital stay. Don't forget to pack glasses and hearing aids with extra batteries. If you use a CPAP machine, bring it with you when you check-in for surgery.

If you're staying overnight in the hospital, pack a separate overnight bag with one or two sets of loose-fitting, comfortable clothes and a pair of comfortable, supportive shoes to wear after surgery. Please have a family member or friend bring your belongings to the hospital after your surgery is done and you have it assigned a room number. Leave any valuables at home. You will be responsible for anything you bring to the hospital.

Before surgery, it is important to call your surgeon's office if you have any changes in your health, especially to your teeth or skin. A tooth infection or an abscess, skin infection, rash, open sore, or cut, can put you at risk for infection and needs to be addressed before your surgery.

Remove nail polish and artificial fingernails before surgery. Your oxygen level will be monitored through your fingernail beds during and after your surgery. Remove all jewelry before coming to the hospital. Please do not bring jewelry to the hospital with you.

Cleanse your skin the night before your surgery as directed by your surgeon. You can also find these instructions in the Preparing for Surgery Section in your spine education book. Completing the skin prep is very important in helping prevent infections following your surgery. Please note in the instructions, it is important not to shave your body below, your neck seven days before surgery.

You should put on clean pajamas and bed sheets after you complete your skin prep, and do not let pets sleep with you the night before surgery. It's also important not to put on any lotion, deodorant, makeup, or hair products. Do not take a shower the morning of your surgery.

On the morning of your surgery, follow the instructions given to you for food and liquid restrictions. You can find these instructions in your spine book. If you do not follow these instructions, your surgery may be delayed or even canceled. These food and liquid restrictions are based on your arrival time to the hospital, not your surgery time. If you are not sure of your arrival time, this should be listed on the paperwork you received from your surgeon's office.

You should also receive a pre-call a few days before your surgery. They will give you that information as well. Generally, your arrival time to the hospital is two hours before your scheduled surgery time. If you did not receive a scheduled hospital arrival time, please contact your surgeon's office.

Take medicines as directed by your health care provider. If you have questions about which medicines to take the morning of surgery, contact your health care provider before the day of your surgery.

It is a good idea to take a look at your hospital map to know where to check-in and where to park on the day of your surgery. It is very important that you check in at your scheduled hospital arrival time. Remember to allow extra time for parking, walking, bad weather, and traffic.

We will now focus on what to expect on the day of surgery and during your hospital stay. You can turn to the section surgery and beyond in your spine education to follow along. When you arrive at the hospital go to the patient registration desk to check-in. You may be asked to fill out some forms. After checking in, you will be directed to a waiting room and then brought back to the pre-surgery care area.

After you are settled, the person with you will be invited to join you. Your preoperative health care team is your nurse, surgeon, and anesthesiologist. They will discuss what to expect before and after surgery, your procedure, and the type of anesthesia that will be used during your surgery. This is also a good time to ask any last-minute questions you may have. You'll be asked to sign a consent form at this time as well.

While you are in surgery and recovery, your care circle can wait in the surgery waiting room. The amount of time you spent in surgery, will depend on the type of surgery you are having. Your surgeon will talk to your care circle when your surgery is over. Please visit the hospital website or call the hospital for updated visitor guidelines.

After surgery, you'll be moved to the recovery room or Post-Anesthesia Care Unit, also called the PACU. Most patients stay about one to three hours in the recovery room where your PACU nurse will monitor you as you wake up from surgery. Your Care Circle is not allowed in the recovery room. They can wait for you in the surgery waiting room.

When you're fully awake and your medical status is stable, you may be moved to the Post Surgery Care Area where nurses specialized in spine care will care for you. If your surgeon feels you should spend the night following surgery, a member of the hospital staff will tell your Care Circle your room number so they can meet you there. This is a good time for them to go back to the car and collect your belongings and bring them to your room.

Now we will focus on your comfort after surgery and developing a pain plan that works for you. You will have pain after surgery. Together you and your health care team who are experts in managing pain will create a pain plan that is right for you. Pain is often feared because pain hurts. Pain can also cause emotional discomfort and anxiety.

Well, pain is sometimes misunderstood. It is a normal response to surgery. Even though pain is expected, reducing pain can help improve your recovery. Having no pain while in the hospital is not realistic but your health care team will work closely with you to help you feel more comfortable while recovering and prepare you for your return to home.

Before coming to the hospital, it is very important to take your pain medicine as directed with a sip of water. It is important to do this even if you have instructions not to eat or drink anything. When you get to the hospital, tell your health care team which pain medicine you have taken. It is a good idea to bring a list of all medicine you are currently taking.

After your surgery or procedure, you will feel new pain such as pain near your surgical area. It can feel kind of scary to think about pain but one of the things you can do to take control is to think about a pain goal. You and your health care team will establish a painful amount of acceptable pain you can tolerate during your hospital stay. Acceptable pain at a tolerable level is when it allows you to do daily activities, like walking, bathing, sitting up to eat meals comfortably, resting in the chair, or visiting with your family member.

This is an example of the pain scale used at Allina Health. Everybody feels pain differently but it is important for your health care team to understand how you are feeling. During your hospital stay, you will often be asked to rate your level of pain. You might be asked to rate your pain using numbers, faces, or words. The goal remains the same. To help you communicate the level of pain you are feeling and to measure your progress.

There is no correct number or description. You may think moderate pain is a three, while others may call it a five. The important thing is to be consistent in how you rate your pain. This will help your health care team understand how you are feeling. For example, if today your pain is a three but tomorrow it is a four, this helps your health care team to understand how you are recovering.

If you have other chronic pain let your health care team know, so they can talk to you about how this might impact your recovery. You may be asked to rate all of your pain, not just pain from your surgery or procedure. You will also be asked to describe your pain. What does your pain feel like? Is it sharp or stabbing? Or is it dull or throbbing? Is your pain constant or does it come and go? Describing your pain helps your health care team find the best options for helping you get comfortable.

Remember this is your pain, be honest about how you feel. Your comfort level is important to us. Your pain will not completely go away, but you can rely on your health care team working to decrease your pain and help you get well.

Opioid Pain Medication is one strategy out of many, that you may use to help with short-term pain and surgery. Initially, pain medication may be provided through an IV. But we'll transition to oral medications as soon as you can take sips of water.

Oral medications or medications you take by mouth will provide the same amount of pain relief as IV medications. Sometimes better and it is what you will be going home on. The goal of Opioid Pain Medication is to reduce pain when it is most intense during recovery. It is important to switch to non-Opioid Pain Medications as soon as you are able. Pain medicine takes time to work, so it is important to take your medicine early on when you first feel pain.

Do not wait until your pain gets worse before taking your medicine. Tell your health care team if you feel any new pain. If your pain is getting worse, or if your pain medicine does not seem to be helping. As with any medicine, there are possible side effects, which occur usually within a few hours. Common side effects include constipation, dizziness, upset stomach, itching, and rashes. Side effects can be managed.

Along with your pain medicine, other methods to manage your pain are just as important. You may receive physical therapy to help heal and become more active. Pain management may also involve cold therapy, cold packs. Cold packs help by reducing swelling.

Integrative health may include breathing and relaxation techniques, aromatherapy, and others. Patients have responded very well to these therapies. Often healing more quickly. Your health care team will work closely with you to develop the best pain control plan possible. Ask your health care team, whether integrative therapies are offered. For more information about developing a pain plan and comfort after surgery, review your patient education book.

Activity after spinal surgery is very important for your recovery and to help prevent complications. On the day of your surgery, you will work with your health care team to sit at the edge of the bed. If you are able you will also stand or walk. The goal is to walk three to five times each day during a hospital stay and sit up in chairs for all meals. Your health care team will help you walk safely and meet this goal.

You will also be asked to do exercises such as ankle pumps, buttocks, and thigh squeezes, as well as other activities if ordered by your surgeon while in the hospital. These exercises along with walking, help promote circulation and to build strength after surgery.

If you're admitted to the hospital following surgery, your surgeon may order Occupational Therapy (OT) and Physical Therapy (PT), to work with you during your hospital stay. OT and PT help to create a plan for managing your daily activities safely such as walking, climbing stairs, getting in and out of a car, dressing, and managing your bathroom needs.

Now we will focus on food and liquids after surgery. You may have nausea following surgery. Your nurse will work with you to treat this. Many patients may start with sips of clear liquids right after surgery. Once your stomach is ready, you'll be able to drink more liquids and eventually eat regular foods. For those of you having surgery on your neck, please review the section, Care After Surgery in your education book for additional details.

Having enough fluids in your body after surgery is very important for your healing. You'll have an intravenous line (IV) to give your body the fluids it needs during and right after surgery. Once you can drink liquids, your IV will be stopped. Your health care team will encourage you to drink six to eight glasses of liquid each day.

Your care team will also help to make sure your bladder and bowels are working properly after surgery. It's very important to prevent constipation after surgery. Constipation can be caused by pain medicines or decreased activity after surgery. Walking is one of the best ways to prevent constipation.

You'll begin walking as soon as you are able after surgery and continue to walk three to five times a day during your recovery. Make sure you drink plenty of liquids and eat high-fiber foods. You may also be given a stool softener or laxative medicine to help prevent constipation. Please review the education book to learn more about your nutritional needs.

After surgery, it is important to focus on breathing and respiratory care. You'll be provided with a device called incentive spirometer. This will help encourage you to breathe deeply and prevent pneumonia. Your health care team will teach you how to use this. You may need to use oxygen briefly after your surgery.

If you use a CPAP machine, remember to bring it with you to use during your hospital stay. Preventing pneumonia after surgery is very important. You'll be asked to walk around and sit in a chair several times a day. This activity will encourage you to take deep breaths. You will also be reminded to do deep breathing exercises.

It is important to take care of your incision after surgery. You'll have a dressing or bandage covering the incision. Your dressing may be changed or removed during a hospital stay. Your surgeon may place a drain next to your incision during surgery. The drain helps to draw extra blood and fluid from the area around your incision. If you have a drain, it is usually removed before you leave to go home.

Before you leave the hospital, you will be given instructions on caring for the incision. Do not soak your incision in water, such as a bathtub, into the pool or lake. Your health care team will also give you instructions on how to shower. Hand washing is very important to help prevent infection. Make sure to wash your hands well with warm water and soap. Ask your family and friends to also wash their hands well before helping you during your recovery.

Please turn to the posture and movement section in your spine education books. We will now be learning about activity after your surgery. All activity restrictions are given to you by your surgeon. After your surgery, you will be instructed BLT's, Bending, lifting, and twisting. Avoid bending, including forward, backward, and side bending. Avoid lifting more than five pounds. Keeping in mind a half-gallon of milk weighs about four and a half pounds.

Avoid twisting your spine. Keep your nose and toes facing the same direction. Will also be instructed to limit pushing, pulling, bending, or squatting after surgery. You will be encouraged to limit sitting to 45 to 60 minutes at a time. Moving every 45 to 60 minutes may help decrease pain and prevent complications after surgery. Your surgeon will tell you how long you will need to follow your activity restrictions after surgery.

Now that we have reviewed the activity restrictions, you will have after spine surgery, let's focus on how to manage your daily activities. The following short videos will provide demonstrations about how to safely do some common activities of the day, such as how to move in bed, how to get in and out of bed, a chair and car, and how to dress after surgery. Your spine education book is a good resource for additional education on how to do common activities.

To move in bed, lie on your back. If rolling to the right, bend your left knee or both knees and put your left arm across your chest. Roll all in one movement to your right. Reverse this for rolling to the left. Be sure to always move as one unit. Your nose and toes should face the same direction.

To get out of bed, lie on your back. Do a log roll toward your side. Swing your legs over the edge as you push your upper body up with your arms. Keep your hips forward and your legs aligned with your upper body. Move forward until both feet are on the floor. Stand up slowly, pushing off with your hands on the edge of the bed. Be sure to keep your head up when going from a sit to stand to avoid bending forward.

To get in bed back up to the bed until the back of your legs touch the bed. Lower yourself slowly to a sitting position on the side of your bed. Lie down sideways onto your elbow. Bend your knees and raise your legs while lowering your head at the same time. Use your arms to help lower yourself without twisting your back. Once in bed use the log roll to get comfortable if needed.

To sit down in a chair, back up to the chair until you feel it against the back of your legs. Reach back with both hands. Grip the arms of the chair and slowly sit down. Scoot your buttocks to the back of the chair. To get out of a chair, carefully slide forward or walk your hips to the edge of the seat. Keep both feet on the floor. Put both hands on the armrest and push up with your legs to a standing position. Make sure to keep your head up when going from a sit to stand to avoid bending forward.

To get in a car, put the seat back all the way. Back up to the car seat. Reach for the back of the seat with one hand and the dashboard or something stable with the other. Slowly bend your knees and lower yourself onto the edge of the car seat. Bend at your hips, not your back as you slide back on the seat. A plastic bag or seat placed on the seat may make it easier for sliding.

When you are far enough back, bend your knees and pivot on your buttocks to bring in your legs. Avoid twisting your body. Do not grab the door or overhead handle on the doorframe for support. To get out of the car, rotate your buttocks until your feet are resting on the ground. Avoid twisting your body. Place one hand on the back of the seat and the other on the dashboard. Scoot your hips to the edge of the seat and stand up using your legs.

For your safety, sit on the edge of your bed or in a chair when you get dressed and undressed. To put on underwear and pants, cross your right leg over your left knee and pull your clothes on. Repeat the step with your left leg. Once your clothes are about knee height, stand up to finish getting dressed. To put on socks and shoes, sit back down on the edge of your bed or in a chair. Reverse these steps to take your clothes off.

If you are unable to cross one or both of your legs over your opposite knee, there is equipment that can be used to help you dress and undress your lower body. Talk with your health care team for more information about the equipment available, or give you the information in your patient education book.

It is important to walk into any home exercises listed in your education book before and after surgery. These activities are listed within the preparing for surgery chapter of your book. Exercise can help prevent complications, promote circulation, and improve healing and muscle tone. Talk with your surgeon before you begin any other exercises.

Walking every day is an important part of your home exercise program. Walking after surgery can help keep your spine healthy and strong, as well as build endurance and strength. Try to walk three to five times around your home each day. Trips to the kitchen and bathroom are not enough. Build up to walking outside and around your community. For your safety, avoid uneven ground, hills, and slippery surfaces. Your patient education book has more information about how to start a walking program after surgery.

It is important to make plans for discharging or leaving the hospital before your surgery. Make sure to talk with your family and friends about the plans for leaving the hospital as soon as your surgery is scheduled. Arrange for someone to drive you home from the hospital. You will not be able to drive yourself. Please ask them to be available at any time of day because you will be discharged from the hospital when you meet your goals. It will be very important to arrange for some help with household tasks after surgery.

There are also resources within the community you can reach out to if you do not have anyone in your Care Circle available. You can find a list of these resources in the resources section in your spine book. You'll be able to leave the hospital if you're recovering well and meet the goals.

These goals are to, be able to tolerate your pain, to do your activities of daily living, be able to pass urine without problems or having a plan for this, be able to tolerate food, be able to have a plan for activities of daily living, getting dressed and bathing.

To move safely with or without an assisted walking device. Understand how to do your exercises if needed. To be able to go up and downstairs. If you do not meet your goals to go home safely, your health care team will work with you and your Care Circle to develop a safe discharge plan.

Before you leave the hospital your nurse will review your instructions for how to take care of yourself at home. Is helpful to have a member of your Care Circle listen to the instructions with you. That way, they can help you at home if needed. Please ask whomever will be picking you up to be at the hospital at least 30 to 60 minutes early to allow enough time for your nurse to review the instructions with you before leaving the hospital.

Be sure to ask questions if you have concerns or do not understand your instructions. It is important to follow all instructions you were given when you left the hospital. It is recommended that you reread your instructions the day after you return home. Refer to your spine book for direction and questions as well. After you leave the hospital call your surgeon's office if you have questions or concerns about any of the instructions.

Because you will be more active at home than you were in the hospital, your pain may increase. Sometimes pain is less when you are at home. Pain should improve over time and you should be in less pain medication every day. Continue walking, using cold packs and other integrative options to help manage pain. More information on how to safely win off Opioid medications can be found in the care after surgery section in your spine book.

Follow any instructions of physical activity, including positioning techniques and use of assistive devices. This will help you heal more comfortably. Should you feel more pain, or your pain becomes out of control, refer to your home instructions for whom to call.

Recovery is different for every person. Be sure to follow your discharge instructions to prevent complications. Your nurse will discuss these with you before you go home. You can also refer to them in the commonly asked questions section found in Care After Surgery chapter of your spine book. Common questions people have after returning home include understanding what is expected, part of recovery, and how best to prevent possible complications, such as constipation and infection.

Other concerns can include medication side effects. You may have side effects from your medicine. It is helpful to take your medicine soda crackers, or light food to avoid an upset stomach. It is recommended that you take a stool softener and a stimulant laxative to prevent constipation. Your pharmacist can answer any questions you may have. Some medicines may cause you to feel dizzy or drowsy.

Be sure to know what the side effects are to help keep you safe in your home. While you were taking prescription pain medicine, follow your doctor's instructions about taking any additional over-the-counter pain medicine. Most patients do not need refills of pain medicine. If you need a refill of your pain medicine, call the doctor referred to in your home instructions, 48 hours before you run out of medicine to discuss.

This concludes the spine pre-surgery class. We hope you found the information helpful and feel more prepared for a successful surgery. Thank you for allowing us to partner with you as you heal and begin your recovery.