Anterior Cervical discectomy and fusion or Posterior Cervical Laminectomy/Fusion

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Pre-Operative Instructions:

Do not take any anti-inflammatory medications such as Aspirin, Motrin, Advil, Naproxen, Aleve, Ibuprofen, or similar medications that may cause increased bleeding for 10 days prior to surgery.  You may take Tylenol (acetaminophen), Vicodin (hydrocodone), Percocet (oxycodone), Ultracet, Ultram, Tramadol instead, up to the date of the surgery. 

Make sure you report to the hospital for pre-operative testing/registration/interview on the arranged given day.  Failure to do so may result in cancellation of your surgery.  If questions, you may call the operating room at Potomac Hospital at (703) 670-1300 or our office at (703) 490-1112. 

Please make sure you arrive at the hospital two hours prior to your surgery time. 

Do not drink, eat, or smoke after midnight prior to your surgery day.  Smoking cessation at least 2-3 days prior to general anesthesia will significantly decrease the chance of postoperative pulmonary complications.

The exact time of your operation may change depending on the operating room schedule or emergencies. Dr Lotfi will see you immediately prior to surgery.

Post-Operative Instructions

BATHING:
The incision is covered with plastic dressing. You may take a quick shower or sponge bath, right away with the plastic dressing on.  Do not soak in a bath tub/hot tub for a month after surgery.

DRESSING:
You may remove your dressing 3 days after surgery and replace with dry gauze or large Band-Aid.  The incision is initially covered with plastic dressing.   If the dressing is blood–soaked or wet, it can be replaced with dry gauze or Band-Aid. If bleeding is persistent, please inform our office for instructions.  Small amount of spotting with blood is not unusual.

SUTURES:
Dr Lotfi utilizes plastic surgery/cosmetic techniques for closure of your incision.  You may have absorbable sutures. Skin may be closed with Dermabond (medical-grade Crazy Glue) which has a crusty consistency. The incision can be washed with soap and water. If used, Non-absorbable sutures will be removed usually 2 weeks after the surgery on your first post-op visit. 

DRAINAGE:
It is normal to have minimal bloody drainage and spotting of dressing.  In case of excessive drainage that saturates the dressing, please notify our office immediately.

PAIN:
You may experience incisional pain or back of neck or pain between shoulder blades for the first month after surgery, which will subside gradually. It is not unusual to have some neck pain or arm/hand tingling as the nerve recovers from surgery.  Some hoarseness and soreness of throat may be present for the first couple of weeks. It is not unusual to have some swallowing difficulty especially with chunky, solid foods or large pills. It will resolve over the first few weeks. please change your diet to soft food if needed..

GENERAL ACTIVITIES:
You may stay in bed for the first night after surgery. You may get up and proceed with activities of daily living on the day after surgery, as tolerated. No lifting over 30 lbs for 3 months.

SEXUAL ACTIVITIES:
Avoid sexual intercourse for the first 1 week. You may resume as tolerated thereafter.

FOOD:
You may start with clear liquids and soups initially and advance to regular meals as tolerated after the first 24 hours.

FEVER:
You may have a low-grade fever up to 100 degrees after anesthesia.  Most likely cause is shallow breathing.  Deep breathing exercises up to 30 times an hour for the first 1-2 days after surgery is recommended.   If you experience fevers of over 101 degrees, please notify us immediately.

MEDICATIONS:
You are typically given pain medications after surgery such as Vicodin or Percocet to be taken as necessary.  These medications are narcotics and may cause some drowsiness and lethargy as well as constipation.  You may discontinue these medicines once your pain is decreased.  Avoid alcoholic beverages while on these medicines.  If you have history of liver failure/inflammation, please inform your physician.  Your prescription should last you long enough till your first post-operative office visit.  Avoid all anti-inflammatory medications as they may decrease chances of solid fusion for 6 months after surgery (such as Motrin, Advil, Ibuprofen, Naprosyn, Excedrin, Voltaren, and Diclofenac, Mobic and Celebrex).

SMOKING:
Continuation of smoking post operatively for 6 months will decrease chances of complete fusion and successful outcome of surgery.

CONSTIPATION:
General anesthesia as well as pain medications may cause constipation. Try to decrease your pain medications as much as possible. Over the counter stool softeners such as Colace/Metamucil can be used in addition to fruits and vegetables with meals.

BRACES:
If provided with a brace, you may use it when out-of-bed. You may remove it temporarily to bath or for meals. Braces are typically worn for 2-3 weeks post surgery.

WORK:
Please submit all work related paperwork to our office in advance and allow for processing time. Patients usually return to office-work/light duty within 2-4 weeks. You may stay off work at least till seen by Dr Lotfi 2 weeks after surgery. No lifting over 30 lbs for 2 months.

DRIVING:
It is not safe to drive while on pain medications. Most patients can decrease/stop pain meds within 3-4 weeks and may resume driving afterwards.

Lumbar Microdiscectomy/ Mini-decompression

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Pre-Operative Instructions:

Do not take any anti-inflammatory medications such as Aspirin, Motrin, Advil, Naproxen, Aleve, Ibuprofen, or similar medications that may cause increased bleeding for 10 days prior to surgery.  You may take Tylenol (acetaminophen), Vicodin (hydrocodone), Percocet (oxycodone), Ultracet, Ultram, Tramadol instead, up to the date of the surgery. 

Make sure you report to the hospital for pre-operative testing/registration/interview on the arranged given day.  Failure to do so may result in cancellation of your surgery.  If questions, you may call the operating room at Potomac Hospital at (703) 523-1200 or our office at (703) 490-1112. 

For outpatient surgery, Please make sure you arrive at the hospital two hours prior to your surgery time.  Also please make arrangements for someone to drive you home upon the completion of the surgery.

Do not drink, eat, or smoke after midnight prior to your surgery day.  Smoking cessation at least 2-3 days prior to general anesthesia will significantly decrease the chance of post operative pulmonary complications such as pneumonia and fever.

The exact time of your operation may change depending on the operating room schedule or emergencies. Dr Lotfi will see you immediately prior to surgery.

 Post-Operative Instructions:

BATHING:
The incision is covered with plastic dressing. You may take a quick shower or sponge bath, right away with the plastic dressing on.  Do not soak in a bath tub/hot tub for a month after surgery.

DRESSING CHANGES:
You may remove your dressing 3 days after surgery and replace with dry gauze or large Band-Aid.  The incision is initially covered with plastic dressing.   If the dressing is blood–soaked or wet, it can be replaced with dry gauze or Band-Aid. If bleeding is persistent, please inform our office for instructions.  Small amount of spotting with blood is not unusual.

SUTURES:
Your sutures or staples will be removed usually 2 weeks after the surgery on your first post-op visit.

DRAINAGE:
It is normal to have minimal bloody drainage and spotting of dressing.  In case of excessive drainage that saturates the dressing, please notify our office immediately.

PAIN:
You may experience incisional pain after surgery, which will subside over the first week. It is not unusual to have some leg pain/ buttock pain or even tingling as the nerve recovers from surgery.

FOOD:
You may start with clear liquids and soups initially and advance to regular meals as tolerated after the first 24 hours.

GENERAL ACTIVITIES:
You may stay in bed for the first night after surgery. You may get up and proceed with activities of daily living on the day after surgery, as tolerated. No lifting over 30 lbs for 3 months.

SEXUAL ACTIVITIES:
Avoid sexual intercourse for the first week. You may resume as tolerated thereafter.

FEVER:
You may have a low-grade fever up to 100 degrees after anesthesia.  Most likely cause is shallow breathing.  Deep breathing exercises up to 30 times an hour for the first 1-2 days after surgery is recommended.   If you experience fevers of over 101 degrees, please notify us immediately.

MEDICATIONS:
You are typically given pain medications after surgery such as Vicodin or Percocet to be taken as necessary.  These medications are narcotics and may cause some drowsiness and lethargy as well as constipation.  You may discontinue these medicines once your pain is decreased.  Avoid alcoholic beverages while on these medicines.  If you have history of liver failure/inflammation, please inform your physician.  Your prescription should last you long enough till your first post-operative office visit.  Avoid all anti-inflammatory medications as they may thin the blood and increase chances of bleeding for two weeks for two weeks before and after surgery  (such as Aspirin, Motrin, Advil, Ibuprofen, Naprosyn, Excedrin, Voltaren, and Diclofenac).

CONSTIPATION:
General anesthesia as well as pain medications may cause constipation. Try to decrease your pain medications as much as possible. Over the counter stool softeners such as Colace/Metamucil can be used in addition to fruits and vegetables with meals.

BRACES:
If provided with a brace, you may use it when out-of-bed. You may remove it temporarily to bath or for meals. Braces are typically worn for 2-3 weeks post surgery.

WORK:
Please submit all work related paperwork to our office in advance and allow for processing time. Patients usually return to office-work/light duty within the first 4 weeks. You may stay off work at least till seen by Dr Lotfi 2 weeks after surgery.
Typically, patients return to work 2-4 weeks after Lumbar discectomy. No lifting over 30 lbs is recommended for 3 months.

DRIVING:
It is not safe to drive while on pain medications. Most patients can decrease/stop pain meds within 1-2 weeks and may resume driving afterwards.

Town Center Professional Building
14605 Potomac Branch Drive, Suite 300 Woodbridge, VA
Phone: 703.490.1112              Fax: 703.878.8735
www.novaorthospine.com

P. M. Lotfi MD

Shoulder Arthroscopy with Repair

ARTHROSCOPIC LABRAL REPAIR 

ARTHROSCOPIC ROTATOR CUFF REPAIR

SHOULDER REPLACEMENT

ARTHROSCOPIC BICEPS TENODESIS

SHOULDER JOINT REPLACEMENT

ACTIVITY:

1. Resume normal daily activities as toleration without using the operated arm.  You will be instructed in pendulum exercises and elbow range of motion.

2. May return to work/school:  AS TOLERATED

3. May drive a car:  AS TOLERATED

INCISIONAL CARE:

1. May remove dressing in 2 days

2. Redress incision with Band-aids

3. No stitches will be removed

4. You may shower in two days.   At that time, you can wet the incision

5. Keep wound clean and dry for two days

6. Keep extremity elevated as much as possible

7. Check color, motion and feeling of operated arm and hand

8. Be alert for possible signs of infection; redness, swelling, heat, red streaks, and elevated temperature.   Contact your doctor if these occur.

9. Report any severe pain, bleeding, or swelling to your physician.   Keep all dressings dry.

DOCTOR’S POST OPERATIVE APPOINTMENT:
Make your postoperative appointment in a week to ten days.   Your appointment may have been made pre-operatively at the time of scheduling your surgery.
MEDICATION:

1. Resume any pre-operative medications

2. Take home prescription to be taken are:

3. Vicodin ES, 1-2 tabs every 4-6 hours as needed

4. Toradol 10 mgs.  Take 1 every 6 hours for three days

5. Other: _______________________________________

ADDITIONAL DISCHARGE INSTRUCTIONS:
Use the shoulder sling until seen in the office for follow-up.  You will be instructed on sling removal and exercise at that time.   You will need the sling for a total of 4 weeks.

Knee Arthroscopy

ADULT DISCHARGE INSTRUCTIONS

Special Precautions 24 hours After Surgery:

1. You should rest and relax for the next 24 hours and you must make arrangements to have a responsible adult stay with you for at least 24 hours after your discharge.

2. DO NOT DRIVE any motor vehicle or operate mechanical equipment for 24 hours following surgery or while taking narcotics.

3. DO NOT DRINK ALCOHOLIC BEVERAGE for 24 hours after surgery or while taking narcotics.

4. It is not unusual to feel lightheaded up to 24 hours after your surgery or while taking pain medication.   If you feel lightheaded, sit for a few minutes before standing and have someone assist you while walking.

5. If you experience nausea, drink clear liquids (7-Up, apple juice, broth, etc.)  It is important to continue to drink fluids in order to avoid dehydration.   Progress to your regular diet as tolerated.

6. It is not unusual to run a low grade fever after surgery.   If your temperature is elevated above 100.4 degrees, persists for longer than 24 hours, or is questionable in any way, do not hesitate to consult your doctor.

7. You may experience a dry mouth, sore throat or sleep disturbances from the anesthesia and medications used during surgery.   Generalized muscle aches can sometimes occur.   These usually resolve in 12-24 hours.

8. Do not make any important decisions for 24 hours after surgery.

Activities:

1. Avoid hazardous and strenuous activities.

2. Avoid climbing stairs without help.

3. Rest the day of surgery

4. Resume normal daily activities the day after surgery

5. You may return to work/school the day after surgery.   However, your pain medications may decrease your attention span and decision making abilities.

6. You may drive a car the day after surgery as long as you are not taking pain medication.

7. Weight bear as comfortable.

8. Begin knee exercises (Straight leg raises, Quadriceps tightening, Ankle pumps) the day of surgery.

Medication:

1. Resume any pre-op medications as previously directed

2. You may begin your pain medications

1. Tylenol #3 1-2 tabs every 4-6 hours as needed for pain

2. Vicodin ES 1-2 tabs every 4-6 hours as needed for pain

3. Toradol (Ketorolac) 1 tab every 6 hours for the first 2 days, then as needed every 6 hours.

Special Post-op Instructions:

1. Remove dressing

1. As necessary

2. 1 day after surgery

3. 2 days after surgery

4. Leave intact until seen for your post-op visit

2. Redress with _________________________________________________________________

3. Stitches/staples will be removed _________________________________________________

4. You may shower

1. 1 day after surgery

2. 2 days after surgery

3. Only if you keep the incision covered

5. Elevate

6. Ice

7. If your post-op appointment has not been made please call our office at your convenience

(703) 490-1112
Call your doctor if any of the following occur:

1. Be aware of signs of infection at the surgical site such as: increased tenderness, a large amount of drainage or bleeding, severe pain, foul smelling drainage, marked redness, increased swelling, temperature greater than 101.4.

2. Normal urinations should resume in 8-10 hours.

3. Headache that lasts longer than 24 hours.

4. Continued numbness, tingling, or weakness the following day if you received spinal anesthesia.

TO CONTACT A DOCTOR CALL: (703) 490-1112

General Post-Op Instructions

Special Precautions 24 hours After Surgery:

1. You should rest and relax for the next 24 hours and you must make arrangements to have a responsible adult stay with you for at least 24 hours after your discharge.

2. DO NOT DRIVE any motor vehicle or operate mechanical equipment for 24 hours following surgery or while taking narcotics.

3. DO NOT DRINK ALCOHOLIC BEVERAGE for 24 hours after surgery or while taking narcotics.

4. It is not unusual to feel lightheaded up to 24 hours after your surgery or while taking pain medication.   If you feel lightheaded, sit for a few minutes before standing and have someone assist you while walking.

5. If you experience nausea, drink clear liquids (7-Up, apple juice, broth, etc.)  It is important to continue to drink fluids in order to avoid dehydration.   Progress to your regular diet as tolerated.

6. It is not unusual to run a low grade fever after surgery.   If your temperature is elevated above 100.4 degrees, persists for longer than 24 hours, or is questionable in any way, do not hesitate to consult your doctor.

7. You may experience a dry mouth, sore throat or sleep disturbances from the anesthesia and medications used during surgery.   Generalized muscle aches can sometimes occur.   These usually resolve in 12-24 hours.

8. Do not make any important decisions for 24 hours after surgery.

Activities:

1. Avoid hazardous and strenuous activities.

2. Avoid climbing stairs without help.

3. Rest the day of surgery

4. Resume normal daily activities the day after surgery

5. You may return to work/school the day after surgery.   However, your pain medications may decrease your attention span and decision making abilities.

6. You may drive a car the day after surgery as long as you are not taking pain medication.

7. Weight bear as comfortable.

8. Begin knee exercises (Straight leg raises, Quadriceps tightening, Ankle pumps) the day of surgery.

Medication:

1. Resume any pre-op medications as previously directed

2. You may begin your pain medications

1. Tylenol #3 1-2 tabs every 4-6 hours as needed for pain

2. Vicodin ES 1-2 tabs every 4-6 hours as needed for pain

3. Toradol (Ketorolac) 1 tab every 6 hours for the first 2 days, then as needed every 6 hours.

Special Post-op Instructions:

1. Remove dressing

1. As necessary

2. 1 day after surgery

3. 2 days after surgery

4. Leave intact until seen for your post-op visit

2. Redress with _________________________________________________________________

3. Stitches/staples will be removed _________________________________________________

4. You may shower

1. 1 day after surgery

2. 2 days after surgery

3. Only if you keep the incision covered

5. Elevate

6. Ice

7. If your post-op appointment has not been made please call our office at your convenience (703) 490-1112
   Call your doctor if any of the following occur:

1. Be aware of signs of infection at the surgical site such as: increased tenderness, a large amount of drainage or bleeding, severe pain, foul smelling drainage, marked redness, increased swelling, temperature greater than 101.4.

2. Normal urinations should resume in 8-10 hours.

3. Headache that lasts longer than 24 hours.

4. Continued numbness, tingling, or weakness the following day if you received spinal anesthesia.

TO CONTACT A DOCTOR CALL: (703) 490-1112

Adult Discharge Instructions

Special Precautions 24 hours After Surgery:

• You should rest and relax for the next 24 hours and you must make arrangements to have a responsible adult stay with you for at least 24 hours after your discharge.

• DO NOT DRIVE any motor vehicle or operate mechanical equipment for 24 hours following surgery or while taking narcotics.

• DO NOT DRINK ALCHOLIC BEVERAGES for 24 hours after surgery or while taking narcotics

• It is not unusual to feel lightheaded up to 24 hours after surgery or while taking pain medication.  If you feel lightheaded, sit for a few minutes before standing and have someone assist you while walking.

• If you experience nausea, drink clear liquids (7-Up, apple juice, broth, etc).  It is important to continue to drink fluids in order to avoid dehydration.   Progress to your regular diet as tolerated.

• It is not unusual to run a low grade fever after surgery.  If your temperature is elevated about 101.4 degrees, persists for longer than 24 hours, or is questionable in any way, do not hesitate to consult your doctor.

• You may experience a dry mouth, sore throat or sleep disturbances for the anesthesia and medications used during surgery.   Generalized muscle aches can sometime occur.   These usually resolved in 12-24 hours.

• Do not make any important or legal decisions for 24 hours after surgery.

Activities

• Avoid hazardous and strenuous activities

• Avoid climbing stairs without help.

• Rest the day of surgery

• Resume normal daily activities the day after surgery

• You may return to work/school 2 days after surgery.   However, your pain medications may decrease your attention span and decision making abilities.

• Weight bear as comfortable with the use of crutches and your brace.

• Post-op knee brace/immobilizer must be worn while weight bearing until your first post-op visit.

• Begin knee exercises (Straight leg raises, Quadriceps tightening, Ankle pumps) the day after surgery.   Formal physical therapy should begin after your first post-op visit.

Medications:

• Resume any pre-op medications as previously directed.

• You may begin your pain medications

• Tylenol #3 1-2 tabs every 4-6 hours as needed for pain

• Vicodin ES 1-2 tabs every 4-6 hours as needed for pain

• Toradol (Ketorolac)_ 1 tab every 6 hours for the first 2 days, then as needed every 6 hours

Special Post-Op Instructions:

• Remove dressings

• As necessary

• 1 day after surgery

• 2 days after surgery

• Leave intact until seen for your post op visit

• Redress with:

• Adaptic

• 4x4’s

• ABD

• Tubi grip

• Ace wrap

• Stitches/staples will be removed at your post-op visit in 7-10 days

• You may shower

• 1 day after surgery

• 2 days after surgery

• Only if you keep the incision covered

• Elevate your leg with pillows under your calf or ankle 24-48 hours as needed.

• Ice your knee 24-48 hours after surgery.

• If your post-op appointment has not been made, please call at your convenience (703) 490-1112.   An appointment should be scheduled for 1-2 days after surgery.

Call Your Doctor if any of the following occur:

• Be aware of signs of infection at the surgical site such as:  increased tenderness, a large amount of drainage or bleeding, severe pain, foul smelling drainage, marked redness, increased swelling, temperature greater than 101.4.

• Normal urination should resume in 8-10 hours.

• Headache that lasts longer than 24 hours.

• Continued numbness, tingling, or weakness the following day if you received block anesthesia.

To contact a doctor, call (703) 490-1112