Post-Operative & Post Injury Instructions J Hatch Md

POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD

POST-OP APPOINTMENT:

WEIGHT BEARING INSTRUCTIONS Do not bear weight on your operated limb Feather Weight Bearing: -rest your foot on the ground; take your weight on your crutches Partial Weight Bearing: -put as much weight on your affected foot as your comfort permits Full Weight Bearing -walk normally on your operated/injured leg as soon as comfort permits

GENERAL WOUND CARE & DRESSING INSTRUCTIONS: Do not remove initial dressing until your next appointment Remove the outer dressing layer (Ace Wrap or Coban wrap): tomorrow Remove the middle layer (white padding & gauze): tomorrow Remove the adhesive bandage on: if soiled

Keep your incision clean and dry. Call me (802) 370-2879 if your dressing becomes saturated. After you remove the initial dressing, cover your incisions with a Band-Aid or clean gauze until the wound is completely dry (no drainage or gauze staining for 36hrs). Once dry for 36 hours, your incisions may be safely left uncovered and you may bathe normally using ordinary soap & water or shower with the incisions exposed. You may cleanse the incisions with an antiseptic if you prefer (though this is not necessary). Antibiotic creams are not necessary.

R.I.C.E.TO REDUCE SWELLING & PAIN

1. Rest: Limit your general activity as well as limiting the use of the operated part to necessary self-care for 2-3 days after surgery – this is the time when swelling develops. In some cases, a splint or bulky bandage will restrict the use of your operative limb. 2. Ice: Apply ice for 20 minutes every 2 hours for the first 48 – 72 hours until the swelling and pain subsides (crushed ice in a plastic bag works best but frozen peas or frozen corn work well too!). If you have a Cryo-Cuff or other cold compression device, replenish the ice & water as needed following the device’s instructions. 3. Compression: A compression wrap helps reduce excessive swelling. Ideally, your compression bandage should extend down to your foot or hand on the operative side to reduce the “downstream” swelling that commonly occurs after surgery higher up. Be sure to follow the instructions at the top of this page as to when to remove you ace wrap or compression dressing. Generally you should re-apply the ace wrap every 2-4 hours to control further swelling around your operative site. You may also try removing the ace wrap if significant “downstream” swelling occurs in your hand or foot. 4. Elevation: Elevate the operative limb above your heart whenever possible. Elbows & hands: When sitting or whenever swelling is problematic, remove your sling & prop your arm up with pillows or the “Swiss Cheese” arm cradle in the “High 5” position. Prop your hand up on pillows or use the “Swiss Cheese” arm cradle when lying down. Shoulder & Upper Arm: use your sling for comfort when standing or sitting. Sleep propped up in bed or in a recliner. Elevate the hand of your operative limb on pillows if possible, but hand swelling (& bruising) is usually inevitable for the first 2-3 weeks!

Arthroscopic Surgery · Joint Replacement · Foot & Ankle Surgery · Fracture Treatment JPH 2015-11 1 POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD Lower Extremities: Lie down with your leg propped up on pillows so that your foot is above the level of your heart (recliners often don’t work here). After knee surgery, loosen or remove the Ace wrap on your knee to reduce swelling in your ankle & foot.

TO PREVENT OR CONTROL YOUR PAIN Follow the “R.I.C.E. Program” on page 1 – it definitely helps to both prevent & reduce pain. Follow this Multi modal Pain Control Program – using several different types of medicine simultaneously to maximize their benefits yet minimize their side effects. Take your first dose as soon as you get home even if you are pain free or your limb is still numb from the anesthesia or nerve block. Often this is all you will need. Do not take NSAIDS after fracture, non-union or joint fusion surgery unless I tell you to.

MULTIMODAL PAIN CONTROL:

1) OTC (Over the Counter) Non-Aspirin Pain Reliever: These drugs block pain at many levels in the pain pathway Acetaminophen (Tylenol, APAP, Tylenol Arthritis): 500mg (1 extra strength tablet) every 4 hrs. (Maximum dose: 3000mg (6 extra strength tablets or 10 regular strength tablets in 24 hrs.)

2) OTC (Over the Counter) NSAIDS (take either Naproxen or Ibuprofen but not both together): These drugs work mainly at the injury or surgery site to reduce swelling and block pain. Ibuprofen (Advil/Motrin): 600mg (3 tablets) every 6 hrs. (Maximum:12 tablets or 2400mg/day) Naproxen Sodium (Aleve): 440mg (2 tablets) every12 hrs. (Maximum 4 tablets or 880mg/day) If you have a prescription anti-inflammatory medicine you may take it in place of Aleve or Advil Do not take OTC NSAIDS at the same time as prescription anti-inflammatory drugs.

3) Prescription Opioid Narcotics: (Oxycodone, Hydromorphone, Hydrocodone or Tramadol): These drugs mainly work in your brain to blunt your awareness of pain. Be sure to take your regularly scheduled OTC Tylenol and your OTC NSAIDS (or NSAID prescription) as your primary means of preventing pain and then supplement these with your narcotic pain medications as needed every 4 hours. You can safely take your narcotic pain pills within minutes of taking Tylenol or NSAIDS if necessary since these all work safely together. Narcotics make you drowsy so avoid driving or making important decisions while taking them. Prescriptions containing Codeine, Hydrocodone or Oxycodone such as Tylenol #3, Percocet, Lortab, Norco, etc. may also contain Acetaminophen (Tylenol) - look for APAP on the label. Do not take OTC Tylenol with these prescription medicines if they list “APAP” or Acetaminophen on the label – remember the daily max. for Acetaminophen is 3000 mg/ 24 hrs.

TO PREVENT NAUSEA

Many pain medicines can cause some nausea especially if taken on an empty stomach. Try eating small amounts of food ½-1 hour before your pain pills and lie down for an hour or so after you take you pain medicine. If you were prescribed an anti-nausea medication such as Phenergan (Promethazine) or Zofran (Ondansetron) take it 1 hour before your pain pills are due (Exception: you may take these around the clock as directed if nausea is severe). Call my office (843) 705-8910 if the nausea persists.

Arthroscopic Surgery · Joint Replacement · Foot & Ankle Surgery · Fracture Treatment JPH 2015-11 2 POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD

TO PREVENT CONSTIPATION

The narcotic pain relievers that you were given during surgery or prescribed after surgery tend to cause constipation. It is very important that you prevent this by drinking plenty of fluids and (once you can tolerate it) resume a healthy diet with lots of fruit & vegetables. Many patients already have their own remedies to prevent constipation such as prunes, prune juice etc. It is safe to take these after most Orthopaedic surgeries. Adults, who have not have a bowel movement by the second morning after surgery, may add medicines such as Milk of Magnesia (1-2 oz. twice daily) or Dulcolax tablets by mouth (usually 4 tablets) which are available over the counter at your pharmacy. As you did in the hospital, you may continue to take Mira Lax (add the contents of the17gm package to a large glass of fluid and drink it down once or twice daily as needed). After 4 days without a bowel movement you may add a Dulcolax suppository or Fleet’s enema to the above program (also available without a prescription at your pharmacy).

BATHING

Do Not soak in the bathtub, swim or use a hot tub for one week after surgery You may shower but first cover your cast or dressing with a waterproof bag (trash can liners are an inexpensive choice) and double tape the opening of the bag securely to your skin. Don’t balance on 1 leg in the shower! Shower benches and chairs are readily available from medical suppliers and Home Health vendors as well as Home Depot and Lowes. If the cast or dressing is damp, dry it thoroughly with a hair dryer using a low heat setting. This may take up to 1 hour. If the dressing is saturated, call my office (843) 705-8910.

Bathing & Dressing After Shoulder Surgery: While standing, remove your sling, let your arm dangle and relax your shoulder and arm muscles. Slowly bend forward at the waist as you continue to let your arm dangle freely while you bend. Your operative arm should hang like a pendulum and will slowly move away from your body as you bend forward. Be sure to support yourself on a secure vanity or similar solid surface with your good arm (and have someone close by to help the first time you attempt this). After washing and drying your arm pit (deodorants are ok too), you may gently slide the sleeve of your fresh clothing up your arm, then slowly stand erect again and re-apply your sling. Once you can do this comfortably and safety and your incision has been dry for 36 hours, you can use this “dangle” technique while showering. It is much easier to always put your operative arm into the sleeve of your clothing first and then put the good arm in its sleeve second. When removing clothing, reverse the process and remove your operative arm from its sleeve last.

HEALING INCISIONS

Once the incision begins to itch, massage hand lotion, Vitamin E cream or any other emollient into the scar. This provides a deep tissue massage that improves local blood circulation.

Arthroscopic Surgery · Joint Replacement · Foot & Ankle Surgery · Fracture Treatment JPH 2015-11 3 POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD Hint: It is the physical massage that helps the healing process the most rather than which medicine you rub into it! Seven to ten days after surgery, if your sutures have been removed and there is no drainage from your incision or wound you may soak in a tub or swim.

RECOMMENDED ACTIVITY

After Hip & Thigh Surgery: Follow any specific restrictions or precautions that I gave you after the surgery. Be sure to use your cane in the hand opposite to your operated hip. Make sure you use the cane until you can walk at a moderate pace with no limp. You will strengthen the muscles quicker and get rid of the limp faster if you use the cane. If you limp around without the cane, paradoxically you are not using the hip muscles as much as when you use the cane, so your recovery will take much longer! Use crutches or a walker if you need more support or your balance is poor. Be sure to call me immediately (802) 370-2879 if there is any conflict between the instructions I gave you about permitted activity, and what your nurses, therapists or other health care workers tell you.

After Knee & Leg Surgery: Use a cane until you can fully straighten your knee, the swelling has subsided and you feel that you “trust” your leg to hold your weight. Use crutches or a walker if you need more support. Remember, while your knee still has an effusion (swelling within the knee joint itself) your quadriceps (thigh) muscles will be weak and you are at risk of falling - so use your cane until the effusion has gone. Continue the daily exercises prescribed in your handout while increasing the repetitions as tolerated. Gradually resume activities that are comfortable while reducing activities which worsen your pain or swelling.

After Foot & Ankle Surgery: Follow the weight bearing instructions on the first page. Initially you will usually be “Feather Weight Bearing” also known as touch weight bearing. Rest your operative foot on the ground with each step but take the weight on your crutches (or walker). It is usually easiest to move the operated leg and both crutches together (small step) and then take a slightly larger step with the good leg. Practice until you are walking smoothly while placing just the weight of your operated foot on the ground. You may weight bear as tolerated so gradually take more weight on the operated leg until you can walk comfortably without the crutches. Use 1 crutch or a cane for balance as needed.

After Rotator Cuff Repair & Shoulder Fracture Repair: For the first 2 months after surgery: Keep your arm at your side. Do not reach forward. Do not reach out to the side and do not reach behind your back. Exception: when performing your specific “Passive-Assisted” exercise program (your good arm helps move the operated arm). When eating, typing or using a computer mouse, keep your elbow touching your side. Remove the sling periodically using the “dangle” technique to bathe, apply deodorant, etc. You may remove the Ultra Sling bolster and waist strap if they are uncomfortable. When relaxing in a chair, it is very important that you remove the sling and place your forearm on the arm of your chair so that your hand is pointing directly forward. This will help prevent the shoulder stiffness from having your arm in the sling across your tummy constantly.

Arthroscopic Surgery · Joint Replacement · Foot & Ankle Surgery · Fracture Treatment JPH 2015-11 4 POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD Most people have difficulty lying flat in bed immediately after shoulder surgery and you may prefer to sleep in a recliner chair initially. Alternatively you may prop yourself up in bed with pillows. It is safe to lie flat as soon as reasonable comfort permits.

CAST & SPLINT INSTRUCTIONS

Keep your cast dry: The fiberglass cast itself is moisture resistant but the white cast padding absorbs moisture. Damp cast padding next to the skin will cause skin irritation & eventually open sores Shower instead of soaking in a tub, hot tub or pool. Use 2 trash can liners – each taped securely to the skin above your cast. (Shower covers are available at most surgical supply stores & pharmacies but are more $$)

Completely dry the inside of your cast if you get it wet: Use a blow dryer set on low/cool. Direct the flow of air into the top and bottom of your cast. This may take up to an hour. Be sure to set the dryer on a low/cool so as not to burn the skin.

Never put anything down your cast! Using coat hangers, rulers, knitting needles etc. to scratch will wrinkle the cast padding leading in turn to more itching or worse to pressure sores! Use a blow dryer on low-cool setting instead. Video games work for kids of all ages to distract you from the itch almost immediately!

Don’t use spray paint on your cast: Markers & artist-brushed paints are ok

Call me at (843) 705-8910 if you experience any of the following:  Unusually severe pain not relieved by your pain medications, ice, rest and elevation  Persistently blue, purple or white fingers or toes  Numbness or tingling that persists 48hrs after surgery  Burning, rubbing, stinging or sore areas in or around your splint/cast  Cracking or softening of the cast  Excessive bleeding or swelling  Fever (101.0 F or higher) or shaking chills  Not sure what to do

DRAINS

If you have a suction drain in place to reduce joint fluid buildup or to remove any excessive bleeding under your incision, your nurse will show you how to empty it whenever the bulb becomes heavy. You do not need to record the exact amount of drainage but please call my office (843) 705-8910 if it requires emptying more than 3 times within 24 hrs. The drain must be removed 48hrs after your surgery to prevent infection from migrating along the tubing into your incision. If you do not have an appointment with physical therapy or with my office to remove your drain, please call my office after your surgery.

Arthroscopic Surgery · Joint Replacement · Foot & Ankle Surgery · Fracture Treatment JPH 2015-11 5 POST-OPERATIVE & POST INJURY INSTRUCTIONS – J HATCH MD You or a family member may remove the drain on the second morning after surgery. Remove any clear plastic dressing which may hold the drain in place. Often when you remove this clear dressing, the drain comes out too! If not, simply pull the drain gently but continuously until it has been completely removed. The portion of the drain within your incision may be up to 6” long. You may discard the entire apparatus in your regular trash. Apply a dry gauze dressing over the drain site for 48hrs or until all drainage has stopped. If you feel severe pain or the drain will not budge; - stop pulling! Apply a dry gauze dressing and call me (802) 370-2879 for further instructions.

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