Hospital Information What should I do before coming to the hospital? Unless otherwise instructed, do not eat or drink anything later than 8 hours before your surgery. If you are having a procedure that involves approaching the spine from the front (anterior surgery), you should eat a light dinner meal on the day before surgery. IMPORTANT EXCEPTION: You may take your usual medications with a sip of water. Consider stocking up on groceries, including easy-to-prepare meals before you are admitted to the hospital, so that your return home will be as smooth as possible. The following substances can cause bleeding, anesthetic problems, and other serious complications. Please stop using the following medications and substances 10 days before surgery: o Anti-inflammatory medications (NSAIDS includes Vioxx, Celebrex, Bextra, Ibuprofen, Naprosyn, Feldence and others). o All herbal supplements (such as St. John's Wort). o Vitamin E. When should I arrive at the hospital? You should generally arrive two to three hours before your procedure to allow to complete necessary paperwork and any needed tests. What should I bring to the hospital? A current list of medications A list of any allergies that you may have to medications Your insurance card, or other proof of insurance. Any paperwork sent to you by the hospital A living will, if you have one prepared (you may prepare one at the hospital if you wish) Photo identification A comfortable set of clothes to go home in Any x-rays or MRI s that you have not already turned over to the doctor You should leave jewelry and other valuables at home When will I leave the hospital? You will be discharged from the hospital when you are medically stable to go home or to a rehabilitation facility. It is important for you to be prepared for your discharge so that non-medical issues (like a ride home, or someone at home to care for you) do not delay your discharge from the hospital.
Hospital Discharge Instructions No bending, lifting or overhead activities. Avoid twisting in the area of your surgery. Do not use tobacco products. Nicotine increases the chances or wound infection, non-union and other complications. Nicotine is contained in all tobacco products (cigars, chewing tobacco and cigarettes) and in Nicotine patches and gum. If you have had a spinal fusion, do not take Anti-Inflammatory Medications (NSAID s) until cleared to do so by Dr. Stevens. This class of medications includes, Naprosyn, Aleve, Ibuprofen, Vioxx, Celebrex, Indocin, Bextra, Feldene, Aspirin and others. Rehabilitation Program: Go for daily walks; walk outside if possible. Walking exercises all of the muscles in your spine, and is the best rehab program for the first six weeks after your surgery. In most cases, Physical Therapy will be prescribed after 6 weeks, if you need it. Unless otherwise instructed, you should remove your dressing on the second or third day after surgery. You may shower after the third day. You should use a shower chair until your balance has returned to normal. Do not soak in a bath or get into a pool until after your 6-week follow up visit. If you were prescribed a brace or collar, please wear it as instructed. Unless you have been given other instructions, you usually do not have to sleep or shower in your brace, and can get up to go to the bathroom without the brace. You may remove your cervical collar for meals. You should wear the brace at all other s unless otherwise instructed. Constipation is a side effect of narcotic pain medication and iron supplements. You should use an over-the-counter stool softener like Colace or Senokot to avoid this problem. If you do become constipated, you should try Milk of Magnesia or an enema. Please notify the office if this problem becomes severe. You should been seen for a wound check by Dr. Stevens 7 to 10 days after your surgery. If you do not have an appointment scheduled, please call 602-253-7000 as soon as possible and request a POST-OP VISIT. The doctor on-call for Dr. Stevens may not be familiar with your case and will not authorize refills on narcotic pain medication! Please make sure you have enough pain medication, and call to request refills at least 5 days in advance. Because Dr. Stevens operates at multiple hospitals, you may not receive medication refills before you run out if you wait until the last few pills before requesting more. Also, some medications (such as OxyContin and Percocet) can only be filled by a written prescription, and we will have to arrange for you to obtain the prescription from the office. We regret that we are unable to mail narcotic prescriptions. If you are taking other medications besides those prescribed by Dr. Stevens, you should discuss possible drug interactions with your pharmacist. Call immediately if you have a fever over 101.0, increasing redness or drainage around your incision, increasing pain, weakness, or numbness, or severe, persistent nausea or vomiting. If you are very concerned about a problem, please proceed to the Emergency Room. Dr. Stevens works at Good Samaritan and Scottsdale Hospital on Shea Blvd. If you wish to be seen by Dr. Stevens, please go to one of those hospitals. However, you should go to the nearest hospital to your location if you have a serious emergency. Please call (602) 253-7000 if you have any other questions. Dr Stevens is usually in the office all day on Tuesdays and Thursday and Friday mornings. You will get the most prompt response to routine questions if you call on those days, since Dr. Stevens is in surgery all day on Monday and Wednesday. You may also e-mail the office for routine questions at questions@csd.md.
Preparing for your Surgery Preadmission Services 1111 E. McDowell Road Phoenix Arizona, 85006 Monday-Friday 7 a.m. - 7 p.m. (602) 239-4700 www.bannerhealth.com Planning for your Hospitalization Your physician has chosen Banner Good Samaritan Medical Center for your surgical procedure. We will work together with your physician to provide you with the best care available. We also want your admission and stay to be as easy and convenient as possible. Please fill out all necessary forms to help make your stay go smoothly. Hospital stays are generally shorter these days, so it is important that we plan your stay carefully to use your wisely. The Preadmission Office is open Monday through Friday from 7 a.m. to 7 p.m. Call (602) 239-4700 about any special needs or concerns that you may have, including referrals or services that you may need arranged prior to admission. Banner Good Samaritan Medical Center has a Case Management Services Program. You will have a case manager available to assist you if needed. Please do not hesitate to ask for him/her. If you have questions regarding your out-of-pocket expenses for your surgery, or don t have insurance coverage, please call Patient Services/Admitting at (602) 239-4301 prior to coming to the hospital. You may need to make arrangements for your preadmission tests (i.e., lab work, chest X-ray, EKG) to be done at an outside facility. They should be completed at least two days prior to your day of surgery. If your tests are done through your medical or primary care physician, you may be asked to bring the results with you on the day of admission. Prior to your surgery here at Banner Good Samaritan, you may be asked to sign consent for a blood transfusion in the event the doctor feels you need one. If you are interested in treatments and protocols that will minimize your need for a blood transfusion, please discuss the options with your physician or call the Blood Conservation Medicine office at (602) 239-6070. Most insurance companies require us to get prior authorization for procedures. Please verify with your physician s office that the surgery is authorized and whether it s for an inpatient or outpatient procedure. We look forward to meeting with you to make your stay at Banner Good Samaritan comfortable and convenient. Banner Good Samaritan Medical Center is a smoke-free environment. Patient smoking is permitted at the discretion of the physician in the designated areas outside the hospital. Hospital Phone Numbers Hospital Operator (602) 239-2000 Administration (602) 239-4200 Admitting In-Patient (602) 239-4301 Outpatient (602) 239-2800 Billing (602) 640-3100 or (602) 239-4300 Emergency Center (602) 239-2222 Patient Relations (602) 239-2236 Patient/Visitor Information (602) 239-3576 Preadmission Services (602) 239-4700 Security (602) 495-4400 Social Services (602) 239-4363 SurgeryWaiting Area (602) 239-2711 If you are from out of town, please request the Banner Good Samaritan Visitor Information Guide. 1
Preparing for your Surgery Information and Instructions The evening before surgery: Do: Ask your physician about special instructions for the morning of your surgery if you take medications such as insulin, heart or blood pressure medicines. Bring a list of your medications, dose requirements, and s of day that you need to take them, unless you have already listed them on other admission forms. Follow any pre-surgery instructions given to you by your physician, such as enemas, douches, showers, etc. Notify your surgeon if a cold, fever or other infection develops before your surgery. Don t: Do not eat or drink anything after midnight, including water, throat lozenges or chewing gum, unless instructed differently by your physician or an anesthesiologist. Your surgery will be cancelled if you eat or drink without special instructions. Do not smoke after midnight. Smoking can irritate the lungs and contribute to nausea. Unless you are instructed to do so, do not bring your medications to the hospital. The day of surgery: Do not wear makeup, hairpins, lotion, powder or perfume. Take a bath or shower the day of your surgery. Cleanliness is an important part of any surgery. Bring your own personal hygiene items, such as robe, slippers, etc. You may brush your teeth, but be careful not to swallow any water. The hospital is not responsible for misplaced or stolen items, such as money, credit cards, jewelry and other valuables. We suggest you leave these valuables at home. If you wear contact lenses, glasses or dentures, bring a container to protect them. Arrive at your designated. Go to the Main Lobby Admitting Desk (12th Street & McDowell entrance) in the hospital. A Patient Services representative will have your admission papers ready for your signature. Be prepared to show your Health Insurance Cards. If you have an Advance Directive/Living Will, please bring a copy with you. You will be escorted to the pre-surgery area. Family or friends may wait in the 2nd floor surgery waiting room. Generally, they are not permitted in the pre-surgery area. Wear comfortable, loose fitting clothing that is easy to take off and put on. Your clothes will either be given to your family or friend, or placed in a locker with your name and brought to you after surgery. Feel free to ask about anything that concerns you. An informed patient is a more relaxed patient. A nurse will take your blood pressure, temperature and pulse rate. You will be asked to sign a consent to authorize the physician to perform your surgery. The physician who gives you your anesthesia will talk with you. You will then be taken to a surgery operating room on a cart. A blood pressure cuff and heart monitor will be attached. Don t be alarmed, this is done so that you are constantly observed during surgery. Following surgery: After your surgery, your physician will talk to your family or friend, and you will be taken to the recovery area for a minimum of 1 hour. While in the recovery area, you will be closely monitored by the nursing staff. Your family or friend will be notified of your condition and your transfer when you are taken to your hospital room. In general, prolonged bed rest after surgery is not beneficial. Most patients will be encouraged to get out of bed and begin activity very soon after surgery, most likely on the same day as surgery. Depending on your type of surgery, your physician may order certain exercises for you which usually include deep breathing, coughing, movement of legs and getting out of bed. These exercises will help you recover more quickly. Discharge: Planning for your discharge is just as important as planning for your admission. We will work with you during your stay to meet any discharge needs. Please let us know if you feel you will have any special needs. If you are discharged the same day as your surgery, post-operative instructions will be given to you at the of your discharge. Please make arrangements for someone to drive you home and stay with you at least 24 hours after your general anesthesia. Preparing for your Surgery 2
Surgical Outcomes Survey This survey will help Dr. Stevens to better evaluate the results of your treatment, and better understand the factors that contribute to successful surgical outcomes. This survey includes several questionnaires proven to accurately measure outcomes in spinal surgery. Many of these questions are similar or identical; however, it is important that you answer all of the questions yourself. If you find that a question does not apply to you, simply skip that question and proceed to the next one. You will be asked to complete similar surveys at regular intervals after your surgery, so that your responses before and after surgery can be compared. Dr. Stevens may wish to use your responses to these surveys for medical research. All personal identifying information will be removed from any report to medical organizations or the medical literature based on the content of any survey completed in this office, in accordance with our privacy policy. Name: Age: Today s Date / / PART 1: Pain and Disability Does your neck or back problem cause pain? No (skip to Part 2) Yes ( please complete this section) This section pertains to pain only. You will have an opportunity to answer questions about numbness and tingling in the next section. Use a pen to mark your pain on the figures below mark the drawing for pain only. RIGHT BACK FRONT LEFT What medications are you currently taking for pain related to your spinal problem, including pain radiating into arms and legs? I have taken no medication for my spinal problem Medication #1 Dose mg. Frequency: pills s per day Medication #2 Dose mg. Frequency: pills s per day Medication #3 Dose mg. Frequency: pills s per day Overall, which single word or phrase would you use to describe your pain most of the? Trivial/Minimal Annoying Limiting Disabling Unbearable
Part 2: Visual Pain Scales As in the shown in example above, with 0 being no pain at all please make a single veritical mark below to show: ALL OF YOUR PAIN right now? ALL OF YOUR PAIN most of the? ALL OF YOUR PAIN when you feel your very worst? ALL OF YOUR PAIN when you feel your very best? Your NECK PAIN ONLY most of the? Your ARM PAIN ONLY most of the? Your BACK PAIN ONLY most of the? Your BACK PAIN ONLY when it is most severe? Your LEG PAiN ONLY most of the? Your LEG PAIN ONLY when it is most severe? Center for Spinal Disorders Pre-Op Survey - 2 -
Part 3: Oswestry Pain Survey: Please Mark ONLY ONE response to each question below. 1. Pain Intensity 6. Standing I can tolerate the pain I have without having to use pain killers. The pain is bad but I can manage without pain killers. Pain killers give complete relief of pain. Pain killers give moderate relief of pain. Pain killers give very little relief of pain. Pain killers have no effect on the pain. I can stand as long as I want without extra pain. I can stand as long as I want but it gives extra pain. Pain prevents me from standing more than an hour. Pain prevents me from standing more than 30 minutes. Pain prevents me from standing more than 10 minutes. Pain prevents me from standing at all. 2. Personal Care 3. Lifting 4. Walking I can look after myself normally without causing extra pain. I can look after myself normally but it causes extra pain. It is painful to look after myself and I am slow and careful. I need some help but manage most of my personal care. I need help every day in most aspects of self-care. I do not get dressed, wash with difficulty and stay in bed. I can lift heavy weights without extra pain. I can lift heavy weights but it gives extra pain. Pain prevents me from lifting heavy objects off the floor, but I manage if they are conveniently positioned e.g. on a table. Pain prevents me from lifting heavy objects off the floor, but I manage light to medium weights if they are conveniently positioned. I can only lift very light weights. I cannot lift or carry anything at all. Pain does not prevent me from walking any distance. Pain prevents me from walking more than a mile. Pain prevents me from walking more than one-half mile. Pain prevents me from walking more than one-half quarter mile. I can only walk using a stick or crutches. I am in bed most of the and have to crawl to the toilet. 7. Sleeping Pain does not prevent me from sleeping well. I can sleep well only by using tablets. Even when I take tablets I have less than six hours sleep. Even when I take tablets I have less than four hours sleep. Even when I take tablets I have less than two hours sleep. Pain prevents me from sleeping at all. 8. Sex Life My sex life is normal and causes no extra pain. My sex life is normal but causes some extra pain. My sex life is normal but is very painful. My sex life is very restricted because of pain. My sex life is nearly absent because of pain. Pain prevents any sex life at all. 9. Social Life My social life is normal and gives me no extra pain. My social life is normal but increases the degree of pain. Pain has no significant effect on my social life apart from limiting my more energetic interests, e.g. dancing. Pain has restricted my social life and I do not go out as often. Pain has restricted my social life to my home. I have no social life because of pain. 10. Traveling 5. Sitting I can sit in any chair as long as I like. I can only sit in my favorite chair as long as I like. Pain prevents me from sitting more than an hour. Pain prevents me from sitting more than 30 minutes. Pain prevents me from sitting more than 10 minutes. 5. Pain prevents me from sitting at all. I can travel anywhere without pain. I can travel anywhere but it gives me extra pain. Pain is bad but I manage journeys over two hours. Pain restricts me to journeys of less than one hour. Pain restricts me to short, necessary journeys of under 30 minutes. 5. Pain prevents me from traveling except to the doctor or the hospital. Center for Spinal Disorders Pre-Op Survey - 3 -
Part 4: SRS-22 Patient Questionnaire Complete only if box is checked: 1. Which of the following describes the amount of pain you have had in the past 6 months None Mild Moderate Moderate to severe Severe 2. Which of the following describes the amount of pain you have had over the last month. None Mild Moderate Moderate to severe Severe 3. During the past 6 months have you been a very nervous person? None of the A little of the Some of the Most of the All of the 4. If you had to spend the rest of your life with your back shape the way it is now, how would you feel about it? Very happy Somewhat happy Neither happy or unhappy Somewhat unhappy Very unhappy 5. What is your current levelof activity? Bedridden Primarily no activity Light labor and light sports Moderate labor and moderate sports Full activity without restriction 6. How do you look in clothes? Very good Good Fair Bad Very bad 7. In the past 6 months have you felt so down in the dumps that nothing could cheer you up? Very often Often Somes Rarely Never 8. Do you experience back pain when at rest? Very often Often Somes Rarely Never 9. What is your currentr level of work/.school activity 100% normal 75% normal 50% normal 25% normal 0% normal 10. Which of the following best describes the appearance of your trunk; defined as the human body except for the head, arms and legs. Very good Good Fair Poor Very Poor 11. Which of the following best describes your medication usage for your back? None Non-narcotics weekly or less (e.g., aspirin, Tylenol, Ibuprofen) Non-narcotics daily Narcotics weekly or less (e.g., Tylenol III, Lorcet, Percocet) Narcotics daily Other medication Usage Center for Spinal Disorders Pre-Op Survey - 4-12. Does your back limit your ability to do things around your house? Never Rarely Somes Often Very often 13. Have you felt calm and peaceful in the last 6 months All of the Most of the Some of the A little of the None of the 14. Do you feel that your back condition affects your personal relationships? None Slightly Mildly Moderately Severely 15. Are you and or your family experiencing financial difficulties because of your back? Severely Moderately Mildly Slightly None 16. In the past 6 months have you felt downhearted and blue? Never Rarely Somes Often Very often 17. In the last 3 months have you taken any sick days from work/school due to back pain, and if so how many? 0 1 2 3 4 or more 18. Do you do out more or less than your friends? Much more More Same Less Much less 19. Do you feel attractive with your current back condition? Yes, very Yes, somewhat Neither attractive nor unattractive No, not very much No, not at all 20. Have you been a happy person in the past 6 months? None of the A little of the Some of the Most of the All of the 21. Are you satisfied with the results of your back management? Very satisfied Satisfied Neither satisfied or unsatisfied Unsatisfied Very unsatisfied 22. Would you have the same management again if you had the same condition? Definitely yes Probably yes Not sure Probably not Definitely no
The SF-36 Health Survey Instructions for Completing the Questionnaire Please answer every question. Some questions may look like others, but each one is different. Please take the to read and answer each question carefully by filling in the bubble that best represents your response. EXAMPLE This is for your review. Do not answer this question. The questionnaire begins with the section Your Health in General below. For each question you will be asked to fill in a bubble in each line: 1. How strongly do you agree or disagree with each of the following statements? Strongly agree Agree Uncertain Disagree Strongly disagree a) I enjoy listening to music. b) I enjoy reading magazines. Please begin answering the questions now. Your Health in General 1. In general, would you say your health is: Excellent Very good Good Fair Poor 2. Compared to one year ago, how would you rate your health in general now? Much better now than one year ago Somewhat better now than one year ago About the same as one year ago Somewhat worse now than one year ago Much worse now than one year ago Please turn the page and continue. SF-36 - Medical Outcomes Trust and John E. Ware, Jr. All Rights Reserved - Page 1 of 3
3. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? a) Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports b) Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf Yes, Limited a lot Yes, limited a little No, not limited at all c) Lifting or carrying groceries d) Climbing several flights of stairs e) Climbing one flight of stairs f) Bending, kneeling, or stooping g) Walking more than a mile h) Walking several blocks i) Walking one block j) Bathing or dressing yourself 4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? a) Cut down on the amount of you spent on work or other activities Yes b) Accomplished less than you would like No c) Were limited in the kind of work or other activities d) Had difficulty performing the work or other activities (for example, it took extra ) 5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? a) Cut down on the amount of you spent on work or other activities Yes b) Accomplished less than you would like No c) Didn't do work or other activities as carefully as usual Please turn the page to continue. SF-36 - Medical Outcomes Trust and John E. Ware, Jr. All Rights Reserved - Page 2 of 3
6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? Not at all Slightly Moderately Quite a bit Extremely 7. How much bodily pain have you had during the past 4 weeks? None Very mild Mild Moderate Severe Very severe 8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Not at all A little bit Moderately Quite a bit Extremely 9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the during the past 4 weeks... All of the Most of the A good bit of the Some of the A little of the None of the a) did you feel full of pep? b) have you been a very nervous person? c) have you felt so down in the dumps nothing could cheer you up? d) have you felt calm and peaceful? e) did you have a lot of energy? f) have you felt downhearted and blue? g) did you feel worn out? h) have you been a happy person? i) did you feel tired? 10. During the past 4 weeks, how much of the has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? All of the Most of the Some of the A little of the None of the 11. How TRUE or FALSE is each of the following statements for you? a) I seem to get sick a little easier than other people Definitely true Mostly true Don't know Mostly false Definitely false b) I am as healthy as anybody I know c) I expect my health to get worse d) My health is excellent THANK YOU FOR COMPLETING THIS QUESTIONNAIRE! SF-36 - Medical Outcomes Trust and John E. Ware, Jr. All Rights Reserved - Page 3 of 3