FAQ

The questions below are frequently asked by our patients and we hope you find this information helpful. If you still have any questions, please click “Contact Us” above to get answers.

FAQs for surgery are found below and further down are FAQs for patients having injections with our Interventional Pain Management doctors.

FAQs for Surgery

What do I bring on the day of surgery?
  • Your current valid insurance information card and photo identification.
  • Any medications you normally take including inhalers or a CPAP machine (if you use them), a walker (we have walkers, but some patients prefer their own), and an incentive spirometer. If ordered by our surgeon, compression stockings are measured and provided to you on the day of surgery. If you are having an injection (and not surgery), please check with your doctor to see if it is necessary to bring any of these things.
  • A smart phone or tablet is a great way to pass the time during your stay, but please respect the privacy of others if your device also functions as a phone or camera. Minimize phone calls in the patient care areas. There is a strict “No Photo” policy once you are checked into the Center.
What time do I show up on the day of surgery?

Proliance Center for Spine and Joint Surgery staff will call you two days before your surgery inform you what time to be at the Surgery Center on the day of surgery.  Remember, your arrival time on the day of surgery will be before your anticipated surgery start time. If you have not received a call from the staff by 3:00pm on the day before your surgery, please call 425-921-6500. You will be asked to arrive 90 minutes before your anticipated start time.

What do I wear on the day of surgery?
  • We recommend wearing loose fitting clothing that will accommodate bulky dressings, soft goods and possibly casting materials that will increase the size of your limb. These items should be easy to put on and take off, for example, shirts that button up the front or loose-fitting slacks/sweatpants.
  • Please leave all valuables at home.
  • If you wear contact lenses, glasses, or hearing aids bring a case or container, and solution for contacts, to protect them while you are in surgery.
  • We recommend wearing shoes that provide support and will not be a tripping hazard. Do notwear flip-flops or slip-on sandals.
What can I eat or drink on the day of surgery?
  • You will be instructed not to take anything by mouth (food, gum, candy, etc.) after midnight prior to the day of surgery (for example, if your surgery is on a Wednesday, you will be asked not to eat or drink anything after midnight Tuesday). (See the next FAQ for information about what to do with any medicines you take)
  • The morning of surgery, you may brush your teeth and rinse your mouth with water (but do not swallow the water or use mouth wash).
What about any medicines that I normally take?
  • The one exception to the “nothing by mouth” rule is any medication you are told by your surgeon or the nursing staff to take with a sip of water on the morning of surgery (you will be informed at your pre-operative visit which medicines, if any, you should take). If you have Diabetes, will also be counseled on an individual basis according to your needs and your scheduled surgery time.
  • For any blood-thinning medicine (anti-inflammatories, supplements like fish oil, coumadin, Plavix, etc.) you will be instructed by your doctor how to manage these around the time of your surgery. We will ask for guidance from your prescribing doctor for certain medicines (like coumadin, Plavix) and will not schedule your surgery until we have this information.  We do this to minimize the risk to you after your surgery.
Do I need a ride home after surgery?

Yes!  You are required to arrange for a responsible adult over the age of 18 to drive you home from surgery. Your escort’s name and telephone number are obtained at the time of surgery. You will also need to have a responsible adult stay with you for at least the first 24 hours after surgery, (check with your surgeon for additional after surgery requirements specific to your surgery). If you do not make these arrangements, we will cancel your surgery and reschedule it for when you are able to meet this requirement.  This is done solely out of concern for your safety after surgery.

FAQs for Joint Replacement

Which medications/supplements can I take prior to my surgery? Which should I stop and when? Are there any I should take the morning of my surgery?

(Note: Your surgeon will instruct you specifically with respect to your medicines, what follows is a general guideline for your information)

In general, medications that thin your blood shouldn’t be taken for 5 days prior to your procedure. This includes medications like NSAIDS such as aspirin, Aleve or ibuprofen, but also supplements such as fish oil, garlic pills, coQ 10 and turmeric. Anticoagulants such as Coumadin, Xarelto or Plavix also need to be stopped prior to surgery, but you will need to check with your prescribing physician to determine how to do this safely. In some cases, you will need to use a bridging medication before resuming your regular anticoagulant.

Most other medications can be taken up until surgery, but we will ask that you hold them the morning of surgery, before resuming them postoperatively. This includes most blood pressure medications, thyroid supplements, statins for cholesterol management, antidepressants and pain medications.

There is one type of medication, however, that we do want you to take the morning of your surgery with a sip of water, and that is the class of medications called “beta blockers.” Typically, these medications end in the suffix “-lol.” A few examples are propranolol and labetolol.

Last, medications for diabetes need to be managed prior to surgery because you will be fasting. Our anesthesiologists ask that you stop your metformin 12 hours prior to your procedure. In addition, those of you taking insulin may need to lower your dose to accommodate for your fasting status. Coordinating your insulin dose with your prescribing physician is recommended.

Sleeping has been difficult for me after my surgery - what strategies can I use to help?

Sleeping can be a challenge. For side sleepers, it may be several weeks before you can comfortably sleep on your side following lower extremity surgery. Shoulder patients often sleep best upright or in a recliner for weeks after their surgery. If you don’t own a recliner, there are foam wedges that can be used in bed to prop yourself up enough to enable sleep. In general, try to find a comfortable position, use pillows to hold yourself there, take your pain medication at bedtime, and do the best you can. For those of you undergoing knee replacement, try to keep from having pillows directly under your knee because it tends to create a flexion contracture, making it difficult to straighten the knee fully. Better to keep the pillows under the lower part of your legs.

When do I have to stop eating before my surgery? Can I drink liquids on the day of my surgery? If so, when should I stop?

In general, you will be asked to fast for your surgery. This is for your own protection, as stomach contents are at risk for being aspirated into your lungs during general anesthesia. In most cases, you can eat and drink normally up until midnight the night before your surgery, and then fast afterwards. We ask that you refrain from drinking alcohol the night before your procedure. If you take a beta blocker medication, you will be asked to take that with a sip of water on the morning of your operation. If your case is later in the day, you may be allowed to have clear liquids up until 4 hours prior to your scheduled procedure time. Clear liquids includes black coffee (no creams or proteins), water, tea, soft drinks, sports drinks, apple juice…etc. No proteins means no coffee creamers or milk, broths and the like. If your case is scheduled to be performed under local anesthesia, you may not be required to fast. Check with your surgeon during your preoperative visit or call the office to confirm what is recommended for you.

What can I expect postoperatively? Will I be in terrible pain? How do I manage my symptoms?

With very few exceptions, most of you will have had some type of local anesthesia during your procedure – even if you had a general anesthetic. As a result, when you awaken, your pain should be manageable. The recovery room nurses are there to monitor your pain level and give you medication as you require it. Some of you will have had a dedicated regional block and will be densely numb afterwards. Blocks last variable amounts of time, but most wear off within 12-24 hours. Anticipate this! This means you may want to consider taking a dose of your pain medication at bedtime, even if you’re not hurting. During the period you are numb, try not to “overdo it” as this can make the pain worse as the numbing agent wears off. Once the numbing agent wears off, there may be more discomfort, but try not to worry because we expect this to happen.

In order to help you manage your pain postoperatively, we recommend multimodal pain management. This simply means addressing your pain from multiple angles. We do use medication – both oral and injectable – but we also use ice and elevation and compression and rest. You might have a pain pump or a regional block. We ask that you also take a role in your pain management. This means being resilient and believing you will get through this because you will. Try not to “catastrophize” your pain. It will improve, sometimes sooner than seems possible.

A brief word about narcotics. First, most of us are aware of the opioid addiction crisis in this country. In the last twenty years, it is no secret that they have been over-prescribed. There are now rules in place limiting the number of pills we can prescribe and the frequency with which we can issue these prescriptions. That said, they do play their role early in your recovery to help you get on top of your pain. You may need to take a full dose of your prescribed narcotic regularly to help with the pain initially. Once you are able to get on top of your pain, then you will able to decrease your dose and frequency. Opioids are addictive – and can cause wicked constipation, among other unpleasant side effects – but if you use them judiciously, and wean off them as you no longer need them, your risk of addiction is minimal. So use them, early.

What are things I should look out for after my surgery? What are possible complications?

Complications are an unfortunate possibility following any surgery. The type and severity of the possible complication varies depending on the location and magnitude of your procedure. More complex, longer operations tend to have a higher complication rate. However, there are ways to minimize the risk of a complication happening to you. The types of complications that we tend to consider include blood clots, infection, nerve damage, stiffness, recurrence of the injury or failure of a repair. Prevention of a complication can take several forms. For instance, we may ask you take aspirin after your surgery and stay hydrated to reduce the risk of blood clots. Additionally, we may give you antibiotics prior to (and sometimes after) your procedure to help prevent infection. Keeping your dressing and wound clean and dry after surgery for a variable period of time is also typically advised. We often will give you gentle exercises to perform postoperatively to prevent stiffness. Alternatively, we may ask you to refrain from certain activities, even basic tasks such as actively moving the operative extremity, in order to prevent damage to your repair. We will discuss this with you prior to your surgery and afterwards as well. If you have any questions about what you should or shouldn’t do postoperatively, please ask us. Similarly, if you have a concern about how you’re healing or feel you may be developing a complication, we are available 24/7 to answer your questions.

How do I take care of my splint or dressing? How should I manage my wound? When do sutures come out? Do I need to wear my sling all the time (if you have one)?

In general, after your surgery you will be asked to keep your dressing or incision clean and dry for some period of time. If you have a plaster splint, you will very likely be asked to keep it in good repair until your first postoperative visit, during which it will be removed. Those of you having arthroscopic procedures are typically asked to keep your incisions (or portals) clean and dry for a week. Waterproof band-aids work well for this. In between showers, wearing a regular band-aid will allow your incisions “to breathe” which aids in healing. After a week, you can typically get your small incisions wet in shower, provided they’re healing uneventfully. Joint replacement patients are typically given an occlusive dressing that contains an antiseptic that can stay on for 2 weeks before being changed. These dressings are water resistant but not waterproof, so it is advised you cover them in the shower with a plastic wrap. As a general rule, any time you change a dressing or come near your wound, make sure you wash your hands well first. Antibiotic ointments and creams are not necessary for healing. Sutures are typically removed at your first postoperative visit, usually at around 10 days following surgery.

Regarding your sling (if you have one), we will want you to wear it most of the time, at least initially, coming out of it to perform your range of motion services or to bathe. It serves as a reminder to you not to overuse your extremity and as a warning to others that you’ve recently had surgery. The small pillow that is part of the sling brings your arm slightly away from your body, which takes tension off of your repair, aiding the healing process. If you must take your sling off, it is advised you rest your arm on a pillow to help with healing. Tucking a dry wash cloth under your arm can help prevent a “heat rash” from forming. As time goes on and the healing process proceeds, you will be allowed out of your sling more and more. In the meantime, please bear with your surgeon as there is a reason we are asking you to wear your sling.

FAQs for Interventional Pain Management Injections

What do I bring on the day of my injection?
  • Your current valid insurance information card and Photo identification.
  • Please check with your doctor to see if you need to bring to your injection any medications you normally take. If you are having sedation, you may need to bring any inhalers or a CPAP machine (if you use them).
  • A smart phone or tablet is a great way to pass the time during your stay, but please respect the privacy of others if your device also functions as a phone or camera. Minimize phone calls in the patient care areas. There is a strict “No Photo” policy once you are checked into the Center.
What time do I show up on the day of my injection?

At the time your injection is scheduled, you will be told what time to arrive on the day of your injection.  For patients who do not receive sedation, we will ask you to arrive 30 minutes before your scheduled injection time. If you are having sedation, Proliance Center for Spine and Joint Surgery staff will call you one to two days before your injection inform you what time to be at the Surgery Center on the day of your injection.  We will ask you to arrive 60 minutes before your scheduled injection.  Remember, your arrival time on the day of injection will be before your anticipated injection start time. If you are having IV sedation and have not received a call from the staff by 3:00pm on the day before your injection, please call 425-921-6500.

What do I wear on the day of my injection?
  • We do not have any specific recommendations. Your clothing should be comfortable and loose-fitting enough to allow the doctor to easily access to the location for your injection.
  • Please leave all valuables at home.
What can I eat or drink on the day of my injection?
  • If you are not having any sedation, you may eat and drink normally on the day of your injection.
  • If you are having IV sedation, you will be instructed what, if anything, you are allowed to eat or drink on the day of your injection.
What about any medicines that I normally take?
  • You may take your regular medicines normally on the day of your injection, unless instructed otherwise by your doctor.
  • For any blood-thinning medicine (anti-inflammatories, supplements like fish oil, coumadin, Plavix, etc.) you will be instructed by your doctor how to manage these around the time of your injection. We will ask for guidance from your prescribing doctor for certain medicines (like coumadin, Plavix) and will not schedule your injection until we have this information.  We do this to minimize the risk to you after your injection.
Do I need a ride home after my injection?
  • If you are not having sedation, you may drive yourself home after your injection
  • If you are having IV sedation, we require you to be driven home by a responsible adult over the age of 18. Your escort’s name and telephone number are obtained when you arrive for your injection. If you do not make this arrangement, we will cancel your injection and reschedule it for when you are able to meet this requirement. This is done solely out of concern for your safety.
How often can I get steroid injections and how many injections can I get?

Steroid injections are usually done in a series of no more than three injections, with each injection being several weeks apart. If you do not have substantial relief after three injections, it probably is not worthwhile continuing them. In addition, concern about potential side effects of the steroid medicine, such as osteoporosis, may impact how often you can receive injections.

How many injections will insurance pay for?

Insurance will typically pay for most epidural steroid injections. There are many different insurance companies and each company has many different types of plans, which each cover different therapies. You should check with your insurance carrier prior to the procedure to confirm that it is a covered procedure and how much you might have to pay out-of-pocket.

“I only felt good the day of the procedure, and now the pain is back.” Does that mean the injection didn’t work?

When performing a steroid injection, we frequently also add local anesthetic to the steroid injection for diagnostic purposes. It is expected that the pain will go away for several hours after the injection and then come back by the end of the day. It can take at least a couple of days, or longer, for the steroid medicine to have start working. You will be reassessed by your doctor several weeks after the injection to determine if you got good relief from the steroid injection and whether you need a second or third injection.

How long does the pain relief from a steroid injection last?

The length of time you experience pain relief after a steroid injection is quite variable, ranging from no relief at all to many months, or even years, of relief. It depends on the type of injection, the reason why the injection was done, and your individual response. There is no way to predict your level of relief before the injection.

What are the side effects or expected symptoms from steroid injections?

In general, steroid injections are well-tolerated, however, some patients can occasionally develop agitation, facial flushing, or have trouble sleeping for a day or two after the injection. If you have Diabetes, you will have a transient increase in blood sugar for several days and you should be prepared to adjust your diabetic medication doses accordingly. The long-term effects of frequent steroid injections include osteoporosis, hypertension, diabetes, weight gain, cataracts, and thinning of the skin. Interventional pain management techniques have been developed to deliver a high concentration of steroid localized to the site where it is needed, which minimizes general body side effects.

What actually happens in the procedure room when I get my injection?

Upon arriving you will check in at the surgery center front desk, and after signing a consent form our nursing staff will escort you to the procedure room for your injection. You will be positioned on the procedure table and the area to be injected will be prepared with a cool antiseptic solution applied to the skin. If this is an injection done with the assistance of fluoroscopy, a “C-arm” fluoroscopic x-ray machine will be positioned so that the site of injection is visualized. Your doctor will carefully place the needle at the appropriate injection site and may inject some x-ray dye to confirm that the needle is in the appropriate place. That will be followed by injection of the steroid, which is commonly mixed with local anesthetic. A Band-Aid dressing will be applied to the injection site and you will be to taken back to the admission area to be readied for discharge.

For patients having IV sedation with their injection (in addition to the information above):

If you are having intravenous sedation for your procedure, after checking in at the front desk you will be escorted to the pre-surgical area of the surgery center where a nurse will place an IV (intravenous line) that is used to deliver the sedation medicine during the procedure.  In order to safely monitor you during your procedure, they will place EKG monitoring leads on your chest, a blood pressure cuff on your arm and a blood oxygen sensor on your finger.

Once you are positioned on the table and the area to be injected has been cleaned with a sterile solution, the sedation medicine will be given before performing the injection.

After your procedure, you will be move to the post-anesthesia care area for monitoring until the effects of your sedation have worn off.

If you do receive intravenous sedation you will need to have a responsible driver to take you home.

Can I get vaccinations before or after a steroid injection?

Steroid injections should not be done within two weeks, before or after, of receiving a vaccination. The steroid injection may decrease the effectiveness of the vaccination.