Patient guidelines for Lumbar Fusion

Patient guidelines for Lumbar Fusion Robert S. Pashman, MD Scoliosis and Spinal Deformity Surgery 10/20/2014 www.eSpine.com 1 As of 10/6/14: Pain...
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Patient guidelines for Lumbar Fusion

Robert S. Pashman, MD Scoliosis and Spinal Deformity Surgery 10/20/2014

www.eSpine.com

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As of 10/6/14: Pain Medication Update 





Medication classified as a triplicate (Vicodin, Percocet, Oxycontin, etc). These prescriptions require a written prescription. We cannot call it into the pharmacy or fax it. You must plan ahead. Prescriptions are filled on Tuesdays morning when Dr. Pashman is in the office. The prescription can be picked up after Tuesday afternoon, or sent FedEx at the cost of the patient. If you run out of medication you will have to visit your local ER. By law the prescription is a maximum 30 day supply. 2

Surgical procedure Dr. Pashman is performing an interbody fusion, either posterior, or anterior/posterior. The surgical plan is developed for each individual based on many factors. The details of the surgical procedure will be reviewed during your pre-op appointment before you sign the consent form. Dr. Pashman will maximize the correction of your spine.

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Surgical Procedure • During your surgical procedure, your vertebrae will be fused together, and instrumentation will be used as an internal brace as the fusion grows over the next year. Only in rare cases is the hardware removed. • More information about the surgical procedure can be found at www.eSpine.com

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Three weeks before surgery 







You will see a Primary Care Physician with privileges at Cedars Sinai Medical Center 7 to 10 days prior to surgery to obtain medical clearance for surgery. If you do not have one, we can assist you. Dr. Pashman rarely requires patient’s to donate blood prior to surgery. If necessary, we will ask you to bank blood a few weeks before surgery. Arrange for transportation home from the hospital. Check out time is normally 10am. Arrange for a baby sitter and pet sitter if necessary. 5

Items to stock up on:  

    

Stool Softener (NOT a Laxative). Long handled brush and shower gel (to reach your legs and feet). Flat slip on shoes. Loose fitting clothes or sweats. Favorite foods and easy to prepare meals. Extra pillows. Books, magazines, and movies.

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Two weeks before surgery: Stop taking these medications You can not take these medications for at least three months following surgery. Advil, Aleve, Anacin, Alka-Seltzer, Anaprox, Arthrotec, Aspirin, Bayer, Butalbital, BuTrans patches, Clinoril, Darvon Compound, Daypro, Diclofenac, Dolobid, Ecotrin, Excedrin, Feldene, Fiorinal, Ginko Bilboa, Ibuprofen, Indocin, Indomethacin, Ketoprofen, Lodine, Lortab with ASA tabs, Midol, Mobic, Motrin, Naprosyn, Naproxen, Orudis, Oyxcodone with ASA tabs, Percodan, Piroxicam, Relafen, Sulindac, Talwin, Toradol, Trisilate, Vicoprofen, Vitamin E, Volraren. 7

Acceptable Medications Safe medications to take before surgery and during the three months following surgery : Acetaminophen (Tylenol), MS Contin, Norco, Oxycodone with cetaminophen, Oxycontin, Percocet, Roxicet, Soma, Ultracet, Ultram/Tramadol, Valium, Vicoden, Wygesic, Zydone.

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One week before surgery 









Stop taking any Laxatives, Stool Softeners or Fiber three days prior to surgery. Have someone move furniture and rugs to make a clear walking path. Put frequently used items at waist level to avoid bending and squatting. Schedule your post-operative wound check appointment with a nurse. Place a bathmat or non-stick decals in the shower or bathtub. 9

Day of Surgery 

Do not eat or drink anything after midnight the night before surgery. The morning of surgery, it is ok to take your approved medications with a small sip of water.



Shower the morning of surgery. Do not bring medication, jewelry, money, or valuables with you to the hospital. Bring your picture ID and insurance card with you.





Bring an overnight bag to the hospital with: tooth brush, toothpaste, slippers, robe, feminine hygiene products, a calling card if you need to make long distance calls. 10

Pain Scale 

You will frequently be asked to rate your pain on a scale of 0-10. This chart will help you assess your pain level.

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Day of Surgery  







Do not wear make-up the day of surgery Do not wear colored finger or toe nail polish the day of surgery (clear polish and acrylic nails ok) Check into Cedars Sinai Medical Center South Tower – 8700 Beverly Blvd, Los Angeles, CA 90048 They will validate your parking for day of surgery and day of discharge. Discounted parking passes are available at Cedars Sinai Medical Center's Parking office located in Building 7, room 100. Office hours are M-F 7:30 am to 4:00 p.m. Phone number: 310-423-5535 12

Day of Surgery 





Dr. Pashman or his assistant will call your family member following your surgical procedure. Please designate who Dr. Pashman should speak with. If they are not in the waiting room, please give their phone number to Dr. Pashman’s assistant prior to surgery. Following surgery you will go to recovery and then be moved to a private room approximately an hour later. One family member or friend can stay with you in your room. Ask the nurse if there is a rollaway bed available as soon as you arrive in your room.

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While you are in the hospital 





Call Button – You can use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are all good reasons to call. Drains – These are thin rubber tubes put into your skin to drain the fluid from around your incision. The drain will be removed when the incision stops draining. Foley Catheter – This is a tube that is put in your bladder to drain your urine. The catheter may make you feel like you have to urinate. Relax and it will drain the urine.

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While you are in the hospital, cont. 



Breathing Exercises – Breathing exercises help to keep your lungs from getting infected after surgery. You will have a devise to blow into. You will be asked to do this once per hour. Pressure stockings or Pneumatic Boots – The elastic stockings help keep blood from staying in your legs and causing blood clots. The boots are connected to an air pump. The boots inflate and deflate to push the blood out of your legs.

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While you are in the hospital, cont. 



Walking – You will get out of bed the day after surgery. Each day you will walk a little further. The more you walk around, the sooner you will feel better. By the time you leave the hospital, you will be able to go up and down stairs. Eating – You will be able to eat when bowel sounds are heard. (stomach growling). Ice chips are given first, then liquids (water, 7-up, apple juice, broth). If you do ok with that, the caregiver will give you soft foods (applesauce, jello, custard). If you do ok with that, then you can resume a regular diet.

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Post-operative Medications 







Dr. Pashman will write prescriptions to be given to the patient upon discharge. There is a pharmacy in CSMC, in the Steven Spielberg Bldg. They are open 830a-6pm M-F There is a Horton Converse in the East Tower adjacent to the hospital. They are open M-F 9a-5:30p. (310) 659-6111 Dr. Pashman usually prescribes medication that is easily available and can be called into a pharmacy. The exceptions are: Percocet or Oxycontin. These must be written and picked up at the office. 17

Visiting Hours   

 





The hospital visiting hours are from 10:00 a.m. to 9:00 p.m. Please limit your guests stay to 15-20 minutes. During Flu season, no visitors under the age of 18 are allowed. Maximum number of visitors in the room is two at a time. Children under the age of 12 are not permitted in the patient's room, nor may they wait unattended in the waiting areas. A caregiver may interrupt your visit during some patient care routines. If your guest is ill, please ask them not to visit. 18

Volunteer Services Cedars Sinai Medical Center Volunteers are available M-F 9a5p to assist you. They can be reached at 310-423-5231. The volunteers can: Provide Companionship. Assist with room amenities (flowers, tv, meal tray set up). Help with preparation for discharge Read to the patient, bring books, magazines. Assist patient with meal preparation/eating. The volunteers CANNOT pick up medications or withdraw money from the ATM.

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Post-Operative Appointments: Approximately 10-12 days following your surgery, you will have a wound check appointment with a Nurse at Cedars Sinai Spine Center or your local Primary Care Physician. Patient’s generally see Dr. Pashman at one and three months post-operatively. Sometimes he may ask to see a patient more or less frequently. At each visit you will have an x-ray to check the fusion status. Please call the office at (310) 4239983 to schedule the appointments.

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Post-Operative Appointments: 

If you require pain medication or non-surgical treatment beyond 3 months post-op, Dr. Pashman may refer you to pain management.

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Healing and Recovery Healing is the body's natural process of restoring its own tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it. Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths. Concentrate on improvement, not on what symptoms remain. This focus on progress, combined with the constant effort to improve, maintains the positive attitude that will speed your return to improved daily activity. 22

Post-Surgery Brace 

Dr. Pashman may prescribe a brace following surgery. If so, you will wear the brace at all times, except when you are in bed or in the shower. Dr. Pashman will determine how long you need to wear the brace. You may wear it from 1 month to 3 months.

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Post surgical care – the first week 





The first month following surgery you will rest as needed, and increase activity (walking, puttering) as you can tolerate/ 10% per day. It is important that you continue your short walks 3-4 times per day for 5-15 minutes each (on a level surface), as well as your normal daily activity. It is very normal to experience abdominal discomfort and/or gas pain. Ensure you are drinking plenty of fluids. You may want to have a stool softener (not a laxative) at home.

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Post surgical care – the first week 

Do Not resume any exercise/activity other than gentle walking until cleared by Dr. Pashman. Stairs at home are okay providing that you hold onto the handrail and to down gently toe first, then onto your heel. You are allowed a maximum of 3-5 trips up and down the stairs per day the first week.



The first week, do not lift anything heavier than a coffee cup. At one month post-op you may lift up to five lbs. You may sleep on your side or back, do not sleep on your stomach.



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Post surgical incision care 

Do not use ice on the surgical area for 2 months post-operatively.



Dr. Pashman takes great care with the closure. The incision should heal very nicely with time. The most important thing you can do is stay out of the sun. The sun will change the pigmentation and make the scar look darker and more prominent. Dr. Pashman recommends that you don't expose the incision to sun for at least 4 months. A plastic surgeon would say a year.

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Incision care, cont. 



No creams or lotions of any kind (NO Neosporin, NO vitamin e, etc.) on the incision for 4 months postop. We do not recommend any products for the incision. Although it is rarely a problem, you can consult a dermatologist if there is discoloration at 1 year post-op. If there are Steri-Strips (white tapes) over the incision, don’t pull them off. Let them fall off on their own. If they’re peeling and snagging on clothing, trim the peeling portion with scissors. 27

Incision care, cont. 





You will have subcutaneous sutures (sutures underneath your skin). You must shower with your incision covered with plastic until the Nurse Wound Chcek. After the wound check you may shower with the wound uncovered. Do not soak the incision. After 1 month you may take a bath. Do not expose your wound to the direct sunlight for 34 months following surgery.

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Post surgical care – body mechanics Stand up straight to brush your teeth, don’t bend over the sink. Don’t arch your back to stand under the shower water. If you’re tall bend slightly at the knee instead of arching back to wash your hair. Rubbermaid has an inexpensive shower extension hose. When turning over in bed, “log roll”. Turn hips and shoulders together. Limit sitting to 20-30 minutes, then changing positions. Reclining or lying down maybe done for longer periods. 29

Post surgical care – eating We recommend that you eat foods high in protein and vitamin C . Protein: Vitamin C: Meat & eggs Oranges, grapes. Milk & ice cream Tomatoes. Fish & Chicken. Beans & rice. Peanut butter. You may want to avoid foods that cause constipation, like fresh apples, bananas, or cheese. If you like bran, be sure to drink lots of liquids (milk, juice, water, etc.). Without the extra water bran can be constipating. 30

Post surgical care – after 1 month 



 



Let pain be your guide with activity. If you experience discomfort, rest. Never take pain medication to allow you to complete any activity. You must maintain good alignment, taking special care getting up or down from a lying/sitting position. Absolutely no bending, twisting or lifting. Do not lift anything over 5 pounds in weight. No Bending, Lifting, or Twisting for 3 months post-op Exhaustion and mood swings are common. 31

Post surgical care – after 1 month cont. 





It is normal to have good and bad days. Listen to your body and rest accordingly. If you do experience back or leg pain/numbness rest and it should go away. Returning to work will be discussed with Dr. Pashman during your postoperative visit at one month. Sexual activities can recommence approximately one month following discharge, provided you take the passive role and your back is supported: you do not need to be in your brace. Lying on your back or side appears to be the most comfortable position.

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Post surgical care – after 1 month cont. 



Always use good judgment. Be aware of good body mechanics as you recover and get stronger. Abdominal muscle strength and good body mechanics will be very helpful in controlling and maintaining a pain free posture. Do not swim or sit in a spa until cleared by Dr. Pashman, usually at 2 months when the fusion is well healed. Do not take a bath for one month following surgery. This is to insure that your incision heals properly.

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Post surgical care: guidelines for taking pain medication Take medications as needed and wean yourself as soon as possible. Pain medications can affect your body’s natural ability to cope with pain and often increases depression associated with chronic pain syndrome. Here is a guideline for taking pain medication. Weeks 1-4: Weeks 2-4:

Take 1-2 tablets every 4-6 hours Take 1 tablet every 12 hours

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Pain medication and Refills  Usually as a patient feels better, they cut back on the pain medicine. As they become more active, they hurt more, take more medicine. Then they adjust, cut back the medicine, become more active, etc. It is important to gradually reduce the amount of medicine. If you abruptly discontinue, you will go through withdrawals.  If your prescription requires a Triplicate (Oxycontin, Percocet, etc.) please allow sufficient time to pick-up a prescription or for mail delivery. These prescriptions can not be called into your pharmacy.  Please allow 24-48 hours for prescription refills. Your pharmacy can fax the request to: 310-423-9963 or call us at 310-423-9983. Prescriptions are refilled Monday thru Friday only. 35

When to call Dr. Pashman:  





If you are experiencing a high fever over 101.9. If the incision is red, oozing, or there are bumps or blisters. If you are experiencing symptoms that were not present before surgery, there is an dramatic increase in pain, weakness, or numbness which persists for more than 3-5 days with no improvement despite bed rest. In the case of after hours emergencies, in most cases the physician on call will direct you to be evaluated at the ER. 36

When to call your primary care physician: Please call your primary care physician for any symptom that is not spine related. (Ex: constipation, blood pressure, nausea, ear aches, etc.) It is common to become constipated with pain medications. Here are the steps in order: 1. Drink prune juice, eat prunes, drink water 2.

Take a stool softener

3.

Use a Fleet enema or suppositories

4.

Contact your primary care physician 37

Urgent Problems 



If you have an urgent problem that requires immediate care (Chest pain, Shortness of Breath/Difficulty breathing, Severe Abdominal Pain, Fainting, etc.), please call 911 or go to the nearest Emergency Department. In the case of after hours emergencies, in most cases the physician on call will direct you to be evaluated at the ER.

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MDA Donation Program Upon your discharge from the hospital, home health care may arrange for one or all of the following items: walker, commode, grabber/reaching device. The Muscular Dystrophy Association is in need of used medical equipment. If you would like to donate your items, please call (310) 450-9032. MDA will pick your donations up. You can also contact a local nursing home or church to determine if they need donations 39

Frequently Asked Questions: Q: A:

Q: A:

After surgery, will I go off in the metal detector at the airport? Each airport maintains their own metal detectors, and sets the sensitivity level. Rarely do patient’s report any problems. The FFA recommends that you notify the airport screener of your metal implants prior to screening. When can I fly? Approximately 10 days after surgery, as long as you don’t lift your luggage (including into the overhead compartment.) 40

Frequently Asked Questions:

Q: Do I need antibiotics before a dental appointment? A: High risk patients undergoing higher risk dental procedures may benefit from antibiotic prophylaxis. High risk patients include: 1) All patients during the first two years following surgery 2) Immunocompromised/immunosupressed patients, 3) Patients with certain comorbid conditions such as a) Previous prosthetic joint infections b) Malnourishment c) Hemophilia d) HIV Infectione e) Type 1 Diabetes f) Malignancy 41

Frequently Asked Questions: High risk dental procedures include: 1) Dental extractions, 2) Prophylactic cleaning of teeth or implants were bleeding is anticipated, 3) Periodontal procedures, 4) Root canal procedures, 5) Dental implant placement and reimplantation of a avulsed teeth, 6) Interligamentary and intraosseous local anesthetic injections

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Frequently Asked Questions: Your Dentist will prescribe one of the following medications : 1) Amoxicillin or cephalexin 2g orally one hour prior to dental procedure (if not allergic to penicillin) OR 2) Clindamycin 600 mg or orally one hour prior to dental procedure Dr. Pashman does not write these prescriptions. Reference: American Dental Association; American Academy of Orthopedic Surgeons. Antibiotic

Prophylactics for Dental Patients with Total Joint Replacement (Advisory Statement) JADA 2003: 134, 895 – 899

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Recovery Calendar: The following calendar is a sample guideline of the recovery period . This is only a guideline and covers anterior, posterior, anterior/posterior and multi-level lumbar fusions. Dr. Pashman’s individualized instructions supersede this document. Each patient is unique, and will recover from surgery in their own time frame.

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Recovery Calendar – Month One 1

2

3

4 Surgery

5 Walk

6

7

8 Shower, Walk up and down stairs

9 Release from Hospital

10

11 do not lift anything heavier than a coffee cup

12

13

14 walking 5-20 minutes 3x per day

15

16 Stair only 3-5 times per day

17 Nurse Wound Check

18 Can shower without wound covered

19

20

21

22 Walk 1 block

23

24

25

26

27

28

29

30

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Recovery Calendar – Month One 1

2

3

4 Surgery

5 Walk

6

8 Shower, Walk up and down stairs

9 Release from Hospital

15

16 Stair only 3-5 times per day

17 Nurse Wound Check

18 Can shower without wound covered

19

20

21

22 Walk 1 block

23

24

25

26

27

28

29

30

12 physical 13 10The Day after 11 surgery the do not liftout of bed to walk. therapist will get you anything The sooner you get up and walk, the heavier than soonerayou will feel better. coffee cup

7

14 walking 5-20 minutes 3x per day

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Recovery Calendar – Month One 1

2

8 Shower, Walk up and down stairs

3

5 Walk

6

7

9 10 11 Release do not lift from anything Hospital The day before you heavier are than a coffee cup discharged from the

12

13

14 walking 5-20 minutes 3x per day

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hospital,17you will shower 16 Stair 18 and walk up and down only 3-5 Nurse Can shower stairsWound on your own. times per without day Check wound covered

19

20

21

22 Walk 1 block

23

26

27

28

29

30

24

4 Surgery

25

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Recovery Calendar – Month One 1

2

3

4 Surgery

5 Walk

6

8 Shower, Walk up and down stairs

9 Release from Hospital

10

12 13 11 do not lift anything heavier than The a coffee cupWednesday following

15

16 Stair only 3-5 times per day

17 Nurse Wound Check

19 20 18 hospital, you will see a nurse Can shower at Cedars Sinai Spine Center without for a wound check. Please wound covered call 310-423-9983 to

21

22 Walk 1 block

23

24

your appointment. 25 schedule26 27

28

29

30

your discharge from the

7

14 walking 5-20 minutes 3x per day

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Recovery Calendar – Month One 1

2

3

4 Surgery

5 Walk

6

7

8 Shower, Walk up and down stairs

9 Release from Hospital

10

11 do not lift anything heavier than a coffee cup

12

13

14 walking 5-20 minutes 3x per day

19

20

21

26

27

28

15

You can shower without 16 Stair 17 covering the wound only 3-5 times per day

Nurse Wound Check

18 Can shower without wound covered

22 Walk 1 block

23

24

25

29

30

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Recovery Calendar – Month One 1

2

3

4 Surgery

5 Walk

6

7

8 Shower, Walk up and down stairs

9 Release from Hospital

10

11 do not lift anything heavier than a coffee cup

12

13

14 walking 5-20 minutes 3x per day

15

16 Stair only 3-5 times per day

20

21

22 Walk 1 block

23

27

28

29

30 Appt with Dr. Pashman

19 18 Can shower without wound First post-op appointment covered with Dr. 17 Nurse Wound Check

Pashman. X-rays will be taken to 24 25 26 evaluate the fusion growth

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Recovery Calendar – Month One 1 Surgery

2

3

4 Stage 2 Surgery

8

9 Shower, Walk up and down stairs

10 Release from Hospital

15

16 Stair only 3-5 times per day

22 Walk 1 block

23

29

30

5 Walk

6

7

11 do not lift 12 anything heavier than a coffee cup

13

14 90% of time in bed, walking 5 minutes 3x per day

17

18 Nurse Wound Check

19 Can shower without wound covered

20

21

24

25

26

27

28

51

Recovery Calendar – Month Two 31 Can resume sexual activity

32 Can lift up to 5 pounds

33 Can Drive car

34

35

36

37

38

39

40 Decrease pain medication

41 Can Drive car – w/o pain meds

42

43

44

45

46

47

48

49

50

51

52

53

54 Decrease pain medication

55

56

57

58 Ok to go up and down stairs unlimited

59

60

52

Recovery Calendar – Month Two 31 Can resume sexual activity 38

32 Can lift up to 5 pounds

33

34

35

You can resume sexual activity, provided you39take the passive role and 40 Decrease 41 your back 42 is supported: youpain do not need be in your CantoDrive brace. Lying on your backcar or–side medication w/o appears to be the most comfortablepain position. meds

36

37

43

44

45

46

47

48

49

50

51

52

53

54 Decrease pain medication

55

56

57

58 Ok to go up and down stairs unlimited

59

60

53

Recovery Calendar – Month Two 31 Can resume sexual activity

32 Can lift up to 5 pounds

38

39

45

33 Can Drive car

34

35

You can lift up to 5 pounds.

36

37

40 Decrease pain medication

41

42

43

44

46

47

48

49

50

51

52

53

54 Decrease pain medication

55

56

57

58 Ok to go up and down stairs unlimited

59

60

54

Recovery Calendar – Month Two 31 Can resume sexual activity

32 Can lift up to 5 pounds

33 Can drive car

34

38

39

40 Decrease pain medication

45

46

52

53

59

60

35

36

37

41

42

43

44

47

48

49

50

51

54 Decrease pain medication

55

56

57

58 Ok to go up and down stairs unlimited

Can Drive car. Please take care to not to drive while taking pain medication.

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Recovery Calendar – Month Two 31 Can resume sexual activity

32 Can lift up to 5 pounds

33 Can drive car

34

35

36

37

38

39

40 Decrease pain medication

41

42

43

44

45

46

47

50

51

52

53

54 Decrease pain medication

57

58 Ok to go up and down stairs unlimited

59

60

Decrease 48 Pain Medication 49 55

56

56

Recovery Calendar – Month Two 31 Can resume sexual activity

32 Can lift up to 5 pounds

33

34

35

36

37

38

39

40 Decrease pain medication

41 Can Drive car – w/o pain meds

42

43

44

45

46

47

48

49

50

51

52

53

54 Decrease pain medication

55

56

57

58 Ok to go up and down stairs unlimited

59

60

Decrease Pain Medication

57

Recovery Calendar – Month Three 61

62

63

64

65

66

67

68

69

70 Decrease 71

72

73

74

78 Pain Medication 79 80 Decrease

81

pain medication

75

76

77

82

83

84

85

86

87

88

89 Pain 90 Appt medication with Dr. Pashman only as needed

58

Recovery Calendar – Month Three 61

62

63

64

65

66

67

68

69

70 Decrease 71

72

73

74

78

79

80

81

85

86

87

88

pain medication

75 82

76

77

84 Take83 Pain Medication as needed for pain

89 Pain 90 Appt medication with Dr. Pashman only as needed

59

Recovery Calendar – Month Three 61 Patient 62 can use ice on surgical area

63

64

65

66

67

68

70 Decrease 71

72

73

74

Post-op appointment 78 79 with Dr. Pashman. Xrays will be taken to 84 assess fusion 85 mass.86

80

81

87

88

69

pain medication

75

76

82

83

77

89 Pain 90 Appt medication with Dr. Pashman only as needed 60

This is a guideline for activities following an Anterior Spinal Fusion, a Posterior Spinal Fusion, or both. This is only a guideline. Each patient recovers at their own rate. Dr. Pashman may change the time frame based on a patient's individual needs. Aerobics

1 year

Housework, Moderate (ironing, lifting grocery bags)

3 months

Anti-inflammatory medications (Aspirin, Aleve, NSAIDs)

3 months

Ice – patient can use ice on surgical area

2 months

Baseball/softball

1 year

Isometric trunk exercises

3 months

Basketball

1 year

Jacuzzi

2 months

Bath

1 month

Jogging

6 months

Bending, Lifting, or Twisting

3 months

Lift 5 pounds

1 week

Bicycling

6 months

Lift 10 pounds

3 months

Bowling

9 months

Lifting weights

9 months

Bungee Jumping

never

Martial Arts

1 year

Carry school Books

2 months

Massage

3 months

Creams or lotions on incision

3 months

Motorcycling

never

Diving

9 months

Movies

2 weeks

Driving a car

3-4 weeks

Pilates

4 months

Football

1 year

Pregnancy

1 year

Gardening

3 months

Return to School

1 month

Golf

6 months

Roller Coasters

1 year

Gymnastics

1 year

Roller Skating

1 year

Hiking

6 months

Rowing

1 year

Horseback Riding

1 year

Sexual activity without pelvic motion

2 weeks

Housework, Light (dusting, washing dishes)

6 weeks

Sexual activity with pelvic motion

1 month

Housework, Moderate (ironing, lifting grocery bags)

2 months

Shopping

3 weeks

61

This is a guideline for activities following an Anterior Spinal Fusion, a Posterior Spinal Fusion, or both. This is only a guideline. Each patient recovers at their own rate. Dr. Pashman may change the time frame based on a patient's individual needs. Shower

1 week

Sky Diving

never

Snow Skiing

1 year

Soccer

1 year

Stairmaster

3 months

Stationary bike

3 months

Suntan

4 months

Surfing

1 year

Surgery (elective)

6 weeks

Swimming

6 months

Tennis

9 months

Track (jumping)

1 year

Treadmill

3 weeks

Walking

immediate

Walking in water

6 weeks

Waterskiing

1 year

Work

2 months

Yoga

6 months

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Forms Disability forms or documents/letters are $50.00 per document. This includes supplemental forms and or private disability forms. You may drop off, mail, fax, or email the forms. Payment can be made by cash, check or credit card payment here: http://www.espine.com/current-patients Paperwork must be completed and signed by patient (if applicable) and payment processed prior to the office completing physician portion, no exceptions. Please include all pertinent dates or special indications. Your primary care physician or pain management physician can also process your forms. 63

Forms Please note paperwork will be processed within 7 days of receipt. Paperwork must be completed and signed by patient (if applicable) prior to the office finishing physician portion, no exceptions, please include all pertinent dates or special indications. If you would like a copy of this paperwork to be forward to you, please enclose a self addressed stamped envelope with your completed forms. A copy of your paperwork will be placed in the electronic chart after the doctor has signed it and will remain a part of your permanent record. This applies to ALL forms. 64

Forms Please refer to the type and category that applies to your paperwork. ● EDD (State of California Employment Development Dept.): Pick up a form at your local EDD office, or call 1-800-480-3287 so that a form can be mailed to your home or you may obtain through the internet at www.edd.ca.gov under Disability Insurance Application. ● DMV, PLEASE NOTE: DR. PASHMAN DOES NOT PRESCRIBE DMV DISABLED PERSON PLACARDS. ● Upon completion, all forms will be mailed appropriately.

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Forms Medical Certificate for Temporary Total Disability or Return to Work: Specify the type of letter required, to whom letter will be addressed, include address, phone or fax numbers, if applicable. Include pertinent information such as your last day worked and when you expect to return to work. If you feel you will need restrictions, e.g. bending, lifting, twisting, pushing pulling or carrying, please include this information. We will forward this information directly to your HR Dept or employer. ● Jury Duty: Jury Duty excuses will be processed only if you have had surgery within one year with Dr. Pashman and at the doctor’s discretion. ●

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