Discharge, as far as sending the patient home, what determines that? In my view it’s really five different factors that you have to accomplish in order to go home. If all five factors are met then you could probably go home safely and that´s the number one thing, are you safe for discharge.
What are those five factors that I look at? One is your pain controlled. Number two is you disconnected from everything. You know, you can’t still have IV fluids; you can’t still have a pain pump, all the drains, all the tubes must be out of you at this point. Three, are you walking? We’re going to make sure you are safe to go home. When you go home the last we want you to do is go home and be confined to a chair, be confined to a bed. So, are you walking? Are you someone independent at that point? Next, are you safe? Are your vital signs good? Medically are you safe? Your blood pressure looks good, your vital signs look okay, and your heart looks okay. And the last thing really is that, you as a patient feel you are welcome to go home.
You have no more concerns, you have no more anxieties, and you feel like what you are there for in the hospital has been met. Your surgery was successful at this point, your pain is controlled at this point, your anxieties are met, you are walking, you are safe, your family, your friends are comfortable with your discharge and if all those things have collectively been met, then we usually could discharge you home.
The first thing I wanna tell patients, and I reiterate to patients is when you go home you will still have some symptoms or some pains that you even felt pre-surgery and that’s important to understand that. Because they don’t want you as a patient to be concern that something may have failed, something is going wrong.
The analogy I like to explain to patients is very similar to a broken bone, and that if you break your arm and you came to see me I’m gonna put you in a cast. Well that bone still has to heal, that bone still has to mend and has to go through its process of healing and that process may take several weeks, it may take several months depending on the type of fracture and. It’s the same analogy when you have your surgery. You go home, the first thing you have to understand and as a patient is, your symptoms will likely still be there.
And so whether your symptoms were numbing, or whether your symptoms were tingling, or even weakness. Those numbing, tingling, weakness symptoms will persists as things heal and recover, and they’d had to do exactly that. The body has to heal. The body has to recover. And it’s the same thing when it comes to pain, now your pain if it was back pain, your back pain may be superseded by surgical pain, and appropriately we give you medications to treat those symptoms while you’re at home.
What we do wanna know is we wanna know are there new symptoms? Okay, if there are new symptoms that you do not have prior to surgery, by example, pre-surgery your right foot was numb or weak, you go home now you develop new symptoms into the left leg that were not existing prior. That’s something we would not expect, and that’s something we want to hear immediately. As a patient you have to understand is there’s a lot of things that you can do to make it worse. There’s very little really that you can do to make it better.
If we give you rules and instructions that basically tell you keep it very sedentary, okay? Walk. Which is one of the things that we really like to encourage patients to do is walk. It is very, very therapeutic for you in many, many different aspects. But [CLEARS THROAT] by walking we refer to casual walking. And if you determine that you’re gonna take an [PH] strenuous hike by example, is not gonna help your body recover. It actually may weaken and make things worse and you’re gonna probably pay for it afterwards.
I like to tell patients, if you had a flu you came into the doctor’s office ‘cause you had a flu, you just felt cruddy, you felt weak, you didn’t feel good. You’re gonna go home, you’re gonna rest, you’re gonna drink fluid, you´re gonna lie in bed, you’re gonna sit on the sofa, you’re gonna watch TV, you may read a book, you’re gonna walk around the house, if you feel good enough you’re gonna walk outside, maybe walk down the block or back. And for the first week, maybe two weeks after surgery that’s what I encourage patients to do.
Okay, don’t plan on going out to dinner, don’t plan a run to the grocery store, may have those things set up ahead of time. If you need additional, uh, equipment that’s our responsibility pre-surgery, during the operation as far as the hospital stay to make sure you have that equipment when you get home. Whether be a walker, or whether be a raised toilet seat, or what I call reacher-grabber and those kind of things again, maybe an asset to you as far as your recovery goes. It’s not necessary for every patient, so I would not encourage every patient to go and purchase those things. It all again, depending upon the procedure you’re having, as well as your recovery.
In general most patients will go home with their pain prescription. We prefer to do it, where we actually give that patient the prescription days in advance. It is difficult to get a prescription upon your discharge and hope that the pharmacy is able to fill it, they are open, and everything works out where you concert to pay medication immediately. Which is one of the recommendations that we give, is try not to lapse in time on your medications, stay consistent with your medications for the first several days following the operation. Very important to your recovery. You don’t wanna allow the waxing and waning of your pain to occur. You wanna keep your pain very comfortable, very controlled for the first several days. So we encourage patients take your medications mm, okay. If you have no pain, well, I not gonna recommend that you take your pain medications, but stay consistent with your medications, narcotics unfortunately have a tremendous side effective constipation. And as I tell patients, you are having spine surgery, that alone is gonna make it very difficult to use the restroom, because we’ve operated on an area very close to the area you’re gonna use the restroom in and so strengthen or pushing creates pain.
Now, if you’re taking your pain medications that’s something you’re gonna struggle with. So we also discuss with the patients have a plan available, have something set up, so when this does happen you are already aware of it, you’ve already have a process in place, that hopefully prevent it.
There’s also separate side effects that go along with medications, obviously we tell patients please don’t drive a car. If you are taking narcotic medications contact your physician, contact your doctor, if any concerns or questions about your medications. And again, we try to get them off those medications or answering appropriate medication as quickly as possible.