Even the most "minor" surgery requires careful planning by both the medical team and the patient. The better prepared a patient is, the more likely the procedure will go smoothly and the recovery will be successful. To help you prepare for your surgery, we have summarized some key information below:

i. Pre-operative tests

ii. Blood donation

iii. Tips to help you prepare

Your physical and psychological health is important to your surgery and recovery. Your pre-operative tests may include:

• Electrocardiogram (EKG)
  An EKG records heart rate and rhythm and helps to determine heart muscle health. This is a simple and painless test that requires electrodes (patches) to be placed on the patient's chest and connected to a recording device. This test is done routinely for any patient undergoing any surgery. If you have had an EKG in the prior year and have no significant cardiac history, then you do not need another one. We will need a copy of the test however.
  
  
• Stress Test
  A stress test is an EKG taken continuously while the patient either walks on a treadmill, pedals on a stationary bicycle, or the heart is stressed with a medication (persantine). The test records the ability of the coronary arteries to supply blood to the heart muscle and the strength of the heart muscle. At CCSI, a stress test is suggested for any patient over 60 years old undergoing a major spine surgery. A significant cardiac history may require this test to be done at a younger age.
  
  
• Thallium Stress
  Test An intravenous line (IV) is inserted into the patient's arm and a Thallium radioscope (small amount of radioactivity) is injected at the peak of exercise (treadmill). A special camera is used to take pictures of the patient's heart immediately after exercise and again four hours later. A Thallium stress test allows the physician to compare blood flow to the heart at peak exercise and at rest. The indications for this test are the same as for a Stress Test.
  
  
• Echocardiogram
  Ultrasound waves returning from the heart are recorded permitting evaluation of the movement of the valves and walls of the heart chambers. Warm conducting gel and a microphone is applied to the patient's chest to record these readings. This test is done routinely only for those patients who have suspected rhythm or valve problems with their heart.
  
  
• Pulmonary Function Testing (PFT)
  PFT tests may be used to determine the condition of the heart and lungs. Conditions such as asthma, emphysema or even scoliosis can reduce the effectiveness of the lungs ability to deliver oxygen to the body. Spirometry can help to measure this while a chest x-ray or CAT Scan can detect fluid or damage in the lungs. Spirometry requires the patient to forcefully blow into a simple device to measure expiratory breath and volume. Pulse Oximetry is a probe placed onto a finger, toe or ear lobe. It can measure heart rate and percent of oxygen the patient breathes in.
  
  
• Blood Tests
  Specific blood tests will be performed no more that seven (7) days prior to surgery. These will include a complete blood cell count (CBC), a battery of electrolyte and enzyme level tests (SMA-22), a test for blood clotting function (PT/PTT), and a test to determine blood types (T+S) should you require a transfusion. Healthy blood function is critical for proper functioning of the entire body, and thus these detailed blood tests will be conducted.

ii. Blood Donation
Certain larger spinal surgeries will require the replenishment of blood at the time of surgery or shortly thereafter. Many patients will elect to pre-donate or "bank" their own blood prior to the surgery. This process often must be planned for and initiated many weeks ahead of time. If a blood transfusion is anticipated for your surgery, your surgeon will most likely recommend this blood banking process. Most surgeries require the donation of between two and three units, or "pints" of blood. This will be arranged by our surgery scheduler for you. Blood will be donated at and managed by a Belle Bonfils center of your convenience.

iii. Tips to Help you Prepare
The team at CCSI wish to make your surgery as safe and smooth as possible. To this end, here are some recommendations of things you can do to help make it all a little easier.

Prepare yourself

Cardiovascular and general fitness is very important whenever the body undergoes a stress such as that during surgery. Consider a fitness program that your spine will tolerate to maximize your conditioning prior to surgery. This may be as simple as a walking program, use of a treadmill, stationary bike or swimming program. Your doctor at CCSI will help develop this program for you.

The process of a spine surgery, the anesthetic agents, pain medications and so on, all tend to cause constipation. This can make you very uncomfortable initially after surgery. The best strategy for this is prevention. Avoid heavy meals such as red meat in the 48 hours prior to surgery. Focus on high fiber, high water content foods. Soups and salads are best. Over the counter fiber supplements will help and should be started days in advance. Consider a stool softener before and certainly after surgery. These can be broken down into laxatives which lubricate such as Colace or Pericolace, or those which retain water in the colon such as Milk of Magnesia, and stimulants which speed pass through such as ExLax and most suppositories or enemas. We recommend that you initially select one from each category and take these after you return home from the hospital until you are regular again. After this, return to a healthy diet as described above.

• Stock your refrigerator with proper foodstuffs. Prepare meals ahead of time which can be stored in the refrigerator for the days that you are away in the hospital. Canned foods, soups or precooked meals are helpful. Avoid those foods which will spoil quickly.
  
  
• Remove any loose rugs on the floor, which could trip you up while walking.
  
  
• Is there an extra bedroom or space all on one level of your home which gives you access to the kitchen and bathroom as well as easy ingress, egress to the home? If so, you may wish to use it temporarily as your bedroom.
  
  
• Is your bathroom safe? Consider such aids as grab bars, raised toilet seats, or shower stall chairs. See our available line of home aids to assist you in fulfilling your needs.
  
  
• Pay all your bills and get your routine financials in order so that you will not have to deal with this again for a few weeks.
  
  
• Do you have a list of needed phone numbers compiled for your use at home as well as in the hospital?
  
  
• Gather comfortable clothing which is elastic or loose fitting, and is easy to get on and off.
  
  
• Consider shoes with no skid soles and Velcro type laces for ease of use and safety.
  
  
• Remember that many pain medication prescriptions require that you or your designee pick them up in person. Arrange for this prior to surgery as you may not feel up to doing this yourself after surgery.
  
  
• Do you have a system in place to care for your home needs after surgery? How about groceries and laundry? For the first two to three weeks after fusion surgery, do not expect to do anything that requires housework, yard work or driving. After minimally invasive surgeries, you may be able to do these things more quickly!

Prepare your paperwork

Prepare an informational sheet with such data as your medical history, list of doctors and their phone numbers, and drug allergies.

• Bring a list of all important phone numbers to the hospital with you.
  
  
• Bring a list of your medications and dosages. Record these directly from the medication bottle. Bring the medicine bottles as well if you so desire. This is especially important if you take some very unusual medications.
  
  
• Do you have a living will? If so, bring a copy of this with you to the hospital. If you wish to prepare one, ask you surgery scheduler at CCSI for a sample document to work from.

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