PRE-OPERATIVE INSTRUCTIONS

  • You will have to be fasting after midnight the night before surgery; this includes all liquids.

  • You will need a driver once you are discharged from the hospital.

  • We suggest that you pack an overnight bag even if you are scheduled for an outpatient procedure.

  • You need to be off of all blood thinners and anti-inflammatories for 3-5 days prior to your surgery. This includes over the counter medications such as Aspirin, Fish Oil, Aleve, Motrin, Advil, Ibuprofen, and Naproxen. If the medication bottle says “NSAID” or “Anti-Inflammatory” DO NOT take it.

  • If you are taking medications for blood pressure or cholesterol it is ok to take these the morning of surgery with a very small sip of water.

  • If you are taking diabetes medication, do not take it the morning of the surgery since you will be fasting and this could cause your blood sugar level to drop too much.

  • The hospital will contact you about a day or two before your surgery to let you know what time to be there. At this time they will go over additional instructions as well as any financial portion you may be responsible for.

  • Some hospitals require you to come in for a pre-assessment appointment a few days before surgery.

  • If you need to cancel or reschedule your surgery for any reason, we ask that you please call our office and give us at least 24 hour notice.

POST-OPERATIVE INSTRUCTIONS

The following is a list of post-operative instructions for your convalescent period following surgery. The guidelines listed below represent general instructions to follow upon your discharge. Please remember that Dr. Bonnen may have specific “do’s and don’ts” in your case. These will be discussed with you prior to your discharge. All restrictions apply until your follow up appointment in 10-14 days, and may be modified by the doctor following that visit. If you have any questions after you are discharged from the hospital please contact the office before contacting the hospital.

  • No lifting, pulling, or pushing objects over 15 pounds. Avoid bending at the waist; rather, bend with the knees. Avoid twisting motions. For neck surgery patients, avoid any overhead work.

  • Your incision may have been closed with visible sutures, staples, or sutures beneath the skin. Visible sutures and staples need to be removed about 10-14 days after surgery. If your sutures are under the skin, you do not have to have these removed. If you have Steri-strips on your incision, let these fall off by themselves. You may trim the edges of the Steri-strips with scissors as they curl up. Do not peel these off! Leave the incision open to air and do not apply creams, ointments, or powders to the incision. It is ok to shower and blot dry your incision but do not soak in a tub or pool for 2 weeks.

  • If you have a drain in place upon discharge, will be instructed to open the drainage container and empty it twice daily. Record the amount of fluid on a piece of paper. Drains are usually removed 3-5 days after discharge and you will be on an antibiotic medication while the drain is in place. It will be removed once the fluid output has diminished.

  • Have a family member or friend look at the incision(s) once a day to observe for signs of infection. These may include:

Pain and tenderness at the incision site that persists several days after surgery

Diffuse redness or heat at the incision

Excessive swelling

Drainage through the incision

Fever over 101 degrees. A low-grade temperature is common after surgery and is usually due to not taking deep breaths and/or being too inactive. Staying out of bed, walking as much as you can, and taking deep breaths should bring down the temperature. If the temperature persists, is over 101, or is associated with any other problems, call the office immediately

  • Avoid neck or back strengthening exercises during this recovery period. When you return to your follow up appointment, an exercise program and/or physical therapy can be recommended if needed.

  • Walking is one of the best exercises to improve your overall fitness and endurance level. Start with a few small trips a day and gradually increase the distance according to your tolerance. Do not try to do too much too soon.

  • Questions regarding your return to work will depend on the type of job you have, type of surgical procedure, and your general recovery. All forms that you may need should be filled out prior to your discharge.

  • Do not smoke following surgery. Smoking is the enemy of healing!

  • You may be given a prescription for pain medication prior to discharge. Pain medication should only be taken if you have pain. You may call your pharmacy for refills on these medications and the pharmacy will call our office for an approval. Prescriptions are called in and refilled during office hours only. You should begin tapering off your pain medication within 2 weeks of your discharge. As soon as you are comfortable, take a non-prescription pain medication (i.e., Tylenol) for pain relief. Do not take any anti-inflammatory (such as Advil, Ibuprofen, Motrin, Aleve, or Aspirin) until cleared by the office.

  • Following neck surgery it is normal to have soreness of the throat and muscles of the neck. This should begin to slowly subside in a few days. Eating soft foods, drinking lots of fluid, and wearing a soft collar help to relieve these symptoms.

  • For spine surgery patients: As discussed prior to surgery, the purpose of the operation was to prevent worsening of neurological symptoms, with the hopes of improving the pain in your arm or leg if you had pain prior to surgery. Arm or leg pain may persist after surgery due to the nerve damage done to the previously compressed nerve roots. If your extremity pain improves after surgery, it is not uncommon to occasionally feel a little “reminder” of the pain from time to time. Usually rest and pain medication should improve these symptoms. If you are unable to get up and move around due to the pain, please call us.

  • Driving may be resumed once you are off of all pain medications, feel confident enough to do so, and are able to concentrate more on the road than on your body. This time frame may vary from person to person depending on the individual recovery time.  (Texas Brain and Spine Center cannot be held liable for any accidents that may occur once the patient has resumed driving.)

SURGERY COST

We understand having surgery can be a very stressful time. Getting multiple bills post-surgery that you are unaware of will not help the situation. We would like to inform you of the parties involved in your healthcare while you have surgery. We hope to prepare you and alleviate you of any additional stress.

1. Hospital – The hospital staff from the front desk to post op will make sure that you have a seamless experience when you come in for your surgery. There will be anywhere from 5-10 people in the operating room making sure that everything is in order during the surgery.  

This is for the cost of all the staff and equipment that is utilized during your surgery. If you have any hardware that is put into your body, that too will be collected by the hospital. Most surgeries are conducted on an outpatient status (23 hours in the hospital). If you stay longer than that for any reason, the hospital will be responsible in getting authorization for the extra time and supplies/meds that are used.

**The estimated portion responsible by you will be proactively collected up front on the day of the surgery. If you are not able to pay it all up front, the hospital can work out payment plans with you. If you owe anything after the claim comes back, the hospital will send you a bill.

2. Intra-operative neuro-monitoring – This is a service that monitors signals sent by your nervous system. It is utilized to reduce the risk to the patient of any damage to the nervous system and to provide functional guidance to the surgeon and anesthesiologist. The portion responsible by you will be billed after the claim comes back from your insurance. You may or may not owe anything. If you have any issues with the bill, please call Sentry Neuromonitoring at 281-970-5900.

3. Anesthesia – They play an important role during your surgery. They make sure that you are not knowledgeable of any pain, and if you have any cardiac or pulmonary issues, they make sure to medicate you appropriately. The portion responsible by you will be billed after the claim comes back from your insurance. You may or may not owe anything. If your insurance is out-of-network with them, please call them at 281-348-0414, and they will only charge you in-network rates.

4. Durable Medical Equipment – Some patients will receive a back brace and/or a bone stimulator. These are given to the patient to supplement in their recovery. They will be billed by Dr. Bonnen’s office. The portion responsible by you will be billed after the claim comes back from your insurance. You may or may not owe anything.

5. Dr. Bonnen – We thank you for letting Dr. Bonnen be a part of your healthcare. He takes great care in making sure that surgery is the right option for you, and if not, direct you to the appropriate alternative treatment. For certain surgeries, there will be a Physician Assistant helping him in surgery. They will be billed to insurance separately.  The portion responsible by you will be billed after the claim comes back from your insurance. You may or may not owe anything. If there is a payment due, we request you pay it in full once you receive the bill.

**Since there will be multiple claims being billed from our office, you will receive a bill for the portion you owe, if any, as we receive them back from insurance.