Information FOR PATIENTS

| Helpful Hints |

Once your surgery has been scheduled, there will be a period of time prior to your admission to the hospital. This time can be used to organize and plan for both your hospital stay and your care after discharge. The suggestions given here are a guide in assisting you to make the best decisions concerning your surgical experience as well as your full recovery. With this goal in mind, please feel free to adapt any of the following to your individual situation.

MAKE LISTS - Making lists can help organize your thoughts and plans during this time. Included here are several ideas for lists you may find helpful to you.

QUESTIONS - No doubt you and your family members will have questions regarding your pre-admission, surgical, and post-discharge care. Making a list of these questions will help in assuring that any and all information needed is obtained. Keep the lists with you (perhaps in a notebook) before, during, and after your surgery, so that all of your questions will be answered by the appropriate people involved with your care.
MEDICINES - Throughout your preoperative as well as your postoperative care, many people may ask what medicines you take. Be prepared by making a list of all the medicines you take (both prescription and over the counter). Include medicines that you are taking for medical as well as orthopaedic reasons. Add to the list any vitamins or nutritional supplements you also may be taking. Be sure to also list any allergies you have to medicines or other substances. Keep this list handy and definitely bring it with you at the time of your pre-admission work-up as well as the day of admission to the hospital
APPOINTMENTS - Depending on where your pre-admission testing is performed, you may have several appointments before your actual admission to the hospital. Pre-admission appointments may include scheduling doctors appointments, lab tests, blood donations, x-ray appointments, and preoperative class appointments. Keep yourself organized by listing the date and time of any appointments necessary and checking them off as they are completed.
PLANNING - Take the time to plan for your care after surgery. Planning and preparing ahead of time will make your experience much more pleasant and productive. By making a list of who and what will be needed to assist you throughout this time, you can be assured that nothing important will be missed. Ideas for planning might include a list of who will be available to assist you to travel to appointments and stay with you after discharge if necessary. The list might also include your plans for home care assistance, meals, and rehabilitation after discharge from the orthopaedic unit.

EVALUATE YOUR HOME - One of the most important goals of surgery is for you to return home and function as independently as possible. By evaluating your home for safety and ease in functioning before your surgery, you can avoid what may later seem like large obstacles to your recovery.

MULTI-LEVEL VS. ONE LEVEL HOMES - If you live in a multi-level home, consider where you will stay after coming home, keeping in mind that you should be able to climb stairs after discharge. For many patients in a 2 level home, they get up in the morning, bathe and dress upstairs, then come down to the first level and remain there the rest of the day. If there is no access to a bathroom on the 1st level, it may be necessary to obtain a portable toilet. While there is no set limitation to the number of stairs you can climb, certainly in the first several weeks after discharge, stair climbing may tire the patient. As stability, confidence, and strength continue to improve, stair climbing becomes more frequent.

A one level home presents minimal problems since all rooms are available to the patient.
STAIRS - INSIDE/OUTSIDE As mentioned, all patients are taught stairclimbing while in the hospital. Evaluate any steps at your home prior to your surgery. Make sure that the handrails are sturdy. If you desire, install rails on both sides of the steps for maximum convenience going up and down. If outside steps do not have a handrail, perhaps now is the time to install one if possible. Evaluate the entrances to your home. Select the one that has the easiest access for you while using crutches or a walker. You'll find if you work on these ideas now, your recovery time won't be hampered by trying to make these decisions.
BATHROOMS - Safety is the keyword when you look at your bathroom. Make sure you can maneuver. Remember, you will be using a walker or crutches for 6 weeks. Some ideas to consider are:
- shower/tub rail
- rail on wall by toilet (many times a sink to the side of the toilet can be used for support)
- raised toilet seat
- shower/tub bench
- non-slip mat inside tub/shower

Many patients who have been living with joint problems already have some equipment in their bathrooms. While not all of the equipment listed is required, the most important one patients need is the raised toilet seat. If you are not currently using one, you may want to wait until you attend the preoperative joint class or until your admission to the hospital. By doing so, you and the occupational therapist can decide which type is best suited for your bathroom. The second most popular piece of equipment used by patients is the tub bench. This allows the patient to be seated while in the shower since standing without support is not allowed the first six weeks after surgery. If you intend to use a tub bench after surgery, please be aware that it will be necessary to remove any tub doors in order for the bench to fit inside the tub. Our recommendation is to purchase a tension rod and shower curtain, and store the tub doors until they can be used again.

The other important aspect to consider in the bathroom is to have any supplies within easy reach. If possible, place shampoos, shaving equipment, toilet tissue...within easy reach (waist to chest level) where there is minimal or no bending over or reaching too far for supplies. You'll find that this is the most efficient way to maneuver, meets any position restrictions recommended in the postoperative phase, and by far is the least likely to cause discomfort or injury after surgery. An added plus is that you'll be able to quickly identify when supplies are running low.
KITCHENS - Again, planning ahead can mean the difference between a recovery period that runs smoothly or one that you feel is constantly frustrating. Using safety and efficiency as the primary guides, take a look at your kitchen. Think about meals and the equipment used for them. Put pots, pans, canned goods and cleaning supplies at waist to eye level for ease of access. When using crutches or a walker you're not going to want to be bending too low nor reaching too high for safety's sake.

- Use your upper cabinets or counter space to store your most frequently used equipment.

- If you plan on preparing meals and freezing them before having your surgery, try to place them in containers that will go from the freezer to the oven, stove, or microwave to make life easier. (Don't make any containers too heavy if you are the one who will need to get them out.)

- Remember the refrigerator too. The same rules apply - try to keep the items you'll use most frequently on the upper shelves to maximize energy conservation and maintain any position restrictions you may have.

GENERAL HOUSEHOLD - In general, most households need just a few adjustments made in order for you to function more effectively after surgery. As with all the suggestions given here, remember to adapt what may be suited to your individual needs.

- Floors - Be sure that your pathways are cleared. If you have small items sitting on floors or stairs, you may want to put these away for now. If you have small children at home, educate them now to put away toys, books, etc. so that everything is up from the floor.

- Household Pets - If you have indoor pets such as cats or dogs, please be sure that someone will be available to help care for them. You will need assistance with their care while using a walker or crutches. In addition, consider the safety factor of functioning in your home with an indoor pet. Remember, you will always want a clear pathway and every effort made to avoid injury.

- Carpets - Scatter rugs should be placed away for later use. They can cause you to lose your footing and perhaps fall. Even those with rubberized backs can be an obstacle to crutches or walkers so our advice is to get them off the floors while recuperating.

- Furniture - In general, patients are most comfortable sitting on higher furniture with arms. Sofas or chairs that are too low can cause problems bending too much to get into, and straining too much to get out of. Pick a comfortable, moderate height chair or sofa for sitting so that your knees are on a level with or slightly lower than your hips when you are seated. Foam cushions on chairs or sofas that are too low may help to keep you on the right level and are available through the physical occupational therapy department while you are in the hospital.

Recliners, if the correct height for comfort and any position restrictions, are a popular type of chair patients use at home.

-GET COMFORTABLE! - Make sure that the things you need - like the telephone, TV remote control, newspaper... are within your reach. You may want to place a small table near the chair or sofa where you will be sitting after surgery in order to keep these things handy.

PACKING FOR THE HOSPITAL - Our advice for this is to pack lightly! The hospital supplies patients with gowns, robes, non-skid footies, and a small personal hygiene pack which has a toothbrush, tissue, soap, and a comb. Most patients use hospital gowns at least for the first day or two after surgery. If you prefer bringing your own clothes, be sure that they are comfortable and loose fitting. They also should allow for easy access to the operative site since this area is checked frequently to be sure no problems develop. Shorts are a popular item for Physical Therapy sessions. Avoid gowns or other clothing made of nylon - they tend to make people perspire and become uncomfortable when in bed for any length of time.

FOOTWEAR - Any closed back, flat shoe or slipper with a non-skid sole is appropriate for the post-op period. Tennis shoes are ideal and inexpensive.

TOILETRIES - Items such as deodorant, combs, toothbrushes, etc. should be brought with you as desired.

EQUIPMENT - Any crutches or walkers you will use post-operatively should be brought on the day of admission so that they are readily available when you start therapy.

HANDICAPPED TAGS - Handicap tags are readily available to patients both before and after surgery. Please take advantage of this benefit if you feel this would be useful. Both permanent tags and temporary permits are available, and require a physician's signature on the application. If you wish to apply for these, complete the required forms and either send or bring them to our office for the physician's signature.
INSURANCE COVERAGE - All insurance companies are different. If you have questions about your specific coverage jot them down before calling your company to clarify your coverage. Any information you obtain should be brought with you on admission to the hospital.

Listed here are examples of frequently used equipment and available insurance information. Please be aware that insurances change frequently, and this information is provided as a guide only. If you need any equipment ordered while in the hospital, the amount of insurance coverage and balance you are responsible for will be verified.

Equipment	Insurance Coverage	Cost to Patient
Walker or Crutches	Yes	No
Cane	Yes	No
3-in-1 commode	Yes	No
Raised toilet seat	No	Price $20-$60
Sock donner	Yes (hospital charge)	No
Dressing Stick	Yes (hospital charge)	No
Reacher	Yes	No
Leg lifter	Yes	No
Long handled bath sponge	Yes	No
Long handled shoe horn	Yes	No

A FINAL WORD - We realize that each patient is unique and has their own needs. We have offered the information presented here as a group of suggestions and ideas that we have collected from our experience with patients. It is our hope that this information can be helpful to you and your family in preparing for your upcoming surgery.