Debbie our surgery scheduler will contact you within a week of your decision to proceed with surgery to discuss scheduling and insurance issues. Her phone number is (562) 430-3561, x 302. Dr. Dee typically performs surgery on Wednesdays and Fridays. Scheduling may take a few weeks depending on Dr. Dee's surgery schedule and insurance authorization. Debbie will schedule you for a pre-operative visit a few days before your surgery date to discuss the surgery and obtain labs and an updated history and physical exam. If you have any major medical problems, (i.e. heart disease, lung disease, cardiac arrhythmias, prior heart attack) please obtain a clearance note for surgery from your primary physician and bring a copy of this to your pre-operative visit.back to top
These devices can help decrease pain, swelling, and inflammation after surgery. Even without the devices, you will have numbing medication injected at the end of surgery which typically lasts 3-5 hours; this will give you enough time to return home and start taking your oral pain medications.
The cold therapy devices are sterile pads incorporated into the post-operative dressings; the pads are attached by rubber tubing to motorized "igloos" which circulate ice-cold water through the pads. This is a controlled method of applying ice to a post-operative wound. One can use a frozen bag of peas or corn kernels as well, but the penetration through the dressing may not be that high, and care must be taken to not get the dressings wet. The cold therapy devices may continue to be used for weeks after the surgery such as after physical therapy appointments.
The pain pumps are automated devices that infuse numbing medication (like novocaine) into the wound via a small catheter. These usually last for 2 days and are removed in the office on your first post-operative visit. The catheters are small as to not need a suture for closure.
Both of these devices may not be covered by many insurances, especially HMOs. Cash quotes from suppliers we use may be obtained by calling Sean Smith of HUB Medical at (866) 438 3868.back to top
This will take place a few days before the surgery date. If you are under 18 years of age, your parent or guardian must come with you to sign your operative consent. Please be prepared to inform the physician of any drug allergies or sensitivities. Also, please inform the physician of any medications that you are routinely taking. The preparation for surgery (work-up day) includes:
Changes in your general health will affect your surgery. If at anytime prior to your surgery any of the following conditions develop, please notify your physician.
Check in where you were directed on your pre-operative visit at least 1 hour prior to your operative time. You will be asked to change into a hospital gown, remove jewelry and contacts. (We suggest you leave your contacts out the day of surgery.) The nurses will check your (pulse, blood pressure and temperature), and ask you a few questions. Once this is completed you will be directed to a waiting area until the operating room notifies the nurses. You will then be taken to the operating room on a cart. The anesthesiologist talks with you briefly, an IV (needle inserted to give you fluids) is inserted, and final preparations are carried out.back to top
Your family will be directed to waiting rooms. Medical staff will notify them when your procedure is completed, and how you are doing. They will be directed to the appropriate area once you have completed your recovery room stay.back to top
When surgery is completed, you will be taken to the recovery room. The usual length of stay in the recovery room is 1 hour, but may be longer according to the surgical procedure and the type of anesthesia.
While you are in the recovery room, the nurses will be checking your blood pressure, pulse, respirations, and temperature frequently. They will also be checking the sensation and circulation in your surgical leg.
You may have a large bandage, a brace or an ice cuff on your knee.
After your stay in the recovery room you will be transferred to same an outpatient observation unit where staff During this final recovery stage your nurses review homegoing instructions, obtain prescriptions, and you may be seen by a physical therapist.
Discharge is based upon your recovery from the effects of anesthesia, and if your pain is under control. Your physician determines if you are ready for discharge. If additional observation is required, you may be admitted to the hospital.back to top
It is normal to feel drowsy for 24-48 hours after surgery and to require pain medication at regular intervals. These symptoms will gradually subside and each day you will feel less sleepy and painful.back to top
While these devices may be used for prolonged periods after surgery to control pain and swelling, it is typically good to turn the device off for 20 minutes and allow the knee or shoulder to "warm up" every 3 hours. If at any time there is increased tingling or numbness in the extremity while the cold device is on, or if there is a burning sensation or significant pain with the device on, you must turn off the device and call our office.back to top
If your right leg is operated on, or your shoulder, you will not be safe to drive for probably 4 weeks post-op. Depending on the type of surgery, if more healing-time is required for strenuous activities (i.e. ACL, rotator cuff repair, knee replacement) safe driving may not be allowed till 6 weeks post-op.back to top
Physical therapy will begin after your first post-operative visit. I will direct and modify your program based on your progress. Two commonly used exercises that you may begin immediately after surgery are quadriceps setting and straight leg raises. The swelling in your knee after surgery causes "inhibition" of the quadriceps (thigh) muscle from "working". These exercises are designed to "re-activate" the quads - the sooner you regain the ability to contract and control these muscles, the sooner you will be able to wean yourself from crutches (provided there are no weight-bearing limitations).back to top
Lie on your back with your knees straight, legs flat and arms by your side. Place your heel/lower calf area on a towel roll or soft chair so that the area behind your knee is suspended. Tighten the muscles on the top of the thigh (quadriceps), and at the same time push the back of the knee down and hold for 5 seconds. Increase the time you hold this contraction up to 15 seconds, then you can attempt to raise the heel. Hold for 5 seconds, relax 5 seconds. Repeat this exercise 6 times on a firm surface at least 4 times a day.back to top
This exercise is as an extension of the quadriceps set above, and can be accomplished only after being able to hold a quadriceps set for at least 15-20 seconds with your heel on a towel roll. Lie on your back with your operative knee flat and straight. Keep the other leg bent with foot flat on the floor. Slowly raise your operative leg about 6 inches off the floor, keeping the leg as straight as you can. Hold for a count of 5 seconds, then lower the leg. Repeat this exercise 6 times on a firm surface at least 4 times a day. The goal is to be able to contract your quadriceps muscle then lift your leg straight in the air and hold for 10 seconds. Ultimately you want to increase your endurance to 30 seconds. The sooner you regain your quadriceps strength and control by doing these excercises, the sooner you will be able to ambulate without crutches and weakness.back to top
I will direct and modify your shoulder physical therapy program depending on the type of surgery you had and your progress. Here are some guidelines:
Shoulder Repair : (i.e. rotator cuff repair, labral repair, capsulolabral reconstruction, SLAP repair) will remain in a sling device for 3-4 weeks. During this time you may use your hand, wrist, and elbow for activities at the waist or table level. You may gently remove the brace 3 times a day to straighten your elbow out, otherwise, you must remain in the brace all times, including sleep. This brace helps protect the repair and ensure proper healing. Do not attempt to lift or elevate the arm more than 30 degrees from the side of your body. You may also squeeze a ball with your hand or squeeze your shoulder blades together and hold for 10 seconds, 3x/day. Physical therapy starts at 3-4 weeks under my direction, and typically involves assisted range of motion and gentle strengthening exercises for the next 3-5 wks. Do not attempt any exercises on your own without direction/clearance from the physical therapist or myself. See "Active Assisted" program below for safe home exercises, once you've reached this stage.
Shoulder "Cleanout": (i.e. decompression, 'spur' removal, debridement, AC joint excision). You will typically be in a sling for comfort for the first 1-3 wks. Your physical therapy will begin within 1 week of surgery. You may begin "active assisted" exercises on your own at home everyday as soon as you are comfortable and pain allows. (see below)
Active Assisted Range of Motion Program: The goal in this phase is to regain motion without over-stressing tissues (rotator cuff and labrum) that are still healing. (it takes 6-8 wks to fully heal).
Shoulder blade shrugs and scapular squeeze - hold each position for 15 seconds, perform for 10 minutes, 5 times a day.
Table Slides - face a table, place your hand on a small folded towel, slide your hand across the table and reach as far as you can. If you move your chair slightly away from the table, this will enable you to lean your body forward to reach even further across the table. This simulates shoulder elevation. You can also turn your body 45 degrees so the table is partially to your side (as opposed to in front). Performing the same exercises in this position will "stretch" and loosen a different portion of your shoulder
Wall Slides/Climb - similar to Table Slides but performed vertically on a wall. Do not attempt until you are comfortable with Table Slides.
Clasped Hands Elevation - clasp your hands together, sit in a reclined chair or lie down, use your non-operated arm to lift the other over your head. Work towards the position of placing your hands behind your head. Once this is achieved, you can bring your elbow tips together and feel the "back" of your shoulder stretch, and spread your elbow tips apart to feel the "front" of your shoulder stretch. Ultimately, you can twist your palms upward and push both arms over your head to complete your motion.back to top
Follow-up visits are necessary for your doctor to chart progress, change bandages, check for any complications and evaluate your rehabilitation progress. Pain Pump patients typically follow up 2 days after surgery. Without no pain pump, you may follow up 7-10 days after surgery.back to top
If the following occurs, contact us immediately: