Surgery Instructions: Pre- and Post- Operative Patients

Preparing for Surgery – Pre-operative Instructions

Pre-operative testing (i.e., blood work, urinary analysis, chest x-rays, EKGs) will be required prior to surgery. All testing should be completed one to two weeks prior to surgery.

Antibacterial Soap

To minimize the risk of infection, you should use an antibacterial soap for two showers prior to surgery. This is usually the night before surgery and again the morning of surgery.

Cleanse your entire body, paying special attention to the area where your surgery will be performed. In the surgical area, use a washcloth and cleanse for approximately five minutes.

Your level of fitness and nutrition prior to surgery should be maintained to the best of your ability. Maintain a healthy, balanced diet.

If you smoke cigarettes, it is strongly advised that you decrease the amount you smoke or stop smoking completely. Research indicates that smoking adversely affects bone healing. In addition, inhalation of smoke irritates the breathing passages and may affect recovery.

Any errands, such as house cleaning and grocery shopping, should be completed prior to surgery. The fewer concerns you have upon discharge, the easier your transition home will be.

Refrain from yard work or any outside activities that may cause cuts, breaks in the skin, or insect bites during the week before surgery. These may increase your risk of infection and could potentially result in postponement of surgery.

Avoid contact with pets if scratches or bites could occur before surgery.

Medications to Discontinue Before Surgery

Please do not take any of the following medications for at least ten (10) days prior to surgery unless otherwise instructed by your physician.

If you are undergoing spinal fusion surgery, you may be instructed to avoid NSAIDs for approximately three months after surgery or until your surgeon advises otherwise.

The lists below are not complete. If you are unsure whether a medication or supplement should be discontinued, please contact our office or the physician who prescribed the medication.

If you are taking aspirin, anticoagulants, blood thinners, or medications prescribed for your heart or circulation, do not discontinue them without first consulting the prescribing physician.

Failure to follow pre-operative medication instructions may require your procedure to be postponed or rescheduled for patient safety.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Advil	Celebrex	Ketoprofen	Naproxen
Aleve	Daypro	Lodine	Oruvail
Anaprox	Diclofenac	Meloxicam	Toradol
Ansaid	Feldene	Mobic	Relafen
Arthrotec	Ibuprofen	Motrin	Vicoprofen
Bextra	Indocin	Naprosyn	Voltaren

Medications Containing Aspirin

Alka-Seltzer	Bufferin	Fiorinal
Anacin	Excedrin	Pepto-Bismol
Aspirin	Ecotrin	Bayer Arthritis

Anticoagulants and Antithrombotics

You will need to consult your physician regarding plans for stopping these medications.

Aggrenox	Halfprin	Persantine
Coumadin	Heparin	Plavix
Ecotrin	Lovenox	Ticlid
Fragmin	Orgaran

MAO Inhibitors

Consult your physician regarding stopping these medications.

Nardil (Phenelzine)

Parnate (Tranylcypromine)

Herbal Medications and Supplements

In general, all herbal products and vitamins should be discontinued before surgery. Some herbal and vitamin supplements increase bleeding during surgery.

Vitamin E (14 days before surgery)	Garlic	Lovaza	Valerian
Multivitamins	Ginkgo Biloba	Ma Huang	Fish Oil
Echinacea	Ginseng	Saw Palmetto	Kava
St. John’s Wort	Redux	Pondimin	Appetite Depressants (14 days before surgery)

GLP-1 (Glucagon-Like Peptide-1) Medications

Generic Drug	Brand Name
Dulaglutide	Trulicity
Exenatide (ER)	Bydureon BCise
Exenatide	Byetta
Liraglutide (3mg)	Saxenda
Liraglutide (1.2mg / 1.8mg)	Victoza
Lixisenatide	Adlyxin
Semaglutide	Ozempic, Wegovy, and others
Semaglutide	Rybelsus
Tirzepatide	Mounjaro

Failure to follow pre-operative medication instructions may require your procedure to be postponed or rescheduled for patient safety.

If you are unsure whether a medication or supplement should be stopped before surgery, please contact our office for guidance. This list is not complete. Please consult your physician regarding any medications not listed above.

Preparations for Your Hospital Stay

Abstain from alcohol for 48 hours prior to surgery.
Eat lightly the day before surgery.
Have nothing to eat or drink after midnight prior to surgery.
If you have young children or family members who depend on your care, arrange alternative care following surgery to allow for a restful recovery period.

Going Home – Post-operative Instructions

When arranging for transportation home, you will need a driver. Make sure you use a car that is easy to get in and out of. Once you arrive home, please call our office to arrange for a follow-up appointment. This appointment should be approximately 14 days from your date of surgery.

In the days and weeks following surgery, it is important to remember that you will need to make some modifications to your normal daily routine.

Keep your wound clean and dry. In most cases, you may shower 3 days after surgery. When showering, remove the bandage and wash directly over the wound. The bandage should be changed daily at home. For surgeries on the back or back of the neck, apply an antibiotic ointment at each dressing change.
For lumbar spine surgery, you may sleep or lie down on your back or sides only. Avoid lying on your stomach.
For anterior cervical surgery, keep the steri-strips on the wound but remove the outer dressing when showering.
After 3 days you may get the suture line wet when showering. Pat dry gently. Bathing in a tub or swimming in a pool or ocean is not permitted until your wound is completely healed (approximately 6 weeks—ask your doctor first).
If you notice your wound becoming increasingly red, swollen, hot, or developing drainage, please call your physician.
You may sit, stand, and walk to your tolerance. Walking can be divided into short time periods if necessary.
You will experience some degree of discomfort after spinal surgery, which varies from individual to individual. Unless under the care of a pain management physician, you will receive a prescription for pain medication prior to discharge. Please take your medication as directed. Do not take more than the prescribed dose unless approved by your physician. If you feel a need to increase the medication, call the office first for approval.
Outpatient physical therapy, if prescribed, will not begin until approximately 2 to 6 weeks following surgery. Only some patients require structured physical therapy programs.
Sexual activity may usually resume at six weeks following surgery. This varies by patient and procedure. Ask the office for additional information if needed.
You may resume driving when you feel comfortable driving and the medications you are taking do not affect your reaction time or alertness. You may not drive while wearing a back brace or hard cervical collar.

Back Brace and Neck Brace Instructions

Back Brace

You will wear your back brace 24 hours a day, 7 days a week, except when showering, using the restroom, or sleeping. At all other times, the brace should be worn as directed.

Neck Brace (Hard Collar)

You will wear your hard cervical collar 24 hours a day, 7 days a week, except when showering. At all other times, the collar should be worn as directed.

At your follow-up appointment, ask your surgeon about transitioning to a soft collar and when that transition may begin.

Things to Avoid

Avoid lifting more than the weight of a gallon of milk. When lifting light objects less than 8–10 pounds, keep the object close to your body.
Avoid movements that involve twisting motions.
If you have undergone surgery for a herniated disc, avoid sitting for extended periods of time (generally longer than 30–45 minutes). Alternate standing, walking, sitting, and lying down throughout the day.
Avoid smoking, if possible, for at least 3 months following surgery. Avoid alcoholic beverages while taking pain medication.
Avoid straining during bowel movements. Constipation is a common side effect of many pain medications.
If you have had a spinal fusion, do not use NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Advil, Motrin, or Aleve for approximately 3 months after surgery unless instructed otherwise by your surgeon. Refer to the medication list included in this packet. You may take Tylenol unless otherwise directed.
After surgery, do not lift anything above your shoulders or below your waist until instructed to do so by your surgeon. Avoid putting on your own shoes and socks or performing activities below your waist that require bending.

Pain Medicine

You may be given narcotic pain medication either before or after your surgery. These medications are controlled substances and should not be taken in excess of the prescribed amount unless specifically discussed with your physician.

Upon discharge, you will be provided with a prescription for pain medication as appropriate.

Constipation

Constipation is a common problem for patients who have recently undergone surgery.

Anesthesia, narcotic pain medications, and iron supplements may all contribute to constipation.

The following measures may help relieve constipation:

Drink six to eight 8-ounce glasses of water per day.
Use high-fiber products and consume fruits and vegetables.
Use a stool softener such as Colace or Docusate Sodium three times daily (over-the-counter).
Use a bulk laxative such as Konsyl or Metamucil, or an osmotic laxative such as MiraLAX or Milk of Magnesia if needed.

If the above measures do not relieve constipation, a laxative may be necessary. In general, chemical laxatives should not be used over prolonged periods. However, short-term use of Dulcolax tablets or Dulcolax suppositories may be appropriate while taking pain medication. Follow package directions carefully.

Follow-Up Visits After Surgery

Every patient should follow up approximately 14–20 days after surgery and again 4–6 weeks after surgery.

Additional follow-up visits may occur at 3 months, 6 months, and 12 months depending on the type of surgery and your recovery progress.

Please make every effort to return for follow-up appointments as instructed by your surgeon.

After-Hours Contact Information

If you need to reach our office after hours, please call 281-333-2727 and select Option 1.

If you are experiencing an emergency related to your surgery, please contact the emergency room where your surgery was performed.

Iatric, LLC
Jorge Ramirez
3118 Bainbridge Hill
Houston, TX 77047

As deemed necessary by your surgeon, a surgical assistant may be necessary to provide the highest level of care during a surgical procedure. Surgical assistants are highly skilled and fully trained licensed and/or certified allied health professionals. Duties include but are not limited to the identification of anatomical landmarks, securing blood vessels, recognizing pathological, and providing and securing adequate, safe, and proper exposure of the operative field, closure of the surgical wound, application of casts, dressings, etc., they also perform other duties delegated by the operating surgeon within the scope of their training. As an integral part of the surgical team, surgical assistants contribute greatly to the safety and quality of the service provided to patients.

The decision to utilize the services of a surgical assistant is solely the surgeons. Your surgeon, after evaluating the surgical procedure and the level of technical involvement it requires, has deemed it medically necessary to use the services of a surgical assistant.

I hereby authorize Jorge Ramirez, Iatric, LLC and partnering companies to bill my current insurance carrier including, but not limited to, private health insurance, employer sponsored insurance and Medicare/Medicaid Programs. I understand that I may receive a statement from my insurance company, an explanation of benefits (EOB), and I may see this benefit on there. These services may or may not be covered by my health insurance company.

I acknowledge that services provided may be provided by an out of network provider and that my maximum estimated out of pocket expense may be up to $500.00 as it relates to services provided. This fee can be charged in the event of no insurance, no or low coverage by any insurance plan for the provided services, and for deductibles / co-insurance / patient responsibility that have not been met (this includes Medicare/Medicaid).

I acknowledge that my insurance company may send payment(s) for the surgical services directly to me, the patient. If the insurance sends money after the surgical procedure, it should come with an explanation of benefits (EOB), and with an attached check for payment of one or many of the services received. The EOB will indicate the date of service, details about the services provided and what provider rendered the services.

There is a contractual obligation to pay on any payments received by the insurance company for services. If there are not enough details included with the check, you must call the insurance as soon as possible to ensure prompt payment of services to provider(s). I acknowledge and agree that if any insurance checks received are for payment of services provided by Jorge Ramirez, Iatric, LLC are sent directly to me, the patient, I am fully responsible for immediate payment of these amounts to the provider of services. If I receive a check or have further questions about payments received, I will contact my insurance company and notify the provider, or the billing company listed below. Payment of amounts received by the insurance company is required by your contract and applicable state and federal laws. I acknowledge and agree that if I fail to do so, I will be held liable for any additional fees, court fees or collection agency fees accrued in the collection process for Jorge Ramirez, Iatric, LLC, and associates.

Mederi Services, LLC, is the medical billing company that may contact you regarding the medical services claim, if needed. Any billing or insurance questions prior or after your surgery may be directed to your insurance or a representative at Mederi Services, LLC.

Telephone: 877-563-3374 Option 2
FAX: 866-730-5515
Email – patientquestions@mederiservices.com
Live Chat and FAQ- Visit our website www.mederiservices.com

Instructions for Collecting a Clean Catch Urine Sample

INSTRUCTIONS FOR FEMALES

Wash hands with soap and warm water.
Spread the labia (folds of skin) apart with one hand and wipe with the towelette provided. Wipe from front to back.
Continue holding the labia apart. As you start to urinate, allow a small amount of urine to fall into the toilet bowl. (This clears the urethra of contaminants) Do not touch the inside of the cup.
After the urine stream is well established, urinate into the cup. Once an adequate amount of urine fills the cup (the cup only needs to be half-full), remove the cup from the urine stream.
Pass the remaining urine into the toilet.
Screw the lid on the cup tightly (do not touch the inside of the cup or lid). Give the cup to the Customer Service Tech.

INSTRUCTIONS FOR MALES

Wash hands with soap and warm water.
If uncircumcised, retract foreskin.
Wipe the end of penis with towelette provided. As you start to urinate, allow a small amount of urine to fall into the toilet bowl. (This clears the urethra of contaminants) Do not touch the inside of the cup.
After the urine stream is well established, urinate into the cup. Once an adequate amount of urine fills the cup (the cup only needs to be half-full), remove the cup from the urine stream.
Pass the remaining urine into the toilet.
Screw the lid on the cup tightly (do not touch the inside of the cup or lid). Give the cup to the Customer Service Tech.

FYI: If nurses at the hospital do not give you a wipe, please ask them for one!