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ALL MAJOR INSURANCE PLANS ACCEPTED

Recovery Period

Cranial: ~4-6 weeks from date of surgery

Spine: ~12 weeks from date of surgery

  • 2 weeks for incisional healing
  • 4-6 weeks for muscle recovery (after spine operations)
  • 4-12 weeks for outpatient physical therapy if needed; beginning around week 4-6
  • Determination of time off from work/ school will be based on patient-specific needs after a discussion with your surgeon. For more strenuous occupations, we will determine together if more time is needed.

Follow Up

Follow up with your surgeon as directed on your discharge papers.

Please schedule an appointment with your surgeon if not already scheduled.

  • Dr. Deven Khosla
  • Dr. Daniel Nagasawa

Please schedule and confirm appointments with your Primary Care Physician in 1-2 weeks for post-operative medical check

  • If you do not have health insurance, you may call 2-1-1 to find a free or low-cost clinic in your area

How To Reach Us

  • We are available to you at all times
  • In case of an emergency, report to your closest Emergency Room or call 911
  • During business hours call Achieve Brain & Spine at 310.710.1919
Patient Instructions

Incision Care

  • If you are discharged with dressings, you can remove your dressings on day three after surgery.
  • Do not wear any hard surface devices that may rub against the incision; Avoid rubbing or scratching the wound. Check your incision daily for signs of wound infections (see below). Do not use alcohol wipes, ointments, or any other chemical agents on your incision. If your wound is secured with Dermabond/Steri-Strips, they will fall off on their own in 1-2 weeks.
  • If your incision was closed superficially with staples or sutures, these will be removed approximately two weeks after surgery by a physician, physician assistant, or nurse practitioner.
  • Avoid excessive sun exposure on wound.
  • Ok to use ice or warm packs around the incision for pain and muscle spasm alleviation; Do not apply directly on the incision.
  • A small amount of reddish-brown drainage is not unusual for 1 to 2 days. Please report any other type or amount of drainage to our office. We may begin you on an oral antibiotic if the drainage persists.
  • Cranial: Eye/facial swelling is common after surgery and may take a few days to a week to disappear. Bruising may occur and will take one to two weeks to resolve. You may feel better if you sleep with two pillows under your head; keeping your head elevated will help reduce facial swelling.

Showering

Please have someone to help you with showering. You can shower when you get home.

If < 3 days after surgery:

  • Continue to keep wound dry using shower cap/water resistant bandages (Tegaderms) to cover the wound prior to showering.
  • When the shower is completed, pat wound clean and dry.
  • Replace new dressing over incision to keep it protected.

If ≥ 3 days after surgery:

  • OK to wet the wound during showering by allowing soap/water to run over the incision, but do not scrub the incision. If you have Dermabond/Steri-Strips, ok to get these wet; they will fall off in 1-2 weeks.
  • After showering, pat wound clean and dry.
  • Ok to leave incision open to air after showering, no need to cover.

Overview of Daily Activities

You may feel more tired for 1-3 weeks after surgery. Get plenty of rest. Instructions on activity are listed below:

Walking

You should walk 2-4 times a day, with short gradual increases in your daily activities. Every few days, try to increase each session by a few minutes. You should walk every day. Walking will improve circulation, increase your feeling of well-being, prevent pulmonary problems, relieve constipation, and decrease muscle soreness after surgery. If you have stairs at home, try to make arrangements to stay on the 1st floor until able to safely navigate them.

Lifting

Do not lift more than 10lbs for at least 2 weeks or until your surgeon tells you ok to do so. Do not participate in sports or activities that increase your risk for injury such as contact sports, bike riding, soccer, football, skateboarding. Avoid falls and trauma. Avoid any tasks that might involve overhead lifting. No aggressive activities, No straining, No reaching up. After spine surgery, avoid twisting or bending.

Other Activities

Avoid straining when having a bowel movement. Take laxatives as prescribed. When you see your surgeon in the follow-up appointment, he or she will discuss decreasing the limits on activity at that time. You may resume sexual intimacy when you feel well enough, but do not overexert yourself. You must have clearance from your doctor before participating in any strenuous exercises/activity.

Driving / Air Travel

You must have clearance from your doctor before driving a car or flying. This will be discussed at your postoperative visit. Do not operate a moving vehicle during your recovery period. Driving is not recommended if you have limited mobility (i.e. wearing a brace), narcotic or sedating medication intake, and/or have a neurological deficit. Riding in the car is acceptable, but LONG CAR RIDES (greater than 2 hours) ARE DISCOURAGED. If you must take a long car ride, stop often to stretch your legs or walk around.

Diet

You may resume the type of diet you had before surgery. Eating a well-balanced diet is important for proper wound healing. The doctor or nurse will let you know if you need a specific diet or food consistency. It is advised to maintain a healthy weight that is recommended for your height. Avoid smoking, alcohol, or drugs, as these can delay your surgery recovery process. An increased intake of water, 6 to 8 glasses per day, will help clear your body of anesthetics and excess pain medication, and will increase the ease of bowel movements. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Work / School

Most patients return to work/school within 2-4 weeks. If you need a note for medical clearance from work/school, your team will provide you with one at your follow up appointment. For the disability application and form, please go online: http://www.edd.ca.gov/disability/

Helmet / Brace / Collar

If you are prescribed a helmet, back brace, or neck collar, please wear as instructed (either at all times or when out of bed) until instructed (if you do not know how long to wear your helmet/brace/collar, please wear until follow-up appointment).

Rehabilitation

If indicated, our rehabilitation professional will assess you prior to your discharge. We will order any rehabilitation needs and equipment prior to your discharge.

Pain Management

It is common to have a headache/pain after surgery, which may last a few days or a few weeks. After spine surgery, you can expect your back to feel stiff and sore. It should improve in the weeks after surgery. You may have trouble sitting or standing in one position for very long. It may take 4 to 6 weeks to get back to doing simple activities, such as light housework. It may take up to 2-3 months for your back to get better completely.

After all surgeries, inflammation is a natural process of healing. We cannot and do not want to completely block this process. Please know we can take the edge off your pain, but we cannot stop all your pain. With each day that passes, you will get stronger and oftentimes, must simply be patient as the healing process begins. You need to be encouraged by the good days as the bad days get further apart.

You will have pain medications prescribed by your doctor for your pain management. The medication may be irritating to the stomach lining, it is advisable to take it with a teaspoon of applesauce or non-fat yogurt.

Narcotic pain medication use for surgical pain is about 1-2 weeks after surgery date. Due to the narcotic addiction epidemic, it is recommended to taper off narcotics and transition to Tylenol as needed for pain as soon as you can.

If you still need narcotic pain medications 3-4 weeks after your surgery / injury date, please follow up with your pain management doctor for further pain medication management. Some of our patients use over-the-counter pain patches such as Solanpas or Bengay creams (as examples) for local muscle pain control. If you continue to have chronic pain, please also follow up with your pain management doctors to establish the best pain control regimen.

Narcan nasal spray is prescribed in case you experience overdose symptoms such as diminished level of consciousness or depressed/ slowed breathing, which can result to lack of oxygen to the brain. Death is a distinct possibility with opioid overdoses. Though alcohol, sedatives, or a mix of opioids (either prescription or illicit) are frequently involved in many opioid-related overdose deaths, opioid overdoses do sometimes occur after a person accidentally takes too much of their prescription medication.

Narcotics may cause constipation. Use a stool softener or gentle laxative if this occurs. If the medications are ineffective, call your doctor's office to discuss on-going management. If you should become constipated there are many agents that you can obtain from any pharmacy over the counter. These include:

  • Mild constipation: Colace, Senna, Milk of Magnesium, Miralax, Dulcolax tablet.
  • Moderate constipation: Milk of Magnesium, Dulcolax suppository.
  • Severe constipation: Please speak to your primary care physician.

Other Measures Against Narcotic Induced Constipation

  • Hydration (Except patients with congestive heart failure (CHF))
  • Warm prune juice, one glass three times a day
  • High fiber diet
  • Magnesium Citrate over the counter
  • Metamucil over the counter, take as directed with plenty of water
  • Lactulose
  • Golytely
  • Fleets or soap suds enema over the counter

NOTE: If you are having loose stools you should hold the above medications.

You may also experience nightmares, hallucinations and sweating from your pain medications. Please let you doctor know if these symptoms occur.

DO NOT drive while taking narcotics!

If you are not allergic to over-the-counter Tylenol, it is ok to use over-the-counter Tylenol (Acetaminophen) as needed for pain. Do not exceed over 4000 mg of Tylenol per day; be aware that some narcotics such as Percocet, Vicodin and Norco also contain acetaminophen and contribute to your total daily dose. Avoid taking these medications more frequently then directed; too much Tylenol can cause liver damage.

No aspirin, ibuprofen, naproxen, fish oil supplements, or blood thinner medications, until further instructed by your surgeon.

A sore throat often occurs after intubation for anesthesia.

Cranial: If you have a shunt and you plan to obtain any MRI scans, please call our office to arrange a same day office appointment for shunt interrogation after completion of MRI.

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