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Holland Bone and Joint Program

A Guide for Patients Having Orthopaedic Surgery Please bring this booklet to each hospital visit, including your hospital stay

www.sunnybrook.ca For patients having a hip or knee replacement, please refer to “A Guide for Patients Having Hip or Knee Replacement�


A Guide for Patients Having Orthopaedic Surgery

TABLE OF CONTENTS Welcome to the Holland Bone and Joint Program ............................................3 Surgery Information .............................................................................................4 Getting Ready For Surgery  Be as Healthy as You Can Be .................................................................. 5  Prepare Your Home .................................................................................. 5  Helping You Quit Smoking Before Surgery ...............................................6  Pre-admission Clinic ..................................................................................7  What to do if You Become Sick Before Surgery .......................................9  Chlorhexidine Shower ................................................................................9  Useful Resources.................................................................................... 11 Your Hospital Stay  What to Bring .......................................................................................... 12  If You Are Staying Overnight .................................................................. 13  If You Are Having Surgery at the Holland Centre Campus ............... 15  If You Are Having Surgery at the Bayview Campus .......................... 16  Anesthesia For Surgery .......................................................................... 17  Pain Management After Surgery ............................................................ 22  Potential Complications/Side Effects and How to Prevent Them ........... 26  Hospital Information ................................................................................ 29 Preparing For Discharge  Your Discharge Home ............................................................................ 34  Top 10 Questions about Pain Medications after Surgery ....................... 37  Incision Care ........................................................................................... 43  Removal of Sutures and Follow Up Appointments ................................. 45 Discharge Instructions  Symptoms Requiring Immediate Attention ........................................ 46  Questions/Concerns After Discharge .................................................... 47 MY NOTES/QUESTIONS ................................................................................... 48 Page 2 Holland Bone and Joint Program

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A Guide for Patients Having Orthopaedic Surgery

Welcome to the Holland Bone and Joint Program The Holland Bone and Joint Program is a part of Sunnybrook Health Sciences Centre. It is one of Canada’s premier centres for musculoskeletal care, and is leading innovation in care models and alternate care provider roles. The Holland Bone and Joint Program is located at two sites. Make sure you know at which campus you will be receiving care and having your surgery. Bayview Campus

Holland Centre Campus

2075 Bayview Avenue

43 Wellesley St. East

Toronto, ON

Toronto, ON

Canada M4N 3M5

Canada M4Y 1H1

416-480-6100

416-967-8500

This booklet will act as your guide before your surgery, during your hospital stay, and throughout your recovery.

Please review this information with your spouse, family, or other caregivers. It is important to bring this booklet to the hospital with you so you can use it as a reference.

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A Guide for Patients Having Orthopaedic Surgery

Surgery Information My surgery date is:

_________________________________________

My surgery will take place at: Holland Centre Campus

Bayview Campus You will be called on the last business day before your surgery between 11am and 3pm to confirm the time of your admission. Your admission could be as early as 6am.

You will receive a call two business days before your surgery to confirm the time of your admission. Your admission could be as early as 6am.

Arrival time: ___________________________________ Plan to go home on: _____________________________ Medication Instructions: STOP this medication before surgery: _____________________________________________________________ _____________________________________________________________ Continue all other medication as prescribed. TAKE this medication the morning of surgery before you leave home: _____________________________________________________________ _____________________________________________________________ Food and Drink Instructions Food andthe Drink Instructions Nothing to eat after midnight night before your surgery. This means no food, gum or candies. You may have clear fluids up to 2 hours before your admission. Clear fluids include water, clear apple or cranberry juice, carbonated soft drinks, and black tea or coffee with sweetener (no cream, milk or whitener). Clear fluids do not include milk, citrus fruit juices/drinks or alcohol.

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A Guide for Patients Having Orthopaedic Surgery

Getting Ready For Surgery… Be As Healthy As You Can Be! It is important to make sure you are as healthy as possible so your surgery and recovery go smoothly. This will also help prevent your surgery from being cancelled because of any medical problems.  See your family doctor if you have health concerns. They will make sure you are medically fit for surgery.  If you are followed by a specialist, such as a cardiologist (heart specialist) or hematologist (blood specialist), let them know you are having surgery. They may want to see you and arrange tests to make sure you can safely have surgery.  If you have a cardiac pacemaker, please make sure it has been checked at your pacemaker clinic within the last 6 months before your surgery.  Inform your surgeon if you have an implanted cardiac defibrillator.  See your dentist and make sure gum or tooth issues are treated. Prepare Your Home There are a number of things you can do to get ready for surgery.  Make sure all stairs that you have to use have handrails.  Ask someone to help you with household tasks such as grocery shopping, house cleaning and laundry.  Arrange transportation for the day of surgery, the day you go home and your first follow-up visit.  You may not be able to drive for some time, so make other plans to get around. Continued on next page… Page 5 Page 5 Holland Bone and Joint Program

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A Guide for Patients Having Orthopaedic Surgery

 Tell your family and friends that you are having surgery and may need help during your hospital stay and after your discharge home.  If possible, cook and freeze meals ahead of time.  Be sure your shower or tub has a non-slip coating or mat.  Get any equipment recommended by your health care team to help you manage your activities safely. Helping You Quit Smoking Before Surgery Stopping smoking before surgery even for a short time can reduce risks associated with surgery, improve surgical success and get you home sooner. This is a great time to think about quitting. What are the benefits of quitting?  Your body heals faster because there is more oxygen in your blood.  It lowers your risk of developing a wound infection.  Your lungs work better and breathing is easier which lowers your risk of developing pneumonia.  There is less stress on your heart because of better blood flow and oxygen. This lowers your risk of heart problems. How can we help? Here is a list of resources to support you:  Register for our monthly “Quit Smoking Tips” class by calling (416) 480-4534 or e-mail at patienteducation@sunnybrok.ca  E-mail questions to smokingcessation@sunnybrook.ca  Canadian Orthopaedic Foundation at www.canorth.org

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Pre-admission Clinic You may be asked to attend the Pre-admission Clinic. During this visit, you will meet with a nurse. The nurse will review your health and discuss any concerns you may have. They will also discuss what to expect during your hospital stay and ways to prepare for your discharge home. Some patients have a health assessment by telephone and do not have to attend in person. We will contact you with an appointment time. Pre-admission Clinic checklist:  Eat, drink and take all of your regular medications the day of your appointment.  Bring your medications in their original containers.  Bring a list of vitamins, supplements and herbal products that you take.  Bring current reports from any specialist you may be seeing, such as your cardiologist or hematologist.  Bring the name and telephone number of your family doctor and specialists.  Bring your most recent pacemaker clinic check, if applicable, and your wallet card / defibrillator information including model and serial number.  Bring your Ontario Health Card and supplementary insurance information with insurance company policy/certificate group plan/type of coverage.  Bring an interpreter if you have difficulty communicating in English or you use sign language.

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 Bring a friend or family member if you have difficulty getting around.  Bring this booklet with you.  Contact number where you can be reached before your surgery.  If you are having surgery at the Holland Centre and flying home after surgery, please call the Pre-admission Clinic with your flight number. We will arrange medical clearance to fly. Telephone: (416) 967-8532. The pre-admission visit is a great place to ask questions, please make your list and bring it with you. During the pre-admission visit, you will meet with a nurse, anesthesiologist and/or nurse practitioner. You may also meet with a medical internist, medical radiation technologist, physiotherapist, occupational therapist or research assistant.

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What To Do If You Become Sick Before Surgery If you develop cold, flu, or stomach symptoms such as vomiting or diarrhea before your surgery, call your surgeon’s office. If surgery must be postponed because of illness, we will make every effort to arrange a new surgical date as soon as possible. If you are having surgery at Bayview Campus, and you need to cancel or postpone within 48 hours of your surgery, call your surgeon’s office as well as the Surgical Services cancellation line at 416-480-6100 ext.85141. If you are having surgery at the Holland Centre, and these symptoms occur on the weekend prior to a Monday surgery, please call the hospital at (416) 967-8500, select “0” and ask for the Hospital Coordinator. Chlorohexidine Shower Before Surgery It is very important to clean your skin before surgery to reduce the risk of infection. Special chlorhexidine soap may be recommended for your surgery. The chlorhexidine soap is to be used in the shower the night before your surgery and the morning of your surgery, for a total of 2 washes. Important Notes:  Stop using chlorohexidine soap if skin irritation develops, and continue with your regular soap following the same instructions.  Do not use chlorohexidine soap on your face. This soap should not come in contact with your eyes or ears. Continued on next page… Page 9 Holland Bone and Joint Program Page 9


A Guide for Patients Having Orthopaedic Surgery

Using the soap:  Test the soap on a small patch of skin to make sure it doesn’t irritate your skin before using it on the rest of your body.  Use a clean washcloth and towel with each shower.  Wash your body from neck to feet. Please note that the soap doesn’t lather much.  Finish with the groin and anal areas.  Leave the soap on for 2 minutes before rinsing it off.  Rinse the soap off your body thoroughly.  Use your own soap on your face.  Use your own shampoo for your hair.  Dry your skin, finishing with the groin and anal area.  Wear clean clothes or pajamas after each shower.  Change your bed sheets the evening before surgery. Don’t:  Don’t apply body/moisturizing lotion or powder after your shower.  Don’t shave the hair at your surgical site.  If having knee surgery - don’t shave the hair on your legs for 5 days before surgery and until 2 weeks after surgery.

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Useful Resources For information about Sunnybrook Health Sciences Centre, go to www.sunnybrook.ca. For direct access to information about the Holland Bone and Joint Program, go to www.sunnybrook.ca/Holland.  There are two sites that can help you find a physiotherapy clinic: 1. To find a physiotherapist or clinic in your area, go to the Ontario Physiotherapy Association website www.opa.on.ca or call (416) 322-6866. 2. For information on OHIP-covered physiotherapy clinics go to the College of Physiotherapists of Ontario website www.collegept.org, or call 1-800-583-5885.  Go to Canada’s occupational therapy resource website www.caot.ca for information on assistive devices and falls prevention, or call the Canadian Association of Occupational Therapists at 1-800-434-2268.  The Canadian Orthopaedic Foundation has a number of helpful

resources online as well as, a peer support program that connects patients having orthopaedic surgery with volunteers who have undergone similar surgery. For more information, go to their website at www.canorth.org and click on “Patient/Public Information”.

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A Guide for Patients Having Orthopaedic Surgery

Your Hospital Stay PLEASE LABEL YOUR PERSONAL ITEMS Due to limited space, please limit personal belongings to one small bag.

What To Bring – Packing for the Hospital

Ontario Health Card

Supplementary insurance information with insurance company policy/certificate group plan.

Current medications in their original containers. Exception: Do not bring narcotics and controlled substances to hospital. For example oxycodone, oxycocet (Percocet), lorazepam (Ativan), methylphenidate (Concerta).

If you use non-inhaled forms of medical marijuana at home and wish to continue use in hospital, you are required to bring your supply of marijuana as well as one of the following: o A prescription for medical marijuana use o The shipping label from a Health Canada-licensed producer o A registration certificate from Health Canada

CPAP / BIPAP machine (if you are currently using one), and distilled water if this is your preference.

Comfortable and loose-fitting clothing.

Supportive shoes with a non-slip sole such as running shoes.

Assistive devices that you may need and already have, such as crutches or cane(s).

For patients having shoulder surgery: an over-sized T-shirt or button up shirt.

Bring a snack with you for after surgery.

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If You Are Staying Overnight

Toiletries (toothbrush/toothpaste, tissues, soap/shampoo, feminine hygiene products, etc.).

Labeled eye glass case / denture cup / hearing aid(s) case.

Short nightgown/pajamas.

Slippers with a back and non-slip sole.

Earphones to listen to education programs on closed circuit TV.

Care of Belongings For Day Surgery Patients – a small locker will be provided to store your belongings. For patients staying overnight – your personal belongings will be taken to your assigned room by your family or a staff member. What To Leave At Home  All piercings and jewelry (including wedding rings) must be removed before your surgery. For safety reasons, if jewelry is not removed prior to surgery, we will need to cut it off.  Perfume or scented items  the hospital is a fragrance-free facility.  Valuables  Medications that are narcotics or controlled substances (bring all other medications to hospital).

Please be advised that the hospital is not responsible for money, valuables or other personal property including eyeglasses, dentures and hearing aids.

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A Guide for Patients Having Orthopaedic Surgery

Final Things to Remember Before Your Surgery….  Remove nail polish from your fingers and toes.  Remove all piercings and jewelry including wedding rings.  If you smoke, do not smoke on the day of surgery.  If you have difficulty communicating in English or use sign language, bring an interpreter to the hospital with you.  If you are going home the same day as your surgery, you must have a responsible adult drive you home and stay with you overnight. Public transit, such as the TTC, is not an acceptable way home after surgery. If taking a taxi, you must still be accompanied by a responsible adult. If you do not have an escort, your surgery will be cancelled.  You must not drive for 24 hours after surgery to allow the effects of the anesthesia to wear off. Surgical times are guidelines only. Delays are common as surgery can go longer than expected. In some cases, your surgery may be cancelled if there is someone needing surgery more urgently. If this happens to you, you will be contacted by your surgeon's office and rescheduled as soon as possible.

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If You Are Having Surgery at the Holland Centre Campus Please use the east elevators (located next to the cafeteria) and go to the 5th floor. For Day Surgery patients – please go directly to the Same Day Admissions Unit. For patients staying overnight – please go directly to Surgical Patient Registration, Room 554. A nurse will meet with you and get you ready for surgery. They will:  update your health history  review your medications  take your blood pressure, pulse and temperature  start an intravenous line in your arm Your surgeon will initial your operative site and you will meet your anesthesiologist. The length of your surgery varies depending on your surgical procedure. Following your surgery you will be taken to the Post Anesthesia Care Unit (PACU), where you will be monitored for about 1 hour. For Day Surgery patients – you will be taken back to the Same Day Admission Unit. For patients staying overnight – you will be taken to your assigned room. Family is welcome to wait in the Patient and Family Education Centre located on the 2nd Floor, Room 253. Page 15 Holland Bone and Joint Page Program 15


A Guide for Patients Having Orthopaedic Surgery

If You Are Having Surgery at the Bayview Campus On the day of your surgery, go to the Surgical Services Registration area, Room MG502. Please arrive on time. Do not have more than one person come with you.  Your name, birth date, and your Ontario Health Card will be checked.  You will be seated in the waiting room until your name is called.  You will be taken to the Same Day Surgery / Pre-operative Unit (MG601) where you will be prepared for surgery. This may take up to an hour. You will have an intravenous started, and your paper work will be completed. Your companion will be asked to wait in the waiting room at this time.  Once you have been prepared for surgery, you may stay with your companion until the Operating Room is ready for you. No food or drinks are allowed in this area.  If you are going home on the day of your surgery, or you are scheduled to stay overnight in the Surgical Short Stay Unit (MG503), your companion may wait in MG502.  If you will be staying longer after your surgery, your companion may wait in A148.  A volunteer is available and will give updates when patients are waking up from surgery. After surgery, you will first go to the Recovery Room. When you are ready, you will be moved to, the Surgical Short Stay Unit, or back to the same Day Surgery Unit for further recovery before discharge, no later than 7:30 pm. Please be aware that due to unforeseen bed shortages, patients may spend the night in the recovery room. Page 16 Holland Page 16Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery

Anesthesia For Surgery All surgery requires some form of anesthesia. This is done by “numbing” various parts of the body or creating a state of “deep sleep” with medications. This allows your surgery to proceed comfortably. Anesthesiologist Your anesthesiologist is a medical specialist responsible for your safety and comfort during your surgery. They also help you manage pain during surgery and while you are in the hospital. They monitor your vital signs and are prepared to manage any problem that may arise during your surgery. Our anesthesiologists work as a team. You may be assessed by a member of the anesthesia team and have another member give you your anesthetic on the day of your surgery. All the information from your Pre-admission Clinic visit will be in your hospital chart and will be reviewed by your anesthesiologist before your surgery. Before the Anesthetic It is important to have an empty stomach before your surgery. Under anesthesia or sedation, food and drink can find its way out of your stomach and into your lungs (aspiration), causing serious problems. Please follow the instructions on page 4 to help prevent this complication.

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General Anesthesia With general anesthesia, several medications are given through your veins (intravenously) so you are fully asleep and unconscious during surgery. A breathing tube is placed in your throat and you are connected to a breathing machine. Following your surgery, the breathing tube is removed when you are breathing on your own. You are then taken to the Post Anesthesia Care Unit (PACU) also known as the recovery room, where you will wake up. What are the Risks of General Anesthesia?  Mild sore throat that lasts 1 to 2 days.  Tooth or airway damage can occur from the breathing tube.  Nausea or vomiting, which can last for 1 or 2 days.  Confusion (also known as delirium), particularly in older persons.  Aspiration of stomach contents into your lungs.  Extremely Rare: Allergic reactions, awareness during surgery, nerve damage, death. How can I lower my risk? There are certain things that you can do to significantly decrease your risk of developing serious complications from anesthesia and surgery.  If you smoke, stop smoking. Smoking increases the risk of pneumonia and other breathing complications after surgery. The longer you stop smoking, the better.  If you are overweight, lose weight. The risk of complications is greater with obesity.  Take your medications as instructed – see page 4. Page 18 Holland Page 18Bone and Joint Program


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Regional Anesthesia Regional anesthesia is used to block the sensation and feeling to a specific part of your body. It includes spinal anesthesia and/or nerve blocks. Spinal Anesthesia With spinal anesthesia, local anesthetic is injected near the spinal cord and the nerves that connect to it. This “freezes” the nerves so that you have no feeling or movement below your waist. This numbness lasts 1 to 6 hours. Spinal anesthesia is suitable for surgeries in the lower half of the body, such as knee, ankle or foot surgery. Most people are given medication through the intravenous to help them relax and fall asleep. This is called “sedation”. You will not see the surgery take place as a big ‘curtain’ will separate you from the surgeon. You should not feel any pain – please inform your anesthesiologist if you feel any pain or discomfort. Your anesthesiologist can adjust your sedation to reduce the chance of you hearing anything during your surgery. Please discuss this if it is a concern. What are the Benefits of Spinal Anesthesia?  Lower risk of nausea and vomiting.  Faster recovery and feeling less groggy.  Better pain control for the first few hours after surgery.  Lower risk of breathing problems after surgery if you have chronic bronchitis, emphysema (COPD) or severe asthma.

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What are the Risks of Spinal Anesthesia?  Mild lower blood pressure in the operating room.  Inability to empty your bladder (urinary retention) particularly in older men with prostate problems. This will resolve in about 24 hours.  Extremely Rare: paralysis, nerve damage, death. Nerve Blocks Nerve blocks are another type of regional anesthesia. Local anesthesia or “freezing” medication is injected near the nerves that give sensation to your surgical site. This numbs your limb so that you have no feeling during your surgery. It also provides up to 24 hours of post-operative pain control. Most people don’t remember having the nerve block placed because medication is given to relax and sedate you before the nerve block is done. Your anesthesiologist will use special equipment such as an ultrasound or a nerve stimulator to locate the nerve(s). When the nerve block is being put in place, you may feel some twitching movements which are normal and show us we are in the right spot. Your anesthesiologist will then inject local anesthetic. You may notice a warm, tingling sensation. Your limb will become weak and feel heavy and numb. Nerve blocks can be used with general anesthesia or spinal anesthesia and may be extended for pain management after surgery. Benefits of Nerve Blocks:  Pain relief from the nerve block may last between 4 and 24 hours, reducing the amount of other strong pain medication needed.  Decreases side effects associated with other pain medication such as nausea and drowsiness. Page 20 Holland Page 20Bone and Joint Program


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Risks of Nerve Blocks:  Less than 1% of patients have a “pins and needles” sensation in the area that may last for 3 to 4 weeks; permanent nerve injury is extremely rare.  Very rarely, local anesthesia may be injected into the blood stream, causing ringing in the ears and a metallic taste in the mouth. If you experience these symptoms, please let your anesthesiologist know.  Nerve blocks for shoulder surgery can cause weakness of the large breathing muscle (diaphragm). This can cause difficulty breathing in people that have chronic lung problems.  It is important to be aware that you will have no feeling in part of your arm. Please take care to avoid hot surfaces that could burn you, such as the stove.

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Pain Management After Surgery Our goal is to make sure you are comfortable enough to get some rest and start moving as soon as possible. Good pain control allows you to exercise and progress with your activity, which is important for a successful recovery. When Do I Treat My Pain? A pain rating scale helps us communicate and understand the level of pain you are experiencing. It can also help you decide when to do something to relieve your pain. We use this scale to determine if your pain medication is effective. 0 1 No Pain

2 3 Mild

4

5 6 Moderate

7

8 Severe

9

10 Worst Pain

If your pain is preventing you from doing your exercises and being active, you should treat your pain. There are several methods of pain control available. Your anesthesiologist will discuss which methods are best for you. They include:  Pain pills  Nerve blocks  Patient-controlled analgesia (PCA) Oral Pain Medication You may be given many different types of pain pills on a regular basis after your surgery to help manage your pain. Each pill works differently in your body and reduces the Page 22 Holland Page 22Bone and Joint Program


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need for large amounts of strong opioid pain medication, such as morphine, hydromorphone, oxycodone which can cause unpleasant side effects. If the medication does not control your pain, please tell your nurse. Additional or different pain medication can be given. Pain medicine can cause side effects such as constipation or nausea. Severe pain can also cause these side effects, so it is important to treat your pain. If you are experiencing side effects, you may not want to move, eat, drink or do your regular activities which will slow down your recovery. Let you nurse know if you are having these problems. See pages 26 to 29 for “Potential Complications/Side Effects� and how to prevent them. Nerve Block In some situations, nerve blocks can be left in place to provide continued pain relief. This makes the area feel numb while the catheter is in place, and local anesthetic is being given. The catheter is usually removed after 2 days. We do send some patients home with the nerve catheter (ask your anesthesiologist if you are a good candidate). This is currently only available if your surgery was done at the Holland campus. If you are going home the same day of surgery AND have received a nerve block, there are some precautions you should take: 1.

DO NOT DRIVE while your limb is numb.

2.

For lower limb block: Use your walker, crutches, or wheelchair until the nerve block has worn off. You may be asked to use a knee splint. You can stop using the knee splint when normal movement, muscle strength and feeling returns to your leg or as otherwise instructed by your surgeon.

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3.

For upper limb block: Use your sling until normal movement, muscle strength and feeling returns to your arm.

4.

Keep your leg or arm elevated as much as possible for the first 24 hours after surgery to help reduce swelling.

5.

Consider taking your pain medication as soon as the numbness in your limb changes to a tingling sensation. This is a sign that the block is wearing off.

6.

Before you go to bed, consider taking your pain medication even if your nerve block has not worn off.

7.

The nerve block normally lasts for 12 to 20 hours.

8.

Remember‌it is important to protect your arm or leg from injury until normal movement, muscle strength and feeling return. Avoid heat (i.e. hot water) and avoid resting your limb on a hard surface. If you have a nerve block catheter (i.e. tube with bottle attached), use a fanny pack to hold the bottle while moving around at home.

Intravenous Patient Controlled Analgesia (IVPCA) With IVPCA, pain medication is given to you from a pump that connects directly to your intravenous line and provides fairly rapid pain relief. The medication is called an opioid, which is a strong pain killer. Using IVPCA allows you to be in control of your pain medication. A special pump will be set up to allow you to take a dose of pain medication when you need it by simply pushing a button. Page 24 Holland Page 24Bone and Joint Program


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The IVPCA is programmed to allow you to receive pain medication every 5 minutes. The need and the length on the IVPCA use varies between surgeries. Side effects such as nausea or itchiness can occur when taking opioids. Medication can be given to relieve these symptoms so let your nurse know if it is a problem. *** It is important that only you push the button of the IVPCA pump. Although your family and friends may think you are having pain, they MUST NOT push the button for you.

Remember‌Good pain control is important to allow you to exercise and recover successfully.

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Potential Complications / Side Effects and How to Help Prevent Them During any operation and anesthesia there is a small risk of developing complications. These complications can develop because of health problems, the anesthesia or the surgery itself. Complications include infection, damage to blood vessels and nerves, and blood loss. There is also the risk of developing a deep vein thrombosis, pulmonary embolism, heart attack, stroke or even death. Although the likelihood of such complications is low, your surgical team will make every effort to minimize the risk as much as possible. Your surgeon, anesthesiologist, nurse practitioner and/or medical internist will discuss these issues with you before surgery.  Infection is a possible complication after surgery. The risk of infection is reduced through careful surgical technique. Intravenous antibiotics before and after your surgery may also be used depending on your surgery. Refer to Chlorhexidine Shower Instructions before Surgery (Pages 9 to 10) and Incision Care Guidelines (pages 43 to 45) for ways to help prevent infection.  Respiratory Complications (Breathing Problems) such as pneumonia can occur after surgery. It is important to do deep-breathing and coughing exercises several times an hour when awake on the first few days after surgery. This helps provide oxygen to your lungs and keeps your airways clear. Sitting up, getting out of bed as soon as possible and being active also helps prevent breathing problems. Page 26 Holland Page 26Bone and Joint Program


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 Cardiovascular Complications (Heart Problems) can occur due to the stress of surgery. In patients with known heart disease, this can increase the risk for developing irregular heartbeats, chest pain or, very rarely, heart attack. These complications can also occur in patients with no known heart problems.  Deep Vein Thrombosis (DVT) are blood clots which can develop in the deep veins of your legs after surgery. This is often associated with lack of movement, so early activity is encouraged. It is important to move your ankles up and down several times an hour after surgery. This is called “ankle pumping”. You are also encouraged to tighten and release the muscles in your legs. These exercises promote good circulation. Anticoagulants (blood thinners) may also be used to prevent blood clots depending on your surgery and health history.  Pulmonary Embolism can occur when blood clots from the deep veins in your legs or pelvis break off and travel up to your lung and get stuck there. If the clot is large enough, blood circulation to your lungs may be cut off. Anticoagulants (blood thinners) may be given after surgery to prevent clots depending on your surgery and health history. Ankle pumping and early activity will also help prevent this complication.  Urinary Problems, such as difficulty passing urine, can happen following any type of surgery. Let your nurse know if you are having problems passing urine. Sometimes a catheter (tube) is inserted into the bladder to drain the urine. The catheter can be left in place for a few days or removed immediately after the bladder has been emptied. Please note that after spinal anesthesia you may pass some urine without being aware of it. This is normal and can happen during the first few hours until the spinal anesthesia wears off.

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 Nausea is common after surgery. Medication may be given to settle your stomach, so let your nurse know if you are experiencing this. In order to minimize nausea, it is important to take your pain medications with food to protect your stomach.  Constipation is common and a potentially serious complication that can occur because of opioid pain medication, reduced activity and not enough fluids. Constipation can lead to and aggravate other medical conditions. Stool softeners and mobility agents are given daily to help prevent constipation. If they are not working, talk to your nurse. Make sure you have had a bowel movement the day before your surgery to help prevent problems after surgery. A high fibre diet, lots of fluids and being active are important to help promote regular bowel movements.  Allergic reactions can happen after surgery and vary from a mild rash to an intense reaction that can interfere with your breathing. Please let us know if you have any allergies. They will be documented in your health record. We will also provide you with an allergy alert bracelet to be worn while you are here.  Skin Irritation can develop from the pressure of lying in bed. It is important to change your position often while in bed and to get up as much as possible after surgery. The nurses and therapists will help you.

Remember…..Getting out of bed and walking as soon as you are able will help prevent many of these complications and allow for a smooth recovery. Make sure you ask for assistance as needed. Page 28 Holland Page 28Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery A Guide for Patients Having Orthopaedic Surgery

Hospital Information Hospital Information Office of the Patient Experience Office of the Patient Experience There may be times when you or your family members need help finding There may be times when you or your family members need help finding information or voicing a concern. Please discuss your concerns with your information or voicing a concern. Please discuss your concerns with your nurse or team leader. If you continue to have concerns, you may speak nurse or team leader. If you continue to have concerns, you may speak with the patient care manager. If you continue to have concerns, you can with the patient care manager. If you continue to have concerns, you can contact the Office of the Patient Experience. They can be reached Monday contact the Office of the Patient Experience. They can be reached Monday to Friday from 9 a.m. to 4:30 p.m. at 416-480-4940 (Bayview location) or to Friday from 9 a.m. to 4:30 p.m. at 416-480-4940 (Bayview location) or (416) 967-8566 (Holland Centre location). (416) 967-8566 (Holland Centre location). Person-Centred Care Person-Centred Care Person-Centred Care brings what you know, care about, prefer and need Person-Centred Care brings what you know, care about, prefer and need into the centre of your health care. You are the most important partner in into the centre of your health care. You are the most important partner in your care. We are here to develop a healing relationship with you that is your care. We are here to develop a healing relationship with you that is built on trust, respect and dignity. built on trust, respect and dignity. We welcome your questions and want you to be active in your health care. We welcome your questions and want you to be active in your health care. We invite you and your family to be our partners in care. We invite you and your family to be our partners in care. As a patient at Sunnybrook, we see you as a person first. Your voice is As a patient at Sunnybrook, we see you as a person first. Your voice is heard; we listen to you. heard; we listen to you. How Can I Take Part in My Care? How Can I Take Part in My Care?  Share information by telling us what is most important to you. Tell us  Share information by telling us what is most important to you. Tell us about your goals, concerns, worries, preferences and care needs. about your goals, concerns, worries, preferences and care needs. Tell us about your family and any others who care about your health. Tell us about your family and any others who care about your health.  Ask questions. Ask us to explain your diagnosis, treatments and care  Ask questions. Ask us to explain your diagnosis, treatments and care plan. Ask us about anything you don’t understand. Feel free to write plan. Ask us about anything you don’t understand. Feel free to write questions or concerns on your Communication Board in your room. questions or concerns on your Communication Board in your room.

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 Work with your health care team by talking about who is caring for you and what will happen after you leave the hospital. Talk with us about how we can support your emotional and physical needs. Take notes to remember details about what is discussed. MyChart MyChart is an online website where patients can create and manage their personal health information based on clinical and personal information. MyChart is accessible from anywhere at any time through the internet. You can learn more at www.mychart.ca. Visiting Hours for Patients Staying Overnight Please let your family and friends know they are not to visit you if they have any of these symptoms: cough, runny or stuffy nose, fever, sore throat, diarrhea, and/or vomiting. A maximum of 2 visitors at a time may come to your room between 8 a.m. and 10 p.m. Children are welcome but must be supervised by an adult at all times. Timely nursing care and therapy sessions are important for your recovery so visitors may be asked to step out of your room at these times. In certain areas, visiting is restricted, such as the Post Anesthesia Care Unit (PACU). Additional Costs During your stay, there may be additional costs that are not covered by OHIP or other health insurance. If you would like a phone while in hospital, there is a charge of $4.00 per day. Patients may now pay their hospital invoices online using MyPayments at https://sunnybrook.ca/payment/. A receipt will be provided for Page 30 Holland Page 30Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery

reimbursement from your insurance company where applicable. If you would like to pay your bill in person, please visit the Cashier/Business Office at: Holland Centre: Room 249 Bayview Campus: Room D117 The cost of canes, crutches, splints and orthotic devices (e.g. braces, special footwear and supports) is not covered under OHIP. You will be responsible for payment for any devices that you use and/or take home. Parking and Transportation Holland Centre: While the Holland Centre does not have parking facilities, it is close to bus and subway services at the Wellesley Station. Public parking is available west of the Holland Centre on Wellesley Street and just south of Wellesley on the west side of Church Street. Direct telephone lines to taxi services are available at no charge in the Holland Centre Lobby. Bayview Campus: Parking is located at the hospital for a fee. Parking Services is located in C-wing, Ground Floor, Room CG01. If you will be in hospital for 5 or more days, a weekly parking permit can be arranged. Smoke Free Environment keep At Sunnybrook Health Sciences Centre, the health and safety of our staff, volunteers, students, visitors and patient population are very important to us. As a health care facility, we strive to assist in the prevention of medical diseases such as lung cancer and chronic pulmonary diseases, asthma and other respiratory conditions that can be caused by smoking and the effects of second-hand smoke. As a result, smoking is prohibited in all areas of the hospital, which includes, but is not limited to, the inside of the building in its entirety, and exterior grounds. Page 31 Holland Bone and Joint Page Program 31


A Guide for Patients Having Orthopaedic Surgery

Fragrance-Free Policy Sunnybrook Health Sciences Centre supports a fragrance-free environment. We ask that patients and visitors refrain from wearing scented personal products. Cellular Phones & Wireless Access Patients, staff and visitors are asked not to use cellular phones or wireless devices in patient areas as they may interfere with some patient care equipment. They can be used in areas of the hospital where direct patient care is not being provided, such as the lobby or family waiting areas. Wireless Access is available and free for patients and visitors. Simply connect to the “SW_guest” network and use the password “SunnybrookGuest”. Teaching Hospital Sunnybrook Health Sciences Centre has a strong relationship with the University of Toronto and other institutions. For patients, this means that trainees/students will often be involved in your care. All trainees/students work under the expert supervision of members of our health care team. If you have any questions or concerns about a trainee/student’s role in your care, please notify a member of your health care team. Protecting Your Personal Health Information Sunnybrook Health Sciences Centre is taking a leadership position in the promotion of personal information privacy rights and obligations on behalf of all members of our staff and patient communities. Personal information is anything that can identify you as an individual such as your name, your social insurance number, or information that is specific to you such as a test result with your name on it. Keeping personal Page 32 Holland Page 32Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery

information private means you have the right to know how and where personal information is being used within the hospital. It also means Sunnybrook Health Sciences Centre has an obligation to ensure that the information is kept confidential. Sunnybrook is taking active steps to ensure that the hospital follows best practices in respecting staff and patient personal information privacy rights. To ensure we comply with information privacy principles, Sunnybrook Health Sciences Centre has appointed a Chief Privacy Officer to oversee the activities involves with establishing comprehensive privacy management policies and procedures. For more information, or to make a comment or complaint regarding personal health information privacy, you may email our Chief Privacy Officer at privacy@sunnybrook.ca, or contact the Privacy Office at (416) 480-6100, ext. 1236. The Hospital Foundation The mandate of our hospital Foundation is to raise funds to support the essential growth and development of Sunnybrook Health Sciences Centre in the areas of facility development, equipment, education and research. Your support is critical to the long-term delivery of quality healthcare for the citizens of Toronto, the GTA and Ontario. If you would like to make a donation, you may contact the Sunnybrook Foundation at (416) 480-4483 for Bayview Campus and (416) 967-8628 for Holland Centre Campus or visit www.sunnybrookfoundation.ca

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Preparing For Discharge Before You Go Home Checklist & Goals Before you go home it is important that you: 

Are able to walk safely with or without walking aids.

Have the necessary equipment to allow you to manage safely at home (e.g. crutches, bath seat).

Are able to get in and out of bed on your own or have assistance arranged.

Able to manage stairs if needed.

Know what exercises to continue at home.

Know what activities to avoid.

Have your prescriptions.

Have your own medications returned, if applicable.

Have your appointment card for follow-up visit.

If you are flying home, have your medical clearance note from your surgeon.

Your Discharge Home Holland Centre: When you are ready to leave, your escort may park in the driveway in front of the hospital. Your escort should tell the security guard at the front desk that he/she is here to take you home. Parking is only allowed for a few minutes in this area.  If you are having Day Surgery, the switchboard operator will inform the Day Surgery staff of your escort’s arrival. One of the staff will take you to the front of the hospital and assist you into your vehicle. Page 34 Holland Page 34Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery

 If you have stayed overnight, your escort can proceed to your room to pick you up. Please ensure you have arranged for your escort to pick you up. Please ask your nurse what time you should arrange to be picked up. Bayview Campus: When you are ready to leave, a volunteer will take you to your escort.  If you are having Day Surgery, your escort can bring their car to the M-Ground Patient Pick Up/Drop Off Door.  If you have stayed overnight, your escort can bring their car to the door closest to where you are located. Going Home on the Same Day of Surgery Arrange for a responsible adult to take you home and to stay with you the first night after surgery. Going home on the subway is not recommended and certainly not without someone accompanying you. Your judgment may be affected by the medications you were given in hospital. For the next 24 hours do not drive a car, operate machinery or power tools, drink alcohol or sign legal documents. It is also important that you don’t take sedatives or pain medications other than those prescribed by your surgeon. After you are discharged home, it is important to rest for the remainder of the day. Resuming Regular Medications Resume your regular medications as prescribed by your family physician once you are able to eat and drink.

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Resumption of Driving Ask your surgeon when it is safe to drive. Check with your insurance company about any concerns you may have regarding your coverage. If you have to wear a sling after upper extremity surgery, you should not drive until the sling comes off. Day Surgery Patients are not permitted to drive for 24 hours after surgery. This time frame can be longer if indicated by the surgeon. Exercises and Activity It is important to stay active after surgery to keep yourself strong and moving well. Balance your activity and exercise carefully with periods of rest. Avoid becoming over-tired or over-working the site of your operation. Gradually increase your activity, e.g. walking, household chores, etc. Follow the instructions you were given by your therapists. Activities of Daily Living Please review the handouts specific to your surgery for more information about how to manage your everyday activities. Depending on your surgery, you may see a physiotherapist and an occupational therapist during your stay. They will review walking with or without walking aids, managing stairs safely, and managing activities of daily living such as bathing and dressing before you are discharged home. Returning to Work Ask your surgeon when you may return to work. Be sure your daily work schedule allows time for your exercises. Talk to a member of your health care team if you have specific questions regarding returning to work after your surgery. Page 36 Holland Page 36Bone and Joint Program


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Top 10 Questions About Pain Medications After Surgery

You will need pain medication to help with the pain from surgery. You may be prescribed a combination of medications to help in your recovery. 1. How often should I take opioid pain medication? Take pain medication if your pain is stopping you from doing the exercises you were taught to do or if you aren’t able to do your everyday activities. Generally, your body will tell you when you need medication for pain; you should take your pain medication at least 30 minutes before activities that may increase your pain. If pain is interfering with your sleep, you may benefit from taking pain medication before sleeping. Caution: Do not take pain medication only for the sedation (sleepy) or mood lifting effects. This may increase your risk for addiction. Sleep problems must be treated differently. See Question 7, 8. 2. How long should I expect to need opioids? Every person is different in their need for pain medication. Take opioids at the lowest dose that relieves your pain. Expect to need it 2-3 days after minor surgery, but up to 2 weeks after major surgery. Opioids work well for severe pain after surgery but are not effective for long-term pain (lasting more than 3 months). Only take opioids for the pain resulting from your surgery. It is not safe and may not be useful to use it for other kinds of pain. For mild to moderate pain, a combination of pain medications (such as Tylenol® and Advil®) may be enough to manage your pain (see question 4). It is important that you do not suddenly stop opioids if you have been taking them regularly; see question 9 to learn about how to wean off your opioid medication. While you are taking opioid medication you should not consume alcohol or drive a car. Page 37 Holland Bone and Joint Page Program 37


A Guide for Patients Having Orthopaedic Surgery A for Patients Orthopaedic Surgery 3.Guide What if I amHaving running out of pain

medication?

3. What if still I amhaving running out do of pain medication? If you are pain, not wait until your pain medication is almost

done; callstill forhaving a refillpain, 3-4 days it isyour finished. If you are do notbefore wait until pain medication is almost done; call for a refill 3-4 days before it is finished. 4. Can I take more than one pain medication at the same time?

4. Can I take for more than oneafter painsurgery medication at the time? Medications pain relief belong to 3same groups – opioids,

Medications for pain relief after surgery belong to work 3 groups – opioids, acetaminophen, and anti-inflammatory. They in different ways and ® acetaminophen, and anti-inflammatory. They work in different ways may work better when taken together. For example, by taking and Tylenol ® ® when taken together. For example, by taking Tylenol may better you may need less opioid (which has the most side effects). and/work or Advil ® and/ or Advil you may need less opioid (which has the most side effects). Always follow the directions on the label of the bottle. Always follow the directions on the label of the bottle.

Pain Medication

Pain Medication

Opioids Opioids

®

ShortActing* Acting* Short

•• •• ••

•• •

Acetaminophen Anti-inflammatory Acetaminophen Anti-inflammatory

® • Celecoxib Opioid • Tylenol Opioid • Tylenol • Celecoxib ® ® (Celebrex ) Combination Hydromorphone Combination Hydromorphone Regular strength(Celebrex ) Regular strength ® ® (Dilaudid (Dilaudid®)®) = 325mg/tab = 325mg/tab • Naproxen • •Percocet Percocet • Naproxen ® (Oxycodone andand ® Oxycodone (Oxycodone Oxycodone (Aleve(Aleve , Extra strength , Extra strength ® Acetaminophen) ® Acetaminophen) Vimovo ) Codeine Vimovo ) = 500mg/tab Codeine = 500mg/tab ® ® • •Tylenol 1, 2, 3 Tylenol 1, 2, 3 Morphine IRIR Morphine • Ibuprofen (Acetaminophen ® • Ibuprofen (Acetaminophen (Statex (Statex®) ) (Advil®) and Codeine) (Advil®) and Codeine) Tramadol IR ® Tramadol IR • Tramacet ® (Ultram®®) • Meloxicam •(Acetaminophen Tramacet (Ultram ) ® • Meloxicam (Mobicox ) (Acetaminophen Long Acting** ® and Tramadol ) (Mobicox Long Acting** and Tramadol IR) Hydromorph • Diclofenac ® IR) Hydromorph ® Contin • Diclofenac (Voltaren ,

® Contin • OxyNeo® ® ® OxyNeoContin •• Codeine

Codeine ER Contin •• Tramadol XL®ER ) • (Zytram Tramadol

®

® , (Voltaren Arthotec )

Arthotec®)

®

®

• Morphine SR ) (Zytram XL (MS Contin®)

• Morphine SR (MS Contin )

® * Short acting (IR) means the medication starts working quickly but doesn’t last as long.

** Long acting (ER/CR/SR) means the medication lasts longer but takes more time to start * Short acting (IR) means the medication starts working quickly but doesn’t last as long. working.

** Long acting (ER/CR/SR) means the medication lasts longer but takes more time to start working. Page 38

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A Guide for Patients Having Orthopaedic Surgery

Opioid: If you were prescribed an opioid combination medication (e.g. Percocet®, Tramacet®, Tylenol® #3), these already contain acetaminophen (Tylenol®) therefore do not take more Tylenol®. Unless directed by a doctor, mixing pain medications from the same group e.g. Hydromorphone® and Codeine® can be dangerous and may increase side effects. Acetaminophen: Unless you have severe liver damage, take 1-2 pills of Extra Strength Tylenol® (Acetaminophen) every 6 hours for 7 days after surgery (then take when needed). Do not take more than 4g (8 pills of Extra Strength Tylenol®) in a 24 hour period. Anti-Inflammatory: An anti-inflammatory helps with swelling (which may reduce the pressure) in the area of your surgery. This group of medications is safe for most people when used for up to 2 weeks. Ask your surgeon, family doctor or pharmacist if you are unsure if it is safe for you. 5. Can I take pain medication with my sleeping pills? You should NOT take any opioids with sleeping pills (such as Ativan®) or medication to treat anxiety. This combination can make you too sleepy. It is generally safe to take Tylenol® or an anti-inflammatory with sleeping pills or medication to treat anxiety. 6. What should I do if my pain medication isn’t working? Check the directions on the label of the pain medication bottle and review this pamphlet to make sure you are taking the medication properly. If you are not sure ask your pharmacist. If you continue to experience problems with pain, contact your family doctor or surgeon depending on what advice you received.

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A Guide for Patients Having Orthopaedic Surgery

7. What are side effects of opioid pain medications? How do I manage them? Constipation (hard bowel movements):  Drink more liquids, you may also find prune juice helpful  Eat foods that are high in fiber (e.g. fruits, nuts, beans and whole grain bread)  Slowly increase your activity  If your constipation lasts more than 2 days, you may need a laxative or suppository to help your bowels to move. Talk to your pharmacist or family doctor about what medication would be best for you. Senokot® or Lax-A-Day® are laxatives the hospital uses; you can buy these over the counter at a drug store. Nausea and/or Vomiting (Stomach Upset): 1. Take your pain medication with food. 2. Ask your pharmacist or family doctor to recommend something to settle your stomach. 3. If your pain level is okay try taking a smaller amount of pain medication, for example one pill instead of two. 4. If this does not help, please contact your doctor. The pain medication may have to be changed. Sleepiness, confusion or dizziness: Stop taking your opioid pain medication and call your doctor if you are confused, very dizzy or too sleepy to do your daily activities (e.g. falling asleep while eating). If your pain medication makes you a little sleepy or dizzy, try taking a smaller dose, for example, one pill instead of two. If less medication does not help, please call your doctor. The pain medication may need to be changed. Page 40 Holland Page 40Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery A Guide for Patients Having Orthopaedic Surgery

8. Will I become addicted to the opioid pain medication? 8. Will become addicted to the opioid The riskI of addiction is low. To reduce yourpain risk,medication? only use the opioids as long as you need andisatlow. theTo lowest dose that relieves yourthe pain (see as The risk of addiction reduce your risk, only use opioids question 1and 2). and Do not uselowest opioids to ‘get to help long as you need at the dose thathigh’, relieves yourwith painanxious (see feelings or poor sleep. It is important to wean yourself off (slowly reduce) question 1and 2). Do not use opioids to ‘get high’, to help with anxious the medication longer needed (see question 9). feelings or poorwhen sleep.it Itisisnoimportant to wean yourself off (slowly reduce) the medication when it is no longer needed (see question 9). Please tell your surgeon if you have a history of alcohol or drug abuse. Please tell your surgeon if you have a history of alcohol or drug abuse. 9. I think I am ready to stop taking opioids, how should I do this? 9. I think I am ready to to stop taking opioids, how should I do this? Wean off opioids slowly avoid withdrawal symptoms (sweating, fever, shaking, diarrhea, more pain, anxiety, feeling Wean offnausea opioids and/or slowly vomiting, to avoid withdrawal symptoms (sweating, fever, tense, worried or and/or irritablevomiting, etc.). diarrhea, more pain, anxiety, feeling shaking, nausea tense, worried or irritable etc.).

Withdrawal symptoms are not a sign that you are addicted. If you experience of these symptoms you are are addicted. weaning off Withdrawal any symptoms are not a signwhen that you If your you medication, you of may be reducing amount are taking quickly. experience any these symptomsthe when you you are weaning offtoo your medication, you may be reducing the amount you are taking too quickly. When you are ready to start weaning off opioids, follow these steps: When arefor ready to start weaning offtaking opioids, follow steps: Step 1you - Wait a longer time between pills. Forthese example, if you have been taking every 4 hours: Step 1 - Wait for apills longer time between taking pills. For example, if you taking pills5every 4 hours: ‐have Takebeen the pills every to 6 hours for 1 or 2 days

‐ Take pills 5 to 67hours for 1 or Then,the take theevery pills every to 8 hours for21days or 2 days ‐ Then, pills less everymedication 7 to 8 hours for time: 1 or 2 days Step 2 -take Startthe taking each Step 2 -are Start taking lesseach medication each time:1 pill each time for 1 to 2 ‐ If you taking 2 pills time, start taking ‐ days. If you are taking 2 pills each time, start taking 1 pill each time for 1 to 2

days. ‐ If you are taking 1 pill each time, cut the pill in half and take only half a pill for 1 to1 2pill days. ‐ each If youtime are taking each time, cut the pill in half and take only half a pill each time for 1 to from: 2 days. (Adapted Weaning off your pain medicine by TWH)

(Adapted from: Weaning your painare medicine TWH) The above instructions do not off apply if you taking by long acting pain ® ® Hydromorph Contin visit your medication such as OxyNeo The above instructions do not, apply if you are taking. Please long acting pain family doctor to discuss a plan to wean off your pain medication. ® ® medication such as OxyNeo , Hydromorph Contin . Please visit your

family doctor to discuss a plan to wean off your pain medication. Page 41 Page 41

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A Guide for Patients Having Orthopaedic Surgery

10. Can I use creams to help with my pain from surgery (e.g. Voltaren®, Arnica®, Tiger Balm®)? To avoid infection, do not put anything on your incision until it is well healed and there are no longer any scabs. It is okay to use these creams as long as you avoid putting them near or on your incision. Along with your pain medication there are other ways you can reduce your pain:  Make a daily plan to exercise and be active but include rest periods between these activities. Increase your activity slowly so that you don’t increase your pain.  Put ice where you have pain. Use ice for up to 10 minutes every hour as needed.  If you have swelling in your arms or legs after surgery, when resting if possible try to elevate the swollen limb above your heart.

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Incision Care The nurse will check off the instructions that are appropriate for your incision care. Refer to page 46 if you have any concerns about your incision Do not get dressings or plaster splints wet. Showers are permitted but dressings/splints must be covered with plastic until dressing is removed and wound is dry 

Remove the dressing on: ___________________________ • Inspect your incision daily once dressing is removed. • If your incision is dry, a dressing or band aid are no longer needed and the incision can be left open to the air. • If your incision is leaking fluid, continue applying a dressing or band aid and change it every day until the incision is dry.

Do not remove your dressing or plaster splint • Keep it clean and dry. • If dressing is soiled with blood, cover it with another dressing. Dressing supplies can be purchased from your local pharmacy (gauze and tape). • Your dressing will be removed at your follow up appointment.

Steri-strips (white tape over incision): • Leave them alone – they will fall off on their own. • After 14 days, your incision should be healed and you can gently remove the remaining steri-strips.

For Aquacel surgical dressing • The dressing is waterproof, gentle on the skin and flexes with the movements you make. • The dressing should stay in place for 7 days. • You can wear this dressing in the shower. • Change this dressing ONLY if it starts to leak fluid or if it lifts away from your skin before the 7 days are up. • You can purchase dressing supplies at your local pharmacy. Page 43 Holland Bone and Joint Page Program 43


A Guide for Patients Having Orthopaedic Surgery

Removing your Aquacel surgical dressing: • Remove your dressing 7 days after it was applied. Your nurse will have written the removal date on the dressing as a reminder to you. Gently lift the corner of the dressing and peel away from your skin. • Look at your incision to make sure it is closed and that there is no leaking present. • If your incision is dry, cleanse it with some mild soap and water and leave it open to the air. No other dressing is needed. • If you have steri-strips, leave them alone – they will fall off on their own. After 14 days, your incision should be healed and you can gently remove the remaining steri-strips. • If your incision is leaking, keep it covered with a dressing. For showering, cover the dressing with a plastic bag to keep it dry. Change the dressing after showering as needed.

Additional Instructions: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

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Removal of Sutures The nurse will indicate instructions to be followed. 

Removal of Sutures: Date: ________________________

Removal of Staples: Date: ________________________

Dissolvable sutures – these do not need to be removed.

No sutures

Don’t swim or have a bath until your sutures or staples have been removed and your incision is completely healed to prevent infection. Follow-up Appointment Appointment Date and Time: __________________________________ Location: 

Surgeon’s Office

Holland Centre Outpatient Clinic (416) 967-8617

Sunnybrook Fracture Clinic (416) 480-4206

WSIB Specialty Programs (416) 967-8699

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Discharge Instructions SYMPTOMS REQUIRING IMMEDIATE ATTENTION ***Visit your nearest Emergency Department if you have any of the following:  New or worse shortness of breath or difficulty breathing  New or worse pain, tightness or pressure in your chest  A sudden, severe increase in pain at your surgery site  A significant increase in pain, swelling or redness in your calf/calves  Uncontrolled bleeding  Difficulty emptying your bladder and feeling of discomfort ***Call your surgeon or family doctor immediately if you have any of the following:  Increased redness, swelling or sudden increase in bruising around the incision site  Drainage from the surgical site for more than 4 days after discharge from the hospital  A foul odour or yellow or green drainage at the incision site  Excessive bleeding  Signs or symptoms of other infections (i.e., fever, chills, burning on urination or a foul smelling urine, etc.)  A persistent increase in your temperature (over 38°C)

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A Guide for Patients Having Orthopaedic Surgery A Guide for Patients Having Orthopaedic Surgery A Guide for Patients Having Orthopaedic Surgery

For Questions/Concerns After Discharge ForQuestions/Concerns Questions/Concerns After Discharge For After Discharge  Monday to Friday 8 a.m. to 4 p.m.: Contact your surgeon’s office. MondaytotoFriday Friday8 8a.m. a.m. 4 p.m.: Contact your surgeon’s office.  Monday toto 4 p.m.: Contact your surgeon’s office.  Dr. Terry Axelrod

(416) 480-6769

 Dr. Paul Marks

(416) 480-6838

(416) 967-8734

 Dr. John Murnaghan

(416) 530-0400

 Dr. Diane Nam

(416) 480-5641

(416) 480-6775

 Dr. John O’Sullivan

(705) 719-3075

  Dr. Dr.Terry TerryAxelrod Axelrod

(416) 480-6769 Dr. Dr. PaulPaul Marks (416) 480-6769   Marks

  Dr. Dr.Hugh HughCameron Cameron

(416) 967-8734 Dr. Dr. John Murnaghan 967-8778 (416) 967-8734   John Murnaghan (416)(416) 967-8778

  Dr. Dr.Amr AmrElMaraghy ElMaraghy

(416) 530-0400   Dr. Diane Nam (416) 480-5641 (416) (416) 530-0400 480-6774  Dr. Dr. Diane MarkkuNam Nousiainen (416) (416) 480-5641 967-8639 (416) 480-6774  Dr. Markku Nousiainen (416) 967-8639 (416) 480-6774  Dr. Markku Nousiainen (416) 967-8639

 Dr. Hugh Cameron  Dr. Amr ElMaraghy  Dr. Joel Finkelstein

  Dr. Dr.Joel JoelFinkelstein Finkelstein

 Dr. Michael Ford

  Dr. Dr.Michael MichaelFord Ford

 Dr. Steve Gallay

  Dr. Dr.Steve SteveGallay Gallay

(416)(416) 480-6838 480-6838

(416) 967-8778

(416) 480-6775   Dr. John O’Sullivan (705)(705) 719-3075 (416) O’Sullivan 719-3075 (905) 480-6775 426-3098  Dr. Dr. John Beeshma Ravi (416) 967-8730 (905) 426-3098 Dr. Dr. Beeshma RaviRavi (416)(416) 967-8730 (905) 426-3098   Beeshma 967-8730

 Dr. Christopher Geddes (519) 603-0605  Christopher Geddes (416) (519) 967-8730 603-0605  Dr. Dr. Jeffrey Gollish  Dr. Jeffrey Gollish (416) 967-8730  (416)  Dr. Dr. Jeffrey JeremyGollish Hall (416) 967-8730 864-6006  Dr. Jeremy Hall (416) 864-6006  Dr. Jeremy Hall (416) 864-6006  Dr. Dr.Patrick PatrickHenry Henry (416) 967-8741  (416) 967-8741  Dr. Patrick Henry (416) 967-8741  Dr. Dr.Richard RichardJenkinson Jenkinson (416) (416) 480-6160  480-6160  Dr. Richard Jenkinson (416) 480-6160  Dr. Dr.Hans HansKreder Kreder (416) 480-6816  (416) 480-6816  Dr. Hans Kreder (416) 480-6816  Dr. Dr.Jeremie Jeremie Larouche (416) (416) 480-6775  Larouche 480-6775  Dr. Jeremie Larouche (416) 480-6775  Dr. Dr.Joel JoelLobo Lobo (905) 426-5460  (905) 426-5460  Dr. Joel Lobo (905) 426-5460  Dr. Christopher Geddes (519) 603-0605

 Dr. Robin Richards (416) 480-5051 (416) 480-5051  Richards (416) 480-6813 480-5051  Dr. Dr. Robin David Stephen (416) Dr. David Stephen (416) 480-6813  David Stephen 480-6813  Dr. Dr. Sebastian Tomescu (416) (416) 928-3279 Dr. Sebastian Tomescu (416) 928-3279  Dr. Sebastian Tomescu (416) 928-3279  Veronica Wadey 967-8615 Dr. Dr. Veronica Wadey (416)(416) 967-8615  Dr. Daniel Veronica Wadey (416) 864-6002 967-8615  Whelan Dr. Dr. Daniel Whelan (416)(416) 864-6002  Dr. Daniel Whelan 864-6002  Stewart Wright (416)(416) (416) 967-7889 Dr. Dr. Stewart Wright 967-7889  Dr. Stewart Wright (416) 967-7889  David Wasserstein 480-5798 Dr. Dr. David Wasserstein (416)(416) 480-5798  Dr. David Wasserstein (416) (416) 480-6815 480-5798  Albert Dr. Dr. Albert YeeYee (416) 480-6815  Dr. Albert Yee (416) 480-6815

 Dr. Robin Richards       

 After toto Friday, weekends andand holidays: Afterhours, hours,Monday Monday Friday, weekends holidays:

 After hours, Monday to Friday, weekends and holidays: Holland Hospital Coordinator at (416) 967-8551. If If HollandCentre: Centre:Call Callthe the Hospital Coordinator at (416) 967-8551.

Holland Centre:mail Callmessage, the Hospital Coordinator (416) 967-8551. If you you cancan expect toatreceive a call backback youleave leaveaavoice voice mail message, you expect to receive a call you leave a voice mailcall. message, you can expect to receive a call back within within24 24hours hoursofofyour your call.

within 24 hours of your call. Bayview Campus: Contact your surgeon’s office. If you leave a voice Bayview Campus: Contact your surgeon’s office. If you leave a voice Bayview Campus: Contact surgeon’s If you leave a voice mail message, you can expectyour to receive a calloffice. back within1 business mail message, you can expect to receive a call back within1 business day. urgent and you cannot reach your surgeon, please returnbusiness to the mail Ifmessage, you can expect to receive a call back within1 day. If urgent and you cannot reach your surgeon, please return to the Sunnybrook Hospital Emergency department or your closest day. If urgent and you cannot reach your surgeon, please return to the Sunnybrook Hospital Emergency department or your closest Emergency department for further attention. Sunnybrook Hospital Emergency department or your closest Emergency department for further attention. Emergency department for further attention.

Page 47

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A Guide for Patients Having Orthopaedic Surgery

Your Notes/Questions

Page 48 Holland Page 48Bone and Joint Program


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Page 51 Holland Bone and Joint Program


A Guide for Patients Having Orthopaedic Surgery

From Hospital To Hospitality

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Copyright © 2008 – 2019 Sunnybrook Health Sciences Centre All rights reserved by Sunnybrook Health Sciences Centre, operating as the Holland Orthopaedic & Arthritic Centre. No part of this publication may be reproduced or transmitted by any means, including photocopying and recording, or stored in a retrieval system of any nature without the written permission of Sunnybrook Health Sciences Centre: 43 Wellesley Street East, Toronto, Ontario M4Y 1H1 (416) 967-8500. Updated: January 2019

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Holland Bone and Joint Program - A Guide for Patients Having Orthopaedic Surgery  

Sunnybrook Holland Bone and Joint Program - A Guide for Patients Having Orthopaedic Surgery

Holland Bone and Joint Program - A Guide for Patients Having Orthopaedic Surgery  

Sunnybrook Holland Bone and Joint Program - A Guide for Patients Having Orthopaedic Surgery