PREPARING FOR SURGERY
The information provided in this packet was designed to help prepare you for your upcoming surgery.
Please carefully review the material, if you have any questions; please contact our office for clarification.
Questions for patients undergoing surgery in Charlottesville should be directed to Victor Somers (RN) at
434-977-8040 & Culpeper to Jamie Compton at 540-825-1350. Scheduling Surgery
Scheduling of your surgery is dependent upon several factors which include your schedule, the surgeon’s
schedule, and operating room availability. Our office will make every attempt to schedule your surgery on
your requested date. Unfortunately, we cannot guarantee dates and/or times for surgery. If your surgery
is considered urgent it will be scheduled accordingly.
Once your surgery has been scheduled, our Surgical Coordinator will contact you to arrange a pre-
operative visit at our office. At this visit, all necessary paperwork will be completed in addition to review of
your post-operative prescriptions, obtain any necessary medical equipment and answer any questions
about your surgery.
Your surgery will be performed at one of the following facilities listed below: Martha Jefferson Hospital
Monticello Community Surgery Center
Culpeper Regional Health System
Culpeper Surgery Center
In preparation for your surgery a pre-operative history and physical by your primary care physician will be
arranged. Any necessary blood tests, chest x-ray and/or EKG will be performed. These tests are specific
to your health condition. In certain medical conditions special diagnostic testing may be required,
especially if you have a history of heart disease, diabetes or poor circulation to your feet. Our office will
assist you in making this appointment. These tests are necessary to assure your safety and success of
your surgery. This examination needs to be completed within a thirty day (30) period prior to your surgery. Please note that your pre-op visit at our office is completed prior to your pre-op history and
physical visit at your primary care physician’s office. Please remember to take the paperwork that
you received at our office to your primary care physician to complete for your surgery.
Our staff will complete the surgery pre-certification with your health insurance company. In rare cases,
your surgery may be delayed due to insurance issues. You will be notified immediately if this occurs. Our
staff will work diligently to provide the necessary information to your insurance company in order to
receive approval. Financial Responsibility
Patients with insurance
– our surgeon’s fee for your surgery will be submitted directly to your insurance
company for payment. You will be billed by our office for any co-payments, deductibles, non-covered
services or supplies dispensed by our office.
Patients without insurance
– our surgeon’s fee for your surgery is due to our office five (5) business
days prior to your surgery. You will receive separate statements from anesthesiology, pathology, radiology, and the facility
depending upon the nature of your surgery for any balances not paid by your insurance company.
If you have any questions, please call our Office Manager.
A minimum fee of $30.00 per form is charged for all disability forms completed by our office. The exact
fee depends upon the complexity and length of the form.
A fee of $300.00 will be charged for surgeries cancelled seven business days prior to surgery without a
valid medical reason. What to Expect After Surgery
As you plan for surgery, it is helpful to prepare your surroundings for recovery and envision how you will
manage. Consider the following and determine how you can plan ahead: shopping needs, daily hygiene,
sleeping arrangements, meal preparation, transportation, space at home for ambulatory devices (walker,
crutches, wheelchair, etc.).
Keep in mind that you will need to have someone drive you home following surgery since you will have
undergone anesthesia. It is recommended that you have someone stay with you for at least twenty four
(24) hours following surgery for safety reasons. Also, refrain from making critical decisions or driving while
taking narcotic pain medication.
It may be necessary for you to use an assistive device such as crutches, cane, walker, wheelchair, or
Rollabout following your surgery depending upon the nature of your condition. It is important to
understand how to use these devices prior to surgery. Therefore, a pre-operative consultation will need to
be arranged with a local physical therapy company. Please contact one of the companies recommended
to arrange for a consultation prior to your surgery. The therapist will determine the type of ambulatory
device that best suits your needs. They can dispense the device and properly teach you how to use it.
If you wish not to have the physical therapy company dispense your mobility device, you may purchase
the unit at a local medical supply company such as (Roberts Medical Supply Company in Charlottesville
at 434-973-7847 or Culpeper Pharmacy in Culpeper at 540-825-7576). Many of these supplies and
devices can be purchased over the internet. Some of the website companies to consider are:
there are many more available
through a simple internet search. Also, our practice has Rollabout Devices for rent, ask our Surgical
Coordinator about availability.
It is important to contact your insurance carrier concerning financial coverage for these devices. They
may have guidelines on where these ambulatory devices can be purchased.
In certain cases, recovery in a rehabilitation center or having a home health care nurse visit you daily may
better suit your medical needs. This should be discussed with your surgeon preoperatively to determine
which may be appropriate. Strict criteria must be met for insurance carrier coverage for these services.
Contact your insurance company prior to surgery to see if you are eligible for this type of benefit. If not,
this will be an out-of-pocket expense.
Eating and Drinking the Day of Surgery
You should not eat or drink anything after midnight the night before surgery to prevent the risk of
complications. The only exception is sips of water to take approved medications.
A representative from the hospital or surgery center will call you prior to your surgery with specific
instructions on which medications you can take the morning of surgery. If you do not receive this
information, please contact our office for instructions.
Medications such as anti-inflammatories (aspirin, ibuprofen, Motrin, Advil, Aleve, Naprosyn, etc.), vitamin
E, and herbal supplements must be discontinued five (5) days prior to surgery.
Medications such as blood thinners (Coumadin, Plavix), insulin, steroids, and immunosuppressives will
need to be discontinued or tapered prior to surgery. Contact the prescribing physician for instructions.
Some medications may need to be discontinued one to two weeks prior to surgery.
Your surgery may be cancelled if these medications are not discontinued pre-operatively. Tobacco Usage
Tobacco usage should be discontinued one month prior to surgery and for at least three months following
surgery. Smoking significantly increases your risk for soft tissue and bone healing complications. Your
surgical results will be compromised if you continue to smoke. If you need assistance to stop smoking,
please contact your primary care physician for a smoking cessation program. Disability Forms and Out-of-Work Notes
Your employer, disability insurance company, or Workers Compensation Company may require
documentation from our office concerning your time off from work. We understand this to be a
requirement during your recovery in order for you to continue to receive your benefits. Please supply the
office with whatever documents that you need to have completed.
There is a $25.00 minimum charge per form depending upon the complexity and length of the form to be
completed. Please anticipate a seven (7) business day turn around for these forms. There is no charge
for simple out-of-work notes or DMV parking applications. Worker’s Compensation Documentation
If your surgery is a result of a work-related accident or injury, we must have all contact information and
approval from your Worker’s Compensation Carrier prior to scheduling your surgery.
It is our goal to transition you to your job duties as soon as possible following your recovery and that your
employer be given the opportunity to provide work accommodations if able. Many businesses have
restricted duty programs for injured employees. If required by your employer, at each appointment, we will
provide you with a simple recovery status report. Please bring a copy of your job description and duties.
Applicable fees will be assessed for the completion of more detailed reports. Your case manager and/or
attorney will assist you as you transition back to work. DMV Parking Applications
DMV parking applications can be obtained through our office. If deemed medically necessary your
surgeon will complete the required documentation on this application. You will then need to take this
completed application to your local DMV for the parking permit.
All patients experience a certain level of pain following surgery. The amount of pain depends upon the
nature of your surgery. More extensive procedures will cause greater pain than a minor procedure that
necessitates stronger pain medication. Your surgeon will prescribe the appropriate medication(s) to help
control your post-operative pain to make you as comfortable as possible during your recovery.
In most cases, a local anesthetic will be administered during surgery that will cause numbness in your
lower extremity. This numbing effect will wear off over several hours up to several days depending upon
the type of nerve block performed, so start taking your pain medication once you get home. It is important
to take the pain medication(s) as directed. If you develop an adverse reaction to the medication, stop
taking the medication(s) and call the office for further instructions. Refrain from making critical decisions
or driving while taking narcotic pain medication. Antibiotics
In most cases, antibiotics were administered through your vein during surgery. If antibiotics were
prescribed for after surgery, take them as directed. Using Ice Therapy
The appropriate use of ice therapy following surgery will help minimize swelling and control pain. You
may apply an ice pack behind your operative knee or over the top of the ankle for 30 minutes four times
per day. If a cast or splint was applied and you are placing the ice over the cast or splint, leave the ice
pack on for one hour instead of 30 minutes. Bleeding/Drainage
A small amount of bleeding is normal after surgery and is expected. If your dressing or splint becomes
saturated, reinforce the dressing with clean gauze. It is important to keep your operative extremity
elevated above the level of your heart for the first three days following surgery.
If blood drips from your dressing, call the office for instructions. Numbness
If local anesthesia was used, your operative extremity will be numb for several hours up to several days.
If your toes are not
warm and pink, call the office for instructions. Skin Itching
Skin itching and some redness may be due to the anesthetic, antibiotics, or pain medication. This can be
controlled with over-the-counter Benadryl 25-50mg by mouth every six hours as needed. If you develop
skin welts, rash, or itching, call the office for further instructions. If you develop swelling of your throat, mouth, tongue, or eyes or if you experience difficulty
breathing go immediately to your local hospital emergency department for treatment.
Anesthesia and narcotic pain medication can cause constipation. Over-the-counter stool softeners are
recommended initially. Medications such as Colace, Senokot, and Pericolace can be purchased at your
drug store. Take these medications as directed by the manufacturer. It is important to drink plenty of fluids
and eat fresh fruits and vegetables.
If you have not had a bowel movement five days following surgery, contact our office for instructions. Urination
During surgery a Foley catheter may have been placed into your urethra and bladder for urination. The
catheter is removed prior to going home. If you have not been able to urinate within 24 hours from leaving
the facility, call the office for instructions. If the office is closed, page or call the surgeon on call. Nausea/Vomiting
Anesthesia, antibiotics, and narcotic pain medication can cause nausea and vomiting. A bland diet with
foods such as clear liquids, rice, bananas, toast, and crackers are more easily tolerated. If you experience
persistent nausea and/or vomiting, call the office for instructions. What to Expect at Your Post-Operative Visits
Your first visit after surgery will be scheduled at your pre-op visit with our staff. It will be listed on your
post-operative instruction sheet given to you at the hospital or surgery center. Your first visit should be
within the first 4-7 days following surgery.
What occurs at each post-operative visit varies depending upon the nature of your surgery. We will take
your vital signs, assess your level of pain, change your dressing and cast or splint where applicable.
Sutures or skin staples are usually removed two weeks after surgery. Pins are usually removed 4-6
weeks after surgery.
Your level of pain and the need for pain medication will be discussed at each post-operative visit.
Please prepare a list of questions to be discussed at each of your post-operative visits. Physical Therapy
Depending upon the nature of your surgery physical therapy may be employed to expedite your recovery
and optimize your outcome. Physical therapy referrals will be made as necessary. Travel
Driving – If surgery was performed on your left
foot or ankle, then you may drive. You should not drive
sooner than 24 hours after surgery or while taking narcotic pain medication. If surgery was performed on
foot or ankle, you will not
be able to drive until you have been instructed by surgeon to wear
street shoes on both feet. It is illegal to drive while wearing a cast or restrictive device and it is not safe.
Flying – Flying after surgery increases your risk for developing a blot clot in your leg or lung. If you are
wearing a cast you may not
fly. Blood clots are a serious medical condition and can be life threatening. If
your travel plans involve flying, please consult with your surgeon. Surgeon Call Coverage
Our practice has a surgeon on call 24 hours/day, 7 days/week for patient care. If you suspect you are
having a medical problem following surgery, please call the office for instructions. If you are calling after
hours, please call the office and listen to the directions to contact the surgeon on call.
Article: ““Interpose Your Friendly Hand”: Political Supports for the Exercise of Judicial Review by the United States Supreme Court” Author: Keith E. Whittington Issue: November 2005 Journal : American Political Science Review This journal is published by the American Political Science Association. All rights reserved. APSA is posting this article for public view on its
LA CAMARA DE DIPUTADOS DE LA PROVINCIA DE SAN JUAN ARTICULO 1º.- OBJETO. La presente Ley tiene por objeto prevenir la violencia laboral, brindando protección a los funcionarios o empleados víctimas de las mismas, los/as denunciantes y/o testigos de los actos o conductas sancionados por la presente Ley.- ARTÍCULO 2º.- CONCEPTUALIZACIÓN. A los fines de la presente ley se considera viol