Introduction 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 434-654-7000 Monticello Community Surgery Center 434-293-4995 Culpeper Regional Health System 540-825-4100 Culpeper Surgery Center 540-829-0700
BEFORE SURGERY 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. Pre-certification
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.
AFTER SURGERY Pain Control 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. Constipation
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 your right 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.
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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