Neurosurgery Patient Handbook

NEUROSURGERY This patient handbook helps you know what to expect BEFORE, DURING, and AFTER your hospital stay.

Please fill out the empty fields throughout the book. Start by telling us what matters to you on your road to improved health.

What matters to you?

Neurosurgery Patient Handbook

This book belongs to:

(write patient name) My diagnosis is: . My primary care doctor is: . My neurosurgeon is: . My nurse practitioner/physician assistant is: . My surgery is: . I am scheduled for a follow-up with my neurosurgeon on (mm/dd/yyyy): / / . I am scheduled for a follow-up with my primary care doctor on (mm/dd/yyyy): / / . The person responsible for my care once I leave the hospital is: __ ____ . My relationship to him/her: ______ ____ .

Contact information

UF Health Neurosurgery | Doctor’s Office (352)273-9000www.neurosurgery.ufl.edu

IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE PHONE NUMBER LISTED ABOVE. WE ARE HERE TO HELP YOU.

TABLE OF CONTENTS

UF Health Neurosurgery Team ....................................................1 UF Health Neurosurgery Contact Information .............................2 Parking and Map Information .....................................................3 Map Directions to Neurosurgery Doctor Office ...............................4 Welcome ....................................................................................5 Neurosurgery Team Duties ...........................................................5 Types of Surgery ..........................................................................6 Day of Surgery ............................................................................6 After Surgery Hospital Stay ..........................................................7

Medications ............................................................................7

Medication Schedule ..................................................................8 Care and Questions after Surgery ........................................... 9-11

Seizures ..................................................................................9 Brain, Spinal Cord or Nerve Issues ...........................................9 Blood Clots .............................................................................9 Wound Care .......................................................................... 10 Braces or Collars .................................................................... 10 Activity Restrictions ............................................................... 11

Follow-Up Care ......................................................................... 12 Additional Services .................................................................... 13 Additional Patient Support ........................................................ 13 Notes ................................................................................... 14-16

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UF Health Neurosurgery Team Physicians

Director of Quality

Improvement

Director of Neurosurgery

Associate Director of

Neurosurgery Jacqueline Baron-Lee, PhD John Regenfuss, MBA Laurie Waite

jbaronlee@ufl.edu john.regenfuss@neurosurgery.ufl.edu laurie.waite@neurosurgery.ufl.edu (352)273-6961 (352)273-9000 (352)273-9000

William A. Friedman, MD

Kelly D. Foote, MD

Brian L. Hoh, MD

Gregory J.A. Murad, MD

Daniel J. Hoh, MD

W. Christopher Fox, MD

David W. Pincus, MD, PhD

Steven N. Roper, MD

David Tran, MD, PhD

Maryam Rahman, MD

Jacqueline Crump, ARNP

Yolanda Gertsch- Lapcevic, ARNP

Advanced Registered Nurse Practitioners/ Physician Assistants

Adam Polifka, MD

Pamela A. Martin, RN

Ashley P. Ghiaseddin, MD

Leigh-Ann Perkins, ARNP

Angela Wolfe, ARNP

Susan Alvarez, ARNP

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UF Health Neurosurgery Contact Information

UF Health Neurosurgery Physical Address: 1600 SW Archer Road, 1st Floor, Room 1097 (Stop #12) Gainesville, FL 32610

Mailing Address: P.O Box 100265 Gainesville, FL 32610-0265

Telephone: (352)273-9000 Fax: (352)392-8413

Website: Visit www.UFHealth.org or www.neurosurgery.ufl.edu

This handbook was designed to help you: Know what to expect during your hospital stay

Know what to expect after your surgery

Answer commonly asked questions

Please read this handbook carefully. If you have any questions, please contact us.

Contact Information

UF Health Neurosurgery | Doctor’s Office (352)273-9000www.neurosurgery.ufl.edu

IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE NUMBER LISTED ABOVE

WE ARE HERE TO HELP YOU.

3

UF CAMPUSSPEED LIMIT

20 MPH

EmployeeParkingGarage

(Location ofUF Health

Fitness andWellnessCenter

Patient Drop Off

Valet Parking

Free Valet Parking for emergency patients

Traffic Light

6. Access for Visitors with Disabilities

? Welcome Center

✇ Shands at UF Main Entrance

✇ UF/Shands West Entrance

✇ West Parking

✇ Davis Cancer Pavilion

✇ Shands Medical Plaza

✇ Children’s Medical Services Center

✇ American Cancer Society’sWinn-Dixie Hope Lodge

✇ Ronald McDonald House

(Shands Human Resources-1st Flr)

Davis

CancerPavilion

Parking and Map Information

UF Health Shands is located in Gainesville, Florida on the University of Florida campus off of Archer Road (State Road 24). It is about 3 miles east of I-75 (exit 384) and one block west of U.S Highway 441. Parking Information The visitor parking garages are just off SW Archer Road on the west (Mowry Road) and east (Newell Drive) ends of the hospital. Parking vouchers can be obtained from the clinic upon checkout. Parking is free for our patients and patient visitors with a parking voucher.* Valet Parking may be used at a cost of approximately $3 with a parking voucher. The valet parking

booth is located along the curb in the front circle of the hospital off Archer Road. Available Monday - Friday, 5:30 a.m. until 9:30 p.m.

Weekend and holidays, 9:00 a.m. until 6:00 p.m. *Please note: If you do not have a voucher, you will be charged approximately $10 when exiting the garage.

UF Health Shuttle transports patients to and from the parking garages and medical facilities. Available| Monday - Friday, 5:30 a.m. until 9:30 p.m.

Key • U.S Highway

441 • Archer Road

(State Road 24) • I-75 (exit 384)

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Map Directions to Neurosurgery Doctor Office

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Welcome Hello and welcome to UF Health Neurosurgery. Our first priority is to provide the best possible care for you and your loved ones. Before undergoing care at our hospital, please review the following list of things needed for a healthy recovery: Medical records and films (e.g. X-Rays, CT scans, MRIs) Radiographs (these usually come on a CD disc and are different than radiographic reports) Medications (please bring with you in their original containers) Advanced directives such as a living will and health care surrogate Any allergies Any concerns or questions you may have

Have these items been reviewed between you and your provider? If not, discuss them with a member of your care team.

Neurosurgery Team Duties

During your stay, you will have a team taking care of you that may include some of the people listed below. Here is a brief description of their duties:

Attending/Faculty neurosurgeon (MD): The doctor who performs your surgery. Neurosurgery residents (MD): One or more doctors who assist your neurosurgeon during your

hospital stay. Advanced Registered Nurse Practitioner (ARNP) or Physician Assistant (PA): Health care providers

who help your neurosurgeon during pre-surgery, hospital stay, and post-surgery care. Registered Nurse (RN): Provides every day care during your hospital stay, including medication

administration, checking your progress, and assisting with after care recovery. Physical Therapist (PT) and Occupational Therapist (OT): Help with your recovery of normal daily

activities after surgery. Case manager: Assist in arranging any after hospital needs (rehab, home nurse visits, skilled nursing

facility), and any needed home equipment. Social workers: Provide services such as coordinating transportation, understanding living wills and

surrogate forms, and assisting with patient care issues. Speech & swallow therapists: Assess individual speech therapy needs and address problems in

communication, language, and feeding. Dieticians: Explain nutrition issues and assist in developing meal plans to maintain optimal health.

Types of Surgery

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Types of Surgery

There are many types of surgeries that may be performed depending on your condition. Listed are some very general categories of brain and spine surgery.

Let us know what category your surgery fits under by checking one or more of the boxes.

Brain surgery: Involves surgery of the brain or its surrounding structures. Spinal surgery: Surgery of the spinal cord, nerve or spinal column. This may include using metal

implants to fuse the bones surrounding the spinal cord. Peripheral nerve surgery: Involves repairing damaged peripheral nerves.

Day of Surgery

Pre-Surgery Waiting Area o You will first arrive to this area to meet with doctors and

nurses as they prepare you to go into the operating room.

Operating Room (OR) o Where your surgery takes place. o A waiting room on the 1st floor is available for your family.

There, they will receive updates while you are in surgery from the operating room nurse.

Recovery Room (Post-Anesthesia Care Unit) o Where you will stay immediately after surgery, usually for a short while. o Doctors and nurses will check on you, and will assess and treat any pain after

surgery. o Please let your doctor or nurse know if you are having pain or if your pain is not

being treated adequately.

Example of a spinal fusion. MRI scan of a brain.

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What to Bring Patients and visitors often find it useful to bring the following items for the day of surgery: sleep clothes (pajamas, robe, slippers), personal toiletries, eye glasses, personal medical equipment, phone or other device charger.

After Surgery Hospital Stay

You may stay for 1 or more days in a hospital room. This may also include the intensive care unit. While you are in the hospital, a nurse, neurosurgery resident, and your neurosurgeon will regularly

check you during the day and at night. Physical and Occupational Therapists may also help you in your recovery of normal daily activities

like eating, getting out of bed, using the bathroom, walking, using stairs, and bathing. A Case manager may also meet with you and a family member or friend if there are any special needs

for after your hospital stay. This may include coordinating inpatient rehabilitation, establishing home nurse visits, or obtaining special home equipment.

The nurse will provide you with any of your home medications that you will need to take while in the hospital. There may also be new medications that you will need as a result of you surgery. These new medicines may include:

Common New Medications Pain medication (to treat pain or discomfort after surgery) Muscle relaxants (to treat muscles spasms or tightness after surgery) Antibiotics (to prevent or treat infection) Stool softeners (to assist in bowel movement) Laxatives (to assist in bowel movement) Anti-seizure medication (to prevent seizures after certain kinds of surgery) Anti-coagulation (to prevent unwanted blood clots in arm or leg veins) Steroids (to decrease inflammation or swelling in the brain or spinal cord) Nausea medication (to reduce symptoms of nausea or vomiting)

Please ask your nurse or doctor about the medicines that you are taking. A chart is provided on the next page to help review your medicines.

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Medications Schedule

Upon your discharge from the hospital, consult with your care team to write down all medications you will be taking. Drug Name Drug

Appearance Dose Directions for Use

(How many times a day? What times? As Needed? Before or After Meals?)

Reason for Taking

Comments (How long to keep taking? Doctor who prescribed?)

Example Drug white, tablet 10 mg

Once a day at bedtime Stool softener Take with food; 10 days

TAKE YOUR MEDICATION EXACTLY AS RECOMMENDED. Steroid and seizure medications need to be stopped over time and should not be stopped abruptly. Call your doctor if you need any instructions, have concerns, or are

experiencing an allergic reaction to your medication, please call 352.273.9000.

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Care and Questions after Surgery Even with a well-planned surgery, problems can sometimes happen. Fortunately, most problems can be successfully treated. Treatment for post-operative problems is best performed as soon as the problem is identified. Therefore, it is important for you to contact us early, if you have any concerns. We are here to take care of you. Our telephone service is available 24 hours a day at (352)273-9000. Some possible problems that may occur are:

Seizures A seizure is a result of abnormal brain activity that may result in a decreased level of alertness, sudden twitching or shaking of the body. Often, people lose consciousness during a seizure. Your doctor may give you medications to prevent a seizure depending on the type of condition or surgery you have. If a seizure takes place and ends within a few minutes, call our 24-hour phone service (352)273-9000. A CT scan and changes in your seizure medication may occur. If the seizure lasts more than a few minutes or you or your loved one experience continued seizures after talking to your neurosurgeon, call 911.

Brain, Spinal Cord, or Nerve Issues Problems with brain function may occur before or after brain surgery. Examples include trouble with vision or speaking, weakness of the face, arm, or leg, numbness anywhere in the body, imbalance or unsteadiness, etc. If you think you are having new or worsening brain, spinal cord or nerve problems, please call our 24-hour phone service at (352)273-9000.

Blood Clots Blood clots can occur in the veins of the arms or legs after surgery, usually due to poor blood flow when recovering in bed. They can cause leg swelling, pain, or sometimes can occur without any warning. Blood clots can also travel to the lungs and cause shortness of breath, a fast heart rate, and/or chest pain. If you think you are having any of these symptoms, please call our 24-hour phone service (352)273-9000. If you are having any difficulty breathing or severe chest pain, please call 911.

SAY NO TO SMOKING, PATCHES, AND E-CIGARETTES Cigarettes and products containing nicotine (patches, electronic cigarettes) can result in poor wound healing.

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Care and Questions after Surgery (cont.)

Wound Care Your surgery site is held together with suture (thread) and sometimes with staples or skin glue. Some sutures will dissolve on their own, and do not need to be removed. Other sutures and staples will need to be removed by your doctor or their assistant, usually between 2 to 3 weeks after surgery. We will tell you if your sutures will dissolve on their own or need to be removed. Your doctor will let you know when you are allowed to shower and have water run over the wound. Do

not sit underwater in a bathtub or go swimming until your doctor checks your wound for complete healing.

You do not need to put any medication, creams, or lotions (like Neosporin or Vitamin E) on the wound. Do not scrub the wound until it is completely healed.

Braces or Collars For those undergoing spine surgery, you may be given a back brace or a neck collar to help your spine heal. Wear your brace or collar as instructed by your care team. This may involve wearing it at all times. If you

have any questions, please ask your care team before you leave the hospital. If the brace or collar causes major redness, blistering, or skin breakdown, please tell your care team to

have the brace checked and re-sized.

Infections are rare but can sometimes occur. Notify your doctor if: There is severe redness, tenderness, swelling,

or warmth around your wound. You notice green, yellow, or cloudy fluid

seeping from your wound site. You have a temperature over 101.5˚F. There is an opening in your stitches and the

edges of your wound are no longer held together.

You see suture threads starting to come out from under your skin.

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Care and Questions after Surgery (cont.)

Activity Restrictions

Strenuous activity like running, exercise, housework, sex, etc.

Returning to work How soon you are able to return to work depends on the type of work you do as well as the type of surgery you had. Typically, patients are not released to work for six weeks after surgery, but some patients are able to return to work sooner. Your doctor can discuss your healing process with you and determine when is the best time for you to resume normal work activity. Staying out of work longer than the time period excused by your doctor can result in non-excused absences. After most surgeries, walking can help your body recover. Walking improves breathing, blood flow, energy level, and endurance. It also decreases infections and can help you sleep at night. If you are unsteady on your feet, ask your doctor before walking for regular exercise. Try walking gradually. As you become able to do so, make it a routine for 15-30 minutes a day. Notes for your specific activity dos and don’ts _____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

You may be limited from doing certain activities after surgery, including the following: Lifting anything heavier than a gallon of milk Bending, stooping, or twisting in a way that may put tension or pressure on your surgery area Driving, if you are taking prescription pain medication

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Follow-Up Care Your neurosurgeon and primary care doctor will monitor your recovery and health after you are discharged. Follow-up care takes place in the weeks after surgery. This may include doing additional exams. Follow-up appointments are very important and should not be missed or rescheduled unless absolutely necessary. Before leaving the hospital, please ask if you have questions about when you should see your neurosurgeon and primary care doctor again.

My follow up appointment is: Date: __________________________________ Time: __________________________________ Location: _______________________________

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Potential resources for neurosurgery patient

Neurology Clinic at Shands Medical Plaza 2000 SW Archer Road 3rd Floor Gainesville, FL 32601 PO Box 112742 Phone: (352)265-8408 Fax: (352)627-4175

UF Health Center for Movement Disorders and Neurorestoration 3450 Hull Road Gainesville, FL 32607 PO Box 112742 Phone: (352)294-5400 Fax: (352)294-5010

UF Health Shands Rehab Hospital 4101 NW 89th Boulevard Gainesville, FL 32606 Phone: (352)265-8938

UF Health Pharmacy – Shands Hospital 1600 SW Archer Road Gainesville, FL 32608 Phone: (352)265-0405

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Additional Patient Support

Emmi Patient Education Program Understanding your health just got easier What is Emmi? Emmi is a series of free, online programs that walk you through important information about a health topic, procedure, or condition-helping to answer your questions and make you feel at ease. Learn More about Your Health Sometimes information about your health can be confusing. Emmi programs take you through the process of a procedure step by step. Learn what your health condition means, what could have caused it, and how it can be treated. You can access Emmi conveniently at home using a computer, tablet, or smartphone. Ready to Learn More? Ask your health care team about which program is right for you!

Teach-Back Protocol Is your provider doing teach-back with you?

If your provider isn’t using teach-back,

please let us know!

You can provide feedback to:

jbaronlee@ufl.edu

What is teach-back? Teach-back is when your provider explains information to you clearly. It is not a test or quiz Why is it important? Sometimes understanding your health can be confusing. Teach-back is a way to check that you understand what your provider is saying What does it look like? If your provider is using teach-back, they will ask you to say in your own words or demonstrate what they’ve taught you

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Additional Patient Support (cont.)

Neuromedicine Mentor Program Have you heard about our Mentor Program? What is the Program? The Neuromedicine Mentor Program is a newly developed initiative aimed at providing extra support to our patients and their caregivers. Patients and/or caregivers can be paired with either 1) a small group of pre-health students and/or 2) a former neuromedicine patient or caregiver. Support Offered Depending on your situation, your student mentees or veteran patient/caregiver can assist with various needs, including: home visits or outings, help knowing what to expect, assistance with navigating the health system, and more! Interested in being paired with a mentee or veteran patient/caregiver? Ask your care team for more information or contact Jacqueline Baron-Lee, PhD, Director of Quality Improvement for more details.

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Notes

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Notes

Contact Information

UF Health Neurosurgery | Doctor’s Office (352)273-9000

Website: neurosurgery.ufl.edu

IF YOU HAVE QUESTIONS, PLEASE CALL THE NUMBER LISTED ABOVE.

WE ARE HERE TO HELP YOU.

Revised 6.7.16 PS113003

N E UR OM ED I CIN E