 I'm a nurse here at Mid-Michigan, and I am providing this video for you so that way you are either having surgery or you have just gotten finished with your neck or back surgery. Today we're gonna go over several things. Physical therapy, occupational, and nursing will be working together to provide you all the instructions that you need leading up to you going home from your surgery and what to do afterwards. This has been recommended by your neurosurgeon. Nursing is gonna go over many of the things that we are expecting you to do before going home. We have to have your pain under control. We have to get you up and moving. And physical therapy is gonna teach you these things. They're gonna teach you how to get out of bed, get in and out of a chair. And occupational therapy will work on things like getting up from the toilet, going to the bathroom, using a shower, and just things of daily living. Now let's begin. Our first goal here is the restrictions you will have following your back or neck surgery. After your surgery, your neurosurgeon has stated that you cannot drive for 10 to 14 days. This will be cleared for you on your follow-up appointment. You can ride in a vehicle. You are expected to wear your seat belt, but you are absolutely not allowed to drive. Now your back and your neck precautions. You can remember this like I do, as a BLT sandwich. No bending at the waist, more than 90 degrees. No lifting more than five pounds. Now five pounds is not a lot. It's about a half gallon of milk. Remember your purses, your laptops, pots and pans usually weigh more than five pounds, so be very careful with this. And twisting. There's no moving or grooving after back surgery. You have to walk nice and easy. Neck surgeries, yours is simply the same. The only difference is the twisting at the waist. Now involves your neck. So be careful next surgery patients. The five pounds still applies. Physical therapy is gonna explain this in more detail shortly. All right, so let's talk about some of the equipment after back surgery. One of the things here is gonna be non-skid socks. The nursing staff, as well as the neurosurgeons are expecting you to wear these any time you get out of bed. This is gonna help prevent falls and also keep the infection rate lower. Many of the other things that you will have on are not on the table. One, for instance, may be a Foley catheter. Now, nurses wanna get these out just as bad as you do. This Foley catheter has been placed by your neurosurgeon so you have a little bit more time to rest before we get you out of bed and take you to the bathroom. Once we can get you out of bed, we're gonna take that Foley catheter out for you. One of the next things that you will have on your legs and you may have found these already is these sequential boots. I tell people these are much like leg massagers. These are very important. These right here are held down by Velcro. It goes on the lower part of your leg and it's gonna inflate and deflate. This is gonna help prevent blood pooling in your lower legs, promoting circulation and avoiding those dreaded blood clots. Any time that you are in bed resting, you are expected to have these on. I've heard many people don't like them. The secret to not having these on is get up and walk and you can't be attached to your bed. The next thing we have here is an incentive spirometer. This right here is a very important tool. This was gonna be for all neck surgeries and back surgery patients. This right here is gonna hopefully prevent you from things like pneumonia. We are gonna set a tab here on the side and this is your goal line. We want you to breathe into this every hour while you are awake. You don't have to wake up at two in the morning. If you're not awake, it can stay on the bedside table. This right here is your mouthpiece. You're gonna put this in your mouth and you are gonna suck in. And when you suck in, you're gonna fully inflate your lungs and hopefully this white bar here is gonna inflate and it's gonna go to your goal line. Don't be scared if you start out at a very low level. This will improve. Let me demonstrate this for you. I'm gonna put the mouthpiece in my mouth. I'm going to suck in and I'm gonna try to hold it there and watch this white come up. Here we go. As you can see, even I did not hit my goal line on the first time. This is not a problem. Keep trying. Get those lungs fully expanded and prevent pneumonia. The next thing I wanna talk to you about is a drain. Some of you guys will have a drain in. Some of you will not. If you have something like this attached to your gown right now, this is a drain. You will not be going home with this, so don't let it worry you. This drain is very important. It's going to help reduce the swelling and the pain in your back. To do this, the neurosurgeon has taken this plastic tube, which is full of holes, and it's inserted just underneath the skin and it's gonna drain out all of that swelling. It's gonna go through this tubing and it's gonna collect in this bottle. The nice thing is is the nurses can come to this, we can open it up and we can dump it out. This is all the bruising and swelling that would normally be by your incision, your back or your neck. So this is gonna help a lot with pain control, reduce the chances of infection, and overall just make you a lot happier. Like I said, you will not go home with this drain, which means the nurses are gonna watch and we're gonna measure this. Before you leave, we are gonna take this out. It's held in with just one cute little stitch. We're gonna pull it out nicely and there's no special things that you have to do to your back where that was. Now the next thing I'd like to talk to you about is exercise. Because of those precautions that I mentioned before, no bending, no lifting, and no twisting, there's not a lot of exercise that you guys are approved to do. The only thing the neurosurgeon wants you to do after your surgery is walk, simply walking. Flat, even surfaces, no treadmills, no ellipticals, no mechanical devices at all, just walking. The nice part about walking, besides it being good for your overall health, is it's gonna reduce the chances of pneumonia because it's gonna expand those lungs and it's also gonna not allow that blood to pool in those calves, which means you're gonna decrease the amount of chance for blood clots. When you get home, we encourage you to continue walking. This is your form of rehabilitation. Physical therapy, we'll talk about this more shortly. The next thing I'd like to talk to you about is pain control. Pain control is very difficult after surgery. So it's very important for the nurse and the patient to communicate very well so we can get your pain controlled and you to go home as quickly as possible. Each patient is different. Some of you may have very little pain. Some of you will be in a lot more pain than your neighbor. This does not mean there's anything wrong with your surgery or you had a worse surgery than someone else. Everybody's body acts a little differently. The nurses are gonna work very hard to control your pain. We do this very shortly after surgery. We will be providing oral pain medication right off the bat. We try to stay away from the IV form as much as possible, but we do have that available if absolutely needed. Our goal is to make your pain tolerable. We cannot take your pain 100% away. We want you to be functional and what that means to nursing is we need to make sure that you can get up, that you can use the bathroom, that you can eat, that you can communicate with us and your neurosurgeon. The nurse will be working to find a combination of pain medications that work for you. The same medications will not work for you as they would for somebody else. Therefore, it's very important that we communicate together to find the right combination. Now, let me explain how this scale works. The nurse is gonna ask you on a zero to 10 scale, 10 being the worst pain you've ever felt, what number would you give your pain? Before you think of this pain number, let me clear up a few things. Your pain cannot be higher than a 10. Therefore, your pain cannot be an 11 or a 15. 10 is the top of the scale. Your pain does not need to be a nine or a 10 for you to receive pain medication. If your pain is a three and it is not tolerable for you and you need pain medication, your nurse can provide that to you. The other misconception people have is people say very often that they live with pain every day and that pain is normally a five. So they think by adding to that five, they're coming up with an accurate number. We need you to forget the pain you had in the past and focus on the pain you're having now. Otherwise, your pain is gonna constantly be in that nine, 10 range. We need you to think of this as a new day. This pain scale needs to start at zero and end at 10. Now, let me explain what the numbers mean. Zero to 10 is a very big range. So let me explain some of these numbers and you can fill in the middle pieces. A five to a nurse is a pain level that if I asked you to get up and go to the bathroom, you could absolutely perform that task. You could get up out of bed and you could walk to the bathroom, but it's gonna be painful. It's gonna be uncomfortable to the point that you are considering, hey, maybe I don't really wanna get up and go, but you can. That is a five. A nine or 10 is for patients who are crying. They are miserable. These patients are not talking on the phone. They are not visiting with your family or friends in the room. These patients are not dozing off and they are not sleeping. These patients the nurse can typically see. They are very uncomfortable and we will work very hard at bringing that number down. Lastly, the zero to 10 or the zero to two scale seems pretty obvious. These people are pretty comfortable. You guys can get up. You guys are walking the halls. You can go to the bathroom. You don't really need any pain medicine right now. If your pain is not controlled on oral pain medication, you will not be discharged home until it is. If you need to go to a rehab facility or even a nursing home facility at discharge to get this under control, we will be discharging you there. We need to have your pain under control on oral pain medications before you go home. Now, one other question that those darn nurses are gonna ask and of course it's not to annoy you but it's to give you the right pain medication. We're gonna ask you, well, what does it feel like? Tell us more about the pain. Now, the nurses aren't questioning if you have pain. We know you just had surgery. We expect you to have some pain. Different medications work differently on the body. A sharp burning pain is gonna require a certain form of medication. If you have tight pain, pulling pain, muscle spasms, this requires a different pain medication. If we don't give you the right pain medicine, we're not gonna get your pain under control. And that, of course, is our goal is to get your pain under control before leaving. So it's gonna be very important that the nurse and the patient communicate well to get this accomplished. Now, many of you probably wanna know what you have to do to get out of the hospital. You want to go home. So let me tell you, walking. The nurse needs to feel comfortable that you can walk when you get home. I have to make sure that you can go from your vehicle into your home, from your couch to your bathroom, from your couch to your bed and so on. If you can't walk there, I cannot send you home there. I am not expecting your families to give you piggyback rides to get you into your home. Next, you have to be able to urinate on your own. Now, I know that sounds kind of like a simple task, but many of you, after having a Foley catheter, might have a couple hours, if not a day or two, where this is a difficult task. Before you go home, you will have this done. Next, you have to be able to eat. Sometimes the medicine we give you can make you a little bit nauseous. We want to make sure that you can eat without throwing up. Pain, I've mentioned the pain. We have to have this controlled on oral pain medications before going home. The drain will be removed before going home. If it's putting out too much drainage, we will not pull it out until it's time. This is going to help reduce that pain that I talked about, and it's very important. Very shortly, physical therapy will show you how to get in and out of bed appropriately. This is going to be another task that will have to be accomplished before discharged. If you cannot get in and out of bed safely, we will have to practice this till you can. And lastly, you need to be self-sufficient. And what I mean by that is, there's many tasks that you can't do that BLT prevents you from doing many things, but there are many things you can. One of them, of course, is walking. You need to be able to get out of bed on your own, which means you do not have somebody pulling or pushing you to do so. This is an individual task. Same thing with getting out of a chair and walking across the room. Family members, be careful. If you guys are pulling and pushing these patients to get out of bed, you're gonna get hurt or they're gonna get hurt. This is not recommended. Now, the next thing I wanna talk about is preventing falls. Preventing falls is very important. If you don't ruin your surgery itself, it's gonna be extremely painful. I've been told by some that it's very similar to having a Charlie horse in your leg and amplify that by a whole bunch, because it's in your back. So from what I can see, it's not very comfortable. So let's work on some tips that we can do to prevent that. One, remove the excess furniture from your house and the clutter you have from your walkways. Anything you're tripping over now, you will likely trip on after your surgery. Pick up throw rugs. Throw rugs on the floor are a very big trip hazard. Now I do want some rugs in your house. By your entrance doors, in front of your bathtub, in front of your kitchen sink, those are all fine. But pick up those pesky throw rugs that are in front of your stairs, in the middle of the rooms, or anything that can catch those feet and make you fall over. Another thing that seems to get people is extension cords. Now, in the holiday season, we have a lot more extension cords running in our house or outside our house for those pretty lights. Those are very dangerous after a back surgery. You can trip on those and fall, be careful. Lastly, I like to mention using the handrail when walking up and down the stairs. Be very careful, tripping over stairs and falling down is gonna be very painful. Another thing that I've heard about is pets and kids. Now, I don't want you to kennel your pets and I certainly don't want to send your kids off to boarding school. So here's a trick that I have heard that works very well. When you go inside the house, have your responsible party go in first. You have an option of either holding the child's hand or putting a pet in a room and shut the door. Then, you as a patient can come inside. You can sit safely in a chair and then let go of the child or let the pet out of the room. Typically, it's about the first 20 minutes or so that is the highest risk for a fall. They're excited, they haven't seen you for a while. Just make sure you are seated safely to avoid that fall. Now, another thing that we need to make sure we do is we need to bathe and we need to change our bandages. Your nurse will specifically instruct you when you are able to shower after surgery. Some of you will have the opportunity to shower within 24 hours after your surgery. Some of you will have to wait five days. This is specifically set by your neurosurgeon and you will be told this upon discharge. No patient, whether you are allowed to take a shower 24 hours after surgery or five days after surgery, are allowed to swim, sit in bathtubs, sit in hot tubs, or use saunas until cleared by your neurosurgeon. All of these will promote bacteria growth in your incision and you are at extremely high risk for infection. Now, bandages are to be changed daily. Whether you are able to shower or not, you will be changing your bandage. These bandages are very simple. It is a piece of gauze and a piece of tape. There are no creams. There are no ointments. There is no anything. It'll be gauze and tape. And we will absolutely show you how to do this before discharge. Just remember to wash your hands before and after changing your bandage. Now, one of the biggest things that you can do after a surgery is to prevent infection. Now, if you can imagine, your brain, your spine, are kind of connected. So anytime you have an infection in your back that involves your spine, it involves your brain too. So we need to pay extra close attention to prevent infection of this surgery. The first thing that you need to remember is washing your hands. When I say that you need to wash your hands, you need to use soap and water. You need to have your hands scrubbed. This should take about 20 seconds or longer. If you can remember to sing happy birthday twice, you've about hit your goal. Change that bandage daily. Change your clothes daily. And those clothes should be clean clothes, not something that you had in the corner that you took off yesterday. If you have a brace, you need to remember that you need to have a clean shirt on first and your brace is to go over top. If you put that brace directly against your incision, you have a very high chance of having bacteria and infection in that location. The next thing you can do at your house is wash your bedding. Now this seems simple. You should be washing your bedding minimally twice per week. This includes vacuuming your mattress. Then you can put sheets back on your bed. Unfortunately, somebody will have to do this for you, as this would break all of your back precautions. Now many people don't realize, but covering your furniture is also important. We spend two-thirds of our time awake, only one-third of our time sleeping. Our furniture does not get cleaned as often as our bedding does. So a good tip would be to place a clean sheet over the area of furniture that you sit and clean pillow cases over your throw pillows. This will allow a barrier between your back and bacteria. Now showering. Now once you're given the clearance to shower, there are still a few things you should keep in mind. One, a washcloth is a very good tool, but you should have two during this time. One for near your incision and another one for the rest of your body. You do not want to wash your feet and then wash your incision. The same is true about towels. You should be using a clean towel every day. This towel should not be hung up over your shower rail, dried, and then reused the next day. You should have a clean new towel and a clean new washcloth every time. Lastly and very important about infection control is your pets. Many of you probably sleep with your pets right now. This is absolutely not recommended after your surgery. Do not sleep with your pets. Their fur and their skin carry dirt and bacteria that is going to get inside your incision and cause an infection. This is very important. Infections in your back and your neck are very painful. And depending on the severity can lead to permanent disability and death. Some people require hospitalization and IV antibiotics for weeks. Please do your part to prevent infections. Now one of the other things I'd like to talk to you about is the signs and symptoms of infection and what to report. So if you have a fever greater than 101 degrees Fahrenheit, if you have redness, swelling, pus, or an odor coming from your incision, this is a sign of infection. If your pain that was controlled is now extremely painful to the touch around your incision, this could possibly be a sign of infection. Family members, if the patient is now acting confused, this is a sign of infection also and should seek medical attention. If you have any new numbness or tingling, pain in your legs or calves, you should also call your neurosurgeon's office. Now there are some also signs and symptoms that you should report instead of to your neurosurgeon to 911. And this should be going to the local emergency room. Shortness of breath, difficulty breathing, chest pain, unable to urinate, unable to move your legs or your arms, unable to speak. Or if you have swelling in one leg versus another or one leg is completely cold or hot, these are all immediate needs attention. We need to go to an emergency room and have this looked at. Now, I'd like to introduce you to physical therapy. Terrin will be talking to you about some of the things about getting up and getting down and moving around. Hello, my name is Terrin, and I'm a physical therapist assistant. What I'm going to be going over with you today is first we're going to talk about the common causes of back pain. Next, we'll talk about braces that you may have, the proper way to get in and out of bed, up and down out of a chair, up and down the stairs, as well as in and out of the car. So the first thing we're going to talk about is common causes of back pain. Incorrect posture plays a very big role in protecting your spine. Let's use, for example, a secretary. She works at her desk 40 hours a week, typing away on her computer. And very common, poor posture that you see in that type of occupation is called the forward head posture. And what that looks like is when the chin comes forward and the shoulders tend to round in. What that actually looks like to your spine, this is the side view. When that happens, when you're increasing that curve, the spine looks like so. Gravity is always putting pressure down on our spine. Instead of that nice S, and it's equally distributing the stress of gravity, when you increase that curve, you're putting the pressure right here at the base of the neck, instead of equally distributing it through the S curve. Another poor posture that you see in this type of occupation is when you sit on your hips. And what that looks like is your hips come forward and you are, again, increasing the curve here. This tends to happen with people who have to stay in one position for a long period of time and stand on their feet. What that looks like is more like so, where you're increasing this curve here. We already talked about the curves a little bit, but this is what more of a natural curve or spine would look like. Here we have our vertebrae. Most people know that. This is the body of the vertebrae through here. Now on the inside, where you see a screw, that's where your spinal cord is located. Now that comes all the way down, all the way through. And off of your spinal cord comes your nerves, the yellow pieces that you see. If you look closely, there's a little hole in between each vertebrae where the nerve needs to sneak through. That goes down to your arms, down to your legs. So for example, if you're having a pinched nerve, that's where that happens, where the nerve has to sneak from the inside of your vertebrae of your spine down to your arms and to your legs. Now if you can see closely, these guys here, these sponges, those are where your discs are at. And that's exactly what it does for your spine is it creates a cushion in between each vertebrae. Now when we talk about body mechanics, having good body mechanics is going to protect your back. Body mechanics are the way that we move throughout our day that either puts more stress on our back, poor body mechanics, or less stress on our back, good body mechanics. So for example, we all want to have good body mechanics. So what you want to do whenever you're carrying or lifting anything, rule of thumb, is to keep it close to your belly button, OK? So let's say, for example, I'm going to get groceries off of the counter. Instead of reaching out here for my groceries, away from my belly button, this would be poor body mechanics. You would want to scoot the groceries to the edge of the counter. Depending upon how tall your counter is, how tall you are, you may have to bend at your knees a little bit, grab your groceries, keeping them close to your belly button, and then carrying them where you need to take them. Same rule applies with the laundry basket. Keep the laundry right close to your belly button instead of twisted over here on your hip. Whenever you're lifting anything up off of the floor, we've all heard, make sure you lift with your legs. Don't lift with your back. Now, to demonstrate this, when I go to bend my knees down to the object, I'm going to keep my back straight, come down to the object. You want to bring the object close to your belly button first to keep your back straight as you come up. Get the object, bring it to you, and keep your back straight as you push up. One mistake that some people make, and they think that they are standing correctly and bringing the object up correctly, pushing up with their legs, is when they bend down to the object, they don't keep their back straight, they keep their back bent here. Push up with their back bent, and then come up at the end, you're still lifting with your back and putting too much pressure and stress on your spine. OK? Now, when we talk about decreased flexibility, when we're talking about protecting your back, that kind of goes back in with correct posture again. Ladies, as we get older, we have a tendency of rounding our shoulders. The pecs, they have a tendency of getting tight. If you tighten this region, you tighten this region, this tends to happen. Gentlemen, as they get older, have more of a tendency of getting tight through the hip flexor region through here. You tighten this part, and this starts to happen. So you can see how important just keeping yourself loose, limber, helps in protecting your back and keeping good posture. When we talk about lack of physical fitness, again, that kind of rolls in with keeping yourself loose and limber. If you're not a very active person, if you have a very sedentary lifestyle and your body calls you up and you need to go help him move, be honest with yourself. Know what you're capable of and what you're not capable of. OK? Know when you need to ask for help. And the last part that I want to talk to you about is structural changes, things that happen with age that can cause back pain. Arthritis, stenosis, a trauma, or an accident, these are all things we don't have control over in protecting our spine and protecting our back. But the first things we just went over and we talked about, you have control over protecting yourself so that you don't find yourself having more back pain and more surgeries in the future. OK? With that said, on common causes of back pain, let's switch gears a little bit now. OK? We're going to talk about now that you've just had your surgery. OK? The proper way for you to be laying in the bed is either laying on your back or laying on your side. You can put a pillow underneath your knees for comfort when you're laying on your back. You can put a pillow between your knees when laying on your side for comfort. That's fine. We do recommend that you just put one pillow underneath your head. Two or three pillows underneath your head. It's going to flex your neck forward. We want you in a nice neutral position, your spine, while you're healing. OK? Now, you're going to want to change positions frequently. You don't want to get in one position and not move for hours because that's going to increase your stiffness. Increase your stiffness. You're going to increase your pain. I tell my back patients that I want them to be shifting their weight, moving their body every 35 to 45 minutes. So let's say, for example, that you're most comfortable laying on your side. Let's say you've been there for 35 minutes. Roll onto your back for a minute or two, then roll back to your side where you're comfortable. Just that moment of changing positions will help keep your stiffness under control. The worst thing you can do is laying one position for long, long periods of time, anticipating the pain, being too scared to move because what's going to happen is you're going to increase your stiffness. You're going to anticipate the pain and guard. When you go to move, it hurts too much to move. So you don't want to move. But the reason that you don't want to move is because you're not up moving. You don't want to get in this cycle. It's really hard to break that cycle and get your pain back under control. So don't be surprised if those nurses are going to have you up, have you moving from the very beginning, OK? Now, next we're going to talk about the proper way to get in and out of bed using a log rolling technique. Now we're going to review your back precautions, going back to the BLT. No bending, no lifting, and no twisting. So when we say no bending, we don't want you bending down like so down to your feet. Same rule applies when you're laying in bed. We don't want you bending straight up as well. No lifting more than five pounds and a gallon of milk. A full gallon of milk weighs eight pounds to put that into perspective. And then no twisting. Your shoulders and your hips, they need to stay in alignment at all times. You're going to be kind of like a robot for a little while. If you need something off the counter to your right, your feet need to move with your shoulders, like so. Next we're going to talk about getting in and out of bed and remembering our back precautions. Mary is going to join us to demonstrate. So to get into bed using what we call log rolling technique, is we're going to first have Mary come down onto her side, down onto her elbow. Notice that she keeps this shoulder forward so that it doesn't fall back and she twists on her spine. Next what she's going to do is bring her feet up into the bed and come down onto her shoulder. Once you're in this position, you're then going to roll in one motion onto her back. Again, her shoulders and her hips stay in alignment throughout the roll. Now that she's on her back, we're going to review how to get out of bed. The first thing she's going to do is to bend up her right knee, which is the opposite knee that she's turning onto. She's going to tighten her abdominal muscles, keep that tight, and roll onto her side. Once you're on your side, she's going to bring her legs over the edge of the bed and pushing up with her arms to bring herself up. You're taking the load of the work off of your abdomen and your back and giving it to your arms to bring yourself upright. Take your time with the log rolling technique. It's not fast and go at your own pace. Next, I'm going to talk to you about the proper chair to use after your back surgery. You're going to want to find a chair with a nice back support, something that sits you nice and upright. You're going to feel more comfortable in that position. Most standard recliners have a little bit of a dip, and your bottom tends to go down into that a little bit. That's why they're so comfortable. But actually, after you have your back surgery, that's going to pull right where you have an incision. It's not going to be very comfortable. I would never take your recliner away from you forever. This is just temporary, maybe for the first couple weeks. So try to think about something at home that you have that'll work good. A lot of people just use their dining room chair as long as it has armrests on it. Queen Anne's chairs, those types of chairs work really nice. Try to avoid chairs that have wheels on them or they rock. It's not the safest thing to be standing up from if it's going to be moving on you while you're trying to stand. This type of chair that we have here works great. Don't go out and purchase something. Again, it's just temporary. Maybe a friend or a neighbor might have a chair that you can borrow for a couple weeks. With that said, I'm going to show you how to get in and out of the chair properly after your back surgery. The first thing you're going to do is back up to the chair and feel it on the back of both of your legs. Now that I feel the chair there, I don't want to twist and look for the chair. That's breaking my back precautions. That's why I want to make sure I feel it behind me. Next, I'm going to keep my back nice and straight and bend at my hips and my knees and find the armrest with my arms. Lower myself down slowly. You don't want to plop into that chair. That will be very painful. We'll never do that again if you do. Next, to scoot myself back into the chair, you're going to want to use your armrests and bring yourself back like so. Or another option if that's too painful is to walk your hips back and I'll show that. All you do is just shift your weight side to side and work your hips backwards, like so. Now, to get out of the chair, I'm going to come out as I came in. I need to scoot my bottom to the edge of the chair first. Again, walking my hips forward. Once I get to the edge of the chair, I want to make sure I have my feet underneath me good to push with. Push with my armrests and keep my back straight as I come up and down. Once you get to this position, some people walk up their legs. You don't have to do that. That's just a little trick that might be helpful to you. Next, we're going to talk about how to properly go up and down the stairs. Most people have two to three entry steps to get into their home. Hopefully, you have a handrail on your stairs. If you don't have a handrail, make sure that somebody's with you the first couple of times that you go up and down your stairs. You just had surgery. You might be a little unsteady. You want to take your time with your stairs and use your handrail for safety. The key with going up and down the stairs is to make sure that you keep your back straight as you go up and down. So you'll use your handrail and keep your hand down by your hip. We don't want you to be grabbing your head to pull yourself forward. We want you to keep your back nice and straight as you go up and down. You'll go up with one leg at a time. Again, use your handrail at your hip, push, and come up. When you go down the stairs, again, you want to keep your back nice and straight. You want to avoid this. So keep your handrail at your hip. Go down one at a time. Keep your back nice and straight as you go down your stairs. Some people have a flight of stairs in their home that they have to go up and down. That's okay after surgery, but we don't want you to do that frequently throughout the day. So for example, if your bedroom is upstairs and the rest of your home is downstairs, come down in the morning, go back up at night. If you need something upstairs in the meantime, maybe send somebody else up there. We don't want you to wear yourself out. Lastly, I'm going to talk to you about the different types of braces. This type of brace is like a corset and this brace would be used for a lumbar surgery or a low back surgery. How this goes on is you let the Velcro out and this piece actually goes over your abdomen. There's a little yellow tab at the top and this is how you know which way is up. It just comes around your abdomen and Velcros in. On each side, you have some pull strings that you can pull to tighten from there. These are helpful in adjusting your brace when you go from the laying position to the sitting position and then the standing position. These do have a tendency to ride up throughout the day. You would just want to take the time to readjust and put the brace backwards both to go. As far as physical therapy is concerned, I want to make sure that you know how to put your brace on and off properly without breaking your back precautions. You will get more instructions on how to use this brace. When it comes off, you're just relaxing your strings and unvelcroing from there. Now I'd like to show you the brace for cervical surgeries. In the front, notice the yellow circle. This is the front of the brace. This is how you know which way is forward. I'm going to use Mary to demonstrate how this brace goes on. On both sides, you have a velcro strap on either side. You're going to take the velcro off and place the brace under your chin. You velcro in. Your chin should be above the brace and not tucked down inside like so. Very good. To take the brace off, again, just take the velcro off and slide it forward. Thank you, Mary. Now, not everybody gets a brace after their back or neck surgery. It depends on if your surgeon has ordered one for you or not. He may feel that your muscles may need a little extra help and support while you're healing and in that case, would order you a brace. However, in some cases, your surgeon feels that he would like your muscles to start in rehab and work from the very beginning and in that case, you would not have a brace. It's different from patient to patient. Your frequency of the brace is also different from patient to patient. Your surgeon may say that he wants the brace on for the first, eh, three to four weeks, sometimes six to eight, sometimes maybe just a week, it's different for everybody and you will know what the frequency is and how long he would like you to wear it as well as how often would he like you to wear it. In some cases, he wants you to have it on at all times and only off to shower, for example, or in other cases, only when you're up walking do they want it on. When you're resting in a chair or resting in bed, you don't need it on, so it's different. We'll give you those instructions and you will know that. The last thing that I would like to talk to you about is walking. We want you to be doing lots and lots of walking. That is the form of exercise that we would like you to do. I can't give you exercises for your arms or for your legs. We just want you walking. The only exception is for our cervical surgeries, you can add shoulder rolls to help with the tightness and the tension that you may have. Now, how do you know if you're doing too much? Well, for example, let's say that I had numbness and shooting sharp pain down my right leg before I had my surgery. I had my surgery and it's feeling much better and I'm going for my walk and let's say as I'm walking, I start to feel a little twinge down my butt cheek into the back of my leg. That's kind of weird and I walk a little more and I feel it traveling even farther. That's your body telling you that you're doing too much and you need to slow it down. You didn't ruin your surgery. Probably what's happening is swelling is increasing and you just need to slow down. Everybody's different. Listen to your body. More frequent short walks is going to be better for you than long, long one or two walks, okay? So you want to keep it nice and short and to your tolerance. Everybody is going to be different. We want you to stay away from treadmills. Let's say, for example, you have a muscle spasm while you're on the treadmill and you need to stop. The treadmill's not going to stop for you. That's why we'd like you to stick to even surfaces. Don't go out hiking out back. We've all done that. You step in a hole and you don't know what's there in that shack that you get. Definitely don't want that. We don't want you tripping on anything. So stick to the even surfaces. Not everybody gets physical therapy after they've had a back surgery in the hospital. If you're having difficulty, for example, doing your log rolling or getting up and down out of the chair, but in most cases, physical therapy isn't needed. So good luck to you. Hello, my name is Mary and I work here at MidMichigan in the Occupational Therapy Department. Now that you've heard everything about the BLT, no bending, lifting or twisting, you're probably wondering how you're gonna be able to get dressed when you get home. I have some special equipment that will help you with this. These are things that you may want to consider purchasing ahead of time or after your surgery to make it easier for you to get dressed, such as a long handled sponge, which will allow you to wash your feet after surgery and a long handled shoehorn to make it easier to put your tennis shoes on. You may also want to consider what we call a reacher or a grabber. This tool will allow you to put your pants on without bending over and breaking those precautions. In order to put on a pair of pants using the reacher, you will be in the seated position. You can fan the pants out in front of you and grab the front of the pants with the reacher. You're gonna put one foot in and the other without bending over. You will have to pull the pants up using the reacher until you get your pants to where you can reach them without bending over. Once you get your feet all the way through, you can then stand up without bending your back and pull the pants up. You can also use a reacher to help you pull your pants down. Once you have them down and back in the seated position, you can use the reacher to pull the pants off. This will take some practice and some patience. This equipment can be purchased at any medical supply store. Sometimes they will come as a kit, which we refer to as a hip kit because we use this equipment with our hip replacement surgeries. Sometimes in the hip kit, you will also have a piece of equipment called a sock aid which helps you to put your socks on. However, the surgeons here at the hospital have told us that this puts too many pounds of pressure on your back. Therefore, we don't want you using the sock aid until your surgeon has told you you are allowed to. The other piece of equipment you may want to consider is a tub seat. The tub seat will allow you to have a rest while you take your shower. It's also slippery and dangerous that you could possibly fall while in the shower. You may want to consider a chair that has a back on it just for added support. If you do want a tub seat, you will want to look for something that has adjustable legs on it. This particular model screws up and down. However, there are models that have a push pin to make it tall enough. You for sure don't want to have anything that's too low where you're having difficulty getting up and down or breaking your back precautions. The tub seat will fit into the tub and instead of having to step up and over the edge of the tub, this will allow you to back up, reach for the tub seat, lower yourself down, keeping your back straight. You can then scoot your hips back and swing your hips or swing your legs into the tub. This makes it a safer option than trying to step up and over. Then you're just going to reverse it to come out of the tub. You can then dry off and apply your brace if necessary. The technique that we use to get into the tub is the same technique that you're going to use for getting in and out of the car. When I go to get into the car, I'm going to have the seat back as far as it will go. Then I'm going to approach the car the same way, backing up to it, feeling it on the back of my legs, reaching for the seat or the dashboard or both, just not the door, because the door is going to wiggle on me. So I want to reach for something that's sturdy. Again, keeping your back straight, have a seat, scoot your hips back if necessary, and then swing your legs into the car. You're just going to reverse it to come back out, keeping your back straight each time. You still need to wear your seatbelt, so make sure that you're not crossing and twisting your back, but grabbing the seatbelt with your right hand and crossing it over. The other thing to think about is you may want to remind your driver not to be a race car driver, because if you think about all the trunk and stomach muscles you use when you go to it, when you're accelerating and decelerating, you're going to want to avoid that in the car. The other thing they might want to avoid is potholes, which is difficult in Michigan, but you might want to take main roads rather than back country roads. The other piece of equipment you may want to consider is a toilet riser. The toilet risers typically look like this, just a donut, which have a groove in it so they don't slide off of the toilet. These toilet risers, we can order for you right here at the hospital. If you do not have a tall toilet at your house, you're going to need a toilet riser to avoid breaking those back precautions. Same rules apply, keeping the back straight, you want to just lower yourself down. If you don't have a countertop or a vanity next to you in your bathroom, you may want to consider something like this, which is a toilet safety frame. These two can be ordered or purchased at any medical supply store. Just some other general safety tips to think about once you return home after your surgery. Bethany already mentioned that you want to pick up your throw rugs and the other trip hazards that you may have at your home. Nobody wants to trip and fall after surgery. Other things to think about is you're not going to return home and be ringing the bell for service. You definitely need to be getting up and moving around. We recommend that you get up and move around approximately every 30 to 45 minutes. You already know the longer you stay in one position, the stiffer your back will feel or your neck. Taryn talked about doing those shoulder rolls. You want to be up and moving so that you don't stiffen up. The other thing to think about is you did have major surgery, so you are allowed to rest. Don't plan on going home and cooking a five course meal for your family. You need to be prepared and have things that are easy to fix, such as sandwiches or throwing something in the microwave. If you're the chief cook and bottle washer in your house, you might have to look at alternatives to meal preparation. You will be able to get things out of the refrigerator, but again, follow your back precautions. No twisting and getting things out and when you carry bigger objects, you can use the countertop to cruise along. The other thing to think about is your bigger chores, such as laundry. You won't be carrying the laundry basket or getting things from the washer into the dryer. You're going to break your back precautions if you do that. You certainly can stand or set and fold laundry, but you're going to need help carrying the laundry basket. You also won't be able to be running the vacuum or on your hands and knees scrubbing the floor. So you get out of chores for a little while. All of these things you will be able to get back to once your back precautions are lifted. Also, with outdoor activities, you need to think about having help with yard work, shoveling snow, raking leaves, any of those big chores out in the yard that require you to be bending, lifting or twisting. So make arrangements for assistance with that. The other safety things you want to think about is such as getting up in the middle of the night. Nightlights are a good thing to have since we all tend to walk like we're a little drunk when we're half awake. You will be on some pretty heavy pain medicines and you won't be too alert. So you'll want to make sure that you have a clear path and maybe even a lit path with a nightlight. The other thing to think about is you're not a prisoner in your home. So your family members or yourself, you can leave the house, but if they leave, you may want to have a cell phone or cordless phone with you just for safety. Thank you for listening to our video on your spine surgery. I hope that you've learned a little bit about your spine and ways to keep yourself safe following your surgery. The biggest thing that I want you to remember after this is to follow your precautions. Remember that BLT, if you can follow those precautions and be really patient until your surgeon tells you that you are able to lift more, bend and twist, you will be better off in the long run. Thank you.