Patient guide

Bring with you

• The images themselves: the CD or film of your MRI, CT and X-rays, not only the written report
• Any nerve conduction results
• Reports of earlier operations, and the names of any screws or implants in your body
• A list of all your medicines, especially blood thinners
• Someone with you, always for brain conditions

Note down before the visit

• When the pain or numbness started and how far it travels
• What makes it better and what makes it worse
• Which treatments you have tried, and how they went
• What you can no longer do
• Any problems with urine, stools or balance

What happens in the examination?

The doctor watches you sit, stand and walk, and may ask you to walk on your toes and heels. Muscle strength, feeling and reflexes are checked. Wear comfortable clothes.

Ask these questions

• Does the image finding match my symptoms?
• What happens if I do not have surgery for now?
• Which sign means I should not wait?
• If surgery is needed, what is its aim and what are the risks?

Be sure to say beforehand

The magnet is strong and some metals are a problem. Tell your doctor and the imaging centre if you have:

• An artificial heart valve
• A pacemaker or heart defibrillator
• A brain aneurysm clip
• A cochlear implant
• A recent artificial joint or a stent
• Kidney disease or dialysis (you may not be able to have contrast)
• Past work with sheet metal (your eyes may need checking for metal fragments)
• A fear of closed spaces

Mention any pregnancy too.

On the day

• Wear clothes without zips or metal buttons.
• Leave jewellery, watches, bank cards, hearing aids, glasses and hairpins outside.
• You may be asked not to eat for 4 to 6 hours beforehand. Ask the centre.

Inside the scanner

You lie on a narrow table that slides into a tunnel. It usually takes 30 to 60 minutes. The machine makes loud thumping and humming noises, and you can ask for ear plugs. An intercom lets you speak to the operator.

You need to stay still, because movement blurs the images. It does not hurt, and you can go back to your day afterward unless you had a sedative.

If you fear closed spaces

Say so early. You may be given a calming medicine or offered an open MRI. If you take medicine, bring someone to take you home.

After the MRI

Collect the CD and the report and bring them to your visit. The patient support network can arrange MRI appointments and send images to your doctor.

Tell your surgeon

• If you are or could be pregnant
• All the medicines, supplements and herbs you take
• If you have diabetes, heart disease or another condition
• If you drink alcohol
• Any new illness such as a cold, flu or fever. Surgery may have to be postponed

The week before surgery

• You may need to stop blood thinners and medicines such as aspirin and ibuprofen for a while. Do not stop them yourself; ask your surgeon.
• Ask which medicines you should still take on the day of surgery.
• Cut down or stop smoking. Smoking slows healing and raises the risk of blood clots.
• Prepare your home: things within reach, a safe bathroom, someone to help.

On the day

• Fast as instructed.
• Take the medicines you were told to take with a small sip of water.
• Arrive on time.

Before brain surgery, you may be asked to wash your hair with a special shampoo the night before.

Questions to have answered

• What operation, and with what aim?
• How likely are my symptoms to improve?
• What are the biggest risks for me?
• How many days will I stay in hospital?
• When can I walk, drive and go back to work?

What to expect

After a disc is removed, recovery is usually quick. You may still have pain, numbness or weakness along the nerve for a few weeks. Laminectomy and fusion take longer, and bone needs at least 3 to 4 months to heal well.

The wound

• Look at the wound every day.
• A little redness and numbness beside it is normal.
• Ask your surgeon when you can shower. Usually the wound stays dry for the first 5 to 7 days.
• Have someone help the first time, and cover the wound.
• Do not smoke. Smoking slows healing, especially after a fusion.

The support network can arrange dressing changes and stitch removal at home.

Moving

• Do not sit for more than 20 to 30 minutes at a time.
• Do not bend at the waist. Bend your knees to pick things up.
• Do not lift anything heavier than about 4.5 kilograms.
• Take only short walks for the first 2 weeks, then slowly walk further.
• Keep stairs to a minimum for the first 1 or 2 weeks.
• Do not start swimming, running or heavy housework until you have seen your surgeon.

If you were given a back brace, wear it as instructed.

Driving and work

Do not drive for the first 2 weeks. After that, drive only with your surgeon’s agreement. On long journeys, stop every 30 to 45 minutes to walk a little.

After a fusion, a young and healthy person in light work is off for about 4 to 6 weeks, and an older person with more extensive surgery for up to 4 to 6 months.

Call your surgeon if you have

• Chills or a fever of 38.3°C or higher
• A wound that is redder, more swollen or warmer, opens up or drains
• More pain where you had surgery
• A change of feeling in your arms or legs
• Calf pain or swelling
• A headache that usual medicines do not help

Emergency

Chest pain, shortness of breath, being unable to pass urine, or losing control of urine or stools cannot wait. Call 115.

What is normal?

• Itching, burning, pain and numbness along the wound
• A clicking sound where bone is healing (full bone healing takes 6 to 12 months)
• A little fluid under the skin near the wound, worse in the morning
• Headaches, especially with deep breathing, coughing or activity
• Low energy, which can last several months

Medicines

Ask your surgeon how long to take each medicine. Do not stop anti-seizure medicines or steroids on your own. Take only the pain relievers your surgeon recommends, because aspirin and ibuprofen may cause bleeding. Do not restart blood thinners without your surgeon’s agreement.

Wound and hair

• Keep the wound clean and dry.
• Wear a shower cap until the stitches or staples are out.
• After that, wash the wound gently and pat it dry.
• Do not put creams on the wound.
• Avoid wigs and hair dye for 3 to 4 weeks.
• Sleep with your head raised on several pillows.

Activity

• Start with walking and slowly do more.
• Use handrails on stairs.
• Do not lift more than 9 kilograms for the first 2 months.
• Do not bend from the waist to pick things up; bend your knees.
• Ask your surgeon when you can drive.
• Rest a lot, with naps during the day.

For the family

Note any change in mood, slower thinking or marked tiredness, and mention it at the visit. If you see more confusion or sleepiness than usual, do not wait.

Call your surgeon urgently if you have

• A fever of 38.3°C or higher, or chills
• Redness, swelling, discharge or opening of the wound
• A headache that medicine does not relieve
• Double vision or a change in vision
• More confusion or sleepiness than usual
• New weakness in an arm or leg, new trouble walking or balancing, or trouble speaking
• Fluid or blood dripping into the throat
• Swelling at the wound that has not gone after two weeks or is getting worse

Emergency

A seizure, being hard to wake, shortness of breath or chest pain cannot wait. Call 115.

First of all

In these cases, call 115 (Iran’s emergency number; use your local number abroad) or go to an emergency department. Do not drive yourself, and bring your medicines. If your doctor has told you something different, follow your doctor.

With back pain or sciatica

• Sciatica in both legs
• Severe or worsening weakness or numbness in both legs
• Numbness around the genitals or anus
• Trouble starting to pass urine, being unable to pass urine, or losing control of urine
• Not noticing the need to pass stools, or losing control of them
• Back pain after a serious accident

With neck pain

• New problems walking
• Losing control of urine or stools
• A sudden loss of co-ordination, for example with buttons

Signs of a stroke

• One side of the face has drooped
• One arm will not stay raised
• Speech is slurred or confused

Even if these signs pass, get help straight away.

With a headache

• A sudden start with extreme pain
• A seizure
• Numbness or weakness in the body or face
• Trouble speaking, balancing, walking or remembering
• Drowsiness or confusion
• Loss of vision
• A high temperature and a stiff neck
• A head injury in the past three months

After a blow to the head

• Being knocked out and not waking, or being unable to stay awake
• A seizure
• A fall from more than 1 metre or 5 stairs
• Problems with vision or hearing
• Clear fluid coming from the ears or nose
• New numbness or weakness
• A change in behaviour

If someone on a blood thinner hits their head or vomits, get medical advice soon.

Contact your doctor soon

These are not emergencies, but they should not wait:

• Back pain with fever, unexplained weight loss or a swelling in the back
• Back pain that is worse at night
• Heaviness or weakness in the arms or legs
• A headache made worse by coughing, sneezing or bending down