Replacement Webinars for Baptist Health La Grange

Thank you for choosing Baptist Health LaGrange for your total shoulder replacement.

Today, we will discuss what to expect, what your treatment team will be doing, and what you will be expected to do in each phase of care.

We will start from the time the decision is made for you to undergo a total shoulder replacement and finish with the recovery phase of care.

Along the way, we will discuss how to prevent and recognize potential complications and an action plan on what to do when complications are suspected.

The purpose of a shoulder joint replacement is to relieve pain, improve mobility, and improve function.

There are two types of shoulder replacements. Here you see the standard shoulder replacement. It involves replacing the head of the humerus with a metal ball attached to a stem and replacing the glenoid fossa or socket with a plastic socket.

With a reverse total shoulder replacement, the humeral head part of the arm bone is replaced with a plastic socket or cap and the metal ball is attached to the existing socket or glenoid fossa. This procedure is preferred if there is rotator cuff damage.

After surgery, nearly all patients discharge home.

You should prepare for your recovery at home in advance.

Place frequently used items at eye level for ease of accessibility.

Cooking and freezing meals in advance is very helpful.

Eliminate falls risks by removing throw rugs and decluttering pathways. You should always wear good closed back non skid shoes. You can add handrails, grab bars, and night lights to help you as well.

You will need to arrange with a family member or friend to drive you to and from surgery and appointments. You may also need help at home after surgery, and having someone help with pet care is advisable.

Once your surgery is scheduled, you'll be sent two questionnaires in MyChart. If you do not have a MyChart account, these will be given to you in the physician's office. Many insurance companies require these functional and quality of life assessments, so please take the time to complete them.

You should shower with an antimicrobial soap the night before and the morning of your surgery.

At your preadmission testing visit, you will be given an instruction sheet on how to use benzoyl peroxide prior to your surgery.

Do not wax or shave for ten to fourteen days prior to surgery.

You will need to stop all alcohol use for at least one week prior to surgery, and you will stop tobacco use of any kind for four to six weeks prior to surgery.

Stop medications as instructed by your physician. Do not stop blood thinners such as Plavix, Xarelto, or Eliquis unless approved by the prescribing provider.

If you have a history of heart problems, you will need to get clearance from your cardiologist prior to your PAT appointment.

Prior to surgery, it will be helpful for you to have several items and articles of clothing at home that will aid in your recovery.

If you do not have these items already, we recommend purchasing them in advance.

It is best if you wear large loose fitting shirts with a button front, pull on pants with an elastic waistband, and slip on closed back shoes with good gripper soles.

Also, having a long handled reacher to help pick up objects that are out of reach as well as a long handled sponge to help with bathing is beneficial.

Please allow at least an hour for your pre admission testing or PAT visit. To avoid delays, please bring with you the physician's orders if they were given to you.

Also, bring all prescribed medications and over the counter medications in their original bottles or have a picture of the bottle on your cell phone.

Bring a copy of your living will or power of attorney documents.

Bring any recent test results you may have had done.

If you have a pacemaker, bring a copy of the ICD card and date of last function and battery life check. You will need to bring a copy of the cardiac clearance letter from your cardiologist if applicable, and you will need the phone number of your primary care physician and or cardiologist as well as a phone number of your pharmacy of choice.

The night before your surgery, sleep on clean sheets and do not sleep with your pets. The morning of your surgery, prior to your arrival at the hospital, there are several things that you should complete.

Make sure you complete all skin care as instructed. Remove fingernail polish and artificial nails. Take the morning doses of your medications unless directed otherwise by your physician.

It is okay and it is expected that you drink a twenty ounce Gatorade two hours before your arrival time. If you eat or drink anything within two hours of your surgery, your surgery could be canceled.

The morning of your surgery, make sure you bring loose fitting clothes and non skid shoes, your medication list, your insurance card and ID, and your insulin pump and or your CPAP machine if you currently use one.

The morning of your surgery, please arrive on time. This is typically two hours prior to your surgery.

At Baptist Health LaGrange, you will want to park in the back of the hospital near the emergency room entrance and enter through the emergency room. Walk to the registration desk and check-in for your surgery there.

Upon arrival, you will be placed in a preoperative room where the nursing staff will prepare you for surgery.

You will be visited by the surgeon and the anesthesiologist. The surgeon will mark the correct shoulder to be operated on while the anesthesiologist will do a brief examination, discuss anesthesia, and perform a pain block.

The surgery itself will last approximately two hours.

After surgery, you will be placed in recovery area where you will be monitored closely.

If you meet discharge criteria, you may discharge home that same day, or you may be transferred to the post surgery unit if you are spending the night.

To prevent delays in receiving pain medications that can occur by stopping at a pharmacy on your way home to pick up prescriptions, Baptist offers a meds to beds program where your discharge prescriptions are filled and delivered to you at your bedside before discharge. You will need your typical copay for outpatient medications at the time of delivery.

Two effective ways for controlling pain after surgery are repositioning and use of cold therapy.

Remember that pain medications can upset your stomach and it is best to take medication with food.

Also, is good to take the pain medication at the onset of pain rather than waiting until the pain is severe. Do not take the pain medications unless you are hurting. Take the medications as ordered and wean off the pain medications as quickly as possible. One of the ways that some patients wean off the pain medication is to alternate the pain medications with Tylenol. It is important not to exceed three thousand milligrams of Tylenol per day as this can affect liver and kidney function. Do not flush excess pain medications down the sink or toilet. Some pharmacies supply a disposal kit for you to use when pain medications are prescribed, but not all pharmacies do this. Return leftover pain medications to the pharmacy or mix them with kitty litter or coffee grounds in a sealed plastic bag and put them in the garbage.

Pain medication should provide you with four to six hours of relief. Do not take pain medication with alcohol or sedatives as this could depress the part of the nervous system that impacts your ability to breathe.

Do not share pain medication with others and do not take more medication than prescribed. The dose you are prescribed is specific to your needs and body size.

It is also important not to drive or operate heavy machinery within twenty four hours of taking pain medication.

Before surgery, your treatment team will discuss with you a proposed discharge plan.

Many people go home the day of surgery and some discharge home the next day. However, you will not be discharged home until you meet specific discharge criteria. Simply put, until you are medically stable and your treatment team feels that you are safe to leave.

It is wise to pack as if you are spending the night just in case.

Before you can be discharged to home, you must be medically stable with breathing, heart rate, temperature, and blood pressure within normal limits. You must be able to toilet and dress yourself. You'll need to demonstrate the ability to walk and climb stairs. The staff may have you march in place to simulate climbing stairs.

In addition, you must tolerate drinking liquids and eating food and have good pain control using oral medication.

If you are assessed to be at high risk for having problems urinating before surgery or demonstrate any difficulty urinating while at the hospital after surgery, you will be required to stay until you urinate an adequate amount without difficulty.

While in our care, we ask that you do not try to get up without staff present after surgery until the treatment team informs you that you are safe to do so.

After surgery, you will be given a special sling to wear.

You should wear the sling at all times except when bathing, dressing, and doing exercises unless instructed otherwise by your provider.

You can remove the sling two to three times a day to perform pendulum exercises and range of motion of the hand, wrist, and elbow.

To make yourself more comfortable, sit in recliner or prop up in bed. You can elevate your arm with extra pillows when in bed or sitting in a chair.

After surgery, there are several restrictions you must follow.

You should do no pulling, pushing, or lifting anything heavier than a glass of water with the arm that was operated on.

You will need to avoid putting weight through the arm that was operated on. You are not allowed to drive until you are out of the sling, off pain medication, and cleared by your surgeon.

There may be additional shoulder precautions reviewed prior to your discharge by your therapist or provider.

Physical therapy may or may not occur prior to your discharge.

You may begin your therapy either in your home or an outpatient center. The physical therapist will progress your exercise program based on the type of surgery that was done, your surgeon's preferences, and your overall condition.

Typically, you will do this exercise program at least twice per day.

General exercises to maintain range of motion of your elbow, wrist, and hand should be done several times per day.

Squeezing a ball helps maintain range of motion and strength in your fingers.

While frequent rest breaks are important in your recovery, lying around more than you are used to can lead to increased risk of blood clots and pneumonia.

It is important for you to do ankle pump exercises ten times every hour and be up and walking short distances every couple of hours while awake to prevent these complications.

Cold packs should be applied after completing your exercises and at any time you are experiencing pain in your operative extremity. Remember to place something such as a towel or a pillowcase between the skin and ice packs to protect your skin.

After your surgery, the incisional site will be covered with a postoperative dressing. Keep this dressing in place and keep the dressing dry as instructed by your provider and contact the office if the dressing becomes soiled or loosened. It is also important not to apply creams or ointments near the incisional site.

After surgery, you cannot soak in a tub, get in a swimming pool, or do any other activity where your shoulder would be submerged.

You will be able to sponge bath after surgery and shower five to seven days after discharge as instructed by your surgeon. You do not want to scrub or rub the incision, and you will want to pat dry the incision area with a clean towel.

Constipation can be caused by inactivity and use of opioid pain medication. To prevent this, you are encouraged to drink at least eight glasses of water daily, have a diet that includes fruits and vegetables, minimize your post op pain medication, and take frequent walks to remain active. Stool softeners and laxatives can be used if constipation becomes an issue.

Antibiotics are used during surgery, but there are several precautions you can take to help reduce your risk of infection. You will want to complete all the skin prep prior to surgery as instructed by your provider.

You and anyone who comes near you should wash their hands frequently.

This is especially important after going to the bathroom or blowing your nose and before eating.

Tobacco and alcohol both are associated with infection risk. You should stop use of both prior to surgery and you should not start back after surgery.

You will also want to keep your pets away from your incision.

The risk of pneumonia is increased after surgery due to inactivity and medication. The anesthesia and pain medications can have a sedative effect, so it is important after surgery to change positions regularly and to take frequent walks to remain active. You should sit up straight for all oral intakes, including eating, drinking, and medications.

It is equally important to exercise your lungs by taking deep breaths and coughing every hour while awake and you should use the incentive spirometer six to eight times per hour while awake. The nursing staff will show you how to use the incentive spirometer, and it is important for you to take it home with you for frequent use.

To help prevent blood clots after surgery, you should perform ankle pump exercises ten times every hour. And as mentioned several times already, take frequent short walks to stimulate circulation.

Medications are often prescribed for a brief period of time after surgery to help prevent blood clots.

To avoid shoulder dislocations, be sure to follow all the precautions related to movement and use of the arm and make sure you wear the sling as instructed. This includes the use of the abduction pillow attached to the sling to keep the arm in a neutral position.

Also, please inform your surgeon or nursing staff if you have a history of difficulty urinating before and or after surgery.

After surgery, you should expect pain, but the pain will decrease as you heal.

Pain medication is provided to help manage the pain.

After surgery, it is not uncommon to run a low grade fever for several days, and there may be a small amount of blood or drainage at the incision site.

Also, bruising and swelling of the shoulder, upper arm, and into the chest are possible.

After surgery, there are several issues that if experienced, you should call and inform your physician immediately.

These include running a persistent fever greater than one hundred and one point five, progressive pain swelling or redness of the shoulder, excessive bleeding or drainage at the incisional site, changes in skin color temperature or sensation of the arm, if the arm length appears to have changed, persistent nausea and vomiting, constipation that is not relieved with over the counter stool softeners or laxatives, difficulty urinating, or if you experience pain in your calf. Any of these conditions need to be addressed by your physician and you should call immediately and not wait until your scheduled follow-up office visit.

After surgery, there are several reasons that if experienced, you should seek emergency care for rather than calling your physician. These include chest pain or difficulty breathing, severe dizziness or loss of consciousness, changes in vision, and slurred speech. Go to the emergency room immediately if you experience any of these symptoms as they could indicate a severe life threatening condition.

Recovery after a total shoulder replacement depends on many factors including your age, overall health and fitness, and how well you adhere to your treatment plan. Your progress will be followed and monitored by your physician at regular intervals after surgery.

While you will be able to do simple tasks such as bathing and dressing within the first few weeks after surgery, getting back to a higher level of function may take up to twelve months.

As mentioned earlier, some insurance companies require functional and quality of life assessments to be completed at specific points before and after your surgery. These are brief questionnaires and will take less than five minutes to complete. It is important that you complete these surveys as this is one way that insurance providers such as Medicare assess the success of your surgery and all surgery performed at our facility.

If you have not already signed up for MyChart, please do so. It provides a means of communication between you and your physician's office that allows for quick answers to questions, requests for prescription refills, access to test results and physician notes, as well as an ability to schedule both in person and virtual visits. You can access MyChart on both your smartphone and computer. Please call the number listed for assistance with signing up for MyChart.

Thank you for choosing Baptist Health LaGrange for your surgical needs and for attending class. Please use your cell phone to access the survey form from the listed QR code or link provided. This survey will give you credit for attending class. We want your honest feedback. Any information provided will in no way affect the services and care that you receive at Baptist Health LaGrange.