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I am having a lumbar spinal fusion in three days. What can I do to make sure I have the best possible results? I know it's ultimately in the hands of the surgeon (and God) but I don't intend to be a passenger on the ride. What are your suggestions?

First of all, follow all directions given you by your surgeon and surgical team. By now you have probably received your pre-operative instructions. This usually involves getting good nutrition, adequate fluids (clear nonalcoholic liquids), and rest. Certain medications will be tapered or stopped (e.g., aspirin, Plavix, coumadin/warfarin). Tobacco use in any form must be stopped. Take all medications as directed, especially pain meds. Studies show that patients who use more (not less) narcotic medications (as directed) before surgery have faster postoperative recovery and thus shorter hospital stays. This strategy of preoperative pain control is thought to be protective -- it keeps the nervous system from setting up a pain response to the surgery. Surgeons may administer oral narcotics as more of a pre-emptive strike to lower the overall pain experience before and after surgery. The end result is a happier, healthier patient. A small financial investment before surgery (i.e., the cost of the drug) can mean a large (thousands of dollars) post-operative savings. After surgery, follow all directions given you by your surgeon and hospital staff. This will include your nursing staff and physical therapist. Keep your pain under control as directed. Many patients try to hold out as long as possible before asking for pain medication. This has been proven unwise -- staying ahead of the pain is a good way to ensure a safe and fast recovery. Some of the important factors in achieving the best possible results depend on your surgeon. Shorter operative times (less time under anesthesia, less blood loss, less time with a decreased core body temperature) are all linked with better results and shorter hospital stays. The longer operative time is important because your body temperature drops as a result of the anesthesia. Decreased body temperature has been linked with heart attacks, death, infection, and problems stabilizing blood. This factor (longer operative time) is important for the surgeon to keep in mind. And also for the surgeon, another significant predictive factor of a longer hospital stay is the use of crystalloids and colloids and the ratio between them. These fluids are used to help keep your body hydrated and replace fluids lost due to bleeding. The longer the operative time, the more fluids are "pushed" so-to-speak. This finding suggests that a more "restrictive" use of fluids may be better than a "liberal" amount. And other studies have shown better postoperative results with fewer lung problems when lower amounts of fluids are given during the surgery. And finally, of course: pray as directed! As you say, ultimately it is in your God's hands. But that doesn't mean the patient, surgeon, and hospital staff can't help out, too!

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