Surgery Guidance

Dr. Jurek wants you to feel as comfortable and prepared as possible before your surgery; please let us know if you have any questions or concerns about your surgical procedure. We will be happy to answer and address all questions!

• Do not have anything to eat or drink after midnight the night before your surgery (commonly referred to as “being NPO”).
• Please complete the medication/allergy list and bring it with you on the day of your surgery. Please include all current medications, including prescription medications, over-the-counter medications, vitamins, and supplements.
• Things to bring with you on the day of surgery:
  • Your photo ID
  • A copy of your insurance card
  • A method of payment for any co-pays required
  • CPAP machine if you use one for sleep apnea at home
  • Inhaler if you have asthma
  • A case/container to protect your glasses, contacts, hearing aids, etc.
  • Comfortable, easy-to-put-on clothes for after surgery to wear on the ride home

• Unless you are specifically instructed otherwise by Dr. Jurek, your primary care physician, or the anesthesiology team, please observe the following guidelines before surgery:
  • Stop all anti-inflammatory and all aspirin-containing medications (e.g., Ibuprofen, Motrin, Advil, Naproxen (Aleve), Excedrin, Anacin, or Naprosyn, etc.) 10 days before surgery. Tylenol (acetaminophen) is an acceptable replacement for aspirin or anti-inflammatory medications.
  • If you take Plavix, Coumadin, Xarelto, or other blood-thinning medication, please contact your prescribing physician to discuss when to stop these before surgery.
  • On the morning of your surgery, you should take all of your other usual morning prescribed medicines with a small sip of water. Use your asthma inhalers and bring them with you to the Surgery Center.

During your preoperative physical, your primary care physician should give you specific instructions on taking your diabetes medications. The Seattle Surgery Center will contact you before your surgery to confirm instructions related to your oral diabetes medicine or your insulin.

Notify Dr. Jurek at (206) 386-2600 if you experience any significant change in your health status, if you suspect you are pregnant, or if you develop a cold or flu, a bladder infection, diarrhea, or other infection before your surgery.

• Figure out your postoperative icing / cold therapy strategy and have it ready to go. See Cold Therapy Options for much more information. Options include:
  • Buying ice gel packs large enough for your shoulder with ACE wraps or shoulder-specific straps to keep them in place.
  • Purchasing an ice machine from our clinic (pick this up before your surgery to have it ready right after surgery).
  • Renting a Game Ready unit before surgery (this requires a prescription from Dr. Jurek’s office; please let us know if you are interested in this, and we can help).
• Figure out your sleeping setup. You will find that sleep is a significant challenge after shoulder surgery and that you will likely not be able to lie flat in your bed comfortably for a few weeks to even a few months after surgery.
  • An electric recliner is a great option, but a manual recliner, especially one with the lever on the same side as your operative shoulder, is NOT a good option after shoulder surgery.
    • Consider purchasing, borrowing, or renting an electric recliner (“powered lift recliner” is the best option) with remote control.
  • Another option is a foam wedge pillow to allow you to sleep more upright in your bed.
  • Propping yourself and your arm up with multiple pillows can also be helpful.
  • Using a neck pillow in addition to any of the options above may make sleeping easier as well.
• If applicable, consider setting up an appointment with Dr. Jurek’s assistant to have your shoulder immobilizer fitted for you before surgery.
• Make sure you have an easy way to stay hydrated after surgery (Nalgene bottle, large thermos, etc.).
  • Adequate hydration helps with postoperative pain control, reduces postoperative nausea, and helps with the healing process.
• Consider your plan for eating/cooking before and after surgery.
  • Consider your plan for making sure your nutrition is optimized both before and after surgery to help with healing.
    • If you would like to meet with a nutritionist a few weeks before your surgery to develop a comprehensive pre and post-surgical nutrition plan, please let Dr. Jurek know, and she can provide a referral.
  • Have mild foods like chicken broth and applesauce ready for when you come home in case of postoperative nausea.
  • Consider meal prep ahead of time to have easy-to-eat options ready after surgery.
• Consider increasing your fiber AND fluid intake in the days before surgery to help prevent constipation after surgery (see Constipation in Post Surgery Guidance section for more info).
• Take steps before your surgery to reduce the risk of tripping and falling after surgery. YOU ARE AT INCREASED RISK OF FALLING AFTER SURGERY WHILE WEARING A SLING.
  • Remove clutter from your living area. Move cords out of the way.
  • Clear the path from your bed to the bathroom of any obstacles to make it easier on yourself at night.
  • Purchase and install night lights where you will need them after surgery.
  • Simplify your living area to keep the items you need within easy reach and keep everything else out of the way.
• Talk to family and friends to set up help ahead of time for the days after surgery.
• Get a soft cloth or piece of clothing ready to put over your arm between the skin and the sling (the sling material can be quite irritating).
  • Long fuzzy socks with the toe cut out, a soft hand towel, a fleece baby blanket cut into quarters, and the cut-off sleeve of a soft long sleeve t-shirt have all been used successfully by Dr. Jurek’s patients.
• Consider strategies for personal hygiene/toileting. This is especially important if your shoulder surgery is on your dominant arm. Options include:
  • Practicing toileting with your non-operative hand
  • Utilizing baby wipes
  • Utilizing squeeze bottles pre-filled with soapy water and water to rinse
  • Installing a toilet seat bidet attachment
• Consider these daily living hacks:
  • Shampoo, conditioner, liquid soap, and lotions in pump bottles for easy use
  • A blow-dryer stand for use when you are restricted from actively lifting and using your operative arm postoperatively
  • Front-closing T-back/racerback bras, camisoles, and tank tops with built-in bras instead of rear-clasp bras with straps over the shoulder
  • Dog leash that attaches around your waist (and a well-behaved dog)
  • Easy-to-put-on clothes:
    • V-neck t-shirts, loose shirts with large neck openings, and oversized button-up shirts to wear postoperatively
    • A vest instead of a jacket
    • A hoodie with a 4-5 inch vertical cut at the front of the “head hole”
    • Sweatpants/joggers with elastic waistbands
      • Avoid tight-fitting pants with buttons and zippers; these will be a challenge for a while after shoulder surgery
    • Slip-on shoes with good tread

• We recommend that all patients shower the night before and the morning of surgery with CHG (chlorhexidine gluconate solution, also known as “Hibiclens”). This can be purchased at any drug store or picked up in the clinic.
  • Night Before Surgery
    • Lather the CHG in your hand or a washcloth.
    • Clean your body from the neck down. Do not use CHG on sensitive areas such as your face or bikini region. Use normal soap in these areas.
    • Let the CHG sit on your skin for 60 seconds, then rinse off.
    • Dry off with a clean towel and put on clean pajamas.
    • Sleep in a bed with clean sheets.
  • Morning of Surgery
    • Follow steps 1 & 2 from your night shower.
    • Spend extra time cleaning your operative shoulder and armpit area.
    • Rinse and pat dry with a clean towel. Put on clean clothing that you will be wearing to surgery.
    • Do not put on any makeup, lotions, hair products, or perfume.

• Different surgeries have different precautions; these will be discussed ahead of time with you by Dr. Jurek and provided to you in detail in the post-operative instructions you obtain before leaving your surgery. If you have specific questions regarding this before your surgery, please let us know!
• If we require that you use a sling or shoulder immobilizer (see Brace Information for instructions and videos), we will provide this for you after your surgery.
  • If you will need a shoulder immobilizer after surgery, it is possible (and even preferable) for you to be fitted ahead of time for this. Please talk to Dr. Jurek’s assistant about scheduling a time before your surgery to do this.
  • If you have your own items, we encourage you to bring them with you to surgery.

• Shower and put on clean clothes (see Preventing Infection above for more details). This will help minimize the risk of infection.
• Wear comfortable clothing that is easy to get on and off and will fit over any bandages/operative area after surgery. Oversized button-up shirts or stretchy shirts with a large neck opening and large armholes work best following shoulder surgery.
• You may brush your teeth; rinse your mouth out but do not swallow the water.
• Do not wear any makeup. Please remove all fingernail polish.
• Please remove all jewelry, including your wedding ring, if you are having shoulder or elbow surgery.
• If you wear contact lenses, glasses, or hearing aids, please bring a case or container and the solution for contacts to hold and protect them while you are in surgery. If you wear contacts, the anesthesiologist will have you remove them before surgery (bring your glasses for after surgery).
• Minors (anyone younger than 18 years old) must be accompanied by a parent or legal guardian to sign the operative consent form and discuss anesthetic risks with the anesthesiologist.
• Before surgery, you will have the opportunity to meet with your anesthesiologist to discuss the anesthesia most appropriate for your medical condition and procedure, as well as to discuss any questions or concerns you may have. If you wish to speak with the anesthesiologist before your day of surgery, you may contact Seattle Surgery Center to arrange this at (206) 382-1021.
• After your surgery, you must be escorted/driven home by a responsible adult. You may take a taxi cab or shuttle if accompanied by a responsible adult (someone you know and trust) who can stay with you after the driver departs.

Most patients are in the recovery room for 1-2 hours following surgery before they are awake enough to return home (or transfer to the hospital room if staying overnight).

• Your follow-up visit for after surgery will be scheduled ahead of time when you schedule surgery in our office. This first postoperative visit is typically 7-10 days after your surgery.
• You can schedule physical therapy to start after surgery. Dr. Jurek typically has you begin physical therapy after your first postoperative visit.

• RELAX and take it very easy.
  • Seriously, take it easy. You just had surgery. Give yourself permission to rest and recover.
  • Do not do anything strenuous or important for a couple of days after surgery.
  • Expect to feel more tired than usual.
  • Expect to need help doing things you usually can do on your own.
  • Don't worry; you will start feeling much better after a few days.
• Your balance may be significantly impacted after surgery due to medication, pain, and wearing a sling. Be very aware and very careful to protect yourself from injury and falls.
• Do not drive, operate machinery, consume alcohol, sedatives, or tranquilizers, make important personal or business decisions, or sign legal documents for 24 hours or as long as you are taking narcotic pain medication.
• Do not plan on going to work or school on the day of surgery or the day after surgery. Go home and rest.
• Begin with clear fluids and light foods, and then progress your diet as tolerated. It is usually best to avoid heavy, greasy, or spicy food on the day of surgery.
• Narcotics cause constipation, so increase the amount of fluid (especially water), fiber, and fruit in your diet. Some over-the-counter medications to prevent or treat constipation are Metamucil, Citrucel, Colace, Docusate Sodium, and probiotics. You can also drink warm prune juice. If you are constipated after surgery, over-the-counter liquid magnesium citrate, taken as directed, can be used.
• It is essential to eat some food every time you take narcotic pain medications (even in the middle of the night). If you don’t, you are more likely to have nausea. Usually, a few crackers, applesauce, or a banana will suffice.
• Some anesthetics can cause urinary retention. If you are having trouble emptying your bladder or have not urinated for 8 hours after the anesthetic, please call Dr. Jurek at (206) 386-2600.
• You can reach Dr. Jurek any time of the day or night by calling (206) 386-2600. After hours, the answering service will page Dr. Jurek.

• Different surgeries have different precautions; these will be discussed ahead of time with you by Dr. Jurek and provided to you in detail in the post-operative instructions you obtain before leaving your surgery. If you have specific questions regarding this before your surgery, please let us know!
• If we require that you use a sling or shoulder immobilizer (see Brace Information for instructions and videos), we will provide this for you after your surgery.
  • If you will need a shoulder immobilizer after surgery, it is possible (and even preferable) for you to be fitted ahead of time for this. Please talk to Dr. Jurek’s assistant about scheduling a time before your surgery to do this.
  • If you have your own items, we encourage you to bring them with you to surgery.

• Be aware that pain after surgery is normal and is expected. The goal of pain medications is not the complete absence of pain (this is an unrealistic goal) but rather to make postoperative pain tolerable.
• Additional modalities may also help relieve pain, including icing (see Cold Therapy Options), elevation, massage, gentle passive motion, and meditation (click here for a terrific meditation app).
• You can expect to experience the most intense pain after surgery within the first 24-72 hours.
• Shoulder surgery is notorious for causing significant pain at night when you are trying to sleep.
• We recommend taking your narcotic pain medication on a routine schedule for the first 24-72 hours.
  • During this time, check-in every 3-4 hours to note if your pain is staying the same or increasing.
    • If your pain is increasing, do not wait until it is severe before taking your next dose of pain medication. You want to keep ahead of your pain instead of falling behind and then trying to play catch up.
    • If your pain is the same as it was one hour prior, do not take a dose of pain medication, but instead wait an hour and reassess; then follow the advice above.
  • Staggering your intake of the narcotic pain medication, Tylenol, and anti-inflammatory medication (such as Meloxicam, ibuprofen, or Motrin) so that you do not take these medications all at once will help stabilize and reduce your pain. This technique also helps reduce your need for narcotic pain medication.
    • The maximum safe dose of Tylenol (acetaminophen) over 24 hours from all sources combined is 3000mg. Do not exceed this limit.
    • We recommend not consuming alcohol while you are taking a maximum daily dose of Tylenol.
  • As your pain diminishes over the first few days after surgery, reduce the amount of narcotic pain medications you are taking while continuing with the same dose of Tylenol and anti-inflammatory (if you are taking one) for a few more days.
  • Be aware of the common side effects of narcotic pain medications:
    • Constipation
    • Nausea/vomiting
    • Stomach pain
    • Drowsiness/fatigue
    • Dizziness
    • Headache
    • Itching
    • Dry Mouth

• Constipation (defined generally as difficulty having bowel movements) is incredibly common (and very unpleasant) after surgery. It can be caused by narcotic pain medications, general anesthesia, and prolonged inactivity.
• Prevention is the best approach.
  • Increase your daily intake of fiber (do this in the days ahead of surgery and after surgery).
  • Stay hydrated (6-8 glasses or 1.5-2 liters of fluids per day).
    • Fluids that count towards hydration: flat or sparkling water, milk, decaffeinated coffee/tea, coconut water, broth, sports drinks, vegetable/fruit juices.
    • Consuming more than 2 cups of caffeinated coffee per day counts against your fluid goals.
    • Alcohol is a huge dehydrator. Avoid drinking alcohol the month after your surgery.
  • Within reason, try to be active and up moving and walking around. This will help stimulate your bowels.
  • When you feel the need to go, go! (Don’t hold it!)
  • Decrease the amount of pain meds you are taking as soon as you are able.
  • Add fiber. Most adults should get between 22 and 34 grams of fiber per day.
    • Fiber-rich foods include fruits, vegetables, whole grains, and legumes.
      • Excellent fiber options include beans, bran, apples, pears, prunes, squash, sweet potatoes, spinach, and collard greens.
      • Many cereals, such as bran flakes, are good sources of fiber.
    • Smoothies with fruits and vegetables in them are good options if your appetite is low after surgery.
  • Take one or more of the following over-the-counter medications while you are taking narcotic pain medications:
    • Docusate 250 mg by mouth, twice a day
    • Senna 17.2 mg by mouth, once a day
    • Miralax 17 gm by mouth, once a day
  • Treatment of Constipation:
    • If you have not had a bowel movement 2-3 days after surgery, take one of the following over-the-counter medications until your bowel regimen returns to normal. Stop taking these if you develop diarrhea.
      • Miralax + electrolyte drink. Mix 32 oz. of your electrolyte drink of choice (Gatorade, Powerade, Nuun, Pedialyte, etc.) with Miralax (4 oz. or 119g). Drink 8 oz. of the mix every 15 minutes so that you finish drinking the entire 32 ounces over 1 hour.
      • Magnesium citrate (liquid). Take this medication with a full glass of water. Taking this medication should produce a bowel movement within 30 minutes to 6 hours.
      • Bisacody|5 mg by mouth once a day. Taking this medication should produce a bowel movement within 6 to 12 hours. Do not take within 1 hour after drinking or eating dairy products.
      • Fleet Enema. 133 mL rectally, once a day.
    • See a doctor for your constipation if:
      • Your constipation lasts for more than 4 days.
      • You have abdominal or rectal pain, nausea, and/or vomiting.
      • You have bright red blood in your stool.

• Patients who are properly hydrated report less nausea (and less pain) after surgery.
• General anesthesia and opioid pain medications both increase the risk of postoperative nausea and vomiting.
• Nausea caused by narcotic pain medications is dose-dependent, meaning the more narcotic pain medication you take, the more nauseous you are likely to feel.
  • Reducing the amount of narcotics you are taking as soon as you can is one of the best ways to reduce postoperative nausea.
• Jurek will prescribe an anti-nausea medication called Zofran (ondansetron). Take this as directed if needed!
  • If you feel nauseated, place the tablet on your tongue and allow it to dissolve in your mouth without chewing.
• Strategies to treat postoperative nausea:
  • Stay hydrated.
  • Reduce your narcotic pain medication intake.
  • Take Zofran as directed.
  • Return to your regular diet slowly. Start with small amounts of clear fluids over a few hours and then slowly transition to soft foods and then to regular foods as tolerated.
  • Avoid strong smells (these can trigger nausea).
  • Consider trying homeopathic remedies (ginger, acupressure, and peppermint aromatherapy can sometimes help).

• Patients who undergo any surgery are at an increased risk of a blood clot after surgery.
• A DVT (deep vein thrombosis) is a blood clot that forms in the deep veins of the leg or arm. This can lead to a PE (pulmonary embolism) where the blood clot travels up through the right side of the heart to the lungs, where it can block blood flow to the lungs, which can be life-threatening.
• Prevention strategies after shoulder surgery include avoiding sitting or lying in bed for prolonged periods, performing regular lower extremity exercises such as ankle and leg lifts while sitting or laying down, and abstaining from nicotine products or smoking cigarettes if you are a smoker.
• If you have a personal or family history of blood clots or significant risk factors, Dr. Jurek may prescribe a blood thinner medication for you to take postoperatively to reduce your risk of a blood clot.
• Seek immediate medical attention if:
  • You develop chest pain.
  • You develop shortness of breath.
  • You develop swelling or pain in your calf (frequently described as a “charlie horse” in the calf that doesn’t go away).
  • You feel dizzy or lightheaded.
  • You experience excessive sweating.

• See Cold Therapy Options for detailed information.
• We strongly encourage you to use ice or a form of cold therapy after your surgery to help with pain control and swelling.
  • This will make your recovery after surgery much more comfortable.
• If you are interested in obtaining an ice machine, a DonJoy IceMan CLEAR3 may be purchased for $150 at the clinic.
  • This ice machine provides extended cold therapy to your shoulder. It has been incredibly well-received by Dr. Jurek’s patients as a very effective way to reduce pain and swelling after surgery.
• Talk with Dr. Jurek if you are interested in renting a Game Ready unit (this prescription-only device provides active cold and intermittent compression therapy to your shoulder) for use after your shoulder surgery.
• If you are using an ice pack, make sure that you protect your skin with a layer of cloth between your skin and the ice to avoid thermal injury, and only use the ice pack for 20 minutes at a time.

• You may be required to wear a sling or a shoulder immobilizer after surgery. Click here for instructions on how to fit your brace properly.
• After surgery, you should wear your sling/immobilizer at all times except for showering and during gentle range of motion exercises of your shoulder and elbow. Dr. Jurek will see you for your first postoperative clinic visit 7-10 days after surgery and will go over the timing of when you can safely stop wearing your shoulder brace.

• Swelling and bruising around and below the surgical site is normal and expected.
• Shoulder surgery frequently causes swelling and bruising down your arm into your arm, forearm, hand, and fingers.
• Gently elevating your arm, hand, and fingers on pillows above the level of your heart while you are seated or lying down will help prevent and reduce this.
  • Gently squeezing the foam ball provided to you with your shoulder immobilizer will also help reduce hand and finger swelling.

• Different surgeries have different precautions; these will be discussed ahead of time with you by Dr. Jurek and provided to you in detail in the post-operative instructions you obtain before going home.
• Unless specifically instructed otherwise, take it very easy with your operative extremity until you see Dr. Jurek in the clinic for your first follow-up visit. Don’t try to use your hand to do or lift anything.
• To avoid stiffness, make sure to gently move your elbow, wrist, hand, and fingers 3-4 times a day for a few minutes at a time. Use your other hand to help do this gently and safely.
• Squeezing a foam ball throughout the day will help reduce swelling and stiffness in the hand and fingers.

• Always clean your hands before and after caring for your incisions.
• Keep pets away from your incisions until they are healed.
• Avoid lotions or perfumed soaps on the incisions until they are healed.
• Do not place antibacterial ointments (bacitracin, Neosporin, etc.) on your incisions. This will break down the normal, healthy bacteria on your skin and cause irritation/skin breakdown.
• Make sure the sheets on your bed and the clothes you are wearing are clean.
• Do not allow family and friends who visit to touch the surgical dressing or incisions.
• Do not soak the surgical site (bath, hot tub, pool, lake, ocean, etc.) for a minimum of 2 weeks after surgery and until your incisions are completely healed.
• Once your incisions are completely healed, there are techniques you can utilize to help reduce scarring:
  • Gently massage your incisions with your finger a few times a day to break up and soften the scar tissue.
  • Apply a silicone scar sheet over your incisions to help soften and hydrate your skin and reduce the appearance of the scar.
  • Keep your incisions out of the sun. Use band-aids or silicone scar sheets if needed.

• The dressings covering your surgical incisions are waterproof and may be left in place until your first postoperative follow-up visit.
• If your dressings become wet or saturated, it is okay to remove them and replace them with sterile bandages/band-aids.
• It is normal for your dressings to have some blood pink-tinged fluid on them. Please call Dr. Jurek’s office if you are concerned about bleeding or drainage after surgery.

• You may shower as soon as you feel safe and ready to do so after your shoulder surgery.
• Take extra care in the shower to avoid slipping.
• You may take off your sling or shoulder immobilizer and hold your arm to your side with either your elbow bent or your arm hanging straight down.
  • If you feel more comfortable, you can use a second sling in the shower and allow it to get wet.
• Your dressings are all waterproof, and it is OK to get them wet. If they inadvertently become saturated in the shower, finish showering with the dressings on, remove them once you are out of the shower, allow your skin to air dry, and replace them with dry, sterile dressings or band-aids.
• Do not soak in a tub or go into a hot tub until your stitches are removed (if necessary), and your incisions are fully healed (this is usually a minimum of 2 weeks after surgery).
  • Tubs are very slippery, and extra care is required to enter and exit a tub after shoulder surgery while you are still recovering.

• An estimated timeframe on returning to driving is determined on a case-by-case basis, depending on your surgery.
• You may not drive until you are off all narcotic pain medications and are not in pain.
• For shoulder and elbow surgery, you must be out of the sling and have a good range of motion at your wrist, elbow, and shoulder.
  • You must feel comfortable making sudden movements.
• Check out this Ortho-pinion blog on “Can I drive in a sling?” for more information.

• You will be sent home from the surgery with gentle range of motion exercises that you may perform on your own at home starting a few days after surgery.
• For all shoulder surgeries, you may begin formal physical therapy (PT) after your follow-up clinic visit with us. A PT prescription will be given to you at your post-operative visit.
• Depending on your particular surgery, you may wait 6 weeks after surgery to start regularly attended physical therapy sessions (usually 1-2 times a week) but can schedule a visit or two after your first post-op follow-up visit and before the 6-week mark to establish care, start a gentle range of motion program, and help with secondary issues like neck and shoulder blade pain after surgery.
• You may go to any physical therapy clinic; we recommend something close to your home/work/school and are happy to make recommendations.
• We recommend you call the PT clinic ahead of time to pre-schedule appointments. You can do this before surgery or in the first week or two following surgery.

• The best nutrition plan in the weeks before surgery and in the months following surgery is a well-balanced diet that focuses on ensuring adequate protein intake (plant-based protein and/or animal protein).
• If you would like to meet with a nutritionist a few weeks before your surgery to develop a comprehensive pre and post-surgical nutrition plan, please let Dr. Jurek know, and she can provide a referral.

• If you have had shoulder replacement surgery, then this applies to you.
  • In the future, any time when you have surgery, dental work, or develop an infection of any kind (e.g., bladder, tooth, ear, respiratory), you MUST notify your surgeon, dentist, or doctor if you have had an artificial shoulder joint replacement. In these situations, antibiotics are often used to prevent artificial joint infections. Call your doctor’s office if you have any further questions or concerns.
  • Jurek will prescribe antibiotics for you to take before any dental procedure for at least one year after your shoulder replacement surgery. In certain situations, this may be extended beyond one year.