For Patients

Urgent Care

If you are experiencing an urgent need for care due to a traumatic injury, please go to the Emergency Department of the Nanaimo Regional General Hospital.

Orthopaedic surgeons from our clinic are on call at the hospital for emergency orthopaedic needs.

Getting A Referral

To see one of our physicians at Nanaimo Orthopaedics we require a referral. To do this, book an appointment with your family physician. Your family physician will examine you to understand the nature of your health issue and concern. If they feel a referral to Nanaimo Orthopaedics is appropriate, they will complete a referral during your visit and the referral will be sent to us. If you do not have a family physician, go to a walk-in clinic where they can also do the same for you. During your appointment with the family physician, they will ask questions to best understand the nature of your issues and will put this information into your referral. This referral is vital in helping Nanaimo Orthopaedics ensure you are directed to and receive the most appropriate care by one of our physicians.

As part of your referral, you will be given the option of being seen by our “First Available Appropriate Physician”.

What this means is you will be seen by the physician in our clinic who is appropriate for your health issue and has the shortest wait time for an appointment. After we receive your referral, you will be added to our wait list. One of our administrative staff will contact you to confirm your appointment date and time approximately 2-3 weeks prior to your appointment

Your Appointment

We know your appointment with one of our physicians is important to you. To make the most of your appointment it is best to be as prepared as possible. This includes having the information we will need from you. Please let us know if there is anything we can do to further improve your experience with us at Nanaimo Orthopaedics. We look forward to seeing you.

Notification of your Appointment

At Nanaimo Orthopaedics, we book our appointments 2-3 weeks in advance. You will be contacted to confirm your appointment date and time. If during your family physician’s visit, you indicated a preference to be contacted via text or e-mail we will contact you in this manner.

What to Bring to Your Appointment

We recommend you arrive 10-15 minutes prior to your scheduled appointment time to ensure you have enough time to complete any necessary paperwork. In order for your visit with us to run smoothly, we ask you to bring the following items with you to your appointment:

• Your provincial Health Card or Driver’s Licence and Services Card

  We do ask that you bring your provincial insurance card so our office can ensure coverage for your appointments.

• Medical Information

  Please bring the following:
• Medication List- Please bring a list of all medications that you are currently taking, along with the dosage and frequency with which you take the medication. Please include supplements and over the counter medicines that you take on a regular basis.
•  Allergy List- Please provide a list of any allergies that you currently have including medication allergies.
• Other information- Any information you feel may be helpful in assessing your condition.

• Comfortable Clothing

  Please wear clothes that allow you to show the affected body part easily. For women with an upper body (shoulder, elbow) injury, please bring or wear a sports bra or tank top without underwires. Those with a lower body (hip, knee, foot, ankle) injury should wear or bring shorts.

Preparing For Surgery

With joint replacement surgery, you will be required to stay at the hospital for approximately X days. On the first day you will be admitted, have your surgery, and then be put into a bed in an “inpatient” unit to begin your recovery. During your initial appointment at Nanaimo Orthopaedics, the physician will have told you what type of surgery you will be having.

Approximately 1 week prior to surgery, Nanaimo Orthopaedics will contact you to remind you of your appointment. It is important that you confirm your surgery with us. If you do not confirm, there is a possibility that your surgery may be cancelled.

The Pre-Admission clinic will call you the day before your surgery (mid to late afternoon) to inform you when you need to come to the hospital. Keep in mind that it could be as early as 6:15 am.

Instructions to prepare you for your surgery

Medications:

• Take all prescription medications as usual unless told not to by your anesthesiologist, surgeon, pre-admission nurse or other specialist. You may take all allowed medications with 30 ml (1 ounce) of water per pill up to one hour before surgery.
• If you take any of the following medications, you must get specific instructions from your surgeon, anesthesiologist or specialist at least 14 days before surgery:
• o Diabetes medication e.g. chlorpropamide, glyburide, metformin, insulin
• Blood thinners e.g. Coumadin (warfarin), Heparin
• Antiplatelet medications e.g. clopidogrel (Plavix), Ticlid, Acetylsalicylic acid (ASA, Aspirin)
• Blood pressure medication
• Non-steroidal ant-inflammatory (NSAIDS) medications e.g. Motrin, Advil, Naprosyn, Torodal, Celebrex
• 7 days before surgery, stop taking Vitamin E and all natural health products including herbal remedies e.g. Garlic, Gingko, Kava, St. John Wort, Ginseng, Dong Quai, Glucosamine, Papaya, etc.
• Do not take regular vitamins and iron supplements on the day of your surgery. You can take them until the day before surgery.
• Acetaminophen e.g. Tylenol may be taken for pain when necessary up to and including the day of surgery

Eating and drinking before surgery: your stomach needs to be as empty as possible. This helps prevent vomiting that could cause choking or stomach contents going into your lungs during surgery. Your surgery will be postponed if you do not follow food and fluid (fasting) instructions.

NO SOLID FOOD after midnight the night before surgery including chewing gum or hard candies.

NONE of the following FLUIDS after midnight the night before surgery: Milk, non- dairy creamer, protein beverages, dairy beverages, tomato or orange juice with pulp, or alcoholic beverages.

It is very important to continue to drink CLEAR fluids until bedtime. This will keep you from getting dehydrated. Clear fluids are allowed until 3 hours before your surgery time. Clear fluids allowed include: water, clear tea, black coffee, fruit juice with NO pulp (apple juice, cranberry juice), carbonated beverages, popsicles, and jell-o.

You may brush your teeth the morning of your surgery.

What to Bring to the Hospital

• Your BC Care Card or proof of substitute Medical Insurance Plan. If you do not have these, bring another form of personal ID
• An interpreter, if you do not understand English
• Reading material, glasses or contact lenses, hearing aids, and dentures with storage cases labeled with your name
• CPAP, bi-level machines or dental device if you use one for sleep
• If required, a shoulder brace is to be brought in BEFORE your surgery.
• Any crutches, cane, braces, or walker that you have been told by your surgeon that you will need, labeled with your name, AFTER your surgery.
• Loose fitting clothing that is easy to get off and on and low heeled, sturdy shoes.

What NOT to bring or wear

• Jewelry or body piercing items. Have custom piercings and tight fitting rings professionally removed before coming to the hospital.
• Personal items such as credit cards, MP3 players, tablets, or computers.
• Cash in excess of $20
• Do not wear make-up, false eyelashes, scented perfume or aftershave, hairpins, deodorant or talcum powder. It is OK to wear face cream or acrylic nails
• If you are having surgery to an arm or leg, nail polish must be removed from that limb. Otherwise, nail polish is okay, although it is best to avoid dark coloured or metallic polish.

Getting Ready & Recovering From Knee Surgery PDF

Getting Ready & Recovering From Hip Surgery PDF

Your Day Care Surgery

Daycare surgery means that you will be admitted, have your surgery, and leave the hospital all on the same say. Daycare surgeries typically include: orthoscopic knee, hip or shoulder surgery, elbow surgery, or foot/ankle surgery. During your initial appointment at Nanaimo Orthopaedics, the physician will have told you what type of surgery you will be having.

1. To get your surgery time, please call the Nanaimo Orthopaedics office at 250-555- 1111 the day before your surgery between 1:00 – 3:00pm. (If your surgery is on a Monday, call this office before noon on the Friday prior to get your surgery time). You must call our office the day before or your surgery could be cancelled.
2. Please take the daycare form given to you at your appointment to the hospital on the day of your surgery.
3. Patients over the age of 60 years or with a history of cardiac arrest must have an ECG (heart tracing) done within 3 months prior to the surgery.
4. Patients taking diuretics must have a serum potassium done within 7 days prior to surgery.

Instructions to prepare you for your surgery

Medications:

• Take all prescription medications as usual unless told not to by your anesthesiologist, surgeon, pre-admission nurse or other specialist. You may take all allowed medications with 30 ml (1 ounce) of water per pill up to one hour before surgery.
• If you take any of the following medications, you must get specific instructions from your surgeon, anesthesiologist or specialist at least 14 days before surgery:
• o Diabetes medication e.g. chlorpropamide, glyburide, metformin, insulin
• Blood thinners e.g. Coumadin (warfarin), Heparin
• Antiplatelet medications e.g. clopidogrel (Plavix), Ticlid, Acetylsalicylic acid (ASA, Aspirin)
• Blood pressure medication
• Non-steroidal ant-inflammatory (NSAIDS) medications e.g. Motrin, Advil, Naprosyn, Torodal, Celebrex
• 7 days before surgery, stop taking Vitamin E and all natural health products including herbal remedies e.g. Garlic, Gingko, Kava, St. John Wort, Ginseng, Dong Quai, Glucosamine, Papaya, etc.
• Do not take regular vitamins and iron supplements on the day of your surgery. You can take them until the day before surgery.
• Acetaminophen e.g. Tylenol may be taken for pain when necessary up to and including the day of surgery

Eating and drinking before surgery: your stomach needs to be as empty as possible. This helps prevent vomiting that could cause choking or stomach contents going into your lungs during surgery. Your surgery will be postponed if you do not follow food and fluid (fasting) instructions.

NO SOLID FOOD after midnight the night before surgery including chewing gum or hard candies.

NONE of the following FLUIDS after midnight the night before surgery: Milk, non- dairy creamer, protein beverages, dairy beverages, tomato or orange juice with pulp, or alcoholic beverages.

It is very important to continue to drink CLEAR fluids until bedtime. This will keep you from getting dehydrated. Clear fluids are allowed until 3 hours before your surgery time. Clear fluids allowed include: water, clear tea, black coffee, fruit juice with NO pulp (apple juice, cranberry juice), carbonated beverages, popsicles, and jell-o.

You may brush your teeth the morning of your surgery.

What to Bring to the Hospital

• Your BC Care Card or proof of substitute Medical Insurance Plan. If you do not have these, bring another form of personal ID
• An interpreter, if you do not understand English
• Reading material, glasses or contact lenses, hearing aids, and dentures with storage cases labeled with your name
• CPAP, bi-level machines or dental device if you use one for sleep
• If required, a shoulder brace is to be brought in BEFORE your surgery.
• Any crutches, cane, braces, or walker that you have been told by your surgeon that you will need, labeled with your name, AFTER your surgery.
• Loose fitting clothing that is easy to get off and on and low heeled, sturdy shoes.

What NOT to bring or wear

• Jewelry or body piercing items. Have custom piercings and tight fitting rings professionally removed before coming to the hospital.
• Personal items such as credit cards, MP3 players, tablets, or computers.
• Cash in excess of $20
• Do not wear make-up, false eyelashes, scented perfume or aftershave, hairpins, deodorant or talcum powder. It is OK to wear face cream or acrylic nails
• If you are having surgery to an arm or leg, nail polish must be removed from that limb. Otherwise, nail polish is okay, although it is best to avoid dark coloured or metallic polish.

If you are unsure of any instructions, please call the Nanaimo Orthopaedics office at (250) 555-1212.

Your Joint Replacement Surgery

A possible outcome to your appointment will be a decision for you to have surgery. If your physician determines that surgery is necessary, you will be required to sign a “consent for surgery” form. After you provide consent for surgery, our administrative team at Nanaimo Orthopaedics will work in consultation with the staff at the Nanaimo Regional General Hospital to schedule a date for your surgery. A surgical request will be made by Nanaimo Orthopaedics to the Nanaimo Regional General Hospital. When a surgery date becomes available, the Nanaimo Regional General Hospital informs the administrative staff at Nanaimo Orthopaedics and we will in turn contact you to confirm your surgery date and time.

In addition to your surgery, you may be required to have other appointments in preparation to your surgery:

Pre-habilitation Or “Prehab” Clinic

This is a 3-hour appointment that takes place a few months to two weeks prior to your surgery. We strongly suggest you take someone with you who will be involved in your care after surgery. The reason of the appointment is to improve your health and daily functioning while you prepare for your hip or knee joint replacement surgery. Areas covered in Prehab include:

1. A video to explain what to expect 
2. Exercises to do before and after your surgery to improve your exercise tolerance and strength, improve nutrition for healing and weight loss, and increase your ability to manage daily activities. 
3. They will give you a list of equipment to have in your home for when you come home after your surgery (walker, cane, reaching assist, raised toilet seat, bath chair, etc.).

Cardiac Clearance

This appointment is decided by your physician. The purpose of this appointment is to determine the appropriate cardiac risk level before proceeding with surgery. It helps to guide you towards appropriate interventions to best optimize your status before proceeding to surgery. It helps you benefit from preoperative therapy to better manage and treat cardiac conditions or risk factors in order to decrease any risks during your surgery.

Pre-admission Clinic Or Pac

This appointment is approximately ?? days before your surgery date. The Pre-Admission clinic will contact you to schedule an appointment. The purpose of a Pre-Admission Clinic is to ensure you are well prepared for your surgery. This appointment will take from one to three hours depending on the type of preparation required. You may receive further education about your surgery and are encouraged to bring a family member or friend to the appointment. Your height, weight, ECG if required, any required blood tests, or X-rays may be done at this time. You will also have a meeting with the hospital pharmacy. You will need to bring your medications with you, including any vitamins or supplements you regularly take. Bring these medications in their original containers or have your pharmacy print you a list. They do not accept hand written lists.

PRE-ANESTHETIC CONSULT

An anesthesiologist will be a part of your surgery team working with the orthopedic surgeon. He/she will be responsible for the management of all necessary anesthetic during your surgery, for example a general anesthetic to ensure you are unconscious during your operation. This appointment may take up to 2 hours. During the appointment, you will meet with an anesthesiologist who will ask you questions about your health. A nurse will also discuss:

• What to expect on the day of the operation and how to get ready for surgery
• Your height, weight, and vital signs (e.g., blood pressure, temperature, breathing rate, and oxygen level) will be taken.
• A review of any medications that you are currently taking
• Any questions or concerns you may have.

Your Recovery & Rehabilitation From Surgery

Immediately after your surgery you will be transferred to the recovery room for monitoring. You will be in the recovery room for approximately 2 hours as you wake up from your surgery. After this time if your procedure requires you to stay in the hospital overnight, you will be transferred to your hospital room. If you are to be discharged that day, you will be transferred to the day surgery recovery unit.

While you are in the hospital, you will be provided with the appropriate medication and care needed for your recovery. In the early post-operative period following a joint replacement surgery, your active involvement is necessary for a quick and successful recovery.

There will be a sterile dressing over your surgical wound. Your wound dressing will be changed regularly and removed about a week after surgery. Depending on the suture material used, the sutures may either be removed or left in to be gradually absorbed. You need to keep your wound clean and dry. Wait 3-4 days and check the incision. If it is dry you may shower like normal. If it is still weeping or draining wait another day.

Upon being discharged from the hospital, your surgeon will prescribe pain medications to ensure your comfort after surgery.  If your surgery requires implants, you will be prescribed antibiotics to protect you from infection. You may also receive a blood thinner for 2-3 weeks to reduce the risk of clot formation after your surgery.

If you had general surgery under anesthesia or intravenous (IV) sedation, you will be considered impaired for up to 24 hours after surgery and should NOT:

• Make important decisions or sign documents
• Drive a car or work machinery
• Do any dangerous activities like bike riding, swimming or climbing ladders
• Travel alone by public transportation e.g. bus, taxi
• Go to work or do business
• Drink alcohol
• Take tranquilizers, sedatives, or sleeping pills
• Have primary responsibility for care of another individual e.g. babies, small children, frail elderly

Movement is important to your recovery! You are encouraged to be active after your surgery. Your physical therapist will teach you specific exercises to enhance your recovery and restore your range of motion. You will also be advised on a home exercise program after your discharge from the hospital.

You will have a follow-up appointment with your surgeon to check on your progress after your discharge. This appointment is typically two weeks after your surgery. During your follow-up appointment, your surgeon will determine whether another follow-up examination is required.

If there are any questions or concerns with your recovery, please contact Nanaimo Orthopaedics: (250) 555-1212.

Getting Ready & Recovering From Knee Surgery PDF

Getting Ready & Recovering From Hip Surgery PDF

Patient Education