August 2011 Allergy and Medical Information All new students are required to submit a Physician's Report form. For returning students, parents are required to inform the school if there is a change in the medical status. Both new and returning students are required to complete the attached form. So that staff members can identify students who might require immediate intervention on sit
Chrisshavermd.comKnee and Shoulder Reconstruction, Sports Medicine, LENOIR CITY OFFICE
FT. LOUDON MEDICAL CENTER DR., SUITE 100 PHONE: (865) 988-8667 FAX: (865) 988-8837 PHONE: (865) 690-4861 FAX: (865) 560-8525 Knee Arthroscopy
Knee arthroscopy, or a knee scope, is a procedure that allows Dr. Shaver to look inside of your knee.
Using an arthroscope he is able to look at your knee joint and surrounding tissues. This allows a clear
view of the knee, diagnose, and treat knee conditions and injuries. Small incisions are made around the
knee to insert the arthroscope, irrigating tool, and reparative instruments. The images are then projected
on a television screen in the operating room, so that the physician has an enhanced view of the knee and
Since its introduction in the 1970’s, arthroscopy has greatly improved knee surgery techniques. Previously, knee surgery techniques included a large incision with an open procedure, and a lengthy hospitalization. With arthroscopy, the procedure is minimally invasive and generally home the same day. The procedure is performed at a hospital or surgery center in the operating room. Anesthesia will be administered under general anesthesia. The procedure usually takes less than 1 hour. Preparing for Surgery
The following is a list of things to do before your scheduled surgery.
An EKG, Chest Xray, and laboratory work may be ordered. Any medical conditions that require better control prior to surgery will be discussed. Moreover, medications that need to be stopped prior to surgery will be discussed.
Consult your primary care doctor and stop any medications that could contribute to prolonged bleeding. Such medications include aspirin, ibuprofen, Aleve, warfarin (Coumadin), fish oil supplements, etc. Ideally, these medications should be discontinued 7 days prior to surgery.
It is recommended that you do not drink or eat anything at least 8 hours before surgery and surgery may be cancelled if this doesn’t occur. This helps prevent any nausea or abdominal upset from the anesthesia and medications.
If you smoke cigarettes or tobacco products, you should stop. Nicotine can increase your chances of having surgical complications, and can delay healing. See your primary care provider for information on smoking cessation.
Arrange for someone to drive you home after surgery. When any narcotic pain medicine, you should not drive or operate any machinery as these medications may cloud your judgment. After Surgery
After your surgery is completed, you will be taken to the hospital recovery room. There the nurses will monitor your blood pressure, heart rhythm, breathing, and help manage any pain you are experiencing. A bandage or dressing will cover your knee to keep the incision clean. After you are more awake and alert, you will be discharged home.
After you are discharged from the hospital, you will need to continue with activity restrictions and incision cares as directed by Dr. Shaver and the hospital staff. The hospital will arrange for an appointment 10-14 days after surgery. At that time, he will evaluate your surgical incision, amount of swelling, and your pain level. Wound Care
Your dressing is to be kept clean and dry. You may remove the ace wrap, or large, stretchy, brown bandage, and the large dressing on the second day after surgery and replace it with bandaids over the incision sites. A small amount of clear drainage or bleeding is normal. If you are having drainage, the dressing should be changed daily to keep the incisions clean. Bathing
You may get the incision wet and shower two days after surgery. The shower should be brief and the wounds patted dry with a clean towel. No baths or soaking the incision until 2 weeks after surgery and the scabs are absent. Pain and Swelling
Ice your knee as frequently as possible. We recommend icing your knee 4-6 times per day for 20-30 minutes at a time. You may use either an ice bag given to you at the hospital, or simply place ice in a Ziploc bag and place it on the knee. Do not place the ice directly to the skin. Always use a towel or cloth to wrap the ice pack in to protect the skin.
Narcotic pain medication will be prescribed for use after you leave the hospital. Try to wean down on the use of these medications as tolerated. These medications can cause constipation, and you may need to take an over the counter stool softer while taking these medications. Tylenol products may be used instead of narcotic pain medications, but the two should not be taken together. Many narcotic pain medications contain Acetaminophen, the ingredient in Tylenol, and excessive doses may cause liver damage. You may take Aleve or ibuprofen for breakthrough pain that is not relieved with the narcotic pain medication. If a refill of medication is needed, please call the office during regular business hours,Monday through Friday, 8:00 a.m. to 5:00 p.m. It is best to call by Thursday to request medication refills. In general, refill requests will not be granted after hours or on weekends, so please plan ahead. Swelling to some degree is common after surgery. To reduce swelling, elevation is very helpful. Elevate your knee above the heart level (“toes above the nose”) for the first 24-48 hours after surgery. Elevation for 30 minutes every 2 hours is our initial recommendation. Moving your ankles up and down (ankle pumps) on a regularly helps circulate blood in your legs and reduces swelling.
Depending on your procedure, you may be able to be full weight bearing or no weight bearing after your procedure (please refer to our post-operative instructions for further information). If you are able to bear weight, you may require assistance such as the use of crutches or other devices, for 2-5 days after surgery. Walk with a heel-toe gait while using your crutches. You must be able to walk without a limp to discontinue the use of the crutches. Try to avoid being up on the knee for lengthy periods of time for the first 7 days after surgery. Driving
To drive, you must no longer be taking narcotic pain medication, as these medications can cloud your judgment and may you feel less alert. Tylenol, Aleve, and ibuprofen do not affect your judgment. To safely drive, you must also be strong and alert. Most people start driving 1-2 weeks after surgery. Exercises
The following exercises should begin the day after surgery, to strengthen your knee and your leg muscles (quadriceps). Quad-sets: straighten the knee by tightening the quadriceps (the thigh muscle), flexing the ankle (point toes toward the ceiling), and pushing the back of the knee into the floor. Hold for 5-10 seconds. Work to 25 repetitions, 4 times per day. Straight leg raises: while maintaining the tightened quadriceps muscle position, slowly raise the straightened leg off the floor and hold for 5-10 seconds. Work to 25 repetitions, 4 times per day. Ankle pumps and heel slides: pump foot/ankle up and down 20 times per waking hour. Heel slides should be performed 20 times per hour as well. Biking on a stationary bike is highly recommended beginning one week after surgery. Biking is used to aid in increasing range of motion. This should be done pain-free and with little tono resistance.
Make sure an appointment has been scheduled for you approximately 2 weeks after surgery.
Occasionally patients experience troubles after surgery and need additional medical attention. Such conditions that require medical attention include the following: Fever of greater than 101 degrees F New or different colored drainage from your surgical incision Swelling, redness that is painful to touch in your leg Inability to stretch or bend your knee or participate in physical therapy as before Pain in your lower leg when you bend your foot upwards Chest pain or shortness of breath Seek medical attention immediately if you develop sudden chest pain, shortness of breath, a rapid heartbeat, lightheadedness or dizziness, and if your leg appears warm, red, and is painful to the touch. Questions or Concerns
If you have any questions or concerns about your procedure or recovery, please feel free to contact us. Our goal is to provide excellent care, and get you back to your active lifestyle.
Title A Handbook of Statistical Analyses Using R (2nd Edition)Author Brian S. Everitt and Torsten HothornMaintainer Torsten Hothorn <Torsten.Hothorn@R-project.org>Description Functions, data sets, analyses and examples from the second edition of the book`A Handbook of Statistical Analyses Using R' (Brian S. Everitt and TorstenHothorn, Chapman & Hall/CRC, 2008). The first chapterof th