Surgery Locations/Schedule

Dr. Rhyneer has privileges at three locations:

• 1. Alaska Surgery Center (same day surgery only)
  4100 Lake Otis Parkway (907) 550-6100
• 2. Providence Hospital (same day and in-patient surgeries)
  3200 Providence Drive (907) 562-2211
• 3. Alaska Regional Hospital (same day and in-patient surgeries)
  2801 DeBarr Road (907) 276-1131

Surgery Schedule

• Monday afternoons at either Providence or Alaska Regional
• Wednesday at Alaska Surgery Center Our clinic does require a surgery deposit of $250.00 prior to your procedure. This will of course be applied to your coinsurance/deductible. If your insurance company pays at 100%, your deposit will be refunded once payment is received from your insurance company.

Preparing for Surgery

Dr. Rhyneer will see you in the office for a pre-operative visit within 2 weeks of surgery. This visit will include discussion and questions about the surgery, a limited history and physical exam, signing the operative consent and any last minute instructions.

If you have any pre-existing medical problems you may need to get medical clearance prior to surgery from the physician who is treating you for those medical issues.

Please notify us if you are taking any anti-coagulants (blood thinners) such as PLAVIX, COUMADIN, HEPARIN AND LOVENOX. These medications need to be stopped prior to surgery.

Some medications and Herbal supplements need to be stopped prior to surgery.

After your pre operative visit with Dr. Rhyneer, if your surgery is at Providence or Alaska Regional, you will be given an envelope with the operative consent, pre op orders and the history and physical paperwork. This envelope needs to be taken to “pre-admissions” at the appropriate hospital the same day or at least 1 day prior to surgery.

If your surgery is being done at the Alaska Surgery Center, you do not need to go to the surgery center prior to the day of surgery. The appropriate paperwork will be faxed to the Alaska Surgery Center. You will need to arrive about 2 hours prior to surgery, any studies that need to be done pre-operatively will be done at that time.

Medicines To Stop Before Surgery

Aspirin needs to be stopped one week prior to surgery since it affects the clotting time of the blood.

The following herbal medications should not be taken two weeks prior to surgery, as they have been linked to adverse reactions with anesthesia:
St. Johns Wort                                      Kava or Kava Kava
Ephedra                                                Ma Huang
Echinacea                                             Valerian
Garlic (in food ok)                                   Herbal Phen Fen
Gingko                                                  Herbal Phentermine
Ginseng

Ask if you are on another herbal supplement not listed and unsure.  Drugs such as heroine, cocaine, etc., can alter the effects of anesthesia and can be fatal if used prior to surgery.  This includes alcohol.  (For safety reasons, please inform your doctor if you have used any of these within the past month.)

The following prescription medications should not be taken prior to the times noted under each medication: PLAVIX, COUMADIN, WARFARIN should be discontinued 10 days before surgery.

Xenical (generic name Orlistat), Meridia (generic name Sibutramine) should be discontinued at least 3 days before surgery. Phentermine (brand names Adipex, Fastin, Tora, Wilpowr, Zantryl)and Redux should be discontinued 2 weeks before surgery.

Day of Surgery

Anti-inflammatory medications such as Ibuprofen, Naprosyn (Naproxen) and Relafen (Nabumetone) also need to be stopped 4 days prior to surgery.

Nothing to eat or drink after midnight the night before surgery.  If your surgery is scheduled for 1pm or later, you may have clear liquids prior to 8am the morning of surgery.  (i.e. water, apple juice, broth)  No coffee, milk, or orange juice. 

*Any blood pressure or heart medications may be taken early in the morning with a sip of water.

 You will need to arrive at the facility for your surgery (2) hours prior to the scheduled surgery time.  This is to allow time to prepare you for surgery, start intravenous fluids, and if ordered, a nerve block for pain control which is put in place by an anesthesiologist. 

If you are having day surgery, you must have someone drive you home (no taxies by yourself or public transportation are allowed- the facility will cancel your surgery if this is not arranged).  Someone should be available to stay with you for the first night after your surgery.  DO NOT DRIVE.

You should expect 3 to 4 surgery bills.  Physician, facility, anesthesiologist and possibly an assistant or radiologist.

Pain Control After Surgery

1. You will be given a prescription for pain medication either prior to surgery or at discharge.  Take medication as directed.  It may make you drowsy.  Do not drive when taking pain medications.  These medications are to keep you as comfortable as possible, but they may not completely eliminate discomfort.
2. Nerve Blocks- If ordered by the doctor, these are started by the anesthesiologist.  A catheter is put in place to block pain in the surgical area.  They may be discontinued after the surgery or you may be sent home with catheter in place hooked up to a small pump which delivers a dose of numbing medication at precise intervals directly to the nerve.  This usually remains in place for (3) days.  Geneva Woods pharmacy will contact you prior to surgery for teaching on the pump’s use and will come to your home to discontinue the catheter and pump. Nerve blocks help with pain control and decreases the amount of oral narcotics needed for those first few days after surgery.  Nerve blocks are used with some shoulder, knee, or leg surgeries. 

Continuous Passive Motion Machines (CPM)
These are used with some knee surgery such as ACL reconstructions, total knee replacements, and cartilage transplants.  The purpose of the CPM machine is to aid recovery of the knee joint.  The motorized device gradually moves the joint, accelerating recovery time.  Decreasing soft tissue stiffness and increasing comfortable range of motion promote healing and prevents development of scar tissue.  Patients report having less pain, swelling, and adhesion formation.

Game Ready System
The Game Ready system is used following some knee surgeries.  This system simultaneously delivers both adjustable cold therapy and intermittent compression.  Patients have found it decreases pain, decreases edema or swelling, and decreases muscle spasm.  It can be used in conjunction with the CPM machine.   The company supplying this equipment will contact you prior to surgery.

Cryo Cuff/Ice Man
After shoulder or knee surgery you will be sent home with a Cryo Cuff or   Ice Man surrounding your shoulder or knee.  This provides ice chilled water to the area to decrease swelling, inflammation, and pain. 
Wear this all of the time for (3) days to a week after surgery.  After that, use as needed to help with pain control or swelling. 

Time Off Work/PT Guidelines

Download thePost Surgery Time Off Work/Physical Therapy Guideline (PDF)

Physical Therapy after Surgery

The amount and frequency of physical therapy needed after surgery varies with the procedure that was performed.  The average length is 2-3 times per week for up to 6-8 weeks.  A prescription for therapy will be given to you at the first post-op visit. 

Post Knee Surgery Instructions

GENERAL INSTRUCTIONS:

• You will come out of surgery with a bandage, ace wrap and possibly a knee brace.
• You may purchase crutches at a local pharmacy.

CRYOCUFF (ICE PACK):

• Re-charge the Cryocuff every 1-2 hours with ice water, “except when sleeping.”
• You may discontinue the Cryocuff after 3 days, and use as needed.

ACL REPAIR:

• It is okay to touch your toe to the ground when walking with crutches.
• You will get a new knee brace at your first follow-up visit.
• Plan for at least 6-8 weeks light duty or off work.
• No sports for 6-9 months.

MENISCUS REPAIR:

• For 6 weeks you will be able to walk only by touching your toe to the ground with crutches.
• Again you will be on crutches for 6 weeks.
• Plan 6-8 weeks of light duty or off work, longer if you do heavy labor.
• No sports for 6-9 months

MENISCAL DEBRIDEMENT, MENISECTOMY OR CHONDRAL DEBRIDEMENT:

• You may use crutches for 2-3 days.
• You may bear as much weight as pain allows.
• Plan for off work or light duty for 2 weeks, 1 month if you do heavy labor.

Post Shoulder Surgery Instructions

GENERAL INSTRUCTIONS:

• You will come out of surgery with a bulky immobilizing sling called a Cryocuff.
• The best position for your arm during this week is palm to chest or palm to belly.
• Do not drive one-armed.

ROTATOR CUFF REPAIR, BANKHART REPAIR OR SLAP LESION REPAIR:

• For the first week, the best position for your arm is palm to chest.
• Do not let arm dangle freely for the first week.
• When sitting, keep elbow supported with a pillow.
• You will be off work for at least two weeks, after two weeks, you may return to light   duty using the opposite arm.
• If you do heavy labor work, you may not return to full duty for up to 4 months.

SUBACROMIAL DECOMPRESSION, MUMFORD PROCEDURE OR AC JOINT RESECTION:

• There are no restrictions on your activity, but remember: the more you move, the more it will hurt. So keeping your shoulder immobilized for the first week will reduce pain.
• You will be off work for at least 2 weeks, then return to light duty.
• If your job requires heavy labor, you may be on light duty or off work for up to 6 weeks.

CAPSULORRHAPHY:

• Activity restrictions are very important to prevent failure of procedure.
• Do not rotate your forearm out from your body, keep your arm close to your chest or belly.
• To dangle arm, move palm from chest to belly down the side of your leg.
• For the next 8 weeks, you must keep your arm palm to chest, belly or side of leg.
• You may return to light duty work after 2 weeks, using the opposite arm. 

Physical Therapy Facilities Frequently Recommended

Anchorage
1. The Physical Therapy Place  
(907) 569-5557
4001 Lake Otis Parkway- Suite 111 

2. Rebound Physical Therapy-South  
(907) 341-5555
O’Malley Square
11260 Old Seward Highway

 Rebound Physical Therapy-East  
(907) 245-5555)
Muldoon Mall  
1251 Muldoon Road-Suite 157

3. United Physical Therapy

Midtown
(907) 561-2260
701 Sesame Street-Suite 101

Downtown
(907) 929-8400
742 K Street

4. Denali Physical Therapy 
(907) 563-2122
751 E. 36th Ave.- Suite 100

5. Alaska Physical Therapy Specialists  
(907) 561-4280
3650 Lake Otis Parkway- Suite 201
(Anchorage Location)

6. Seethaler Physical Therapy
(907) 561-5006
2704 E. Tudor Rd.

7. Chugach Physical Therapy   (907) 743-3333
*Preferred provider for most union insurance*
1) 2740 Lake Otis Parkway
2) 11001 O’Malley Centre Drive- Suite 104

8. Select Physical Therapy
1) 4100 Lake Otis Parkway- Suite 106   (907) 563-4115
2) 12350 Industrial Way- Suite 170   (907) 522-1088

9. Frontier Therapy Services  
(907) 646-9774
2421 E. Tudor Road- Suite 103

 

Hand Therapy in Anchorage

Advanced Hand Orthopedics  
(907) 563-4263
3600 Lake Otis Parkway- Suite 202

 

Eagle River

1. Eagle Center Physical Therapy  
(907) 696-5678
11470 Business Blvd.- Suite 200

2. Alaska Physical Therapy Specialists  
(907) 694-5515
13036 Old Glenn Highway – Unit D

3. Select Physical Therapy   
(907) 694-8085
12836 Old Glenn Highway- Suite 101

 

Wasilla

1. Wasilla Physical Therapy  
(907) 376-7334
3750 E. Country Field Circle- Suite A

2. Excel Physical Therapy 
(907) 376-4325
North Fork Professional Building
1700 East Bogard Rd.- Suite B203

Palmer

1. Body In Balance  
(907) 746-0722
642 S. Alaska St.- Suite 209

2. Select Physical Therapy  
(907) 745-8686
561 S. Denali Street- Suite F

3. Excel Physical Therapy 
(907) 746-4373
Scenic View Professional Building
809 S. Chugach Street- Suite 1

Medication Refills

1.  If possible, please call before 4PM to request a refill on your medication.  Please allow at least 24 hours for the refill.  It will be called to your pharmacy as soon as possible after approval from Dr. Rhyneer.

2.  Some prescriptions cannot be called in or faxed to a pharmacy by law.  These are the controlled substances (Schedule II) narcotics which include:

• Percocet/Percodan (all strengths)
• Endocet/Endodan (all strengths)
• Roxicet
• Roxilox
• Tylox
• Dilaudid (Hydromorphone)
• Demerol (Meperidine)
• Mepergan
• Oxycontin (Oxycodone)

 

The above medications must be on a written prescription, signed by the doctor, and hand carried to the pharmacy.

3.  Pain medications that may be called in or faxed include:

Vicodin (hydrocodone)
Norco (hydrocodone)
Darvon or Darvocet  N100 (propoxyphene)
Ultram (Tramadol)
Tylenol with Codeine

Antibiotic Prophylaxis for Invasive Procedures following Total or Partial Joint Replacement

We follow the guidelines issued by the American Dental Association.  It is recommended that for 2 years following total or partial joint replacement that the patient be pre-medicated with a dose of antibiotics one hour prior to a dental procedure or any invasive type procedure.

Recommended medications
Those not allergic to penicillin:
Cephalexin, Cephradine, or Amoxicillin- 2 grams by mouth, 1 hour prior to procedure.

Those who are allergic to penicillin:
Clindamycin- 600 milligrams by mouth, 1 hour prior to procedure. 

*No second doses of these medications are necessary.

Durable Medical Equipment

Devices such as canes, walkers, crutches, wheelchairs, braces, and supports are often needed after orthopedic injuries or surgery.  These can be purchased locally or rented (as with a wheelchair) at:

Bernies Pharmacy  
(907) 562-2138
4100 Lake Otis Parkway

Lake Otis Pharmacy  
(907) 563-7878
4201 Lake Otis Parkway

Geneva Woods  
1) Anchorage-    (907) 565-6100
501 W. International Airport Rd.- Suite 1A

2) Wasilla-   (907) 376-8200
3674 E. Country Field Circle

Northern Orthopedics
For off the shelf braces, custom braces, orthotics, heel lifts

1) Anchorage   (907) 561-1777
4200 Lake Otis Parkway

2) Wasilla   (907) 357-3737
3719 E. Meridian Loop- Suite H

Casting Information

It is important to keep the cast clean and dry.

• When showering, cover the cast with one or two plastic bags or trash bags, use a washcloth or hand towel at the top of the cast to absorb any water leaking in, and secure the plastic bag with tape or rubber bands. (There are cast covers available to purchase at some pharmacies or medical supply stores costing about $20.00)
• If the cast does get wet, try drying it with a hair dryer on cool setting. The padding under the fiberglass is very difficult to dry completely. Skin under the cast can be easily irritated and may even develop a fungal infection if continually wet or damp.
• Do not use or place any foreign objects under the cast such as pens, rulers, sticks, money (this is not the place to store your coins!) Your skin can be easily scratched or irritated leading to infection.

Swelling
It is normal to have swelling in the injured arm or leg even after the cast is applied. Wiggle fingers or toes periodically to stimulate circulation in the injured arm or leg.

Keep the casted body part elevated as much as possible. The injured area should be elevated in such a way that it is higher than the level of your heart.

For arm injuries take arm out of the sling and prop it up on pillows.

For leg injuries, when able, lay on a couch or bed and prop the leg up with pillows so that the injured area is higher than the level of your heart.

Cast Shoe
If you are permitted to bear weight on your leg, always wear the boot/cast shoe you are given when up and around. It will protect the bottom of the cast and prevent slipping on a wood or tile floor.

Driving
For your safety and the safety of others, it is not recommended that you drive with a cast on your hand or arm and your right leg. (This includes the left leg if using a clutch)

Pain
It is normal to still experience discomfort in the area of the injury even after casting. Take prescription pain medications as ordered or over the counter Tylenol or Ibuprofen if no contraindications such as allergy, gastrointestinal problems/ulcers. Elevating the arm or leg may also help.

Other Post-Op Questions

(Regarding dressings, showers, driving and returning to work)

1- When should I change my dressings?
Leave dressing applied at the time of surgery on until your first post-op visit, about one week after surgery.  A clean dressing will be applied at that time if still needed.

2- When can I shower?
After surgery, the incision needs to be kept clean and dry to prevent infection.  After your first post-op visit when either sutures are removed or steri-strips are changed, you may then shower and allow the water to run over the incision.  (No tub baths or hot tub use until approved by the doctor).

3- When can I drive?
-If you are taking narcotic pain medications you should not drive since these medications can make you drowsy and possibly impair judgment.
-If you have had surgery or injury to your left leg, you may drive when you feel comfortable. 
-If you have had surgery or an injury to your right leg, the driving restriction will vary on the type of procedure done.  For uncomplicated procedures or fractures it may be possible to drive two weeks after surgery or cast removal if you are comfortable and feel safe.  For total joint replacements, ACL reconstruction, cartilage transplant, etc, and more complicated fractures, driving may be permitted after 6-8 weeks.  Decisions will be made regarding driving restrictions on a case by case basis.
-Shoulder surgery- due to restrictions on movement and use of the arm, driving may be allowed 2-4 weeks post-op depending on strength and range of motion.
-While in a cast on either arm, you should not drive due to the inability to have full control of the wheel and range of motions needed for safety.

The above listings are guidelines; the doctor will impose restrictions as necessary with each patient for their recovery and safety. 

4- When can I return to work?

Work restrictions vary with the type of job and how your medical problem is affected by the specific work that you do.  Many times the patient is able to go back to work on “light duty”.  This may be shorter work hours or less days a week, sedentary work instead of a physically demanding job, restrictions on length of time on your feet or limited lifting amounts, etc.  Some employers do not offer “light duty”.