P 816.252.7300
F 816.836.8435
19550 East 39th St, Ste. 205
Independence MO 64057


Questions regarding your dressing

Dressings and bandages are put on with the intent of compressing and preventing skin irritation or wound breakdown. Bandages that feel too tight are usually because of inadequate elevation and can be remedied by elevating the extremity. This means keeping the body area above your head. If your dressing is an ace wrap, you may call the office to inquire whether it's appropriate for it to be wrapped looser, if the above does not help.


You should never remove or change your dressing. These dressings are put on in the operating room under sterile conditions. It is very normal for "old drainage" that may stain the dressing and can oxidize or change colors. If the dressing comes off or if it is saturated with drainage, then call the office.


Due to the need to keep the dressing on and intact, it is imperative the only way in which you may shower or bathe, is if a protector was provided to you at the hospital or the ambulatory surgical center. If there was no such protector provided, then you must "sponge bath" and not get the wound or dressing wet in any way. Garbage bags do not work...they leak.



Issues regarding swelling


Swelling is an inherent side affect of any type of injury or surgery.


The basic treatment for swelling is elevation, elevation, elevation. By this, we mean elevating the extremity above the heart. 


Related to resolving swelling, it is essential your support/TED hose be maintained at all times during the day (they may be removed at bedtime when you sleep). You will need to continue wearing your TED hose until you present back to the office for your follow-up visit after surgery. 



Wound and cast issues


All wounds will require at least a minimum of two weeks to heal and, therefore, sutures will be maintained for two weeks. On smaller wounds or finger type wounds, a smaller dressing may be applied on the first postop visit, but sutures will remain for two weeks.  Removing them earlier simply puts your wound at risk for coming apart. 


Cast removal is based upon the duration and timing of fracture healing.


When your cast was applied and your appointments were made, the timeframe upon which the cast is needed is based upon many factors. 


It is not appropriate or possible to remove a cast earlier than scheduled without a high risk the protection the cast provides is therefore lost. As a result, the fracture inadequately healed, may displace, causing increased pain and/or deformity. 


Casts must at all times be kept dry. While the fiberglass is somewhat water resistant, the underlying dressing and your skin are not. Getting your skin and dressing or cast padding wet will lead to secondary fungal infections and skin breakdown problems. If you have itching, it would be recommended to use dry baby powder and blow it underneath your cast using a hair dryer set on cold setting. 


Cane or walker usage


It is imperative after knee arthroscopy, crutch supported ambulation allowing weightbearing as instructed, must be maintained for the first two weeks until your office visit. This helps to minimize secondary joint irritation, soft tissue swelling, and prolonging your rehab recovery.


Walker or crutch or cane usage following fractures or lower extremity total joints is an individualized thing and should never be discontinued or adjusted until you have specifically discussed the issues with Dr. Hummel at your next follow-up visit to get instructions as to changing their use or status. 

Pain management issues


Pain is one of the most difficult things to judge. Every person has an individualized pain threshold. Please understand I try to match, based upon my training and extensive 30 years of experience with thousands of patients, what the generalized need, and expectations are for pain management. I desire to have patients comfortable, but not have secondary side effects or put them at risk for extensive pain medication usage/addiction. 


Sometimes postoperative pain is because the patient did not follow the recommendations at the time surgery was performed to get ancillary blocks. There is not much we can do about that if you chose not to do such a block. 


Pain can also be from failure to follow through on instructions regarding elevation, or maintaining limited weightbearing, or inappropriate overextended activities without proper elevation. 


Pain can certainly be dramatically diminished through "Boy Scout methods" of using ice on the injured area and heat underneath the limb, if a joint replacement was performed. 


Pain medication can be refilled upon request, but understand generally the amount prescribed is expected to last you until your next scheduled follow-up office visit appointment.


In order to make pain medication appropriate and last long enough, please do not exceed the recommended frequency or number of pain pills taken. This will often lead to increased secondary side effects as well as exhausting the amount of pain medication available for your needs.


Non-narcotic pain medication supplements may certainly be possible depending upon your medical profile and medications. 


Over-the-counter options that may be possible include Ibuprofen (i.e. Advil, Ibuprofen, and Nuprin). This would require taking three to four tablets (600-800mg) with food three times a day.  Do not take anti-inflammatories if you are also taking Coumadin postoperatively. Contact the office if you're on Coumadin for alternatives to narcotics. 



Office follow-up/return to work issues


Rechecking earlier than scheduled is only for emergency needs. Coming in because it's more convenient will often disrupt the normal recovery process timing and, therefore, simply result in an extra visit without really changing the long-term program or allowing me to adjust your treatment. Additionally, unnecessary follow-up visits are another reason why many patients end up waiting so long in doctor's offices. If you truly have an emergent/urgent need, please contact the office and we will evaluate that on a case-by-case basis. 


Returning to work is determined at the time of your follow-up visits. I try to balance a rationale return to work based upon your individual work requirements versus medical decisions as to what would be harmful. I certainly adjust that based upon the ability of the employer or employee to do restricted or light duty and, finally, the appropriateness or risks to you for work return. Understand the above applies to jobs that you are doing whether they are an employed job or simply working around the home, volunteer work, etc. Returning earlier or later than previously discussed and scheduled is rarely adjusted unless there is good reason for either of the extremes. 



Resumption of activities of daily living issues


The return to driving is a varied activity based upon extremity injured, age, type of driving, and of course, the nature of the underlying injury. This varies so dramatically it is impossible to generalize those restrictions. Please note this will generally have been discussed with you preoperatively and will certainly be clarified with you on your first postoperative visit. 


Travel after a total joint replacement. This generally will be possible under extreme emergent situations at any time after you are discharged home. Routine travel should largely be restricted to 30-minute trips due to the problems that prolonged sedentary activity in a car/plane poses for both stiffness, increased risk of phlebitis, and wound issues. 



Physical therapy issues


Physical therapy is an essential part of recovery. If I have set up or prescribed therapy, it is expected that you will follow through initiating that as soon as possible upon leaving the office by contacting the physical therapist. Doing so immediately not only facilitates your recovery, but also insures you do not lose or misplace the physical therapy prescriptions because of inordinate delays. 


Exercises are less often forgotten if you initiate your therapy immediately upon leaving the office and ask for a list or copy of exercises from the therapist. 


Our website can also provide some resources to review exercises that we have discussed in the office. 


Economic issues that restrict physical therapy participation should ideally be discussed at the time you're in the office and we're setting up therapy. 


You may have options to discuss payment plans with your physical therapy group.  Rarely, is it possible that therapy can be "done on your own" and doing so often lessens your outcome and is a "cost" that in many ways you cannot afford.



Injection treatment:


Corticosteroid injections may often cause some post-injection irritation, soft tissue swelling, and pain.  It is for those reasons we have usually prescribed a few pain pills when you are seen in the office. It is also why we apply ice both before and after, and usually recommend doing so upon returning home. That pain, swelling, irritation will usually resolve in a day or two. 


If you're a diabetic, we have already discussed in the office that cortisone injections may cause a transient (several day) elevation in blood sugars of 50-100 points. 


We have already told you in the office that if excessive blood sugar elevations above 250 occur, or more than 4-5 days duration, you would need to contact your primary care physician.


SUPARTZ injections-you have already received a brochure regarding Supartz injections that details the logistical process. 


As we have already shared, you need to "keep activities light" the day you have the injection, but may resume normal everyday activities and exercise activities the next day. 



Durable medical goods (materials supplied to you in our office)


These are provided as a convenience, but also an integral part of your treatment plan and are done so in a way I know what you're getting, the appropriate type of material, and how to use it. This is not something that generally can be done if getting them at an outside facility, pharmacy, etc. 


We will generally bill for these articles but you will have already been informed that often insurances will underpay or not pay for these supplies which then are your responsibility. 


BIOFREEZE is an excellent pain topical medication that is applied for 10 second to the affected area followed by 10 minutes of ice to activate.


You may get these or other durable medical goods if you lose or need a replacement without necessarily seeing me. You would need to let the office know what you're interested in having provided and pay for it at the time you purchase it.



Insurance and medical history forms


People do not like filling out paperwork. However, it is absolutely essential, in this day and age especially, with changing insurance coverages as medications may be denied by insurance carriers or adjusted. Often you may have seen another physician between your last visit and our last update. For your safety and to insure the best quality of medical care, these forms must be filled out at every visit. It is essential that includes an updated form detailing your medications.