You have to quit smoking if you’re going to have surgery and what risks do you have if you’re a diabetic top spine surgeon dr ghoshabru savonik has the answers for you let’s take a look surgeons and we’re scientists so we see the complications right so the newer techniques are better we’ve taken down the risk of non-union and the risk of having to go back in from 36 percent down to about three percent it’s amazing so it’s a tenfold improvement infection rate is much lower now because the incisions are smaller the risk of injuring other tissues is lower so we didn’t really discuss this but I mean there is a risk of bleeding risk of neurological injury surgery and that has become significantly lower with these newer techniques as well but that’s rare correct now with these minimally invasive techniques you’re using and especially now that we’ve learned to go to the front of the spine the risk of non-union has now fallen significant so I really couldn’t even though it’s probably in the range of about one percent or less than one percent i want to talk about the recovery after because this is something that you’ve also brought up throughout the show and the importance of recovery first with not doing the heavy lifting lifting from your back or not lifting from your back so how much does this recovery matter in a patient’s prognosis it matters uh and you know in when we talk about recovery we have to put it within context of which operation the patient uh underwent so if it’s a discectomy then it’s a good idea to wait about six weeks before major sports participation or before sort of uh achieving new feats so if it’s something a patient normally does then it’s reasonable and i tell patients to use their pain to guide them if it’s a fusion surgery the classic fusion surgery these patients need about six months of rehab they need to wear a brace no lifting twisting no bending i mean that’s really why I don’t do these operations because my patients expect better the newer techniques um we have become a bit more cavalier at not restricting patients so uh with these newer methods uh no restrictions no precautions no brace no therapy um they associate no nothing they just kind of go back to their normal lives and you actually from previous segments that we’ve done together you you like your patients to be moving around after surgery same day of surgery absolutely so we have a very good communication with the nurses and we really ask the nurses to make sure the patient gets up uh this you know as soon as possible after surgery within a few hours right um that not only prevents the risk of a thrombosis of clot formation um it also avoids the morbidity of laying down and the older we get the more this is an issue even a day or two of laying down will cause us to you know loss of bone quality and um you know other issues pneumonias urinary tract infections movement is very important very important now it’s important to keep moving as dr bruce vonnegut said after surgery to help with the recovery so check out this short video that explains tips for strengthening your back [Music] there’s still time to call in if you have a question for dr bruce avonik that number is seven nine 855-790 four four seven five now we were talking right before off camera and we were saying how insane it was in the past that instead of movement as we saw in that clip doctor wanted you to have complete bed rest and that’s actually the worst thing you can do especially after recovering from back surgery yeah look um this generation and all the subsequent generations will never be hungry for information there will be always a plethora of information and we as practitioners have been taught to grade evidence and I think that with time the public needs to sort of understand to grade the evidence um we did you know and by we I mean grand we as the physicians we did a lot of ridiculous things to patients over the past century that had no value and would hurt patients but did not have the know-how to prove them wrong so look if a doctor tells you his opinion make sure you understand that that’s an opinion and when a doctor tells you what he knows you’ve got to understand it that’s what he knows because of scientific basis you know we always uh we asked a lot of questions as physicians that we may not have scientific basis for the answer right it’s important for the patient to ask whether the information that they’re getting is legitimate information that coming from coming from studies or this is just an opinion and I think that will help clarify because a lot of treatments that are offered are just nonsense right and as you mentioned sometimes they come in for something that they may not need and they need a second sometimes even third opinion you got it exactly it’s never wrong to get a second or third opinion and um look um uh I have a website that actually tries to sort of dispel some of the myths and look at some of the research so it’s called spine doctor miami.com spine doctor miami.com there’s some videos there for various conditions that hopefully will help clarify uh some of the um inconsistencies and then we also have a list of some ways patients can lower the risk for surgical complications as we’ve been talking throughout the show so can you walk us through these dr bruce sabonick which is you’ve been saying this one communicate with your doctor yeah that’s above all else and make sure that before you go to battle meaning before you let a surgeon operate on you this is not a type of a person that you can’t reach this isn’t someone who is difficult to reach and this is someone who’s going to be there for you you know if your pre-surgical appointment you’re already getting a cold shoulder things will only get worse and when you need that doctor you got to make sure the doctor will be there for you of course verify your medications absolutely no one is going to be as much of a leader for your care as you the patient so make sure that your medications are safe for that operation make sure you’re not taking anti-inflammatories which can thin your blood make sure you’re not taking medication that are going to interfere with anesthesia medications keeping wound clean is important okay and I would just follow that surgeon’s sort of guidance in terms of how he likes his wounds to be covered i like to use a multi-layer closure and then glue on top and then a waterproof dressing on top so patients can shower immediately and sort of it’s sort of low maintenance smoking that’s an obvious one and if after surgery you’re sneaking in cigarettes you are endangering the the hopefully good outcome and risking and you’re putting yourself at risk for probably thrombosis correct well actually that’s a great point so there’s been evidence that showed that especially in women and especially women who are taking birth control if they are also smoking their risk of thrombosis becomes sky high so there’s just no reason to smoke anymore dr bruce avonik said there really is no reason to smoke anymore and i’ve learned anything from the health channel it’s that smoking can lead to so many problems down the road so quit or don’t start.