Frequently Asked Questions
In the following section, we answer some frequently asked questions we’ve received from patients over Dr. Berti’s thirty years of practice. The responses given by Dr. Berti below are intended to be general answers; we ask our patients to keep in mind that each person’s case is different. Please use the answers as a general guideline and remember that you must always consult with Dr. Berti or your physician for your own, personalized answers.
1. How long will my surgery take?
The duration of your spine surgery depends on the complexity of the procedure being performed. Simple surgeries, which include disc surgery and pain procedures (inserting neuromodulators, for example) may take less than an hour. More complex surgeries may run up to several hours, depending on the number of discs or vertebral bodies being operated on, or the complexity of the procedure.
A rough estimate for operating one level (the space between two vertebrae) would take one hour. If we use instrumentation, such as titanium pedicle screws, for example, the surgery may take longer. In the case of brain surgery, the length of surgery is usually prolonged and depends on the type of lesion operated. Ultimately, we recommend that you speak with your physician for the best answer, as he or she will have a better grasp of your situation.
2. How long will I be hospitalized?
The length of hospitalization will depend on the kind of procedure performed. You may be treated as an ambulatory patient when undergoing minimally-invasive spine surgery or other simple procedures. On the other hand, you may be admitted for five days or more, depending on the complexity of the procedure. For example, complex spinal instrumentations will take from five to six days. Remember, patients stay in the Intensive Care Unit one of those days after a complex surgery. (Dad- aren’t there instances where people stay in the hospital longer than this? Angela, advise?)
Dr. Berti strongly believes that patients should spend as little time in the hospital as possible due to the many benefits for patients recovering at home. First and foremost, patients belong at home, surrounded by their loved ones in a familiar, comfortable environment, where the care people receive is, by its nature, personalized. The familiar setting should promote healing and relief from the stress of surgery, as well as emotional and psychological comfort.
Patients with special needs may be assigned a home health agent, be it a daily visiting nurse or a physical or occupational therapist who will deliver rehabilitative and nursing care appropriately. Being cared for at home is also beneficial in that the patient is not exposed to other patients who may have contagious illnesses, which must be avoided by all means.
Again, length of stay at a hospital varies based on the patient’s needs and the doctor’s recommendations. You will need to speak to Dr. Berti personally to get a more accurate answer.
3. Will I need physical therapy and rehabilitation?
Dr. Berti’s philosophy emphasizes providing post-operative physical therapy and rehabilitation for every patient. Surgery is just one step in the process of recovery, and while it is a good, important step, he believes that patients must undergo rehabilitation and certain therapies in order to safely resume the healthy, productive lifestyle they deserve, be it as active members of the community or returning to the workforce.
Dr. Berti will personally determine and tailor the rehabilitation program for each patient, as each pathology or operation requires different rehabilitative methods. He writes the orders and then refers patients a to a rehabilitation facility or to a physical therapist to have the orders carried out.
He is adamant that his patients receive complete, well-rounded care, whether they are at home or whether they are deemed to be suitable in-patient candidates at a rehabilitation facility. To be transferred to a rehabilitation facility, the patients must comply with strict criteria for admission. This includes up to three hours of physical therapy every day prior to being admitted to rehab so that the patient can tolerate the intensity of rehabilitation and more. It is very rare for a patient to undergo more than one or two weeks at the rehabilitation center.
4.How long does the pain last?
Pain typically lasts three to four days, depending on the procedure. Pain control following surgery is a major priority for Dr. Berti. He will make every effort to safely minimize pain with analgesics and prescription medication, according to what makes you comfortable.
Patients should be pain-free so they can have a pleasant post-operative experience. Pain control may also help you recover faster; for example, if your pain is well-controlled, you will be better able to perform your physical therapy. It is extremely important that you inform your doctor if you are experiencing pain. You have a hand in controlling your pain, and will work with him closely to monitor it.
5.How should I modify my activities?
Generally, when a patient is discharged from the hospital, he or she will receive written instructions on behavioral modifications from the physician. Post-operative recovery may require certain dietary and physical restrictions and prescribed amounts of rest. The extent to which Dr. Berti may ask his patients to modify their activities depends on the intensity of the procedure performed as well as on the physical fitness of the patient.
It may take from one to several weeks to get back to one’s daily routine. This will depend on quite a few variables, as there is definitely a subjective factor to recovery. Each operation will come with a different set of prescribed ranges of motion. For example, if you have had a fusion, you must not perform any activities without corset.
These are a few general guidelines we can provide for you:
For dietary restrictions: you may have to stop drinking alcohol if pain medication is prescribed.
In the home: Dr. Berti may recommend avoiding lifting objects, climbing stairs, performing exercise (unless prescribed physical therapy, and this is under the supervision of a trained professional), or even sexual relations. The doctor will also instruct you on incision care, and how to tell if it has become infected (odor, redness, swelling, and fever, for example).
Some patients are prescribed durable medical equipment post-operatively, such as walkers, or hospital beds, beside installing certain commodes and railing in their bathrooms. The patient may be required to make changes to the spatial arangement of their desks and work sites to improve their body mechanics and to prevent injuries.
Again, quite a few patients are assigned to rehabilitation centers early in their postoperative course; others are seen by home health agencies at home and provided with daily nursing, physiotherapy, aid and personal assistance for care. You may require a nurse or live-in care for some time.
A patient needs to learn correct ergonomics, proper body mechanics, and be monitored while learning. The nurse practitioner or physical therapist will teach them. The goal is for the patient to become involved in the act of daily living progressively, with no shocks to the system.
In cases of neuromodulation: For neuromodulation therapies that are implanted sub-cutaneously, patients will receive instruction on keeping the incision clean from their doctor.
Remember, maintaining good communication with your doctor is very important, so please ask him as many questions as needed to understand your condition.
6.When can I bathe?
On average, wounds seal after twenty-four hours. Nurses will cleanse your wounds daily at the hospital; the patient may shower by the third or fourth day. Dr. Berti advises that patients take special care when showering as the incision must be kept dry. Keeping it dry can be difficult; should you wet the incision you must blot the wound dry very gently with a clean towel and cover it with fresh gauze and dressings. Again, your best option is to ask the doctor directly.
7.When can I return to work?
Once again, the answer depends on the surgery and the type of work being performed. Most patients usually return to work in the fourth week after complex surgery. If a simple disc surgery is performed, you might return to work within 10-15 days. If your job is sedentary in nature (for example, office work), a patient may return in two weeks. If the patient is an active worker (truck driver, construction), then he or she may return to work after any braces have been removed, and after the patient has been cleared by Dr. Berti. Keep in mind returning to work will take not take less than three months with complex surgeries.
8.When can I drive?
A patient’s ability to drive is determined on a case-by-case basis, dependent upon the type of surgery performed, the patient’s progress, and Dr. Berti’s discretion. If you have had brain surgery and are taking anti-convulsants, by law, patients must not drive for a total of six months. Similarly, people who have had seizures have to be seizure-free for six months in order to drive.
In other cases, your doctor will make sure you are free of debilitating pain, in stable condition, and capable of safe reflexes (such as performing an emergency stop) that will allow you to operate a vehicle safely. Please speak with Dr. Berti for specific guidelines and insurance requirements.
9.When can I wash/dye my hair?
The doctor will decide this on a case by case basis, as well. For example, if you have had spine surgery, you may wash your hair as soon as you can do so comfortably in bed or in the bathroom when you are ambulatory. In the case of cervical spine surgery, the nurses usually perform the shampoo during the second post-operative day.
If you have had brain surgery, you must wait until the wound is totally healed. This means that an appropriate amount of scalp recovery and healing has taken place. Do not brush your hair away from the incision, as it might strain the sutures, and do not use a hair dryer. Most importantly, please run it by your doctor first.
10. When can I resume sexual activities?
It is best to ask your surgeon specifically, “when is it safe to have sexual intercourse?”. The answer will depend on the kind of surgery a patient has undergone. If you’ve had simple surgery or radiosurgery, you should be able to have sex when you are able to return to work and full physical activity. Those patients who have undergone extensive and complex inpatient surgery may require sexual re-education and rehabilitation (such as learning to use alternative positions, or waiting until you are fully recovered to resume sexual activity). This will also be answered on a case-by-case basis.
About CyberKnife
FAQ: CYBERKNIFE QUESTIONS
CyberKnife Questions:
The CyberKnife Robotic Radiosurgery system is a state-of-the-art, non-invasive treatment alternative to surgery for both cancerous and non-cancerous tumors throughout the body, including the spine and brain. The treatment accurately delivers high doses of radiation beams to tumors. The precisely targeted beams destroy tumors painlessly, without incisions, and spare the surrounding healthy tissue.
CyberKnife provides a pain-free, out-patient option to those who have otherwise inoperable or surgically complex tumors, as well as to those patients looking for alternatives to conventional surgery. As the medical director of Mercy Institute’s CyberKnife program, Dr. Berti has personally overseen countless treatments, and answers some of the more common questions his patients have had over the years, below.
1. What can I expect during my CyberKnife treatment?
A CyberKnife treatment session is typically a comfortable experience for patients. After meeting with their doctor and the radiation therapist, (the physicist, radiation oncologist, and radiation therapist) to have the appropriate imaging performed as well as an outline of treatment plan, patients will lie on a padded table for less than an hour while the CyberKnife’s robotic arm delivers highly-accurate doses of radiation guided by their image tracking guidance software. Because of the sophisticated imaging software, CK does not require a patient to wear rigid head frames; all they need to do is rest. No anesthesia is needed as there are no incisions, so patients will not feel pain. Some patients even fall asleep during the session.
I have had patients ask me if they will feel “rays” or “lasers” on the body; in fact, they will feel nothing. Very rarely a person might have mild headaches after treatment, but again, this is highly unusual as most people recover quickly. Your physician will disclose all side-effects prior to treatment, of course. There is no hospitalization, very little to no recovery time, and you can resume your daily activities immediately. You may visit www.cyberknife.com for further information or click here for their brochure.
2. How long does treatment take?
Each treatment takes between 30 and 90 minutes, with an average of forty-five minutes, depending on the tumor. The patient may have to return for more treatment if the treatment is being done in stages, but that is typically not more than five times. This will be determined by your doctor.
3. Is CyberKnife treatment a surgical procedure?
Despite its name, the CyberKnife Radiosurgery System is not a surgical procedure. There is no incision, no pain, and no blood loss. At the most, it could be called “surgical” because it is performed by a surgeon. Please refer to this link: www.cyberknife.com
4. Are CyberKnife treatments covered by insurance? How can I find out if CyberKnife is an option for me?
Yes, CyberKnife radiosurgery is covered by most insurance companies. While it helps many, CyberKnife is not always an option for all. We recommend that patients always consult with a physician in connection with any and all treatment options, and if required, obtain prior authorization from their insurance companies once a treatment option is determined. You may either call Dr. Berti’s office of have your doctor call our office for more questions or a referral: 305.661.8288
5. What are the benefits of CyberKnife treatment?
The CyberKnife radiosurgery system offers treatment for cancerous and non-cancerous tumors along the whole body. Its purpose is to control tumor growth and decrease the size of tumors with the delivery of appropriate radiation levels to those tumors. It has revolutionized the treatment of deeply-rooted tumors with its ability to reach through body structures with precisely targeted radiation, making potential complications from open surgery a thing of the past for those who qualify.
The treatment is painless and non-invasive, as it doesn’t require any incision or anesthesia. There are virtually no risks of any kind other than the delivery of high intensity radiation to a very precise point within the body, and to address this we can deliver the treatment in multiple stages of lesser doses that won’t put the surrounding organs and healthy tissue around the lesion in peril.
Over 100,000 patients in the United states have benefited from this highly-effective treatment thus far. The CyberKnife is also ambulatory and cost-effective. Patients only have to take 30 to 90 minutes out of their day for the procedure and can return to work the same day. They no longer need to pay for extended hospital stays or as much costly medications.
For an excellent overview of the CyberKnife treatment process, please visit www.cyberknifemercy.org. or view a video on YouTube.