Parkinson's Law #1 states, "Work expands so as to fill the time available for its completion," so if you have 2 months to get these things done, start now.

Your Paperwork

• If you didn't have pain in the wrist, you wouldn't be needing surgery, but you have to fill out a monstrous amount of paperwork. To make things easy on yourself, start organizing the information. Get a folder or binder to put things in. Go as slowly as you need, but don't put it off.

• Collect your insurance documents, your insurance card, and any letters you received from the insurance company regarding Kienbock's Disease. Make several photocopies.

• On a single sheet of paper, list all of your doctors, with names and addresses. Include your primary care physician, dentist, orthopedist, rheumatologist, allergist, dermatologist, opthamologist, physical therapist, gynecologist, urologist, neurologist, psychiatrist, and any other doctor you've seen in the past 10 years or so. Include the name, phone number, and address of your preferred pharmacy. This is good information to have on hand, so make a copy to keep near the phone or in your address book.

• Make a list of any diagnoses you have, allergies, and dietary restrictions. Write down everything, even if you don't see how it could be relevant. List any previous surgeries of any type. Make a few copies.

• List every medication you take, its dose, its schedule, and the prescribing doctor. It's easiest to copy it directly from the prescriptions' labels. Also include every supplement you take, from vitamin C to St. John's Wort, and any over-the-counter medicines you take with any regularity, like tagamet, Tylenol, or Sudafed.

• You don't have to write it down, but inform your doctor if you use medications that were not prescribed to you (a friend's Valium, for example), would have withdrawal symptoms if you were denied alcoholic beverages for 24 hours, or use any type of street drug, including marijuana, methamphetamines, or heroin. Your doc isn't interested in prosecuting you; he just needs to know these things as they do factor into your treatment and recovery.

  Include copies of any legal papers like a living will or durable power of attorney. Because any surgery has risks, notify your family of your beliefs concerning life-saving procedures, organ donation, and final wishes. Don't dwell on it or heavily weight it, just mention it.

• When you've had as much paperwork you can take, smile sweetly and tell the receptionist or nurse that you just can't write anymore. Ask if you can place copies of the notes you've made into the records instead.

Your Surgery

• Anything you'll need to know after surgery, you need to learn before surgery. There are many post-op issues presented here for that reason.

• Try to schedule your surgery for early in the week, not just before the weekend or a holiday. You'll want to know that your doctor is in his office and easily reached the first day or two after surgery in case you need anything.

• You should have a sit-down discussion with your doctor so that he can explain to you exactly what's going to happen and what you can expect.
  See also:Questions For Your Doctor

• If at all possible, have your caregiver attend this appointment with you. Four ears are better than two, especially when two of them are going to undergo surgery and be medicated.

• If you have trouble remembering what the doctor says at your appointments, ask if you can record your visit with a small tape recorder, then you can review it at home when you are under less stress. Not all doctors will allow this but some will.

• You should be given pre-op instructions by your doctor. Examples would be:
  • Nothing by mouth for 8-12 hours before surgery
    
  • Remove all jewelry and glasses, do not take jewelry to the hospital
    
  • Don't take any products containing aspirin for 72 hours before surgery

  (These are examples of things you might be told, not actual instructions!)

• Whatever instructions you're given, make sure you understand them and can follow them.

• Ask specifically about taking any daily medications before surgery. Some docs say take them with a sip of water on schedule, some say don't take them the morning of surgery.

• Double check that your doctor is aware of every medication (particularly aspirin) or vitamin supplement you take. These can affect your anesthesia or bleeding.

• Do not wear makeup, perfume, nail polish, hair clips, dentures, contact lenses, or jewelry into surgery. Have your caregiver keep important items, like eyeglasses, for you; leave anything else at home.

• Wear loose clothing the day of surgery.

• Shower well the morning of your surgery and savor every drop. It's the last time you'll feel truly free and clean for a while.

• If you become ill in the days before your surgery, inform your doctor as soon as possible. He may wish to reschedule rather than compromise your health.

• Even if you are scheduled as an out-patient, take an overnight bag of necessities with you. You can leave it in the car or with your caregiver. If you prepare for the unexpected, then it isn't unexpected.

  I always say, the day you don't carry your umbrella is the day it's going to rain.--srhd

• There's no delicate way I could think of to put this, so I apologize for having to blurt it out. Women, if you have the option, try to schedule your surgery for the first week of your cycle so that you have time to adjust to your limitations and recover before you have to entertain Aunt Flo.

Your Appearance, Primarily For Women

• Get your hair cut. You won't be able to brush and dry and style your hair for a while. If you have someone to do that for you (a husband or friend) it will be easier if it's a simple style. If you don't have someone to do it, get it cut as short as you can stand so that it's wash-and-wear. You can wait until after surgery to have this done if you have someone to drive you.

• Several suggestions have been made as to what to do with long hair. Among the best I've seen are to have it braided into small braids (think Bo Derek in 10), which can then be gathered into a ponytail and need to be taken down to wash only every week or two, or to have long hair cut and donated to Locks of Love.

• Find a cheap manicurist nearby. Make an appointment to be seen a week or so after surgery. You'll have trouble fixing those little fingernail snags yourself, and a coat of bright red on the nails is a great mood brightener.

  Get a pedicure, too, just for fun. --srhd

• Practice putting on pants and a bra with one hand. You may need to get some sweat pants or elastic-waisted shorts/skirts.

• Bras are going to be a problem for those who wear them. There's not a way to get around it, but you can practice now and consider buying one or two that are a bit larger than you actually need. Say, a 36B instead of a 34B. The wiggle room will help. Front-hook or zip bras are reportedly easier to manage. Tank tops with built-in shelf bras do double duty as shirts. And for the blessedly small-breasted, go without a bra whenever you can.

• You'll also appreciate extra roomy t-shirts and slip-on shoes, but loose sandals like flip flops might not be a good idea. You will be a bit groggy from the pain meds and you want sturdy, nonslip shoes on your feet so you don't trip and fall.

• If you must wear make-up, figure out what one item makes the most difference. For me, if I'm wearing lipstick, I can get away with an otherwise clean face. For a friend, it's eyeliner. Maybe you need only a dusting of blush or a light coat of tinted moisturizer. Pare it down as best you can. You will have prominant accoutrements (a cast or bandages) that let the world know you can't use one arm. No one will fault you for not being fully made up.

Your Home, Primarily For Women

• Accept that your house will likely fall to crap. You can fix it later. Don't sweat it. No one will look down on you for it.

  Make a Chores list and assign jobs to anyone who walks in.

• Ask a neighbor, or pay a local teenager, to mow your lawn and carry your trash to the curb for a few weeks, if you live alone.

• Visit Flylady and consider joining her email reminder list for keeping your house in order. The site has been mentioned in issues of both Woman's Day and Time magazines. This relaxed and simple program, which incorporates advice for those dealing with illness, would be best started a month or two before surgery, but it's just as easy to begin during recovery.

• Take a few minutes to find out exactly who in your area will deliver dinner to your home: pizza, chinese, KFC, a local deli. Collect the menus for them.

• Make up a whole bunch of meals and put them in the fridge/freezer to be heated up easily. Soups keep well, but use freezer bowls instead of canning jars. You will not be able to open a jar or use a standard can opener.

• Put away any good or sentimental dishes (and favorite coffee cups) so that you aren't tempted to use them. If you should drop and break one, you'd feel bad about it.

• Stock up on paper plates, plastic flatware, and "disposable" bowls (made by Glad and Ziploc, available in the paper products section of the grocery store).

• Check out Active Forever for a few products like the Tab Grabber for soda cans, elastic coil shoe laces, NorthCoast Rheumatic's Black Lite Touch Pen, the Maddak Un-Skru Jar Opener, lap trays, and the Krups one-hand Open Master can opener.

Your Mind

• In the coming days, subscribe to your favorite magazines. If you look in the fine print of the masthead, there will be a phone number for subscriptions. You'll get your issues sooner by calling than if you mail in the subscription card.

• Grab those old novels you've been meaning to read (or reread) since college. Wuthering Heights, Jane Eyre, Brave New World, War and Peace, The Sun Also Rises, The Great Gatsby, Catcher in the Rye, and Lord of the Flies are all good. There are collections of short stories like Sherlock Holmes mysteries, O. Henry, or E. A. Poe. And don't feel guilty about the time you spend reading instead of doing. You're broadening and exercising your mind.

Your Comfort

• Make yourself a comfy spot on the couch or favorite chair where you have access to everything you need in case no one is around... books, medicines, water, snacks, remote control, telephone, blankets, pillows. Put all this in a pretty basket or something that will keep it all together so you won't have to go reaching and looking for it if you're groggy.

• If you don't have one, invest in a cordless phone. If you do have one, plug it in near your comfy spot. Either have your doc on speed dial or have his phone number in your basket.

• Do not hesitate to call with even the most trivial of questions or concerns if you feel like you need to ask him or his office. Don't be surprised if you communicate with him through a nurse instead of speaking to him directly. It doesn't mean you're not important. If he trusts his staff, so should you.

  If it is after hours, your doctor may not be on call. Ask him beforehand what to do in that situation. Often the on-call doctor can answer your questions, but sometimes he can't.--srhd

• Place a small trashcan near your comfy spot for the first couple of days. Some pain meds can cause nausea. If you get nauseated and it persists, CALL and get a different prescription, but Do Not stop taking the old one until you have the new one in hand unless you're specifically told to stop. As Phyllis Walker says, you have to stay in front of the pain.

  (If your mouth, tongue, or throat begin to swell or you begin to have difficulty breathing, race immediately to the emergency room. Do not take the time to call your doctor first. Call him from the car or let the emergency room staff do it for you. These are symptoms of a life-threatening reaction. If necessary, call an ambulance.)

• Collect a few pillows of various kinds: bed pillows, throw pillows, firm, soft, big, little. Have them near your comfy spot to prop up on. You may need a different combination every few minutes. If you do, don't become agitated at having to rearrange them. I mean, what else do you have on your schedule?

• If you have one, put a "breakfast-in-bed tray" near your comfy spot. It makes a good desk or impromptu table for dinners, as long as they aren't terribly hot or likely to spill. A lap desk (usually a beanbag-like pillow with a hard surface on top, but they come in many other designs as well) is a fine substitute.

  "The Bed Desk" by Layd-Back Productions is by far the best tray or lap desk made.

• Add a portable dry erase board to your basket, or slide one under your comfy spot. The large dry erase markers will be easier to hold if your dominate hand is affected. Making large letters is easier than trying to write normally with a non-dominate hand. A note written in large, colorful print (even if it is child-like in quality) can be left for your caregiver to read while you sleep.

• Sharing a bed with another person may be uncomfortable for both of you. Try to make alternate arrangements.

• A recliner makes an excellent comfy spot place to sleep after surgery. You can prop your arm up on a bunch of pillows stacked on one of the arms and you can adjust the chair different ways to try to get comfy.

• Antibiotics can cause diarrhea and yeast infections. In case you will be given antibiotics, have on hand either a few servings of yogurt or buttermilk or vitamin supplements containing acidopholus. One serving or supplement each day that you're on antibiotics will keep your natural flora intact, a fancy way of saying it will protect you from diarrhea and yeast infections.

Your Surgical Site

• Have the doc review with you and your caregiver what to look for in terms of infection. "What does the site look like if it's healthy?" "I should call you if I see what signs?" It's best to do this before surgery.

• The doctor or the hospital staff may give you "aftercare" instructions. Pick out a specific place to put these so they don't get lost. Inform your caregiver where they belong.

• The only specialized product you ought to need on hand for cleaning the stitches would be peroxide. Usually plain water will do the trick. You may not be responsible for cleaning the stitches (some docs don't want them touched), so ask about it and listen carefully to the instructions. It's best to do this before surgery, as well.

• Regular q-tips are good for cleaning with hydrogen peroxide or water.

  There are specific instructions for site care if it is ordered.

  (Peroxide must be washed off with water, not allowed to sit on the skin).

• Have some Neosporin (triple antibiotic ointment) on hand, but don't expect to need it.

Your Hygiene

• Get a waterproof cast protector! This is a great contraption for your arm that allows you to shower or even go swimming. It's a vacuum that you put on and pump the air out... and then you're home free! Trust me, you'll want one.

  Alternatively, the old bread bag over the arm is a faithful standby. Double bagged with 2 rubber bands staggered at different parts of the upper arm (or tape) keep drips from seeping through.

• If you will be under anesthesia for a long time make sure you have a stool softener on hand. Anesthesia and narcotic painkillers can be constipating. Docusate Sodium is a recommended as a stool softener. Bulk forming laxatives like Metamucil or Fiber-con are an alternative. Avoid "stimulant" laxatives. Always drink plenty of water when using a laxative.

• Buy a pack of baby wipes. They're much more efficient at personal cleaning than toilet paper.

• Practice brushing your teeth, including applying toothpaste to the brush, using only your non-affected hand. This is obviously easier if your non-dominate hand is affected, but it's still not easy. An electric toothbrush may be more effective if you have to brush with your non-dominate hand.

• Have a terry cloth robe on hand to use rather than a towel after a shower or bath. (Shower only if your doc permits!) You can slip it on and let the robe absorb the water. Makes drying your back much easier.

• Use pump top bottles for shampoo, conditioner, body wash etc.

Your Caregiver

• Someone will need to be available in the waiting room while you are in surgery and take you home afterward. Remind him or her to buy a roll of quarters for the vending machines and pay phones (cellular phones are restricted inside medical facilities because the signals may interfere with the equipment). Provide him or her with the phone numbers of anyone who would need to be notified of complications or an unexpectedly extended stay.

• You will need someone to stay with you for a few days after surgery to assist you. If possible, have two or more people available so that they may take breaks and avoid overstressing themselves.

• Give your caregiver permission to wake you in order to take your pills on time at least for the first 48 hours. It may seem silly, but you must stay in front of the pain.

• Give your caregiver permission to turn away visitors if you're not up to them. A little white lie won't hurt anyone and is entirely appropriate in this situation. If you don't want to face your adoring public, allow your caregiver to lie to them, to tell them that you're "finally" sleeping, and to ask them to leave a note for you so that you'll know they were concerned.

• If visitors show up with gifts of food, have them transfer it to your own dishes (another handy use for the disposable bowls) and take their own dishes home with them. You have enough to do without micromanaging (or breaking) other people's dinnerware.

Your Responsibilities

• Familiarize yourself with the post-op suggestions.

• Plan to sleep. A lot. It's primarily during sleep that the body heals itself.

• Inform your friends, neighbors, church group, or social club that you will be having surgery. It hurts feelings when they find out later that you didn't tell them.

• Try to maintain, with the help of your caregiver, a list of people have shown concern or brought tokens for you so that you may, when you've recovered enough, send thank you notes to them. (If someone asks if they can get something for you, and all your other needs are met, ask for a book of stamps and/or a package of small, blank cards).

• Update your address book before surgery.

• Ask someone to post to your lists, especially the Kienbock List, on your behalf while it's difficult for you to type.

• If you are responsible for the finances of your home, fill out the checks you will need for the coming days (weeks if it's your dominate hand) and sign a few blanks. Keep them in a SECURE location. Sign up for any electronic payments or deposits that your situation permits.

• Configure your mouse to work with your non-affected hand and practice using it.

• Do your dead-level best to stop smoking. This is a difficult and stressful time, and there will be boredom to contend with, but every cigarette you don't smoke increases your chance for recovery and positive outcome. If it is impossible to quit entirely, begin to limit the number of cigarettes you smoke in a given day until you're down to less than half a pack. You can talk to your doctor about Zyban or Chantix, drugs that significantly decrease the nicotine cravings, or try using the nicotine patches and gums.

• After anesthesia and while you're on narcotic pain medications, you will need to perform deep breathing exercises. Anesthesia and narcotics can make the lungs a bit lazy and can suppress the cough reflex. In a worst-case scenario, it could lead to pneumonia. Learn what to do and how to do them and practice them before surgery.

  See also: Dealing With One Hand

  Significant contributions by
  Stacy Goodman and Lydia Kedzierski.