Pre-Appointment Instructions

Prior to your first appointment, please be sure to fill out the forms mentioned below completely and remember to bring them with you to your appointment. This will be a great help in limiting your waiting time before seeing the doctor.

Please arrive for your appointment on time. We will make every effort to schedule you at a convenient time whenever possible. If you know that you can't make it to your appointment, just call us so we may give that time to another patient. If you arrive for an appointment more than 15 minutes late, we may need to reschedule you.

If you have private insurance, bring the card with you so we may copy it. If you have been injured on the job, you must fill out the Workers' Comp Information Sheet. A "First Report of Occupational Injury or Illness" (numbers 1-18) is required if you have not already completed on at your Primary Physician's office.

Many insurance companies require prior authorization for treatment by a specialist like Dr. Howard. We ask that you call your insurance carrier to obtain information on you policy's requirements. We will assist you in obtaining authorization if required. Please call our office prior to your appointment if you need assistance.

We are committed to providing you with the highest quality care. Please assist us by bringing the following information to your first appointment:

  • Completed Patient Intake Form
  • Films and reports of all x-rays, MRI scans, myelograms, C.T. scans, bone scans and discography testing pertaining to your current problem.
  • Reports of diagnostic testing such as EMG/nerve conduction testing, bone density testing or arthritis panel testing.
  • Medical records from referring physician as well as reports from other specialists you have seen for this problem including orthopedic or neurosurgeons, neurologists, pain management specialists, etc.
  • Referral from physician or care provider.

Please note that insurance co-payments (if any) will be collected at the time of your visit.

We want to make your experience with us as pleasant as possible. If we can be of any further assistance, please call our office between 8:30-5:00 Monday through Friday.


Pre-Op Instructions

Please be sure to bring along a list of your medications to Dr. Howard's office the day you are scheduled for pre-op clearance. You will want to ask him what needs to be discontinued and what medications you can continue taking.

Please be sure that any of the following blood thinning medications are discontinued at least 10 days prior to your surgery:

Aspirin or any Aspirin containing medications such as: anti-inflammatories, Vitamin A, Vitamin E, St. Johns Wart, MSM, Glucosamine, SAM-E, Ginger and garlic tablets OR non steroidal anagelsics such as: Advil, Aleve, Ibuprofen, Mobic, Nuprin, Naprosyn, Chinese Herbs or plant extracts (especially: Ginko-Biloba, Mahuang, Kava Kava Root, or Ginseng).

Most pain medication will not need to be discontinued.

Most patients are asked to bring ALL of their spine study FILMS with them to the surgery center for their surgery. Dr. Howard will not be able to perform your surgery unless you bring these FILMS with you. These studies may include X-rays, MRI, CT and/or myelograms. If you do not have these FILMS, please, contact our office and be sure that our staff has them. If our office does not have them we may assist in tracking them down prior to your surgery.

You will need to contact our office staff to schedule a post-operative appointment. This appointment is usually within 1-2 weeks after the date of your surgery. In addition, please you will have another appointment 1 month and 3 months after surgery.

Please do not eat or drink after midnight the night before your procedure. If you need to take your pain medication in the morning you may do so ONLY with a SMALL SIP of water.

You will be seen by Dr. Howard before surgery and prior to being discharged from the surgery center. You will have time to call on a friend or family member to collect you.

If there is something the in-house nurses cannot answer or you feel more comfortable speaking with someone on our staff then we can be called or paged immediately.

We are available for you at anytime with any questions (please keep messages as short as possible). In case of an emergency, you can call (831) 655-5380 and ask for Dr. Howard to be paged directly. We are available 24/7 for your questions and are committed to promptly answering them.

Please feel free to call our office anytime with any further questions or concerns. We are more than happy to help in anyway we can.


Post-Op Instructions While in surgery center:
  • The day after your surgery you will be assisted by a physical therapist to regain mobility. After your physical therapy session you should be mobile several more times during the day as tolerated.
  • Showering is permitted (a waterproof dressing will be applied).
  • You will be released from the hospital when you achieve a relative level of independence (i.e. you achieve a moderate level of mobility status, you can eat without nausea, and can manage your pain with oral medication).
  • Your bladder should be functioning as it was prior to surgery, but your bowels may not work until you get home.
  • You will not be kept in hospital if you have not had a bowel movement, but you will be started on a bowel program immediately after surgery. Therefore, you can expect activity either in hospital, or soon after you get home !
  • A family member or friend will be able to transport you home, with regular transportation (2 seater convertibles, are discouraged).
At home (~ first 4 weeks)
  • Somebody responsible should assist you for the first several days at home.
  • You may NOT take any blood thinning medications. No aspirin, anti-inflammatories (eg. ibuprofen, advil, aleve), heparin, or warfarin/coumadin, without written consent from your pre-operative internist, or Dr Siddique or Perri.
  • No bending, twisting, or lifting anything heavier than a gallon of milk (>10lbs).
  • Avoid activities that cause strain or stress on your incision.
  • Climbing stairs is permitted (and encouraged), but should be done slowly and carefully.
  • Showering is permitted (do not allow the jet to spray directly onto your incision).
  • You do NOT need to cover your incision, pat the incision dry once you are done in the shower.
  • Do not soak your incision in a bath tub for 2 weeks.
  • A bandage or dressing MAY be placed over the incision site, to protect your clothes but a dressing is not necessary, or essential.
  • Your steri-strips will start to curl up after one week, we will remove them one week after your surgery.
  • Driving is not permitted until cleared by the doctor. You should not drive, especially if you are taking medications (i.e. narcotics) that impairs or effects your judgment.
  • If you have been given a lumbar brace, you must wear it at all times when out of bed, other than when you are sleeping or showering.
  • If you are given a cervical collar, please wear at all times (including sleeping) except when showering.
  • Suture removal will not be necessary as you will have a cosmetic skin closure with absorbable suture material. If this is not the case, the doctor will remove the sutures one week after surgery.
  • If you develop a temp greater than 101 F, or your incision becomes red, swollen, or starts to drain, please contact us immediately.
  • Call our office (831) 655-5380 to schedule an office visit with Dr. Howard one to two weeks after your surgery .
Call immediately if you have:
  • Increased pain or worsening of symptoms
  • Bulging, redness, or pus drainage from incision site
  • Persistent nausea/vomiting
  • Fever greater than 101 degree Fahrenheit
Office visit (2 weeks)
  • Your incision site will be examined and new care instructions will be offered.
  • You will have returned to relatively normal activity level except impact exercises (i.e. running, weight lifting).
  • Physical therapy will be recommended at this time.
  • At this point you have probably resumed driving.
  • Restricted level of sex may be resumed unless otherwise instructed by the doctor.
  • While a certain amount of pain is common in the recovery process, ice application (place ice around the incision and not directly on it), TENS unit and certain positions my help reduce your pain symptoms.
  • Physical therapy, lifestyle changes, drinking enough water, sleeping on a good mattress (firm, but not hard), not smoking, and maintaining the ideal body weight, through regular exercise are all important considerations for post operative spinal surgery recovery.
General Information
  • Commitment and determination to a full recovery is dependent on the patient's willingness to work hard with the information shared by the medical team.
  • Fusions require three months to six months to become stable (NEVER smoke or take any anti-inflammatories until approved by the doctor as this will decrease fusion rates potentially leading to redo surgery).
  • You may be required to use a bone growth stimulator during the first 8 weeks.
  • The bone tissue rebuilding process requires muscle stressors and gravity to help the fusion become stronger. Therefore, please do not stay in bed (this type of reduced activity is not indicated).
  • Almost all patients are de-conditioned before their spine surgery thus a strong commitment to rehabilitation is vital for a successful outcome.
  • If you are overweight, your results may be adversely affected, and may contribute to further spinal surgery. Therefore identify your ideal body weight, and strive to achieve it, (You don't want to go through the surgery, and recovery process again!)
  • This is your opportunity to get back in shape.
  • Walk a mile a day.
  • Swimming, Pilates, core conditioning, and other non-impact exercises are an ideal form of exercise.