11 Steps For Surgery: What Patients Need To Know

June 11, 2012 by Sharon Adams
. [ILLUSTRATION: ©Betsy Everitt/i2iart.com]

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ILLUSTRATION: ©Betsy Everitt/i2iart.com

The prospect of surgery can turn the strongest of us into wimps. Who wouldn’t feel helpless, lying sedated, surrounded by a bunch of masked people armed with sharp instruments, poised to pierce your skin?

You may not be able to change that scenario, but preparing yourself mentally and physically for surgery can have an impact on the outcome—how quickly you heal, maybe even how much pain you feel.

Advice for preparing for surgery is not one-size-fits-all, and depends on severity of the procedure, your personality, your health going in and advice from your surgeon and family doctor. Picking and choosing what makes sense for you from the following tips can help you feel more in control—a full member of the team working to get your body well.

 

Knowing What To Expect

Knowledge can ensure peace of mind. Talking with doctors and people who’ve had the same surgery and trolling the Internet “can increase your sense of control, decrease uncertainty and increase your sense of being ready,” advises Dr. Joel Katz, director of the Acute Pain Research Unit at Toronto General Hospital. But don’t overwhelm yourself with information.

“Patients are likely to do best when they have confidence,” says Dr. Michael Klar of St. Michael’s Hospital in Toronto, who has 15 years of experience helping patients prepare for surgery. You should know surgery is right for you and have confidence in your surgeon. Has the surgeon done a lot of these procedures? Would you like a second opinion?

Go over risks and benefits with your family doctor and your surgeon, including what happens if you don’t have surgery. Since there’s a lot of information to digest, it’s a good idea to take someone with you or to take notes or record the conversation. Be sure to discuss how treatment of other medical conditions, like diabetes, will be handled.

It will also boost your confidence to know what will happen during surgery and recovery. Write down questions before meeting your surgeon, advises Klar.

Will you have a choice between general and local anesthetic? How will pain be handled? Will you need help at home? When will you be able to move, to begin rehabilitation, to drive, to return to work? What is your rehabilitation plan? Are there written materials that can help?

Most hospitals have websites detailing surgical procedures and how to prepare for your particular surgery and what to do to aid healing.

Someone who’s had your type of surgery “will tell you what to expect, how they prepared, what worked for them and what didn’t,” says Katz. But avoid people who concentrate on the negative.

Plan for recovery, too. You’ll recover faster if you provide your body with nutritional tools to heal itself, says Toronto naturopath Dr. Jean-Jacques Dugoua, who has a decade of experience helping patients prepare for and recover from surgery.

Find Peer Support

Ortho Connect (www.orthoconnect.org) matches joint replacement patients with people nearby who’ve undergone similar treatment. Tel. 1-800-461-3696. E-mail orthoconnect@canorth.org.

The Canadian Cancer society website www.cancerconnection.ca directs patients to CancerConnection telephone peer support in their own province or territory.

Prostate Cancer Canada Network www.prostatecancer.ca/PCCN/Support-Groups has a list of groups across the country and an online support group.

. [ILLUSTRATION: ©Betsy Everitt/i2iart.com]

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ILLUSTRATION: ©Betsy Everitt/i2iart.com

Be In Good Shape For The Condition You’re In

Surgery will place demands on your heart and lungs, your liver and kidneys, your infection fighting system and your healing system. “Discuss with your family physician what your baseline (fitness) level is and how you can move up,” Klar advises.

Pay attention to nutrition. You want to be well-nourished before surgery, advises Dugoua. Our digestive systems become less efficient as we age. Chronic health conditions and tobacco and alcohol use also can deplete the nutrients your body needs to fight infection and heal. “People’s needs are different,” he says, but everyone can benefit from a good multivitamin leading up to surgery.

The body needs stores of vitamins A, B and C for collagen formation, tissue repair and support of the immune response. Make sure your multivitamin also contains zinc and selenium which are needed for tissue and wound healing, cell regeneration and repair. Vitamin D and magnesium are required for hundreds of biochemical reactions throughout the body. And protein provides the building blocks for tissue repair and remodelling.

Taking probiotics in the weeks prior to surgery and as soon as you are allowed solid food afterwards is a good idea, says Dugoua. They boost the immune system and restore the normal balance of bacteria after a course of antibiotics, helping to prevent diarrhea.

If you’ve been requested to lose weight prior to surgery, it is a good idea to talk to your doctors about when to come off a diet before the operation.

Don’t Put That In Your Mouth!

Equally important to what goes in your body is what to avoid.

If you smoke, stop or cut down. Smokers often have to be on respirators longer, their bodies heal more slowly and they’re more prone to infection. Smoking affects secretion of collagen for tissue repair. It also uses up vitamin C, which is needed for healing.

Cut out alcohol. You don’t want your liver busy detoxifying alcohol when you need it to filter out toxins, flush out bacteria, and transform nutrients into fuel.

If you use recreational drugs, tell your surgeon. Some drugs interact with general anesthetic agents causing swings in blood pressure and heart rate during the operation. Some increase the anesthetics needed to keep you under during surgery.

A week or two ahead of surgery your surgeon may want you to stop taking certain prescriptions, medications and supplements that may increase bleeding, interact with anesthetics or medications and raise the risk of complications.

Your surgeon will tell you if and when to stop prescription medications, but be sure to also discuss over-the-counter medications, vitamins, minerals and herbal supplements. Fish oils, vitamin E, garlic, ginseng and ginkgo biloba increase bleeding. Herbs taken to lift mood or promote sleep, like St. John’s wort and skullcap, can dangerously interact with medications.

Choose Your Support Team

Some hospitals suggest a coach—a spouse, relative or friend—for support through surgery, hospitalization and rehabilitation. A coach can record information when you’re overwhelmed by data or emotion, transmit information to family members and friends and encourage and support you to stick to your rehab routine.

You may need help at home during recovery. You’ll need someone to drive you to and from the hospital and post-operative appointments and run errands. Will you need someone to change dressings or administer medications, bring you meals, walk the dog or feed the cat, bring in the mail, answer the phone or manage visitors? With good home support you can get the rest you need.

The Do Aheads

Life immediately after surgery will be easier if you take care of some chores well in advance, including:

• Getting pre-surgical tests done as early as possible.

• Filling post-operative prescriptions so they’re on hand when you need them.

• Renting or buying special equipment—hospital bed, wheelchair, crutches, bandages and dressings, etc.

• Dealing with dental problems. Dental work releases bacteria into the bloodstream, and you don’t want it to cause an infection in, say, a new joint or stent in a blood vessel.

• Getting the house shipshape so you’re not tempted to clean while you recover. Your doctor will tell you when it’s safe to vacuum or mow the lawn again.

• Preparing and freezing meals in advance if you won’t be able to cook for awhile.

• Setting up your home recovery centre. You might want to move a bed so you don’t have to negotiate stairs or are closer to the bathroom. Make sure things you need are easily at hand.

Documentation

You are about to field a ton of questions. It’ll be easier to answer if all the information is in one folder containing:

• Your medical history, including names of doctors you’re seeing and their phone numbers.

• A list of medications, including how much you take and how often. Include vitamins, herbs and mineral supplements, as well as drugstore remedies like Tylenol or Aspirin.

• Your provincial health insurance number and the name of private insurer, along with group and certificate number.

• Your living will or arrangements for power of attorney and your legal will.

Be sure to make photocopies in case some contents go astray.

Preparing For Hospital

Be sure to rest up for at least a day prior to surgery.

Unless you have been properly advised, don’t eat or drink anything after midnight the day of surgery. If your stomach isn’t completely empty you could vomit during the operation, possibly inhaling food particles, liquids, bacteria. This could lead to a serious lung infection.

You’ll need a lift to the hospital and home again—even if you’re only having day surgery. You’ll need at least 24 hours to recover before doing anything requiring co-ordination or clear judgment.

Don’t wear makeup or perfume to hospital.

Leave valuables—jewelry, large sums of cash, electronic devices—at home. But remember documents and medications the hospital and surgeon have requested.

Cut down the risk of hospital-borne infections by making sure everyone who enters your room disinfects their hands or puts on fresh gloves.

Reduce the risk of hospital treatment error by checking (or having a companion check) that medications administered are for you, are the right meds and the right dosage.

Watch For Problems

Alert your doctor immediately if you see symptoms of infection, like redness and warmth or discharge around the wound, more pain than makes sense, or if you feel like you’re coming down with the flu.

Knowing How Tissue Heals

The body responds to a wound by reducing blood flow to the area and plugging the opening. Platelets clump together to form a clot and a thick, sticky yellow fluid called serum binds the tissues, creating a protective scab and supporting skin formation.

Next, white blood cells flood in, destroying germs. Then the body concentrates on healing, beginning with increasing the blood supply, causing the area to redden and warm up. Tissues near the injury become stiff, so your surgeon may recommend gentle motion to minimize stiffness and swelling.

Collagen will eventually fill in the wound and build new blood vessels. Scar tissue forms by about the third week.

Not only do different tissues heal at different rates, depending on things like blood and nerve supply, but different people heal at different rates. Children heal faster than adults. Smokers and diabetics heal slower. Healing can be delayed by stress, nutrient deficiencies or another illness or infection.

Learn To Relax

Even if you’re not afraid of the knife or needles, surgery is stressful. Fear, stress and anxiety raise levels of cortisol, the ‘fight or flight’ hormone, leading to slower healing, decreased immune response, increased risk of infection and a longer recovery.

Stress intensifies pain perception and intense pain delays healing.

Relieving stress may not make pain disappear, but may reduce its intensity, making you feel more in control, says Katz, who’s been researching pain and working with surgical patients since 1990.

Remember, although pain is unpleasant, it can be managed. Talk to your surgeon about pain management in hospital and at home. Don’t grin and bear it—you’ll delay healing.

Pick and choose from these stress-busting techniques:

Breathe Easy: Deep breathing gets more oxygen into the bloodstream and relaxes the body, reducing pain perception. As you breathe, move your abdomen, rather than moving your shoulders up and down. Close your eyes and take a deep breath through your mouth. Hold it to the count of six. Slowly exhale through your nose. Repeat a couple of times.

Be Mindful: Progressive relaxation, prayer, yoga and meditation reduce anxiety. Brain scans during meditation show less activity where pain is registered and greater activity in the part that handles unpleasant feeling.

Acupuncture: Inserting thin needles at specific points in the body can relieve or reduce pain, coincidentally cutting down use of painkilling drugs, thus side effects. Brain MRIs show acupuncture deactivates areas of the brain associated with pain processing and brain scans reveal brain waves switch to those characteristic of sleep and deep relaxation.

Visualization: Imagine doing something peaceful and enjoyable. Bring your senses into play as you layer in detail: beautiful colours; enjoyable sounds; delightful scents; pleasant sensations on the skin, like the warmth of the sun or the kiss of a gentle breeze; the taste of a beverage or favourite flavour; the comforting presence of loved ones.

Stimulate Happiness: Love and laughter have been shown to reduce pain perception and activate “feel-good” neurotransmitters in the brain, so watch comedies, read humorous books, listen to music that gets your toes a-tappin’. Just be careful of the belly laughs if you’ve got lots of stitches.

Email the writer at: writer@legionmagazine.com

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