Thursday, 24 January 2013

Preparing For and Recovering After Surgery

Having written about all the cosmetic things I do to keep myself looking and feeling nice while I'm recovering from surgery, I felt that there were also a number of things I would do to help my mental and physical health during the recovery period.

One of the things that people never tell you about surgery is how hard that recovery period can be. In an age where cosmetic surgery is touted as a 'quick fix' and an 'easy option', it's natural to lose sight of what actually happens during a surgical operation.

In my opinion, surgery is not an easy answer to anything. But, having said that, sometimes surgery is the only answer. Not, in my case, to get bigger breasts, slimmer thighs, or a smaller nose. I have surgery to stabilise my joints on the rare occasion that there seems to be a surgical solution to a particularly problematic (unstable) joint. I have had surgery in the past to remove my appendix, my tonsils and my adenoids, and more recently, to fit a feeding tube into my small intestine, after months of trying everything to avoid the need for surgery.

So, we've established that I'd rather not have surgery, and that I would prefer a conservative approach, exploring all other options before resorting to surgery. But now I need to have an operation, and I want to make sure that my recovery is as smooth and straightforward as possible. For me, the key to this is preparation, which falls into three categories: before the surgery, immediately after the surgery (hours and days), and in the recovery period (weeks to months). Of course, the answer always lies in a list!

 Be mentally prepared:

Know that after the surgery, you will probably have a wound. This is a cut that goes through all the layers of your skin and the tissues underneath it. If you were lucky enough to have 'keyhole' surgery, you will have several shorter wounds, but they are still wounds, they will still hurt, and they still need to heal. If they are on your abdomen, you are likely to feel them with every movement for several days, if not longer.

So you have at least one wound. But the wound is just the access point that allowed the surgeon(s) to get to the part of your body that interested them. If you've had orthopaedic surgery, it is likely that the muscles, ligaments and cartilage around the joint will have been stretched, if not cut, torn or moved and reattached. You may have broken bones (either the cause of the surgery, or resulting from it if you need a joint re-aligned, for example) and pins, screws, plates, and other things that belong in the garden shed, rather than inside one's body. Sutures, staples and dressings all bring their own brand of discomfort, as do plaster casts. Those applied during surgery are unbelievably heavy and unwieldy. You may find that the dressings or stitches cause irritation and itching, and problems all of their own, without even thinking about the wound.

If your surgery involved your GI tract, you may find that you have a lot of pain, bloating and distension. The intestine does not like being handled, and will make its displeasure known. Even if your GI tract was left well alone, you may find that the medications given during surgery have a GI effect. Painkillers can cause constipation; antibiotics can cause diarrhoea. If you were ventilated during your operation, you may have a sore throat from the tube, and/or a dry mouth, throat, nose and face from the oxygen and anaesthetic gases. Ah yes, those anaesthetic gases. And the other medications used to induce and maintain anaesthesia. They cause nausea for many people, as do some of the strong painkillers that are often used. Just for a moment stop and imagine how much you would NOT want to vomit immediately after abdominal surgery. Or surgery to your head/neck. Or to your ribcage/lungs/heart.

Cosmetic surgery and weight loss surgery get so much coverage, and are now such common procedures that it's easy to forget that they are still surgical procedures. I once had orthopaedic surgery (actually, more than once, but we'll just consider this one example). I was in hospital overnight after the procedure, which lasted approximately half an hour. By any standards, this was a routine, straightforward operation. I left hospital with three scars, each only a couple of millimetres in length, two wires in my wrist, and a plaster cast from finger tips to shoulder. I can't tell you how much pain I had after that surgery. My surgeons had focused on how simple the procedure was (from their point of view), so I was really not prepared in my own mind to have lots of pain as well as the usual annoyances of having a limb in a cast.

Before the surgery:

Prepare yourself mentally for it to hurt a lot. Make sure that your doctor or surgeon prescribes appropriate painkillers for after the surgery and ask if there is anything they can use during the surgery (e.g. a nerve block or local anaesthetic injection) to reduce the pain afterwards, or if they would recommend using TENS, guided imagery, heat or cold therapies. You may find that you only need simple over-the-counter medications and ice packs for a couple of days, but it's always easier for things to be prescribed in advance. If you find that simple painkillers are not enough, chances are that it will be the middle of the night and it's hard to get the on-call doctors to come and assess you (because there's been an emergency, say) and then to write up the medication, which may need to be ordered from pharmacy, while you feel miserable for hours. If it's already prescribed and ordered and you don't need to use it, that's great, but make sure it's there if you need it. I would recommend asking your doctor to prescribe something for nausea as well, to be given if you need it.

Discuss any other medications that you take with your doctors and ask if there's anything that you need to stop prior to surgery (e.g. garlic supplements, St John's wort, blood thinners) or anything that you might need to increase (e.g. steroids). If it's likely or possible that you might have problems with swallowing after the surgery, ensure that your medications are written up in alternative forms, e.g. IV. If you take regular medications, make sure that you have a good supply before going into hospital, and if you're started on any medications while in hospital, ensure that you're given enough to last you the full course (or until you can get more from your GP).

If you have had previous problems with anaesthetic, or if you have other complex or severe medical conditions, make sure you get blood tests done prior to the surgery (this is usually offered at pre-op assessment, along with ECG testing and x-rays if necessary) and speak to the surgeons and anaesthetists beforehand. If you know that you need things to be done a certain way, don't be afraid to ask. If you're a hard stick for IV access, the anaesthetists can knock you out with anaesthetic gas and then get the IV while you're asleep, if that's more comfortable for you. If you have problems with fasting, ask if you can be admitted the previous day for IV glucose, and/or to have your surgery scheduled early in the day. If you have problems with anxiety, ask for premedication for it. There are so many things for the anaesthetists to consider before your operation, so if you don't mention the things that are important to you, they may not think about them. Don't be afraid to take responsibility for your own care!

Think about what you're going to eat and drink for the week or fortnight following the surgery. If you normally cook for other people at home, think about that too. Being prepared for the worst case scenario, assume that you will not cook. If you can, stock the freezer with meals to reheat - making double portions of casseroles, bolognese, etc. for a couple of weeks prior to the operation, and arrange for a friend to bring a meal or pick up something from a local restaurant the first night you're home. If you're not in an area where you can order groceries online for delivery, ask a friend or family member to shop for you for a couple of weeks. Stock up on meal replacement drinks or 'easy' snacks if you think you might struggle to eat 'proper' meals. If you're likely to have a course of antibiotics, consider buying probiotics to use once you've finished the course of antibiotics.

If you have pets or children, arrange for someone else to take on the main responsibilities for a while. You can always go with them for a walk, but it can be helpful to know that you don't *have* to go if you don't feel up to it.

Consider where you're going to sleep. Is it upstairs? Is that going to be a problem? Is it near to the bathroom if you need to get up in the night? Do you have plenty of pillows and cushions to support you in bed, if that's where you're going to spend a lot of time? Think about how you're going to be able to get to the bedroom, the bathroom, and any other room where you expect to spend a lot of time. You may find that it's safer to have a pair of crutches downstairs and another pair upstairs so that you can shuffle up and down the stairs on your bottom without trying to carry sticks at the same time!

If you're on crutches, how are you going to get around the house, and how are you going to carry things? I have a little backpack that I wear around the house. Actually, it has my feeding pump in it, but it has enough space for a bottle of juice (doesn't spill). Consider putting hot drinks in a flask and cold drinks in a bottle for safe carrying around the house. If you think that you might need any equipment ( has some good examples of equipment or adaptations that may be helpful in various situations), order it with plenty of time. The Red Cross are often able to loan wheelchairs and equipment if you can't get the equipment from your local Social Services department or from the hospital.

I always try to increase my protein intake prior to surgery, and take a vitamin and mineral supplement. If you smoke, surgery is a great reason to stop (or cut down, or take a break). Almost nothing else impairs healing quite like cigarette smoking. If you're diabetic, try to control your blood sugars extra carefully in the run-up to surgery. If you're overweight, try to lose some weight; if you're underweight, try to gain some!

Recovering from surgery can be tedious, especially if you can't go straight back to work, or back to your usual activities. Set up 'dates' with friends, either for visits in person, or for telephone calls or Skype calls. Now is a great time to stock up on DVD box sets (beg, borrow or buy) and to sign up to a service that allows you to watch films and TV programmes online. 

Immediately after the surgery:

Don't leave the hospital without written instructions on what medications you need to take, the dose and the frequency. If it is a short course of medication, make sure you know when to stop taking it. Get written instructions about who to contact if there is a problem (including out-of-hours) and what consistitutes a problem. Ask your doctors, nurses and therapists to be as specific as possible. 'Get in touch if things get worse' is a really common instruction, but can leave you with a dilemma if things do get worse. How worse does worse need to be in order to contact a doctor by telephone at midnight? You may have several instructions - if you have a fever, or very fast heart rate, you may need to go back to the hospital, but you may be able to deal with other problems during normal clinic hours or with a visit to your own GP. If possible, let the professionals make these decisions for you!

Take your medication as prescribed. Painkillers work much better to prevent pain than to stop it once it's got a hold on you (apologies, this is a particular soap-box issue for me!). If you're worried about waking up every six hours to take painkillers, you can ask for a long-acting preparation that only needs to be taken every 12 hours. Set a timer to help you remember to take your medications. Adding new meds can always be confusing, especially if you're exhausted from the surgery and spaced out on medications!

Ask for help. Friends and family often say (and mean), "let me know if there's anything I can do" and we don't let them know because we don't like to impose. Make a list of the things that you find difficult after the surgery and show it to friends and family if they express a desire to help. People are often happy to pick up a few extras while they're at the supermarket, and other parents at the school will often not mind collecting your children along with their own. The more people you can find to help, the less you need to ask any one person to do. If you can't cope with the idea of asking your friends to come in and help with housework, now is a good time to pay for a cleaner. It's cheaper than a course of physiotherapy, or having to have your wound restitched because you put too much strain on it too early.

Make sure that the house is warm enough/cool enough. Even if you just heat/cool one room, it's important to be comfortable. Trust me, shivering with a fresh four-inch abdominal wound is uncomfortable.

Rest, recuperate and DO NOT FEEL GUILTY. Now is not the time. If you need to stay in bed all day, do it. If you can only concentrate on trashy fashion magazines, go for it. Don't push yourself to get straight back to all your usual activities and responsibilities. Sometimes we all need time and space to recover, and no-one will begrudge you a few days in your pyjamas, snuggled up with the cat, especially if you've just had surgery. Don't plan too many activities - this is not a free holiday from work (at least not in the first few days!) but give yourself time to rest.

In the longer term after surgery:

Do the things that will help you to maintain your health. There is no point in having surgery in the first place if you then do all the things that your surgeon asks you not to do. You've put yourself through the pain and difficulty of surgery, so you are certainly strong enough to stick to a medication or exercise schedule, prescribed diet, or rehab plan. I understand the temptation to 'just' play the piano a little bit (immediately after wrist surgery) or to 'just' take off the splint for a little while.

Follow up with your surgeons and any other specialists that are involved in your care. If your wound is not healing properly, for example, it's better to get specialist input earlier rather than later. If your surgeon has suggested that you shouldn't need to take painkillers after five days, and you are still clock-watching for the next dose after a week, a quick call to your surgeon's office could save you a lot of pain.

I've written previously about pacing yourself and setting goals, and those skills are likely to be relevant during your recovery period. Don't beat yourself up if things don't go completely to plan. No-one will blame you if you get an infection, have problems with wound healing, or the surgery is just not a success. Keep dialogue open with your doctors, nurses and therapists, and don't be afraid to ask if you think that you would benefit from counselling, physiotherapy or any other specialist input.

If you feel that you would benefit from complementary therapy, or input from another therapist or medical specialist, don't be afraid to ask. Many doctors and surgeons are open to input from complementary therapists, but do check with them first - they may be able to offer some services at the same hospital or clinic, or they may recommend some therapies as being more suitable than others. 

Remember that your individual surgery may not be a big deal in a surgeon's life. What has a place in his life for a couple of hours on one day, along with several other operations on other people, can be life changing for you. Some surgeons are very good at understanding how much their patients can be impacted by surgery; others not so much. Don't take it personally, but seek support from other sources if your surgeon is not a 'people person'. If he or she is good at the job, and does a beautiful job of the operation, that's enough. There are plenty of other people, professional and otherwise, who can support you emotionally and with the physical consequences of the surgery.

Stay positive!

Wednesday, 23 January 2013

Being Prepared for Surgery

Before we go any further, you should know that this blog post does not contain any medical advice. There are no exercises, no medications (or alternative remedies), no recommendations for tests or monitoring, and no diet guidelines.

So, if this isn't a medical guide, what is it?

This is a list of things that I do in the days or weeks before planned surgery to make my life easier in the days and weeks after the surgery. Of course, the nature of the surgery will change some things, but I'll try to be as general as possible.

Here in the UK, most people will know their surgery date at least a month in advance (for routine, non-urgent procedures). I like to use that time to think about the effects the surgery may have on my life while I'm recovering, and try to come up with as many solutions as possible before the problems have a chance to rear their ugly heads!

In my opinion, there is almost nothing worse than feeling weak and feeble, in pain, limited by wounds/dressings/plaster casts. Add to that the feeling of unwashed hair and skin, unwanted body hair, and flaking nails, and it's almost a recipe for disaster! Here are a few of the things that I do to prepare my body for surgery and to keep myself looking as normal as possible afterwards.


Book a haircut as close to the date of your surgery as humanly possible - this will ensure that your hair looks as good as possible, even if you're not able to give it much attention. If you have very long, thick or curly hair, consider a change of style to one that needs minimal maintenance. This doesn't always mean short! My hair is wavy/curly and prone to frizz. Short styles, for me, mean endless conditioning and styling products and hours of blowdrying or using straightening irons or tongs. With a blunt cut just above shoulder length, I can get away with scrunching a little mousse through my hair and leaving it to dry naturally.

If your hair is coloured, make sure you get your roots done, preferably just before surgery, so that it will look fresh for as long as possible while you recover and build up enough energy to get to the salon for the next colour!

Styling your hair may be another hurdle, especially if the surgery affects your hands/arms/shoulders, or is likely to leave you feeling very weak. I recommend investing in the following basic kit:
1. Dry shampoo: Having hair that looks bouncy and freshly-washed without getting out of bed is like a miracle! If possible, try a couple of brands and stock up on cans of your favourite in various sizes. You may still need help to apply it, massage it in and brush it out again, but it still takes considerably less effort for both you and your helper than a full shampoo and conditioner, plus it doesn't leave your hair wet, so no risk of getting chilled (or getting wet bedclothes)
2. Alice bands and 'crocodile' clips: These are enough to hold your hair back from your face, even if you have one hand out of action. Some people find the fabric bands easier than solid ones, but I'm a fan of the solid ones. The wider the better, in order to cover as much hair as possible! Having the crocodile clips as well means that you can try out a variety of styles with minimal effort or assistance
3. A wide-toothed comb is great for gentle hair-styling (or just detangling); if you can get one with a long handle, so much the better!

If your surgery means that blowdrying your hair is not an option, there are two things you can do. The first is to resign yourself to having a different style for a few weeks, working with your natural hair texture. As you'll be giving your hair a break from heated styling tools, it's a good opportunity to use intensive deep conditioners. Put a soft towel over your pillow and apply the conditioner. Massage your scalp well, and then comb the conditioner through to the ends of your hair. It can stay there until you next wash your hair. Not particularly glamourous or attractive, but your hair will be in better condition afterwards! The other option is to book a course of regular blow-dry treatments at your hairdressing salon. It's a lovely thing to do to pamper yourself, and may be the only way to get your hair washed and styled properly if you have an arm in a cast, but consider how you're going to get to and from the salon if you're not up to walking and not allowed to drive.


After surgery, you may not feel like keeping up with your usual skincare regime. I like to cleanse, tone and moisturise, and have various favourite products to exfoliate and moisturise my skin. This all goes out of the window after any surgery, but especially if I have an arm in plaster. Simple cleansing wipes are my saving grace - they remove everything (even betadine, chlorhexidine and EEG glue - all of which you may encounter during your hospital stay!), and leave my skin feeling lovely. At a pinch, you could use them to wash your body, but I wouldn't recommend doing this more than once! My top five tips for skin have to be:
1. If you wax, book a wax prior to your surgery: If you don't wax, think about whether you're going to keep up with whatever method you normally use, and whether it would bother you if you didn't keep up with it. Waxing lasts for 4-6 weeks for most people, and there's nothing quite like feeling smooth and polished when you're a bit weak.
2. Simple cleansing wipes
3. A pleasantly fragranced deodorant (I find spray easier than any other method of application)
4. A real sponge and a mild liquid soap: it's hard to rinse properly if you're washing in bed or in a chair, but it's not the end of the world if a mild soap stays on your skin - aqueous cream can be used instead of liquid soap - it doesn't feel particularly 'cleansing' but it does work, and it'll leave your skin lovely and soft
5. A luxurious moisturiser: it may be more difficult to apply, but having the luxury of my favourite scent as well as soft skin is worth the time it takes to apply it! There are lots of different types of moisturiser, depending on your needs - it may be easier to use a body butter that's almost solid and won't run everywhere, a pump dispenser, or a spray.


More than any other part of me, my face gives me away after surgery. It takes almost nothing to make me look pale and drawn, with dark circles around my eyes, and it is guaranteed to make me feel worse if I see myself in the mirror looking like that. Of course, there's always the option to just avoid the mirror, but let's assume that we generally like mirrors.

Before surgery:
1. Shape your eyebrows and wax/thread/pluck any stray hairs
2. Get your eyelashes tinted: this is cheap and readily available at salons, and will mean that you don't need to wear mascara for up to six weeks. I have no arguments for the pedants who say that you don't need to wear mascara anyway. I like to have dark lashes, and drawing attention to my lashes and big green/blue eyes is better than drawing attention to the dark circles around my eyes!
3. Invest in a cream blush, or even better, a cream product for cheeks and lips: I love the Benefit Benetint lip and cheek balm and Bobbi Brown's Pot Rouge in Powder Pink. Give me 30 seconds with either of these, and I'll magically transform into a healthy-looking creature before your very eyes.
4. Get a really good brightening concealer for under-eye bags and any other dark shadows that may emerge post-surgery: My intention is not really to promote lots of beauty products, but I use Clinique's Airbrush Concealer. I've used it for many years, and love it. It is also very easy to apply. Even with one hand. Even if that hand is your non-dominant hand.
5. Stock up on moisturiser and lip balm: Hospitals are dry places, and my skin is dry and flaky for days or even weeks afterwards, so I use a much heavier moisturiser than usual.
6. Choose some low-profile jewellery to wear while you're recovering: You'll probably have to remove all your jewellery for the surgery (you may be allowed to tape over a wedding band) but you'll need something simple to wear afterwards, if only to maintain piercings (don't forget about belly buttons, tongues, lips, etc. and make sure you have someone ready to put them back in for you after surgery if you can't do it yourself). I usually wear plain pearl or diamond stud earrings, a simple, light necklace, and my wedding and engagement rings, but no other jewellery. It's enough to keep me looking polished, and to keep the holes in my earlobes open, and that's all I need.

After surgery:
Get a manicure and pedicure: Don't make the mistake of doing this prior to surgery, as you'll just have to take it off, which is a bit of a nightmare if you have a gel or shellac manicure. Once you're safely out of the hospital, book yourself in for a mani-pedi, preferably with gel or shellac polish, which lasts for a couple of weeks without chipping or flaking. I like to get a bright colour on my feet and a neutral colour on my hands - it does have to go with everything for two weeks, after all! If you're not well enough to go out for your manicure, you may be able to find a mobile technician who will come to your home, or even to the hospital.

After all this preparation, I'm sure you're just about ready to just get to the hospital so that you can have a break, but three last things:
1. Order some pretty seasonal flowers to be delivered a couple of days after you get home from hospital (unless you're likely to be inundated with floral gifts from friends), or buy yourself an orchid in bud, so that it'll flower when you get home and are there to see it.
2. Put fresh sheets on your bed ready for when you get back. If you're anything like me, this thought will sustain you through the hard first night in the hospital after surgery. I tell myself that I just have to get through this night (and maybe a couple of others) and then I can go home and snuggle into my lovely soft bed with the clean, fresh sheets, and that means that Everything Will Be Alright.