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!

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