Preparing for Surgery (© Harise Stein 2002-2006)

Introduction
As you prepare for surgery, remember that there are many methods and sources of support to help you cope.  It is very important to remain flexible, since invariably some things don't go quite as planned.  Also, maintaining whatever you can of your sense of humor is a tremendous help.

Below are some suggestions to help you at this challenging time; some are obvious and are included for completeness sake, while others you might find pleasantly surprising.  

Why prepare myself?
Can using imagery help?
How do I prepare myself?
Using preop tapes
Preparing mentally
Practical matters
Preparing physically
Preparing emotionally
Preparing spiritually
Pitfalls in communication
Questions for your doctor
Questions for your anesthesiologist
Getting a second opinion
Where should you have your surgery?
Autologous (self) blood donation
Paperwork
What to bring to the hospital
Postop
Concluding comments

Why prepare yourself?
Having surgery is one of life’s most difficult experiences.  It is a time of ultimate vulnerability and loss of control, and it brings us face to face with our mortality.  In addition, there is fear of pain, the unknown, disability, disfigurement, loss, and embarrassment, all the while in the context of separation from family. This is a huge psychological burden that patients must face, in addition to the difficulties of the medical problem they’re having.  Traditionally, hospitals have either not addressed any preop issues other than a consent form, or simply provided handout sheets and tours to give practical information about what will be happening to your body.  You must prepare your emotions and spirit yourself.  Why bother to do this? 

Anxiety, especially anxiety that has built up over days or weeks prior to surgery, can:
1) Lead to increased smoking and alcohol use, at a time you need to cut down on both.  (Alcohol use decreases immune function, delays wound healing, and interferes with anesthesia; smokers have decreased blood flow to the skin, impaired wound healing, and increased postop infections.)
2) Lead to increased cortisol (stress hormone) levels, which interfere with immune function, putting you at increased risk for infection and decreased wound healing. On the day of surgery, cortisol levels can rise to over 10 standard deviations above the mean in unprepared patients.
3) Lead to increased catecholamine (stress chemical) output, which can increase risk of high blood pressure and irregular heartbeat.
4) Cause the anesthesiologist to give you more medication, which will take longer to leave your system and lead to increased side effects of nausea, headache, etc.
5) Inhibit higher cortical brain function, leaving you unable to think clearly to make important decisions for your health.
6) Lead to increased feeling of pain.  Many studies have demonstrated a direct correlation between anxiety and the intensity of pain felt.

The sensation of pain after surgery is best avoided as much as possible, since pain can:
1) Decrease your ability to cough up secretions, making you vulnerable to pneumonia.
2) Decrease normal digestion and appetite, adding to your hospital stay and decreasing the nutrition your body needs.
3) Decrease your ability to get out of bed, leading to increased risk of blood clots in your legs.
4) Interfere with sleep, during which hormones are released which enhance healing.

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Can using imagery help?
For over twenty years, studies have shown that surgical patients who have been prepared so that they are calmer have less pain, heal quicker, have less complications and leave the hospital earlier.  Since the healing process is a cascade of events, eventual final wound healing is very dependent on the initial repair process, which can be sabotaged by early problems.  We also now understand that one way the syndrome of chronic pain can come about is when acute pain is not controlled well.  The following are the results of two recent studies showing the dramatic benefits of relaxation and imagery for surgery, to decrease pain and anxiety and improve postoperative course.

In this first study, patients who listened to a preop surgical guided imagery relaxation tape before having major bowel surgery had a significantly better experience.  They had less pain (p<.001), less anxiety (p<.001), used less medication (185 vs. 326 mg of opioid) and had quicker recovery of bowel function (58 vs. 92 hours).

The second study involves sedated invasive surgery, where patients were awake, but given IV pain medication.  Three groups were used—a control group, a group with someone sitting next to the patient giving them attention, and a group with someone sitting next to the patient suggesting relaxation imagery.  All groups could have as much pain medication as they wanted.  The relaxation group had significantly less pain, anxiety, medication use, time in the operating room, and very significantly fewer complications (only one relaxation patient became hemodynamically unstable vs.12 in the control group).

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How do I prepare myself?
You can prepare yourself with various mind-body techniques, including whatever method you are already familiar with such as meditation or yoga.  You can also make your own pre-op tape, use a commercial preop tape, attend a mind-body oriented surgical preparation course at your hospital, or see a mind-body practitioner to aid you in your preparation who might make you a customized tape.  The point is not to be utterly relaxed, but more in “calm confidence” or “relaxed readiness” mode, since you need to be able to take care of yourself.  One researcher, Henry Bennett, PhD.,  has suggested to “think of yourself as an athlete training for a major event, rather than as a passive body being handed over to the surgical team.”  There are many ways to become more self-empowered and achieve some degree of control over what happens to you; this alone can help you feel calmer. Preparing yourself psychologically for surgery is strongly recommended, and quite worthwhile, as the above studies have shown.  If you want to do this on your own, the simplest way to go about it is to use preop tapes. 

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Using preop tapes
1) See tape review to chose a tape or view instructions for making your own.  If you are a Blue Shield insuree they will provide you with a free Belleruth Naparstek guided imagery tape at (800) 394-3516. 
2) If you do not want to pursue using a tape, it is advised that at a minimum you listen to music via headphones during your surgery.  Many studies have shown that people can hear under anesthesia.  You might subconsciously hear something upsetting, or misinterpret what is said.  Anesthetic drugs sometimes make sounds seem very loud.  Listening to music blocks out the confusion of the OR and helps you maintain a peaceful state.  In addition, nurses note that patients who listen to music in the recovery room are less agitated and need less pain medication.  [See Research-Hospital-Anesthesia]
3) If you chose to bring music, pick something calming, with a rate of about 70 beats/minute or less.  Your heart rate has a tendency to mimic the rate of the music you are listening to, and you want to maintain calm heart rate and blood pressure.
4) Label your tape player and all of your tapes with your name.
5) Use a player with auto reverse, put in fresh batteries, and bring extras for your hospital stay.
6) Once you set the volume, etc. tape down the controls!

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Preparing mentally
1) Do you need to have surgery?  Have you had a second opinion, and thoroughly researched all your possible alternative options?  What will happen if you don't have surgery?
2) Do you need to have this particular surgery?  Is this the best method for you?  (For instance, an abdominal vs. a vaginal hysterectomy.)
3) Do you need to have this surgery now?  If this is elective, is this the best time in your life?  Would waiting longer possibly change the need for surgery, make it easier for the surgeon, less stressful for you, or less risky for you?
4) Do you have all the information you feel you need in order to make these decisions?  Know your coping style; people are usually either “vigilant”, wanting to know everything they can, or “avoidant”, wanting to leave the details in the hands of someone they trust.  Having the right amount of information for your coping style can make you feel more comfortable. A mismatch between your coping style and information level might make you feel more anxious.

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Practical matters

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Preparing physically
1) As much as possible, stop smoking or using alcohol and other drugs for as long as you can prior to surgery.
2) Eat a nutritious diet to build up nutrients for wound healing.
3) There are many opinions about supplements, but it would not be unreasonable to take a general multivitamin to cover all the bases, paying special attention to modest increases in vitamin C and zinc, necessary for wound healing.  Do not take more than a minimal amount of vitamin E, since in some people vitamin E can interfere with blood clotting.  Check with your doctor regarding supplements.
4) Have your surgeon OK all medications that have been prescribed by all of your physicians, and know whether to take them the day of surgery or not.
5) Unless advised otherwise, avoid aspirin and other anti-inflammatory medications such as motrin and aleve for two weeks prior to surgery, since these can interfere with blood clotting. 
6) Have your surgeon OK everything you are taking without a prescription, especially herbal preparations.  Some herbs might interfere with anesthesia, and garlic, ginkgo and fish oil among other substances may interfere with blood clotting.  If you feel uncomfortable discussing this issue with your doctor, stop them a minimum of two weeks in advance.
7) Modest exercise can help relieve stress, plus maintain muscle tone and flexibility as you are facing some time staying in bed.

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Preparing emotionally
1) Assess how you are feeling emotionally.  What comes up?  Fear, anxiety, depression, anger?  In the past when you have felt this way, what have you done to help yourself feel better?
2) What are the roots behind these emotions, and are there practical things you can do to alleviate them?  For instance, if you have a specific fear about the surgery, can you obtain information, go on a hospital tour, or talk to women who have had this surgery already to help put your mind at rest?
3) What “negative self-talk” is present?  Write down thoughts that pop into your head and really look at them. Is there a pattern? There are many techniques to try and prevent this from happening, since these negative thoughts can become a vicious cycle, draining your energy. For example, try to recognize when you are having these thoughts, imagine a large red STOP sign appearing, and then repeat the thought in a positive way.
4) Use journaling as an outlet to express how you feel. 
5) If you have had a previous difficult experience with surgery, perhaps even as a child, it might be worthwhile to work on this with a counselor before you have surgery again.
6) If you have had a history of sexual abuse, especially if you have never told anyone about this, here is another area where seeing a counselor first would be a good idea.  Having surgery is a time when you are very vulnerable, and in a sense your body is being violated.  For some women, this may bring up emotions related to previous abuse. If you are having extreme anxiety at the thought of surgery, consider this as a possible reason.
7) For many women, the possibility of losing a female organ (breast, uterus or ovary) represents more than some tissue. Aside from practical hormone concerns, are you having worries about your sexuality, your sense of “womanness”? How much will this surgery change how you feel about yourself? How does your partner feel?  Discussing this out loud will help with postoperative adjustment.
8) The thought of losing a body part can also engender a sense of loss, and a kind of anticipatory mourning--especially if there are very charged emotions involved, such as having to have a hysterectomy after never being able to have a child. Many women feel very angry at, betrayed by, or negative toward the part that they feel “isn’t working right.”  Realize that your body is constantly trying very hard to be as healthy as it can, and it is not its fault if genetics or environmental exposure have swamped its resources. This body is the only body you will ever have.  Learning to appreciate and accept it with compassion for all of its flaws, will bring a sense of acceptance of yourself as well.  Using imagery to say goodbye and thank the part for what it did, or tried to do for you, can bring peace before surgery, and closure afterwards.
9) Many people deep down feel guilty that there is something they did that caused or contributed to the reason they are having surgery.  While all of us wish there are things we’d done differently in our lives, we are human, we make mistakes, and we usually make the best decisions we can at the time with the options we have available.  Self-forgiveness will help you heal in more ways than your incision. [See Books, Tapes for a book on forgiveness by Fred Luskin, and a tape “Anger and Forgiveness” by Belleruth Naparstek at healthjourneys.com.]
10) Facing surgery is an opportunity to re-connect with others.  Are there friends or relatives you’d like to contact again?
11) Arrange a support network of friends and family who can spend time with you before going to the hospital, visit or call during your stay, and help with after care.  This is not a time to see people who upset you, out of duty.  Being with others who care about you decreases anxiety and increases immune function.
12) One way of feeling connected to your support network is to draw a little symbol on the middle of the inside of your lower arm, between your wrist and inside elbow, with a long acting pen.  This area of your body is not usually used for anything medical except giving a TB test.  A religious symbol, the initials of your partner, little hearts drawn by each of your children, etc. can remind you of their presence.  Even if your arm is restrained with an IV, you will see these symbols in your mind’s eye and know they are there.
14) Check with patient services at the hospital as to what complementary services are available.  Massage can help decrease pain, improve immune function and improve sleep.  Do they have someone on staff, or will they allow you to use the services of a body worker you know?  Even if there are concerns about interfering with an incision, a simple foot massage can be very relaxing.  This might be a useful thing for friends and relatives to chip in and provide.  Alternatively, do you have a friend that can come and play a musical instrument for you?

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Preparing Spiritually
1) If you believe it will be helpful to you, ask people who care about you to send positive thoughts or prayers during the time of your operation and afterwards.
2) If you desire, arrange for a religious or spiritual advisor or hospital chaplain to visit.
3) Facing surgery is an opportunity to consider our sense of meaning and purpose in life. What can help you on this journey, or help you feel more at peace?  Is this a time to visit a museum, go to the beach, journal, talk to a soul mate or religious advisor?  What changes do you want to make in your life?  Consider filling out something like this: 

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Pitfalls in communication
1) When people are given bad  news, are traumatized, or are in pain, they sometimes go into a spontaneous state of self-hypnosis.  For instance, they might hear the word “cancer” and not consciously remember anything after that--one reason to bring a tape recorder or have someone else go with you to certain doctor visits.  When people are in this state, they also might be highly suggestible, so the next words out of the doctor's mouth are very important.  If certain phrases from health care providers keep repeating in your head (“This is the worst case of ....I've ever seen.”), you may have a mild form of post traumatic stress disorder, and could benefit from talking to a counselor or trained health care support person. 
2) Sometimes when people are afraid they revert to a more childlike state, and look to others to make decisions for them.  Later, when they are feeling more themselves, they might not be entirely happy with those decisions.  Unless it is an emergency situation, try not to make any immediate decisions in the doctor's office until you have had time to reflect in a different setting.
3) Similarly, you may have been too overcome to even think about what further information you wanted. Do not be afraid of scheduling an additional appointment, and make a list of questions.  Fax the list to the office when you make the appointment, or give it to the nurse as you are being put into the room.  Doctors try their best in a difficult managed care environment, and letting your doctor know ahead of time what you want to know can help her decide whether to call you instead, or adjust how much time she will need with you.  Pulling out a list during your visit can sometimes irritate doctors, not because they don’t want to talk to you, but because they are usually behind schedule and don’t know if you have 2 or 20 things to discuss.  Help them help you by giving them a heads up.
4) Some doctors feel uncomfortable giving bad news, and this awkwardness can translate into the appearance of being brusque or unfeeling.  These doctors may shut themselves off from feelings because the situation is painful to them, also.  Do not let your dismay at this attitude interfere with taking care of what you need to do for yourself.  Don't dwell on it.  Find another doctor, or find the support you need elsewhere.

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Questions for your doctor
[Again, first decide how much you want to know.]
1) What pre-op tests are necessary?
2) By when does the surgery need to be done?  (So you can make arrangements at home or work.)
3) What of your condition is treatable with this surgery, and what is not?
4) What will happen if you don't have the surgery?
5) If the operation can be done more that one way, what are your options, what does she recommend, and with what method is she most comfortable?
6) Will there be a scar, and where?
7) What is the success rate of this operation?
8) What are the risks, including death rate and short and long-term complications? How often do these happen?  Is there anything about you that would make you more prone to complications?  Is there anything you can do to reduce these risks?
9) Can this be done as an outpatient?  What does she suggest in your case?
10)  In what facility will the surgery be done?  Who will be in the room?  How long will it take?
11) Will more surgery be necessary?
12) What are the anesthesia options?  What kind does she recommend?  When can you meet with the anesthesiologist?
13) How much blood loss does she expect?  Does she suggest you donate blood for yourself? (See self blood donation.) What is her threshold for transfusion?  If you are very against transfusions, would she use a cell saver (a machine that saves the blood you lose and recycles it back to you)?
14) Does she have any reservations about your using a tape player in the operating room?
15) Would she be willing to say something positive at the end of the procedure, such as that things had gone very well, and that she expects you to heal easily?
16) What can you expect after you wake up in the way of tubes, vaginal discharge, etc.?  When will the tubes be removed?  When can you eat?
17) What postop limitations will you have, and when can you resume activities?

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Questions for your anesthesiologist
1) What are the anesthesia options for your procedure?  What does she recommend?  With what type of anesthesia is she most experienced?  (If you believe you want an epidural, but she is an expert at spinals, you might want to go with a spinal, or ask for a different anesthesiologist.)
2) What are restrictions on eating and drinking the day of surgery?
3) What is her usual practice for premedication?  Let her know how sedated you do or don’t want to be.
4) Does she have any reservations about you using a tape player in the operating room?
4) What are the possible complications from the anesthesia?
5) What are the possible side effects afterwards?
6) What are your options for pain relief after surgery?  Is PCA available (patient controlled analgesia—an IV button you can push to give yourself pain medication when you need it, within certain limits).
7) Let her know your fears and concerns.
8) Let her know your previous experience with anesthesia as well as your family’s history with anesthesia.
9) Detail any allergies, medications you use and over-the-counter meds including herbs. Make sure you know which of your medications she does or doesn't want you to take the day of surgery.
10) Be honest about alcohol and drug use.  This can impact how sensitive you are to anesthesia.
11) Alert her to any possibility of pregnancy.

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Getting a second opinion
If you make it a point to always get three estimates for household repairs, why would you not even get a second opinion for something so vital as your health?  Even if you have excellent rapport with your doctor, and she is an acknowledged expert in her field, it never hurts to talk to someone else.  At the least it will confirm in your own mind that what you are doing is right.  A second opinion can verify the diagnosis, provide another viewpoint on what your available options are, pick up on something that was missed (no one is perfect), and provide additional information that might be of use to you.
1) Do not use another physician in your doctor’s same practice.  They probably work together because they think reasonably alike, and you are looking for someone with a fresh angle.
2) Hand carry your records to make sure they are not lost. 
3) Try and see this doctor early enough so that you have time to think about the information and possibly do further research before your surgery.  Feeling mentally calm and assured that this surgery is something you need to do, and with the surgeon you have chosen, is very important.
4) Do not use the internet for your second opinion.  While the internet is an invaluable resource, some information can be incomplete, outdated, confusing and biased.  Just because something is in black and white doesn’t mean it is true.  Be open-minded but judicious; if there is conflicting information, or new information, discuss it with your doctor so that these issues can be resolved satisfactorily in your mind.
5) Do not feel embarrassed about asking for a second opinion, or inhibited about changing your plans afterward.  Many women end up doing things they don’t want to do because they don’t want to hurt their doctor’s feelings.  If you are uncomfortable, write a note explaining your situation and reasoning.  Most doctors are understanding about this.  A note might even open up a dialogue to resolve an unintentional misunderstanding.

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Where should you have your surgery?
Usually the choices are between a smaller community hospital that you know, and a major medical center further away.  Factors to consider are:
1) How complicated is your surgery?  Is it a fairly routine operation, or something new, or is there something about you that would make your surgery more difficult technically?
2) Do you need a specialist?  For instance, if this is your third bladder repair for incontinence, or it is felt you probably have ovarian cancer, you might want to see subspecialists in gynecologic urology or gynecologic oncology rather than your general ob/gyn.  Sometimes arrangements can be made so that your regular doctor can do the surgery with the specialist.
3) How is your general health?  If you have a lot of significant medical problems, discuss with your doctor whether it might be in your best interest to be taken care of at a higher level medical center.
4) How important is it to you that you be in familiar surroundings, with doctors you know, and friends and family readily available?
5) How important is it to you to have absolute cutting edge technology?
6) Who will be doing the surgery at each place, and how do you feel about them?  Many major medical centers are teaching hospitals, and at least part of your actual surgery might be done by a resident or fellow, rather than the specialist to whom you were referred.  It is vitally important that you have faith in your surgeon.  For some people, that means faith that this is a wonderful doctor, a solid surgeon, who cares about them personally.  For others, they have faith and find comfort that the doctor has a reputation as “the best”, as a superb technician, even if that doctor has a minimal bedside manner.  (Again, how much expertise do you really need?  The vast majority of operations are fairly routine from a surgical perspective.)
7) What are insurance considerations at each institution? 
8) Do you want to take part in any kind of a research study, or have your tissue samples made available for investigational vaccines or other therapies?
9) How do the physical surroundings make you feel?  Will your surgery and recovery be in a clean, pleasant, comfortable atmosphere?
10) What is the reputation of the nursing staff?  The best surgery in the world can be undone by poor aftercare.  Nurses are vitally important to your well being, and are often underappreciated and overworked.

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Autologous (self) blood donation
1) This is probably not worthwhile unless you are going to be donating two units.  Your doctor will be able to advise you what kind of blood loss is typical for your particular surgery, or if you have some special condition that would warrant donating blood, such as unusual antibodies.
2) Units can be donated 4-6 weeks in advance, and you want to wait two weeks between units, preferably with the last donation two weeks before surgery.  There is no point going into an operation weakened and anemic.
3) Find out where the donations need to be made.  Can you go to your local hospital, or do you have to drive to a special blood bank further away?
4) What are the costs to you?  Will your insurance cover this?  (Some insurance will only cover if you are actually given back the blood in surgery—otherwise there can be considerable drawing and processing fees.)
5) Make sure you replace iron.  It takes three doses of iron a day for one week to build back one unit of blood.  Iron can be constipating—discuss different formulations with your doctor.  Iron is also extremely poisonous to small children, so keep secure.
6) Increase fluids, B vitamins and protein, necessary for forming red blood cells, to build yourself back up.
7) Discuss with your doctor her philosophy on giving you back one or more units “anyway”, even if you don’t strictly need them.  There are pros and cons, including the remote possibility of lab error and contamination, even though it is your blood.

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Paperwork
Some of these forms can be anxiety provoking to read about.  Skip this section if that is the case and have someone give you a synopsis.  On the other hand, it might help you feel more secure to review this list, to know how to go about attending to important issues and make things easier on your loved ones.
1)  “Informed consent” is a form required by law prior to surgery, and can be a daunting document.  Try to sign it sometime before the day of surgery, so that you are not confronted with it at a difficult time.  Make sure you understand exactly what the operation listed consists of.  “Exploratory laparotomy” legally means making an incision into the abdomen and giving the surgeon carte blanche to go in and do anything and everything she deems necessary.  Is this what you want?  As you read the complication list, keep reminding yourself that for legal reasons anything even remotely possible is listed.
2)  “Advanced health care directive” or “Durable power of attorney for health care” is an optional form that gives someone else the power to make medical decisions for you if for some reason you cannot.  Different states recognize different forms, and there can also be variations within each state.  The most basic just lists who will make these decisions.  This issue can be extremely important if you do not have a recognized legal relationship with your partner, leaving you parents or other relatives to be legally in charge.  Other versions document your wishes in different scenarios, such as advanced life support, heroic measures, feeding tubes, etc.  Still other versions have a section regarding organ donation.  Even if you use a basic form, discuss these issues with your health care appointee.
3)  “Organ donor” form is a separate form that similarly notes your wishes about organ donation.  There is also available a wallet card and/or a designation on your driver’s license in case you are in an accident.
4)  “Do not resuscitate” is handled differently at different hospitals.  This is when you are in a health situation where you do not want sustaining health measures to be performed.  Find out what needs to be filled out and by whom (your doctor needs to sign) and where copies are to be located.  Have one prominently displayed at home in case paramedics are called.
5)  “Durable power of attorney” is a legal instrument that can be written in such a way as to give someone else the right to handle your non-medical affairs if you are incapacitated.    If you are in a coma and you are the family breadwinner, does your partner have financial access to pay the mortgage? 
6)  “Will” - It might be prudent to see an attorney to organize your affairs before surgery.

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What to bring to the hospital before and after surgery
1) Get a list from the hospital on the usual items—toiletries, etc.  Usually it is recommended to leave cash and jewelry at home.  Have relatives bring you a simple watch with large numbers to help keep you oriented after surgery.  Older patients, especially, might benefit from an inexpensive clock radio at the bedside with music, the time, news, etc. to help them stay in touch with reality.
2) Magazines, books, crossword puzzles, etc. to spend relaxed time while your body resumes functioning.
3) Flowers, family photos, cards, posters to make the room warmer and more cheerful.
4) Music, books on tape, humorous or inspiring tapes (see tapes section), since reading postop may be tiring or difficult with certain medications.
5) Spiritual or religious art, medallions, beads, etc.
6) Favorite food, if allowed.
7) List of phone numbers you might need.
8) Notepad and pencil to have by your bed to jot down questions for your doctors or nurses.
9) Your own pillow, quilt, pjs.  This is marginal, although having one or two familiar washable items can be comforting.  Consider what might happen if you throw up, bleed or spill food on your nice things.  Items can get lost in bundled up laundry.  Also, hospital gowns are very open for a reason—so health care providers can get to all of you quickly if needed.   
10) Something nice to smell to counteract the hospital atmosphere can be very uplifting.  Lavender is often used for relaxation, and Melissa (the “gladdening” herb) has a fresh lemony scent.  Sample some fragrances to see what appeals to you and/or discuss with someone knowledgeable about aromatherapy.  A few drops of a high quality essential oil on a cotton ball inside a small paper cup by your bedside can be very pleasant without bothering a roommate.

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Postop
The most important goal after surgery is to allow yourself time to heal.  Many times patients are holding both themselves and their families together as well as making arrangements and reassuring everyone else.  Then they have surgery, and although they didn’t have cancer and their incision is healing beautifully, they look terrible and have no energy.  They are wiped out.  They used up everything they had to get to that point, and they have nothing left for healing.  And almost as soon as they open their eyes and can speak coherently, everyone expects them to take over again.  This situation is a setup for poor long-term healing and recurrent medical problems.   
1) Appoint someone to deal with visitors if you want to sleep more.  Ask the hospital operator to turn off your phone for a while and have the nurses put a note on your door saying no visitors until a certain time if you want to take a nap.
2) Give yourself a vacation from being the arranger for a while.  Delegate beforehand and pretend you are out of town.
3) Seeing your small children can be very reassuring to both of you.  However, it might be best right after surgery when you less energetic and might have several tubes in, to call them on the phone instead.  In this time period your state might be frightening to them, and you will have less energy to cope with their exuberance.  If they do come to see you when you have tubes and/or a large visible bandage, make sure they are prepared in a positive way beforehand.
4) Besides pain medication, sometimes asking for ice or a heating pad can be helpful.
5) To help prevent blood clots in your legs, flex and point your toes several times every hour when you are in bed.  Get out of bed as much and as soon as your doctor allows, even though the first time may be a challenge.  The sooner you start acting normally, the sooner you will get out of the hospital.
6) Ask a nurse to show you how to hold a pillow over your abdomen to help you cough, and how to properly turn and push off out of bed so as not to put stress on an abdominal incision.
7) If you are going to be in bed for an extended time, ask for a physical therapist to work with you and teach you exercises to do on your own.  There is much that you can do with a stretch band.  At home, there are even videos you can use such as “Bedtop Yoga”.
8) Sometimes the findings at surgery are not optimal, and patients have to start making immediate decisions about further treatment.  This can be overwhelming and lead to feelings of anxiety, desperation and depression, all of which are not good for tissue healing or the immune system.  Continue to listen to music or your surgical tapes (some versions of which include postop support), meditate, or use other relaxation skills.  Some hospitals offer general counseling, specific counseling (cancer support nurse), or mind-body therapy postop.  Using imagery can help you find strength and clarity as well as an inner support system.  Utilize your network of family and friends, and don’t be afraid to ask for what you need from them, your doctors or the hospital staff.   Many people are available to help you, and you are never alone.

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Concluding Comments
Although surgery can be a stressful experience, there are, as you can see, many methods to help you cope.  A calm relaxed focus on a positive outcome, confidence in a team of highly skilled professionals, and control over the care you receive with assertive but respectful communication, can put you in the best possible frame of mind to enhance your recovery.  The attitude of the patient entering surgery is as important as the skill of the surgeon.  The surgeon may expertly manipulate organs and blood levels of chemicals, but it is the body that ultimately heals itself.  Allow your mind-spirit-body to express the full range of its incredible power to heal.

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Comments or suggestions about this topic are appreciated by Dr. Stein