Help Yourself Heal: Before surgery
Course sections
- Benefits
- How it works
- Before surgery
- After surgery
- Healing results
- Relaxation resources
As we have seen, research and patients' direct reports of their experience show that relaxation practices can have a positive impact before and after surgery. To help this type of training become a regular part of presurgical preparation we are offering this free online course developed over the past eight years by Aurora Ocampo, clinical nurse specialist at Beth Israel Medical Center in New York City. In this way, anyone with access to a computer can get these benefits. We are grateful to the Balm Foundation for making this possible.
Let's begin with Ms. Ocampo's work with patients before surgery which combines helpful information and direct relaxation practice.
Reducing stress and boosting your healing
What we really want before surgery is to trigger the release of healing hormones like endorphins and serotonins that will assist you in healing in a normal time frame or healing faster. Endorphins are known to be your body's natural pain killer so they also help you cope better with your pain. And as studies show, being physically, emotionally and mentally prepared for surgery through relaxation practices may also help prevent many complications that can delay your healing.
Learning how to manage your anxiety really is the foundation and success of these practices. When you're anxious and your stress level is way up, your body releases a hormone called cortisol that can alter white blood cell function, compromise your immune system and create a more open environment to infection. In preparing for surgery you want to be in an optimal level of wellness so that you prevent any complications.
These techniques work to support your body's ability to mend, to decrease complications and to shorten the recovery period. By healing faster or at a normal rate, you're able to go back to your activities of daily living, go back to work, go back to enjoyable recreation a little faster, and not delayed.
Self assessment
Let's begin by looking at how you are managing stress in your life.
Do you have any general strategies you use such as taking a walk, listening to music, doing a hobby, exercising, reading or talking with a friend?
Are you using any specific stress management techniques right now? Do you do yoga, deep breathing, tai chi, qigong, meditation, guided imagery, prayer or some other practice?
If you use any of these specific stress management techniques, think about which help you.
- How much they are helping you?
- Which did not help you at all?
- Notice how consistent you are in doing your practice
- Notice things that get in the way of your practice
- How long did you try to practice a technique before you said it was not working?
What are some of the barriers that prevented you from being successful in a practice?
- It could be a phone ringing, traffic noise, an uncomfortable position...
- Why do you think it hasn't worked?
- Is there anything you could change to help it work?
- Have you tried to remove the distractions that may be interfering such as finding a quieter space, finding a more comfortable seat or position, or unplugging the phone?
- Maybe it would help you if you made a list of these distractions – then you can slowly try to correct or eliminate the things that are in your way
You may also want to print out the holistic self-assessment form [PDF] to help you look at the affect of stress on your emotional and physical health and how you are managing it. This can give you a new understanding of the role of stress management in your life both before and after surgery.
If you are not doing any relaxation practice, are you open to trying one or two of the following techniques?
Learn relaxation techniques
Some of the techniques I will share with you today can be practiced on your own and this will give you a sense of control – not just for preparing for surgery but even after surgery when you are back to your usual activities. Stress is a normal part of life – and it's not a bad thing but we have to learn to cope and learn how to manage it.
The foundation of any stress management program is breathwork. There is no right or wrong way to breathe – but I will teach you how to breathe more efficiently. I'm going to demonstrate the technique later and then we'll do it together.
I have some simple techniques you can use so that you can slowly and gradually bring this into your life without worrying about whether you can do it or not. For instance, meditation. One of the techniques I'm going to teach you is an introduction to meditation, where you focus for a short time, a minute or two minutes or less.
We'll go over each of the techniques that you can do for yourself: breathing, imagery, simple biofeedback. There are also techniques that a healthcare practitioner can do for you that will help you manage the anxiety of going through surgery or a medical procedure. These include practices like massage, acupuncture, gentle yoga and energy healing such as Reiki. Another possible way to maximize your healing process is the use of nutrition for healing before and after surgery.
Healing goals
We are going to create healing statements based on your concerns about surgery and how you want the surgery to turn out for you. These statements can be practiced during the period of time before you have surgery.
We will also work on a few statements that you will want to give to the surgeon or anesthesiologist to read to you just before anesthesia induction. These positive healing statements are what you want to hear just before you go under anesthesia so that your mind will receive the positive messages and your body will respond.
Healing statements to prepare you for surgery
In preparing for surgery ask yourself if there is a concern that you have and if so what it is. The healing goals you write will depend on your concerns. For example, you could be worried about postoperative pain.
For pain:
Most people are afraid to wake up having a lot of pain. So your healing goal might be "When I wake up after surgery, I will feel minimal discomfort" or realistically maybe you would say "tolerable discomfort." Do not even think of the word pain.
For nausea and vomiting:
If this is your concern, you might want a healing goal that says, "When I wake up after surgery I will feel comfortable and my stomach will feel calm."
For the recovery period after surgery:
What is your expectation about recovery? You might say "After surgery I will heal at the normal pace that is expected" or "After surgery I will heal faster than expected."
You can incorporate these statements into your relaxation practices when you feel you are in a deeply relaxed state. You can say these healing goals to yourself knowing that whatever you're thinking, the body will react as if it is happening.
You can also practice this at any time of the day or night. It doesn't have to be part of a routine relaxation practice, although it could be, or you could just think about those phrases or statements over and over throughout the day and before you go to sleep. Think of this as being in training to prepare for a successful surgery. The more you practice this skill, the better you will be at it.
Healing statements on the day of surgery prior to anesthesia
Sometime before surgery, tell your surgeon or anesthesiologist that you will be giving them healing statements that you would like one of them to read out loud to you just before anesthesia on the day of surgery. If you are not comfortable talking to your doctors about this you might ask the primary care nurse on the unit or your partner or spouse to advocate for you by speaking with your doctors and delivering your healing statements to them on your behalf.
Provide them with either a typewritten statement of goals or an easily readable handwritten note. It will be more effective if you limit your healing goals or statements to no more than three.
Here are examples of healing goals that your doctor will read to you:
For pain:
"When you wake up from surgery you will have minimal or tolerable discomfort."
For nausea and vomiting:
"After surgery you will wake up and feel comfortable, and your stomach will feel calm."
Another example is to use craving a food that you love on waking up because you can't feel sick to your stomach and crave food at the same time. So the healing statement might be:
"After surgery when you wake up you will be craving ____________."
For healing:
"After surgery you will heal either in the normal time frame for your surgery or faster."
These healing statements will assist you in your preparation for surgery and may enhance your healing process and perhaps shorten your recovery period.
Nutrition
Begin increasing protein intake a few weeks before surgery to build up both your strength and your tissues. Eat high quality proteins such as fish, poultry, eggs, nuts and seeds. High-fiber foods (whole grains, vegetables, fruits and legumes), calcium-rich foods (nuts, fruits, some leafy greens, molasses and small amounts of dairy products), and foods containing essential fatty acids (some nuts, seeds, or vegetable oils) are also helpful.
Try to avoid a lot of dairy products, sweets, and baked goods as well as high saturated fatty foods such as fried foods, heavy meats, and cured meats. Your diet can usually be a little lighter a few days before surgery, emphasizing more fruits, vegetables, and liquids. This will help ease the stress on your digestive system. Avoid stimulants such as coffee and sedatives such as alcohol prior to elective surgery.
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