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The
morning you have been dreading has come. It is the crack
of dawn and your family is about to help you to the car
and drive you to the hospital for your long awaited operation.
Have you done everything you could to prepare for surgery?
It
seems like a strange question, doesn’t it? What do you mean:
have I done everything I could to prepare for surgery? I
don’t need to prepare for surgery-my surgeon needs to prepare
for surgery. I just need to show up.
On
the contrary, you need to prepare for your surgery just
as much as your surgeon does. You are about to enter one
of the most important athletic contests of your life. What
athletic contest is that, you ask? It’s your operation.
It is a competition between pain and comfort, disease and
wellness, happiness and sadness.
Think
about it. There are many parallels between surgery and athletic
contests. Your surgeon will enter a locker room, put on
a uniform, scout out the opponent (your disease as demonstrated
by your CAT and MRI scans), enter a hallowed ground to perform
difficult technical tasks, and, with the help of a skilled
team of professionals, do battle against your nemesis (the
disease that has brought you to the operating room).
It
follows from those similarities that you are involved in
a very important athletic contest-one in which you are the
central figure. You must prepare for this moment of truth.
You must stack the deck of cards in your favor. The most
successful technical operation means nothing without the
proper patient preparation and attitude.
How
Can You Prepare for Surgery?
First,
you must physically prepare your body for the stress of
undergoing surgery. Not all people have this golden opportunity,
as some operations are urgent or even emergent. If you do
have time to prepare physically for your surgery don’t squander
this opportunity.
Eat
Right
Good
nutrition is paramount in keeping your immune system healthy.
By eating a balanced diet with vitamin supplements in the
weeks before your surgery you will have a higher chance
of healthy wound healing and decreased chances of infection.
Dietary supplements are a controversial medical issue. Suffice
it to say that the best form of nutrition is a healthy balanced
diet from the four food groups. There are some encouraging
results from studies looking at various dietary supplements
and their effects on health and nutrition. They will be
reviewed in a future spinal column.
If
you are overweight it is a good idea to slim down before
your surgery. This should be done gradually with safe and
proven dietary modifications. If you are considering a significant
weight loss program (greater than 25 pound weight loss)
this should be under the supervision of a licensed professional
nutritionist or physician.
Particularly
with spine surgery, unnecessary weight is baggage that the
spine must accommodate. If one likens the spine to a flagpole
stabilized by guide wires of the back musculature in back
and abdominal muscles in front, it follows that any additional
baggage in front will put unnecessary strain on the spine.
This additional strain can inhibit the healing process,
and increase post-operative pain. To convince my back pain
patients that are overweight of this point I ask them if
carrying a gallon of milk (eight pounds in weight) or a
grocery package (typically a few pounds more) makes their
back pain worse. Invariably they say yes. I try to point
out that that is exactly what they are carrying internally
if they are significantly overweight.
Although
one should not have drastic weight changes shortly before
an operation, a carefully planned weight reduction program
can optimize surgical results. Moreover, by making a lifestyle
change prior to surgery, a patient is more likely to continue
better eating habits in the post-operative period. These
habits may lead to a healthier lifestyle and better long-term
health.
Get
in Shape
| This
may not make sense to you, but it makes perfect sense
to your body. The weaker your muscles and cardiovascular
endurance are entering surgery, the harder it will be
to get on the comeback trail. Ever wonder how professional
athletes can undergo major operations and return to
the playing field one or two months later? It is because
they are in such excellent condition that their recovery
time can be quite short. Maybe their knee is not functioning
well, but they compensate with other exercises like
swimming and upper body weight lifting. Their muscular
tone and strength going into surgery is on such a high
level that the down time of surgery is only a minor
setback. I have seen many athletes in all sports working
out their uninjured muscle groups even the day before
their surgery. |
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Age
is not barrier. You can improve your health at any point
in your life by engaging in a sensible exercise regimen.
And you can improve your chances for surgical success no
matter how old you are if you enter the O.R. in your peak
physical condition. This may require physician or professional
trainer supervision if you are just starting out. There
is strong evidence to suggest that light weight, high repetition
exercises with a focus on cardiovascular endurance will
improve pulmonary function in the elderly. This could translate
into lesser dependence on oxygen in the hospital and quicker
recovery time. Walking is another excellent exercise to
prepare for surgery if your pain is not limiting your activity.
Also
remember that exercise boosts your immune system, and can
counteract depression, a common emotion prior to surgery.
I try to encourage my patients to stay in shape any way
they can prior to surgery.
Stop
smoking
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This
sole lifestyle change is one of the most important actions
you can perform in your life. If you have planned to
quit smoking in the past, consider your surgery a golden
opportunity to embark on that mission. Smoking significantly
increases your chances for an unsuccessful operation
and complications. The ill effects of smoking on lung
function during and after anesthesia are multiple. A
smoker has a much higher chance of developing pneumonia
after surgery than a non-smoker. Also, smoking is well
known to advance the arthritic processes on the spine.
It may have helped bring you to the OR in the first
place! Smoking also significantly increases the chances
of failed spinal fusion. In fact, some spine surgeons
refuse to perform fusions on smokers. |
Even
if you plan to return to smoking after your surgery, there
is good evidence that temporary abstinence from smoking
during the pre and post-surgical periods improves outcomes
and decreases complications. Ideally, you should stop at
least one month before your surgery. This will allow some
of your pulmonary function to improve, decrease the amount
of secretions your lungs produce, and clear your body of
all remaining nicotine and carbon monoxide (yes, smokers
actually inhale small amounts of the deadly gas carbon monoxide
when they inhale cigarette smoke).
Physical
Preparation- Conclusions
Although
it may not be possible to stop smoking, loose weight, or
get in shape if in severe pain, it is important to understand
that you do have some internal controls when it comes to
elective surgery. By following the above suggestions you
will optimize your chances for recovery and know that you
have done all you can to improve your health.
Dr.
McLaughlin practices neurosurgery in Springfield, Massachusetts
with a focus on complex spine surgery. He serves on the
topic editorial board of Spineuniverse, and has co-authored
two books covering spine surgery.
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SpineUniverse
Editorial Board Comment:
Dr. McLaughlin's comments are right on target, and
point out a very important fact which many people
(patients and physicians) often forget. Surgery is
a contract between a physician and his patient (and
family). The physician promises to utilize his skills
and training to the extent of his ability to safely
perform a surgical procedure on his patient; one which
he/she believes will help that patient. The patient,
however, must also promise to do his/her utmost best
to maximize the potential results of that surgical
procedure. This includes following you doctors instructions
as closely as possible, preparing mentally, preparing
physically, eating well, sleeping well, and stopping
activities which might increase risk or decrease potential
success (e.g. smoking). By adhering to this contract
closely, the chances are excellent that the surgical
procedure will be performed safely, the results will
be as expected, and both the patient and the physician
will be happy with the result.
Richard
G. Fessler M.D. - Editorial Board, SpineUniverse
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