BODY WATCH : Get Well Soon : What You Know Before Surgery Can Hasten Recovery

Before the Big Day

The better prepared you are for surgery, the more quickly and completely you will recover. It is important to learn all you can about the procedure and prepare yourself, your home, your family and your employer for it.

Here are some tips.

* The better your physical condition before surgery, the quicker you’ll recover.

“Go into your surgery well-nourished,” says Kathy Carder, a registered nurse who works with critical-care patients at Santa Monica Hospital. “Protein is necessary for the antibodies and cells that fight infection. Calories, vitamins and minerals are also very important. Before and after surgery is not the time to diet.”

Carder also suggests that patients who smoke try to stop at least two weeks before surgery.

* “Bathrooms can be dangerous for all but the most physically fit patients,” says Dr. Hilary Siebens, assistant medical director for the Department of Physical Medicine and Rehabilitation at Cedars-Sinai Medical Center.

“Remove all throw rugs, and find out if you’ll need a stool in the tub or shower. Consider moving your bedroom to the first floor during recovery,” she says. “Find out if you’ll need help with self-care while recuperating.”

* Siebens suggests that patients and families discuss how their roles will change after surgery. Delegating who will manage finances, household chores and children should be discussed before surgery.

“Families also need to consider what will happen if full recovery is not possible or your surgery uncovers a more serious problem or terminal illness,” Siebens says.

* Let your employer know how much time you anticipate being gone. Tie up loose ends and find out who will take over your work duties. Arrange for your wages to be picked up or deposited directly to your bank account. Ask how much your insurance company will cover of your procedure and post-operative care, especially if special help or equipment becomes necessary during recovery.

* Find out if you will need a blood transfusion. Ask what your options are.

* Find out what your post-surgical medications will be and see if you can purchase them ahead of time.

* Stock up on groceries, toiletries, pet food, stationery and stamps. Get enough to last six weeks.

* Cook extra food and freeze meal-size portions.

* Have lists of household instructions posted for any helpers coming to your home.

* Arrange transportation for incoming helpers and post-operative trips to the doctor.

* Alert your postal carrier if you’ll be confined to the house. Ask if he or she will pick up outgoing mail.

* Take care of banking and bills ahead of time or arrange to do it by telephone.

* Get some of those back-burner projects that you’ve been waiting to do organized and ready to tackle.

* Purchase reading materials.

After It’s Over

Ever wonder why patients who have just been through surgery are forced to sit up, stand up or walk as early as the day after surgery?

Although exercise of any kind in the few days after surgery may feel like torture, “Movement is extremely important after surgery,” Santa Monica Hospital’s Carder says. “Early walking is most effective in preventing skin breakdown, blood clots, pneumonia and constipation.”

Movement is so important that patients who cannot walk are generally turned side to side by a nurse.

“While bed rest is very important, the body loses muscle strength, flexibility and cardiopulmonary stamina, which is reversible through exercise,” Siebens of Cedars-Sinai says.

Once you are at home, alternate periods of rest and activity, and don’t worry if you’re sleeping more, Carder says.

“Tissues heal faster during sleep,” she says. “Some days you may feel great; others, worse.”

Carder warns that pain can prevent necessary deep breathing, movement and sleep.

“Don’t be afraid to ask for sufficient pain medication,” she says. “Drug addiction almost never happens because of surgery and you must move.”

Attitude plays a big part in the recovery process.

“For some patients, coping with recovery is straightforward; others deal with many mood swings,” Siebens says. “Find someone to talk to about your feelings. If depression persists, seek some help.”

More ways to a speedy recovery include:

* Psyche yourself up and remember the big picture.

* Learn what signs of infection look like.

* Know the side effects of your medicines.

* Have telephone numbers handy for medical personnel who can answer your questions. A good number to have is that of the nurses station of the hospital floor you stayed on. Someone who may be familiar with your case is there 24 hours.

* Keep post-operative instructions handy for you and anyone assisting you.

* Watch your fatigue level.

* If you’re walking with crutches or a cane, use a carpenter’s apron with many pockets to help carry things. A patient using a walker can attach a basket.

* Stick to your doctor’s recommendations regarding exercise. Overdoing it can hurt you.

* Encourage non-stressful visitors. Talk to people who will make you laugh. When someone asks what they can do to help, tell them.

* If family or friends are running errands, ask to go along for the ride.

* Tackle a few projects you’ve been putting off. Organize a photo album, start a journal, catch up on correspondence or computer work.

* Splurge on books, magazines and crossword puzzles.

* Order in a pedicure.

* Indulge in a soap opera.

* Learn a new card game.

* Do a jigsaw puzzle.

* Get some fresh air daily.

* Set daily goals--but within reason. Visualize yourself doing something that recovery is keeping you from now and work toward that goal.

Best Advice From the Doctors

There’s no doubt that recovery from any surgery can be a challenge. The doctors we spoke to overwhelmingly said that the best route to recovery is good planning and understanding of the proposed surgery.

Here’s what else they suggest.

Dr. Kim Bader, OB-GYN; Glendale:

As a practicing obstetrician-gynecologist, I work exclusively with women. Surgeries are diverse--from Cesarean sections to hysterectomies to infertility surgeries. The preparations for each are as different as the outcomes.

What few women consider before their surgery is how their role at home will change during the recovery period. If you are the primary caregiver, cook and bottle washer, your role is about to change drastically.

With any surgery, you will need some sort of help in the early days of recovery. Plan for it. If you are coming home with a brand-new baby, not only will you need assistance, but you should consider how your family dynamic will change.

Dr. Michael B. Van Scoy-Mosher, oncologist; Cedars-Sinai Medical Center:

One of the best steps toward a healthy recovery is to focus on the long-term benefits of the procedure.

Find a surgeon who is not only knowledgeable and skilled, but has your best interest at heart. Make sure he or she will spend sufficient time explaining your procedure, and don’t be shy about seeking second opinions.

Remember that the human body rebels against surgery and will send strong messages of its displeasure. Remarkably, the body does know how to heal itself, and in time normal life can be resumed.

Marc Schoen, Ph.D., psychologist; UCLA School of Medicine:

How you prepare mentally before and after your surgery will profoundly affect your recovery. Some important points to consider are:

* Control. Establish a sense of control before and after your surgery by becoming a part of the decision process. Ask questions about the procedure, anesthesia and recovery period.

* Relaxation. Stress interferes with our immune system; therefore healing is enhanced when the body is in a relaxed state. Useful tools before and after surgery include self-hypnosis, meditation and prayer.

* Suggestion. Studies show that hypnotic suggestions given while under anesthesia have helped to shorten hospital stays and lessen the need for pain medications. Patients can listen to tape-recorded suggestions prior to surgery and in the recovery room.

* Support. It is comforting and reassuring to know there is someone we can rely on following surgery. Have someone available who will not only be helpful after surgery but will be an advocate for your health.

Dr. Michael J. Patzakis, professor and chairman, USC School of Medicine, Department of Orthopedic Surgery:

Maximizing functional independence following orthopedic surgery is essential. I suggest patients ask the following questions:

* Will I need crutches, cane, wheelchair or other devices?

* Will I need a cast or splint, and for how long?

* Will I need physical therapy or an exercise program?

* Will I have to keep certain limbs elevated?

* How do I avoid complications?

* What functional level can I expect after surgery?

* What is the length of my convalescence?

Patients who are immobile should plan ways to occupy their time. If you will not have assistance once you reach home, ask your doctor to arrange appropriate care.

Dr. P.K. Shah, director of In-Patient Cardiology, Cedars-Sinai Medical Center; professor of medicine, UCLA School of Medicine:

After uncomplicated heart surgery, many patients are ready to return to work in eight to 10 weeks. The success of that recovery depends on a heart-healthy diet, exercise and a positive outlook.

At home, patients are encouraged to continue their prescribed exercise therapy and progressively increase the duration and number of sessions a day throughout the next four to six weeks. Patients are also encouraged to begin a casual walking routine, progressively increasing speed and duration.

Once patients return to work, they should continue to participate in an organized exercise program that offers instruction on modifying heart disease risk factors.

Dr. Lee S. Berk, psychoneuroimmunologist at Loma Linda School of Medicine and School of Public Health:

Laughter may truly be the best medicine. It is well-known that any of the hormones we produce when we are distressed stifle the immune system, but good stress or what is known as eustress (pronounced U-stress ) can work in our favor.

Eustress can come from the exhilaration we feel after exercise, when we experience good anticipation or from laughter.

In a recent study, we found that blood samples from medical students watching humorous videos showed measurable physiological changes in endorphins, which act as the body’s own painkiller. These hormonal changes can aid in overcoming classical stress. By making yourself feel good, physiology is affected by psychology.

Patients recovering from surgeries should find something each day to look forward too. Try to keep your spirits light and relate to people you enjoy.

Diversions such as humorous books, funny movies, enjoyable music or other entertaining activities will aid your recovery.

How to Be a Great Visitor

It’s nice to show how much you care, but visiting a patient at the hospital or at home comes with some guidelines too.

Paul Mignano, registered nurse and manager of the Medical-ICU Coronary Care Unit at Huntington Memorial Hospital in Pasadena, offers these suggestions for visitors:

* Find out the hospital’s policies for the unit you’re visiting.

* Don’t overstay. Twenty minutes is long enough to give your best wishes unless the patient asks you to stay longer. Remember they are there to recover, not to entertain.

* Unless you are asked to stay and help, leave the room when medical personnel are there to work with the patient.

* Ask about the patient’s restrictions before bringing flowers or food to the hospital.

* Don’t use the in-room telephone or bathroom.

* Wash your hands before and after your visit, and observe all rules regarding contamination.

Patients usually feel better once they are home, but visitors should remember that they are still recuperating, says Elo Tanielian, director of Home Health and Hospice for St. Joseph Medical Center in Burbank. She offers this advice for home visits:

* Schedule your visit--don’t just pop in.

* Keep your visit upbeat and short. Focus on how well the patient is doing, not how far they have to go.

* Let the patient direct the conversation. Be a good listener.

* Don’t play the “I can top your symptoms” game or concentrate on your own troubles.

* Ask if you can bring a meal or special food you can share together. Take care of the cleanup.

* Anticipate needs. Ask if you can bring in the mail, pick up grocery items, run an errand or help the patient accomplish a task at the home.