How To Prepare for Surgery

How To Prepare for Surgery

I am a week or so away from another surgery. A planned one for a change! It has been almost three years since my first surgery and things are different this time around – I know what to expect, how the pre op appointments work, the process of a surgery and recovery but how exactly do you prepare and organise yourself for a major surgery?

Here I’ll be going through step by step what is expected during your journey for surgery – from first surgical appointment through until the operation – peppered with my own tips and hints to what I’ve done before or trying this time around.

NB: I am a very organised and prepared patient. Some what part of my personality, the rest from the journey with IBD to this point. Please don’t take my own words as medical advise, I am not medically trained. This is a A-Typical guide to surgery and can differ between hospitals and NHS Trusts.

At any point, if you feel what is happening to you – if and when you have surgery – is not right / appropriate / fully explained, please speak to you medical team. Surgery is a huge undertaking and is not easy. Thought and respect should go into surgery, as well as consent.

 

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Surgical Appointment

You’ll usually have the opportunity to meet your surgeon at their clinic.  They will discuss with you what options are available to you, given your own personal circumstances for needing or wanting surgery. They will explain what will happen before, during and after your operation, and any pain you might have. It as this point you will be to ask questions and understand exactly what will happen. You might find it helpful to prepare beforehand, with any concerns you have. Examples of questions could be:

  • What happens before the operation?
  • Why do I have to wear the surgical stockings?
  • What will I feel like after the operation?
  • How long will the effects of the anesthetic last?
  • How will my pain be managed after the surgery?
  • What should I do, and who should I tell, if I’m in pain?
  • What are the visiting arrangements?
  • Will I return to the same ward after the surgery?
  • When will I see the consultant?
  • When can I expect to go home after the operation?
  • When will I be told about any results of samples taken?

This will help you to feel well informed and in a position to give your consent for the procedure to go ahead.

Pre-Operative Assessments

You will most likely go to a pre-assessment clinic a few weeks or days before your operation for routine tests. The Assessment Team will explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop. This is because smoking increases your risk of getting a chest and wound infection. That can mean it will take you longer to recover from surgery. They will know what best for optimum recovery from your operation and how you can best help yourself too.

They will also check what medicines you’re normally on and advise if you should stop taking any of them before surgery.

Make sure you follow their instructions for taking your medications before surgery. If you normally take tablets or insulin for diabetes, make sure you discuss this with them as soon as possible before your operation. They will also go through routine pre-operative questions – if you’re allergic to any medication, or whether any relatives have ever had any problems with an anesthetic, your previous surgeries, history on your heart, lungs and immune system is also taken, so any suitable precautions can be taken prior to your surgery.

They will give you information about when and where you need to arrive on the day of the surgery and go through your immediate pre-surgery check list. Finally, they will check your height, weight, blood pressure and sugar levels before taking bloods. These items are needed as close to the operation as possible so they can give the right amount of anesthetic and the right blood, if you need any during surgery.

Day before Surgery

You may have been given instructions at pre-op to follow a special carbohydrate-rich diet before your operation, especially if your condition means you’ve lost weight. You may also be asked to take laxatives on the day or the day before. Or you may need to have a bowel washout (enema). This involves having a small amount of liquid medicine inserted using a small nozzle into your back passage (rectum). This will help you to empty your bowel before surgery.

Don’t eat or drink anything before your surgery. You’ll be told exactly when to stop – it’s usually:

  • 8 hours before surgery (eating)
  • 2 hours before surgery (drinking)

Your doctor may also suggest you have an antibiotic injection before your operation to reduce the risk of infection. For Enhanced Recovery, your pre-operative appointment will detail how this takes place and what is required. This is usually pre-op carbohydrate drinks and an anti coagulate injection, administered the evening prior to surgery to ensure good recovery and a lower risk of developing a Deep Vein Thrombosis (DVT). Compression socks will also be included in this. Enhanced Recovery is done as some hospital, not all, but is important for bowel surgery, as the digestive system is affected by anesthetic and prevents ileus – where the bowel goes to sleep. More information about Enhanced Recovery can be found here.

 

Day of Surgery

You will arrive at your hospital’s Surgery Admission Unit for the final preparations before surgery. At this point, you may be asked the same questions by several people. This is routine, and ensure that correct information about you is checked and available at each stage of treatment.

Your surgeon will come round and see you beforehand, go through anything you might want to ask, and what they will do about any pain you might have. This is another opportunity to understand exactly what will happen. Accompanying the surgeon will be his registrar and the anesthetist. Sometimes, depending on the circumstances, an acute pain team also come to ensure pain management plan is in place for recovery. Everything up to this point is to ensure you feel well informed and in a position to give your consent for the procedure to go ahead. Even on the day of the operation, you can decide to not consent. 

Bowel surgery takes place under general anesthesia. This means you’ll be asleep during your operation; a tube down your windpipe to help you breath on a machine for the duration of the surgery. Any anesthetic can make you sick so it’s important that you don’t eat anything for six hours before your operation, to avoid an vomit entering your lungs via the intubation tube.

You may be offer to have a pain-relieving medicine injected into the space that surrounds your spinal cord – this is known as an epidural. Having an epidural can enhance your recovery, by helping your gut to return to normal working order and allowing you to get up and moving quicker after surgery. It can also reduce your risk of certain complications. If for any reason this is not suitable, fails or does not last long enough, you can always have a PCA pump – a patient-controlled analgesia pump – which delivers pain relief directly into your bloodstream. The type of pain relief will be decided by your Pain Management Team, given your relevant medical history and wishes. Be aware that this can sometimes be hard to come off, as it is not a constant flow of relief and dependence towards it can grow.

You’ll usually need to stay in hospital for between three and nine days if you have bowel surgery without any complications. They will want you to be able to walk unaided, be tolerating food and liquids, as well as having bowel movements before being discharged home. Recovery at home from bowel surgery depends on if it is open or laparoscopic; but can be between 4-6 weeks. This is always guided by the surgeon, so please do take their advice on what to do after surgery ie. working, lifting, carrying, exercising and intimacy.

 

Thinks to consider:

1. Make sure you can get there. Don’t forget to make travel arrangements, as it is unlikely that you will be able to drive yourself to and from hospital. If you are relying on friends or family, give them plenty of notice so they can ensure they are free to help.

2. Make sure you have everything you need. If you are staying in hospital, make a list of all the things you might need and start packing a few days before. Think about nightwear, day clothes, underwear, dressing gown and slippers, a small hand towel and toiletries, sanitary products, books or magazines, a small amount of cash, your regular medication and the doses you take, glasses or contact lenses if you use them.

3. Be as well as you can be. Research has shown that patients who maintain a reasonable level of fitness before surgery, have better results. Think about your diet and lifestyle too – healthy food and giving up habits such as smoking have been shown to improve recovery post-surgery.

4. Don’t eat or drink if you’ve been told not to. If your doctor has advised you not to eat or drink for a specified period of time before your operation, always follow their advice. This includes light snacks, sweets and water. If you don’t then your operation could be canceled. Having an empty stomach greatly reduces the risk of vomiting under anesthetic.

5. Take your medication. If your hospital doctor has asked you to take any medicines before surgery, make sure you do so.  As part of your pre-operative assessment you will have been asked about whether or not you are allergic to certain medication or if you or any of your relatives have had a problem with anesthetic. If you have been told to stop taking any regular medication, you must do so – if you don’t your surgery might have to be canceled.

6. Clean up before you arrive. Make sure to have a bath or shower before you arrive, and remove all body piercings, makeup and nail polish. As well as reducing unwanted bacteria in the hospital, it also helps the medical team to see your nails and skin so they can check your blood circulation.

7. Avoid bites, scrapes and scratches. One of the many functions of the skin is to act as a barrier to infection. It keeps out the sort of bacteria which can enter the bloodstream and cause problems with some types of operations.

8. If you are anxious, speak up. Most people experience a certain amount of anxiety before an operation, but if you are really anxious don’t be afraid to contact the hospital to let them know. They will be able to provide all manner of advice and information to help allay your fears.

9. Provide information to family and friends. Be sure to let family and friends know about your hospital’s visiting hours, and let them have a contact number just in case. If a family member or friend is taking you home when you are well enough to be discharged, make sure they know when and in plenty of time for them to be free to help.

 

For your own peace of mind, you’ll want to prepare yourself physically, emotionally and mental before surgery:

  • Make sure you understand what you are likely to experience in terms of post-operative recovery. This is an important discussion to have with your surgeon in clinic as you can begin to understand what is really going to happen. If you have other friends who have had surgery before, it might be helpful to ask for their experience; but be aware that recovery is still a individual thing and sometimes complications can arise.
  • You may want to make plans ot resolve any work or family obligations that might arise during your recovery. If you are employed, you should be allowed time off to recovery from your operation. On discharge from hospital, you can be given a fit note – signed by your consultant or surgeon – stating when you can resume work or if you need ot be review by themselves or your GP before going back to work. This is dependent on the type of job you do.
  • Enlist family or friends to help with household obligations, including meals, cleaning and any other activities. Its much better to have too much off your plate than to be overwhelmed as you recover. This is probably most important for those who are living alone or far away from family. I’ve found getting my household in shape – including getting my kitchen stocked with food, drinks and essential household items – is benefiting me most this time around.
  • If you have time before the procedure, get into the best physical shape possible; including focusing on your optimum diet, weight, and nutrition for your situation. For bowel surgery it is a good idea to improve your core – the abdominal muscles – if you have open surgery. This will help reduce any risks in recovery of a hernia – muscle weakness – forming.
  • Stay away from people who are sick – as well as high-germ situations – immediately prior to the surgery to ensure your immune system is operating at its strongest. This will help your body fight off any potential infections.

Most of all, remember: You’re not alone in this.

 

My next two posts will cover why I am having this surgery done – Why? Proctectomy Explained – and what I’m taking into hospital with me – What’s in my Hospital Bag? – come next week!

Do you have any questions or queries? Or just want to share your own experiences? You can leave me a reply here or leave comments via my social media accounts – on Twitter, find my blog page on Facebook and over on Instagram

Further reading:

BUPA – Epidurals for surgery and relief

Bowel Cancer UK – Preparing for surgery

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