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Holistic Surgery Preparedness

If you are reading this handout, chances are good you or someone you know is about to have surgery. Even if you’ve already had surgery, this handout can still be of help. I wrote this based on my own experiences as a surgical patient and as a post-op physical therapist, including inpatient and outpatient experience. Below is a comprehensive list and explanation of how to get the most and best out of your surgery. When this is followed, people have an easier surgery and a faster and easier recovery. They also find that they recover better than what is seen on average. I believe this is due to preparing the whole body prior to surgery as well as reducing stress around the surgery. There is so much more to surgery recovery than just bed rest as you will read below. At the end of this handout you will find a checklist of everything covered. 

PT appointments/other appointments for after surgery

Make sure you schedule all appointments needed well prior to surgery. Oftentimes practitioners are booked weeks or even months in advance, so as soon as you know your surgery date, get on the books. 

PT appointments before surgery

This is to review how to use any assistive devices you may need after surgery, learn exercises you will need to do before and after surgery, as well as going over any other concerns you may have that are PT related. As stated above, getting an appointment booked asap is needed to ensure you get an appointment. 

Other treatments to prepare for surgery

Taking time to prepare your body for surgery in other ways is very helpful. This can include acupuncture, massage, fascial work, energy healing, sound baths, soaking in epsom salt baths, psychotherapy, qigong, tai chi, or any other treatment that you like. The key is to help clear your body of any tension or toxins so that you can go into your surgery as fresh and clear as possible.

Equipment

Be sure to check with your surgeon and PT prior to surgery about what kind of equipment you might need. If it is something that needs adjusting to your height (like a cane or walker), be sure to see your PT prior to surgery to have it adjusted. The kind of equipment you will need depends on what kind of surgery you’re having, and includes but is not limited to:

Walker

Cane

Shower chair (with arm rests/railings)

Car Cane (for getting in/out of a car more easily)

Back/leg brace

Sling

Surgical boot

Waterproof cover for showers

Hospital bed

It is generally a good idea to have a shower chair for any kind of surgery due to fatigue. Being able to sit when showering is helpful in conserving energy and also ensuring safety. Hospital beds can offer ease of movement with their ability to raise/lower and sit you up. They can be rented too. Be sure to ask your insurance if it covers any of this equipment.

Support

Most people find they need around the clock help for 3-7 days after a surgery, and maybe longer depending on the kind of support needed. It is recommended to have someone be able to come check in on you even after this initial time period to ensure safety as well as needs being met. 

Healing happens in waves, and while you may feel great two weeks after surgery, you may feel exhausted the following day and need help again. I have found that having someone on call for up to a month is a good idea. 

One other way to think about it is, if you are taking oxycodone or any other form of this pain med, you will likely have poor memory and need someone to help track your meds/exercises and attend to any other needs. As long as you are taking these kinds of meds, you will need support at home. A great way to ensure safety so as to prevent an overdose is to have a tracking sheet. The person helping give you your meds should be the one doing the tracking. It is not uncommon for someone who is on these meds to fall asleep before checking off the meds they took or forgetting to check it off. The helper should also be aware of the need for this safety so as to prevent any overdoses.

Food before

Eating well before surgery helps with recovery. This means limiting inflammatory foods (ex: sugar, alcohol) and also eating more protein. I have heard from several surgeons that eating 80 grams of protein a day for 6 weeks prior to surgery reduces recovery time while also improving the quality of the healing body part. Every patient I have seen do this has had a much easier time healing. 

Food after

Prior to surgery, make sure you have a plan for food to eat when you get home. Usually people have a reduced appetite for a few days to a few weeks post-op, and so it is important to have easy to digest, nutrient-dense foods available. For me it has been turkey sandwiches. 

Some people will cook up a bunch of food just before surgery and have it ready in the fridge. Others will organize “Meal Trains” where friends/family show up with food ready to eat. I suggest making a calendar so that you can track who is providing means and when. This can help you plan to fill in the gaps as needed and to avoid getting too much food at once. Whatever your preference, make sure you aren’t going to be wondering what you are going to eat when you are two days post-op and too exhausted to make a decision. 

Conditioning for surgery and exercises post-op

When it comes to any surgery, being as physically fit as possible will go a long way in helping with healing and recovery time. You don’t have to be in the gym running three miles or lifting 200 lbs though. This means getting out for walks as much as possible and seeing your PT for specific exercises related to your surgery. Research has shown this be invaluable in all aspects of recovery. 

Below are some examples for common surgeries. Practicing these exercises before surgery helps by giving you time to learn what to do and how it feels. Your body will know what to expect and it will take less brain power/energy to perform exercises that you are familiar with. These are exercises that are often prescribed for after surgery too.

• Common Exercises for Knee Replacements

  • Knee extensions

  • Heel slides

  • Mini squats

  • Side to side weight shifting

  • Heel raises

• Common Exercises for Hip Replacements

  • Mini squats

  • Butt squeezes

  • Heel raises

  • Side to side weight shifting

  • Mini marches

Movement After Surgery

General movement after surgery is very helpful to the healing process. It helps increase circulation, which bring oxygenated and nutrient-rich blood to the area healing while also taking away cellular waste/inflammation. In addition to the exercises specific to your surgery, walking is the best thing you can do. 

Balance is the key here and requires listening to your body. Some days you will feel like you can do more than other days. Your energy levels and pain will fluctuate. I recommend frequent, short walks, such as walking to your kitchen for some water, going to the mailbox, or even spending 5 minutes walking around the neighborhood. You will find yourself gradually increasing your time and distance. Make sure you always have a way to rest or stop before you start walking.

Visualization and Setting Intentions

There is incredible power in visualization. Research has demonstrated many times that spending time “seeing” how you want your surgery and recovery to go actually helps with the outcomes.

Here is a link for the video I recommend to all my patients before they go into surgery: https://northwellcwim.com/guided-imagery-for-a-successful-surgery/

Setting intentions for a good surgery and easy recovery with another person or a group is also profoundly helpful. Not only does it help to feel supported by others, but there is also a potential that is more easily accessed and amplified when others are a part of your intentions. Below is an outline for setting intentions that can also be used for your own visualization practice. You may wish to add a description of your surgery or details of specific bones/muscles/organs involved, but it is not necessary. You may also wish to assign each section to someone in your support circle for them to focus on. 

The purpose of this circle is to hold healing intentions in whatever way makes sense to you. This can look like sending positive vibes, prayer, or meditation as examples. Whatever you choose to do, it will be helpful, and it is appreciated.

You do not need to do this at the time of surgery or for the duration of the surgery, although if you do wish to hold intention during, it will be from _______ to ________ on ________ at __________. The night before is perfectly fine too. Whatever you do, it will be felt, helpful, and appreciated.

Assignments for your intentions are as follows:

• Group: That I will heal well and there will be no infections. That I will sleep well the night before and rest well afterwards.

• Veins and Lymphatics. That all cellular waste and inflammation are removed from the surgery site and out of my body with ease to allow for fresh, healthy blood to enter the surgical sites. That there will be vasoconstriction during surgery to limit blood loss, and vasodilation after surgery to allow for ease of movement of the blood from the surgery sites. That they will knit back together with ease and minimal scar tissue.

• Arteries. That there will be vasoconstriction during surgery to limit blood loss, and appropriate vasodilation after surgery to allow fresh blood to enter the surgical sites for healing. That nutrients needed for healing will be brought to the surgical sites. That they will knit back together with ease and minimal scar tissue.

• Muscle. That all muscles involved will relax and accept the surgical instruments with ease. That anything attached to them that is to be removed will be released with ease. That they will knit back together with ease and minimal scar tissue.

• All organs. Focus on all organs involved relaxing and receiving minimal trauma throughout, that they will be accepting to the probing of the instruments. That I will not be constipated after surgery, that my liver/kidneys will filter my blood appropriately and with ease without being overtaxed. That my adrenal glands will not go into overdrive producing cortisol. That they will knit back together with ease and minimal scar tissue.

• Adipose. This tissue (fat) holds so much in the way of emotion and memory. It also is a conduit for neurovascular structures. The intention held is that any adipose being cut will release with ease while maintaining appropriate protection of all that it holds. That my body will release any memories of trauma rather than storing it in the adipose. That it will knit back together with ease and minimal scar tissue.

• Ligaments. That all ligaments involved in the support of my body will not be injured and will hold appropriately after surgery. That any ligaments being removed or repaired will do so with ease. That everything will knit back together with ease and minimal scar tissue.

• Skin. That my skin will cut easily and relax for the placement/movement of instruments with ease. That I will not have any flares of eczema. That it will knit back together with ease and minimal scar tissue. That the release of any scar tissue from my previous hernia repair will be with ease.

Things to keep you entertained afterwards

You will want to have some things to keep your mind occupied after surgery. Keep in mind that anesthesia can affect you for several weeks, or longer, and so your concentration and memory may be limited. Having a variety available is a good idea so that you have choices. This can include:

• Easy to watch tv/movies

• Puzzles

• Stitching/crochet/knitting

• Familiar books

Consider staying at a hotel before/after

If your surgery is off island (or longer than 30 minutes away), you’ll likely want to stay the night before surgery near your hospital. Patients are often required to arrive at the hospital before 7 am, which means that even the earliest ferry is unlikely to get you across in time. This also means that a longer commute means getting up and leaving that much earlier.

More and more surgeries these days are considered “out patient” where you leave the hospital the same day that you have surgery. There are three ways to go about what you do after surgery:

1. Go home

2. Stay in a hotel

3. Request that you can stay overnight at the hospital due to the location of your home 

Staying nearby the hospital the night after your surgery can provide peace of mind that you are within easy reach of the hospital should anything happen that requires immediate medical attention. It also means that you won’t be stuck in the car for several hours right after being under anesthesia and being operated on. Having easy access to a toilet, bed, and food, not to mention rest, is crucial during those first 24 hours. 

Clothing

Loose-fitting clothing that’s easy to get on/off will save you a headache. You will likely be challenged in dressing yourself, and clothing that someone else can help you get on/off easily will keep your stress lowered. It will also be more comfortable for you. One other thing to note, you will be covered in antiseptic before and after surgery, so you will want to wear clothes that are easy to wash, preferably hot water-tolerant. 

Pain and inflammation management

Having your pain meds ready ahead of time will keep you from having to take a trip to the pharmacy after surgery. It is also good to know how you will be managing your pain so that you and those helping you will know what to do and what to expect. This can include: over the counter meds like Tylenol and Advil (they work great together better than individually), oxycodone (or some other variation), ice/heat (depending on what kind of surgery you have). 

The best advice I can give you about pain management is don’t wait until you are in pain to take meds. Go ahead and plan on needing meds for several weeks straight. It is harder to get on top of pain once you are already in it, so set up a schedule and have someone there to make sure you are able to stick to it. Set alarms to wake you up so you don’t sleep through when you need to take them.

One other thing to mention about pain meds is that they often also manage inflammation. These two things are related, however it is often a misconception that pain is the only indication for medicinal management. Excess inflammation can sometimes be pain free and still limit healing. If you are finding that you have tolerable or no discomfort, but that the site of operation is still swollen, taking an anti-inflammatory may be the right course of action. I have found this to be true for both myself as well as my patients post-op.

I want to emphasize that there is no shame and no guilt in taking pain meds. Absolutely none. Your body heals the way it heals, and others will heal in their own way. Just because someone didn’t need meds after two days doesn’t mean you shouldn’t either. Healing goes in waves too, so there can be a period of time (ex: 8 weeks) before you find yourself in another healing uptick and you need an assist again. It takes 1-2 years for the body to heal after a surgery, so it is always possible that you may need to take something for your recovery throughout that time. At the time I am writing this handout, I am 6 months post-op for a complete hysterectomy, and I still need to take something for inflammation occasionally. 

You do what you need to do to best take care of yourself and give yourself the best possible outcome.

Constipation management

Anesthesia and oxycodone cause constipation. The last thing you want is to be stopped up and unable to push or sit on a toilet for very long. It hurts, it slows down your recovery, and it’s just not fun. There are a number of ways to manage constipation, some of which can interfere with healing/pain meds, so be sure to talk with your doctor prior to surgery so that you know what you should take. 

Miralax is often recommended because it has been found to not interact with medications and it is tolerated easily. 

Hydration afterwards

Water, electrolyte drinks, and tea are all great ways to keep your body hydrated. Don’t wait until you are thirsty, keep fluids near you at all times and sip often. 

A note on electrolyte drinks; many are filled with lots of sugar. While some is fine, a lot will cause blood sugar crashes and increased inflammation. Many also only contain salt and sugar while leaving out other helpful electrolytes such as potassium and zinc. My rec for this is Ener-C.

Peppermint tea is amazing for digestion, clearing out toxins, and removing gas/free air. If you were inflated during surgery (abdominal/belly surgeries) then you will very likely have some free air roaming around. Peppermint tea really helps with getting this air absorbed and released through your gut and lungs. Also, with the disruption to your gut from medications/stress, you will likely have increased flatulence/burping, and this tea helps with releasing that more easily.

Practice how to move for after surgery

Much like practicing your exercises before surgery, it is helpful to practice how you will move. This includes: getting in/out of bed, in/out of a car, on/off a toilet, on/off a seat, up/down stairs, and walking with your assistive device. Below are some common methods for movement after surgery:

• Stairs: “Up with the good, down with the bad”. Going up stairs you want to lead with your “good” leg (think heaven) and going down stairs you want to lead with your “bad” leg (think hell).

• Car seats: 

  • Use your good leg to lift your bad up and out of the car while turning in the seat

  • Sit down/stand up from outer edge of the seat (your butt will be towards the car while you face away from it)

• Toilets/Chairs: 

  • Standing: Make sure your weight is over your toes (nose over toes) and lean forward to use your momentum to stand up.

  • Sitting: Stick your butt out with your nose over your toes

• Bed: it can be a little scary at first and feel contrary to what you think is helpful, but rolling completely on your side before sitting up is going to help you tremendously. Use your legs to counter balance you so that you don’t have to be lifted or push as much. Make sure to roll onto your side that is not being operated on.

• Walking with an assistive device: keep it close and turn with it. Lifting it and holding it up can not only cause a tripping hazard, but it also then isn’t there on the ground to hold you up.

Checklist to complete before surgery

• Get all post-surgery appointments scheduled as far in advance as possible

  • Physical therapy

  • Post-op with surgeon

  • Any others specific to your surgery __________________________

• Pre-op appointments

  • Pre-op with surgeon/surgeon’s team

  • Pre-op with PT for reviewing exercises and how to move after surgery

• Get all equipment needed

  • _________________

  • _________________

  • _________________

• Get all support set up 

  • Person staying overnight for at least 2 weeks

  • Checking in daily for at least a month

• Meal prep/”food train” 

  • Breakfast

  • Lunch

  • Dinner

  • Snacks

• Exercise

  • Walk

  • Exercises specific to your surgery site

• Pre-op meditation/visualizations

• Intentions group/prayer circle set-up

• Collect entertainment 

• Hotel stay

  • Night before surgery

  • Night after surgery

• Clothes for after surgery

• Pain management

• Constipation management

• Hydration sources

• Practice how to move