How to prepare for surgery

How to prepare for surgery
by Dixie Mills, MD, FACS


Only the rare person escapes having to go under the knife at least once in her lifetime. Surgery is big business for hospitals these days. Over 50 million Americans undergo surgery each year — the majority of whom are women. Most people think of having surgery with some sense of trepidation. Some are quite fearful and avoid the operating room at all costs, often to their disadvantage. There is even a psychiatric disorder where a person demands unnecessary surgery (called Munchausen’s syndrome). Most of us, however, take a deep breath and say “okay” when an operation seems to be a necessary medical decision.

But when is surgery medically necessary? Who should make that decision? And how does one make the best choices? This article will present a set of questions that you, as a wise consumer, can ask your doctor and yourself, to help you come to a solid conclusion about whether to undergo surgery or not. And if you do decide surgery is the best option, and you want to make the most of it, there are now proven techniques that have been shown to decrease postoperative pain and the need for painkillers, decrease blood loss, and decrease the length of hospital stays.

As a surgeon, I always found it gratifying to have a patient who wanted to partner with me in her care and came with questions, rather than me having to dictate everything. Let’s look at the essential questions to ask before surgery and how you can get yourself and your support team ready for the big day and afterward.

Elective or emergency surgery?
I’d like to address first the differences between elective surgery and emergency surgery. If you have been injured in an accident, or a medical emergency develops, you may be required to have emergency (or within-24-hour) surgical intervention. Thankfully, our bodies are capable of restoring themselves pretty effectively, so most of the time we don’t need surgery and our bodies heal on their own, usually with some help from modern medical interventions like antibiotics and fluids. But in an emergent situation, you won’t have the time to prepare for surgery, and most of the work may need to be done after the case. Some of the following tools can be used for post-op care or physical therapy, or even after other procedures such as chemotherapy and radiation.

In this article, we will talk more about the surgical procedures you can prepare for, and how to view these experiences from a positive perspective. Most surgical procedures these days are elective or “voluntary,” performed at out-patient, ambulatory facilities (meaning patients “walk away” from the procedure). It also means that patients themselves are expected to assume much of the pre- and postoperative care that nurses and other hospital staff provided in the past. As with many things these days, medical care has become our responsibility.

While we may not be expected to put the knife to our own skin or insert our own IV’s, it is incumbent upon us to know what to expect in a hospital operating room and recovery room. Many hospitals have modernized pre-op clinics, but unfortunately these often seem to be check-in-and-out mills where little teaching goes on, or where patients are given pages of boring or scary information about risks and complications.

Some more progressive institutions do have “prepare for surgery” workshops, and some surgeons’ offices have staff available to answer patients’ questions or supply very instructive handouts.

So if you have some time before your surgery, what questions should you ask of them?

Before you decide to have surgery

Let’s start with a very common example. Many women during perimenopause have heavy bleeding — menorrhagia. When this happens, oftentimes they are told variations of the following: they must have, should have, could have, or would benefit from having a hysterectomy. Now menorrhagia can be a real nuisance, and women can develop low red blood cell counts, but it’s rarely an emergency situation. Medications can help, and the bleeding usually stops at least for another month. Therefore, I think this is a perfect situation for a woman to do some research on her health and life. She can look at what she can and wants to improve, reassess her priorities, look at the next few months or years and then figure out which alternative looks best for her.

Here are some basic questions to ask before you make the big decision to have surgery or not:

Seven questions to ask before surgery

Why do I need this operation? Is it to cure a condition or to find an answer?
How soon do I need this operation?
Where should I have this operation performed?
What alternatives to surgery do I have?
What would happen if I took a watch-and-wait approach instead?
What are my detailed pre-op and post-op instructions?
Are there things I can do to help myself prepare for surgery, such as reviewing specific reading materials or relaxation techniques?

If we stay with the example above, some women find heavy bleeding to be the worst possible thing and having a hysterectomy is a welcome answer. For others, like a colleague of mine who didn’t have time in her busy career to schedule surgery for six months — by which time the bleeding stopped — waiting might be the answer. This is actually a positive for the Canadian health care system and its supposed delays in scheduling surgery — waiting a little bit longer can work out best for the patient, and the economy, because neither truly needed the surgery! A family member of mine took advantage of this time to research all her options, then chose to have a noninvasive (no cutting) procedure, and has done well. (See our article on hysterectomy options and alternatives for more information.)

Now let’s say you decide you do really want and need that hysterectomy. What steps can you take to make the experience the best it can be? Well, you’ve already done a lot to make that decision. The worst outcomes that I’ve seen have occurred when a person was pushed or rushed into making a choice she didn’t want, and it came back to haunt her. There will always be situations in life where we have to do something we don’t want to, but with help, we can usually frame these events in a more positive light.

How to prepare positively for surgery
Preparing for surgery can involve physical, mental and even spiritual work, and can bring positive outcomes on all these levels. There are various books and audio recordings on the subject which I recommend to my patients, but the one I am most familiar with is Peggy Huddleston’s Prepare for Surgery, Heal Faster. Peggy created this book over 10 years ago, basing it on over 20 years of research, yet I’ve found it is just as valuable today as when it was first published.

But there are many to pick and choose from. Similar programs have been developed by many doctors, including Bernie Siegel and Andrew Weil, each with their own slightly different twists. Regardless of which program you follow, it’s important to recognize that you decide what will work best for you.

On a side note: whether we are going in for surgery ourselves or taking our children to the operating room, preparation is essential. Peggy Huddleston says that, as mothers, we can give our children a great gift if we prepare them well for surgery. Making surgery a teaching moment rather than a traumatic event can be a huge asset for a child.

It may help to go through some of the answers to the above questions with your child as well as the relaxation techniques and logistics below. Guided imagery and hypnosis have both been found helpful in decreasing pain and anxiety in children (and adults) before and after surgery. There are many such resources available to parents and children, especially in children’s hospitals, to benefit children’s emotional health.

Here are five main areas where you can take positive steps to prepare yourself for surgery.

Logistics — choosing your surgeon, operative facility, and time of surgery

If your surgery is elective or does not need to be performed within the next 24 hours, you have the opportunity to choose your surgeon and your hospital. You may be limited by your insurance plan, but even here there are usually a couple of options. Doing this research — asking around, interviewing doctors and getting second opinions — may seem overwhelming, especially if you’re not feeling well, but from what you learn, I can almost guarantee you’ll be glad you did. It’s a bit like having to go back to learn a subject you never wanted to take, but it can be an excellent way to put your friends and family to use. Ask them to collect information and summarize it for you.

Your primary care provider may refer you to a particular surgeon or specialist for consultation. But if you don’t hit it off with that person for whatever reason, you won’t be insulting either your PCP or the surgeon by seeking another opinion. You may be worried about offending someone, but remember that in the long run, you come first.

Here are some considerations when deciding on a surgical facility or hospital. For one, studies show that people have better outcomes if the volume of cases for that particular procedure is high at that facility. (This makes sense, when you think about it: the more often the surgical staff and their support teams perform a technique, the more expertise they develop.) Getting access to this information may be tricky, but such numbers are public information, and hospital PR offices should be able to provide it.

Sometimes one assumes that a university center or teaching hospital would be superior to a community hospital, but it doesn’t always work that way. For various reasons, older institutions may not be early adaptors, and smaller, more private facilities can have more experience and volume. Naturally it would be nice if we all had a doctor in the family, but usually we can find out the necessary information ourselves if we try hard enough.

A woman can also request a list of dates and times available for her surgery, so she can schedule it at the convenience of her family or work. While there is rarely a perfect time to have surgery, there is often a better time than another. I had one patient who consulted her astrologer for her surgery time. While you probably don’t need a wedding planner to orchestrate your surgery, there are certain things that you can do in advance to make everything go more smoothly.

Readying your body for surgery

First you can get your body in shape — the healthier it is going in, the faster it can heal. Now if you only have a month and are really out of shape this may not be realistic, but it doesn’t hurt to increase your workouts or yoga sessions or stretches before surgery.

This can also be a good time to evaluate your diet. Eating more protein and fiber, and less processed junk food, will provide your cells with the building blocks of wound healing. Some women have used their surgery as an opportunity to start afresh, with a healthy cleanse and detox prior to surgery to create their new selves. Cleansing your system prior to surgery can also help to metabolize anesthesia drugs, but more about that later.

I want to emphasize that it’s critical to disclose to your healthcare team information about your general medical condition and all the medications and supplements you’ve been taking. You should also have had a physical within the previous six months to rule out any underlying conditions or complications. Any allergies, and in particular your prior experiences with anesthesia, should always be provided as well.

Medications and supplements before surgery

There is a litany of medications and supplements to not take before surgery. The most essential are those that could cause unnecessary bleeding, such as aspirin-containing products, NSAID’s (non-steroidal anti-inflammatory drugs), and extra vitamin E, garlic, ginseng, or Ginkgo, which should be discontinued a week or so before surgery. Depending on the type of surgery, some surgeons will ask you to stop these products two to three weeks in advance.

If you are taking the blood thinner warfarin (Coumadin), you will usually be advised to discontinue this within a certain time before surgery. Your blood counts will be closely monitored and special arrangements made to ensure that your blood won’t clot and cause a problem.

For patients with arthritis or chronic pain, as long as the case is a small biopsy and the bleeding can be controlled, I would allow medications such as Advil and Aleve, up until a couple of days before surgery if they are needed for pain.

Some herbs, such as kava kava and valerian root, could potentially interfere with anesthesia, and these too should be stopped at least a week before surgery. And of course, this may be a good time to consider stopping smoking. Many plastic surgeons require their patients to stop a month before surgery. Preparing for surgery does not mean increasing one’s alcohol intake, either. This too can adversely affect the liver and its ability to metabolize anesthesia drugs.

There are, on the other hand, some supplements that are recommended prior to surgery because they have been shown to increase wound healing, build new collagen, and decrease inflammation and swelling. These should be continued postoperatively for another couple of weeks.

Supplements recommended before and after surgery

Vitamin A: 10,000–25,000 IU per day, beginning a week before surgery (unless you are pregnant).
Vitamin C: 500–1000 mg per day, beginning at least a week before surgery.
Bromelain: 500–1000 mg per day, beginning a week before surgery.
Omega-3 fatty acids: Presurgical use is controversial because some studies have shown them to be very beneficial in increasing immune function, while others indicate they may increase bleeding.
Arnica montana: A homeopathic preparation to help with bruising or soreness that can be taken in pellet or tincture form beneath the tongue, right before surgery and again once you’re awake in the recovery room.

Keep in mind that all of this should be discussed in detail with your surgeon. Many pre-op facilities have become quite rigid about certain medications and supplements, but the ultimate decision is the surgeon’s. The pre-op nurses should also go over with you which medications, if you are taking any, should be continued on even the day of surgery. Our multivitamin/mineral is a perfect option to help women prepare, and we recommend taking it right up until the day before surgery.

Mind-body preparation for surgery

Once you have made up your mind about having surgery, you are halfway to a good outcome. For an even better outcome, one thing we know is that a little bit of mind preparation goes a long way. In a recently published (August 2007), well-controlled study of 200 women undergoing breast surgery, researchers reported that providing just 15 minutes of hypnosis an hour before surgery significantly reduced patients’ need for intraoperative anesthesia and analgesia. Plus, the women in the hypnosis group also reported less postsurgical pain and other side effects. Moreover, their surgery required less time to complete, reducing institutional costs by over $700 per patient.

This study, by showing how hypnotic instruction alters the perception of pain and anxiety in the brain via dopamine pathways, helps verify the value of hypnotherapy in surgery. As one behavioral scientist at Stanford put it in his editorial on the subject, “The strain in pain lies mainly in the brain.”

This next section explores some mind-body tools to help you relax before the surgery, during the surgery, and afterwards. In her book, Prepare for Surgery, Heal Faster, Peggy outlines a five-point plan, which I will only summarize here. If you are going to have surgery, I would encourage you to get the book and tape or CD for yourself. And whether you buy another copy or pass yours along afterward, this set makes a great get-well gift prior to surgery for a friend or loved one.

Step 1. The first step involves learning how to relax and get around your fears and terrors about surgery. Peggy teaches a deep relaxation skill to be practiced before surgery and afterward (which can be useful throughout life). As many of you know already, deep relaxation may bring up some unexpected emotions. All of us carry around some unresolved tension and stress, and this experience is a good one for letting that all come out. Studies have also shown that deep relaxation can improve your immune system. This can make a huge difference in recovery from surgery. Peggy recommends listening to her audio recording (or there are others) for 30 minutes each day for two weeks before surgery for optimal benefit.

Step 2. The second step adds to relaxation by envisioning your healing. Imagining yourself feeling good, comfortable and happy after the operation will go a long way toward creating that very result. Her studies also show that seeing yourself surrounded by a healing light, sound, or a sense of deep peace can be very powerful. Again, to repeat this visualization every day with the relaxation exercises is the most beneficial. You can even bring the tapes, CD, or now your iPod into the OR, and play them during your procedure.

Step 3. In the third step, you are encouraged to ask for help. You can create a network of friends, relatives, or co-workers to be your team, assigning them particular duties or times to help you — before surgery, during, or afterward — to visit you, assist at home, take care of the kids, or whatever else will need doing. One interesting request that many of my patients report as helpful is to have your team envision you on a pink healing cloud the day of your surgery, and to send more such clouds to you throughout the healing process.

Step 4. The next step involves filling out a form in the book that has a list of healing statements to be spoken by the surgeon or anesthesiologist before and after your surgery. The first is: Following this operation, you will feel comfortable and you will heal very well. The next are open-ended statements to be completed by the patient, including: Following this operation, you will be hungry for…. I was always curious about what my patients chose, and the overwhelming answer was some sort of ice cream! I always enjoyed reading the affirmations for my patients, though in the beginning it did seem a little strange to be repeating something five times. I got used to it because it did seem to work!

Step 5. The final step in Peggy’s book is to meet with your anesthesiologist prior to surgery. This is often the most difficult step because it is simply difficult to arrange. Pre-op clinics are “manned” by doctors who will most likely not be the particular anesthesiologist doing your case. But you can tell them that you are preparing for your surgery, and they should note that on your chart. This is the time to review your past experiences with anesthesia (if you have had them), and how you would like to feel afterward.

All of the steps above involve preparing yourself psychologically for surgery, and there are many additional ways to calm and relax yourself. One of my patients decided to get her first massage ever before her surgery. She loved it, and gets them regularly now. If you know someone who practices acupuncture, Reiki, or therapeutic touch, this may be the perfect time to set up an appointment with that person. Some post-op areas have nurses qualified to provide these services.

If you are still feeling terrified of having surgery after going through the five steps, and can’t relax or get peaceful about it, Peggy Huddleston also offers phone consults. Alternatively, she may be able to recommend someone locally who has undergone her training.

The big day — going in to go under

Most of this article focuses on techniques you can use to prepare yourself for a smooth surgery and rapid recovery period. With effective preparation, you will most likely be ready and feeling positive about a successful surgery on the day you go in, as well as when you return home to recover.

For a glimpse at what goes on just before surgery in the operative suite, from pre-op meds and anesthesia to presurgery protocol to protect patient safety, see what to expect on the day of surgery.

Afterwards — coming home from surgery

A very important, but sometimes forgotten, step is for you to discuss your personal postoperative desires prior to surgery with your surgeon. Let him or her know your preferences, if you have the choice, regarding when you would like to go home, as well as sharing your prior experiences (if any) with pain medications, along with the details of your home situation for post-op care.

Be sure to have your questions answered about what things you can and cannot do after surgery. While most are common sense, every surgeon seems to have her own “rules” about when to shower or bathe, when the bandages come off, which exercises are okay, when you can drive, how much weight is safe for you to lift and when, and how long it will be before you return to see her again. Ask about when and how you will learn your pathology results too, if this is an issue for you.

Post-op (or incisional) pain is real. Many surgeons use a local anesthetic to dampen the soreness for a few hours, and applying ice to most incisions will also decrease the initial pain and swelling. Being psychologically prepared for this pain can help decrease it, but keeping levels down with pain-relieving medication is also beneficial, particularly in the first day or two after surgery.

Following some surgeries, alternating low-level analgesics, like Tylenol and Motrin, is enough. For others, a few days to a week of a stronger pain-relieving drug may be necessary. If using these medications strictly short-term for pain, they do not become addictive. It’s certainly wise, however, if you have any addictive tendencies, to discuss with your doctor ways to circumvent problems beforehand. Keep in mind as well that narcotics will slow down the digestive tract, and it is strongly encouraged to use fiber or a laxative while taking them. One of my patients’ favorites is Smooth-Move Tea. While during the first 24–48 hours one can take the painkillers on a regular, every-4-to-6-hours schedule, most people can stop and reevaluate their use after this time, and perhaps use them only at night for sleeping, with Tylenol during the day.

Some nurses are better at assessing pain than others. But the majority are wonderful and have a lot of experience under their belts. If you are hospitalized, you may have a PCA (patient controlled analgesia) pump, which allows you to monitor your own pain. These pumps are nice, in that the patient does not have to rely on a nurse for an injection or pill, but again, narcotics can cause you to feel sick to your stomach and not your best self.

It is also important to realize that you may not really feel like yourself again physically, or get your old energy level back, for several weeks. Expect to have — and enjoy — a nap (or a couple of them) for the next month or so, depending on your type of surgery. As a surgeon, I used to blame this fatigue on the anesthesia, but in all honesty it is probably a combination of the drugs and the body repairing itself from surgical incisions.

Your scar will take some time to heal. Sutures (rare these days) or staples are usually removed in a week to ten days. At this time you can start putting some vitamin A and D or E creams on them to decrease the redness or bumps. Some scarring (keloiding) can occur for genetic reasons. In certain areas, like the central chest, incisions are known not to heal as well. In other places, like around the nipple, incisions fade into the skin remarkably well. Time seems to heal most incisions quite well on their own.

Some people come to value their scars. After experiencing the often life-changing event of surgery, many of my patients have been able to reflect on their lives while healing and forgive themselves or loved ones for past mistakes. For them, forgiveness is written in their scars.

Scars or not, it’s very important to give your body all the tools it needs to heal properly after surgery. Acupuncture can be particularly helpful in restoring or returning a body to balance after a procedure. We’ve also found that eating a balanced diet of healthy proteins and fats, as well as lots of vegetables and fruits, which are loaded with natural antioxidants and anti-inflammatories, is a great way to help your body heal. Because this is not always easy after surgery, many women have found a nutritional supplement, like the one offered in our Personal Program, helpful to fill in any nutritional gaps and help your body on the road to recovery.

The best way to heal from surgery

At Women to Women, we always say greater knowledge leads to greater wellness. It’s extremely important for you to be sure surgery is the best decision for your individual situation. And once that decision is made, the more you know, the better equipped you’ll be to get through it and heal successfully.

Staying positive through this time is what I’ve found to be the best preparation for surgery and the best tool for healing quickly afterwards. Be gentle with yourself, and use the suggestions above to keep your mind and body healthy and strong. And remember, the tools we acquire in this process not only help us through what could be a difficult, very stressful time, but are valuable skills we can apply to all aspects of our lives.

Our Personal Program is a great option
We’ve had great success with our Personal Program in helping women achieve the natural hormonal balance that’s vital to symptom relief and optimal health. For over 21 years we’ve used this approach to help women at our clinic. And now we can help you with our convenient, at-home version.

We invite you to feel better; go to Choose the plan that works for you.
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