Podiatry Weekly is owned and operated by Marat Kazak DPM. All information presented here is for educational purposes only and is not meant to be taken or used as medical advice. Always consult with your doctor before starting or changing your medical therapy or exercise routine. Podiatry Weekly is a participant in the Amazon Services LLC Associates Program and other affiliate programs. We are compensated for referring traffic and business to these companies. We may earn money or products from the companies mentioned in this post.
In previous blog post, I discussed physical aspects of preparing for surgery. This post will concentrate on psychological preparation.
How to prepare your mind for foot and and ankle surgery?
The most important thing you can do to mentally prepare for surgery is learn as much as possible about the details of the surgical procedure and exact steps to follow to achieve successful outcome.
Of course, I am not talking about the nitty-gritty of every instrument that is going to be used during surgery. Lets dive in and learn about this topic.
Instead, concentrate on big facts and ask the following questions to get a clear picture of what to expect.
1. What to bring on the day of surgery?
2. Are there alternatives to the proposed procedure?
3. Why is proposed procedure the best for your problem?
4. Who should you bring on the day of surgery?
5. What is the morning of surgery like?
6. What is the best time of the day to do this surgery?
7. How long is the surgical procedure?
8. What type of anesthesia will you be receiving?
9. What kind of non-weight bearing will be involved?
10. How will you be progressed to full weight-bearing?
11. How will your pain be controlled?
12. How can you prepare for surgery in terms of physical fitness optimization?
13. How can you prepare for surgery in terms of nutritional optimization?
14. Will any type of wound care be required after surgery?
15. How long are you expected not to wet the incision site/not to bathe?
16. What are potential complications associated with your surgery?
17. How can the chance of these complications be diminished/controlled for?
18. If these complications are encountered, how will they be addressed?
19. How much time off work/school should you expect to spend?
20. How many of these surgeries has your surgeon done?
21. What is the exact cost of this surgery including cost of hospital/surgical center and anesthesiologist? Will these be covered by your insurance completely?
22. Should you ask for a second opinion?
23. Is the condition being treated likely to reoccur at some point after surgery?
As you can see, there is a lot of information to obtain and enough time must be allocated to ask these questions and to get thorough answers.
Your surgeon will likely concentrate on volunteering answers to some of these questions (the ones he or she finds essential for successful outcome). However, the surgeon will not be able to cover all grounds comprehensively without you becoming proactive. Therefore, it is essential that you come prepared for the sake of your peace of mind and to allow the surgeon to be thorough. Your surgeon should appreciate that you are asking these questions.
They should not find these questions offensive, annoying, or frustrating. If they do, it is time to start looking for a different surgeon. Success in surgery requires a team effort, if your surgeon is not interested in supporting you before the surgery, how can you expect something better after surgery.
The same is true for your side of the bargain. Your surgeon trusts you to follow outlined recommendations on wound care, pain management, rehab and offloading. If you are unwilling or unable to follow through, it would not be fair of that surgeon to allow you to undergo surgery.
But you may wonder how knowing the answer to all these questions may help you?
The answer is that it will decrease your stress level and should provide you with tools to prepare for what may be a life changing procedure.
Poorly addressed psychological stress and anxiety do not represent just a negative emotion but, in fact, lead to physiological body changes that delay healing!
In fact, psychological stress leads to release of hormones like oxytocin, cortisol, epinephrine and encourages unhealthy behaviors that further compromise healing.
This figure provides for a nice summary of what happens when a person experiences stress:
The impact of psychological stress on wound healing: methods and mechanisms.
Gouin JP, Kiecolt-Glaser JK.
Immunol Allergy Clin North Am. 2011 Feb;31(1):81-93. doi: 10.1016/j.iac.2010.09.010. Review.
Oxytocin and vasopressin hormones
These two hormones are important in social bonding and are released during positive social interactions. There are scientific studies that show a connection between higher levels of these hormones as correlated with faster wound healing by creating a signal that decreases release of proinflammatory molecules.
This reinforces the fact that people who have strong network of friends or supportive family assist them through surgical preparation and recovery tend to heal faster and with less complications than those who feel lonely and isolated.
Cortisol
This what is known as the official stress hormone. Excessive levels of this hormone in the body is known to correlate with delayed wound healing by reducing production of matrix metalloproteinases. These molecules are responsible for wound remodeling and low levels would delay the repair process. Uncontrolled stress can be produced by feeling out of control, feeling of depression, frustration, loneliness, out of control pain, etc. All of these are common with surgical procedures in individuals with poor social support and those who did not emotionally prepare for what is required after surgery.
Antimicrobial peptides
Stress also increases susceptibility to bacterial infection of the wounds because it reduces production of antimicrobial peptides. This can be caused by sleep deprivation which is common with poor post-operative pain control. Other factors that may affect sleep are bulky offloading devices like casts, splints, or boots or requirement to keep the limb elevated on multiple pillows. If you are a stomach or a side sleeper, foot surgery and wear of bulky offloading device will frequently require you to sleep on your back. This will likely feel unnatural and uncomfortable resulting in poor sleep quality and duration, thus leading to stress.
Catecholamines
This is a group of proinflammatory molecules with epinephrine being the most well-known. This is a fight-or-flight hormone which is released in response to stress. Though it is very important in danger evasion, it is also detrimental in wound healing. Epinephrine release leads to low oxygen level in the wound and promotes increase of inflammatory molecules in the wound base.
This out of control inflammation and low oxygen levels prolong healing. Obviously, it is natural to feel fear in response to surgery. Unfortunately, out of control stress related to fear will have an impact on surgical wound healing. Therefore, it is essential to keep the fear and stress under control (it is likely impossible to completely eliminate it) to allow the body to heal without significant complications.
Behaviors that lead to complications
It is very important to discuss any history, current or past, of unhealthy behaviors that can be brought about or worsened by stress with your surgeon. This may include eating disorders, smoking, alcohol consumption, any nonprescription drug use, or addictions.
The stress of surgery and recovery may act as tipping point to drive you into these behaviors if you are in recovery or can worsen these behaviors. The worsening occurs as a result of using these behaviors to reduce the stress. Though seeking stress reduction is absolutely legitimate, it must be done in health promoting way.
If these are discussed openly prior to surgery, appropriate resources and techniques can be utilized to reduce the chance of inappropriate stress reduction outlets use.
There are several concrete preparatory interventions you can utilize to reduce anxiety, control overall pain, reduce the length and number of pain medications used, and to achieve a positive surgical outcome.
1. Providing information
This was thoroughly discussed previously and basically involves comprehensive discussion of preprocedural, procedural and post procedural details. This includes a conversation about pain management, activity modification and restriction, length of recovery, expected body changes, and anesthesia related facts.
Having this type of information allows you, the patient, to have a certain degree of control in a situation where you must put complete trust into people who are basically foreign to you. This reduces anxiety, reduces stress related hormones in blood stream, reduces risk of infection, and promotes healing.
2. Relaxation
This technique involves learning and employing muscle relaxation and mediation principles to reduce perioperative pain and complications. Targeted muscle relaxation allows reduction in movement around incision site by learning to avoid muscular contraction around the incision.
This, of course, involves the use of other muscle groups which are used to compensate for lack of motion in area of the body that just had surgery. Excessive muscular contracture around incision site does not only cause pain but also can lead to painful cramps, increase in inflammation, wound dehiscence, increased drainage, and prolonged recovery.
3. Strategies for cognitive coping
These involve several techniques and approaches directed at improving attitudes and beliefs about surgery process. These can include positive self-talk, employing motivational audio or video, concentrating on positive elements of surgical experience, restructuring your point of view on current situation.
Most of these strategies force your mind to concentrate on the positive aspects of life or start an activity that brings pleasure/excitement/fulfillment.
This allows you to combat ruminating on the pain and temporary, yet powerful, discomfort associated with surgical process. I found this article to be to the point on the strategies with a nice list of what you can engage in to begin feeling better.
http://www.creativeresiliencecounseling.com/42-cognitive-coping-strategies/
In addition, mediation principles can be of help to redirect the mind away from thoughts of pain and towards the thoughts about recovery as a process. It is important to look at the big picture and review why you decided to proceed with surgery.
Looking towards the future improvement will make dealing with current situation much more manageable as you will be encouraged by improved upcoming level of fitness and decrease in pain.
4. Rehearsal
This technique is more common with children who are scheduled to undergo surgical procedures and involves the use of props to rehearse events that are going to happen. There has not been a large-scale study on its usefulness in adults as kids basically reenact the surgery with dolls.
This modality is unlikely to appeal to an adult patient. However, with virtual reality becoming more affordable and advanced, an immersive positive virtual experience of surgery may become more common to prepare both adults and children for what surgery may involve.
For the purposes of elective surgery, such an experience may dissuade you from undergoing surgery if you are not emotionally ready for it.
5. Social support and reassurance
This type of therapy engages your community (friends, family, doctors, nurses, etc) in the process of empathetic support and encouragement. Engaging listening and responding complemented by reassurance and physical/emotional support will help you deal with the temporary difficulties at every stage of surgical process.
This step does depend on you being open about your needs, frustrations and difficulties. If you do not have a close person to assist you through surgery, you should consider joining a support group of likeminded individuals going through similar life process.
At this time, this does not even have to involve travel and can be done online through resources like facebook.com, reddit.com, or quara.com
It is important to remember to keep your specific health information private and to share only as much as you are comfortable with a group of strangers online.
Overall, I believe that attending a physical meeting sponsored by an official organization like a hospital, or medical/surgical association will give you a better opportunity to interact and build long lasting positive relationships with like minded people. Encouragement through word and reading does not engage all sensory modalities.
Attending a physical meeting allows for tactile contact, eye contact, auditory contact, social network building, food sharing, etc.
This, in turn, provides for a more comprehensive rehabilitative experience.
In the next blog, I will discuss importance and tips of putting your house in order and obtaining proper rehab equipment as you prepare for surgery!
Please share this blog if you found it helpful and do one thing today to make it a better tomorrow!
Author bio:
My name is Dr. Marat Kazak.
I have been working as a professional Podiatrist serving Northern California community since 2014. My extensive medical and surgical knowledge combined with an ongoing curiosity to learn about the latest trends define my success in the field of foot, ankle and leg medical and surgical care.
The goal of this website is to give you the tools to better care for yourself, to dispel medical myths, and to empower you with information to save time and money! If you are looking for an answer on foot and ankle pain, this is the place to find it. If you do not see your topic of interest covered, please send me a message and I will do my best to discuss it thoroughly in my next upcoming post.
Visit this blog often to learn about latest developments, treatments, and approaches to healing and recovery!