Surgical Preparation: Specific Details.

Recently we have been writing posts about preparing patients for surgery. Benefits can be mental, but our focus has been on learning mind-focused ways to improve patient’s physical reactions during and after surgery.

We found that many published studies indicate that outcomes are significantly improved in patients who were given presurgical training. For example, patients lose remarkably less blood if they are taught how to move the blood away from the spine during the surgery and then have it return to the spine to facilitate healing after surgery.

At this point, many readers may be thinking that there is no way for the mind to move blood around in the body. Patients who are being trained tend to feel that way too.

An important step is to explain how that can happen. Scientifically designed studies are normally kept very simple, but in clinical practice the methods may be more complex. A common method used in research is pointing out that our minds often trigger movement of blood. Remind the trainee that most people blush when they are embarrassed. We also move blood to our genitals by having erotic fantasies. You can direct your blood to your hands by relaxing, suggesting that your blood is flowing down your arm into your hands, and picturing the suggested flow. This is not at all remarkable, the “fight or flight” reaction includes moving blood away from the periphery of your body. Relaxation inhibits the “fight or flight” reaction, so it makes blood flow to the hands.

There is much more evidence that the mind can control supposedly “involuntary” bodily reactions, but for this post we want to describe Debbie’s experiences with preparing patients to deal with upcoming surgery. Like most clinicians, she uses methods that go far beyond the simple methods assessed in published studies.

In her words:

“As a therapist I had remarkable success in assisting some of my patients to prepare for surgery or other medical procedures.

In therapy sessions, I begin by having the patient talk about the surgery and what the aim or primary goal is particularly from their perspective. We explore any feelings or concerns that they have about the surgery. What is their relationship with the medical people including the surgeon? Have they had surgery in the past and how did it go? Were there any complications? Have there previously been any poor outcomes.

The potential benefits of preparing psychologically in advance of the surgery are explained. I cite examples from published literature and describe my own experiences with other patients to explain how beneficial preparation can be. If for example the patient does not trust the medical field or has had bad experiences, we work to come to some sort of peace with it, enough that this does not transfer to the present situation. If they have had bad outcomes from surgery we explore this together to see if there are differences in the present situation.

We talk about mentally shifting to a place where the patient can see the medical team as being there to help them achieve their objectives.

We discuss how getting to a place where they are trusting of the medical provider makes it possible for their body to cooperate with the surgeon and not fight against her/him. It is understandable that at some level the body will protest being cut into and it is best to get the surgeon and patient working together, helping the body to relax.

The patient  tries to find out as much as possible about the surgery and what the procedure consists of, including a description of the steps along the way.

The patient  learns some form of relaxation procedure and oftentimes  is provided an audio to practice at home. In the counseling sessions I use the same relaxation procedure and while the patient is relaxed begin to guide them in imagining the surgery and positive outcomes. I provide some of the “script” but also encourage them to offer input and improve it.

I re-emphasize that the surgeon is here to help the patient and cooperating with him/her is what is needed now. Usually they visualize the knife entering their body for a noble purpose and that the blood at the time moves away from the surgery site.

Surgical steps are reviewed and how particularly the patient, the surgeon and the patient’s body are cooperating. They visualize how the area of the body is being “corrected” and how wonderful it will be for the quality of their life and health afterwards.

They imagine the anesthesia wearing off in a pleasant manner. I suggest that, as the anesthesia wears off, they will soon want water and some food. We discuss their body eliminating in a normal way and the body vitals being such that they can soon go home.

Other images might include seeing loved ones arrive to take them home and how soon they see the anticipated surgical improvements. Any rehabilitation services can also be incorporated into the imagery exercise.

Typically, it is best  to have several weeks to prepare for the surgery but have seen benefit in just a few sessions.”

Notice that there are three main devices being used. They are relaxation, imagery and suggestion. This is a triad that can help get you through just about any difficult situation.

RELATED READINGS

For clinical techniques we recommend Stanley Fischer’s “Discovering the Power of Self Hypnosis : A New Approach for Enabling Change And Promoting Healing.” The book was published in 1991, so is likely to be out of print but you can probably get a good used one at Abebooks.com at a very low price.

For a very good review of research on the evidence that supports the efficacy of this kind of method for surgical preparation we recommend “Mind-Body Interventions for Surgery: Evidence and Exigency,”published in Advances in Mind-Body Medicine, volume 14, Number 3 in the Summer of 1998, Pages 165-234. You can probably get a copy at little or no cost from your library. Be sure to ask for an interlibrary loan. Reading the article will likely be a challenge unless you have background in scientific writing , including statistical methods.

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