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 These directions need a more commonsense approach to rest, diet and
pain, Dr. J. David Richardson of the University of Louisville School
of Medicine in Kentucky writes in the Journal of the American
College of Surgeons.
"We give patients these catchphrases about how they'll feel better,
but that's not always true," Richardson told Reuters Health.
After 40 years of practice as a surgeon, and having undergone 40
operations himself, Richardson sees the need for practical advice,
especially as minimally invasive procedures become more popular, and
patients are discharged from the hospital quickly to recover at
home.
"For a long time, surgeons have been happy with surgical outcomes as
long as a big issue didn't come up, such as an infection," he said
in a phone interview. "Patients are concerned about the small
aspects of recovery, and we should be attuned to that."
One of the most important tenets of recovery, he writes in his
commentary, is that it's not a progressive linear process. The
advice that "You will feel better every day" is not true, for
example, and it often makes patients uneasy when they don't recover
as they believe they should. Instead, patients tend to have a
"stuttering progression to wellness," Richardson writes, which means
three steps forward and two steps back. When patients are aware of
this, they're less apprehensive and less discouraged when they have
a "bad day." Rather than measuring progress daily, he advises
tracking progress from one Friday to the next.
"Some days just don't go that well, which is the way the body
functions," he told Reuters Health. "Patients need to know that what
they're going through is normal."
Richardson also disagrees with the advice to recovering patients
about activities, "You can do what you feel like doing." Although it
sounds practical, this often backfires or discourages patients as
they go through the healing process. Some feel great after waking up
but then have fatigue or adverse reactions later in the day. Those
who try to drive, shop or return to work too quickly may "hit a
wall," he notes.
The body needs a physical recovery as much as a mental recovery, he
notes, so he often tells patients to be cautious about performing
mental tasks after a significant operation. Avoid "trying to work in
a fog" or making important decisions in early post-operative stages,
Richardson said.
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"Earlier in my career, patients were in the hospital for days and
would come in the night before surgery to prepare and discuss more
details," he said. "There's a time pressure difference now and an
enormous push to get people out of the hospital."
Diet is another aspect that is often misrepresented, and the advice
to "Eat what you feel like eating" can be too vague. Instead, a
slower progression to a full normal diet could prevent nausea,
vomiting, bloating, constipation and other gastrointestinal issues
that occur during the early recovery phase. This is particularly
true when patients are taking new pain medications, Richardson
added.
On a related note, pain management can also be misleading, he said.
The opioid crisis speaks to the dangers of over-prescribing pain
drugs, and points to the fact that pain is an individual response.
Some patients require fewer doses, and others need heavy doses, but
prescriptions are often given "by the book" where one size fits all.
A more nuanced, individualized approach would help, taking into
account previous pain medication use, psychotropic medication use
and previous operation recovery experience.
"Patients have little information about recovery in part because
patients' experiences are unique depending on their operation,
fitness and psychology," said Richard Kwasnicki of Imperial College
London in the UK, who wasn't involved in the commentary.
Kwasnicki studies how wearable sensors can help patients during
post-operative care through reassurance and motivation to complete
their rehabilitation goals.
"When recovery is slow, it is often difficult to see the small
incremental improvements," he said in an email. "There may also be
setbacks, which are viewed more substantially by patients than
similar gains."
SOURCE: https://bit.ly/2VeNIpx Journal of the American College of
Surgeons, online December 7, 2018.
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