Women’s health articles
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
Here are some basic questions to ask before you make the big decision to have surgery
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.
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
Here are five main areas where you can take positive steps to prepare yourself for
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
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
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
- 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
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
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 place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Related to this article:
Further reading on how to prepare for
Last Modified Date: 06/02/2011
Principal Author: Dixie Mills, MD, FACS