Why, Why, Why? Please Tell Me Why!

Why? Short, simple question, but ultimately profound. Why this? Why that? Why? Why not?

Good things to ask, especially when embarking on the journey of preparing for surgery – or any other major life event for that matter.

But staying focused on surgery and healthCARE, as you go to doctors, they will inevitably give you opinions, recommendations and directions. Great. Listen and take notes, but also be sure to ask questions.

Question everything.

While doctors have been through special, even specialized, training, that doesn’t make them all the same or infallible. This is true about diagnosing and true about communciations. Some doctors are simply better than others. Asking questions is how you understand what is going on and get clear for yourself. It is your right and for your benefit.

So keep your power. Don’t give your power away by blindly doing what someone, a doctor, for example, says. Take responsibility for your experience and ask questions; learn why a doctor is making a certain recommendation. Find out why doing what doctors say is important and how it's going to impact your experience or recovery.

Remember, there are no small or stupid questions when it comes to your care, your health and your well-being. In the end, what matters is you and whether or not you feel comfortable and safe with a course of action. You should know everything about it, it's your body and your right.

  

Big and small "whys" can empower and enroll you.

Here are a few specific examples to get you thinking about questions and whys.

Be sure and tell your doctor everything (medicines, over-the-counter drugs, herbs, supplements and vitamins, even recreational drugs like marijuana, ecstasy, mushrooms, etc.) you’re taking before surgery. Okay, but why? 

Because it may be important to discontinue some medicines, herbs, supplements and vitamins prior to surgery. Things like over-the-counter aspirin, ibuprofen and naproxen, Alka-Seltzer^® products, Pepto-Bismol^®, the herb ginseng, vitamin E, non-steroidal anti-inflammatories and/or other agents can cause bleeding problems or other complications during or after surgery. For an optimal, safe outcome it’s best to disclose everything and follow your doctors directions on their use prior to and following surgery.

Don’t eat or drink the night before surgery. Ok, but why is that really important? 

Because if there is any food or liquid in your stomach during surgery, anesthesia can cause nausea and vomiting, which can aspirate to the lungs and cause serious complications, or even death in extreme cases. Thus, to be as cautious as possible, don’t eat or drink anything 10 – 12 hours prior to any surgery, or as directed by your anesthesiologist.

Stop smoking. Okay, but why? 

In short, because it can cause complications, delay healing and interfere with the actions of certain drugs. The most common complications related to smoking are (1) delayed or impaired wound and tissue healing, (2) greater scarring, (3) wound infection, (4) cardiopulmonary complications (smokers are at greater risk for requiring the ventilator for longer periods of time), and (5) possible interference with the actions of certain drugs. Not smoking will allow lungs to work better and which will in turn cause blood flow to improve, which keeps circulation moving, which sweeps debris away from the incision site, helping you to heal more quickly.

Be sure and get extra sleep. Okay, why? 

Because, among other benefits, the restorative growth hormone required for healing the body is only released when you hit level 4 sleep. This is just one reason why it’s important to sleep, and sleep well, prior to and following surgery or any other kind of illness or trauma.

 

Keep asking why until you are completely satisfied.

 
Remember, ask your doctor why he/she is making certain recommendations. Often doctors fail to communicate why what they say or recommend is so important, especially about "routine" recommendations like "don't eat or drink the night before surgery." This may be an awesome recommendation, but for me, knowing the “why” behind the “what” is really important! Among other things, knowing why enrolls me in following through on a doctors recommendation(s). Following directions is easy, but if I know “why” I’m doing something and how it’s affecting or impacting me, then I’m more motivated and invested and likelier to do it.

How do I get my questions answered?

Read my upcoming book. :D And, do your homework. Use the library, bookstore and

Internet. Get a 2nd opinion (I think this is very important). Keep looking, researching and asking questions until you feel absolutely satisfied with the answer, until you feel "yes" in every cell in your body. 

Don’t take mine or anyone else's word on anything; get clear for yourself. Get clear and comfortable with the answer(s) for you and your body. After all, this process is all about you.

Ask For Help: Create & Structure Support

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WE NEED EACH OTHER! Especially when facing challenging situations, like preparing for, going through and recovering from surgery.

Me with special friends!

My experience (and belief) is that as social beings we need each other. We are inter-connected and need each other to grow and to thrive in all we do and undertake in life.

How are we inter-connected? Pick one: family, friends, school, team, spiritual affiliation, community, business, neighborhood, city, state, country. You are a part of and connected to something; something that doesn’t work without each of the other parts. When supported, parts can move forward. When unsupported, nothing moves.

With any kind of healthcare situation, planned or emergent, it is important to intentionally build in support throughout the entire process, from the planing phase through recovery; asking for help and support is paramount for success.

Asking for help – support –

may be one of the single most important things we do for ourselves,

yet, we do it very infrequently.

Support is important no matter who we are or what we’re going through. Support is the thing that allows us to make solid, sound, well thought out decisions and to thrive. With busy, full lives, pushed and pulled by work, family, friends, the Internet, T.V., cell phones, smart phones and all the rest, sometimes we forget that we still need each other. There is no substitute for person-to-person contact and support. As independent and self-sufficient as we think we are (and may appear), we still need each other. Doing it all ourselves is a myth that we've come to believe.

Consider this, depending on the procedure you have, you may be unable to perform even simple, basic, typical daily tasks or routines, especially simple household chores, that require bending, lifting, twisting, or standing for an extended period of time. Now is the time to ask for help and support. Intentionally - strategically - set the foundation and create structure from which will can be successful. 

Sometimes we don’t ask for help because we don’t know what to ask for and sometimes we don’t ask for help because we are afraid to ask. When faced with the need to ask for help, I’ve learned to ask myself, “What’s the worst thing that could happen?” The answer is always the same, “nothing”, which is what will happen if I never ask. The great possibility, however, is that if I ask, I will get what I ask for, like help and support during a time I need it.

What does support look like? Feel like? Include?

Support has many faces. For example, I live in Salt Lake City, Utah and my mother and

Me 'n' Bert with Ann & Rocky! Thanks Ann!

father both live in Southern California. After my head injury I needed a great deal more support and structure than I had living alone in Utah, so I had to move back to California where first I lived with my brother and then a friend. In this case, support looked like living with someone who could assist me with some daily activities and encourage me as I healed - it was a scary time.

Many years earlier, when I had reconstructive knee surgery and had been completely unprepared and caught off guard with the healing and recovery process, support looked like my father getting on a plane and flying from California to Utah

Thanks dad!

and staying with me in my apartment for close to a month doing all the shopping, cookingand cleaning, including ferrying me back and forth to physical therapy and doctor appointments, all while sleeping on my futon. Thanks dad! I don’t know what I’d have done without you.

For my back surgery a couple of years ago I was more prepared and asked my mother – before I had surgery – if she would stay with me after my surgery. She accepted and in addition to staying with me following surgery, she became my greatest advocate before surgery, going to doctors appointments with me and patiently listening to me when I would have the occasional meltdown. And how grateful I

Thanks mom!

was after surgery for her patience as she checked my surgical site, helped me with ice packs, did all the cooking, errands, laundry, getting the mail, feeding and walking Bert the dog, all while I rested and healed, so I could rest and heal.

I have also had the opportunity to view recovery and support from the vantage point of a caregiver. On one assignment as a hired caregiver, I provided support to a 65-year old woman, who was recovering from lumbar spinal fusion surgery. The hospital discharge instructions from the surgeon were: 
(1) that she should lay flat on her back (knees up to take stress off the lower back) and rest so that the fusion process could take place, 
(2) to follow up in the surgeons the office in two weeks to have the surgical staples removed; and 
(3) to then follow up again in the office in six weeks to see how the fusion was progressing. 

Since following her 10-day hospital stay, her daughter and son-in-law, who lived with her, had to be out of town for several weeks, I was hired to live-in, check her incision, assist her in being comfortable, taking medications on schedule, prepare meals, do shopping and errands, manage the home health nursing aids that came to check her temperature, blood pressure and help her shower, clean the house, do laundry and care for, feed and clean up after her cats. During this period I was also her sounding board and voice when necessary. Going from a busy, strong, independent woman to having to lay flat on her back for several weeks was a big challenge for her, but having support allowed her to let go of the day-to-day and simply rest and focus on healing.

So, ask for help as you prepare for surgery. 

Reach out, call family members and friends and 

start laying the foundation for your process, for your success.

When asking others for help and support, I learned that seemingly large, overwhelming-feeling projects can be easier to manage and accomplish when broken down into smaller, one-step tasks. Large projects broken down into manageable tasks can easily be assigned to a family member, friend or other support person for help. Single tasks with clear objectives are quick and easy for people to understand and carry out correctly.

Your list of tasks will be particularly handy when someone says “Let me know if you need anything.” Ahhh, now you know how to take them up on their generous offer. Keep a list handy and ask for specific help. Being specific also allows for not overwhelming any one person with too much. A neighbor’s teenager can easily drag the garbage to the street and back once a week!

Here are some examples:

• “I need a ride each Tuesday at 10:00A to physical therapy (or to radiation, or, or …)"
• “My garbage cans need to be taken to the curb each Monday night and then returned to the garage Tuesday afternoon.” 
• A friend can easily grab you some groceries when they are at the store if you tell them what you need, “A dozen eggs, a pint of low-fat cottage cheese, two bananas and a yellow onion.”

What I know now is that life for me could have been easier 

if I’d asked for help and support.

Start creating a list of things you could use help and support with. A great tool to begin with is getting and using a simple, dedicated, spiral notebook (or even phone app) to track everything.

As you prepare it's helpful to write things down as you think of them. Notes are crucial for me! I keep refining my system for taking and keeping notes. Right now I use Evernote on my computer and the Calendar and Reminders features on my iPhone.

Arrange for help and support BEFORE surgery.

The time before surgery can be stressful, overwhelming and scary. Preparing ahead of time with a family member or friend can ease any feelings of burden and eliminate feelings of having to do it all alone. Sometimes even the simplest of tasks can feel overwhelming and like too much. These are normal feelings and they are indicators that it is time to ask for help.

Recruit and enroll your spouse, parent(s), siblings, relatives, friends, neighbors and co-workers to help and support you before and after surgery – for as long as you need it! My experience has been that generally, people want to help, but usually don’t know how, or what to do, so asking them for specific help and giving them specific tasks is really helpful.

Below are suggestions of tasks and projects that friends and family can assist you with prior to surgery. This list may look overwhelming, but hang in there, it’s broken into small, easy to accomplish tasks. These are just suggestions, so keep breathing, read on and see if it resonates for you. There are infinite ways to slice a pie, this is just one. 

Ask for help before surgery with:

• Brainstorming things that need to get accomplished prior to surgery.
• Organizing your thoughts, priorities and “to do’s.”
• Creating lists of things you’d like to remember, make notes of, get done, ask your doctor about, etc.
• Organizing your home – bedroom, bathroom, kitchen, living room – for safety, ease and mobility. (See Chapter 3 for lists of ideas on preparing and organizing everything from medical files to your living space.)
• Setting up a phone tree so that with one phone call your family and friends can get updated on your condition, or are ready in an instant in the event you need something right away.
• Setting up support and structure following the surgery. 
• Grocery shopping and food preparation.
• Mundane errands. Everything’s always funner and easier with a friend. 
• Going to doctor’s visits.
• Pre-arrange rides to and from the surgical center or hospital from a reliable adult. Patients must have a ride from the hospital/surgical center and will not be permitted to drive themselves. Driving yourself after any kind of anesthesia – or while on pain medication – is unsafe (and against the law) as anesthesia and pain medication can impair your ability to focus, make decisions, react or respond in the event of an emergency.
       Note: Reliable is important. I asked a boyfriend to pick me up after knee surgery once and he “forgot.” (Yes, super lame :O((.) Luckily, my friend Lisa was around and happily came and got me and stayed the night to make sure I was ok. “Note to self: ‘Reliable’, very important!”
• Pre-arrange rides physical therapy, or other appointments.
       Note: Following surgery, patients are often restricted from driving for potentially extended periods of time. This is especially true for patients who have had abdominal or thoracic surgery. Check with your doctor regarding possible driving restrictions and plan accordingly. (See pages 33–34 for more about driving after surgery.)
• Ask a family member or friend to stay with you for at least the first 24 hours following surgery. This is an IMPORTANT SAFTEY precaution, in the event of an unforeseen complication or emergency. This person is there “just in case” cause complications don’t happen on a schedule.
       If possible ask that person to stay with you longer than 24 hours. Best case scenario: someone is willing to stay with you for as long as it takes, which could look like someone spending the night in your guest room for a week or longer depending on the procedure you’ve had performed and how you are feeling.
       Note: Oral surgery (i.e., having a tooth or teeth pulled, etc.) and cataract surgery count as surgery! They are surgery and they require rides to and from and someone be with you for at least 24 full hours following the procedure. I confess that even my own mother needed a reminder on this one. She recently had cataract surgery and didn’t bother calling anyone to stay with her until the morning of. Oh mom.
       If it isn’t possible for someone to stay longer than 24 hours, then arrange to have someone drop by on a regular schedule to check on you and handle any little tasks you may need assistance with.
       For example, depending on the procedure and projected recovery, it could look like someone stopping by every day or every other day for 1–2 hours to straighten and tidy, pick things up off the floor, do some food preparation, assist with a seated shower, wash and blow-dry your hair, move heavy objects, take out the trash, change the cat litter box, do a load of laundry, get the mail, etc.     Create this schedule ahead of time with a reliable family member, friend or combination thereof.

Arranging for help AFTER surgery is equally important.

After surgery you may require more assistance than usual. That’s normal. Planning for extra help and support after surgery is smart. Too much help is a better problem to have than too little. Plan ahead.

Here are some examples of where physical support comes in handy:

• Taking or applying medications. For example, my friend’s mother is blind in one eye and required surgery on her good eye. Following surgery she needed to put an ointment in the surgical eye three times a day, but how do you do that – apply ointment into a “good”, but injured eye – when the other eye is blind? It requires help.
• Getting or adjusting ice or pillows for comfort.
• Getting in or out of bed or a chair.
• Walking up or down stairs, even with the use of a supportive rail and/or cane.
• Getting to the toilet including sitting down on to the toilet and/or getting up off the toilet.
• Bending or reaching to get a roll of toilet paper out of a low or high cupboard.
• Showering or bathing.
• Bending over the bathroom sink to brush your teeth and rinse.
• Placing items in or taking items out of the oven, refrigerator, or dishwasher.
• Picking up groceries AND putting them away.
• Getting prescriptions refilled.
• Preparing meals AND washing, drying and putting away pots, pans and dishes.
• Picking something up off the floor.
• Getting the mail.
• Taking out the trash.
• Taking trashcans out to the curb on trash day.
• Helping with children – taking/picking them up from school, etc.
• Watering plants, which means lifting and carrying watering cans, and bending down or reaching up to water plants.
• Doing laundry, which includes: bending and lifting laundry from the laundry basket into the washer, lifting heavy detergent bottles, then lifting wet laundry into the dryer, then bending to get clothes out of the dryer. Laundry also entails standing for long periods of time folding clean clothes and carrying stacks of clothes to be putting away, which can again require bending or reaching.
• Housekeeping and chores. Regular household tasks require standing, bending, lifting and even twisting. These may be contra-indicated activities for a while.
• Pet care. Feeding, changing water, walking, cleaning up after them.  If it’s a dog(s), letting them in or out of the house. It might be important to implement some pet management too. Pets that normally jump on the bed can be a problem (startling someone resting or landing on an incision – ouch). Pets that have a tendency to jump up can cause you to loose your balance and possibly fall.
• Rides to/from work when you’re ready to return to work.

It’s important to know who can help when. Some people can only help on the weekends while others can help during the week. For example, I sometimes work nights, so am available and flexible during the day. Other friends work during regular business hours and are only available in the evenings or on weekends. Create a reference list or schedule of available friends you can call and their availability. This is a handy list to have as a reminder.

As you prep, better too much help than too little. It’s easier to send someone home, than to feel anxious because something is falling through the cracks.

Stay tuned for information on my book release announcement.  ;0))

In the meantime,  

Remember, YOU CAN TOTALLY DO THIS!

 

Get An Advocate! WE NEED EACH OTHER!

Whether elective or emergent, going through surgery is too much to do alone, even for the most capable, independent, strong individual.   

Making difficult decisions, going to doctors visits and organizing your personal and work schedule, can be very overwhelming, especially if you are trying to do it by yourself.  

This is the time to break it down to smaller steps... 

 

The first step, start by (1) accepting your situation and (2) recognizing that you will need help and support. (For other steps, sign up for blog updates. :0)

This is the time to begin creating your team.

Start by assigning yourself an advocate.  

An advocate is:

• Someone to help you navigate the process of preparing for and recovering from surgery. 
• Your sounding board throughout the surgical process; someone to bounce ideas, concerns and fears off.
• Someone you trust to be your extra set of eyes and ears and, when you can't speak, someone to be your voice.

Why do I need an advocate?

• Because even though we are amazing, we simply cannot do it all by ourselves. 
• Because in spite of great efforts, made by all parties, mistakes still get made.

It is estimated that there are approximately
 550 deaths EACH DAY (200,000 a year) due to medical mistakes.

• Because contrary to what we see on T.V. on shows like “Grey’s Anatomy”, where Dr. Bailey knows everything and always saves the day, doctors don't have all the answers. In fact, doctors – good doctors – learn every single day from both colleagues and patients. 
• Because it would be a mistake to think doctors know everything or that they are going to instantly find a miraculous answer to some medical mystery. 
• Because it will make your life easier and lighter; take some of the burden off you doing it all alone.

An advocate is someone present with you at appointments, to help listen to what is being proposed and help you not get overwhelmed, star struck, or stymied, by a doctor's degrees or, in some cases, a doctor’s intimidation technique or arrogance.  

An advocate is there to support you as you interview doctors and get clear on what surgery or procedure is proposed or required. If necessary, an advocate is there to help you question authority. It is my opinion that your doctor – every doctor – must really present his/her position or argument on your medical care rather than just assume you will do what they say. If a doctor's argument doesn’t make sense, ask questions until it does. 

Framed degrees and certificates of excellence hanging on the wall are great, but they don’t mean you should give your power away. And, after your meetings with doctors, if you, or your advocate, have lingering doubts in the pit of your stomach, do some some research. Google can be a mighty powerful too. (A word of caution: With the abundance of information available on the Internet, some good, some bad, some scientific, some opinionated and unsubstantiated, if you do research online, or anywhere, be careful not to over-diagnose or freak yourself out.)  
 

Who should I choose as my advocate?  

An advocate can be a parent, sibling, relative, spouse, partner, significant other, friend, or even hired caregiver (or any combination thereof), who is willing to walk through the surgery process with you and, if necessary, stand up for you and be your voice when something's not going according to plan.

In my opinion, a meeting with your doctor or surgeon is an awesome opportunity to partner  with them on your healthCARE. Your personal advocate is simply part of your health and wellness team; someone whose only interest is you, you and only you.

We advocate or champion for our family and friends all the time whether it's cheering them on in sports or at work, or defending them in an argument. When facing important, life-changing medical decisions and intervention, we need our family and friends advocating and championing for us, making sure we get heard and receive proper medical attention. Having a second set of ears to hear important, often technical and overwhelming information, is extremely valuable. And, since your advocate isn't scared, in pain, or on pain medication, for example, their mind is clear and they can articulate questions and push for answers if necessary and assist you in getting clear. Let your advocate help and support you.  

Knowing that whoever advocates for you has your back will allow you to relax and feel safer and more secure during your health and wellness journey. Knowing you have an advocate in place an on your team will give you relief from trying to do it all on your own. And, this will also allow someone who loves you to show up for you when you need it and show you just how much they care. To me, getting an advocate is a win-win.  

What does an advocate do?  

An advocate is there to:

• Listen to you.
• Attend pre- and post-surgery doctors visits with you.
• Be a second set of ears at doctor’s appointments, taking notes and asking questions. 
• Give you feedback on what they hear at doctor appointments.
• Help you get clear about what you want to do when you feel overwhelmed.
• Support you.
• Be your voice when you can’t speak.
• Assist you in having the experience you desire, getting what you want and need.
• Make sure you get appropriate care in the hospital.
• Check medicines nurses are administering when you’re in the hospital, especially if you have allergies.
• Take post-surgery instructions on your behalf. Following any kind of in- or out-patient surgery, you may be groggy from anesthesia or pain medication. Knowing this in advance, it is a good idea to arrange to have your advocate get and review post-op surgical instructions from your doctor on your behalf before you go home. It is important to have someone double-check all instructions prior to leaving the hospital or surgical center as sometimes things can slip through the cracks. Remember, there are no bad questions and double-checking – getting crystal clear on all instructions is for patient safety – your safety. Once at home, your advocate can communicate these important instructions to you, when you are more up to it. 

How do I choose an advocate?

Since an advocate is there to speak up and be strong on your behalf if necessary, here are some traits you may want in your advocate:

• Trustworthy. Someone you trust!
• Has a good understanding of your expectations.  
• Is simply focused on you, your intention(s) and your desired outcome.
• Confident.
• A good sense of timing.
• Pro-active.
• Observant.
• Active listener (repeats back important points to make sure everyone is hearing the same thing and in agreement).
• Team-oriented.
• Good note taker.
• Inquisitive.
• Problem-solver. 
• Decisive. Able to make decisions when necessary.
• Patient. Able to navigate tedious situations, such as hospital bureaucracy – if necessary.
• Protective.
• Courageous.
• Diplomatic. Positive.
• Organized. 
• Articulate, clear, concise, even in the face of confusion.
• Professional.
• Good communication skills. Good at asking questions and expressing needs clearly and directly.
• Good social skills and public relations. Acknowledges the efforts of others (healthcare providers, etc.) who have been of assistance.
• Ability to act as a liaison between you and healthcare providers, if necessary.
• Persistent and assertive, if necessary.
• Willing to question authority, if necessary.
• Willing to speak up – be the squeaky wheel, if necessary.
• Non-negotiable on your behalf, if necessary.
• General medical knowledge and knowledge of how the medical system works is helpful.
• Good at plain ol’ hand-holding and moral support.

Prepare your advocate with your wishes.  

It is important to arm your advocate with any pertinent documents you may have that specifically address your wishes should you become incompetent or unable to communicate; an advance directive, for example. If you don’t already have these documents in order, now may be a good time to put pen to paper with your wishes in the event something unexpected occurs. 

While you have the right to decide how you will be cared for, down to the last second, unless it’s written down, it cannot be implemented on your behalf. If no such paperwork has been done and there is a problem, such as a patient does not have the capacity to decide on their own, a doctors only recourse is to consult with available family members to make any necessary decisions.

Documents recognized in the event of an emergency, when a patient becomes unable to speak for themself, include:

• Special Power of Attorney (SPOA) or Health Care Power of Attorney. A SPOA is a legal document, which allows you to appoint another person (called an “attorney-in-fact” or “agent”) to make decisions for you, if you should become temporarily or permanently unable to make the decisions yourself. The SPOA only becomes effective if you are temporarily or permanently unable to do so. Appointment a SPOA allows someone – your agent – to respond to unanticipated situations, such as a healthcare emergency. (Note: You can also do a special Health Care Power of Attorney, which just allows an agent to make medical decisions in the event you are unable to do so.)  
• Living Will.  A living will deals with medical issues while you are living; it is different from a regular will or trust, which addresses distribution of assets after death. A living will tells your doctor whether or not your want life-sustaining treatments (which would only prolong dying), or procedures (such as mechanical respirators) administered if you are in a terminal or persistent vegetative state.
• Medical Treatment Plan.  A Medical Treatment Plan is created by you and your doctor AFTER you have suffered an injury, for example, and BEFORE you under-go an operation or medical procedure that may result in substantial impairment or death.

What if I have to advocate for myself?   

If you have to advocate for yourself, it is up to you to have your own back. For example, if you have a serious allergy, you will need to remain vigilant and constantly remind each doctor, nurse, or attendant of your allergy. While it may feel like you are constantly repeating yourself, it’s okay. The singular most important thing is always going to be you and your health, safety and well-being. If that means repeating yourself, so be it. Better safe than sorry! Too much information rather than too little.

If you must advocate for yourself, know that you can do it. Use all the same tips listed above to encourage yourself. You can totally do it. In fact, by reading this blog, you are, in fact, doing it already, advocating for yourself by becoming more informed.

Like the bee and the flower, we need each other.

And when we help each other, we help ourselves.

 
Till next time, knowing your health and well-being.