Caitlin Whyte (Host): This podcast is for informational purposes only and is not intended to be used as personal medical advice.

Welcome to Be Well with Skagit Regional Health. I'm your host, Caitlyn Whyte and joining me today is Dr. Xue Zeng from Skagit Regional Health, we will be talking all about preparing for surgery and recovery.

Great to have you on the show today, Doctor. My first question for you is, what are the most important things patients should do to prepare for surgery, both physically and mentally?

Xue Zeng, MD, FACS: Thank you. That is a question a lot of patients ask us too. From a physical side, these are the things that are typically addressed in the patient's pre-op package. Very important for patients to read through the pre-op package, particularly knowing when they last need to eat or drink and what medications they need to take.

Also, uh I would recommend patients to stay active, as they were preparing for the patient, but then get plenty of rest the night before their surgery. In addition, sometimes they'll also be given instructions on whether they need to do any bowel prep or any like additional antibiotics or special diet to do before the surgery.

Those are important instructions, to talk to your doctor and follow them through and mentally really, have a good support system, practice stress relief techniques like deep breathing and mindfulness. And we also want to arrange the logistics of going into the surgery and how to recover and getting plenty of help at home and with help of transportation.

Host: Wonderful. So that is preparation for surgery, but can you walk us through also what typically happens on the day of surgery from check-in to post-op?

Xue Zeng, MD, FACS: Typically, I tell my patient too, that when you come for surgery, no matter how short the surgery is, you do want to prepare that as a whole day event. Sometimes, you need to come into the hospital early to complete the paperwork, change into surgical attire and also at the same time, after that, you will have IV placed.

Our nursing staff and our anesthesiologist will talk to you about the medications, your medical history, the procedures you have. Some surgeries do require some imaging studies to be done, procedures to be done prior to the surgery. For example, for orthopedic surgeries, you may need to have a nerve block placed.

And then for breast surgery, injections or localization pictures done prior to the surgery. Then after everything is, you are prepared; you've talked to anyone who's going to be with you. That includes your doctor, your anesthesiologist and in the nursing staff. In the operating room, you will be moved to the operating room, getting the type of anesthesia you're going to have and have your procedure performed. When you wake up from surgery, the first place most patients will remember is the post-anesthesia care unit, what we call PACU. That's a place where you will get close monitoring by our PACU nurses while you are waking up from anesthesia and that's a space you won't have your family or friends with you.

And when you're more awake from anesthesia and when you're safe to do so, then you'll move to area when you recover more from surgery. But that's the time when you see your family and friends. And then, depending on the surgery you have, you either will go home from there or you'll go to a hospital bed to continue your recovery.

Host: Wonderful. Well, what are some misconceptions that patients have when it comes to surgery and recovery?

Xue Zeng, MD, FACS: One of the most common things, at least some of my patients have is the recovery course. Like the surgery is more of an instant. I have a problem; I have pain, the surgery, fix it and then I'm back to my baseline. But surgery is really just one, small part of this whole recovery and healing process.

After surgery, our body needs to recover from the surgery itself and then we'll need to continue the healing and rehabilitation to make you back towards your baseline and that can take from a few days to a few weeks or sometimes a few months depending on what surgery you're having, what conditions we're treating and how your body's recovering from surgery cause everyone's body's different. The other common thing is that pain after surgery that means something is wrong. Pain equals something is wrong. Some pain is expected and normal after surgery cause you are having just had a invasive procedure. So that's your body's natural response is to sense the pain from the procedure itself.

So that having pain itself doesn't mean there is something wrong and your doctors will walk you through what is expected and what is not expected. And the goal of treating the pain or either through ice packs, heat compress, or medications, is not to completely eliminate the pain.

But it's to help you cope and handle this discomfort after surgeries too, so that you can continue to head towards a better recovery.

Host: Hmm. And how does a patient's overall health and lifestyle impact their surgical outcomes?

Xue Zeng, MD, FACS: A patient's overall health and lifestyle is very, very important, in the patient's ability to tolerate surgery and recovering well from surgery. Patients in better physical shape and fewer comorbidities like for example like heart disease, lung disease, diabetes, are more likely to have fewer complications after surgery, tend to heal faster and recover more fully and lifestyle factors like smoking, poor fitness exercise tolerance can delay the healing process or rehabilitation process and increase the risk like infection, blood clots and wound healing issues.

Host: And on that note, what role does nutrition play in preparing for surgery and healing afterward?

Xue Zeng, MD, FACS: So healing afterwards, surgery has two parts where you typically consider like the healing from the surgical wound site and healing in terms of rehabilitation, getting your strength back, back on your feet and in both parts nutrition plays a very essential role. Proper nutrition like as simple as enough caloric intake, proteins and the vitamins that we take plays an important role to give the building blocks for our body to heal. And the same goes for nutrition, building blocks of the proteins. The energies also are what helps you have that energy to continue doing exercise, working with the therapist to get you back on your feet and gain your strength back.

And another important factor we see along the nutrition is particularly in our populations, are blood sugar. While we need the calorie, need the energy to help to recover, we also want to make sure that we are making right choices in terms of our food and having good control of our blood sugar. High blood sugar is a common thing that affects our healing, particularly our body's ability to fight infection or healing the wound, letting the skin heal.

Host: And doctor, what are some signs of a healthy recovery? And then when should patients be concerned or call their doctor during recovery?

Xue Zeng, MD, FACS: Healthy recovery is something what I would define that when patients see gradual improvement, both in their wound, like reduced swelling, reduced bruising over time, sometimes you really do see the swelling or bruising to get worse the first few days before it gets better and that does not mean something's wrong. And that's part of the healing process. Same goes as a gradual pain improvement. I do not expect my patients to have the pain just all sudden go away.

This is more of a gradual process and sometimes it doesn't follow a straight line of like, every day is going to be exactly better than the previous day.

We will have good days and bad days, but what we want to see is overall trajectory towards reducing pain, reducing bruising, swelling and the return of energy and appetite. Some red flags, that we are concerned after surgery versus like possible signs of infection.

 Typically that's marked by fever over 104 points Fahrenheit. Or if there's increasing pain more than what your doctor explained to you as expected, increased pain and swelling at the surgery site more than what your doctor explained to that particular procedure you are having. If you're seeing pus like yellow, white, opaque, fluid training from your wound, those are, for the most part, not expected to happen. And are definitely a sign of infection. Anything that affects your breathing, gives you chest pain, it affects your ability to stay awake and affects your ability to keep any food down. If you're nausea, vomiting and you feel dehydrated, dizzy, all those signs that you need to discuss with your surgeon right away or even head to the emergency room if you have those symptoms.

Host: Well, how can family members or caregivers best support someone after surgery?

Xue Zeng, MD, FACS: So family members, caregivers are a very, very essential part for recovering after surgery. Most times, patients after surgery have some kind of physical limitations, either it's because the procedures they're having, because of the rehabilitation needs or because of the pain and discomfort caused by the surgery.

So as simple as transportation to and from surgery and appointments is a something that the family and caregivers can support the patient a lot. Other things like meal prepping, transportation, carrying heavy objects are very essential as well. And also, our families and caregivers can also help monitor any signs of complications, like what we talked about before, signs of wound breakdown, signs of infection, difficulty with breathing or chest pain, those are the signs. Sometimes if the patient's too sick, family members and caregivers may be the first person to notice something is not right and the first person to ask for help.

Host: Then what should patients know about returning to work, exercise, or just daily activities post-surgery?

Xue Zeng, MD, FACS: In general, after surgery, we want to return to activities, return to work gradually and with the consultation from your surgeon. Depending on the particular surgery you have, the rehabilitation need, the restrictions after surgery is different. Particularly you want to avoid heavy lifting or any strenuous exercise until you've talked to your surgeon and are cleared to do so.

Another thing is, you definitely want to listen to your body. If your body is, you're doing certain activity and your body is in extreme pain, fatigue; that's your body trying to tell you that maybe you're not ready for these activities yet. You may want to listen to your body, take a break or check with your doctors to see if those are some signs that's expected or you need to take additional time off work or activities.

But on the same time, for most part, after surgery, we do not expect the patient to be staying in bed or sitting and not moving much for a prolonged period of time. Because when we're not moving as much, we're not walking, that puts you at risk of having ileus of, uh, which is your intestines falling asleep.

That increase your risk of getting bloated, constipation and also increases our risk of having blood clots in our legs. So, it really is a fine balance of doing enough to keep your body active while not harming the recovering process.

Host: That was Dr. Xue Zeng. For more information, please visit skagitregionalhealth.org. And if you enjoyed this podcast, we encourage you to share it on your social media and explore our entire podcast library for more topics of interest I'm Caitlyn Whyte and this has been Be Well with Skagit Regional Health.

Thanks for listening.