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Facts to Know Before Surgery - Learn What You Can Do To Make A Difference
Studies show that making changes to improve your health before your surgery will lead to a better recovery.
Featuring:
Learn more about Laura Ziegler, CRNP
Laura Ziegler, CRNP
Laura Ziegler, CRNP, is a certified registered nurse practitioner with the Surgery Optimization Clinic. She received her bachelor’s and master’s degrees in nursing from the Pennsylvania State University. Prior to becoming a nurse practitioner, Ms. Ziegler was a registered nurse for UPMC Harrisburg and UPMC Community Osteopathic in the Peri-anesthesia and Medical Surgical units. She also has experience in orthopaedics. Ms. Ziegler is a member of the American Association of Nurse Practitioners and the Pennsylvania Coalition of Nurse Practitioners.Learn more about Laura Ziegler, CRNP
Transcription:
Bill Klaproth (host): So, if you're listening to this podcast, you probably have been told you need surgery. And you're trying to find out information on the Surgery Optimization Clinic. Well, I got to tell you, studies show that making changes to improve your health before surgery helps you achieve better outcomes. So this is really important, and we're going to learn more with Laura Ziegler, a certified registered nurse practitioner with the Surgery Optimization Clinic at UPMC. M C.
This is Healthier You, a podcast from UPMC. I'm Bill Klapoth. Laura, it is great to talk with you. Very interested in this topic. It's very interesting. So let's talk about the surgery optimization clinic. Why is it important to improve your health before surgery?
Laura Ziegler: Thanks, Bill. Thanks for having me. So, it's important to improve your health before surgery because surgery is a big deal. You're putting stress on your body, not only physically, but mentally, maybe emotionally. So it's good to be in the best spot possible before you undergo this process.
Bill Klaproth (host): So, it's basically helping your body accept the surgery, if you will. I would imagine this helps with the recovery as well. Is that right?
Laura Ziegler: Definitely. And that's all part of it. It's kind of surgery's this big comprehensive thing. And being prepared is not only going to help you right when you're having surgery, but afterwards, too, in the healing process, the recovery, how fast you're going to recover, things like that.
Bill Klaproth (host): So when you have surgery, this is a big event on your body. , So being in the most optimal health just seems to make sense, is that right? I mean, just, looking at it from the outside, it's like, "Yeah, that seems to make sense."
Laura Ziegler: Definitely. Yeah, for sure.
Bill Klaproth (host): So when we're thinking of common conditions, somebody might think, "Okay, well, I've got to lose weight." It's probably deeper than just losing weight, right? Do you have some common conditions that can have negative effects on surgical outcomes? I'm thinking like maybe people who had diabetes or high blood pressure. Are there several other types of things that someone would say, "You know what? We need to kind of get that in check before a surgery."
Laura Ziegler: Definitely. The majority of the conditions that we see here at the optimization clinic are uncontrolled diabetes. So for instance, if you have an A1c of 8 or greater, we consider that to be uncontrolled. High blood pressure, if you smoke or use tobacco products, that can put you at risk for delayed healing. And of course, Overweight, obesity. impaired skin integrity, even poor dental hygiene.
Bill Klaproth (host): Wow. I wouldn't have thought of that one. And then I would imagine just general being overweight or even underweight. Is that a thing?
Laura Ziegler: Yes, even underweight. That's not as common, but that is one that you want to think about because, if you're underweight, more than likely your nutrition status is poor and that's going to put you at risk for not healing right.
Bill Klaproth (host): Yeah, that makes a lot of sense. You also mentioned one that I didn't think of, impaired skin integrity. When you think about it, your skin is going to be opened up. So does that mean we need healthy skin, so the wound heals properly? Is that right?
Laura Ziegler: Some people, I mean, and this might go hand in hand with some of these other conditions like uncontrolled diabetes, if you are frequently getting skin infections, we don't want to throw you into surgery when you're already having frequent infections on your skin. We want to get that under control. So yeah, we're going to focus on getting your diabetes under control, but we're also going to make sure your skin is in a good place too.
Bill Klaproth (host): So let's talk about the Surgery Optimization Clinic. How do you help people? What is the process that someone has to go through? I would imagine there's an evaluation at first. And then, you prescribe the steps. How does it work?
Laura Ziegler: The way it initially works is, first off, the patient is identified by either the surgeon or the primary care provider, and that's how the patient is referred to our clinic. Now the patient themselves could say, "Hey, I have an upcoming surgery. I want to make sure I'm in good health. I know I have these conditions," and they could put it forward to their doctor and say, "Hey, what do you think about referring me to this clinic?" Once they're referred to us, the patient will see myself or one of our other nurse practitioners for a one time face-to-face our appointment. This is a very comprehensive appointment where we go deep into their medical history, their medications, their allergies, their previous surgeries, and we identify anything that puts them at risk that we could potentially modify. We come up with a plan together and we set goals.
So this plan could include starting new medications, adjusting current medications; referring them to other specialties, such as cardiology or pulmonology; perhaps ordering tests, like a very common one that we will order is a sleep study test to evaluate for sleep apnea.
Once we come up with this plan, our care doesn't stop there. So what's really cool about our clinic is we have nurse navigators that are assigned to our patients and they continue their care up until after their surgery. So they'll be calling the patient. They'll be coordinating care between the patient, perhaps the other specialties they were referred to. They'll be sending messages to the surgeon's office or primary care doctor, if there's any issues. So yeah, it's very comprehensive.
Bill Klaproth (host): Absolutely. So it's an hour-long evaluation. You said you dive deep into their medical history. You look at allergies, other medications, other surgeries. And then, if you discover that, "Hey, maybe their cardiovascular system or their heart, isn't really strong," you'll then also refer them to a cardiologist and then also a nurse navigator who will follow them through the process. So this is a multi-disciplinary team, if you will, on the surgical optimization team. Is that right?
Laura Ziegler: Very much so.
Bill Klaproth (host): Yeah, that is very comprehensive. I'm wondering if there's a general timeframe that it takes someone to get ready to have a surgery. I know each person is different and this is probably a hard question to answer. But is there a general timeframe before someone is ready for surgery after they visit the Surgery Optimization Clinic?
Laura Ziegler: That is a great question. It varies. It depends on what we're trying to optimize. So weight loss, that can take several months up to a year or even longer. Weight loss is a slow process because that's how weight loss works. It's safe to do it in a slow process. Smoking, for instance, that's one where evidence shows it's best to be nicotine-free for eight weeks prior to surgery. So that also might take several months to work on.
So it really does depend. I would say on average it's best to at least have a couple months with the patient before their surgery date. And what's kind of nice about our clinic is that we will see patients even when they don't have a surgery date scheduled yet. So if somebody has been with an orthopedic doctor for instance, and they decide, "Yeah, you're going to need a knee replacement sometime in your near future," but it's not scheduled yet, they have time, it'd be a great time to come to us and try to work on these things while we still have time.
Bill Klaproth (host): So you set a goal and then when the patient generally meets that goal, then they're scheduled for surgery. Is that generally how it works?
Laura Ziegler: Not always. Sometimes it's kind of driven by the surgeon and the patient. Well, it is. It's driven by the surgeon and the patient. So, some surgeons have very specific goals in mind, like they'll say, "I will not operate on this person unless their A1c is less than 8. I will not operate unless their BMI's below 40." Other surgeons just say, "Hey, let's send you here. Do the best you can. We're going to operate regardless, but I want you to get to the best point you can possible."
Bill Klaproth (host): Right. Some surgeries are more urgent than others and it's going to be like, "We need to operate within a certain timeframe. In that timeframe that you have, do everything you can to get this person in shape."
Laura Ziegler: Yes, for sure.
Bill Klaproth (host): Okay. So, very individualized specific targeting for each person. So then after surgery, Laura, do you keep in contact with the person? What happens after surgery?
Laura Ziegler: So after surgery, our nurse navigators who were assigned to the patient will do a one-time followup call after the surgery when they're home and makes sure they have everything they need, that they don't need any further assistance. And then, we close out. Now, if we initiated treatment here, say for losing weight or smoking cessation or diabetes care, a lot of times the treatments we initiated will continue after we're done. We just aren't doing them any longer. It's now the doctor or the clinic that we referred them to. Because those things, they can take a long time or need longer care and followup.
Bill Klaproth (host): Well, that's good to know if there's a certain aspect of their health that is ongoing and will need to be addressed after surgery that the treatments initiated will continue after the surgery through the doctor or the clinic that you referred them to. So that is good news. Laura, this has really been fascinating to learn about the surgery optimization clinic at UPMC. Thank you so much for your time. We appreciate it.
Laura Ziegler: Yeah. Thank you so much, Bill.
Bill Klaproth (host): And once again, this Laura Ziglar and for more information, call 7 1 7 7 8 2 4 7 8 5 that's 7 1 7 7 8 2 4 7 8 5 or. You can go to UPM c.com/central PA. S O C that's upmt.com/central PA. S O C to learn more. And if you found this podcast helpful please share it on your social channels and check out the full podcast library for topics of interest to you this is healthier you a podcast from u p m c i'm bill clapper auth. thanks for listening
Bill Klaproth (host): So, if you're listening to this podcast, you probably have been told you need surgery. And you're trying to find out information on the Surgery Optimization Clinic. Well, I got to tell you, studies show that making changes to improve your health before surgery helps you achieve better outcomes. So this is really important, and we're going to learn more with Laura Ziegler, a certified registered nurse practitioner with the Surgery Optimization Clinic at UPMC. M C.
This is Healthier You, a podcast from UPMC. I'm Bill Klapoth. Laura, it is great to talk with you. Very interested in this topic. It's very interesting. So let's talk about the surgery optimization clinic. Why is it important to improve your health before surgery?
Laura Ziegler: Thanks, Bill. Thanks for having me. So, it's important to improve your health before surgery because surgery is a big deal. You're putting stress on your body, not only physically, but mentally, maybe emotionally. So it's good to be in the best spot possible before you undergo this process.
Bill Klaproth (host): So, it's basically helping your body accept the surgery, if you will. I would imagine this helps with the recovery as well. Is that right?
Laura Ziegler: Definitely. And that's all part of it. It's kind of surgery's this big comprehensive thing. And being prepared is not only going to help you right when you're having surgery, but afterwards, too, in the healing process, the recovery, how fast you're going to recover, things like that.
Bill Klaproth (host): So when you have surgery, this is a big event on your body. , So being in the most optimal health just seems to make sense, is that right? I mean, just, looking at it from the outside, it's like, "Yeah, that seems to make sense."
Laura Ziegler: Definitely. Yeah, for sure.
Bill Klaproth (host): So when we're thinking of common conditions, somebody might think, "Okay, well, I've got to lose weight." It's probably deeper than just losing weight, right? Do you have some common conditions that can have negative effects on surgical outcomes? I'm thinking like maybe people who had diabetes or high blood pressure. Are there several other types of things that someone would say, "You know what? We need to kind of get that in check before a surgery."
Laura Ziegler: Definitely. The majority of the conditions that we see here at the optimization clinic are uncontrolled diabetes. So for instance, if you have an A1c of 8 or greater, we consider that to be uncontrolled. High blood pressure, if you smoke or use tobacco products, that can put you at risk for delayed healing. And of course, Overweight, obesity. impaired skin integrity, even poor dental hygiene.
Bill Klaproth (host): Wow. I wouldn't have thought of that one. And then I would imagine just general being overweight or even underweight. Is that a thing?
Laura Ziegler: Yes, even underweight. That's not as common, but that is one that you want to think about because, if you're underweight, more than likely your nutrition status is poor and that's going to put you at risk for not healing right.
Bill Klaproth (host): Yeah, that makes a lot of sense. You also mentioned one that I didn't think of, impaired skin integrity. When you think about it, your skin is going to be opened up. So does that mean we need healthy skin, so the wound heals properly? Is that right?
Laura Ziegler: Some people, I mean, and this might go hand in hand with some of these other conditions like uncontrolled diabetes, if you are frequently getting skin infections, we don't want to throw you into surgery when you're already having frequent infections on your skin. We want to get that under control. So yeah, we're going to focus on getting your diabetes under control, but we're also going to make sure your skin is in a good place too.
Bill Klaproth (host): So let's talk about the Surgery Optimization Clinic. How do you help people? What is the process that someone has to go through? I would imagine there's an evaluation at first. And then, you prescribe the steps. How does it work?
Laura Ziegler: The way it initially works is, first off, the patient is identified by either the surgeon or the primary care provider, and that's how the patient is referred to our clinic. Now the patient themselves could say, "Hey, I have an upcoming surgery. I want to make sure I'm in good health. I know I have these conditions," and they could put it forward to their doctor and say, "Hey, what do you think about referring me to this clinic?" Once they're referred to us, the patient will see myself or one of our other nurse practitioners for a one time face-to-face our appointment. This is a very comprehensive appointment where we go deep into their medical history, their medications, their allergies, their previous surgeries, and we identify anything that puts them at risk that we could potentially modify. We come up with a plan together and we set goals.
So this plan could include starting new medications, adjusting current medications; referring them to other specialties, such as cardiology or pulmonology; perhaps ordering tests, like a very common one that we will order is a sleep study test to evaluate for sleep apnea.
Once we come up with this plan, our care doesn't stop there. So what's really cool about our clinic is we have nurse navigators that are assigned to our patients and they continue their care up until after their surgery. So they'll be calling the patient. They'll be coordinating care between the patient, perhaps the other specialties they were referred to. They'll be sending messages to the surgeon's office or primary care doctor, if there's any issues. So yeah, it's very comprehensive.
Bill Klaproth (host): Absolutely. So it's an hour-long evaluation. You said you dive deep into their medical history. You look at allergies, other medications, other surgeries. And then, if you discover that, "Hey, maybe their cardiovascular system or their heart, isn't really strong," you'll then also refer them to a cardiologist and then also a nurse navigator who will follow them through the process. So this is a multi-disciplinary team, if you will, on the surgical optimization team. Is that right?
Laura Ziegler: Very much so.
Bill Klaproth (host): Yeah, that is very comprehensive. I'm wondering if there's a general timeframe that it takes someone to get ready to have a surgery. I know each person is different and this is probably a hard question to answer. But is there a general timeframe before someone is ready for surgery after they visit the Surgery Optimization Clinic?
Laura Ziegler: That is a great question. It varies. It depends on what we're trying to optimize. So weight loss, that can take several months up to a year or even longer. Weight loss is a slow process because that's how weight loss works. It's safe to do it in a slow process. Smoking, for instance, that's one where evidence shows it's best to be nicotine-free for eight weeks prior to surgery. So that also might take several months to work on.
So it really does depend. I would say on average it's best to at least have a couple months with the patient before their surgery date. And what's kind of nice about our clinic is that we will see patients even when they don't have a surgery date scheduled yet. So if somebody has been with an orthopedic doctor for instance, and they decide, "Yeah, you're going to need a knee replacement sometime in your near future," but it's not scheduled yet, they have time, it'd be a great time to come to us and try to work on these things while we still have time.
Bill Klaproth (host): So you set a goal and then when the patient generally meets that goal, then they're scheduled for surgery. Is that generally how it works?
Laura Ziegler: Not always. Sometimes it's kind of driven by the surgeon and the patient. Well, it is. It's driven by the surgeon and the patient. So, some surgeons have very specific goals in mind, like they'll say, "I will not operate on this person unless their A1c is less than 8. I will not operate unless their BMI's below 40." Other surgeons just say, "Hey, let's send you here. Do the best you can. We're going to operate regardless, but I want you to get to the best point you can possible."
Bill Klaproth (host): Right. Some surgeries are more urgent than others and it's going to be like, "We need to operate within a certain timeframe. In that timeframe that you have, do everything you can to get this person in shape."
Laura Ziegler: Yes, for sure.
Bill Klaproth (host): Okay. So, very individualized specific targeting for each person. So then after surgery, Laura, do you keep in contact with the person? What happens after surgery?
Laura Ziegler: So after surgery, our nurse navigators who were assigned to the patient will do a one-time followup call after the surgery when they're home and makes sure they have everything they need, that they don't need any further assistance. And then, we close out. Now, if we initiated treatment here, say for losing weight or smoking cessation or diabetes care, a lot of times the treatments we initiated will continue after we're done. We just aren't doing them any longer. It's now the doctor or the clinic that we referred them to. Because those things, they can take a long time or need longer care and followup.
Bill Klaproth (host): Well, that's good to know if there's a certain aspect of their health that is ongoing and will need to be addressed after surgery that the treatments initiated will continue after the surgery through the doctor or the clinic that you referred them to. So that is good news. Laura, this has really been fascinating to learn about the surgery optimization clinic at UPMC. Thank you so much for your time. We appreciate it.
Laura Ziegler: Yeah. Thank you so much, Bill.
Bill Klaproth (host): And once again, this Laura Ziglar and for more information, call 7 1 7 7 8 2 4 7 8 5 that's 7 1 7 7 8 2 4 7 8 5 or. You can go to UPM c.com/central PA. S O C that's upmt.com/central PA. S O C to learn more. And if you found this podcast helpful please share it on your social channels and check out the full podcast library for topics of interest to you this is healthier you a podcast from u p m c i'm bill clapper auth. thanks for listening