Anticipate challenges of post-surgery recovery

<p>Leslie had a successful knee replacement, but she called me several hours after she came home from the hospital. I knew the call was trouble when I looked at the clock: midnight. She was in pain, her knee was swollen, her teeth were chattering, and she wasn’t sure if she should go back to the hospital’s emergency room.</p><p>Surgery, whether planned or in response to a sudden unexpected need, is traumatic. We cloak it in medical terms, talking about procedures, risks and benefits. But surgery is at best a skillful cutting into the body, naturally causing fear and pain that we control with social support and medications.</p><p>The first day or two after a successful surgery are sometimes euphoric. You know the worst is over, and you are very grateful for the nurses and the flowers and the medications that are so effective. Anxious to go home, you work hard to get strong enough to take care of yourself, to eat solid foods, and to graduate to oral pain medications. Once you succeed at these tasks, discharge is imminent.</p><p>Patients are leaving the hospital after surgery much sooner than they used to. Surgeries are often not as invasive as they used to be, and when an IV is no longer necessary, insurance may not pay for hospital care. So you are given a few prescriptions for medicines to use at home, told to make a follow-up appointment with the surgeon and discharged. You load up all your personal belongings, ride in a wheelchair to the car and head for home.</p><p>As good as the fresh air smells and as welcome as your own home may be, this transition can be very difficult. There are ways to make it easier.</p><p>First, unrealistic expectations have been the downfall of many a patient recovering from surgery. Feeling good in the hospital does not mean you will feel that good when you get home. The energy it takes to get out of the hospital, into the car, and all the way to your home is the most you will have expended in several days. It may tire you more than you anticipated, and this exhaustion can exacerbate pain.</p><p>It’s always good to take a strong dose of pain medication right before you leave the hospital, and another as soon as recommended on the prescription you have been provided. Staying ahead of the pain is essential because it’s always harder to play catch-up with post-operative pain.</p><p>Don’t stop at the pharmacy on your way home. Let your family get the prescriptions for you, or have them delivered. Go straight home.</p><p>Should you go to your bed or try to sit up in your favorite chair? The wisest choice is the one that is the most physically comfortable. It may be best to go lie down in your own bed for a while, at least until you have recovered from the trip home.</p><p>You may need narcotic pain medicine for several days after a significant surgery. One of the most commonly forgotten side effects of pain medicine is constipation. As long as you are taking narcotics, you should also be doing something to keep your bowels moving. A daily stool softener may be enough, or using an over-the-counter gentle laxative may be all you need to keep you regular. If your surgery involved the GI tract, you would want to talk to your surgeon before treating constipation. But be prepared to have that talk.</p><p>What happened to Leslie? She was in too much pain to be clear about her prescriptions, and she was reluctant to use ice on her swollen knee as her teeth were already chattering. We sorted out her medications, and I suggested she put a heating pad on her chest for comfort while the ice and her pain medication took effect.</p><p>If you or someone you love has surgery, anticipate the challenges of coming home, and make sure that pain is adequately treated. Done right, homecoming can be a good part of the healing process.</p><p><em>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.</em></p>