The PreOp-Guide
A Patient's Guide To Surgery
Chapter 9
Long Term Care and Recovery
      The first weeks to months after surgery can sometimes be a difficult period.  If you had a minor operation or a curative procedure for a benign condition, you will probably be getting back to your usual routine by now.  Your stitches or staples have been removed, you have returned to work, and your stamina is returning.  If you fit into this category, congratulations, you have successfully navigated the tricky world of surgery.  A few basic points bear repeating for you at this time.
     Now that your operation is over, you are thinking about taking up some of your old preoperative habits such as smoking.  The single most important thing you can do to protect your own health and future well being as a user of tobacco products it to quit for good.  You weren’t able to smoke in the hospital, and you may have noticed that you are breathing easier and that you don’t wake up with a cough or the desire for a cigarette.  Run with this opportunity; kicking the habit will save you trouble down the road, no doubt about it.  If you lost weight associated with your surgery, now is also a good time to consider what you would like your weight to be.  While I do not advocate surgery as a method of dieting, in the period after surgery you will lose both muscle and fat as your body attempts to repair itself.  Now is a good time to begin a healthy diet and institute a routine of daily exercise.  While you are at home recovering, get in the habit of taking a walk and maybe doing some stretching or other form of exercise.  This will not only improve your recovery period but it may also set the stage for a healthier future.  There are no diet or exercise routines which will cure every disease; but as we age, keeping our bodies in the best shape possible will improve the quality of our lives and increase our ability to recover from future medical problems.
     The incision that was made in your skin, as well as the manipulation of your organs necessary for the operation, heal by a remarkable natural process.  This is a long-term process that literally begins minutes after your operation is over.  By the end of one week, the healing process progresses to the point that your incision is able to hold itself together.  The wound continues to remodel and strengthen over time, but the process is not complete for nearly a year.  At the same time, the dissolvable suture material used in the operation slowly degrades in your body.  Unless you are a professional athlete under the care of a sports physician, you should avoid any strenuous activity like heavy weight lifting, downhill skiing, mountain biking, or competitive sports for 3 to 6 months.  This depends, of course, upon the type of operation you had, but it emphasizes the fact that wound healing is a very slow process.  Another point to keep in mind is that scar tissue is never as strong as the tissue it replaces, and in best case scenarios, you will achieve only 80% of the original tissue strength.  Fortunately, this is adequate for virtually all normal activity; even strenuous activity, but remember, it takes time for this strength to develop.  Remember also that scars are very light sensitive; you should protect your incision from direct sunlight for a year or so.  Failure to do so will result in a deeply pigmented scar that will take longer to fade away.  If you must expose your incision to sunlight, keep it well coated with the strongest suntan lotion you can find.
     Now is also the time to develop a long-term follow-up plan with your primary physician and surgeon.  If your disease was benign and has been cured, you may not need to worry about this.  However, if you had a cancerous or pre-cancerous lesion removed, it is possible that you will have a recurrence of this disease in the future.  There are few, if any, cancers that can be said to be cured 100% of the time by surgery.  For this reason, you may need to have semi-annual or annual exams for the rest of your life.  In this case, as with all of medicine, the earlier a disease is recognized, the easier it is to treat.  Your diligence in scheduling follow-up care is the best step you can take to be certain you remain in good health.
     For patients who have had a malignant disease, this is the time when additional treatment will begin.  You may need to have chemotherapy or radiation therapy to improve your chances for cure or treat any residual disease.  If this is the case, you may have weeks, months, or even years of therapy ahead of you.  Unfortunately, I don’t have any profound words of wisdom or encouragement to offer.  Dealing with cancer is a highly personal issue, and every patient and physician deals with it differently.  I would like to remind you that there are numerous support groups and sources of information available, and many of these resources can be found on the Internet.  As a first step, you can ask your surgeon, primary care physician, or specialty doctors you are seeing for information.  Many offices have extensive files of information that you can use to find the resources you need to cope with your disease.  Again, I would like to point out that in this day and age, there is no substitute for information and you should become as knowledgeable as possible about your condition so that you can participate fully in the decision making process that may lie ahead.  
     For patients with chronic diseases or those who have had complicated operative courses, this may be a time to consider rehabilitation placement.  Surgery and its attendant complications can take months or years to fully recover from.  If you began your operation in a weakened condition or if your hospital stay left you unable to care for yourself, a short stay at a rehabilitation hospital may be your ticket back to independence.  Today’s acute-care hospitals can no longer fulfill the role of chronic rehabilitation, so a new brand of care facility has arrived to fill the gap.  These are not nursing homes but rather facilities that specialize in the reconditioning and rehabilitation of patients who are expected to regain the ability to care for themselves.  I personally look at rehabilitation hospitals as the ultimate location for postoperative recovery.  They tend to be modern facilities with a dedicated and professionally trained staff, who enjoy the challenge of improving your strength and endurance while providing the necessary therapy and medical care to get you back on your feet.  If your surgeon recommends this option for you, I suggest you jump at the chance. Many people feel a stay at one of these facilities is equivalent to being “put out to pasture.”  I assure you that this is not the case and the time you spend in rehabilitation will be time well spent.

Chapter 2
Chapter 3
Chapter 1
Chapter 4
Chapter 5
Chapter 6
Chapter 8
Chapter 9
Chapter 10
Chapter 11