Sometimes people ask that question with preconceived notions that I have to make sure I alleviate or address before they leave so that I don’t miscommunicate what’s really going to happen and how things will go.
I think the whole point is–and I tell people this–when you wake up in the morning, you won’t get out of bed and go “UGH, my fill in your injury here.”
So it should be that you get up, go about your day, and you don’t make any change or adjustments for your injury because it has run its course. It’s over, done with, you’re moving on. That’s what “feeling normal” means for me as a surgeon.
What challenges do patients face when dealing with post-operative expectations?
(ST): For instance, someone comes in for surgery A which is very small. The procedure doesn’t take very long, the recovery period is short, and they’ve recovered and are happy. Then, that patient talks to his neighbor, cousin, or coworker, who needs a procedure that’s similar, but not the same. The cousin, let’s say, may have a completely different recovery experience.
This is where we get into expectations of what’s involved. One of the most challenging things is to have performed a procedure on someone and to–afterwards–have them say “I had no idea this was going to be this involved, or big or long.” I want to make sure that every patient understands before they sign up what they are up against and what that means.
Recovery is different for everyone, and you really have to lay it out there what you mean, and sometimes people have no reaction because it’s what they expected. Some people have no reaction because they are so scared, they just want to run for the door. Others are shocked, and begin asking “what can I do, and when?”
Give me a generic timeline of the “feeling normal” process.
(ST): We’ll use shoulder for instance, but knee or other procedures would work as well: this all applies.
- Time zero: you have surgery
- Typically you’ll be at the facility the better part of a day.
- You’ll take pain medication for X amount of time.
- You’ll see your surgeon about 10 days after surgery.
- We’ll go over the arthroscopic photos (if applicable)
- And that’s usually the visit where we talk about what we found, how serious it is, and where we go from here. We give them a sense of all this preoperatively so that there is an idea of what to tell work, spouse, family, etc.
- Then from there, we have levels of activity.
- The first 4-6 weeks the patient is usually in a sling. After four weeks, we get rid of the pillow, then after six weeks we get rid of the sling, but there’s a weight limitation of 1-3 pounds, and that builds.
- Then we see the patient back about every four weeks to address new concerns, new issues, check range of motion to guarantee progression, and answer questions about therapy.
We’re essentially letting out the leash slowly. That’s hard to do all in one visit preoperatively. It’s a lot of information for someone to process in one appointment.
So I have to strike a balance between information overload and not enough information.
Then after 6-12 weeks of physical therapy, patients still are not normal. It takes awhile to get back to “normal” to the point where you’ve forgotten that I, your surgeon, exist.
How do people generally handle the recovery process emotionally, physically, etc.?
(ST): Most people handle post-op very well because of the way we explain things to them preoperatively.
Example: if you’ve never seen a roller coaster before, and you get on the biggest, “baddest” coaster ever, you may think you’re going to die.
But if you’ve been on a coaster before, then you at least know in general the things that will happen on a roller coaster.
So we try to paint the roller coaster for our patients. We want them to know what it’s going to be like before they actually experience it.
And we celebrate milestones. It’s all about the milestones.
We also review a lot–for my own benefit and for the benefit of the patients.
Do you ever have patients who struggle, who have crisis moments?
(ST): Those people who do have crisis moments are generally those that have a bigger problem than we realized going into it. Maybe we saw an old MRI, the tests just didn’t show the extent of the problem, or they are struggling with stiffness.
There are also confounding factors that I don’t necessarily know about: a death in the family, another family member in the hospital–there could be all kinds of things.
In general, 12-16 months time goes by before a procedure has run its course. Having had at least four orthopedic procedures myself, I can attest to that. You’re back and functional, but you’re still dealing with it by making adjustments to your life and doing your exercises at home.
I tell people “There are things that will linger around for quite awhile. This is the nature of muscular skeletal surgery.”
Do you think it’s helpful to share your surgery experiences with patients?
(ST): I try not to bring up my experiences on other people because it can be so different. I want to empathize and be able to say “I know what you’re feeling; I’ve been through this,” but my experience may not be your experience, and the last thing I want to happen is to isolate a patient because his/her experience is not going well or like mine at all.
Sometimes people will ask, and sometimes, my experience just lends itself perfectly to another patient’s experience.
What activities do people ask about returning to the most?
(ST): They’ll want to know when they can go back to making phone calls, emails, visiting people in a sales situation, when they can drive.
Do you ever recommend postponing a procedure for non medical reasons?
(ST): If someone has a lot on her plate unrelated to their injury, and maybe they have some pretty serious issues going on, it’s not the time to have an elective procedure, even if it makes sense medically.
One time, a patient of mine lost a child right before a scheduled surgery, and I told her that we needed to postpone. Family crises can have a very real, detrimental effect on surgical outcomes. She ended up postponing her surgery for about two months and had a great outcome. Had we gone ahead with the procedure two months earlier, I think the initial grief would have dramatically hindered her outcome.
Functionally, mechanically, a patient could be normal again, but if there are still other confounding variables, you may not feel normal. Subjectively, you may not feel like you did well.
Does that subjective feeling have a physical impact?
(ST): Absolutely. The mind is very, very, very powerful. Rehab could not go well. You may think “I can’t do it,” and then your mind makes it so that you really can’t do it. Then you have to overcome two hurdles: a healing body and negative mind.
When you sign someone up for surgery, you need to be sure–absolutely sure–that they are ready.