Unpacking: Surgery Day
If you’ve ever wondered why surgery can “fix” the structure but not always fix the pain, you’re not alone.
Dr. Megan Steele and Holly Osborne explore what really influences surgical outcomes, especially for people living with chronic pain. Join them as they break down why pain isn’t purely mechanical, how your nervous system’s threat detection can shape recovery (even under anesthesia), and why scar tissue, stress, and past medical experiences can change the healing process.
You’ll also hear practical ways to prepare before surgery - like prehab, planning for the hospital experience, and using calming strategies to dial down stress - plus realistic post-op considerations many people aren’t warned about, including digestion issues, brain fog, and why early movement matters. Along the way, they share a simple framework for evaluating newer procedures and what to ask a surgeon before agreeing to an approach that may not have a long track record.
Helpful for anyone weighing surgery, supporting someone through it, or trying to make sense of why “successful” operations don’t always lead to relief.
Links to interesting things from this episode:
Transcript
When you're under anesthesia, you're not dead, right? The part of your brain that senses and has awareness and those types of things is offline.
But the part of your brain that does the survival mechanism, does the threat detection, does some other important things to keep you breathing and functioning. Brainstem type of things is online still. And so you're cutting into a body that has a threat detection system that's online.
And for again, a newbie who's never had this surgery before, maybe they're going into it with highest of hopes. They heard great things about this surgeon. They're mentally prepared, all the things.
Their threat detection system is going to be at a different rate than somebody who's gone through this surgery and had negative outcomes.
Intro:Welcome to Unpacking Pain, a podcast dedicated to understanding the complexities of chronic pain, what causes it, how it affects our lives and what we can do about it.
Join Doctor of Physical Therapy and Pain science researcher Dr. Megan Steele and me, Holly Osborne, a chronic pain sufferer, as together we explore the biological, psychological and social aspects of chronic pain and create community and understanding in the process.
Holly:We are diving into an interesting topic today which I think is inevitably on the minds of people who are suffering chronic pain. It's a surgery day.
We are talking surgery going under the knife and or going under the laser as the case may be and in modern days. But Dr. Megan and I both have some, some perspectives to share on this and hopefully some, some helpful education.
And I think really a good place to start is in just mapping out for you where we want this conversation to go to let you know, we want to talk a little bit about why sometimes surgery works and why sometimes it doesn't.
So we're going to hear from Dr. Megan on that and then we're also going to get into some pre and post op tips and tricks, some things that you can do physically and mentally to prepare yourself. We may even chat a little bit about how to pick the right surgeon. I've got some thoughts I can share on that.
So without further ado, I want to tap into Dr. Megan's expertise here around why there are times that surgery works brilliantly, but other times it just does not seem to fix the problem. Can you help us unpack that, please?
Megan:Sure. Well, there are a number of reasons why surgery doesn't always work, but one of the primary reasons is that pain is not just biological.
Pain involves, as we've talked about many times on this podcast, our psychological state, our social factors that contribute.
And so if we were machines, if we were robots and there was a malfunction in a wire or there was a ball bearing that wasn't working particularly well. You would go in and you would replace it or repair it and problem solved. But we are much more complex human beings.
And so some of the time that works quite well. You get in there and you take the old knee joint out and you put the new knee joint in and life is joy and other times not so much.
Holly:Do we think that there's evidence that that shows like the right moment for someone to have surgery? Is it sometimes that we've waited too long and the injury is too far gone?
Megan:That's a great question. And I don't know that there's really solid, concrete evidence for every type of surgery in this, in that question.
But what I do hear often from surgeons and from patients who come back from a surgical consult is they want you to say surgery should be your last resort. And I completely agree with that. Your body will never be the same after surgery. And so it should be.
Actually, I'm going to say I don't completely agree with that. I partially agree with that. I think it should be one of your last resorts.
But because you want to have tried other less invasive, less potentially life changing options first, and oftentimes they say once it's starting to impede or impair your quality of life, for example, we can go back to the knee surgery example and you can say, my knee's bothering me, it's stiff and achy, I can still do my walks, I can still get up and down off the floor, I can still participate with my grandchildren.
But when those things start to not be true anymore, that's when I start saying to someone, okay, let's really start considering seriously the potential of surgery.
And why I don't agree with the absolute last resort example is because, not because more damage has occurred, but because when your knee is so, so bad that you're either walking on a bent leg or you're doing other things, you'll start to see compensations in the body.
So if I'm walking on a bent knee, I'm kind of doing this sort of like limping with every step, side bend, which is going to affect my back, it's going to affect my hip, it's going to affect my ankle.
So once I'm to that point where it's so bad I'm affecting other joints, that, that may be a situation where I might have waited too long and, or if it, if I'm no longer participating with my family, I can't do the things I enjoy, and that's affecting my mental health or my social relationships. That may also be a time where maybe I've waited a little bit too long.
Holly:You said something that I'd really love to spend a little bit more time on too, which is that your body is never really the same after surgery.
And I think it would be helpful to expand on what we mean by that because we know that if someone's a first time surgery recipient, they do know that they will be changed and that they probably expect a scar or, you know, some, some evidence of stitching. But the way that they probably expect things to be different is pure improvement. Right.
It's like, well, I certainly hope I'm not the same after the surgery. But. But you know, and I know also from experience as well, that we actually can experience some sort of unintended consequences. Right. Some.
Some downside. The body does make some sacrifices and experiences something that isn't always positive. What can you tell us about that part of it?
What are the ways in which our bodies might potentially change from a surgery that we would not have necessarily put in the plus column?
Megan:Sure.
You know, there are so many ways that your body can change from a surgery, but I would say primarily one of the big issues we think about and talk about and are concerned with is scar tissue.
Scar tissue is almost always going to be a factor because anytime that you cut into the body's tissue and the healing, you know that that tissue has to come back together at some point. Um, anywhere you've cut through, you don't get that normal tissue to grow back. In most cases, you get scar tissue in between. And so any area.
I always tell people that physical therapists would be great, like consultants for your fantasy football team. Right. Because they can tell you, oh, this person had a grade three muscle strain, that muscle is going to fill in with a fair amount of scar tissue.
So I would trade that player. Right.
Holly:I like this in mind for my husband's next round.
Megan:There you go. Yes, I, I work by the hour. No, by the player, obviously.
But you know, something like a grade one muscle tear, which is equivalent to maybe like a micro surgery potentially, that has a more, more likelihood of that muscle being able to grow back a little bit stronger, maybe a little less scar tissue in between. And so they'll be able to get back to maybe 95% strength.
Whereas somebody, and I'm making these numbers up, these are not based in fact just for generalities, whereas somebody with a much larger muscle tear would Maybe get back to 75% strength. Now, a professional athlete is still gonna run circles around you. And I. Holly. Well, I'll speak for myself there, at least me.
Holly:No, you're. You're right.
Megan:And so 75% may be enough for them to get back to a very high level of activity. But again, scar tissue is always a component of things.
And it has to be taken into account when you're thinking about, how am I going to recover from this?
Holly:When someone comes out of surgery, is there something they can be doing in like right off the bat to battle back that scar tissue and prevent it, or is it an inevitability depend? I mean, of course, that every body is.
Heals differently, but as a general rule, is there something we should or could be doing differently to avoid that?
Megan:Well, it depends on a lot of things. Some people genetically make a lot of scar tissue. And you'll see this in people who have keloid scarring. If they have like a.
A skin laceration or something, you'll see kind of a bubble where that that injury was. And that's an indicator that their body makes a great deal of scar tissue. And that typically is seen.
They go under the knife for other types of surgeries, but we don't always know who's going to lay down a great deal of scar tissue compared to those who won't. And there are certain types of surgery, like knee surgery.
If you begin your mobility work early on in your recovery, you're less likely to lay down scar tissue in such a way that limits your mobility. So you will still lay down scar tissue, but because you're keeping moving, that scar tissue is less likely to impede your movement.
And from a pain science standpoint, the things that you do after surgery are nowhere near as important as the things that you do before surgery.
Holly:Oh, that's interesting. Okay, I'll. Let's definitely get into that in a minute. I've got a couple more questions for you on the the why my surgery didn't work topic.
Megan:Sure.
Holly:So question about the scar tissue, because this is really opening up, I think a helpful understanding of what the body goes through, you know, before and after.
If someone were unfortunate enough to have to have a repeat surgery, does that scar tissue come back with an even greater vengeance the second time around? Does it kind of end up taking over or it's a fresh start each time sometimes.
Megan:I mean, that again, depends on if they go through the same scar again or if they go through those same holes again. Usually they can't go through the Same area in terms of arthroscopic surgery, they would go, like, just slightly adjacent to it.
And again, it depends on your genetics. Are you somebody that lays down a lot of scar tissue? Are you somebody that's going to get moving pretty quickly out of surgery? Are you.
Did you have a type of surgery where you can start to move quickly after surgery, or do you need to be immobilized in a sling for six to eight weeks? Yeah, there are a lot of factors, but there are. I always laugh at the. There's a type of surgery.
I cannot remember the name of it right now for the life of me, but it's basically to go in and clean up scar tissue, like a debridement, essentially, if there's a lot of scar tissue in an area that's inhibiting movement.
But that never really made sense to me because I'm always thinking about, okay, you're going in to get rid of scar tissue, but what are you creating when you cut somebody open again to go in there? Right.
Holly:Yes. That was one of the surgery options that was offered to me along the journey before I was able to get my shoulder replaced.
So as they were trying to kind of put that off and buy more time before the replacement, one of the surgical options was, we're gonna go in, aggressively, remove scar tissue around the shoulder, and then we're gonna give you a pain blocker in your ne so that as soon as you come out of surgery, you have no pain for weeks on end. And the protocol in physical therapy. And this is where I'm dying to get your perspective. Is to.
We are going to crank, crank, crank the living daylights out of your shoulder so that the scar tissue has no chance to reform. And I thought that sounded worse than 100 root canals in 100 days. And I just. It just. I think that certainly. Look, we're not here.
I'm certainly not here to make any kind of medical assessments, but I think you. You reach a point where a certain part of your body is going through hell over and over again.
How much more disruption, inflammation, upset, trauma are you willing to inflict? I think there's a point where you have to start to Megan's point. Think about, you know, am I bad enough here?
Is this dire enough that I'm willing to take the chance? That was a no for me, that.
Megan:That one, having been through as many surgeries as you went through, your nervous system, has a memory of that. Right.
And so you go into a surgery with a different frame of mind than someone who's A newbie, we'll call them, who's never been through a shoulder surgery. Right.
You go into shoulder surgery with all the history and knowledge and understanding of how things did not go right or well or according to plan, or the pain increased, or it was very challenging after surgery. All of those things play a factor or play a role in your outcome from the next surgery. That's.
Holly:That's really interesting because it hearkens back to some conversations we've had from prior episodes around the body's pain memory and the nervous system's threat detection mechanism. Right. And so it. It's probably on high alerts.
Megan:Yeah, absolutely. So a big part of that, too, has to do with the fact that when you're under anesthesia, you're not dead. Right.
The part of your brain that senses and has awareness and those types of things is offline.
Holly:But.
Megan:But the part of your brain that does the survival mechanism, does the threat detection, does some other important things to keep you breathing and functioning. Brainstem type of things is online still. And so you're cutting into a body that has a threat detection system that's online.
And for, again, a newbie who's never had this surgery before, maybe they're going into it with highest of hopes. They heard great things about this surgeon. They're mentally prepared, all the things.
Their threat detection system is going to be at a different rate than somebody who's gone through this surgery and had negative outcomes.
Holly:Great point and fascinating about the way the mind works when you're under anesthesia and am I making this up, or were there some studies around what patients undergoing surgery could actually hear happening in the room as they were being operated upon? Basically, what the surgical team talks about, even the music that's being played could affect the brain and the perception of how the surgery went.
Is that a legit study?
Megan:I'm not up to date on that research, but there has been research about positive versus negative interactions between the care team in the surgery room and the positivity or negativity of the music impacting some things. And I'm sure that goes back to some of that threat detection system that's like you say, still online.
Holly:Interesting.
Megan:Yeah.
Holly:I've read about certain patients requesting that their surgery team say certain words that they play certain music that they avoid. Other words too, I think. And this is talk about people who are newbies versus veterans. I think those requests probably come from the veterans.
Megan:I would guess.
Holly:Yes.
Megan:Yeah.
Holly:Okay. This is my third rodeo or whatever it is. Um, so why do we sometimes need Multiple surgeries. I. I know the answer for myself, but let's. Never mind me.
Let. Let's. Let's talk about why someone's knee, or why someone's. Whatever it is, wrist might need multiple surgeries.
Is it because the first one didn't work, or is there a progress? Like, does the technology get better so a few years later we can do something better?
Megan:I'd say both of those are true. And there are, you know, many, many other factors that people require a repeat surgery for. So I'll give the example of a lumbar spine fusion.
So typically, if there is an issue between two lumbar vertebrae, they'll go in and they'll put in something where that
Holly:disc used to be.
Megan:So they're kind of giving you a little bit more space in that area so those nerves can have room to move and they're not being pressed upon. And then oftentimes, they'll fuse the vertebrae above and below so that.
That doesn't create an issue in the future, but anytime in the body where you've got an area that has less mobility above and below, then have to kind of pick up the slack. And so what sometimes can happen is people will have a fusion, and then a few years later, they have to fuse the level above.
A few years later, they fuse the level above, and so on and so forth, because they're constantly asking more of those other vertebrae.
Holly:I see. Okay. Could we talk for a minute about surgeries that are tried and true versus something that's a little bit newer or more experimental? I'm.
I'm curious about how we can help people listening, evaluate, maybe, and certainly again, want to disclaim. We're not here to offer medical advice by any means, but perhaps just a framework to think through, particularly in the shoulder area.
A lot of times in joint replacement, new techniques keep coming online. And, you know, some of these sound really good in description. Others of them end up discontinued.
And so I. I've had about three or four of the procedures that I've undergone are just not discovered done anymore. Like, for example, shaving down the person's collarbone.
I lost 2 inches off the end of my collarbone in the hopes that that would open up more room for my shoulder to rotate. Turns out that that's not a winner.
Megan:Yeah.
Holly:OATS procedure, which is an acronym for bone plug replacement. Not really a winner. Hemiarthroplasty, which was. I had a half shoulder replacement. Sorry, once again.
If you were on Family Feud, you're gonna have three strikes. You are totally. Yeah. Okay.
But each time I think the patient can hear something in something very positive in the idea that there's a new technique that's been developed. Dr. Megan, what are some questions that we could be asking? What are some things we could be doing to educate ourselves?
How do we make a decision whether to go for something that's a little bit newer?
Megan:That's a great question. And of course, it's going to come down to everybody's individual risk tolerance. Right.
Am I somebody that wants to go for it and risk it even if it's going to potentially negatively affect my function if it doesn't work out, or am I going to wait and see? Me personally, I'm quite risk averse, having had a surgery once. No, that's not true. I had my tonsils out, but that doesn't really count.
I had one orthopedic surgery when I broke my leg in undergrad, and that was when I decided I'd prefer to never do that again. Thank you so much. I had a couple of surgeries to remove some hardware afterward that were pretty minor.
But, yeah, if I can avoid surgery in the future, I will do it at all costs. With the exception of maybe something like a total hip replacement. I think it's like a 98% success rate on total hip replacements.
And the most common thing that people say after having the total hip replacement, can you guess what it is?
Holly:Why did I wait?
Megan:You're absolutely right. Ding, ding, ding. I wish I would have done it sooner. Yeah. Why did I wait so long? Yeah, it's just a very successful surgery.
It's a very stable joint now. They do them anteriorly, so they have to cut through very little muscle to get to your hip joint. It's just the technology has.
Has come a long way there. And yeah, it's a great surgery.
If it were me in terms of like an experimental surgery or kind of a new surgery, and I've had patients who have had, it seems like the shoulder, they're always coming up with new and different. Like, I had a patient who had a capsular shrinkage surgery when she was in high school, which is really not terribly common anymore.
And if it were me, I would. I would say, how many surgeries have you done like this? How long has this surgery been around? And what's the success rate of this surgery?
And not only the success rate, but the success rate for people that look like me? Because when. Yeah, that's big. It is big.
Because when you take the broad swath of success rates, they're taking all of the population that's had this type of surgery and we can parse out and we can say, for 29 year old females such as myself, how is the success rate? Right. Young, healthy, gorgeous females, do they have stunning women? Do they have a higher success rate than your 60 year old males, for example?
You know what I mean?
Holly:Right.
Megan:So, so what's the overall success rate? And, and then what are the success rate for people that are like me?
Obviously, in new, newest surgeries, they're not always going to be able to give you those numbers. They're going to say, maybe we've done this twice and none of the, none of our previous patients looked like you or were like you in any way.
In that case, if it were me, I'm going to say, I'll give it a year. You know, yes, I'll let you get a couple reps under your belt.
But I'm also the person that like, I don't ever switch to the new phone when it first comes out. I'm like, let's make sure it doesn't light on fire first and then I'll think about it.
Holly:Okay, so you're not an early adopter.
Megan:That's very, say, very not. Yeah, very much not. And yeah, I want to know that it works. I want to know that it's safe.
I want to know that, you know, I'm not going to have to go under the knife again like you say.
Holly:It actually reminds me of another question that is good to ask is ask the surgeon herself or himself how many times they have done the surgery.
Megan:Absolutely.
Holly:Yep. So, you know, there are thousands of shoulder replacements done in the US probably every month or whatever the stat is.
Uh, so it is a common, it is not an uncommon surgery. But how many times a month does your surgeon perform this particular procedure? Sure.
And yeah, you may not be able to ascertain success rate from that particular surgeon. That may be proprietary information. But one of the other things that I like to do is ask if I can speak with someone else who's had the procedure.
Megan:That's a great idea.
Holly:It's cool. It's not always offered. Although in cancer related surgeries such as prostate or mastectomy, the programs are a little bit more developed.
They do a good job oftentimes of connecting you with other cancer survivors who've undergone a surgery because there's just a lot involved in that recovery and the choice to go into radiation or not or so forth. So there's a little bit more support there.
From what I've understand But in terms of choosing a knee replacement or not, it's not like they have a database of, like, well, you know, here's this wonderful guy, Jeremy. He loves to talk to all our patients about his. That is less likely to happen.
But if you ask for it, the hospital or the surgery center is likely to make an effort to connect you with someone who's been through it.
Megan:Absolutely.
And I think also another great place to meet people who have gone through a surgery that you're considering or have gone through yourself is in physical therapy.
Holly:Oh, yeah?
Megan:Yeah.
If you're in an open gym and you're looking around in the waiting room and you see a big scar going down the front of someone's knee and you're in line for a knee replacement, hey, how'd it go? You know, what are your impressions? And that doesn't mean that you're going to have the same experience.
I often tell people, you know, no two surgeries are ever the same because no two people are ever the same. And two knee replacements, even within the same body, are going to be completely different surgeries. But if you want to get an idea for generalities.
Excuse me, I'm going to say that again. If you want to get an idea for generalities of, you know, what somebody's impressions of this surgery are, you could ask.
Ask your neighbor on the physical therapy table right next to you.
It might also be nice to know a little bit about that person before you take their opinion and make decisions with it, because you might not know that this person has PTSD or they had a tremendous amount of childhood trauma, or this injury was from a very traumatic car accident. Those types of things are all going to, of course, play a role in how they recover and how they experience the surgery.
And so that would be important for me to know if I'm saying, hmm, I wonder if my experience will be similar to yours.
Holly:That's really helpful. I mean, and even if you can't, if it's not okay to ask those kinds of questions because they're sort of a new person, they're.
You're sort of strangers to each other, then I think Dr. Megan's point still stands, where you just need to take it with a grain of salt that it's just like anything too, in life, right, where someone. Two people can take the same bite of, like, a seafood dish and one person finds it totally foul, and the other person is. Is in heaven.
So it's just that, you know, where to each his or her own experiences.
And we know from everything We've learned from Dr. Megan so far that based on the biopsychosocial model, that these other factors she mentioned, like ptsd, like an adverse childhood situation or experience, or, you know, it could be something along the lines of your. How much sleep you're getting, how much stress you. How dedicated were you to physical therapy?
All these things can affect how someone came out of something and healed.
Megan:Absolutely. And I think that's a great segue into how can we go into surgery hoping for the best outcome or in an attempt to ensure the best outcome.
Holly:Absolutely. But do you mind if I just do a quick shout out?
Because when you mentioned asking someone to physical therapy, I want to remind everybody out there that PT is one of the best places to meet a cute person to date. So if we have any lonely listeners out there and you're going to physical therapy, do not say sleep on that. Because, Ivy, it is just an easy way.
Like, if they look cute to you,
Megan:they're on the table next to you.
Holly:It is so easy to be like, wow, what happened to you there?
And everybody loves talking about their injuries, so I just couldn't help but throw that out there because, you know, also just to have a buddy along in the pain journey, maybe you just make a new friend at pt and it's like you share stories and so forth, but. All right. Okay. That's my little. My little public service announcement.
Megan:That's a great idea. Way to get people to come into their. Their PT appointments. You might make a love connection. You never know.
Holly:I know. Dr. Megan, you might be. You might end up the first PT who has, like, a Tinder section of your app.
Megan:That sounds a little intense. Yeah, I'm going to hold off on that for right now, but I'll. I'll roll it around.
Holly:I'm teasing. I'm teasing. Okay, so, yeah, I think your. Your segue was right on.
I think it'd be helpful to understand what are some of the things that people can be doing, Mindset, physically, all of the above, when they're heading into surgery, what makes a difference?
Megan:Okay, so first thing would be, you talked about how. How can we know, you know, when is the right time for surgery?
And I think there's one way to know or to help you decide whether or not your particular case is surgical or not. And that is what is my symptom pattern? Do my symptoms change with movement?
Do my symptoms change with inactivity, activity, a certain type of movement? Those types of things will give you a lot of insight into what's driving that protective pain mechanism.
And again, we're talking about people who've had pain for longer than three months. So these are our chronic people that we're talking about.
And if your pain doesn't fit a quote unquote pattern or a predictable pattern, that may be a signal that your pain is not just mechanical or not even primarily mechanical.
It may have been at one time, but as things have gone on longer and longer, the biological piece has healed and now there may be another piece of that biopsychosocial pie that's driving this
Holly:good reminder. And I think it's hard for some people to hear that message the first time. It, it might take a little while to soak in.
And like we've discussed in previous episodes, not everybody is ready to open themselves up to that possibility and to examine what may be going on for them psychologically and socially. But as we've said before, you eventually hit a point where it's just not working anymore.
Megan:Right.
Holly:Similar almost to the point where you decide the surgery is the right option. Right. Where you've noticed that everything that you've thrown at it is not working and your lifestyle is still affected enough. Your life is.
You're not getting on the floor to play with grandchildren. It's time to do something that's also happens on the emotional journey. Right. Dr. Megan, you.
You said you have patients sometimes who aren't forthcoming in the beginning of treatment, but over time they start to sort of unpack like a lotus flower. Like, hey, I think I'm open to exploring what else may be going on here.
Megan:Sure. Yeah, absolutely. And I mean, I don't blame them either.
Being somebody who's very risk averse, I'm not gonna meet you and tell you my whole life story and all of my past traumas and those types of things. And, you know, as we go along and I, I earn your trust and you decide, I'm not an idiot, hopefully.
And we work through some of the musculoskeletal, some of the biological components of what could be contributing to your pain.
And you're saying, I'm still having a percentage of pain or I'm still having pain when I get really stressed or really sad or really afraid, then we can say, well, would you be open to starting to talk a little bit about that?
And I think that's a really important piece to help people to recognize and understand that, like we've talked about many times, pain is not just physical.
And I think part of some people's hesitation there comes from the medical Community not recognizing that for so many years and then dismissing people who show up with great looking X rays or negative mri. So there is something called Waddell signs that were meant to determine who would and who would not benefit from back surgery.
mean, a long time ago in the: Holly:feeling old, sorry.
Megan:And they were developed by someone who meant them to be used as a way to determine who had biological. He called them non organic or organic components to their low back pain.
And so what happened was when people would fail these Waddell signs, rather than saying, oh, this is not an organic thing, it.
It then became, oh, well, these people are malingering or they have a secondary gain as to why they're not getting better or they're exaggerating those types of things. And so understandably, this led to decreased faith and decreased trust in the medical community.
If I'm, if I can't see it on a scan, then I'm going to call you a faker.
Holly:That's tough.
Megan:Yeah, that doesn't really work out for those people that have real pain that's just not caused by biological symptoms or the biology.
And so luckily over the last few years, people are starting to recognize, I mean, I learned Waddell signs when I was in PT school as a way to weed out malingerers.
Holly:Is it malinger, someone who is getting some sort of attention or benefit from being in pain?
Megan:Right. Yeah, it's like a fancy term for faking.
Holly:Okay, okay, yeah, that. That's gotta touch a nerve for so many people. Anyone listening? Myself included. You too, Dr. Megan. You've been through surgery. You've.
And you, you treat patients who oftentimes aren't seen, quote unquote, fully seen for them full. Their full selves and their full suffering.
Megan:Absolutely.
Holly:That's a tough one.
And I think also you've shared that you do have a responsibility as a practitioner to get to the bottom of if there is something really fuzzy, very nebulous and kind of hard to pin down about what is really happening here with this person. Obviously there's. You want to be. I think you've described looking for potential secondary gain. You're not completely closing the door to that.
But I think what we learned more times than not is that the pain, even if it's not, it almost doesn't even matter if it's on the X ray or not. Right. It's like if the person's experiencing it, that it is real and it needs to be treated.
Megan:That is exactly the way that I approach it. I want you to say that again. Say that again.
Holly:Yeah. It's like it doesn't matter if the X ray shows it or not. If you are in pain, that's real and it needs to be treated.
Megan:That's exactly right.
If we can't see it and you can't measure it and you can't objectify it and put it into a number and that's the way that you treat someone, then you need to refer that person to someone else because you're not the practitioner for them. It's not that they have the problem. And for so long we've shifted the onus back onto the patient and said, well, can't find anything.
So what are you getting out of this kind of thing? Right. And anybody who's been on a pain journey that's encountered any number of medical professionals has at least had that experience once. Right.
Where you were, if not outright accused, then sort of at least insinuated that like, well, are you having a good time off work or what is it? Right, yeah.
Holly:Isn't that interesting? I think that you can have a generous, even work in a situation where there is some generous leeway for recovery.
In fact, even in the uk, if I'm not mistaken, maternity leave is mandatory one year away, which is amazing. Right.
Megan:Everyone gets more than us in the us. I don't even praise, praise that. But yes, bless them. Happy for them.
Holly:Yeah.
Megan:Moderately jealous, but happy for them.
Holly:Little jealous. Yeah.
But I think that there's such a huge misunderstanding around what recovery is like for people who've gone through bodily trauma and, or who experience persistent pain. And you know, I think that it is a complex bundle of, of circumstances. It's never just one thing.
And I, I think we need more and more people to start understanding that it's a three legged stool. And you may even say, well, our co worker Jenny, I never saw she had a limp before. She wasn't limping. So what's up with this?
You know, she's out again for this, this knee pain and just remember that you have really no insight into that person's story. You really can't know, just as Jenny has no clue about what you've been through. So it's just a good reminder.
Megan:Yeah, it is, yeah. And, and to that end, you know, there are things that we can do as individuals to help ourselves on the way out of surgery.
So even if you're someone that's had a lot of trauma, who's had a lot of body Bodily injury had a lot of surgeries that didn't go great. And they've determined everybody's on board. This surgery needs to happen.
I want to say one of the most important things that you can do is help your threat detection system not start out at 11. And one way you can do that is go to the surgery center or the hospital beforehand, get the lay of the land, visualize it.
Maybe you get somebody to give you a tour. Sometimes that happens. See what the gowns are like, see what the beds are going to be like.
Maybe they could even give you a picture of an operating bay if they can't necessarily bring you in there to see a tour. And then your job is to go back and visualize while regulating your nervous system before going into surgery.
Holly:Okay. This is pretty powerful because I've been handed tools like, hey, here's a breathing exercise to start in the week leading up to your surgery.
But I didn't always know why. What was the context? What am I trying to do here? Is it just kind of. Because being calm is good. But it sounds like it sounds. Yes, that's true.
But it sounds like it works even a little bit more deeply than that.
Megan:Yes, absolutely. So being calm is great. That's when you have your thinking brain online.
And that's also when your body does less protecting, less of that subconscious reflexive protecting of your body.
And that's when your body can dedicate more resources to healing, because it's not dedicating resources to flooding your system with epinephrine and cortisol and all these other stress hormones that get you ready to go, ready to run, ready to fight, which you don't need when you're going into surgery. You want to be in a place of calm and relaxation and rest and digest.
And I mean to say nothing of the digestive issues that can sometimes happen after surgery. That can be a huge bonus of breath work after surgery and before surgery.
And so, really, if I have somebody that's going into surgery, one of my main goals is how can we get pictures of this place where you're going to have surgery? How can you talk to as many people as are going to be in the room with you? Who can you have in the waiting room with you?
You know, we've talked a lot about social connection. You want to have that, like, primary safety person in your life in the waiting room with you, holding your hand, telling you positive things.
You want to know that they're going to be that first person you see when you wake up on the Other side. That's not, you know, part of your medical team. All of those things help to just take that threat detection system down a notch.
Holly:Truth. I mean, yeah, that makes a huge difference.
One of the things that I've discovered over different surgeries at different hospitals is that parking is a friggin nightmare.
Megan:Yes, and good point.
Holly:And so oftentimes you pull up for the day of surgery and it is chaos because you were supposed to be in there at a specific time and you're running a couple minutes late because of traffic and there is nowhere to park. And how could there be so many people already at this hospital at 7:18am Right?
Megan:Yes, exactly.
Holly:I've had situations where I'm frazzled and upset and apologizing already when I walk into the surgery. I'm sorry I'm late, you know, I'm ready, I'm ready. I mean, wait, I don't have my wallet here. My wallet's still in the car.
You know it's just like that, right? Yeah, these are little tips and tricks.
But okay, so we want a mindset going into it that you said something that's so powerful and I want to repeat it again about enabling our threat detection system to calm down or sort of disabling.
Megan:That would.
Holly:Is that the right way of saying it?
Megan:Well, you're never going to disable it because you need to keep breathing. Darn it. You know,
Holly:can't ever go totally out.
Megan:Yeah, shoot. Your heart has to keep beating. I suppose it's just a little inconvenient. But yeah, so you'll never disable it.
But you can, you know, you can turn up the dial and you can turn down the dial and you want the dial to be turned down. You want to say, I got here an hour early, I had a little nosh, you know, I got a scone, whatever it is, I'm relaxed.
I'm going into this situation in a really positive way. I want my support person to only say positive things to me. They got a text message about something weird that happened at home. Keep it to yourself.
We are in positive mode here. Right. Like I can deal with that. Maybe after surgery. But before I go in, I want really happy, positive, lovely things to be said to me.
I want to be going in thinking that this is going to have a really positive outcome. And I may also, I guess I would say the other thing would be prehab. Of course.
I'm a physical therapist, so I'm going to advocate for physical therapy.
And there are a fair number of surgeons, at least Where I am in Southern California, that for things like ACL tears, are having patients come in to physical therapy before surgery so that they can get more range of motion and more strength. Because oftentimes the way that you go in surgery is the way that you come out of surgery that makes sense.
So that would be my other recommendation for how to prepare yourself, is you want to go into surgery with the most strength and the most range of motion that you can.
Which is again why I think like that, that waiting until the last absolute minute for surgery is not ideal because it's very likely that you're so debilitated that you've lost some strength and you probably have lost some range of motion. And so let it be like the second to last resort potentially for surgery.
Holly:I like that. And it's a really helpful. I don't think a lot of people have really considered or would, would realize that there'd be a reason to do prehab.
And it just makes all the sense in the world, right, that you're strengthening, that you're creating mobility, blood flow, all of those positive things to the area. I mean, it's. What's that phrase? If you rest, you rust. And I, I think there's something to be said for when you come out of surgery.
As Dr. Megan was describing, the scar tissue is doing its job. It's coming on fast and furious. Right. Thinking that it's protecting you.
And the less mobility, strength, balance, get up and go that you had going into that surgery, I just can only imagine how much harder it would be to get yourself back.
Megan:Right. Yeah.
You have to remember surgery is going to wipe you out for a couple of days, if not a week or so, and then you'll slowly start to regain movement. And you know, maybe it's standing on the edge of your bed once or twice a day is your goal at that point, depending on your type of surgery.
Or Maybe it's walking 20ft down the hall. Those are good early movement potentials because, yeah, you don't want to rest.
They used to do that with people after surgeries and they found that the outcomes were so much better with early mobilizations and even things like hip and knee replacements.
n, in a hospital, this was in:So people needed to be up with physical therapy, out of bed, assessed, have an exercise program all given to them on the same day that they had surgery.
Holly:Ah.
Megan:And they would even have a special shift that was like 5 to 8pm or something that you could pick up if you needed, you know, an extra evening shift. Because we had one surgeon that would just go all day long.
And so some of his surgeries would finish at five or finish at six or, sorry, four or five. And then he still wanted those people to get up same day.
Holly:Yeah. So that's an interesting protocol that just affirms that that movement immediately after is.
Megan:Is.
Holly:Is a positive thing.
And I remember actually when I think it was my, after my replacements that an occupational therapist would come in the room and get me to do just unweighted pendulums and I was like, leave me alone, man. Like, I'm just, I'm recovering here. It actually, yeah, I think that was a really smart thing.
I, I have a couple other little tips and tricks for coming out of surgery as well. And one of them is around something you just mentioned, Dr. Megan of Digestion.
I think some people have not been prepared for what happens down there. It is brutal. And this, this does not know gender or age.
12 year olds and 62 year olds and 80 year olds and everything in between experience some really difficult digestive issues. You can talk to your doctor a little bit more about what that entails, but be ready for that because that can be its own separate struggle.
Megan:Sure, absolutely. And it can compound, you know, some of the suffering and the discomfort that you're having after surgery as well.
Holly:Totally. Yeah. It's like. And some of it, I think, is it from the anesthesia, Dr. Megan. And then. Okay, so that's because they shut it all down.
And then I think certain of the painkillers also are not helpful.
Megan:Correct.
Holly:For that.
Megan:Yeah. So, yeah, it's like the perfect storm. So you have anesthesia, you have painkillers, and then you're moving less.
So and you're probably eating a lot less, you know, leafy greens and fruits and vegetables and things like that. So all of those things contribute.
And I always tell people, if you have the type of surgery where you have to have a BM before you leave the hospital, start with the prunes before you go in. Start with something.
Yeah, that's going to help you because if not, you're going to be subjected to the magic bullet, which every hospital has a different magic bullet, but the hospital all mint. The hospital where I worked, it was warm prune juice with butter.
Holly:Yeah, it's rough. I had one surgery where they did not allow me to leave. This was at usc, University of Southern California. They operate out of a city hospital.
But I thought that the nurse just had it in for me. It was like, I don't see why I have to do this because here, just let me go home. I swear I'll make it happen.
She's like, you're not leaving this hospital until you do. Number two. I was. This is so wrong.
Megan:Adding insult injury.
Holly:Okay, so moving on from that embarrassing anecdote, another thing is also related to food. Try to, try to get your food protocol sorted out before you get home from surgery.
Megan:Yes.
Holly:And yeah, so you gotta have the healthy things to eat, the right things to eat, but also a little bit of nurturing. You know, some. Some feel good foods, within reason. I'm not talking about a freaking Tabasco flavored Slim Jim.
Like, please, like, don't be ridiculous. That would be. But yeah, I think have that set up. Have a couple days worth of food and snacks and things set up.
Okay, one other thing, and then I'll pass it back to you, Dr. Megan, and we'll. We'll wrap up in a minute, but. Okay. Anesthesia. I know it's going to hit everybody a little bit differently.
I turn into a big dum dum for several days, even up to a week after anesthesia, and experience challenges in things like telling time and counting money. So I have been known a week after surgery to.
I went to a Starbucks, paid, handed like a $10 bill over for my latte, and could make no sense of what the barista was handing back to me and kept trying to hand her a bill back. And she was like, no, sweetheart, no. You just know you. That you keep that part in your hand. Okay. And reading the clock, I was like, is it quarter to?
No. What is it? Wait, what am I looking at? So what. What the heck is going on there? Dr. Megan? Is that normal?
Megan:For some people it is. Yeah. And some people have trouble with memory afterwards. Some people in my family come out of surgery swinging.
It's a really lovely thing to have to explain to people. He doesn't hate you. He's just confused, you know? So, yeah, like I say, it hits everyone differently.
And there's some research that's showing us that it stays in our systems for a lot longer than we realize.
And that's another reason why it's great to be drinking fluids and getting moving and having someone around that can make sure you're not giving away your life savings or that can, you know, tell you it's time for a nap and that type of thing. Again, just a support person that, you know, after they, you get home from the surgery and you get comfy on your couch, it's. Their job is not over.
You know, it's. It's really important to have somebody to help you with even sometimes minor tasks, even if you're a quote unquote, healthy, functional person.
Anesthesia is a big deal. And like you say, everyone does come out of it differently.
Holly:That's. Yeah, that's. That's a great way of putting it. It's just, it's. It's a little bit of a mixed bag. You don't necessarily know what you're going to get.
Megan:So you need to.
Holly:You need your person.
Megan:Yes, exactly.
Holly:That may be. Yeah.
Well, if, if our listeners have other questions about going into surgery or evaluating, you know, keep in mind we're not here to dispense that medical advice, but we are here to help you feel seen and, and to, you know, try to direct you as best we can. We can point out some resources or some other things that you can use.
But I, I just want to thank Dr. Megan again for bringing all of this education and learning to the table. It's a big topic, it's a big decision, and it's a big thing for people to go through surgery. So really glad we got to touch on this today.
Megan:Yes, absolutely. And thank you for bringing your experience to this as well. I think that is incredibly valuable.
Holly:I'm glad it counts for something right after.
Megan:After all this. After all the times. Yeah, yeah, exactly.
Holly:All right, well, thanks so much for listening and we look forward to catching you next time.
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