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The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery
(Simple, Practical Techniques for Patient, Family and Friends)

Recover faster from Surgery and feel better sooner with this easy-to-read guidebook to naturally enhanced self-healing:

Recommended by surgeons:

“This book is great – and very well referenced. Thank you for that detail!  Will feature in an upcoming “e” or newsletter.
Christiane Northrup, MD”

“Wow! Great book!  I am very very impressed….I think we are thinking along the same lines…..God that must have taken you forever to write!  Strong work…..well-documented and referenced and a good read.  I will be more than happy to refer patients to you…..
All good things,
Andrew Mirhej, MD”

“Joe Casey presents a very comprehensive discussion to assist patients to prepare themselves better for surgery. Surgery, whether relatively minor or more major, is a concern for most and is frequently accompanied by fear and anxiety. This book offers a generous variety of suggestions ranging from a well-referenced academic approach to psychological and spiritual perspectives. Pre-surgical preparation as described in this book will help allay patient apprehension and promote a favorable surgical outcome.”
Stan James, MD

 “As you prepare yourself or a loved one for surgery, take heed of the invaluable information in the following pages to remove the obstacles to a successful surgery. Practice the exercises to relieve your mind of unnecessary fears; provide your body with the raw materials it requires to do its job of recovering and healing; trust in the ability of your body to respond and heal; invoke the participation of spirit; invite your loved ones to care for you; empower your surgeon and surgical team; and heal on all levels of your Being… The most important message in the following pages is that if you only try a few of the methods of getting ready for your surgery, you will still be way ahead in improving your outcome, and in learning from the extraordinary opportunity that your surgery offers.”
Judith J. Petry, MD, FACS (From the Foreword)

Would You Like to Know How to…
* Heal faster and more fully?
* Feel safer and more confident all the way through?
* Need less medication to be comfortable?
* Minimize hospital errors and hospital-caused infection?

 Surgery is an event that we do better at when we prepare actively. This applies to all kinds of surgeries, whether ‘major’ or ‘minor.’ It helps sometimes to think of it as the mind-body equivalent of a sports event you are training for. The information applies to all kinds: plastic and cosmetic surgery, gastric bypass, eye surgery, heart surgery and others. You will have your own surgery coach to help you make your journey as safe, comfortable and successful as possible.

This groundbreaking book is a bridge between medicine and the expanding world of natural wellness. You don’t have to choose one or the other. They work together. Recent research shows that surgery patients who engage in even one or two of the natural practices in the book have significantly better outcomes in these ways:
* Shorter hospital stays (1.5 days sooner in studies)
* Lower anxiety and stress
* Greater comfort, less pain and need for medication
* Faster incision healing
* Lower incidence of hospital infection
* Minimized possibility of error and complications
* Better overall result – feel better faster
* Lower out-of-pocket expense
The exact information you need to promote yourself into the ranks of the best-healing patients.
You will learn:
* How to increase your comfort levels throughout the process and reduce your need for pain medications afterward.
* Two ways to ensure you stay anesthetized during the operation.
* How to shorten waiting time before the operation and how to make the most of any waiting period that comes up.
* One sure method of avoiding nausea during and after the operation.
* The seven key factors in healing faster, shown by research, and how to use them effectively.
* The single most important factor you need to know to recover more fully.
* Three vital things to know to stay unstressed, even calm, through the entire process.
* Eight different strategies to strengthen your immune system and raise your own powers of self-healing.
* Two crucial things to lower your risk of mistakes and other adverse medical events.
* How to make healing allies of your surgeon and anesthesiologist.
* The secret of why some patients heal faster than others.
And it’s simple
* Easy to read. Every suggestion is explained clearly.
* You will easily learn how to help yourself.
* Well documented: every idea proven to work in published studies.
* Easy to choose from the menu of helpful actions.
* A checklist of questions to ask your doctor and anesthesiologist.
* Endorsed by surgeons.
The key is knowing the right things to do – the ones that have been proven to work most effectively.
The Surgery Coach provides a selection of well-researched techniques that support both your doctor’s work and your goals. Choose one and you will benefit. Choose two, three or more and become a model of recovery. Your doctor might even ask you to advise and coach other patients because your recovery was so remarkably swift and successful.
You’ll find out the best things to do for yourself, why to do them and, most important, how to fit them into your life. Available from amazon.com by clicking here.

Surgery is a major event. It deserves extra attention.  For those interested enough in the subject, there are a lot of good clues in what follows and in other material here.  Many clinical studies have shown that anyone facing surgery, no matter how major or “minor,” can improve the likelihood of a successful outcome with certain non-medical techniques.
A recent comprehensive review of the mind-body literature relating to surgery stated: “Several hundred studies involving thousands of patients confirm that relatively simple behavioral interventions prior to surgery can demonstrably improve postoperative outcomes in such measures as reduced need for pain medication, shorter hospital stays, less blood loss, and fewer surgical complications.”
Dreher H, Mind-Body Interventions for Surgery: Evidence and Exigency, Advances In Mind-Body Medicine 14, 207-222, 1998.
I have made a study of which “interventions” or techniques actually make a difference. I’ve written a book, The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery
I work with people before surgery to help them be emotionally ready, by releasing unnecessary fears and concerns, by visualizing the entire event, and seeing the positive outcome. The purpose is to help you be in the best possible state. I am able to do this by phone or in person.
Many doctors are in favor of patients helping themselves with methods that bring them to the hospital in top form. Doctors and staff know that when patients enter the hospital in a high, positive state, they are more likely to do well. The entire surgical team is happier when patients are mentally, emotionally, and spiritually tuned up. Why? They know that well-prepared patients do better.

 Hypnosis and Imagery before Surgery
I have made two recordings on CD that embody the results of the major research:  Before Surgery and Healing After Surgery or Injury, available here.

There are good reasons to like Guided Sessions
Out of all the things you can do for yourself, the top performer – or very close to it — is hypnosis, or guided imagery. Discovering the evidence, some of which is summarized below, convinced me to study hypnosis in order to help more effectively.
Guided imagery, also called hypnosis, has been studied in hospital settings for over 25 years, now more than ever, as hospitals are realizing that their patients can get better faster. The cumulative research shows that recorded suggestion programs are effective for:
* Increasing immune function.
* Increasing natural killer cell activity.
* Lowering complication rates.
* Reducing and stabilizing blood pressure.
* Lowering anxiety, promoting peace of mind and relaxation.
* Less pain, greater comfort.
* Lowering need for pain medications.
* Reducing depression, raising mood.
* Lowering cholesterol and blood glucose levels.
* Minimizing blood loss during surgery.
* Reducing effects of chemotherapy, especially nausea, depression, and fatigue.

Clearly, you can get good results from a recording. The individual sessions that I do are tailored to the person’s concerns, so there is, I believe, even more benefit, even on the phone.

From an MD hypnotist’s perspective
One of the pioneers of complementary surgery preparation, Neil Neimark, MD, says that basic relaxation techniques, by themselves, are not enough. A surgery is a stressful and demanding body-mind event requiring preparation and training, like an athlete getting ready for a game, he writes. Athletes don’t just relax. They also train, preparing mentally and physically, building up strength and stamina. Dr. Neimark cites a review of the latest research showing “that the best outcomes from pre-operative mind/body interventions are derived when the intervention involves specific ‘training’ of the body and mind.”
Neil F. Neimark MD, Mind & Body: The Newsletter for Health and Healing, Summer 2002.
He delivers the “training” he refers to in a recorded hypnosis session containing specific suggestions of the body’s responses and comfort level. Dr. Neimark has made an excellent tape containing specific suggestions based on the research. He provides a pre-surgery session that instructs your body how to act during and after surgery. The research shows major improvement in results when the patient has received specific instructions, as compared to simple relaxation. http://www.mindbodymed.com/
Here’s Dr. Neimark’s quick summary of why to listen to a recorded pre-surgery preparation:
“Recent studies verify that listening to a properly prepared guided imagery cassette tape prior to surgery can bring about positive post-surgical outcomes in patients, including:
1. decreased blood loss during surgery,
2. decreased length of stay in the hospital and
3. decreased need for post-operative pain medication.
Additional benefits for many patients include improved wound healing and decreased anxiety.”

And please consider owning my book, The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery. There’s a post with that title here.

Science Daily    Tue Aug 28,2007

Hypnosis Reduces Pain And Costs In Breast Cancer Surgery

 The use of hypnosis prior to breast cancer surgery reduced the amount of anesthesia administered during the operation, the level of pain reported afterwards, and the time and cost of the procedure, according to a study published online August 28 in the Journal of the National Cancer Institute.
Breast cancer surgery patients often suffer side effects such as pain, nausea, and fatigue during and after their operation. These complications can lengthen their hospital stay, lead to hospital readmission, or require additional medications–all of which increase medical costs. Several previous studies have suggested that hypnosis may reduce pain, recovery time, and the need for medications after surgery.

Guy Montgomery, Ph.D., of Mount Sinai School of Medicine in New York and colleagues conducted a clinical trial to examine the effects of hypnosis when it is given within one hour before surgery. Two hundred women were randomly assigned to either 15 minutes of hypnosis by a psychologist or a control session in which they spoke with a psychologist.  The researchers then compared the use of pain medications and sedatives during surgery, as well as the levels of pain and other side effects reported afterwards. The hypnosis session began with suggestions for relaxation and pleasant visual imagery. The patients were also given suggestions on how to reduce pain, nausea, and fatigue, and instructions on how to use hypnosis on their own. Patients in the hypnosis group required less anesthesia than patients in the control group. They also reported less pain, nausea, fatigue, discomfort, and emotional upset after surgery. They spent less time in surgery (almost 11 minutes less), and their surgical costs were reduced by about $773 per patient, mainly due to the time savings. “Together, the combination of potential improvements in symptom burden for the hundreds of thousands of women facing breast cancer surgery each year and the economic benefit for institutions argues persuasively for the more widespread application of brief presurgical hypnosis,” the authors write.

In an accompanying editorial, David Spiegel, M.D., of the Stanford University School of Medicine in Palo Alto, Calif., describes the history of hypnosis in medicine and the evidence for why hypnosis could reduce pain.  “It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it … It is now abundantly clear that we can retrain the brain to reduce pain: ‘float rather than fight,'” Spiegel writes.

References:

Article: Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, et al. A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients. J Natl Cancer Inst 2007;99:1304-1312

Editorial: Spiegel D. The Mind Prepared: Hypnosis in Surgery. J Natl Cancer Inst 2007; 99:1280-1281

Note: This story has been adapted from a news release issued by Journal of the National Cancer Institute.

  Number of Inpatient Procedures  (2004)

   National Center for Health Statistics

 

  Total number of inpatient surgical procedures performed:   45.0 million

 Number of selected procedures performed:
-Arteriography and angiocardiography using contrast material: 2.1 million
-Cardiac catheterizations: 1.3 million
-Endoscopy of small intestine with or without biopsy: 1.1 million
-Computerized axial tomography (CAT scans): 828,000
-Diagnostic ultrasound: 813,000
-Balloon angioplasty of coronary artery or coronary atherectomy: 664,000
-Hysterectomy: 617,000
-Reduction of fracture: 667,000
-Endoscopy of large intestine with or without biopsy: 596,000
-Insertion of coronary artery stents: 615,000
-Coronary artery bypass graft: 427,000-Total knee replacement: 478,000
-Total hip replacement: 234,000

Source:  2004 National Hospital Discharge Survey, table 8 

More Data

Discharges with at least one procedure in non-federal short-stay hospitals, by sex, age, and selected procedures, 1993-1994 and 2003-2004 Health United States, 2006, table 99 

Rate of all-listed procedures for discharges from short-stay hospitals by procedure category and age  2004 National Hospital Discharge Survey, table 9 

Source: National Center for Health Statistics                        http://www.cdc.gov/nchs/fastats/insurg.htm

Nine Rewards of Having a Support Team for Your Surgery 

Why do you need a Support Team for any and every surgery? In a nutshell, you will do better, feel better and recover faster. Having support lowers stress and speeds recovery and total healing. Hospital patients receiving personal support do better by every measure: less pain, less need for medication, lower stress and shorter hospital stays. This is a time when it is appropriate to allow yourself to receive help.  

What does a Support Team do? Anything and everything, ranging from everyday household tasks to being with you in the hospital, looking after your interests. The purpose is to keep your stress level as low as possible. Everyone can act as a healer just by picking up a strand for a friend. Plus, the more people who believe in you doing well, the larger your aura of wellness.   Asking friends for help offers them an opportunity to be of genuine service. Don’t mind the ones who don’t accept. Give thanks for those who do.  

Who Do You Need?  

1. Someone to go with you to meetings with your doctors, take notes, help ask questions and maintain your calm, balanced state of mind.When you visit the surgeon’s office with an optimistic friend or two or more, you shift the expectancy of doctor and staff so they believe you are going to do well. 

2. Someone to take you to the hospital and be with you before your operation. 

3. Someone to help you get settled when you come out of recovery.  

4. Someone to stay with you in your room, in 2-4 hour shifts, most or all of the time, while you are in the hospital. What do they do? –Reassure you and nurture you as you wish.–Keep the caregivers optimistic about you by enlisting them in the reality of your excellent recovery..–Have a list of your medications, make sure there are no errors, and question if there’s a change. –Keep you from getting steam-rolled by something the staff wants to happen that might not be in your best interest.–Guard you against being awakened unnecessarily. –Provide the foods you need, the tape you want to hear, the aromatherapy you want, the healing aids you’ve brought with you.–Keep your energy from being drained by visitors you don’t really want. 

5. Several someones to be with you at home recovering but not completely self-sufficient. Help at home is crucial. Your team should be able to keep anyone away from you who wants to demand your attention. Your recovery period will go faster if you have few social visits that require you to speak, or even listen to casual conversation. Your energy is best directed to healing. The best possible people for the above roles are your most sympathetic friends, calm and outgoing, with caring, nurturing qualities. Their first job is to engage with hospital staff on your behalf, so they have to be willing to ask questions and say, “Hey, is that supposed to happen?”  

6. People to clean house, put dinners in the freezer, help with driving or take care of children, take care of pets, paint the house, and so on. Make a list of the things you’d like help with and give the right task to the right person.  

7. Several people who agree to think of you positively, pray for you, meditate on your healing, or whatever they like, around the time of your surgery. As many as you like from wherever they are. No travel time needed. Prayer has been clinically proven to improve recovery, so encourage even a commitment of a couple of minutes.  

8. Find as many talented healers as you can. Some hospitals are now providing access to Reiki, Therapeutic Touch, Massage Therapy and the like, which lower stress and increase immune function.  

9. Ask for a healing circle. It can be as easy as friends gathering around you for a few minutes of healing intention. Before your surgery, the group emphasizes relieving stress and worry, plus holding positive thoughts about your good prospects. For a circle after the operation, the emphasis shifts to healing the physical trauma and the emotional wear and tear from the whole adventure. Keep in mind that you are deserving of attention and care at this time. Your job is to be receptive. Allow it in. 

The above is adapted from the book, The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery, by Joseph Casey. Available at www.TheSurgeryCoach.com. 

…A lot more than just about anyone can imagine. The bottom line is that every aspect of recovery is positively influenced by preparation. The most bang for the buck is finding ways to release fear, stress, worry, and related negative emotion. These matters are in your hands. The docs do not have the time, training or inclination to help patients prepare.  Once you know what a difference you can make, the only thing left to do is find out how.   A popular T-shirt reads: “If I had known I’d live this long, I’d have taken better care of myself.”  Same thing applies to surgery. If you’d rather recover quickly and feel better sooner, it’s possible, but you have to take care of yourself.  Those who seek, find.

 

Patients do well to think about how to own their power in the medical system.  It is more considerable than you might imagine.  It seems a miracle that some hospitals are finally offering Reiki, massage, music therapy, and other ‘complementary-alternative’ adjuncts. But this has not happened because doctors said they wanted it.  Patient demand has been the key, along with increasingly enlightened nurses working clandestinely. Patient evaluation forms are the most powerful force bringing the entry of mind-body-heart practices into hospitals. This collective power derives from individuals owning their own power over what happens in hospital. When enough individuals know that they can ask for something, that something will soon happen.  When enough of us ask hospitals to think about how to improve results by advising patients to engage in a ‘complementary’ practice, they’ll do it.  Hospital food will be the subject of a post all its own.

 

Americans have been well trained to comply with the authority of doctors. That model is crumbling, but retains lots of footholds. I still see reasonably enlightened people completely lose their senses when illness comes, surrendering all knowledge to the doc. When we respect what docs can do, yet understand their limits, and when we know and use our own resources, that’s when things go best.

A rich harvest of scientific studies in the last 15 years has demonstrated the effectiveness of mind-body techniques, or complementary wellness methods, to help bring about faster, better recoveries from surgical procedures. These practices have been shown to help surgical patients in all the ways that doctors usually measure: shorter hospital stays, lower costs, fewer complications, lower rates of infection, less pain, and less need for medication, as compared with control groups. There will be more about these practices and the studies in future posts.    Mind-body-heart practices also seem to help in ways doctors don’t measure, such as quality of life, mood, relatedness. outlook, and contentment, to name a few.

 The biggest antagonist to healing is stress. Until recently, it wasn’t well understood how stress affects healing.  This excerpt from Science Daily speaks volumes:

Scientists investigating why wounds heal more slowly on patients who are stressed have found that psychological stress can increase the levels of some hormones in the blood. These hormones can slow the delivery of certain compounds – cytokines – to the site of the injury to start the healing process. But if the process is slowed at the beginning, the wound will take much longer to heal, posing potentially serious consequences to patients recovering from surgery. “There is a lot in the medical literature suggesting, if possible, that a patient should not be under stress before surgery,” explained Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University. “Stress, depression and anxiety prior to surgery have all been associated with poor surgical recovery.”[i]  

Researchers Learn How Stress Slows Wound Healing, ScienceDaily, July 28, 1999

Source: Ohio State University. Article at: www.sciencedaily.com/releases/1999/07/990728073743.htm

 

 Here’s a passage from my book, The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery:

“Surgery takes place on many levels. It is a multi-layered event. On the physical-mechanical plane, doctors in modern hospitals are doing a good, often great, job. It would be nice to pretend that’s all there is to it, but that is not so. We all have feelings, emotions, worries, hopes, doubts, thoughts both dark and light, uncertainty, and more. We know intuitively that healing happens best when we feel safe and nurtured, when our anxieties are comforted and our souls honored. Rarely, though, does a surgeon address the non-medical issues. Sometimes family practitioners do, but by and large, spiritual, psychological, and emotional questions don’t get a lot of time in the short interviews we have with doctors these days. They are under pressure to see more patients in less time and must deal first with the strictly medical issues. If your doctor takes an active interest in your inner well-being, engaging with you about how you feel, consider it a big plus. If you have a doctor who recommends a course of mind-body preparation and suggests who and what might help you, consider yourself fortunate to have such an enlightened physician.

The more usual case is that we must rely on our own resources for preparation and recovery assistance that is not narrowly medical. These entries are intended to help bridge the gap by suggesting useful things to do, how to go about doing them, and what sort of people to talk to get the assistance you want.” www.thesurgerycoach.com

  

Even if your surgery is outpatient or relatively “minor,” you can help yourself by preparing yourself mentally. Studies of people going in for “minor” surgery show heightened heart rates and other signs of anxiety as great, or nearly as great, as patients going in for “major” surgery. One thing remains true: the better prepared you are, the better you are likely to do.

Joe Casey’s home site is www.wellnesscoaching.net

The following letter from a client describes her process. Everyone would benefit from doing it as she did. She was very very nervous about it at the start.
  
Joe,
I wanted to follow-up after my recent surgery and thank you for you surgery 
coaching.  It was so helpful.  I thought it might be helpful for you if I wrote 
something about my experience.  Feel free to use this text however you'd like.  
Thank you so much for all of your help!
Megan K
 
I recently underwent surgery to have fibroids removed from my uterus.  The 
procedure was laparoscopic.  Four incisions were made in my belly, a camera  
and other tools were inserted, the fibroids were dissected from my uterus, 
shredded, and removed through the incisions.   Five fibroids were removed from
 my uterus, and one of them was bigger than a grapefruit. My surgery went so 
well.  I attribute this to all of the things that I did before and after the surgery to 
prepare myself physically, emotionally, and spiritually.  This was possible 
because of my session with Joe Casey and the guidance in his book, which I 
read and followed.  
Prior to my surgery I has a session with Joe Casey in which we worked on my 
fears around undergoing anesthesia, being given drugs I might react to, and 
other fears.  He used Emotional Freedom Technique and by the end of my 
session I no longer held these fears.  He also gave me some really helpful 
concrete tips of things I could do including gathering a support team, having 
a Reiki session, and asking my doctor to say healing statements to me during 
my procedure. 
 He also told me some things I didn't know about anesthesia, which were really 
helpful. I did a lot to prepare myself in the weeks after that session.  I read 
The Surgery Coach and did the things that felt right to me:  I brought my sister 
with me to all of my appointments with the surgeon, so that she could listen to 
what he said and help me remember what he told me.  I also wrote it down. It 
was nice to have her there with me.  I brought a list of questions for my 
surgeon, including questions from the book.  I found a surgeon I felt really 
comfortable with and that I trusted.  I found an anesthesiologist I felt comfortable
 with and trusted.
 I emailed all of my friends and family and let them know that I was having 
surgery and that I would need some help afterward.  I gathered a support team 
for the hospital - someone to be with me when I was admitted and to be there 
when I woke up, someone to bring me healthy food, someone to advocate for 
me having my herbs and vitamins, someone to bring me decorations. Afterward
 I stayed at my mom's house to rest and recover for a week and she was 
available to cook for me, go to the store for medicine, and help me with anything
 I needed.  It turned out I didn't need much help.  I also took several weeks off 
work to make sure I had time to recover well.
I had a Reiki session about a week before my surgery to help with stress.  I had 
an acupuncture session to help my body prepare for the trauma of the surgery.  
I also had an appointment with my naturopathic physician who prescribed 
arnica for pain and multivitamins, iron, and other herbs for the week before 
and the weeks after my surgery.
 I used the Healing Response Statements from the book and said them aloud 
to myself daily for two weeks before the surgery.  I asked my anesthesiologist 
to say healing statements from the book to me during my procedure.  She did 
this for me.
 I used the guided imagery for self-healing after my surgery to visualize my
 body healing well. I listened to Joe's CD titled "Guided Imagery and Relaxation
 Before Surgery" every night for two weeks prior to my surgery.  I listened to 
Belleruth Naparstek's CD titled "Successful Surgery" every night for two weeks 
after my surgery.  I asked my anesthesiologist to play my tape of soothing music 
in my headphones during my surgery and she agreed.
I ate the foods recommended in the book, especially leafy greens, chicken 
vegetable soup, raw veggies, fresh fruit, meat, yogurt and blueberries, before,
 during and after my surgery.   I drank LOTS of water after my surgery.  I took 
many of the supplements listed in the book before and after my surgery and 
consulted my naturopathic physician as well.
 I got someone to bring me food in the hospital so I didn't have to eat the hospital 
food.   I got lots of sleep.  I went running and did other exercises right up until 
the day before my surgery so that I would be as strong as possible going in. 
I knew my surgery and recovery would go well, but I had no idea that they 
would go as well as they did.  My surgery went so well.  As I was being 
admitted I was in good spirits.  I enjoyed interacting with the prep nurses and 
my surgeon and anesthesiologist.  I was afraid that I would be afraid as I was 
going in, but I wasn't.  Not even for a moment.  I was looking forward to my surgery!  I got rolled into 
the operating room and noticed all of the fancy equipment that was going to 
be used on me: TV screens, monitors, etc.  As I was going in, I thought of 
my support team, friends, and family, and I thought of my peaceful garden 
retreat. 
When I woke up the surgeon and anesthesiologist both came to me and said, 
 " You did great.  It went very well."  They both also commented about how big 
the fibroids, which were removed, had been.  I had not needed an open 
procedure.  They were able to do the whole thing through the small incisions. 
 I had also not needed a blood transfusion, because I hadn't bled that much 
and my hemoglobin levels were high, probably because of all of the blood 
building I'd done with iron and foods prior to my surgery.  This was all good 
news and I was really pleased.   I hada reaction to coming out of the anesthetic 
state and was shaking and very uncomfortable for about 20 minutes, but that 
passed quickly.  Apparently it had been a very difficult procedure, which took 
about four hours.
 In his report the surgeon wrote "postoperatively, the patient did extremely well."
 I had an epidural so I really had no pain when I woke up.  Friends and family 
visited and called that evening and the next day.  I was feeling pleasantly tired 
and relaxed, although I wasn't on any sedatives or pain medication at that point. 
  I slept well in the hospital.  I had two Vicadin tablets while I was in the hospital 
and other than that, I didn't need any pain medication.  I was able to drink and 
eat by the next morning, so my IV was taken out.  My bowels started moving 
and I was able to urinate right after the epidural wore off.  My surgery happened 
on Friday afternoon, and I was able to go home on Saturday.  That night at home 
I was able to climb stairs and the next day I was able to go for a 10 minute
 walk.  Each day after I was able to go on alonger walk.  Over the next week I 
rested at my mothers house and spent my days eating, sleeping, taking my 
supplements and some Advil and going for walks.   I was in very little pain.   It 
hurt me to sneeze, cough, and laugh and my stomach muscles and uterus hurt 
when I moved in certain ways, but the pain was minimal. Three of my incisions
 healed really quickly and one got infected, but it’s healing now.  In the three 
weeks after my surgery I've been able to go hiking and walking.  I started
 jogging again, gardening, and returned to work.  At the three week mark I don't 
have any pain.  I've followed up with acupuncture and Reiki sessions after my 
surgery as well.  I've been taking good care not to overdo it, but I'm so pleased
 at how good my body feels.
 Megan 
 

My purpose is to provide aid and comfort to surgery patients, offer information and explore possibly helpful points of view about the interaction of the medical world with the universe of complementary  or adjunct wellness.  I’ll write about how the failure of American organized medicine to integrate more of the models of wellness into daily practice is one of the reasons for high costs. In the US, diagnoses often lead to a cascade of costly tests and procedures. In Europe, not the same. Not so many costly scans, but more homeopathy, more aromatherapy – more stuff US docs are trained to reject as too “alternative” – is right there in the medical office. More later on that, but now back to the program.

Well-prepared patients do better. They resist infection better, they leave the hospital sooner, they have fewer complications, and more. In a study done at Mt. Sinai School of Medicine, patients who had hypnosis sessions sometime prior to surgery had clinical outcomes better than 89% of control groups.  Remarkable when you stop and ask yourself what other procedure, drug, or intervention makes anywhere near that much difference.  I’ve posted reports of studies of hypnosis before (and during) surgery so you can see for yourself.

I cite hypnosis studies because:  1. hypnosis is the most studied complementary presurgery method.  2. It’s the most effective method studied.  And 3. I have a practice as a hypnotherapist with both a corresponding bias and a lot of clients who have done well in surgery.  There are several other great things patients can do to prepare.  FYI, I view the surgery process from the consumer point of view, looking for everything and anything of benefit.  I’m not a doctor and of course make no medical claims or diagnoses.

Helping people get ready for this very important event is one of my favorite things to do. It has such high and obvious value.  The dog doesn’t bark in the night. The bad things don’t happen. Recovery is swifter than most, according to the studies, reports from clients, and my own eyes.

When a client has had the best possible experience for their situation,  and I get to hear how satisfied they are, how comfortable, how smoothly it went, it makes me glow with delight.  

There’s more about this work at www.wellnesscoaching.net

 

The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis
Anesth Analg 2002 Jun;94(6):1639-45,
Montgomery GH; David D; Winkel G; Silverstein JH; Bovbjerg DH
Biobehavioral Medicine Program, Cancer Prevention and Control, Ruttenberg Cancer Center, Mount Sinai School of Medicine
Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients’ self-reported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients’ pain and method of the administration. We conducted meta-analyses of published controlled studies (n = 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction affects hypnosis efficacy.
Our results revealed a significant effect size (D = 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. IMPLICATIONS: A meta-analytical review of studies using hypnosis with surgical patients was performed to determine the effectiveness of the procedure. The results indicated that patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients.

 Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial
Am J Clin Hypn 2003 Apr;45(4):333-51
Ginandes C, Brooks P, Sando W, Jones C, Aker J
Department of Psychology, Harvard Medical School, McLean Hospital, 115 Mill Street Belmont, MA 02478, USA
Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants’ group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants’ subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group’s objectively observed wound healing to be significantly greater than the other two groups’, p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.
 

Guided imagery in cardiac surgery Halpin LS, Speir AM, CapoBianco P, Barnett SD. Outcomes in Management & Nursing Practice, 2002 Jul-Sep;6(3):132-7.In 1998, a research team led by Linda Halpin at the Inova Heart Center of Inova Fairfax Hospital compared cardiac surgical outcomes between two groups of heart patients – with and without guided imagery. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it, and, in addition, data from the hospital financial cost-accounting database were collected and matched to the two groups of patients.
Analysis of the data revealed that patients who completed the guided imagery program had a shorter average length of stay, a decrease in average direct pharmacy costs, and a decrease in average direct pain medication costs while maintaining high overall patient satisfaction with the care and treatment provided.
Guided imagery is now used as a standard, complementary therapy to help reduce anxiety, pain, and length of stay among the cardiac surgery patients at Inova Fairfax.
 
Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.Montgomery GH, Weltz CR, Seltz M, Bovbjer DH.  International Journal of Clinicial and Experimental Hypnosis. 2002 Jan;50(1): pp.17-32.In a randomized clinical trial at The Ruttenberg Cancer Center, Mount Sinai School of Medicine, to determine if brief presurgical hypnosis on breast biopsy patients helps with postsurgery pain and distress, 20 biopsy patients were randomly assigned to a hypnosis or control group (standard care). The study found that the brief hypnosis did reduce postsurgery pain and distress and suggested that presurgery expectations influenced and mediated this outcome.

The use of relaxation techniques in the perioperative management of proctological patients, preliminary results.  Renzi C, Peticca L, Pescatori M.  International Journal of Colorectal Disease 2000 Nov;15 (5-6): pp. 313-316.In a randomized, controlled clinical trial, researchers assessed the effects of guided imagery on the postoperative course in proctological patients. Patients undergoing surgery for anorectal diseases were randomized into group 1 (n = 43) with standard care and group 2 (n = 43) with relaxation techniques, where they listened to a guided imagery tape with music and relaxing text before, during, and after surgery. Patients evaluated their own (a) postoperative pain measured by visual analogue score, (b) their quality of sleep measured by a similar score, and (c) the nature of first micturition, evaluated as normal or difficult. Groups were similar in age and sex distribution, type of disease, and operation performed. The pain score was 3.2 +/- 1.4 in GI patients and 4.1 +/- 2.1 in controls (P = 0.07). The quality of sleep score was 4.8 +/- 2.9 in GI patients and 6.4 +/- 2.7 in controls (P = 0.01). The first micturition was painful in 10.3% of GI patients and in 27.3% of controls (P = 0.09). Perioperative relaxation techniques thus showed a trend to reducing pain following anorectal surgery and significantly improving the quality of sleep; a decrease in anxiety and a consequent muscle relaxation may be involved. The study concludes that guided imagery is a low cost and noninvasive procedure, can be recommended as a helpful tool in this type of surgery.


 
Hypnosis as adjunct therapy in conscious sedation for plastic surgery Reg Anesth 1995 Mar-Apr;20(2):145-51 (ISSN: 0146-521X)
Faymonville ME; Fissette J; Mambourg PH; Roediger L; Joris J; Lamy M
Department of Anesthesia and Intensive Care Medicine, University of Liege, Belgium
BACKGROUND AND OBJECTIVES. Sedation is often requested during local and regional anesthesia. However, some surgical procedures, such as plastic surgery, require conscious sedation, which may be difficult to achieve. Hypnosis, used routinely to provide conscious sedation in the authors’ Department of Plastic Surgery, results in high patient and surgeon satisfaction. The authors conducted a retrospective study to investigate the benefits of hypnosis in supplementing local anesthesia.
METHODS. The study included 337 patients undergoing minor and major plastic surgical procedures under local anesthesia and conscious intravenous sedation. Patients were divided into three groups depending on the sedation technique: intravenous sedation (n = 137) using only midazolam and alfentanil; hypnosis (n = 172), during which patients achieved a hypnotic trance level with age regression; and relaxation (n = 28), comprising patients in whom hypnosis was induced without attaining a trance level. In all three groups, midazolam and alfentanil were titrated to achieve patient immobility, in response to patient complaints, and to maintain hemodynamic stability. Midazolam and alfentanil requirements; intra- and postoperative pain scores; as well as pre-, intra-, and postoperative anxiety score, reported on a 10-cm visual analog scale, were recorded and compared in the three groups.

RESULTS. Intraoperative anxiety reported by patients in the hypnosis group (0.7 +/- 0.11) and in the relaxation group (2.08 +/- 0.4) was significantly (P < .001) less than in the intravenous sedation group (5.6 +/- 1.6). Pain scores during surgery were significantly greater in the intravenous sedation group (4.9 +/- 0.6) than in the hypnosis group (1.36 +/- 0.12; P < .001) and the relaxation group (1.82 +/- 0.6; P < .01). Furthermore, midazolam requirements were significantly lower in the hypnosis group (P < .001) and in the relaxation group (P < .01) as compared with the intravenous sedation group: respectively, 0.04 +/- 0.002, 0.07 +/- 0.005, and 0.11 +/- 0.01 mg/kg/h. Alfentanil requirements were significantly decreased in the hypnosis group, as compared with the intravenous sedation group: 10.2 +/- 0.6 microgram/kg/h versus 15.5 +/- 2.07 micrograms/kg/h; P < .002. In the relaxation group, alfentanil requirements were 14.3 +/- 1.5 micrograms/kg/h (ns). Postoperative nausea and vomiting were reported by 1.2% of patients in the hypnosis group, 12.8% in the relaxation group and 26.7% in the intravenous sedation group. Greater patient satisfaction with the anesthetic procedure and greater surgical comfort were also reported in the hypnosis group. CONCLUSIONS. Successful hypnosis as an adjunct sedation procedure to conscious intravenous sedation provided better pain and anxiety relief than conventional intravenous sedation and allowed for a significant reduction in midazolam and alfentanil requirements. Patient satisfaction was significantly improved.

 Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery  Manyande A, Berg S, Gettins D, Stanford SC, Mazhero S, Marks DF, Salmon P. Psychosomatic Medicine. 1995: 57: 177-182.Of 51 patients undergoing abdominal surgery, those who were taught guided imagery before surgery had less postoperative pain than those who did not. They were also less distressed by the surgery, felt as if they had coped with it better and requested less pain medication than patients who did learn imagery skills.


 
Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial.Ashton C Jr, Whitworth GC, et al.  J. Cardiovascular Surgery (Torino). 1997 Feb; 38(1): pp. 69-75.Patients who were taught self-hypnosis/relaxation techniques before undergoing first-time elective coronary artery bypass surgery were significantly more relaxed following the operation, as compared to a control group. They also used significantly less pain medication. Surgical outcomes were the same for both groups.

Hypnosis and imagery improve healing in fracture patients

Carol Ginandes, PhD, Mass. General Hospital, Dept of Bone and Joint Disease; Alternative Thera. Health Med 1999; 5(2): 67-75) A small exploratory study by psychologist showed that when hypnosis and imagery were used on 12 fracture patients, to suggest or imagine reduced swelling, stimulation of tissue growth and fusion at the site of the break, along with a reduction in pain and stress, results at 6 weeks showed dramatically improved healing, as well as better mobility, strength and less need for analgesics at weeks 1, 3 and 9.  

Blue Shield of California Reports Success with Imagery Tape
SAN FRANCISCO, Jun 18, 2002 /PRNewswire via COMTEX/ — Citing strong evidence of the therapeutic and economic value of its new Guided Imagery Program for pre-surgical patients, Blue Shield of California announced the findings of a comprehensive year-long study at the recent National Managed Care Congress. The study shows that guided imagery, a simple, but powerful, mind-body technique that features the use of relaxation tapes and other imagery exercises, provides documented benefits to patients preparing for surgery, while decreasing hospital charges. According to the study, which ran from June 2000 to 2001, 57 percent of patients who listened to the audio-recordings said they experienced less pain than expected from their surgery. Members also reported a significant reduction in anxiety after listening to the tapes prior to surgery. Forty-five percent of patients experienced high anxiety before listening to the tapes, but less than 5 percent experienced similar anxiety from listening to tapes before surgery. Not surprisingly, the more anxious patients felt, the more frequently they listened to the recordings and the greater improvement they documented. These findings were compiled from the review of 900 completed patient surveys. In addition, the study compared claims from 166 hysterectomy patients who reported using the guided imagery tapes and completed surveys against a control group of 183 hysterectomy patients who did not listen to the tapes. The comparison showed a 4.5 percent decrease in average total hospital charges billed for surgery among patients who used guided imagery prior to surgery, and an 8.4 percent decrease in the average hospital pharmacy charges. Acceptance and usage of the program was high, with 85 percent of patients who used it would recommend it to a friend, and 84 percent would use it again when having surgery. Blue Shield launched the Guided Imagery Program to improve the personal experience and outcomes of members facing surgery. The company is committed to offering therapies that encourage members to take an active role in their health care. “Our research shows that Blue Shield members define health broadly to include the mind and the body,” said Deborah Schwab, R.N., M.S., director of New Product Development. “They want tools like guided imagery that help ease the anxiety they feel during vulnerable moments such as surgery. The fact that guided imagery actually saves money is a wonderful bonus.” Launched in June 2000, Blue Shield’s Guided Imagery Program features a complimentary guided imagery toolkit for patients, along with phone support from a registered nurse. Audio recordings are provided by Health Journeys, an organization founded by therapist and author Belleruth Naparstek. Guided imagery practice sessions are short, simple to use and do not require special knowledge or equipment, enabling members to achieve meaningful results in a short period of time. Schwab believes “ease of adoption” is a major reason why 75 percent of members invited to participate in the program decided to use the materials. From the health plan’s perspective, the program has proved to be extraordinarily cost-effective. The retail cost of $18 per recording nets an average hospital claim savings for billed charges of $654 per participating member. According to patients, the option of guided imagery made a difference. “I listened to [the audio recordings] four times,” said Blue Shield member K.B. “Each time I listened to it my fears and worries were put at ease. The night before my surgery I slept peacefully. In contrast, the surgery prior to that I had to be given Valium and it was a horrible experience.” As a result of the encouraging findings, Blue Shield has decided to expand Guided Imagery to patients in its asthma and cardiac disease management programs.    

Audio suggestions during hysterectomies The Lancet reported that surgical patients who listened to audio suggestions via headphones while under anesthesia in the operating room recovered from their surgery faster than those who did not. Patients in the study underwent hysterectomies. During the procedure, they heard cassette recordings of suggestions such as, “How fast you recover is up to you–the more you relax, the more comfortable you will be,” and:  “The patient is fine; the operation is going well.”  One-half of the patients studied were released from the hospital just one day after the removal of their stitches. Only ten percent of the patients who weren’t exposed to the recordings were released in that time. Patients who heard the tape left the hospital 1.3 days sooner than the other group. Source: Study by the United Medical and Dental Schools of Guy’s and St. Thomas’ Hospitals, London. Drs. Evans and Richardson; Reported in Advances Vol 5:4, p. 11, 1989 

Hypnoanesthesia Perioperative use of medical hypnosisTherapy options for anaesthetists and surgeons]
Anaesthesist. 2004 Feb 27
Hermes D, Trubger D, Hakim SG, Sieg P
Klinik fur Kiefer- und Gesichtschirurgie, Universitatsklinikum Schleswig-Holstein/Campus Lubeck
BACKGROUND. Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. PATIENTS AND METHODS. During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. RESULTS. Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. CONCLUSION. Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.   Evaluation of intraoperative standardized hypnosis with the State-Trait Anxiety Inventory]
[Article in German]
Hermes D, Gerdes V, Trubger D, Hakim SG, Sieg P.
Mund Kiefer Gesichtschir. 2004 Mar;8(2):111-7. Epub 2004 Feb 06.
Klinik fur Kiefer- und Gesichtschirurgie, Universitatsklinikum Schleswig-Holstein, Campus Lubeck. hermesddd@aol.com
BACKGROUND: Surgical treatment under local anesthesia is commonly restricted by limited compliance of patients. Hypnosis may represent an alternative to sedation or general anesthesia. As the procedure demonstrated promising prospects during 1-year experience, the observed hypnosis-induced effects are now being evaluated in clinical studies. PATIENTS AND METHOD: The prospective study included 50 patients scheduled for dental surgery. All procedures were performed under standardized surgical conditions. The experimental group (n=25) received supplementary standardized tape hypnosis, whereas the control group received standard treatment (only local anesthesia). Individual and situative anxiety levels were determined by the State-Trait Anxiety Inventory (STAI).

RESULTS: After simultaneous increase of preoperative state anxiety, anxiety levels in the hypnosis group showed a significant intraoperative reduction to baseline level, whereas intraoperative anxiety of the control group (n=25) remained unchanged. CONCLUSIONS: Hypnosis reduces intraoperative anxiety of oral and maxillofacial patients significantly. Further clinical studies on the use of hypnosis are considered useful.

Notes From Textbooks

Joseph Barber's Hypnosis and Suggestion in the Treatment of Pain: A Clinical
 Guide, 1996, pg. 248 – 249, states that hypnoanesthesia is very effective and quite
 necessary in the relief of pain for burn victims, in which the use of chemical
 anesthesia could possibly be quite dangerous.  Barber also suggests that simple 
pre-operative suggestions via the use of hypnosis are quite effective for speedy
 recovery after surgery.
 
Crasilneck in Clinical Hypnosis: Principles and Applications, 1975, pg. 81 – 88 
provides advantages of hypnoanesthesia in situations where chemical agents are
 considered dangerous due to respiratory, cardiac, or other diseases.  He also 
states that the repeated use of anesthetics have a debilitating effect upon the 
recovery of burn patients, and that in certain cases, such as chemopallidectomy, 
it is desirable to have the patient conscious in order to respond to questions.
 
Olness, and Kohen's Hypnosis and Hypnotherapy with Children, 3rd edition, 1996, 
pg. 272, reports a controlled study by Gaal, Goldsmith and Needs, 1980, on the
 effects of hypnosis on anxiety and pain in children, those that received hypnotic
 preparation before surgery required only one fifth as much post-operative pain 
medication.
 
Andre Weitzenhoffer's The Practice of Hypnotism, Second Edition, 2000, pgs. 497 –
- 515, states that hypnoanesthesia for major surgery is only effective for about 10
percent of the population, but that its effectiveness as an adjunct to chemical 
anesthesia is great.  Some of the primary benefits include hypnoanesthesia in 
obstetrics, which allows more control over the birth movements, and also
 eliminates all the ill effects of chemical anesthesia upon the infant. 
Weitzenhoffer states that hypnosis is an excellent preoperative tool, allowing for
 relief of preoperative fear and anxieties, and works as an alternative to preoperative
 sedation.  
Benefits postoperatively are many including the control of constipation, hiccups, 
coughing, retching, and for eliminating all sorts of postoperative pains in turn leading
 toward speed of recovery.  
The use of hypnoanesthesia for major surgery requires a preparatory period, a 
maintenance phase, and a postoperative phase for greatest success.