Preparing for your operation and enhancing your recovery

Physiotherapy

Information and advice on how you can prepare for your operation and help with your recovery. Depending on your personal circumstances there may be some variations from what is outlined, but these will be discussed with you by your specialist team.

What is the Enhanced Recovery Programme?

The aim of the Enhanced Recovery Programme is to get you back to full health as quickly as possible after your operation. Research has shown that it is beneficial for you to get out of bed and to begin eating and drinking early in your recovery. This will reduce the likelihood of developing complications such as chest infections and blood clots after your operation.

Before you come into hospital

You may feel anxious about having an operation, but there are a number of ways in which you can help to prepare yourself before coming into hospital:

Physical activity

Being physically active prior to your operation will aid recovery. Exercise will maintain and improve your heart, lung and muscle strength. Try to keep active by completing your usual exercise routine or gradually trying to increase your daily activity levels by taking regular short walks or completing any form of exercise you find enjoyable.

Smoking

Stopping smoking is very important before surgery to reduce the risk of getting a chest infection afterwards and to allow your body to heal better. If you need any further support or advice on stopping smoking contact your GP or speak to the team in pre-assessment.

Breathing exercises

It is important to start doing deep breathing exercises as soon as possible after your operation. These will help to re-open your lungs and prevent chest infections. It is also very important to get rid of any phlegm you may have in your lungs. Try to cough after every set of deep breaths. Drugs used in your anaesthetic slow down parts of your respiratory system that help you to clear phlegm.

Pain after your surgery can inhibit your ability to take a deep breath but you will not cause any damage by taking deep breaths and coughing.

• Take a slow, deep breath in, hold for one to two seconds and then gently sigh out.
• Repeat three to four deep breaths.
• Place your cough cushion (or rolled towel or pillow) over your stomach, support it with your hands and try a strong cough.
• It is easier to cough in an upright position. If laid flat in bed, try to bend your knees up to ease the strain on your stomach.

Eating well

Good nutrition is a key part of your preparation for surgery. Some conditions may cause you to lose weight before an operation, and it is not uncommon to experience changes to your appetite, nausea and vomiting which may contribute to some weight loss after surgery. Eating the right types of food can help to minimise this.

What should I do if I am underweight or losing weight before an operation?

If you are experiencing a poor appetite or weight loss, the following may be helpful;

• Try to have “little and often”. 5 to 6 small meals may be easier to manage, or additional snacks or puddings in between meals.
• Choose high calorie, full fat options.
• Choose nourishing drinks such as full fat milk or milkshakes.
• Add extra butter, oil, cream, cheese etc. into savoury dishes.
• Add extra sugar, honey, jam, syrup etc. into sweet dishes.
• Weigh yourself weekly, if you are losing 1lb (0.5kg) weight per week or more, or you are worried about your appetite then contact your GP or specialist nurse.
• Your GP may prescribe oral nutritional supplement drinks or products such as Complan® are available to buy over the counter in supermarkets and chemists.

Foods high in protein are especially important to help maintain muscle strength and to help wound healing. Try to include 2 to 3 portions of the following foods daily before and after your operation.

• Meat and poultry
• Eggs
• Fish
• Pulses such as peas, beans (including baked beans) and lentils/dhal
• Cheese
• Milk
• Meat alternatives such as tofu, soya and Quorn
• Yogurts

What should I do if I am overweight?

It is not advisable to lose weight quickly through “crash diets” before an operation. Your surgeon may advise that you lose some weight gradually in preparation for surgery. The focus should be on following a healthy balanced diet.

The following may be helpful to help improve your diet before an operation;

• Try to eat regular meals.
• Ensuring a good protein intake (see above list) but try and choose low fat versions of these such as lean cuts of meat, trimming visible fat off meat, avoiding skin on poultry, choose low fat dairy products and opt for healthier cooking methods such as baking or grilling rather than frying.
• Eat at least 5 portions of a variety of fruit and vegetables every day
• Avoid sugary snacks and drinks.

Getting into hospital

Don’t forget to make travel arrangements, as it is unlikely that you will be able to drive yourself to and from hospital. If you are relying on friends or family, give them plenty of notice so they can ensure they are free to help. Make sure to have a bath or shower before you arrive, and remove all body piercings, makeup and nail polish.

Medication

Ensure you have a good supply of your regular medications at home as the hospital will not routinely supply regular medication on discharge. Before you come into hospital, stock up on regular over the counter medicines, for example, Paracetamol, Ibuprofen and laxatives such as Senna or lactulose – hospital policy is to not routinely supply these on discharge.

Check with your local pharmacist or GP if you think these may not be suitable for you.

What should I bring into hospital with me?

The following list is a guide;

• Bring in your own medications from home. Keep these with your belongings until you reach the ward where they will be locked safely away. We will use these while you are in hospital to ensure you do not miss any doses.

• An up to date list of all your regular medications (including cream, sprays, inhalers, vitamin and herbal medication).
• Notebook and list of important contacts or phone book.
• Any walking aids that you use on a daily basis for example, walking frames, sticks Glasses, contact lenses.
• Any dentures.
• Well fitting, clean slippers.
• Comfortable loose fitting clothes and dressing gown.
• Toiletries.
• Towel.
• Snacks or drinks which can be kept in your bedside locker (unfortunately we cannot keep patient’s own food in the ward fridges).

• Food such as ginger biscuits and mints can help if you experience nausea (feeling sick).

On the day of your operation

On the morning of your operation take all your usual tablets with up to 200ml of water before 7am unless you have been instructed otherwise. You will be admitted to the surgical admissions unit on the day of your operation. You will be given a hospital gown and some stockings to wear. These stockings help to reduce the risk of developing blood clots in your legs.

You will be advised by your specialist team as to how long you need to fast prior to having your operation, and some specialities may give you specialised carbohydrate (sugar-based) sachets to take the evening before and morning of your operation.

The days following your surgery

Most patients will return to the surgical wards following an operation, however, following some more complicated operations you may need to be initially monitored on the high dependency unit. This again will be discussed with you by your specialist team.

Pain control

You will be given pain relief in a number of different ways. If you are able to eat and drink this may be in tablet form.

You may also be a given patient controlled analgesia (PCA). This involves pressing a button to deliver a set amount of pain relief. It is set so that you cannot overdose yourself. Please let the nurses know if you feel your pain is not being adequately controlled.

It is not uncommon to experience nausea (feeling sick) after an operation. Tell your nurse if you feel sick as there are medications which can be given to help with this.

Getting up and out of bed

Once on the ward, you will be helped to get out of bed and sit out in a chair. The staff on the wards will be there to help you and help with any drips or catheters. If you are able, the Physiotherapists will assess you and aid you in going for a short walk. This will help to re-open your airways, improve your circulation, clear any phlegm you may have on your chest and promote general healing.

You will be given a cough cushion which you should place over your wound to help your pain when completing the breathing exercises listed above. These should be completed at least every hour.

If you are able to complete personal care tasks (such as washing and dressing) independently you will be encouraged to get washed and change into comfortable, loose fitting clothing. If you require assistance from staff they can support you to get washed and dressed. If appropriate you can be referred to Occupational Therapy who may complete a washing and dressing assessment to promote your independence and identify any areas of difficulty.

Eating and drinking after an operation

The majority of patients will be able to start to eat and drink within 24 hours of having an operation.

In some cases after an operation you may initially need to be fed via a feeding tube or intravenously. You should always follow the advice of your surgical team as to when you are able to start eating and drinking, and the types and amounts of food and drinks you are allowed.

After some operations it may be necessary to build up your intake of diet and fluids gradually, and your specialist team will guide you on this. You may be prescribed nutritional “build up” drinks by the surgical team or a dietitian.

It is not uncommon to experience a poor appetite in the days following an operation. Try to eat on a “little and often” basis. The hospital offers three main meals daily and additional snacks are available throughout the day.

If you can only manage small portions, you can also try to add extra nourishment into your meals, by the following;

• Ask for extra margarine, butter and cheese to add to jacket potatoes, mashed potatoes, toast or vegetables.
• Ask for jam or marmalade to add to toast, milky puddings and porridge.
• Add sugar to cereal, porridge, milky puddings and drinks.

Throughout your hospital stay

Ideally you should aim to sit out in your chair twice a day for approximately two hours each time. The more you are able to sit out of bed the better it will be for your breathing and keeping your chest clear. Try to maintain your normal daily routine. As soon as you are able, get dressed into your comfortable day clothes and keep pyjamas for night time.

The physiotherapists will visit daily to increase the distance you can walk until you are up and about on your own. Remember to stop if you feel short of breath or experience increased pain and talk to your physiotherapist or nursing staff.

The physiotherapists and occupational therapists may work together with you and set goals to progress your mobility and independence with activities of daily living. Such as mobilising to the bathroom and then completing independent washing and changing of stoma bag.

Before you are discharged home you may be asked to complete a stairs assessment. This will involve walking up and down a flight of stairs with the physiotherapy team to check you are safe. Please inform the ward staff if you were finding this difficult before you came into hospital or if you do not have stairs at home.

If you are required to follow any specific dietary restrictions following an operation, this will be discussed with you. A small number of patients may need to go home with a feeding tube, again this will be discussed with you and any necessary training and equipment will be provided.

Going home

Transport

We recommend that you arrange for a relative or friend to collect you once you are ready to go home. If this may be a problem for you, please speak to a member of the team before your operation.

Help on discharge

Physical activity

When you go home it is important to continue with your exercises. You should take regular exercise daily. Gradually increase your exercise during the four to six weeks following your operation until you are back to your normal level of activity. It is important to rest in between. Feeling physically tired after an operation is natural. Be guided by your body and your common sense.

Avoid any heavy lifting (anything heavier than a half full kettle) for a minimum of two weeks as healing inside takes place. Examples of things to avoid are; hoovering, ironing or carrying heavy shopping bags. Please arrange for friends or family to help you with this.

The occupational therapist can suggest techniques and strategies to promote your independence with domestic tasks and may provide loan of some assistive equipment for use whilst you are recovering.

Driving

Do not drive until you are confident that you can drive safely and make an emergency stop. This is usually between two to four weeks. Contact your insurance company to inform them of your operation.

Many people are able to return to work within two to four weeks of surgery. If your job involves heavy, manual labour this period may be longer, or you may need to ask your employer about reduced or restricted duties.

Eating and drinking

Depending on the type of surgery you have had, it may take you 4-6 weeks to fully recover and for your appetite to return to normal.
If you are experiencing a poor appetite when you leave hospital try to follow the advice outlined within the section ‘What should I do if I am underweight or losing weight before an operation?’

Diet advice for patients following bowel surgery

After bowel surgery it is not uncommon to experience changes in your bowel habits, or you may have had a stoma formed. If you are experiencing diarrhoea or you have had a new stoma formed, you might find it helpful to follow a low fibre diet for the first few weeks after surgery.

Low fibre advice for initially after bowel surgery;

• Try to choose white bread rather than brown, wholemeal or seeded.
• Try to choose low fibre cereals such as porridge, rice crispies and cornflakes.
• Try to avoid raw vegetable and salad vegetables.
• Try to peel fruit where possible and limit those with seeds and pips.
• Try to limit or avoid beans and pulses i.e., baked beans, kidney beans, chickpeas.
• Avoid spicy foods.

If you have had a stoma formed, you may wish to limit or avoid the following foods;

• Mushrooms, sweetcorn, peas, dried fruit, nuts and seeds – may pass into the stoma bag undigested.
• Onions, garlic, green leafy vegetables, fizzy drinks, baked beans, chickpeas and lentils – may cause excess wind.
• Fish, eggs, onion and garlic – may cause unpleasant odour.
• Spicy foods, fruit juice, fruit with skins, pips or seeds, citrus fruits, stewed fruit and coffee – may increase stoma output.

Summary

The best way to enhance your recovery and help you return to normality as soon as possible is to participate actively in your recovery by walking and eating and drinking as advised.

We will support you by removing attachments such as drips as soon as possible after the operation to make moving easier.

Each day you should feel improvement. Please ask your specialist team or ward staff if you are worried about anything or have any questions.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

ST0499