08.12.2020
Your doctor says that it is useless to continue conservative treatment of the joint. You seem to trust him - after all, you tried to find a good specialist. And at the same time, at the mere thought of surgery, some kind of chaotic mess arises inside, and you are ready to take literally handfuls of pills, just to avoid “going under the knife.”
Sound familiar?
It remains to understand what to do about it.
Surgery with local anesthesia
A local anesthetic numbs the area of the body being operated on. The patient is conscious and can observe the progress of the procedure or not see what is happening from behind a screen by agreement with the surgeon.
Often, such operations are performed quickly without serious tissue damage and do not pose a threat to the patient’s life. But if you still can’t calm down, then try the following:
- Discuss the progress of the operation with your doctor. Ask to talk about the risks, the time of the procedure, what the doctor will do and how dangerous it is for you. Ask about how other patients experience surgery, how long it takes them to recover, and what concerns they usually have.
Many patients are anxious primarily because of fear of the unknown, and everything incomprehensible seems dangerous to the brain, so awareness can play a key role in calming the patient.
- Ask your doctor if you can take any sedatives before the procedure and ask for a prescription if possible.
- Rest the day before the procedure. Take a walk in the fresh air, get some sleep, chat with your loved ones. Eliminate emotional stress and stress.
- Share your concerns with a loved one and enlist their support. Have them escort you to the clinic and pick you up after surgery to give you peace of mind.
- Think about how the procedure will benefit you. Focus on the result, not the process of the operation itself.
WHY PEOPLE AFRAID OF GENERAL ANESTHESIA
The modern history of plastic surgery begins at the end of the 19th century, when new surgical instruments were developed, antiseptics appeared, and anesthesia began to be actively used. Agree, it’s somehow strange to go through pain and suffering to improve your appearance, in fact, to improve your quality of life. It was only when anesthesiology reached its peak that women went in droves for rejuvenation.
The first plastic surgeries were performed under local anesthesia, and their radicality was minimal and their effectiveness was moderate. For example, anti-aging facial plastic surgery consisted of excision of a small strip of skin in front and behind the ear and suturing the wound: no detachment, no SMAS lifting, just skin. This rejuvenation could be performed annually.
As the operation became more complex, so did the anesthesia. Today we have the opportunity to safely carry out serious complex operations aimed at correcting all parts of the face. The duration of anesthesia can be from one to eight hours. All types of pain relief can be divided into local, regional and general.
MYTH No. 5 “Anesthesia does not work on a drunk person.”
Anesthesia affects any living person! The only question is choosing the right combination of drugs and their dosages. Alcohol intake affects anesthesia in two ways. Chronic alcohol intake in the early stages leads to constant “combat readiness” of the liver, therefore the activity of its enzymes that destroy molecules of both alcohol and many anesthetics increases and large doses of anesthesia drugs are needed to achieve the desired depth of anesthesia. With prolonged alcoholism, patients develop cirrhosis of the liver and the detoxification capacity of the liver drops sharply - as a result of this, much smaller doses of anesthetics are needed.
During acute intoxication, the effect of many anesthetics is enhanced, and some are modified. Therefore, you probably shouldn’t drink alcohol before going under anesthesia...
How to help a patient accept changes in appearance?
Active treatment does not make anyone look better, surgery and chemotherapy deplete one’s strength, facial features become sharper, the skin becomes pale, and some medications cause hair loss. It is very difficult for women to endure these changes. You can reassure the patient that “I always like you,” but the woman will not be reassured by an untruthful stock phrase.
Changes in appearance are upsetting and frightening. One can hope that after completion of therapy everything will improve - this indeed is the case. Or you can, as in the “Fashionable Sentence,” change here and now: buy new clothes, put on makeup, cover up your hair loss with a bright scarf or hat. It is ideal to visit a stylist, it immediately changes your mood and increases your self-esteem.
Rule one. You shouldn't endure pain just to avoid anesthesia.
Almost any manipulation associated with causing severe pain is more harmful to the body than anesthesia. Therefore, in the civilized world they adhere to this point of view: where it is possible to relieve a patient of pain, this is certainly done. Modern medicine has very wide possibilities for this.
In addition, anesthesia with the use of artificial respiration devices significantly expands the capabilities of surgeons and allows them to provide assistance to those patients who cannot be helped with other types of surgical intervention. Of course, all contraindications of the patient, his age, and body capabilities are taken into account.
FEAR ONE: “I’M AFRAID OF NOT WAKING UP AFTER GENERAL ANESTHESIA”
This is why some patients ask to have the operation performed under local anesthesia or a “lighter” intravenous anesthesia.
Let it be known to you that endotracheal anesthesia, when the machine breathes for the patient, is the most controlled, manageable and safe. Thanks to the endotracheal tube, the patient's tongue never sinks - which is precisely what intravenous anesthesia is dangerous for.
There was a sad situation in my life when my friend died after a gynecological operation due to retraction of the root of the tongue. They didn’t keep track of the position of the lower jaw, and oxygen stopped flowing into the respiratory tract.
It is to control the state of breathing even during intravenous anesthesia, for example during minor operations lasting up to two hours, that our anesthesiologists always use air ducts or laryngeal masks, which help control the position of the lower jaw and the root of the tongue.
Modern anesthesia machines are sensitive to the slightest change in pulse, pressure and oxygen level in the patient’s blood. In case of danger, they sound such a siren that it is simply impossible to miss this state. In addition, almost all drugs used by anesthesiologists for anesthesia have antidotes: substances that neutralize them. So, I hope I managed to dispel this fear.
Rule three. Recovery from anesthesia depends on the type of anesthesia and the characteristics of the body.
Typically, the patient recovers from anesthesia within one to four hours, depending on the amount of anesthesia used and his individual characteristics. The fact that recovery from anesthesia was normal can only be assessed by a doctor based on various indicators of the body’s functioning.
The patient himself usually remains half asleep for quite a long time during the day. His relatives who are present should not be afraid. The patient's body is simply under the influence of analgesics. They are necessarily administered in order to alleviate pain after surgery - after all, the anesthesia has ended, but the cause of the pain remains.
Article on the topic
In facts and figures: epidural anesthesia does not work for 1 in 20 patients
There may be another condition after anesthesia - excessive excitement. This usually happens if a person has previously abused alcohol or had mental problems. This complication is also amenable to medical control - the patient will simply be given sedatives and sleeping pills for a while.
Preoperative examination
Once a patient is suspected of having colon cancer and surgery is planned, there are several other important tests that need to be done before surgery.
This survey has two main objectives. First, by performing several studies, the stage of the tumor and its extent can be determined. Determining the stage of the tumor in the preoperative period will help you choose the right treatment tactics. Obviously, treatment for colon cancer that has metastasized to the liver will be very different from treatment for a small tumor that does not extend beyond the intestinal wall. Secondly, additional studies will help evaluate overall health and tolerability of surgery. Since surgery is extremely stressful for the body and can worsen existing problems with the lungs, heart, kidneys and other organs, special testing will help identify those patients who are at increased risk for complications in these organs during and after surgery.
Chest X-ray. The main purpose of this study is to evaluate the presence of cancer metastases to the lungs. This is a standard test that can determine with fairly high accuracy whether there are tumor nodes in the lungs. Chest X-rays can also look for signs of heart and lung disease. Therefore, this study is performed routinely in all patients before major operations.
Computed tomography (CT) of the abdomen and chest. Using this study, you can evaluate the condition of the liver and abdominal cavity for the presence of foci of tumor metastasis. If a chest CT scan is performed along with an abdominal examination, then a plain chest x-ray is not required.
Magnetic resonance imaging (MRI) of the pelvis. This study allows you to obtain clear images of the pelvic organs, assess the extent of spread of the rectal tumor, damage to the lymph nodes, and involvement of the anal canal muscles in the tumor. Unlike radiography and CT, MRI does not expose patients to ionizing radiation.
Positron emission tomography (PET). This type of examination uses a contrast agent containing a radioactive form of glucose, which helps determine the location in the human body where the tumor is located. Although this method can accurately identify “occult” tumor metastases that cannot be detected using CT or MRI, PET is currently not the method of choice for the preoperative evaluation of patients with colorectal cancer.
Ultrasound examination (ultrasound) of the abdominal cavity. Using this method, you can determine the condition of almost all abdominal organs and suspect the presence of tumor metastases in other organs, most often in the liver. You can also evaluate the condition of the kidneys, pancreas, and gallbladder. If it is not possible to perform a CT scan of the abdominal cavity, this study is the method of choice for assessing the presence or absence of distant metastases.
Transrectal ultrasound (TRUS). This study is performed using a special sensor, which is inserted into the rectum through the anal canal. This method allows you to identify the degree of tumor invasion of the rectal wall, assess the condition of nearby lymph nodes and rectal sphincters. If it is not possible to perform an MRI of the pelvic organs, it is the method of choice for assessing the spread of a rectal tumor.
Blood tests. A standard set of blood tests includes: a complete blood count, a biochemical blood test and a blood clotting test.
A complete blood count evaluates the total number of red blood cells (red blood cells), hemoglobin, leukocytes (white blood cells), and platelets. These cells play a crucial role in the functioning of the body. Red blood cells, with the help of the hemoglobin they contain, are an oxygen carrier and are responsible for supplying oxygen to all tissues and organs. In colorectal cancer, bleeding may occur from the tumor, so the number of red blood cells in such patients may be reduced. In severe cases, a blood transfusion may be required after surgery, and sometimes before surgery. Because platelets play an important role in normal blood clotting (blood clotting), counting these blood cells is a necessary test. If the patient has not had any episodes of abnormal bleeding in their lifetime, such as heavy nosebleeds or bleeding from the gums of teeth, there will likely be no abnormalities in this test. However, studying the platelet count is very important to determine the possible risks of bleeding during surgery.
As part of a biochemical blood test, plasma electrolytes, such as potassium and sodium ions, are assessed. Levels of these ions can be very low or high in patients taking medications for high blood pressure or other medications. Before surgery, it is necessary to restore the normal level of these ions in the blood plasma.
The blood clotting profile evaluates the effectiveness of clotting, which is important to know because blood clotting may be impaired in patients with hemophilia or other clotting factor disorders.
Also, mandatory tests that are performed on all patients before surgery are the determination of blood type and Rh factor, since these data may be required for blood transfusion, and the determination of markers of infectious diseases - viral hepatitis (B and C), syphilis, HIV infection. In the absence of all these tests, the operation is impossible.
Electrocardiography (ECG). This is a simple screening test that can determine heart function. It can help identify signs of atherosclerotic heart disease (narrowing of the arteries of the heart), which is a serious risk during surgery. ECG signs of a previous myocardial infarction or cardiac ischemia (lack of blood supply to certain areas of the heart due to insufficient blood flow) are signs of atherosclerotic damage to the coronary arteries (arteries of the heart). If you receive an abnormal ECG picture, you may need to perform additional tests, which will be prescribed by your doctor or cardiologist.
Here and now
— How can you cope with stress when your loved one is seriously ill?
- In fact, relatives of seriously ill people also suffer and go through the same stages - from shock to denial and aggression. It even happens that a relative is physically ill, and loved ones receive such psychological trauma that the same organs themselves begin to suffer. Therefore, there can only be one piece of advice here - stay in the present, do not fantasize about various options for events and drive away gloomy thoughts. There is no need to bury anyone in advance! After all, at the moment your loved ones are alive, which means you can enjoy communicating with them. Whatever it may be, everyone is alive here and now!
