Preparing for Surgery
For some, surgery is performed in an emergency situation and there may not be time to prepare ahead. However, if your surgery is planned, you may have days, weeks or months to prepare. Preparing for this type of brain surgery is difficult because there is not a specific type or length of recovery – each person’s recovery is a unique experience. It is good to be prepared for the worst case, but hopefully you will find that your recovery is much easier than you expected. Below are some suggestions you may want to consider if you do have time to prepare ahead for you surgery.
Months/Weeks Prior to Surgery
Find the best neurosurgeon possible
Take time to research, get referrals and interview multiple neurosurgeons. Finding the best neurosurgeon for your particular surgery is probably the most important thing you can do. Make sure your neurosurgeon has the best qualifications for your particular surgery and also that they are someone you feel comfortable talking to. Prepare a list of questions to ask during your appointment with the surgeon.
Prepare family and friends
Make sure your family and friends are prepared for how they can help you with your recovery. Give them specific duties ahead of time so there is no confusion about who is doing what. For example, who is going to drive you to the hospital and follow-up appointments? Who is going to take care of the children? Who can prepare dinners or go shopping? etc. Also, try to share the duties so that one person is not taking on too much and so that all your loved ones feel they have helped.
Prepare your employer
Talk to your employer about how you need to help prepare for your absence including both short and long term scenarios. Also, find out if your employer is willing to accommodate modified duties upon your return including part-time hours, working from home, light physical duties, etc.
Check with you medical insurance provider regarding any out-of-pocket costs that may be associated with the surgery and make sure you have all necessary pre-approvals. Find out about disability benefits in your State in case you are not able to return to work right away. Also, try to make sure all your bills are up to date prior to surgery. If possible have bills set up on automatic payment so this is one less thing you have to worry about during your recovery.
Some hospitals require payment before booking. Ask for a written estimate that covers all anticipated costs such as MRI’s, surgical fees (may be separate) and hospital fees. Some of these fees are usually an estimate as every patient visit is different.
Prepare an Advanced Directive
Prior to your surgery, you may want to consider drafting an Advance Directive to specify your medical wishes in case you are unable to communicate them yourself. Thinking about worst-case scenarios prior to facing surgery is difficult; however, it is important that you know that you, or someone you trust, are in control of your medical decisions.
An Advance Directive is a legal document that specifies your wishes about your health care and/or names someone else to make decisions for you if you become unable to do so. Each state may have different restrictions and/or formalities with regard to creating Advance Directives so you should consult with a state representative or an attorney to determine your state’s laws.
There are two types of Advance Directives: The Living Will and The Power of Attorney for Health Care:
A Living Will directs doctors and medical providers about certain types of medical treatment such as artificial life-support. It will usually specify when life-sustaining measures should be withheld if you are terminally ill or near death. A living will is not as strong as a Power of Attorney for Health Care because it only covers what is specifically written and it doesn’t name someone to interpret what is written.
Power of Attorney for Health Care
A Power of Attorney for Health Care (also called Durable Power of Attorney for Health Care) is a written document in which you specify someone as your decision-maker with regard to your healthcare if you cannot make decisions for yourself. This person can negotiate on your behalf with doctors and other caregivers and can make decisions according to your directions. This document can also specify kinds of treatments you do or do not want. If your wishes in a particular situation are not known, then your agent will have the power to make decisions based on what they think you would want.
Week/Days prior to Surgery
- Prepare your hospital bag. Make sure you have everything you need for the Hospital – see Things for the Hospital for a specific list of items.
- Check with the Hospital regarding any necessary paperwork you need to bring with you, for example insurance pre-approvals, insurance cards, MRI films, prescriptions, etc.
- Find out when you will be admitted to the hospital and any specific admitting instructions.
- You may want to create a list of people and phone numbers that you want a family member or friend to call following your surgery. Coming out of surgery, you won’t be up to this task. An alternative may be to designate a person who is outside of the hospital to email everyone when you come out of surgery and send regular updates after that.
- Find out if you will require any post-surgery prescription pain medication and/or muscle relaxants, etc. If so, try to have them filled beforehand so that they are with you when leaving the hospital.
- Have a couple of gel ice packs in the freezer for after surgery.
- Have an appointment set up with your family doctor to have sutures or staples out ten days after the day of surgery.
- If traveling by air, notify the airline to request a wheelchair be available to you at the airport and upon arrival.
- Some airlines will inquire as to the nature of your trip/surgery. Depending upon the airline, your surgeon may be required to complete paperwork stating that your health is suitable before flying home, e.g., medical approval form. This will then need to be faxed to the airline before departure. Find out beforehand about their policies for traveling after brain surgery.
- Hotel arrangements should be considered and arranged in advance for family during your stay. Close proximity to the hospital is convenient as loved ones will be visiting daily.
- Some hospitals offer less expensive “hospital rates”. Make sure you inquire as they otherwise won’t usually state these deals.
- Print out area maps for loved ones ahead of time so they can easily find their way around. Find out the easiest way from the airport (if flying) to the hotel and hospital ahead of time
- This may be a good time to take time to do something you love and spend some quality time with your family. Also, many people find relaxations techniques, such as meditation and yoga, help them to stay calm during stressful times such as these.
Day Before and Day of Surgery
You will most likely be given specific instructions from the hospital with regard to the day before and day of surgery. Make sure you follow all specific instructions provided to you by the hospital staff. Below is a list of some things you may be asked to do prior to surgery.
- Shower/bathe with anti-bacterial soap the night before or day of surgery;
- Not to eat or drink after a specific time the night prior (usually midnight). It is best to have an empty stomach while under anesthesia;
- Not to put on jewelry. You should leave your valuables at home or with a family member;
- Remove contact lenses sometime prior to surgery;
- Not to wear nail polish (It interferes with the device used on your finger to measure you blood-oxygen level);
- Make sure you have instruction on which medications you should take prior to surgery and if you can take them with water;
- You may be scheduled for an MRI the day prior and special mapping devices may be glued to your scalp. If so, you should not wash or get your hair wet;
Going to Surgery
Your surgery time has arrived; hopefully you have the peace of mind that you have done all you can. Do your best to relax and know that your neurosurgeon is going to do the best of his/her abilities.
You may be admitted to the hospital either the day of your surgery or the day before. You probably need to go to an admitting area before you become a patient of the hospital. At this time you will probably be completing and signing standard hospital forms and asked questions about your medical history including any allergies.
Prior to entering the pre-op area you will probably have to say goodbye to your family and friends. Once you are sent to the Pre-Op area you will be changing into a hospital gown and you will probably have an intravenous line (IV) inserted at this time. The surgeons and anesthetist will likely come in to greet you and briefly explain the surgery. At this time, if you haven’t already, you may want to ask him or her what sort of temporary deficits, if any, you can expect immediately after surgery and when to expect them to diminish. These may vary depending upon the surgery.
Once you are moved to the operating room, you will be sedated. After you are sedated, a catheter will be placed into your bladder to drain urine. A portion of your head will probably be shaved at this time. The amount of the hair clipped will depend upon on many things, therefore it is best to leave this up to the doctors on the day of surgery.Hopefully, prior to surgery your surgeon will have prepared you for where and how big the incision will be. While you are in surgery, the surgical team will notify your family as to the progress of your surgery. Also, your surgeon probably told you how long the surgery would take; remember this is an estimate. There are many factors that can cause the surgery to run longer. Some hospitals give family members pagers so they can be notified when surgery is complete.
Once your surgery is completed, you will be taken to a post anesthesia or recovery area so the nurses can monitor you as you wake-up from the anesthesia. If your vital signs are stable you will probably be moved to the Neurosurgery Intensive Care Unit (NICU) for at least twenty-fours. It is normal for you to be moved to NICU following this type of surgery so you can be observed more closely. At this time you will probably still be connected to lots of monitoring devices to check your heart rate, temperature, respiration, medication, etc., and you may still have the catheter. Also, be aware that these machines have alarms that may sound for many reasons including medication doses being low, devices falling off, etc. Some hospitals have inflatable devices on your legs that will massage your legs to help you from developing blood clots.
Once the the anesthetic wears off, it is normal to feel some pain around the surgery site and possibly some muscular neck pain. The nurses will offer you ice packs for relief. Pain medications may be administered via IV or orally. Expect sleeping to be uncomfortable for a few weeks, until the surgical site heals. It may be normal to feel numbness around the surgical site; this will slowly diminish. Always advise your doctor or nurse as to any unusual pains or sensation you may be experiencing during your stay. As you will feel groggy and weak, it may be advised to keep the amount of visitors low for the first day or two.
First Few Days After Surgery
Hopefully, during the first few days after surgery there will be many improvements. If your recovery is progressing well, you will be moved to a regular hospital floor and most of the monitoring devices, the catheter and the IV may be removed. However, you may not have a private room (this is where the ear plugs come in handy) and nurses may take longer to respond to your needs due to a higher patient load. If you feel up to it, you may be able to sit up in bed, sit in a chair or walk around the hospital depending on your recovery progress. Always have someone with you as you’re walking up and down the halls. You may ask a nurse to wash your hair before you leave the hospital as you will need assistance. Once home, for about two weeks after surgery, you will need a family member or friend to wash your hair for you, as the incision site must be kept dry. Be sure that the nurses clearly explain your recovery process and any limitations you will require following your surgery. Also, your doctor may order you to start some in-patient physical therapy depending on your rehabilitation needs. Take it SLOW – remember recovering from brain surgery takes time.
Leaving the Hospital
Once you are discharged from the hospital you may be able to go home, however you will need some assistance from family and friends for a while. If you are not ready to go home yet, you may be transferred to a rehabilitation hospital were you will receive both medical care and intensive therapy (see Rehabilitation). Neck pillows (the kind used for air travel) are highly recommended for head support as your neck muscles may be weak and sore. Post-surgery, this is handy for both air and car travel.
Recovery may be very frustrating because daily tasks that were easy prior to surgery may be hard. Remember, this is not an overnight type of recovery you will continue to make gradual improvements over time. Try to stay positive and focus on your improvements and slowly add more and more activities to your daily routine. Listen to your body when it tells you to rest.