Barbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing
Introduction
This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer. This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery. Part Two addresses managing ongoing recovery at home. These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.
Part Two: Healing, Getting Stronger, Eating and Sleeping Better – Trial and Error and a Pinch of Patience
Because everyone’s recovery from surgery is different, your healthcare team can only give you basic information and guidance based on what they see and hear from other patients. Knowing what to expect in terms of wound healing, fatigue following surgery, physical activity, and eating and sleeping—all things which are essential to the healing process—is where trial and error and waiting may come into play.
Wound healing takes time. You can aid the health process by getting enough protein and calories, treating any anemia you might have, and keeping the wound and the surrounding area clean. These are all things that you can do with the help of a caregiver. Protein intake should ideally include 30 grams of protein with each meal for an average size adult male and less for a smaller female (30 grams includes a piece of meat, chicken, or fish the size of your fist, or several eggs). If you continue to feel unusually tired at home, tell your healthcare provider. They may do a blood test to check for anemia (an insufficient number of red blood cells, sometimes called “iron-poor blood”). If you have some anemia, your provider may have you take an iron supplement. Eating iron-rich foods is always a good idea when healing. Try dark leafy greens, dried fruit, beans, enriched breads and cereals, meat, eggs, and some fish. Keeping your wound clean with soap and water and showering as soon as you are able to will also help with healing. Then sit back and let the healing take place!
Physical activity is very important to the recovery process, and requires willingness and motivation. A caregiver can be helpful in terms of encouraging you to sit and do chair exercises, go for a walk, practice going up and down stairs, or, when stronger, going to an exercise class. I was surprised at how weak I was when I first came home from the hospital. I was determined to get stronger and eventually back to where I was before my surgery. For the first several days I focused on daily activities such as bathing, dressing, putting away dishes and laundry, and other types of household chores. After a few days I began going up and down the stairs, and then progressed to taking short walks outside. I gradually lengthened my walks to three times a day for about 20-30 minutes at a time. I am fortunate to have a treadmill at home to use when it is cold or rainy outside. I also have multiple flights of stairs and used those as a way to improve my endurance. Most of these approaches don’t cost the patient or caregiver any money and can be done at times that work for both of them.
Getting your appetite back after surgery can also take time, but good nutrition is important for healing. Once I went home, my healthcare providers did not give me any instruction about nutrition, other than the amount and consistency of what I could eat due to the type of surgery I had. This is not unusual as there is generally no nutritionist in the outpatient setting. My family and I looked up the calorie counts and nutritional value of the foods I like best, and I have worked hard at maintaining or gaining some weight. As I write this, I can still only eat a half to two thirds cup of food or fluid every 3-4 hours. So I make sure everything I eat is packed with calories. While recovering from any type of surgery, eating small frequent meals is particularly helpful, since larger meals can be too overwhelming to even try, and therefore decrease overall daily calorie intake. Examples of compact calorie combinations include a scrambled egg made with melted cheese, mashed potato with margarine, cheese, and milk, or hot chocolate made from milk. Protein drinks can be used if you find they taste good to you.
Finally, how to get a good night’s sleep? Some unfortunate people have trouble with this even when they are not trying to recover from surgery, but I felt that I was particularly challenged with sleep because the type of surgery I had required that I sleep in a semi-upright position for a while. When I asked my healthcare providers if other people with my type of surgery complained of trouble sleeping, I was told that most patients experienced being tired, but didn’t have problems sleeping. Sleep problems are not always easy to address or resolve. I did find that moving from a bed to a recliner during the night aided my sleeping somewhat, and I have heard this from others. So, trying different positions, pillows, or chairs may help you find what works best for you to help you sleep.
The bottom line is that the recovery process following surgery involves a lot of trial and error and patiently allowing time for recovery to occur. You and your caregivers know your body, your preferences, and your needs best, so experiment with what works for you in terms of tolerance and enjoyment. Don’t hesitate to tell your family or other caregivers, or call your healthcare team, when things feel painful, if you notice any changes, or if you have any questions. You, your family, and your healthcare providers are all part of the team that support your recovery!