Tips for Nervous System Support Pre + Post Surgery

SUMMARY:

Did you know that according to studies, 20-40% of patients experience some form of psychological trauma post-surgery? This can lead to conditions such as post-traumatic stress disorder (PTSD), anxiety, and depression​. The autonomic nervous system activates self-protective responses when it perceives threats, whether real or imagined. During surgery, the nervous system might interpret the intervention as a threat, triggering fight, flight, or freeze reactions. These responses can persist post-surgery, creating chronic nervous system dysregulation and hindering the healing process, so it's important to minimize or prevent them whenever possible. Therefore, the goal to a productive and non-traumatizing surgery is to go in calm, prepared and informed. In essence, the more relaxed equals the less active the survival responses.

Note: This blog was inspired by an incredible Somatic Experiencing session in the Body-First Healing Program, where I led a client through somatic tools to help process surgical trauma. I offer two sessions per month in the program, and clients can volunteer if they’d like to participate! Join today and learn the power of somatic experiencing for processing and releasing trauma stored in the body.
 

BEFORE SURGERY

Meet your surgical team

Build a rapport with your surgical team to establish trust, meeting with and interviewing the surgeon to discuss the procedure, their experience, and motivations. Requesting to inspect their hands, the tools of their trade, can further enhance trust and personal connection, moving beyond being just a patient number to being seen as an individual. Human contact in the form of holding hands, light touch, gentle massage and so fort is known to dramatically increase the speed of recovery fro stress and pain. Ask whatever questions are needed to feel safe and informed.

Orient to the Space

If possible, visit the surgery center prior to the day of the surgery and orient yourself to the environment. You will be disoriented coming out of anesthesia, and having some prior familiarity with your surroundings will go a long way to help you reorient. Visiting prior to the day of the surgery will also help take the activation level you will experience on the day of surgery down a level, because upon arrival you will already know where you need to park and how to get to your destination. You may even see familiar faces upon check in from your prior visit.

Anesthesia

Communicate with your anesthesiologist to ensure that Versed (midazolam) is not administered during surgery. Known as the “forget the surgery” drug for its amnesia-like qualities—versed can erase explicit AND implicit memory of the procedure. Implicit (body memory) is a crucial element explored in the SE modality to renegotiate or heal a potential surgical trauma. It's also crucial to avoid Versed during surgery as it doesn't relieve pain or emotional distress and increases the risk of post-operative PTSD. Opting for a local anesthesia shot at the incision site is advised, as it directly blocks the pain signal between the body and brain, leading to a smoother recovery compared to generalized anesthesia, which doesn't specifically block local pain signals.

 Ask to meet with the anesthesiologist provider beforehand, if possible. Getting details can greatly reduce fear. Useful info to ask: 

• Which medications?
  • Method of administration, (IV?, injection? mask?, pill?)
  • What might you feel going under and upon awakening?
  • Side effects? like nausea, inability to urinate, swallow or move 
• How long may effects last? 

 Designate an Advocate

Designate an "Advocate" to accompany you during pre and post-surgery hospital stays, someone trustworthy, calm under pressure, and capable of providing comfort. This advocate should understand and support your needs, without challenging or exacerbating your situation, whether they are a family member, spouse, friend, or professional.

Prepare your home and life for your recovery period

Prepare your household and anticipate a recovery time double the expected duration. If needed, re-arrange furniture and remove throw rugs or other tripping hazards to prevent falls. Set up resting areas so needed items will be within reach (charging cords, remote controls, phone, place to set drinks and snacks, important numbers, medications). Stock up on groceries or other items you will need after surgery. Think about the healthy foods that comfort you and have them on hand before surgery. What foods calm your stomach if you are nauseated from anesthesia or pain medications? Know what foods can you have with the medications that you are taking. Make sure someone is taking care of bills, buying groceries, looking after the kids, walking the dog, watering plants etc. 

Minimize stress before surgery

Minimize activating or upsetting activities before surgery, and address unresolved symptoms of traumatic stress weeks beforehand. Prioritize stress reduction, relaxation, and stabilizing the Healing Vortex (ie moments of ease and regulation) in the approach to surgery.

SURGERY PREP

Surgery Rehearsal

If possible start to work with your therapist or SE Practitioner in preparing for surgery months or weeks in advance. You may want to do some “rehearsing” of the actual day to help discharge some of the fear. This will also help to assess the most effective resources of support and safety when the day comes. Then, as surgery date approaches, work primarily with resourcing (ie focusing on what feels good, safe or supportive to your system).. 

Altered States

Practice going in and out of “altered states.” This can be done alongside a qualified SEP to guide you, or on your own. Examples include: imagine waking from sleep, imagine the last time you were intoxicated, dream imagery, free association imagining, diving/ flying trance experiences–all of these help develop acceptance of the altered states that will come with the anesthesia and pain medication during and after your surgery. Hypnosis is particularly good for this. You can do an Internet search on Google for "Free Hypnosis mp3." You can listen to these and practice "letting go.")

Comfort Items

Take in whatever comfort items hospital will allow:
• favorite music or relaxation tapes
• tapes with positive suggestions
• pillow or special blanket 

• stuffed animals 
• pictures 

 Engage in Laughter & Play

Watch funny videos prior to surgery, or engage in playful laughter exercises to loosen up and reduce anxiety and stress. Deep laughter works the diaphragm and helps to clear the lungs.

DURING THE PROCEDURE

Hearing

Depending on the depth of the anesthetic state, hearing may still be intact, and many people can report pretty accurately what was said during a surgical procedure. Encourage the surgeon or nurse to say positive things about how the surgery is going, and to ask that they discuss challenges of the surgery outside of your hearing range. If they cannot agree to this, ask if you can use headphones or earplugs to block noise. In the case of lighter anesthesia, it can be comforting if the surgeon reports what is going on as they proceed. Statements like, “you’re going to feel a pressure, you may hear some sounds...” can be supportive.

AFTER THE PROCEDURE

Coming out of Immobility

At some point the drugs will wear off and you will come out of the Immobility state and start to "wake up." This will happen slowly, in waves, over time. You may hear sounds before you can open your eyes. Additionally, the paralytic may still be somewhat active–causing you to potentially wake up in pain, yet unable to move or speak. It is important that this be as gentle a process as is possible. Having as much quiet and safety around you as you can have is very helpful for this to happen.

Lean on Your Advocate

It’s important that you not wake up alone. This is the most important time for the help of your Advocate. It is a very vulnerable time for you, and a crucial time for the to provide support, stability and some healthy co-regulation. They should be there saying, “Its OK, you’re coming out of anesthesia, the surgery was a success...” And if it was not a success, they can state “You’re coming out of anesthesia, you’re here and safe. We can talk about the surgery later…”

This is also a time when the doctors will be coming in to check on you. Unfortunately they often do this quickly and abruptly. Your Advocate should not try to stop them from doing their job, but be close by to answer any questions they can and take the attention off of you whenever possible.

The Advocate should also concentrate on supporting your own timing in emerging from this drugged state. They should not pressure you to wake up but instead "hold space" for you and support you in a kind way to follow your own pace.

Proactive Pain Management

You will hopefully be allowed to orient at your own pace before being moved or discharged. 

Pampering is recommended after surgery. Accept help from others and focus on pleasure rather than pain—proactively taking pain medication at regular intervals to keep pain at a minimum. Relying on pain to tell you when to take the drugs again will reinforce the pain signal in the body, running the risk of developing a pain syndrome. You instead want to keep the pain signal consistently low. 

 Discharging

It is best if the Advocate understands a bit about Freeze/Immobility and is comfortable with this process, which often moves through another phase sometimes called "Discharge." This Discharge phase can look like trembling or shaking and is a positive thing for the patient's nervous system to allow to happen as long as the movements are not so big that they threaten the sutures/ stitches from the surgery. Simple words like "you're doing fine, you can just let that happen" can help a person allow the discharge process to complete itself.

Doctors and nurses do not always understand the importance of this process (known as the Stress Response Cycle) and often give drugs to stop it. If at all possible, it is best to allow this process to continue uninterrupted without drugs. It will stop on its own if the proper support and allowance is present. The allowance of this Discharge phase is critically important to successfully negotiating this type of stress to the body. Reviewing the chapters on Freeze and Discharge in the book Waking the Tiger by Peter Levine may be helpful.

Renegotiating Surgery

By nature, surgery often comes with incomplete or thwarted self-protective nervous system responses (the need to fight or flight). This, coupled with potential emotional imprints of fear, loss or even anger could arise. Working with a trained SE professional can support you in completing these necessary responses and alleviating symptoms. 

Conclusion

Ensuring a calm and prepared approach to surgery can significantly mitigate the autonomic nervous system's self-protective responses, fostering a smoother recovery process. Building trust with the surgical team, familiarizing oneself with the environment, communicating effectively about anesthesia, and having a supportive advocate are crucial steps. Additionally, pre-surgery stress reduction, practice with altered states, and allowing natural post-surgery responses contribute to a successful and less traumatic surgical experience.