Before Your Operation
Psychological Preparation
Imagine two different scenarios. Patient being prepared for lumbar discectomy and has been prepared by his physician. The patient has good family support with a satisfying occupation. He also enjoys outdoor activities but is frustrated of the pain and disability imposed by the herniated disc. Patient has not been depressed in the past and is looking forward to recover and return to a full functional life. He undergoes surgery (discectomy) and is sent home to recover. One week later he looks forward to returning to work. To begin his outdoor and sport activities, he begins a physical therapy program and within one month is able to play golf. Undoubtedly his healthy mental status contributed a great deal to his healing process. His motivation to improve lead to full participation in physical therapy. He also reached to his family for support and was looking forward for return to socializing with family and friends. The second scenario involves the same medical condition in a patient that has a history of depression and also frustrated by his condition. However, the patient works in a stressful office and is in constant battle with his employer. The patient is also overweight since he does not participate in any sport activities. His spine condition also provides him a mean to get attention from other family members and get special treatment at work. This patient too undergoes an operation to remove the herniated disc failure of conservative treatment. He wishes to stay in the hospital since he has no family support and is anxious to be home alone because he does not trust in himself. He is discharged home after two or three days. The patient requests to stay off work for a few months since his job is not satisfying secondly he is getting paid while laying at home. He does not realize that his absence from work is de-conditioning his body and lowers his endurance. He also continues down the path of depression which lowers his motivation in physical therapy. He further gains weight and gets more depressed. The cycle continues and his mental status keeps his back pain in place.
Very often we get surprised by patients that recover very quickly from very large operative procedures. We compare these patients to others and the only difference is their mental status, attitude, and motivation. Undoubtedly, metal well being contributes to faster recover with better results. The mechanism that this works is still unknown, but it is without question that worst results are seen in depressed patients, people unhappy with their work, lack of family support, sedentary life styles, and lack of motivation.
The role of education regarding the disease process and treatment options resolves a great deal of anxiety. It gives some control back to the patient elevating confidence and reducing the feelings of frustration. Realistic goal setting is of outmost importance since it places the patient on a track to improvement and eliminates guess work. Depressive episodes that may ensue from lack of hope may resolve by these realistic goal settings and may actually prove to make the difference between a motivated patient or the one that is waiting for a miracle.