Preconditioning before surgery

Health Topic

Preconditioning before surgery : aka leaked paper before the exams!

Imagine yourself preparing for a very tough competitive examination. You are allstressed out about your performance, and suddenly you get the whole 
paper sent to you plus the ideal answer sheet! And that too one day prior! Well, you obviously will do well in that exam.

Now extrapolate that exam and think about a surgery you are planning to undergo. Can we have a leaked question paper here as well?

The answer is yes! We have started employing a new concept now for all our patients undergoing joint replacement surgeries. We see that most of our elderly patients coming in for surgery are malnourished and also lack exercise training. 
All these surgeries require a huge participation from the patients as far as the post-surgery exercises go. A well nourished patient also does far better than a malnourished patient for obvious reasons.

So, we now do two different things once we start planning our surgery. We screen the patient for any malnutrition. Blood parameters tell us about 
malnourishment but simple home measurements are also good indicators. 
For example, Mid-upper arm circumference < 24 cm is a good indicator of malnourishment. We then refer such patients to a qualified nutritionist 6 
weeks prior to surgery. Based on patients’ food preferences and their religious beliefs a good balance diet is prepared. Sometimes we see a 
patient loose 5 kg weight as a result of this diet plan. 
We also take the help of a qualified physiotherapist and they help the patient understand what kind of exercises they will need to do after the 
surgery. Patients learn and do these exercises at home. Anyone after the surgery is not keen to try new exercises as they are in pain, may have a 
disturbed sleep or any other medical issues. However, if they have already been practicing these exercises before the surgery, they find it very easy to
follow the instructions in the hospital

It is very popular diet now a days and helps us tremendously if a patient followsthis. Anyone can use these guidelines without worrying about their co morbid conditions. However, since many patients have diabetes, blood pressure, kidney ailments it is always better to consult a qualified professional.
We mainly need a high protein diet for patients to build good muscle mass before the surgery. Here are a few simple sources of protein in India.

We recently came across an elderly 
gentleman, who needed a knee replacement.However, he had undergone 2 major surgeries in the last 6 months. Both hissurgeries were performed to ease the pressure on his spinal cord. He had hardlywalked due to his various illnesses and his bad knee for almost 1 year. We thus puthim in this preconditioning program. He lost 5 kg weight before we performed hisknee replacement and after the surgery, he went home 
on the third day 
walking well. At 15 days post-surgery he could shift to a stick for walking and could bend his knee fully! 
Unfortunately we also see a lot of elderly patient who land at our doorstep with afracture. The surgery is an emergency one so no preconditioning is 
possible. But
post surgery dietary help improves them tremendously.
The take home message is that before you plan your surgery make sure that your surgeon looks after your diet and exercise programme. Its therefore correctly said that “well begun is half done!”

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