There are many similarities between lockdown and surgery. Both have a preparation and recovery phase.
- Social distancing- mental prep and check lists
- Surgery and lockdown are final- there is no going back
- There are stages of recovery
- How we do is a combination of our starting point and surgery
- Recovery is a process- be patient
- Recovery is a mental and physical process
- The second time is easier
Social distancing- the mental prep and check lists
As numbers of positive cases started to build and we became aware of this virus, we knew something had to happen, and so we started with an address from the president. A state of disaster was declared and we would begin with social distancing- we were not to have large gatherings, schools closed and although lockdown had not been announced we knew something big was coming. Before lockdown was announced post of people seeing the army out in the suburbs were reported, something was happening. A sense anticipation or trepidation was in the air- what was the next step.
In the weeks of social distancing before lockdown I could feel the mad rushing around, as we prepared for lockdown. We weren’t really sure what would happen. We rushed around finalizing things. I remember getting home late on the Thursday night and squeezing a last minute run around the neighbourhood in- I knew this would not happen for a little while.
This is much like my patients preparing for surgery- the madness in the weeks before surgery- medical aid authorisation check, dentist check, physician check, applied for leave check, out of office reply check, computer set up to work from home check, ready made meals check… and so the list goes on. check check check. The stress builds, they come in to hospital, have surgery and then the reality sinks in, and the question comes “what does my recovery look like?” I look at them incredulously and wonder why was this question not asked before? But having gone through the same with lockdown I can see how this happens. We were so busy planning for the event (lockdown/surgery), we forgot to ask about the recovery process.
Surgery and lockdown- there is no going back
I woke up on the morning of Friday 27 March and there was a sense of calm- there was nothing left to do. I sometimes at this point get the question from my patients “Do you think I did the right thing”. My answer is always the same “It doesn’t matter what I think, we need to carry on from this point, what is done is done” I don’t say this to be flippant. Whatever decisions lead us to the point that surgery/lockdown was done was based on consultation at the time, examining best evidence and current situation. Neither were taken lightly.
And so, we started to live the reality of post lockdown. But I can now see where the question comes “Do you think I did the right thing?” comes from. I did not know what lockdown would look or feel like. Yes, I had the brief but even so. I was happy to follow the rules. But as I went through lockdown, I couldn’t help but wonder, was there another way, was this our only option. And then everyone’s opinions started- this one thinks this, that one thinks that. Same with surgery- you speak to a friend they did something else, should you have done that instead, would that make a difference. The thousands of opinions can start to cast doubt on what was an informed decision at the time.
There are stages of recovery and healing
Immediately post op I tell patients to go home and rest. The have some exercises to do- they can do these at home, no they shouldn’t go out, no driving, and use their crutches or arm sling. We recommend taking time off, not heading back to work, resting, and recovering. In this early phase we need things to settle. Sound like lockdown level 5?
Then there is a follow up and we re-assess, what is next, can you go to the next phase, or do you need to stay where you are at.
What do most people feel at the end of this- much better. Common comments post this strict recovery period “I have never taken so much time off, where I couldn’t do anything else”. Yes there is stress in this time, but they appreciate the time off. I think many of us felt like this at the end of the first 3 weeks. We had done different things, probably worked from home, enjoyed less rushing. But then alert level 5 got extended- WHAT?! We didn’t anticipate or plan for this.
From there we move to rehab level 4- you can start to go out a bit, not for too long. You still need your crutches. Not dissimilar to lockdown level 4- we could exercise from 6-9, more businesses opened. Ideally those who could work from home should work from home. You must wear your mask aka use your crutches or sling.
Rehab level 3 – you can exercise anytime, more businesses are open, you can start to return to work, but again take it easy and don’t over do it. In the home you shouldn’t need your crutches but if going out use your crutches. If you overdo it in level 3, we may have to move back to level 4. My advice to patients here is that they need to look after themselves, if they need to rest they need to let people know. As they start to drive and be more independent their support group forgets about their surgery because they are doing more. But you need to be aware of what you are doing. This is the same for lockdown level 3- we are here as part of a recovery process. Our easing of precautions for recovery for patient post-surgery is based on tissue healing time, and the tissues ability to take new load. In dealing with the pandemic the easing of restriction is based on state of readiness of hospitals to deal with the load of people who will enter the system.
How we do is a combination of our personal situation, the external environment, and the type of surgery
Common questions at every level- am I on track, how do I compare to other people. Comparisons are important but as I remind every patient- your starting points are different- some are fitter, younger, have comorbidities, want to get back to different levels of sport. Some friends with the same surgery may be doing better or worse. Why is that? Because we don’t know what they went into surgery looking like.
As South Africa compares itself to other countries, we remember the demographics of our country are different, the age of the population, the comorbidities are different, access to resources are different. As we weigh up these things as we compare ourselves in terms of the pandemic to other countries, the same applies to surgery. We know how this thing is going, but how your fair depends on all the variables. We will do the best we can with what we have at the time.
Recovery is a process- be patient
In the first few weeks post surgery I tell my patient this period is all about you injured joint. Every appointment probably focuses on how much range you have, how much longer on crutches, in the brace or sling. But there comes a point where it is not all about your hip or knee surgery. A turning point for most patients is the point they can start to drive- it brings with it a sense of freedom and independence again. I always remind them at this point- as you start to do more, you may have a temporary setback, that just means ease off, take a break. As you get your independence don’t forget your healing is not done- there is still a way to go. This phase is about learning to live and adapt to the situation- each day gets better. So for my hip and knee patients they return to work, they might find things difficult e.g. climbing stairs, but we can deal with that.
As we move into level 3 lockdown- more businesses are open, we are healing, and we can take on more things. However, the threat of the virus is still there- we still need to wash hands, sanitise and wear a mask. But this process is about integrating back into our life.
Many people post-surgery have a sense they are different and have seen the world differently. Some people slow down, change some things in their life.
Recovery is a mental and physical process
As patients recover from surgery and return to their lives we often chat about the mental recovery.
A phased return is needed. As I emerged out of level 5 lockdown from running around my complex and garden, and now had the freedom to run outside, that freedom felt daunting. I had run 5km on most days. Weekly running a 10km and then once pushing and running a 21km (21km for 21st day of lockdown). And yet the first 5km in lockdown level 4 felt terribly far. What I take from this is that as we can do more, we should not underestimate the emotional shift that comes with that freedom.
We are in alert level 3 lockdown. Already there are more cars on the road. Driving home from work was an assault on my senses- there were more people at work, there were taxi’s, pedestrians. This was a shift from the quiet roads of the last 8 weeks. I have been adjusting through the levels 5, 4, and now into 3. For those who are returning to work or school, who perhaps have not ventured out, and felt that gradual sense of things getting busier, do not underestimate the emotional shift. From a rehab perspective we need to get back to work, but we understand this is a process too- venture out for a little, assess how you feel.
Level 3 of lockdown this requires me to be more vigilant in my work space- ensure my cleaning protocols are in place, that I look after myself. This is not the time to drop our guard and believe all is ok.
In lockdown alert level 2 and 1 we hopefully should be more at home with the virus. We will be reminded of how things were, and that we are not there yet. As with rehab there may be flare ups and set backs, and we may need to take time out again. However, when this happens the return is less scary.
And yes, we will move out of the state of disaster, you will have forgotten about your surgery. You will be different, but the difference will be part of who you are now. Just as we will move out of level 3 and into level 2 and 1. We will be different. We will have re-evaluated our lives. Some things will stay- and perhaps maybe we are not sure which ones they are. We will be forever changed.
The second time is easier
It is likely that this virus will stay with us, and it is anticipated we will have waves of the virus to come. But with each wave we will have learnt from the last wave, we will be more prepared. If patients come in for surgery a second time, I tell them the second time is easier. They know what to expect, and mentally they are more prepared.
As always, we wish everyone a speedy recovery, and we are there to partner with you on the journey to recovery- through lockdown and post injury or surgery.