Having an op? Don’t shave your legs

Published Jan 27, 2016

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London - What you do in the hours and days leading up to an operation can make a bigger difference than you might think.

In fact, one National Health Service operation is cancelled every ten minutes in England — around 60,000 a year — because patients fail to follow doctors’ instructions beforehand.

It’s because they ignore directions about fasting or medication, according to Oliver Warren, a consultant surgeon and co-author of a new book, Going Into Hospital? A Guide For Patients, Carers And Families.

Other mistakes won’t necessarily lead to your op being cancelled, but they could impede your recovery. Here, we look at some common blunders people make:

 

Don’t shave your legs or shower the night before

Many people believe they are doing their surgeon a favour by shaving their legs before a leg operation, says Andy Goldberg, a consultant orthopaedic surgeon at The Wellington Hospital in London.

‘But shaving leads to microscopic cuts and abrasions which can disrupt the skin’s barrier defence against bugs — these can then colonise the skin and hair follicles.’

A 1983 study of more than 1,000 patients, published in the journal Archives Of Surgery, found there were ‘significantly fewer’ wound infections in patients who had body hair removed on the morning of the op, rather than the night before.

‘Many more studies have been carried out since and, while the risk is not very high, it’s good practice to leave the shaving to the surgeon,’ says Dr Goldberg. ‘The best time to remove hair is immediately before the operation, rather than in advance.’

A week without shaving should be enough for any damage to the skin to heal, keeping infection risk to a minimum, suggests Dr Ron Cutler, a microbiologist at Queen Mary University of London.

 

Slim down on the crash diets

Overweight patients are often advised to slim down before surgery. Being obese can make you more prone to complications with anaesthesia, as you may need more of it.

It can also raise the risk of infections (fat has a poor blood supply, so wounds may take longer to heal) and deep vein thrombosis. And being unfit means the surgery places more strain on the body and increases the risk of heart or chest complications.

However, some people go too far, embarking on a crash diet, says Rebecca McManamon, a registered dietitian and spokeswoman for the British Dietetic Association.

‘If you lose weight too quickly - more than a pound or two (about a kilo) a week, unless under specialist supervision - you start losing muscle mass.

‘This is because if the body is not getting as much energy as it needs, it uses fat reserves, but also turns to the energy stores in muscle.’

It has implications for the whole body. ‘Your arms and legs may be affected, which can affect your ability to become mobile afterwards, and the muscles in organs such as the heart and lungs can be weakened, too - so you can be more susceptible to infections.’

If you’re dieting, the typical advice is to stop limiting calories around five days before an op - then you’ll usually be given advice particular to your procedure.

 

Failing to disclose your garlic habit

It’s not unusual for patients to get mixed up when it comes to medications ahead of surgery.

Blood-thinning medication, such as warfarin, to protect against heart attacks and strokes, has to be stopped so blood can clot during surgery. But when it comes to blood pressure tablets, it’s important that patients carry on taking these up until the operation, as uncontrolled blood pressure can put you at risk of stroke, as well as slightly increasing your bleeding risk.

These two instructions are often mixed up by patients, and are a common cause of operations being cancelled, says surgeon Oliver Warren. ‘It’s no wonder patients get confused as there is so much information. You should be told everything at your pre-operative assessment. To avoid error, make careful notes or take someone along to help. And if there’s anything you don’t understand, always say so.’

Herbal remedies can be significant, too. It’s thought that garlic, ginseng and ginger, for example, can increase bleeding risk, so tell your doctors if you’re taking them.

 

Chewing gum to cope with fasting

Avoiding solid foods before an op is important, as the stomach needs to be empty. Otherwise, you risk vomiting under anaesthetic, which, if inhaled, can be fatal, says Dr Anna-Maria Rollin, a consultant anaesthetist and spokeswoman for the Royal College of Anaesthetists.

However, some patients try to ‘cheat’. ‘One thing people do is chew gum, as it feels like they are eating.

‘The problem is that your stomach produces extra acid in anticipation [of food]. Then, when you’re under the anaesthetic, all the sphincters [valves] in the gastro-intestinal tract relax, so you are more likely to regurgitate. If this acid then gets into the lungs, it can kill.’

There is, however, some debate among anaesthetists as to how serious a risk chewing gum actually is.

It’s important to note fasting rules have changed in recent years — we used to fast for up to 24 hours before an op. Now, the accepted length of time is six hours.

And until recently, patients were advised to drink only water up to two hours before an operation. ‘Now, we tell people to drink sweet, clear fluids (such as squash, or tea with sugar but not milk),’ says Dr Rollin. ‘Water is OK, but it’s better to have something sweet, so you have a few calories in reserve. If you have fasted too long, it can inhibit the healing process.’

 

Have a shower -but don't worry about your nails

Having a shower before you head to hospital not only gets rid of bugs on your body, it could also get you better treatment from staff.

‘It’s always a good social thing to look and smell presentable — it makes people more likely to want to sit on your bed and talk to you, for example,’ says Dr Rollin.

If you have to be up early, you may be tempted to shower the night before. But this is a mistake, adds Mr Warren. ‘Try to shower on the day you go in, as you might not have the chance for a day or so after the op: you may be immobile or have a dressing that can’t get wet.’

Your nails should be cut before going into hospital as long nails are more likely to harbour dirt, raising the risk of infection, says Dr Cutler.

Don’t be tempted to have a manicure, though. ‘During surgery, we use probes to measure the level of oxygen in patients’ blood. These are attached to the finger, so nail varnish has to be taken off before they can be used,’ says Mr Warren.

 

Bring two toothbrushes

Bring two toothbrushes, advises Dr Cutler. ‘Hospitals are very clean these days, but it’s useful to have a second toothbrush in case you lose one or drop it on the floor - it helps to minimise the risk of infection.’

It may also be a good idea to switch toothbrushes after your op, he adds, as your immunity may be reduced as a result of the surgery, meaning the bugs on the brush you used before could pose a problem.

 

Smoking cigarettes the day before

If you stop smoking even just one day before an operation, it can make a difference to your recovery, says Dr Rollin.

‘The longer in advance you stop, the better, but even 24 hours can help,’ she adds. ‘Smoking wrecks the lungs, and damaged lungs are more likely to become infected - post-operative chest infections are more common in smokers.

‘This is because smoking is an irritant that can make you cough, which is especially uncomfortable when you’ve just had an op. But if you try to suppress the cough, it will raise the risk of a chest infection.’ (The cough smokers often experience after giving up does not usually begin until ten to 14 days later.)

Another reason to stop, even just the day before surgery, is that smoking instantly makes the blood stickier, which can hinder the blood supply to the tissues during the op.

‘People often think they are unable to give up permanently, and that it’s not worth trying to cut down. But that’s not true,’ adds Dr Rollin.

 

Just relax

You are bound to be a bit nervous before your operation, but too much anxiety can raise your blood pressure, which may mean the op has to be postponed.

According to Mr Warren, one of patients’ biggest sources of anxiety is failure to make sure their pets are looked after. ‘I’ve had patients who wake up after an operation and the first thing they say is there’s no one to check on their cat. It’s important to make plans ahead of your stay.’

He also recommends a trial run of your journey to hospital, so you have no undue stress on the day.

‘Anxious people are harder to put under general anaesthetic and also have lower pain thresholds, so will need more medication after surgery - and that can come with side-effects,’ he says.

 

Asking how long the op will take

It’s a common question, says Mr Warren, but not the most important. ‘What patients never ask, but should, is how long it will take for them to get back to normal.

‘It really doesn’t matter how long the operation lasts because, when they’re under general anaesthetic, the patient’s experience will be the same, whether it’s one hour or ten.’

The process of being put to sleep, cut open and put back together is, however, ‘unbelievably traumatic’ to the body, he adds. ‘Yet people are often surprised when, two or three weeks later, they are still tired.

‘We encourage people to think about the legacy of the surgery. They may never fully return to normal, but that’s something to accept as the pay-off of being cured.’

Daily Mail

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