Discussing Options with Your Health Care Team Can Avoid Severe Pre-Surgery Anxiety

Even with seasoned surgery "pros", one bad experience can lead to overwhelming surgery anxiety, which in turn can lead to avoiding medical care when it is needed the most. Many people go into surgery for serious conditions and complicated procedures, where little can be done to avoid major anxiety or lessen post-operative side-effects, however, new technology is offering minimally invasive surgery options for certain conditions such as a laproscopic procedures, cystoscopies through the urethra, or colonoscopies. With these procedures, there can be more wiggle room for your comfort.

The first step in avoiding surgery anxiety is learning all that you can about your condition. After exhausting your doctor's wealth of information, the Internet is a good next step for more information if you go to the right place. For instance, the National Institutes of Health (http://www.nih.gov/) has information on most diseases, and you can decide whether to learn through the text of a patient, or the medical jargon of a health care provider. While some believe too much information is flat out scary, I believe it is empowering.

On the day of your surgery, if you are able to hold a conversation, you will see your surgeon, pre-op and recovery nurse (sometimes the same person), your anesthesiologist and the registered nurse anesthesiologist. This team is there to keep you informed and as comfortable as possible. If you have any questions at all (and keep in mind that no question is a stupid question), they are there to answer them and put your mind at ease. Most hospitals can provide pastoral care as well.

If you are like me and have a chronic condition that leads you to sever operating room trips a year, more than likely you know your disease inside and out. Your knowledge of the uses and effects of pre and post-op medications could give a seasoned pharmacist a run for his or her money, and above all, you know your body better than anyone else and you know what works and what doesn't.

Don't be ashamed of this knowledge. Speaking up to your care provider team before surgery is key in avoiding unwanted and fully-avoidable side effects such as pain and nausea. If you're in the OR to receive your thousandth stent, and know that one type works better than another from prior experience, speak up! If you are like me and would rather endure 10/10 pain than experience extreme nausea for a full day after general anesthesia, then ask your anesthesiologist about a different type of anesthesia. If you are going to receive anti-nausea medications pre and post op, and know that Reglan gives you the worst case of the bubble-guts, ask for a similar anti-emetic such as Zofran, or demand that you be given IV Pepcid to avoid immediate post-op cramps and diarrhea.

After 5 successful cystoscopic surgeries for kidney stones in the past few years, I know what works and know what doesn't. However, after moving to a new city and having my 6^th surgery with a new urologist, I awoke to a complete hell. First, despite knowing that my old OR team realized that I do much better with epidurals and light sedation than general anesthesia, it had been a while since I had an operation and I forgot that little piece of information. I awoke to unstoppable nausea and severe cramping from the raglan used along with the Zofran to avoid any nausea.

Also, this urologist had placed a ureter stent but left the string hanging out of my urethra. It made sense - just pulling it out when it was time instead of an in-office/more invasive cystoscopic removal, which I was perfectly used to. Instead of ease, this stent left me feeling as if I was going to die from the pain, literally. Despite passing hundreds of kidney stones on my own, this pain was far, far worse. It was so bad I would black out a little and see the pain in colors. After hunting down my old urologist, I learned that most docs choose to take the string out in women to avoid tugging and irritation.

Despite this new-found knowledge, my latest 5X7mm ureter stone left me terrified in the ER on two occasions. I was afraid of enduring the pain of another stent from this doctor. I was terrified to the point where I knew I needed medical help, but I refused any and all narcorics both times because I needed to get out of the hospital as soon as possible due to my anxiety. One time I even faked that I was feeling better and pretended I had to urinate because I overheard the doctor tell a nurse that I had to give urine before I could leave.

The fear was indescribable. I felt a fight or flight sensation, and this is coming from someone who looked forward to all of my previous operations knowing I would feel instant relief.

I don't mean to take away from people like cancer patients, who endure the fear of all fears, but to me, this was my own personal demon.

The day of my last operation I was miserable. My kidney function was becoming non-existent due to the blockage (I was passing less than 100ml of urine in 7 hours), I was nauseous from the blockage and I had been dealing with the bubble guts for days and was sure I would give the surgeon a nice little surprise if I was given raglan again.

This time I stood up for myself from the get-go. My urologist thought I was nuts, but he agreed to cut the string out of the stent. My personal nurse knew of my anxiety and other issues and made sure everyone was aware of how I felt. She even gave me the option of opting out of the surgery that day. My anesthesiologist was amazing that day. He agreed that I would do better with an epidural and light sedation, and a random doc in the OR, before putting me under, gave me pepcid for the bubble guts. I instantly felt at ease. I was being listened to, and was being taken care of.

When I awoke, I peeked my eyes open and saw my nurse. My first words were, "Oh my God, what a difference it made not to have the general anesthesia." I didn't feel like throwing up once. I was extra numb because the lidocaine didn't work before I was knocked out, and my anesthesiologist went for a stronger epidural medicine called marcaine (something new for me to remember - the learning never stops). He did everything possible to ensure my comfort, because I overcame my anxieties and opened my mouth.

This was about a month ago, and thanks to my rare kidney condition, I'm experiencing another stone as I write this, but I have no fear. I've learned (again) that doctors and nurses respect those with a good deal of knowledge about both their condition, previous negative experiences and pharmaceutical knowledge.

Sometimes there is no wiggle room, depending on the specific procedure or your state of health, but never be afraid to speak up, and don't let yourself be intimidated by doctors, whether they are intentionally foreboding or not.