The Insider’s Guide To Making Hospital As Comfortable As Possible

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Nobody Likes Surgery, But Here’s How To Make It Much Less Bad

This is Dr. Chris Bonney. He’s an anesthesiologist. If you have a surgery, he wants you to go in feeling calm, and make a quick recovery afterwards, with minimal suffering in between.

Being a patient in a hospital is a bit like being a passenger in an airplane:

  • Almost nobody enjoys the thing itself, but we very much want to get to the other side of the experience.
  • We have limited freedoms and comforts, and small things can make a big difference between misery and tolerability.
  • There are professionals present to look after us, but they are busy and have a lot of other people to tend to too.

So why is it that there are so many resources available full of “tips for travelers” and so few “tips for hospital patients”?

Especially given the relative risks of each, and likelihood, or even near-certainty of coming to at least some harm… One would think “tips for patients” would be more in demand!

Tips for surgery patients, from an insider expert

First, he advises us: empower yourself.

Empowering yourself in this context means:

  • Relax—doctors really want you to feel better, quickly. They’re on your side.
  • Research—knowledge is power, so research the procedure (and its risks!). Dr. Bonney, himself an anesthesiologist, particularly recommends you learn what specific anesthetic will be used (there are many, and they’re all a bit different!), and what effects (and/or after-effects) that may have.
  • Reframe—you’re not just a patient; you’re a customer/client. Many people suffer from MDeity syndrome, and view doctors as authority figures, rather than what they are: service providers.
  • Request—if something would make you feel better, ask for it. If it’s information, they will be not only obliged, but also enthusiastic, to give it. If it’s something else, they’ll oblige if they can, and the worst case scenario is something won’t be possible, but you won’t know if you don’t ask.

Next up, help them to help you

There are various ways you can be a useful member of your own care team:

  • Go into surgery as healthy as you can. If there’s ever a time to get a little fitter, eat a little healthier, prioritize good quality sleep more, the time approaching your surgery is the time to do this.
    • This will help to minimize complications and maximize recovery.
  • Take with you any meds you’re taking, or at least have an up-to-date list of what you’re taking. Dr. Bonney has very many times had patients tell him such things as “Well, let me see. I have two little pink ones and a little white one…” and when asked what they’re for they tell him “I have no idea, you’d need to ask my doctor”.
    • Help them to help you; have your meds with you, or at least a comprehensive list (including: medication name, dosage, frequency, any special instructions)
  • Don’t stop taking your meds unless told to do so. Many people have heard that one should stop taking meds before a surgery, and sometimes that’s true, but often it isn’t. Keep taking them, unless told otherwise.
    • If unsure, ask your surgical team in advance (not your own doctor, who will not be as familiar with what will or won’t interfere with a surgery).

Do any preparatory organization well in advance

Consider the following:

  • What do you need to take with you? Medications, clothes, toiletries, phone charger, entertainment, headphones, paperwork, cash for the vending machine?
  • Will the surgeons need to shave anywhere, and if so, might you prefer doing some other form of depilation (e.g. waxing etc) yourself in advance?
  • Is your list of medications ready?
  • Who will take you to the hospital and who will bring you back?
  • Who will stay with you for the first 24 hours after you’re sent home?
  • Is someone available to look after your kids/pets/plants etc?

Be aware of how you do (and don’t) need to fast before surgery

The American Society of Anesthesiologists gives the following fasting guidelines:

  • Non-food liquids: fast for at least 2 hours before surgery
  • Food liquids or light snacks: fast for at least 6 hours before surgery
  • Fried foods, fatty foods, meat: fast for at least 8 hours before surgery

(see the above link for more details)

Dr. Bonney notes that many times he’s had patients who’ve had the worst thirst, or caffeine headache, because of abstaining unnecessarily for the day of the surgery.

Unless told otherwise by your surgical team, you can have black coffee/tea up until two hours before your surgery, and you can and should have water up until two hours before surgery.

Hydration is good for you and you will feel the difference!

Want to know more?

Dr. Bonney has his own website and blog, where he offers lots of advice, including for specific conditions and specific surgeries, with advice for before/during/after your hospital stay.

He also has a book with many more tips like those we shared today:

Calm For Surgery: Supertips For A Smooth Recovery

Take good care of yourself!

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  • The Compass of Pleasure – by Dr. David Linden

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    There are a lot of books about addiction, so what sets this one apart?

    Mostly, it’s that this one maintains that addiction is neither good nor bad per se—just, some behaviors and circumstances are. Behaviors and circumstances caused, directly or indirectly, by addiction.

    But, Dr. Linden argues, not every addiction has to be so. Especially behavioral addictions; the rush of dopamine one gets from a good session at the gym or learning a new language, that’s not a bad thing, even if they can fundamentally be addictions too.

    Similarly, we wouldn’t be here as a species without some things that rely on some of the same biochemistry as addictions; orgasms and eating food, for example. Yet, those very same urges can also inconvenience us, and in the case of foods and other substances, can harm our health.

    In this book, the case is made for shifting our addictive tendencies to healthier addictions, and enough information is given to help us do so.

    Bottom line: if you’d like to understand what is going on when you get waylaid by some temptation, and how to be tempted to better things, this book can give the understanding to do just that.

    Click here to check out The Compass of Pleasure, and make yours work in your favor!

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  • Beat Cancer Kitchen – by Chris Wark & Micah Wark

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When we eat, many things can increase our cancer risk. Some we might remember to avoid, like ultra-processed foods and red meat. Others might be more neutral when it comes to cancer, neither good nor bad.

    But! Some foods also have cancer-fighting properties. Which means reducing cancer risk, and/or having an anti-proliferative effect (i.e., shrinks or at least slows growth of tumors), in the event of already having cancer.

    That’s what Chris & Micah Wark are offering here; a cookbook built around anti-cancer foods—after the former beat his own cancer with the help of the latter. He had surgery, but skipped chemo, preferring to look to nutrition to keep cancer-free. Now 18 years later, and so far, so good.

    The dietary advice here is entirely consistent with what we’d offer at 10almonds; it’s plant-based, and high in anti-cancer phytonutrients.

    The recipes themselves (of which there are about 70-ish) are as delicious and simple as the title suggests, and/but you might want to know:

    • On the one hand, many recipes are things like sauces, condiments, or dressings, which in a recipe book can sometimes feel like underdelivering on the promise of recipes when we expect full meals
    • On the other hand, those things if you just purchase them ready-made are usually the things with the most ultra-processed products, thus, having anticancer homemade versions instead here can actually make a very big difference
    • On the third hand, there areplenty of starters/mains/desserts too!

    Bottom line: if you’re looking for an anti-cancer cookbook, this is a very good one whose ingredients aren’t obscure (which can otherwise be a problem for some books of this kind)

    Click here to check out Beat Cancer Kitchen, and take good care of yourself and your loved ones!

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  • Five Advance Warnings of Multiple Sclerosis

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Five Advance Warnings of Multiple Sclerosis

    First things first, a quick check-in with regard to how much you know about multiple sclerosis (MS):

    • Do you know what causes it?
    • Do you know how it happens?
    • Do you know how it can be fixed?

    If your answer to the above questions is “no”, then take solace in the fact that modern science doesn’t know either.

    What we do know is that it’s an autoimmune condition, and that it results in the degradation of myelin, the “insulator” of nerves, in the central nervous system.

    • How exactly this is brought about remains unclear, though there are several leading hypotheses including autoimmune attack of myelin itself, or disruption to the production of myelin.
    • Treatments look to reduce/mitigate inflammation, and/or treat other symptoms (which are many and various) on an as-needed basis.

    If you’re wondering about the prognosis after diagnosis, the scientific consensus on that is also “we don’t know”:

    Read: Personalized medicine in multiple sclerosis: hope or reality?

    this paper, like every other one we considered putting in that spot, concludes with basically begging for research to be done to identify biomarkers in a useful fashion that could help classify many distinct forms of MS, rather than the current “you have MS, but who knows what that will mean for you personally because it’s so varied” approach.

    The Five Advance Warning Signs

    Something we do know! First, we’ll quote directly the researchers’ conclusion:

    ❝We identified 5 health conditions associated with subsequent MS diagnosis, which may be considered not only prodromal but also early-stage symptoms.

    However, these health conditions overlap with prodrome of two other autoimmune diseases, hence they lack specificity to MS.❞

    So, these things are a warning, five alarm bells, but not necessarily diagnostic criteria.

    Without further ado, the five things are:

    1. depression
    2. sexual disorders
    3. constipation
    4. cystitis
    5. urinary tract infections

    ❝This association was sufficiently robust at the statistical level for us to state that these are early clinical warning signs, probably related to damage to the nervous system, in patients who will later be diagnosed with multiple sclerosis.

    The overrepresentation of these symptoms persisted and even increased over the five years after diagnosis.❞

    ~ Dr. Céline Louapre

    Read the paper for yourself:

    Association Between Diseases and Symptoms Diagnosed in Primary Care and the Subsequent Specific Risk of Multiple Sclerosis

    Hot off the press! Published only yesterday!

    Want to know more about MS?

    Here’s a very comprehensive guide:

    National clinical guideline for diagnosis and management of multiple sclerosis

    Take care!

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  • 7 Steps to Get Off Sugar and Carbohydrates – by Susan Neal

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We will not keep the steps a mystery; abbreviated, they are:

    1. decide to really do this thing
    2. get knowledge and support
    3. clean out that pantry/fridge/etc and put those things behind you
    4. buy in healthy foods while starving your candida
    5. plan for an official start date, so that everything is ready
    6. change the way you eat (prep methods, timings, etc)
    7. keep on finding small ways to improve, without turning back

    Particularly important amongst those are starving the candida (the fungus in your gut that is responsible for a lot of carb cravings, especially sugar and alcohol—which latter can be broken down easily into sugar), and changing the “how” of eating as well as the “what”; those are both things that are often overlooked in a lot of guides, but this one delivers well.

    Walking the reader by the hand through things like that is probably the book’s greatest strength.

    In the category of subjective criticism, the author does go off-piste a little at the end, to take a moment while she has our attention to talk about other things.

    For example, you may not need “Appendix 7: How to Become A Christian and Disciple of Jesus Christ”.

    Of course if that calls to you, then by all means, follow your heart, but it certainly isn’t a necessary step of quitting sugar. Nevertheless, the diversion doesn’t detract from the good dietary change advice that she has just spent a book delivering.

    Bottom line: there’s no deep science here, but there’s a lot of very good, very practical advice, that’s consistent with good science.

    Click here to check out 7 Steps to Get Off Sugar, and watch your health improve!

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  • Intuitive Eating Might Not Be What You Think

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    In our recent Expert Insights main features, we’ve looked at two fairly opposing schools of thought when it comes to managing what we eat.

    First we looked at:

    What Flexible Dieting Really Means

    …and the notion of doing things imperfectly for greater sustainability, and reducing the cognitive load of dieting by measuring only the things that are necessary.

    And then in opposition to that,

    What Are The “Bright Lines” Of Bright Line Eating?

    …and the notion of doing things perfectly so as to not go astray, and reducing the cognitive load of dieting by having hard-and-fast rules that one does not second-guess or reconsider later when hungry.

    Today we’re going to look at Intuitive Eating, and what it does and doesn’t mean.

    Intuitive Eating does mean paying attention to hunger signals (each way)

    Intuitive Eating means listening to one’s body, and responding to hunger signals, whether those signals are saying “time to eat” or “time to stop”.

    A common recommendation is to “check in” with one’s body several times per meal, reflecting on such questions as:

    • Do I have hunger pangs? Would I seek food now if I weren’t already at the table?
    • If I hadn’t made more food than I’ve already eaten so far, would that have been enough, or would I have to look for something else to eat?
    • Am I craving any of the foods that are still before me? Which one(s)?
    • How much “room” do I feel I still have, really? Am I still in the comfort zone, and/or am I about to pass into having overeaten?
    • Am I eating for pleasure only at this point? (This is not inherently bad, by the way—it’s ok to have a little more just for pleasure! But it is good to note that this is the reason we’re eating, and take it as a cue to slow down and remember to eat mindfully, and enjoy every bite)
    • Have I, in fact, passed the point of pleasure, and I’m just eating because it’s in front of me, or so as to “not be wasteful”?

    See also: Interoception: Improving Our Awareness Of Body Cues

    And for that matter: Mindful Eating: How To Get More Out Of What’s On Your Plate

    Intuitive Eating is not “80:20”

    When it comes to food, the 80:20 rule is the idea of having 80% of one’s diet healthy, and the other 20% “free”, not necessarily unhealthy, but certainly not moderated either.

    Do you know what else the 80:20 food rule is?

    A food rule.

    Intuitive Eating doesn’t do those.

    The problem with food rules is that they can get us into the sorts of problems described in the studies showing how flexible dieting generally works better than rigid dieting.

    Suddenly, what should have been our free-eating 20% becomes “wait, is this still 20%, or have I now eaten so much compared to the healthy food, that I’m at 110% for my overall food consumption today?”

    Then one gets into “Well, I’ve already failed to do 80:20 today, so I’ll try again tomorrow [and binge meanwhile, since today is already written off]”

    See also: Eating Disorders: More Varied (And Prevalent) Than People Think

    It’s not “eat anything, anytime”, either

    Intuitive Eating is about listening to your body, and your brain is also part of your body.

    • If your body is saying “give me sugar”, your brain might add the information “fruit is healthier than candy”.
    • If your body is saying “give me fat”, your brain might add the information “nuts are healthier than fried food”
    • If your body is saying “give me salt”, your brain might add the information “kimchi is healthier than potato chips”

    That doesn’t mean you have to swear off candy, fried food, or potato chips.

    But it does mean that you might try satisfying your craving with the healthier option first, giving yourself permission to have the less healthy option afterwards if you still want it (you probably won’t).

    See also:

    I want to eat healthily. So why do I crave sugar, salt and carbs?

    Want to know more about Intuitive Eating?

    You might like this book that we reviewed previously:

    Intuitive Eating – by Evelyn Tribole and Elyse Resch

    Enjoy!

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  • What is a ‘vaginal birth after caesarean’ or VBAC?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track.

    In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean. A VBAC is much more common in some other countries, including in several Scandinavian ones, where 45-55% of women have one.

    So what’s involved? What are the risks? And who’s most likely to give birth vaginally the next time round?

    MVelishchuk/Shutterstock

    What happens? What are the risks?

    When a woman chooses a VBAC she is cared for much like she would during a planned vaginal birth.

    However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.

    In fact, one of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing.

    This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.

    Uterine rupture is rare. It occurs in about 0.2-0.7% of women with a history of a previous caesarean. A uterine rupture can also happen without a previous caesarean, but this is even rarer.

    However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.

    The risk of uterine rupture increases if women have what’s known as complicated or classical caesarean scars, and for women who have had more than two previous caesareans.

    Most care providers recommend you avoid getting pregnant again for around 12 months after a caesarean, to allow full healing of the scar and to reduce the risk of the scar rupturing.

    National guidelines recommend women attempt a VBAC in hospital in case emergency care is needed after uterine rupture.

    During a VBAC, recommendations are for closer monitoring of the baby’s heart rate and vigilance for abnormal pain that could indicate a rupture is happening.

    If labour is not progressing, a caesarean would then usually be advised.

    Pregnant woman lying in hospital bed wearing monitoring device around belly
    Giving birth in hospital is recommended for a vaginal birth after a caesarean. christinarosepix/Shutterstock

    Why avoid multiple caesareans?

    There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.

    Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned.

    Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.

    We looked at what happened to women

    The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC.

    We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.

    We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.

    We also confirmed what national data and previous studies have shown – there are lower VBAC rates (meaning higher rates of repeat caesareans) in private hospitals compared to public hospitals.

    We found the probability of subsequent elective caesarean births was higher in private hospitals (84.9%) compared to public hospitals (76.9%).

    Our study did not specifically address why this might be the case. However, we know that in private hospitals women access private obstetric care and experience higher caesarean rates overall.

    What increases the chance of success?

    When women plan a VBAC there is a 60-80% chance of having a vaginal birth in the next birth.

    The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.

    For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.

    An Australian national survey we conducted found having continuity of care with a midwife when planning a VBAC can increase women’s sense of control and confidence, increase their chance to be upright and active in labour and result in a better relationship with their health-care provider.

    Midwife with arm on shoulder of pregnant woman standing up, in labour, in hospital, looking out of window
    Seeing the same midwife throughout your maternity care can help. Tyler Olson/Shutterstock

    Why is this important?

    With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose.

    Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.

    Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University, and Lilian Peters, Adjunct Research Fellow, Western Sydney University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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