Regardless of the giant technological leaps that have been made in the field of medicine in the last century, the prospect of undergoing surgery is still a scary one. The entire procedure is accompanied by an enormous amount of stress. There is the anxiety awaiting the operation, which is often heightened by routine pre-surgery procedures, like having the area that is to be operated on shaved, washed and prepped, or having an enema. There is also the physical stress experienced during the operation, and the distress caused by pain and incapacitation afterwards, to be considered. Over the past few decades, science has shown that various strategies that are employed to lower this stress, result in quicker, more complete recoveries with fewer complications and shorter hospital stays.
These days stress is a term that is largely overused and yet little understood. A formal definition of the term is that stress is the state arising when the individual perceives that the demands placed on them exceed (or threaten to exceed) their capacity to cope, and therefore threaten their well-being. When faced with a potentially harmful situation or stressor, certain psychological and biological reactions occur, which are referred to as the stress response.
This stress response has also been called the "fight or flight" response and involves a rapid switch of priorities from long-term to short-term survival. Biological resources are channelled to systems that might be needed to cope with imminent challenges. This explains the pounding heart and the heavy breathing, which are due to an increase in blood pressure and the dilation of the bronchial tubes, the cold feet and hands and the churning stomach, which are a result of the blood being directed away from the extremities and the digestive processes to the muscles, heart and brain. Biological processes that are not vital for short-term survival, like growth and reproduction, are shut down.
There is also a major impact on the immune system and the body's ability to heal itself. Johannesburg psychologist Colinda Linde explains: "The stress response is a complex psychophysiological state of arousal in response to demands from the environment. One of the consequences of activation of this response, is the release of stress hormones such as cortisol, epinephrine and norepinephrine. These hormones impair the functioning of the immune system, which leaves the individual vulnerable to foreign agents such as viruses and bacteria. There are clear connections between stress, reactivity and health."
Numerous studies have also shown the detrimental effects of stress on the immune system. One study involved a surgeon using a surgical punch to make small uniform wounds on the roof of each of the volunteering dental students' mouths. One wound was made during the summer vacation and the other was made on the opposite side of the mouth six months later, just before exams. The wounds took on average 40 % longer to heal during exams than during the vacation period. This is attributed to the fact that levels of interleukin-1B, a component of the immune system central to wound healing, have been found to decrease during periods of stress.
An interesting finding though is that stress, much like beauty, is in the eye of the beholder. What some find stressful, others might find challenging - stress depends entirely on how we perceive the demands the environment is placing on us. Factors that influence the way that people perceive various stressors are their past experience, beliefs, education, personality, physical health, genetic make-up and social environment.
An example of how personality affects our unique stress response is shown by a study that was conducted at the Carnegie Mellon University, which found that of those people who had had heart bypass surgery, those who scored high on a 10-item "optimism" questionnaire, recovered more quickly. They were able to return to their normal activities sooner and were less likely to be hospitalised again for complications, during a five-year follow-up period. This is explained by the fact that personality is related to coping styles, and whereas optimists were more likely to change their diets and their lifestyles to prevent further problems, pessimists were more likely to use denial as a coping strategy, which prevents them from confronting the reality of the situation and from taking steps to improve their lives.
As for the effects a person's social environment has on the way they perceive stress, numerous studies have shown that people who feel they can have support from family and friends tend to feel less stressed, as they feel they can cope and can get the necessary help when required. There is evidence that spousal support can actually shorten the length of hospital stay and improve the well-being of the patient. In the longer term, it can also improve compliance with recommended lifestyle changes, such as diet and exercise, and longer-term health.
All of these factors highlight the importance of a support group. As well as providing the obvious support, a variety of information is also available. For more information and referrals to the relevant professionals, the Depression and Anxiety Support Group can be contacted, Mondays to Fridays, from 8am to 8pm, and on Saturdays, from 8am to 5pm, on (011) 783-1474/6. Although it is highly unlikely that an optimist can be made of a pessimist, altering some of the behaviours and coping styles that distinguish them from an optimist could improve their chances of a more complete recovery.
One of the strategies that is often used, is referred to by psychologists as "reframing". It entails changing one's conscious perception of a situation by focusing on the positive manageable aspects and identifying possible solutions. In some cases, it entails coming to terms with the inevitable. Using this method, setbacks are now viewed as stimulating new challenges and disasters are viewed as valuable opportunities for personal growth.
There are a number of tips that can be followed to decrease the stress of surgery and facilitate the recovery process:
Don't go it alone
Before your operation, talk to others who have had the procedure, talk to your doctors and nurses about what to expect, read about the operation, and feel free to share your concerns with your loved ones.
- Give your body positive healing instructions
Imagine yourself after the operation with a good recovery and result. Read positive statements repeatedly or listen to pre-recorded positive statements.
- Choose a room with a view
Looking at nature scenes out a window or even a picture of nature can speed your recovery.
- Try to use a few old nuggets of folk wisdom
Try to set realistic recovery goals, don't be a perfectionist, keep things in perspective and have a sense of humour.