0:01
hi if you're an older patient with
0:03
cancer or a family member of a patient
0:06
with cancer considering surgery these
0:08
are some of the questions that is going
0:11
to go through your mind all
0:13
day will I be able to recover from
0:16
surgery is the risk of complication too
0:18
high given my age will I become a burden
0:22
family will I experience confusion after
0:25
surgery and finally is this surgery
0:28
really going to improve my quality of
0:30
life or it's just going to prolong my
0:32
suffering this is Dr armen Sharni i'm a
0:35
geriatrician and oncologist with 12
0:38
years of experience of taking care of
0:39
thousands of older adults with cancer
0:42
especially during the time of their
0:43
surgery in this video I'm going to talk
0:46
to you about seven facts that will
0:49
improve your understanding of your
0:50
cancer surgery how to make a decision
0:53
about surgery what sort of issues you
0:56
may be facing and how you and your
0:58
family can play an important role in
1:02
outcomes these seven facts are your
1:06
fitness not your age should dictate your
1:10
number two understanding your frailty
1:13
and going beyond your age number three
1:16
understanding the difference between
1:18
surgeries and surgery
1:21
stress number four how you can select a
1:24
highly skilled surgeon for the type of
1:26
surgery that you're going for number
1:28
five we're going to talk about conundrum
1:31
of decision making number six I'm going
1:34
to share with you a very important
1:35
checklist that can make your questions
1:38
organized and then number seven we are
1:40
going to talk about the multi-phase
1:42
pathway to improve your care and is
1:44
essential to know that you're in at the
1:46
center of that multi-phase pathway after
1:50
watching this video if you're more
1:52
informed about your cancer surgery
1:54
decision making I hope that you hit the
1:57
like button subscribe to this channel
2:00
and share this video and it content with
2:02
your family and friends imagine the
2:04
turning point for time itself plays a
2:06
crucial role in a life-changing battle
2:09
cancer global challenge impacting
2:11
millions but age it throws a curveball
2:14
changing the game 20 million people
2:17
every year face a cancer diagnosis 16
2:19
million are told surgery is needed but
2:22
here is a twist age changes the odds
2:25
just 2% of population is over 85 yet
2:27
they account for 8% of all cancer
2:29
diagnosis that's 140,000 individuals in
2:32
the United States at a vulnerable stage
2:33
of life considering major surgery lung
2:37
prostate breast colon familiar cancers
2:39
but in older adult the decision is
2:41
different early detection offers
2:43
possibilities but are they taken only
2:46
65% of women over 85 opt for breast
2:48
cancer surgery compared to 89% of
2:51
younger women and for complex surgeries
2:53
like pancreatic cancer that number drops
2:55
to a mere 3% the key question emerges
2:58
who makes the best choice are the 65%
3:01
who choose surgery making the right call
3:03
or the 35% who declined making a wiser
3:06
decision what factors truly matter what
3:09
factors influence these crucial moments
3:12
this video isn't just about the
3:13
statistics it's about understanding the
3:15
complex world of these decisions we'll
3:17
explore the factors that shape these
3:18
choices and will reveal strategies that
3:21
can enhance the likelihood of a positive
3:22
outcome we are going beyond the surface
3:24
into the heart of a challenging scenario
3:27
where age illness and informed choice
3:29
intersect get ready to explore a topic
3:31
that's both important and
3:34
fascinating fact number one beyond
3:36
numbers your fitness not your age should
3:39
dictate your potential age is a mere
3:42
metric a chronological marker that fails
3:44
to capture the truest essence of your
3:46
health and vitality whether you're 75
3:49
80 90 or beyond your fitness level if
3:52
not your birthday should be the primary
3:54
determinant of your medical decisions
3:57
this concept often challenging to accept
3:59
is vital we are bombarded with studies
4:02
linking age to various health outcomes
4:04
ranging from surgical success to
4:06
mortality rates to the likelihood of
4:08
nursing home placement yet these studies
4:11
frequently overlook a critical factor
4:13
one's individual fitness consider these
4:17
scenarios does age truly matter if
4:19
you're able to compete in a marathon
4:22
perform hundreds of push-ups or maintain
4:24
a rigorous daily work schedule
4:27
conversely is your youth relevant if you
4:30
struggle with basic mobility experience
4:33
frequent falls or endure repeated
4:36
hospitalizations the prevailing mindset
4:39
prioritizes age patients and their
4:42
families frequently voice concerns like
4:44
"I'm too old for surgery," or "The
4:46
doctor wouldn't want to operate because
4:47
of my age." This age-centric perspective
4:50
ignores the profound impact of
4:52
individual fitness instead of fixating
4:55
on your chronological age shift your
4:58
focus to your physiological fitness for
5:00
surgery the question should not be "Am I
5:03
young enough but rather am I fit
5:05
enough?" The opposite of fitness is
5:07
frailty a state characterized by
5:09
diminished resilience and increased
5:12
vulnerabilities fact number two
5:16
frailty you need to go beyond your age
5:19
it's about your body's stress threshold
5:21
so it's crucial to recognize that
5:23
frailty is not simply synonymous with
5:25
weakness rather it fundamentally
5:28
reflects your body's diminished capacity
5:30
to effectively manage
5:32
stress when the demands placed upon your
5:35
physiological systems surpass their
5:37
inherent limitations adverse outcomes
5:40
become not only possible but in fact
5:42
inevitable furthermore these
5:44
consequences tend to escalate in
5:46
severity as the level of the stress
5:49
increases to truly grasp this concept is
5:52
helpful to envision your post-surgical
5:54
outcome as a direct reflection of your
5:57
overall fitness or conversely your
5:59
degree of frailty and the cumulative
6:02
stressors that you endure both before
6:05
during and after surgical
6:07
procedure to fully appreciate the
6:09
profound impact of these factors it's
6:11
essential to first delve into
6:13
multiaceted nature of stressors these
6:16
stressors originate from a diverse range
6:19
firstly the sheer number and severity of
6:22
your pre-existing illnesses or
6:24
coorbidities play a substantial role for
6:27
instance the stress imposed by a single
6:30
well-managed condition like hypertension
6:33
is significantly less than that imposed
6:35
by simultaneous management of 10
6:37
conditions such as heart disease
6:40
diabetes and advanced cancer
6:43
secondly the intensity of each
6:45
individual co-orbidity contributes to
6:47
the overall stress burden a localized
6:50
cancer for example exerts considerably
6:52
lesser stress than a metastic one
6:55
thirdly even the treatments intended to
6:58
provide relief can inadvertently
7:01
introduce additional stress medications
7:04
despite their therapeutic benefits may
7:06
generate side effects that compound the
7:09
existing issues such as dizziness that
7:12
falls furthermore your living situation
7:15
exerts a significant influence on your
7:18
stress levels social isolation strain
7:21
interpersonal relationships and
7:23
caregivers own health concern can all
7:26
contribute substantially to the overall
7:28
stress burden finally the financial
7:31
strain associated with health care even
7:33
with comprehensive insurance coverage
7:35
presents a substantial and often
7:39
stressor having explored the diverse
7:42
origins of stress we now turn our
7:44
attention to the concept of frailty
7:46
itself as previously established frailty
7:50
represents your body's diminished
7:51
ability to tolerate these various
7:53
stressors as we progress through the
7:56
aging process we tend to accumulate age
7:59
related impairments which gradually
8:02
erode our tolerance to stress this
8:05
erosion can often unfold as a cascade of
8:08
events hypertension might lead to the
8:11
development of heart disease which in
8:13
turn might necessitate medication that
8:15
produce side effects potentially leading
8:18
to prolonged hospital stays subsequent
8:20
muscle loss increased risk of falls
8:23
fractures requiring surgical
8:24
intervention post-operative delirium and
8:27
ultimately cognitive decline importantly
8:31
this progression is not solely dependent
8:32
on your chronological age a 90-year-old
8:35
individual could potentially be at the
8:37
initial stage of this cascade while a
8:39
65year-old individual might be further
8:43
continuum to illustrate the real world
8:46
implication of these concepts let's
8:48
consider a study conducted by Dr chzn
8:50
and his colleagues involving a cohort of
8:53
82,000 patients over age of 70 this
8:56
research revealed that five-year
8:58
survival rates following cancer surgery
9:01
significantly while chronological age
9:04
did play a role with survival rates
9:07
declining from 75% for those aged 70 to
9:11
74 to 50% for those age 85 and older
9:15
frailty emerged as a more potent
9:17
predictor of survival fit patients
9:20
experienced a 33% mortality rate within
9:23
5 years while frail patients face a
9:26
significantly higher 50% mortality rate
9:29
notably in frail patients non-cancer
9:32
related deaths become the predominant
9:35
cause of mortality after 3 years this
9:38
finding brings us to a critical takeaway
9:41
message it highlights a common and
9:44
potentially detrimental oversight the
9:47
tendency to focus exclusively on cancer
9:49
treatment while neglecting the patients
9:52
overall health and functional
9:54
status while cancer undeniably demands
9:57
immediate and focused attention
9:59
overlooking coorbidities and functional
10:01
status particularly in frail individuals
10:04
can have severe and far-reaching
10:07
consequently prioritizing comprehensive
10:10
geriatric assessment and adopting a
10:12
holistic approach to patient care is
10:14
essential for optimizing patient
10:16
outcomes and ensuring the best possible
10:19
quality of life fact number three
10:22
surgical stress not all cancer surgeries
10:24
are equal it's a misconception to assume
10:26
all cancer surgeries impose the same
10:28
level of stress on the body while both
10:31
breast cancer surgery and pancreatic
10:32
cancer surgery fall under the umbrella
10:34
of cancer surgeries their physiological
10:36
impact differ significantly surgeons
10:39
consider numerous factors when assessing
10:41
surgical stress but three stand out as
10:43
particularly crucial number one expected
10:46
blood loss number two surgical duration
10:49
and number three the extent of a skin
10:51
incision these are general principles
10:53
and their application requires a
10:55
specialized expertise for example while
10:58
open surgery might be completed more
10:59
quickly laparoscopic surgery despite its
11:02
longer duration can be less stressful
11:04
due to smaller incisions and induced
11:06
blood loss ultimately the anticipated
11:09
blood loss surgical duration and
11:11
incision size are key determinants of
11:13
the stress your body will experience
11:17
surgery fact number four for older frail
11:20
individuals the selection of a highly
11:22
skilled surgeon is paramount in my view
11:26
the characteristic of an exceptional
11:28
surgeons include number one a
11:32
specialization a surgeon specializing in
11:34
a limited number ideally single organ
11:37
system rather than a general surgeon
11:39
demonstrates focus expertise number two
11:43
individualized assessment a surgeon who
11:45
evaluates patients beyond chronological
11:47
age considering their overall health and
11:50
frailty provides more personalized care
11:53
number three attentive communication
11:56
while not requiring exceptional oratory
11:58
skills a surgeon who actively listens to
12:01
patients concerns foster a collaborative
12:03
approach number four transparent
12:06
discussions of alternatives a surgeon
12:08
who welcomes questions regarding
12:10
alternative treatments or option of
12:12
foregoing surgery and offers insightful
12:15
explanation demonstrates patient
12:17
centered decision- making and number
12:20
judicious decision making this may seem
12:23
counterintuitive but a surgeon who
12:25
understands when surgery is not in the
12:27
patient best interest even when
12:28
technically feasible distinguishes
12:31
themselves their ability to articulate
12:33
the rational behind this decision
12:35
despite potential initial disappointment
12:38
reflects a commitment to preventing
12:40
adverse outcomes and prioritizing
12:45
fact five the conundrum of making
12:48
decisions the landscape of geriatric
12:51
oncology has undergone a remarkable
12:53
transformation marked by a substantial
12:55
expansion of evidence
12:56
base however despite this advancement
12:59
oncologists continue to grapple with
13:01
significant uncertainties when
13:03
navigating treatment decisions for older
13:05
patients this conundrum arises in part
13:08
from the inheritant disparity between
13:11
clinical trial populations which often
13:13
consists of healthier individuals and
13:16
the realities of the community practice
13:18
where frailer patients constitute a
13:20
significant proportion of patient
13:22
population consequently translating
13:25
research findings into effective
13:26
clinical practice necessitate an
13:31
to address this challenge a robust
13:33
framework is essential for guiding
13:34
treatment decisions in geriatric
13:36
oncology this framework grounded in the
13:39
principles of evidence-based medicine
13:41
emphasizes the importance of considering
13:45
evidence critically evaluating its
13:47
quality and integrating patient values
13:49
and preferences particularly in
13:51
situations characterized by significant
13:55
uncertaintity at its core this framework
13:57
is built upon three fundamental
14:01
the accurate determination of patients
14:03
age related vulnerability through
14:04
comprehensive geriatric assessment the
14:07
careful consideration of benefits and
14:09
harms associated with cancer treatment
14:13
vulnerability and the integration of
14:15
patient values preferences and
14:17
trade-offs into this decision-making
14:21
estimating the potential benefits of
14:23
cancer treatment for older patients
14:25
necessitates true assessment of whether
14:28
the cancer is likely to cause symptoms
14:30
within patients remaining lifespan this
14:33
involves evaluating the aggressiveness
14:35
of cancer and estimating the patients
14:38
non-cancer specific life expectancy
14:40
utilizing prognostic calculators such as
14:43
those available on e- prognosis website
14:45
which incorporates variables derived
14:48
from the geriatric assessment once the
14:50
patient center benefit has been
14:52
established the risk of treatment
14:54
related toxicities and complications
14:56
must be carefully weighed against these
14:58
benefits these harms are influenced by
15:01
treatment intensity and the patients
15:03
health status with increased toxicity
15:05
and complication observed in patients
15:07
with multiple geriatric syndromes
15:10
notably geriatric assessment has been
15:13
proven superior to traditional
15:15
performance assess measures in
15:18
discriminating toxicity and complication
15:21
risks ultimately the decision-m process
15:24
involves balancing trade-offs in the
15:26
context of patients unique values and
15:30
older patients may perceive treatment
15:32
benefit and harms differently than
15:33
younger patients necessitating the use
15:36
of validated tools to elicit preferences
15:39
and determine which treatment benefits
15:41
are most desired which harms are
15:44
unacceptable and whether a given
15:46
treatment represents a net benefit or
15:50
furthermore the social context including
15:53
family members caregivers and health
15:55
care team plays a critical role in real
15:59
making oncologists and surgery
16:02
oncologists must also be aware of
16:04
potential biases such as agism which can
16:07
lead to undertreatment or overt
16:08
treatment by adhering to this framework
16:11
oncologists can strive to match
16:13
treatment intensity with age related
16:15
vulnerability and align outcomes with
16:17
patient preferences ultimately
16:20
optimizing care for older adults with
16:23
cancer so fact number six is the
16:26
importance of having checklist american
16:28
College of Surgeon has done a great job
16:30
of preparing the checklist for older
16:32
patients going for surgery this is not
16:35
unique or specific to cancer surgery but
16:38
it serves a purpose i'm just going to
16:40
walk you over this document to for you
16:43
to become familiar with you can find it
16:45
at cs.org or geriatric surgery patient
16:51
PDF so to patients families and
16:53
caregivers the American College of
16:54
Surgeons knows that preparing for
16:56
surgery could be overwhelming we created
16:58
this patient checklist to help you
17:00
prepare for your operation and recovery
17:02
the checklist includes questions to ask
17:04
and information to prepare and share
17:06
with your surgical team it helps you
17:08
keep track of your questions so you can
17:10
be sure to get them answered prior to
17:12
surgery and this checklist can also help
17:14
making sure that you and your care team
17:17
understands your goals so then it's your
17:20
name type of surgery surgeon's name and
17:22
these are the questions you need to ask
17:25
yourself before your first appointment
17:27
with surgeon and the care team so number
17:29
one is what matters most to you what do
17:32
you hope to gain from the surgery how
17:34
will this operation affect your
17:35
activities walking gardening and your
17:37
lifestyle travel or self-care
17:40
question number two have you chosen the
17:42
person to make healthcare decision for
17:44
you in case you're not able to do a
17:46
proxy question number three do you have
17:49
advanced directives an advanced
17:50
directive is a document that lets you
17:52
have a say about how you want to be
17:54
cared for in case you cannot speak for
17:56
yourself next question if I'm too sick
17:59
or unable to speak for myself how can I
18:01
make sure you know my wishes next
18:04
question do you have someone ready to
18:05
help you with care when you're home
18:09
do you have a primary care provider and
18:11
do you want us to send a summary of your
18:14
surgery question number six are you
18:16
taking any medications this include
18:18
prescriptions vitamins supplements
18:20
weight loss medications over-the-counter
18:22
medications nicotine whether it's smoke
18:24
patch chew marana or cannabis products
18:27
and alcohol and then if yes you need to
18:30
provide the list of your
18:32
medications you have to list your
18:34
allergies to any medication or
18:36
supplements and then the next part of
18:39
this question is the questions to ask
18:40
your surgeon care team during your
18:43
surgery it's important to write these
18:46
things down so you do not forget or if
18:48
you have any follow-up questions you can
18:50
refer to these notes you have prepared
18:52
for yourself what surgery am I having
18:54
why do I need this operation what
18:57
happens if I do not have the operation
18:59
are there any treatment choices and what
19:01
is the best option for me what are the
19:04
risks and possible problems of having
19:05
the operation how does my health and
19:08
lifestyle change my risks what should I
19:10
expect if everything goes well will
19:13
surgery improve my quality of life in
19:15
what ways how do I prepare for my
19:17
operation what are the tests or
19:19
medication changes are there things I
19:21
should be doing beforehand to help me
19:23
have the best recovery such as nutrition
19:25
drinks exercise setup or additional help
19:28
how long I will be in the hospital what
19:30
can I expect during recovery when can I
19:33
go back doing a certain activity can you
19:36
tell me about my wound care lifting and
19:38
activity changes how will I become
19:40
active again or at least be up and
19:42
moving after surgery how will my pain be
19:45
managed after surgery are there any ways
19:47
to manage my pain without opioids are
19:50
there any specialist screenings or
19:52
issues review before surgery if there
19:54
are any issues can you tell me how they
19:56
may affect my recovery from surgery so
19:59
these are things like your cognition or
20:01
thinking delirium or confusion risk
20:03
functional status or daily activities
20:06
mobility walking or moving nutrition
20:09
swallowing the next question if
20:11
applicable I wear glasses hearing aids
20:13
or dentures or other personal assisted
20:15
devices how will these items be stored
20:18
and when I will get them back after
20:19
surgery how do you identify and prevent
20:22
confusion after surgery a very important
20:24
question do you anticipate any need for
20:27
the following after my surgery check all
20:30
that apply home health rehabilitation
20:32
service or skilled nursing and if yes
20:34
how will my transition of care be
20:36
managed and will I receive a
20:39
plan the next question is your hospital
20:41
involved in any age friendly initiative
20:43
such as American College of Surgeons
20:45
geriatric surgery verification program
20:48
and at the bottom they have some tips
20:50
for communicating with surgeons and our
20:52
care team so it's mentioned that it's
20:54
important to communicate your feelings
20:56
questions and concerns with your health
20:58
care provider before having surgery if
21:00
you do not understand your healthcare
21:02
provider's response ask questions until
21:04
you do very important take notes and or
21:07
ask family member friend or caregiver to
21:09
accompany you and take notes for you
21:11
again very important ensure you receive
21:14
a copy of your instruction in writing
21:16
from your healthcare provider ask your
21:18
healthcare provider where you can find
21:20
more information about your condition
21:21
some providers have printed resources in
21:23
their offices or digital materials
21:25
available through patient
21:32
portals we've completed six facts let's
21:35
get to fact number seven this is a paper
21:37
they published on surgical consideration
21:39
for older adults with cancer time for
21:41
surgery can be divided into three
21:43
categories the pre-operative period the
21:46
operative period and the post-operative
21:48
period pre-operative period is from
21:51
diagnosis until surgery operative period
21:56
is from surgery until 24 hours later
21:58
post-operative period is 24 hours after
22:01
surgery up until 30 days following
22:04
surgery there are activities to improve
22:06
outcomes we're going to talk about
22:09
that in the pre-operative phase it's
22:12
important to look at your frailty so one
22:15
major component would be frailty
22:17
screening tools that your primary care
22:21
geriatrician or even a surgeon can use
22:24
in order to figure out whether you're
22:26
fit or frail for surgery
22:29
if deemed frail and if you're able to
22:32
see a geriatrician then that
22:34
geriatrician can figure out some of the
22:36
aging related impairments that you may
22:38
have that may need impact your outcomes
22:40
such as if you're taking too many
22:42
medications or if your social support is
22:46
exhausted or if your living condition is
22:49
not optimal if you're having difficulty
22:52
with nutrition lost weight that
22:54
geriatric care provider or primary care
22:57
provider would distinguish push
22:59
modifiable versus non-modifiable factors
23:01
if a factor is modifiable they can
23:03
implement interventions to improve
23:05
that another component that has become
23:09
relevant these days is prehabilitation
23:12
generally you go for surgery after
23:14
surgery you may go to rehab or engage in
23:18
activities over the past decade there's
23:20
emphasis on prehabilitation this is
23:23
going through rehab process before
23:25
surgery with the idea of boosting your
23:28
strength and stamina and resiliency so
23:31
you would be able to tolerate surgery
23:33
better within that pre-operative phase
23:36
is shared decision making between you
23:38
your family your surgeon and care
23:40
providers pay attention to the
23:42
information share have somebody in the
23:44
clinic take notes ask questions and then
23:46
put it within the context of yourself to
23:49
figure out what decision is best for you
23:52
obviously if there's a need for any
23:54
treatment such as medical treatments
23:57
chemotherapy or other sort of cancer
24:00
related treatment before surgery cancer
24:02
multi-disiplinary team hopefully align
24:05
with the frailty expert would be able to
24:08
assist you in that decision making as
24:11
well then we get into the operative
24:13
phase this is usually out of your
24:16
control however you may want to know
24:17
about minimally invasive surgery also
24:20
known as laparoscopic surgery that
24:22
there's a lot of literature that for
24:24
most surgeries a minimally invasive
24:26
surgery puts your body through less
24:28
stress than open surgery it's important
24:32
to have that conversation with your
24:33
surgeon there are certain criteria that
24:37
they need to go through to make sure
24:39
that they are picking the right surgical
24:41
technique the second component is
24:43
enhanced recovery after surgery or IRAS
24:46
done by surgeons and
24:48
anesthesiologists it focuses on variety
24:51
of initiatives to reduce the stress of
24:54
surgery early mobility getting you out
24:56
of bed as soon as possible using very
25:00
limited if at all opioids for
25:02
post-operative pain management feeding
25:05
you sooner than you ever expected in the
25:08
past and there are six seven components
25:11
that programs that do have enhanced
25:14
recovery after surgery
25:17
implement and then the third phase is
25:20
the post-operative period which there
25:22
are certain activities that can improve
25:24
your outcomes one is collaboration
25:26
between surgeons and geriatrician also
25:28
known as geriatric management so in this
25:31
model while surgeons are focused on
25:33
taking care of issues related to surgery
25:36
geriatric care providers focus on your
25:38
aging related issues engaging with other
25:41
disciplines such as physical therapy
25:43
occupational therapy social workers case
25:46
managers nutritionists psychologists
25:48
another component is rehab you're
25:50
obviously very familiar with this a lot
25:52
of patients especially after major
25:55
cancer surgeries need rehab to recover
25:58
faster another component is addressing
26:01
social support who takes care of you is
26:03
that person healthy what is your living
26:05
condition do you live in a walk up
26:08
apartment do you live in a place that
26:10
you need to drive in order to buy
26:12
grocery these are important questions to
26:15
address and then obviously a good number
26:18
of patients after surgery may need
26:19
additional treatment like chemotherapy
26:22
radiation the faster you recover from
26:24
the surgery maybe the sooner that you
26:26
would be able to receive these sort of
26:30
treatments so let's look at it again we
26:33
do have pre-operative period operative
26:35
period and post-operative period and in
26:38
the pre-operative period be as
26:40
physically active as possible boost your
26:42
calorie intake review your medication
26:44
list make sure that you have an accurate
26:46
list of medication carry a copy of that
26:49
with you just in case the medical and
26:51
surgical team want to look at that list
26:53
if there is any certain concern that you
26:56
have share that with with the team
26:57
earlier rather than later using
27:00
incentive barometry plastic machines
27:02
many patients use after surgeries like
27:04
hip surgery in order to expand their
27:06
lung get more air in is very important
27:09
to practice before surgery so in the
27:12
aftermath of surgery you're familiar
27:14
with how you should use that incentive
27:16
barometer in the post-operative period
27:19
it's very important for you to be an
27:22
active participant in your care physical
27:24
therapists are going to come by and they
27:26
need to work with you and they rely on
27:29
you to be cooperative willing and
27:31
engaged push yourself to work with them
27:34
obviously family members are at bedside
27:36
always is a good thing for them to
27:38
engage with you ask questions show
27:41
photos play music you like so your mind
27:43
keeps functioning so we can reduce the
27:47
likelihood of post-operative confusion
27:50
depending on your surgery you may be
27:52
given less or more of opioids and the
27:55
most important question that they will
27:57
ask you is from 0 to 10 what's your
27:58
level of pain 8 9 or 10 means severe
28:01
pain and they're more likely to give you
28:04
opioids opioids are good for pain
28:07
control but can make you a little bit
28:08
drowsy maybe a little bit more confused
28:11
maybe a little bit of constipation so
28:14
take that into account if you're seven
28:16
or six don't don't say eight because
28:18
that may mean unnecessary opioids for
28:20
you you're going to be given incentive
28:23
after surgery so use that as much as
28:26
possible usually 10 times every hour
28:28
while awake that brings more oxygen into
28:31
your lungs avoid a collapsed lung avoid
28:34
pulmonary complications it's a helpful
28:37
tool to recover quickly in the
28:38
post-operative period there are certain
28:40
medications to avoid antiolinerics they
28:43
can cause confusion after surgery there
28:45
shouldn't be any concern for you about
28:47
urinary control after surgery
28:48
antihistamines like benadryil given for
28:51
itching or dry skin unfortunately some
28:54
patients take it for sleep they can
28:56
cause confusion after surgery we would
28:59
like that avoided benzoazipines like
29:02
lurazzipam or dazipam interfere with
29:05
posttop recovery if you've been on it
29:07
for a long time that might be fine but
29:10
if you've been taking it once in a while
29:12
it's better not to take it during
29:13
surgery and the last one is opioids we
29:16
would like you to use as little as
29:18
possible we don't want you in
29:19
excruciating pain so my suggestion to
29:23
you is again take that scale of 0 to 10
29:25
into account share that number with your
29:27
team and be an active participant in
29:29
your post-operative recovery