If you are an older adult with cancer or a caregiver of an older adult with cancer, deciding whether you should proceed with cancer surgery or not seems like a losing bet, no matter which side you choose. The burden of making THE RIGHT DECISION looks too heavy. You also may lose many nights of sleep thinking about whether you made the right decision?
You may have so many questions to ask surgeons and other care providers, but at the end, you may feel that you have forgotten many of your questions. You may not even recall the surgeon's responses because you were distracted by fear of UNKNOWNS.
You are not alone in this feeling. Unfortunately, every year in the US, thousands of older adults are diagnosed with cancer and may need to decide whether to proceed with surgery or not.
Many times, the initial question that you ask yourself is if you are TOO OLD to undergo surgery? You will ask almost every care provider, family member, and friend the same question. THIS IS A WRONG APPROACH to your decision-making.
I have taken care of thousands of older patients with cancer during this crucial time of their lives. While that decision is ALWAYS COMPLEX, there is a wrong and proper approach to making this complex decision. After watching this video, I hope you learn a thing or two, SEVEN, in fact, to improve how you approach this decision-making process.
#cancer #cancersurgeon #cancersurgery #olderpeople #healthcare #delirium #preop #frailty #decisionmaking
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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
0:21
on my
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
1:01
improving your
1:02
outcomes these seven facts are your
1:06
fitness not your age should dictate your
1:08
potentials
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
5:14
understanding
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
6:18
of sources
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
7:11
can lead to
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
7:37
overlooked
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
8:42
along the
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
9:00
varied
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
10:06
consequences
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
11:15
during and after
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
12:19
five
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
12:42
patient well-being
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
13:29
individual approach
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
13:43
all available
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
13:59
principles
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
14:12
in light of this
14:13
vulnerability and the integration of
14:15
patient values preferences and
14:17
trade-offs into this decision-making
14:19
process
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
15:28
preferences
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
15:48
net harm
15:50
furthermore the social context including
15:53
family members caregivers and health
15:55
care team plays a critical role in real
15:58
life decision
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
16:49
checklist the
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
17:45
medical
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
18:42
appointment before
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
22:20
provider
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
23:17
certain physical
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
#Aging & Geriatrics
#Cancer
#Seniors & Retirement

