Stress is a complicated and mysterious physiological phenomenon. Surgical stress is even more complicated and often lies at the heart of poor surgical outcomes.
Stress can be triggered by the mind or by the body. Either way, it activates a shift in the autonomic nervous system that can undermine how you withstand and recover from surgery.
Psychosocial stress likely begins the moment your physician first suggests an operation. The sudden possibility of going to a hospital, putting on a flimsy gown, and lying on a table as someone cuts into your body is understandably unsettling.
This anxiety and fear activates your sympathetic nervous system’s “fight, flight, or freeze” mode. Faster breathing, an accelerated heart rate, and other aspects of this state can put patients at risk for arrhythmias, immune dysfunction, hyperinflammation, and organ dysfunction.
Anesthesia drugs might be able to turn off the conscious brain, but they’re not yet able to compensate for the body’s innate stress response. Stress to the body—sometimes called inflammatory stress—is unavoidable, starting with the first incision. In other words, even general anesthesia can’t knock out your body’s self-protective stress response—however unhelpful it may be.
The unfortunate irony is that this stress response is meant to ensure our immediate survival, and it does so in part by shutting down the counter to the sympathetic nervous system: the parasympathetic nervous system.
This system manages your body’s rest, digestive, and recovery functions—all of which are tremendously helpful to a surgical patient.
The Stress of Surgery
If there were a way to inhibit the sympathetic system and enhance the parasympathetic system during surgery, it would create a cascade of desirable anti-inflammatory benefits and reduce the potential for secondary injuries, as pointed out in the 2020 article in the International Journal of Surgery.Inflammation in surgery is when blood rushes to the site of injury, causing an accumulation of fluids, swelling, and pain, as well as a temporary loss of function that necessitates rest.
In surgery, incision, excision, cauterizing, manipulation, suturing, and anesthesia can all increase sympathetic discharge, which is changes in organs, tissues, hormones, and more triggered by the stress response. Included among these tissues are the adrenal medullae, which release epinephrine and norepinephrine into the blood.
Various attempts have been made to control the nervous system’s response during surgery and restore balance to the sympathetic and parasympathetic systems and suppress inflammation and lower the body’s energy demand. Yet no drug therapy has fully succeeded.
The delicate balance of a patient’s nervous system on the operating table might be out of medicine’s reach. Still, there’s evidence that patients can tend to their stress before and after surgery and lower their risks.
A Holistic Relaxation Tool
It’s a subject that Dr. Brij B. Agarwal is particularly passionate about. Dr. Agarwal makes a point of informing his patients of proven techniques that can improve their recovery from surgery. He’s a colorectal surgeon, researcher, and innovator of gentle surgical techniques who spent a year of his medical studies getting a yoga diploma.“Yoga is a wonderful prehabilitation,” he told The Epoch Times, noting that it’s time-tested and harmless and has a very easy point of entry.
Evidence for Yoga
A study placed 173 older cancer survivors who received surgery, chemotherapy, radiation, or some combination of the three into groups doing yoga or a behavioral placebo of health education. Those in the yoga group reported significant positive differences in quality of life, with 94 percent describing the intervention as useful for symptoms and something they would recommend to others. Results were shared this year at the American Society of Clinical Oncology annual meeting.“Our findings are consistent with earlier studies using behavioral and relaxation approaches to improve postoperative outcomes. A variety of hypnotic-relaxation interventions appear to shorten hospital stays, decrease pain, and promote faster recovery following surgery,” the study authors wrote. “Others such as relaxation with guided imagery and exercise have demonstrated stress-relieving outcomes closely associated with wound healing.”
Dr. Agarwal said yoga doesn’t need to be complicated. Mostly, it’s about a simple posture—any posture or even movement—in which the same breathing technique is maintained for four to six minutes. The key is to hold a posture without being hyper-aware of it, even if it’s to lie down in what’s sometimes called “corpse pose.”
Training for Surgery
A practice of mindfulness and relaxed breathing will help you on surgery day, especially if you’re able to practice stress reduction techniques for 10 to 14 days, according to Miranda Jo Davis, a health and wellness coach. The more anxious you are about your surgery, the more these methods are likely to help.- Taking even breaths in and out to a count of four, working up to a count of eight with deeper and fuller expansion.
- Incorporating aromatherapy such as lavender or frankincense, which has been used to treat anxiety and inflammation.
- Repeating a phrase such as “I am” with each inhale and “relaxed” or “calm” with each exhale.
She suggested a combined grounding and diaphragmatic breathing technique that can be done standing, sitting, or lying down by putting the hands on the ribs, either by hugging yourself or placing them on the side of the body, to feel the expansion of the ribcage as you inhale.
“Direct breath to the hands,” Ms. Heimann said. “Just think, ‘Move the breath into my hands.’ What this does is help with diaphragmatic breathing which triggers a parasympathetic response. That just means it’s activating the parasympathetic nervous system to better regulate stress so you feel calmer. That’s really important.”
Most people do not involve the diaphragm when they breathe, and she said shallow breathing can sometimes create a sympathetic response. Focusing on the breath has the added benefit of keeping the mind centered on the present moment and not thinking about the past or worrying about the future.
“After you’ve had a surgery, you can feel less-than, you can feel weakened, you can feel scared, even if it’s a minor surgery,” Ms. Heimann said. “We need to come into our body and help become more resilient. We can do that by paying attention to how we move and being really present with that.”
There are many other ways you can also lower your stress levels, from spending time with loved ones to walking in nature to becoming more aware of thoughts that trigger stress and thereby bringing them under conscious control.