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Healing Kitchen

Preparing for Surgery with Mind-Body Techniques
Each year millions of people hear the dreaded words: You need an operation. And, in a quick fast-forward, an unsettling image pops into their mind's eye: They see themselves alone and vulnerable, shivering under a flimsy hospital gown, with all control surrendered to an impersonal team of relative strangers.

That sense of anxiety and fear flooded over 62-year-old Anita Mandel when she learned that she needed pelvic reconstruction surgery at New York City's NYU Medical Center a few years ago. "You're pretty afraid," she now remembers. "The reality is, it's the closest you're ever going to come to dying. You definitely need some way to relax and refocus in order to take the fear away."

Experts in mind-body medicine contend that getting ready for surgery doesn't have to be so scary. And they endorse a veritable toolbox of mind-body techniques that will help people cope--and even improve the outcome--if they're open to the possibilities.

"The key," says Peggy Huddleston, a well-known Massachusetts psychotherapist, "is to show people how they can participate in their own healing, and how their own emotions and attitudes can enhance the body's healing process."

Research Identifies Real Benefits

Studies now show that the transformation from passive patient to active healing participant can generate dramatic results. By coping with fear directly, research indicates, it's possible to feel peaceful before and during an operation. And even better, recovery is often swifter: Blood loss is reduced; less pain is perceived; and fewer analgesics are needed. Moreover, the immune system seems to respond better. And hospital stays can be shorter and money can be saved.

These benefits contrast starkly with the disadvantages of approaching surgery swamped with worries. When this happens, increased stress hormones can precipitate such undesirable reactions as heightened pain perception, more complications during and after surgery, excessive bleeding, even slow-to-heal wounds.

In recognition of this, many doctors are now endorsing the idea of dealing directly with pre- and postsurgical stress. Echoing other experts in the field, Maine surgeon Dr. Dixie Mills actually celebrates the emerging mind-body approach to surgery, which she describes as a "return of the human spirit to the sterile, high-tech operating room."

Finding a Road Map

New York City surgery patient Anita Mandel would definitely agree. One the best things to happen to her, she says, was coming upon Huddleston's program Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques (available in book and audio form), which she immersed herself in during the few days and hours before her operation. She also squeezed in time for a workshop.

And her efforts paid off. Just 24 hours post-op, she was up and walking around. "Now I didn't have abdominal cuts, but still--the surgeon was amazed!" Mandel marvels. "I felt like I had scripted the entire experience. I was in control, and I remember thinking to myself, 'I am part of this whole thing!'"

Like so many who turn to mind-body programs to prepare for surgery, Mandel was reluctant to take pain medications. "They nauseate me, and they're constipating. After the operation, believe me, I wasn't a martyr--I pushed that button for morphine--but I needed much less than I'd expected. And I really didn't suffer."

In short, Mandel did what leading mind-body medicine experts so highly recommend: She viewed her upcoming surgery as a time to prepare as intelligently and vigorously as she would for a competitive sporting event. Her goal was to acquire what Huddleston and others call "relaxed readiness," a state characterized by calm confidence and a sense of anticipation--but not by anxiety.

Huddleston's Five-Step Approach

In her preparation for surgery program, Huddleston focuses on a simple yet powerful five-step approach. The program breaks down as follows:

Step One Find ways to relax and feel peaceful; jitters respond well to a relaxation tape or CD used before, during, and after surgery.
Step Two Practice actually visualizing your body healing itself through the use of guided imagery.
Step Three Organize a support group of family and friends to surround you with a metaphorical "pink blanket of love." This is Huddleston's favorite piece of advice. It also involves asking loved ones to focus on you especially in the 30 minutes before surgery.
Step Four Ask the surgeon, anesthesiologist, and others in the operating room to repeat "healing statements" during the operation. At centers that offer Huddleston's program, patients can specify certain statements be expressed. The words are prepared ahead of time, written down, and then taped to the patient's surgical gown so the surgical team can see them. An example might be: "Following this operation you will feel comfortable and heal very well."
Step Five Contact the anesthesiologist before the surgery to establish a supportive relationship.

The reason her five-step program works, Huddleston asserts, is that when someone feels peaceful, it strengthens their immune system and creates, in her words, "a complex biochemistry that enhances healing."

The Mind-Body Link

Huddleston's is just one of an increasing number of mind-body surgery programs now available nationwide. Although there are many different approaches, the most effective interventions contain an element of either guided imagery, biofeedback, hypnosis, or relaxation. The most important element in a successful experience is to find an approach that clicks for you and meshes well with your own coping style.

And indeed some techniques seem to work better than others. For instance, in a sweeping analysis of different approaches published in a 1998 issue of Advances in Mind-Body Medicine, the authors found that relaxation tapes helped surgery-related healing. But the programs were most effective when specific guided imagery statements were linked to physiologic changes in the body--in other words, to mental pictures of blood moving where it's needed, or images of the bowel resuming its normal work, or of stitches gathering together and healing a wound.

Naparstek's Guided Imagery

This type of deft merging of relaxation with exact healing imagery may hold the clue as to why the audio programs of Ohio psychotherapist Belleruth Naparstek are so effective--and recommended by so many experts in the field.

With gentle music playing in the background, Naparstek's soothing voice offers poetic imagery to help the listener visualize a successful surgical experience. She makes specific statements (known as affirmations) to help empower the mind to focus positively and prompt the body to heal. She provides an image of the body slowing down its blood flow, for example, and of the listener surrounded by loving protection and support.

In an important 1996 study, Naparstek's guided imagery tapes produced some highly significant results. Compared to a control group, patients who listened to her tapes experienced notably less blood loss during the operation, and in many cases needed a full day less in the hospital.

Hard Data Increasingly Available

Based on his own experience, Boston-area cardiologist Dr. Harvey Zarren has found that mind-body programs definitely benefit surgery patients. "Language and feelings and attitude have an extraordinary effect on the body's physiology, and these factors are hugely underestimated," he says.

Research findings are beginning to offer real evidence of the value of mind-body preparation to skeptics as well. A 1992 meta-analysis of 191 research studies involving 8,600 patients, for instance, found that people who prepared mentally and emotionally for surgery had notably less pain, less blood loss, fewer complications, and a faster recovery.

Another study found that patients undergoing abdominal hysterectomy used 23% less pain medication (compared to a control group) if positive "healing statements" were made by the operating team during the procedure. In another instance, patients undergoing gallbladder surgery showed considerably less anxiety and lower postsurgical levels of the stress hormone cortisol when they'd practiced relaxation and guided visualization techniques.

None of this is a surprise to Dr. Zarren, who has found that "people's own ability to heal, and even to alter their own vital signs, is really quite extraordinary."

One Healer's Journey

For Peggy Huddleston, the logic of a mind-body approach to surgery preparation came intuitively. She was convinced of the need for it first, and then found that there was research aplenty to support her hunches.

Working in Philadelphia about 30 years ago, she noticed a trend during her counseling sessions. "In groups of 50 people, there would always be a few who said 'I am having surgery and I am terrified,'" she recalls. "I saw that nothing was being done to give these individuals coping tools, or to lessen their need for pain medications."

Because of this, Huddleston, who is also a graduate of Harvard University Divinity School, went on to develop her Five Healing Steps. "I found that there was research and backup for each step. It's a natural sequence," she explains. "But no one had put the five steps together."

Over the years, research to support the wisdom of each step has only expanded. Huddleston is very pleased with powerful new research findings from a controlled trial for knee-joint replacement at New England Baptist Hospital in Boston. Other studies of hers are also in the offing.

Hospital-based Workshops

Since starting her workshops about 20 years ago, Huddleston estimates she's taught self-healing techniques to more than 6,000 health-care professionals in the United States and Europe. They then go on to lead one-hour workshops, which are often offered through the hospital's anesthesia preoperative clinic.

For the last three years, Mary Swindlehurst has been leading Huddleston workshops twice a day, three times a week, at Kaiser Permanente Santa Clara Medical Center in California, one of the approximately 15 or so hospitals across the country that conduct the workshops.

"It's really exciting!" she reports. "I've seen such a positive response. After people go through our program, they generally need less pain medication. They heal faster. They get out of the hospital quicker." Swindlehurst adds that Five-Step participants also buy Huddleston's book and tape for family and friends, and even take the workshop again if they need other surgery.

It was through just such a hospital program in New York City that Anita Mandel was introduced to Huddleston's Five Steps. And today she recommends it highly to anyone facing surgery. As evidence of how effective the mind-body approach was for her, Mandel relates that when she was coming out of anesthesia her first thoughts were not about how terrible she felt. Instead, she recalls, she remembers thinking with some surprise: "Hey! I'm healing more than I'm hurting!"

For More Information

 Peggy Huddleston's book, Prepare for Surgery, Heal Faster. A Guide of Mind-Body Techniques, or the companion cassette tape, is available on her website (www.healfaster.com) or by calling 1-800-726-4173. An updated book with accompanying CD is slated for release in the fall of 2003. Information on her workshops is also on her website.

 Belleruth Naparstek's two-tape or CD set, Successful Surgery, is available on her website (www.healthjourneys.com) or by calling 1-800-800-8661.

Date Published: 07/29/2003
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