iCal <==> gCal <==> iPhone

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Step 2 - Back Up Your Data

This cannot be stressed enough. When we create our sync, gCal will be our primary Calendar, and any data you have on iCal or the iPhone Calendar will be lost. Back them up now, before you proceed any further.

My day job is as an anaesthetist (an anesthesiologist for our North American friends). I see it every day - patients who have done nothing to help themselves, and expect us (doctors and nurses) to “make them better”. They put the burden of care on external forces rather than taking responsibility for their own health.

Modern anaesthesia is very safe. Death and injury rates have fallen dramatically over the last 50 years, and even within the last 15 years, huge improvements have been made. However, some people will sail through anaesthesia and surgery much better than others. Having an operation and undergoing anaesthesia is a very demanding exercise for your body. It will put stresses and strains on your heart and lungs especially. And since your heart and lungs support every other organ in your body, it makes sense that they need to be in top shape.

By making some lifestyle changes, you can help yourself get through anaesthesia and surgery better in the following ways:

• Faster surgery
• Faster recovery times
• Quicker wound healing
• Less pain
• Less chance of infection and bleeding
• Less chance of complications and death

So what can you do to help yourself?

1. Take Responsibility

During your surgery, your general well-being will be looked after by a large number of people, including the anaesthetist, the surgeon, nurses in theatre, recovery and wards, physiotherapists, and even your family and friends. However, more important than any of these is you. You are responsible for your health, not others. Take that responsibility and use it to make some simple changes to your lifestyle, and your surgical outcome may be much smoother.

2. Stop Smoking

If you are a smoker, then the single most important thing you can do before your surgery is to stop smoking. If you ignore everything else on this page, at least stop smoking. Smokers having surgery are far more likely to have more complications:

• 3 to 10 times more likely to get an wound infection
• up to 6 times more likely to get a blood clot
• 2 to 6 times higher chance of a chest infection
• longer hospital stay and a higher chance of requiring Intensive Care
• 2 times increased risk of heart attack
• 1.5 times higher risk of death

It is not enough to stop smoking the day before your surgery. Within 24 hours, your oxygen levels start to return to normal. However, over the next 48 hours your airways start producing more secretions and may make your airways more irritable, actually making things worse.

However, there are clear benefits of stopping smoking 2 to 4 weeks prior to your surgery, and by about 10 weeks, your risks may have reduced to that of a non-smoker.

3. Lose Weight

No matter what type of surgery or anaesthesia you have, a lower body weight reduces your risks. Being obese makes most surgical procedures, and especially abdominal procedures much more difficult. More importantly, obesity increases the risks of the anaesthetic, from problems with finding veins to difficulty with breathing.

The reason for this is that after you go off to sleep for a general anaesthetic, the anaesthetist usually takes over your breathing. We do this by inserting an airway or “breathing tube”  either into the back of your throat or down into your trachea. Being obese often makes this a difficult procedure, and occassionally life-threateningly so. After the airway is inserted, the patient either breaths on their own or is artificially ventilated. With so much more body mass to move with each breath, this simple act of breathing may be difficult to acheive causing problems with oxygen levels during surgery.

Losing weight is not easy. However, it is something you can do to improve your chances under an anaesthetic. Take responsibility for your own health! Every bit helps - even 10kg (20lb) of weight loss can make a huge difference.

3. Exercise

Having an operation and an anaesthetic puts your body through a lot of physical strain. It is often described as slowly running a marathon while you are asleep. It puts extra stresses on your heart and lungs especially. If your body is not in good condition, it may have more trouble during surgery. Conversely, if your body is used to doing physical exercise, then having surgery and an anaesthetic will be so much easier, and your recovery will be smoother.

It doesn’t take much and doesn’t have to be overly strenuous. As an anaesthetist I have noticed that elderly people who do 45 minutes of brisk walking 4 or 5 times per week will do much better during their anaesthetic and  their recovery. Fit healthy people who do regular exercise often sail through anaesthesia. Again, take responsibility for your own health!

4. Stop all herbal and non-prescription medications

You may be taking some over-the-counter or herbal medications to help with various conditions. That’s fine. But when it comes time to have your surgery, make sure you stop them at least 7 days before. Herbal medications especially may have active ingredients that are not standardised or listed and those ingredients may interact with the anaesthetic drugs or pain killers that you will need. The best known culprits are St John’s Wort which can dangerously interact with anaesthetic drugs, and high doses of garlic which can significantly thin the blood, increasing your chance of bleeding. The best policy is to stop all herbal drugs 7-10 days before surgery.

5. Get advice on prescription medications

Most of the time, your anaesthetist and surgeon will ask that you take all your usual prescription medications as you normally would, even on the day of your surgery. Taking your morning medications with a small sip of water is usually OK, even if you are told not to eat or drink.

There are some medications that may be required to be ceased before your surgery. Usually, blood thinning medications such as warfarin will need to be stopped. Most simple anti-inflammatory medications such as ibuprofen can also interfere with normal blood clotting, so your surgeon may advise you to stop taking these at least 7 days before your operation. Some blood pressure medications can also cause very low blood pressure during anaesthesia, so you may be asked to omit them on the morning of surgery.

If there is any doubt, ask your surgeon and anaesthetist well before, and get them to write down exactly which medications to continue, and which to cease.

6. If you suffer from reflux…

Reflux is a condition where the normal acid stomach fluids travel up the esophagus to cause heartburn and pain, especially when lying flat or bending over. Normally, when you are awake, any such fluid that comes up as far as your throat is simply swallowed. If any enters your trachea, you simply cough it up. No problems.

Under an anaesthetic, your normal protective mechanisms of swallowing and coughing will be absent. Any acid that comes up could go down your trachea and into the lungs, a condition known as aspiration. In its mildest form it may cause minor chest problems. At its worst it can cause catastrophic lung injury and even death.

If you have reflux or heartburn, tell your anaesthetist about it. We can take precautions to protect your airway from the acid while you are under the anaesthetic. Better still, get it treated. There is effective medication that can treat the majority of reflux symptoms. If you are on treatment for reflux, make sure you take it at least the night before and the morning of your surgery. Again, if in doubt, ask your anaesthetist.

7. If you snore…

Unfortunately, snoring is regarded as a nuisance or even as a joke. However, it can be a sign of a serious condition called obstructive sleep apnea. Sleep apnea causes a partial or complete blockage of your airway while you are asleep, causing snoring, breathing problems and if untreated, even heart failure.

Under an anaesthetic, you will be much more deeply asleep than when you sleep at night. If you have sleep apnea, you may have a lot of trouble breathing during the surgery. Worse still, if you have already developed heart problems from the sleep apnea, your heart may not cope well with the physical strains of the procedure.

If you snore, or have choking epidsodes during normal sleep, you may have sleep apnea. Tell your anaesthetist about it. Again, we can take precautions to prevent most of the problems of sleep apnea during your anaesthetic. Better still, get it investigated early, and treated well before you come to surgery. Often all that is required is losing weight. Sometimes, a special breathing machine (called a CPAP machine) will be required.

The Bottom Line

This is your body and your life. Take responsibility for it. There are some simple thing you can do to make your surgery and anaesthetic a faster, safer and more pleasant experience.