Pre Surgical Anxiety: How to Prepare for Endometriosis Excision Surgery for Women in New York and Washington DC
Image by: Annie Spratt
You have found your way here because you or someone you love are scheduled for an excision surgery. Welcome! You may be thinking “What now?” Or “How do I even begin prepare for this?”. Understandably, you may be feeling lots of anxiety surrounding this event. Especially if you already struggle with mental health diagnoses such as depression or generalized anxiety disorder, these symptoms may be heightened when you are about to undergo such an intense procedure.
What is excision surgery for endometriosis?
The Center for Endometriosis defines excision surgery as “surgical cornerstone of any high quality, multidisciplinary approach to correctly treating endometriosis. LAPEX allows for the disease to be properly, meticulously removed – cut out – from all areas, without damaging surrounding structures or removing otherwise healthy organs. Excision of endometriosis is associated with improved pain and quality of life.”
Surgery is the only definitive way to diagnose endometriosis or rule it out as a reason for pelvic pain. Excision surgery is the gold standard for endometriosis removal. When looking for a surgeon, it’s important to advocate for yourself by seeking true experts in the field. This requires extensive training on the part of the surgeon. You deserve the best care possible! If finances are a barrier, inquire if payment plans are offered. Many surgeons offer financial ways to provide the best care possible!
How are depression and anxiety related to endometriosis?
Endometriosis often is co-occurring with depression or anxiety. Given that women with endometriosis tend to have significantly more symptoms of anxiety and depression, it is best practice to include mental health support for endometriosis patients. If you are looking for a therapist who truly gets how chronic health issues impact your life, learn more about my practice.
What is medical trauma?
Pre surgical anxiety may be impacted by medical trauma. Medical trauma is our body’s physical and emotional response to an internal threat, like chronic illness, chronic pain or ongoing medical treatment to address the medical need.
How does medical trauma impact endometriosis excision surgery?
Medical trauma is very real. It can be created by both an emergency, life threatening medical event or long term chronic pain and chronic illness. It can be triggered by dismissive medical staff, increase anxiety and affect the ability to seek treatment. Often, the idea of going under anesthesia can be very overwhelming when a patient has a history of medical trauma and endometriosis. Trauma informed counseling paired with Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can be extremely helpful in preparing both your mind and your body for surgery.
What is pre-surgical anxiety?
Pre surgical anxiety may look like:
Racing thoughts about surgery
Obsessive thoughts about surgical outcome
Extreme fear of anesthesia
Excessive distress surrounding medical appointments
Avoidance of medical care
Hyper-vigilance seen as frequent medical care
Anxiety surrounding upcoming appointments or treatments
Jumpiness during medical appointments
Possible panic attacks
Nightmares about previous medical experiences or future surgeries
Trouble sleeping
How do I cope with anxiety before my endometriosis surgery?
Coping skills for pre-surgical anxiety for endometriosis excision surgery include:
Make a playlist for the ride to the hospital and while waiting to be admitted.
Lean into music that provides the opposite emotion of how you are feeling. For instance, if you are feeling high levels of anxiety, create a Pop playlist of your favorite upbeat hits or classical music to help calm the mind. If you are feeling down, try a mood boosting playlist to help distract you from your current emotions.
Ask your surgeon for a trauma informed approach to discuss exactly what surgery day is like.
You are the expert on YOU. You know exactly what anxiety or stress feels in your body. You know what is comforting when you need support. As challenging as it can be sometimes, you always have the power to advocate for yourself. Ask your doctor during your pre op visit to explain what it will be like during surgery day. What will happen once you get admitted? Where do you wait? Which providers on your surgical team will you see? This could be your nurse, your anesthesiologist, your surgeon and more. What will anesthesia feel like? Write down any and every question you have. The more knowledge you have, the more ready you will feel come surgery day.
Have a support system at the hospital.
COVID-19 guidelines changed a lot of “normal” visiting hours. Take a look at your hospital’s website to get the most up to date information on who can accompany you. Who is that person? How can they support you while you wait?
No visitors allowed yet? Big family and only one person allowed to see you? Don’t panic! Technology makes it possible to still connect with those strong supports. Have a plan to FaceTime a loved one if waiting alone-even if there is silence, you can see that someone is sitting with you (even if in another space).
Practice the drive to the hospital.
Many times folks are traveling out of state or long distances to get to their surgeon. The idea of navigating a new route when already under stress is not a good combination. If at all possible, practice the route you will take to get to the hospital, whether thats via car, cab or public transportation.
Focus on what is in your control when lots of things feel out of control.
It can feel like there is nothing in your control when you get the news that surgery is the next step. However, there are always things we can control, even if it is just our reaction to our current circumstances. So, what do you feel is in control? Can you prepare for your surgery by meeting with a therapist? Can you research endometriosis so you feel informed? Can you spend time with friends leading up to surgery so you feel distracted? Can you practice meditating each day to calm the sympathetic nervous system? There are lots of things you CAN do!
Get your hospital bag ready.
Pack a small overnight bag with essentials. Bring your favorite face wash to feel refreshed after waking up from anesthesia. Pack a toothbrush to get that minty re-fresh. Don’t forget cozy slippers and large pajamas to leave the hospital in-remember, you will most likely be bloated and tender after your procedure. You want to ride home in comfort! Other things you may want close to you are a soft blanket and pillow for your stomach on the way home.
Get a trusted therapist on your team.
Research demonstrates best practice when treating clients with chronic pain and chronic illness is using an integrative approach of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. Cognitive behavioral therapy (CBT) can help create reframes that are more helpful and realistic to say to ourselves rather than unhelpful thought patterns rooted in cognitive distortions. Cognitive distortions may include things like catastrophizing or all or nothing thinking.
Meet with a pelvic physical therapist.
Support your recovery by creating a team that has your back. Pelvic physical therapists are experts in their field and know how to support your physical recovery. They can help schedule an appointment both before and after surgery to help create goals for your recovery and strength building. Things get better with a team of supporters behind you!
Create a plan for post endometriosis surgery care.
Who will be able to provide some hands on support those first few days after surgery? Maybe a parent, spouse or friend can take turns helping you complete those activities of daily life, like showering, getting food, or even support getting in and out of bed. These things will all get easier over time-its okay to ask for help in the beginning when you are just starting to recover.
Live in a new city? Look at hiring a home health nurse to assist during the first few days post surgery. Having support is still possible even if loved ones are far away.
Have pre-made meals ready in the freezer to heat up.
Read through your surgeon’s instructions for recommended food post surgery. Take time to prep food before surgery so you don’t have to navigate cooking while healing. Stock up on any food and medications you may need before you head to the hospital. This can really reduce stress during healing.
Ask friends to check in when you are ready, whether that is in person or through a call or video chat.
Many loved ones will want to help you out after surgery. You may be up to in person visits- if so, amazing! If you’re not quite ready to have folks over, or your support system lives far away, ask for FaceTime check ins or Zoom movie nights. Technology is an amazing tool to keep you connected during your recovery.
Watch those TV shows and movies on your watch list.
Now is the time to do some binge watching! This can be a healthy distraction when feeling pain or anxiety as well as an activity to look forward to while your physical activity is lessened.
Have some magazines and books on hand.
When you need a break from the blue light of FaceTime calls and television, distract yourself with interesting magazines and books. Literary adventures are an amazing way to escape to a new world with no travel or passport required.
Use breathing exercises prior to surgery to decrease feelings of anxiety or panic.
Image by: Katerina Jerabkova
Box Breathing Directions:
Inhale through the nose for four seconds.
Hold the breath for four seconds.
Exhale through the mouth for four seconds.
Hold the breath for four seconds.
Repeat four to five times.
Use mindfulness and meditation techniques to address your anxiety. Below is a script for a specific mindfulness exercises, called the Container Meditation, to help manage anxious thoughts.
Container Mindfulness Directions:
You can use this script to help manage feelings of anxiety.
Close your eyes if you feel comfortable.
Take some deep breathes in through your nose and out through your mouth.
Take a few moments to visualize a space in your mind. This is a safe space. This place may be real, an actual place you live or have visited, or an imagined place you would like to visit or a fantasy location completely in your imagination. Go wherever feels most comfortable.
Now that you have a safe space imagined, create a container in this space. This container may look like an ornate wooden trunk or a plastic storage bin. There is no right or wrong. Take a few moments to identify what the container looks like, what it feels like and what it smells like.
Open your container.
Notice what anxious thoughts are coming up for you.
One by one, put those anxious thoughts into the box.
As you place your anxious thoughts into your container, remember that you can come back to these thoughts anytime. You are simply putting them away for now.
Scan the visual space you are in again.
Notice if you missed any anxious thoughts and take time to put those in the safe container as well.
Once all your anxious thoughts are in the container, seal it shut. This may be through a visual lock and key, a latch or an imaginary spell you cast. Do whatever feels right.
Find a space in your visual place to store the box for safe keeping.
As you put your locked container away, remember that you can return to this container anytime. You are simply storing those anxious thoughts away for now.
Take a few deep breaths, in through the nose and out through the mouth. Take a moment to slowly open your eyes and scan your body. Notice how you feel now compared to when you started the exercise. Give yourself gratitude for taking time to be mindful and take care of yourself before moving on to the rest of your day.
Create a team to help manage your anxiety before endometriosis excision surgery.
I hope these approaches and techniques provide you new tools to help manage your feelings of anxiety before surgery. In my personal experience, the best way to manage feelings of anxiety and depression as well as the challenges of living with chronic pain are to create a team of support. A trusted surgeon, a mental health professional to provide space to process your experience as well as a pelvic physical therapist can help manage both the mental and physical aspects of endometriosis. Invest in your healing and sign up for your free 15 minute consultation today.
Image by: Dan Meyers