Hello and welcome to your Royal Derby Hospitals 'physiotherapy and you' DVD.
Royal Derby Hospitals are promoting an enhanced recovery programme after surgery.
The route to an enhanced recovery is to encourage you to take control of your own care and for
you to be a part of your operation, not to have the procedure done to you.
All ward staff will motivate you to get better quicker and keep you fully involved in your
care.
The aim of the enhanced recovery programme is to reduce your length of stay in hospital,
reduce post operative complications and improve your overall hospital experience.
You will be seen by a physiotherapist as part of your post operative care. Getting you moving
as soon as possible will play a vital role in a quicker recovery.
Your physiotherapist will emphasise and encourage you to achieve your 'enhanced recovery milestones',
as written in your pre-operative hand book.
Your milestones are a minimum daily goal, if you are able then you should aim to walk
further and more frequent.
However your goals will be tailored to you as an individual if required.
Stopping smoking will also play a big part in a quicker recovery.
Research shows that smoking greatly increases your risk of complications during and after
your surgery.
Therefore increasing your stay in hospital and the length of your recovery.
Not smoking before your operation will also improve your general health and well being.
It is important to remember that all NHS hospitals operate a no-smoking policy.
Smoking is not tolerated anywhere on the hospital premises, both within the hospital buildings
or outside in the car parks and grounds.
If you feel ready to go smoke free and stop smoking for good then there is no need to
struggle alone.
Evidence shows that you are more likely to stop smoking if you get the right support.
Your local stop smoking service, Fresh Start, can help you cope free of charge via the NHS.
Fresh Start provide a telephone support service and weekly stop smoking clinics at the Royal
Derby Hospital site.
During your operation a catheter will be placed into your bladder to monitor your urine output
and kidney function.
A drip will also be placed into your arm to provide you with fluids and a drain will be
placed into your abdomen.
You will also have lines providing you with pain relief and additional oxygen.
These attachments will not stop you getting out of bed or moving but they will limit your
independence.
Therefore your physiotherapist and nursing staff will assist you when moving by taking
care of your attachments.
The type of pain relief you receive will be decided by your anaesthetist.
It is expected that you will experience pain after your surgery but you need to help us
to keep it under control.
Your pain should not stop you from taking a deep breath,
being able to cough or being able to move.
If this is the case then you should inform your nurse and /or doctor.
Please do not wait to be asked.
Remember good pain relief will help your body heal and prevent post operative complications.
Your physiotherapist will see you the day after your surgery.
Participation in physiotherapy will prevent you from getting a chest infection,
restore your mobility and prevent other complications associated with surgery such as the development
of pressure sores and circulatory problems.
Therefore reducing your length of stay in hospital and improving your overall hospital
experience.
Your physiotherapist will encourage you to perform deep breathing exercises independently
every hour following your surgery.
Performing these exercises correctly will prevent you from acquiring a chest infection
by removing any phlegm that may have built up after your anaesthetic.
Deep breathing exercises will also improve the ventilation of the bottom of your lungs
and reduce the length of time that you may require additional oxygen.
You should start these exercises as soon as you feel able to on the evening of your surgery.
To perform these exercises correctly you need to acquire an upright position in bed.
To begin place your hands gently either side of your abdomen and relax your shoulders.
As you breath in you should feel your hands move away from your body and as you breath
out you should feel your hands move towards your body.
This is called diaphragmatic breathing.
When you are ready,
take a long slow deep breath in through your nose,
hold for 3 seconds then relax,
let the air gently out of your mouth.
Repeat this process 3 times.
This should then be followed by a huff or a cough.
To perform a huff you should take a deep breath in through your mouth.
Open your mouth wide and then push the air out hard and fast,
as though you are steaming up a mirror.
When you feel ready place your hands,
or a rolled up towel over the area where it is sore and apply pressure, then cough.
Remember your pain should not stop you from taking a deep breath or coughing.
Please ask for additional pain relief if required, do not wait to be asked.
Following your deep breathing exercises you should perform your leg exercises.
Compliance with you leg exercises will maintain the strength and circulation in your legs
in preparation for walking.
To begin, straighten your right knee and gently raise your leg about 2 inches off the bed.
In this position briskly move your ankle up and down.
Continue this movement for 15-20 seconds before repeating this exercise on your other leg.
Repeat this exercise hourly as with your deep breathing exercises.
The morning after your surgery you will be encouraged to get out of bed and sit in your
chair.
Remember nursing staff or physiotherapists will assist you and take care of your attachments.
Discomfort is to be expected but the following technique will minimise pain.
Your pain should not stop you from getting out of bed or walking.
Therefore it is important that you request pain relief or use your patient controlled
analgesia prior to moving.
Firstly bend your knees up towards you, then roll onto your side and place your legs over
the edge of the bed.
You should then use your arms to sit yourself up.
You are now ready to achieve your milestones.
When you are ready to go home we will plan your discharge from hospital.
Please remember we may not be able to give you a precise date as your discharge from
hospital will depend on a number of things.
We must ensure that you are eating and drinking well and that your pain is under control,
in order for your doctor to declare you as medically fit for discharge.
It is also very important that you are able to walk and climb stairs safely and independently
if required to do so.
It is also essential that your wound can be managed by a district nurse in the community.
It is important to remember that you will not be routinely assessed by an occupational
therapist or social services on the ward.
If you feel that you will struggle at home then your occupational therapist can assess
you and provide treatment to help you to be more independent with essential daily activities.
These activities include-getting on and off your bed, armchair and toilet, getting to
your toilet in time, accessing washing facilities and making and carrying your own food and
drinks.
Again if you are concerned about any of these activities please inform ward staff as soon
as possible so that a referral can be made to your occupational therapist.
If you feel that you will require essential support at home with tasks such as shopping
and getting washed and dressed then please inform nursing staff as soon as possible and
a referral can be made to social services.
Following abdominal surgery it is essential that you gently increase the strength of your
abdominal muscles.
These muscles play a vital role in stabilising the core of your body and therefore help to
protect your back.
However you must not begin these exercises until your clips or stitches have been removed
and your wound has healed.
It is also vital that you seek immediate medical attention and stop performing the exercises
if they cause you pain, discomfort or any changes to your wound such as redness, inflammation
or leaking.
Please note it is recommended that you do not perform a full sit up following abdominal
surgery.
We advise that you initially perform each exercise 5 times twice a day.
To start lie on your bed or floor with your knees bent up and your feet flat on the surface.
The first exercise is pelvic tilting.
Push your lower back firmly into the surface while tightening your abdominal muscles.
Hold this position for 5 seconds and then relax.
The second exercise is knee rolling.
Push your back into the surface while slowly rolling both knees to the right as far as
you are able.
Slowly bring your knees back to the centre before repeating the process to the left side.
The third exercise is curl ups.
Push your lower back into the surface while gently sliding both hands up your thighs towards
your knees lifting your head and shoulders off the surface.
Hold this position for 3 seconds then slowly return to the starting position.
The fourth exercise is curl ups with a twist.
Push your lower back into the surface while gently reaching 1 hand across to touch the
opposite knee lifting your head and shoulders off the surface.
Hold this position for 3 seconds then slowly return to the starting position.
Repeat this exercise to the opposite side.
When you feel comfortable with these exercises, gradually increase the number of repetitions
to 10, the number of sessions each day to 4 and hold time to 7 seconds.
But please remember it is recommended that you do not perform a full sit up following
abdominal surgery.
When you return home do not be afraid of standing up straight and slightly stretching your wound.
A stooped posture places extra pressure on your back.
If required, when sitting, place a small rolled up towel in your lower back to provide support.
You are advised not to lift any thing heavy for 4-6 weeks.
The maximum you can lift is the equivalent to a kettle full of water.
At approximately 3 months you should be back to your pre-operative ability.
However, please remember the safe lifting technique.
You are advised to commence driving at 4-6 weeks.
However it is your responsibility to ensure that you are safe and confident to do so.
If you wish practice your manoeuvres in a static car.
You must feel comfortable performing an emergency stop and turning the steering wheel quickly
if necessary.
It is recommended that you avoid high impact exercise for 3 months.
Gentle walking is the best form of exercise for the maintenance of general fitness.
Therefore try to undertake regular exercise several times a day and gradually increase
this until you are back to your normal level.
However it is important that you pace your activities, listen to your body and modify
your exercise.
If you play golf please be mindful that it involves a lot of walking and twisting of
your back.
Remember prepare yourself by increasing walking distance and knee rolling or play a shorter
game initially.
Swimming is beneficial as the buoyancy helps you to move more smoothly and easily.
However consult you doctor as your wound must be fully healed before swimming due to the
risk of infection.
When dog walking please take care with lively dogs as they may pull on the lead and cause
undue stress on your wound and back.
You are advised to return to work within 6-12 weeks.
However you must avoid heavy manual work for 12 weeks.