Preparing for Surgery? 4 Ways to Reduce Its Traumatic Impact: Part One

This is part one of a two-part article about preparing for surgery. In this article I describe why the different components of surgery can lead to a traumatic response. I also include some common symptoms that appear with each of the different kinds of traumatic events. In part two, I offer four steps you can take to prepare for surgery that can speed your recovery and minimize the possibility of the surgery causing a traumatic response.

Whether you are preparing for surgery hours or days away, there are steps you can take to minimize its traumatic impact. By minimizing your nervous system’s threat response, you may reduce: the time you spend in the hospital, the amount of pain you experience, the amount of medication you require, and the cost of hospitalization. Your preparation can help strengthen your immune response thereby minimizing post-operative infections and helping you to return to a normal routine sooner.

Potential for Overwhelm

Surgery by its nature is an invasive and complex procedure and it’s natural that your nervous system could perceive it as a threat. By definition, trauma happens when you stay stuck in any of the biological steps that naturally occur when the physiology gets stuck in a startle response, is unable to orient toward the threat, is unable to fight or flee and has to freeze or is not able to recognize that the threat has passed and it’s safe to relax.

Symptoms of Trauma from Surgery

There are several symptoms that may appear if your nervous system does become traumatized from the surgery. These include:
· feeling foggy
· feeling disoriented
· wavy body feelings
· a sense of floating
· a sense that something is missing
· drowsiness that lasts after your body has healed
· always asking yourself, “What else will go wrong?”
· intermittent pain that cannot be explained by physiological changes
· scars that partially heal after the doctor thinks they should be healed

Causes for Trauma

There are several potential aspects of surgery that could lead to you feeling overwhelmed or traumatized. These include:
1. Sense of being physically injured
2. Anesthesia
3. Perception that you are under attack without any way out
4. High fever
5. Emotional pain.

Physical Injury

At the very least, surgery breaks the skin boundary and it often disturbs the organs, muscles, flow of fluids and nerve tissue. Sometimes parts of the body are removed. The body’s unconscious response is to regard this as physical injury even though your conscious mind may have chosen to have the procedure and trusts that the surgery will improve your functioning. Surgery can cause a dilemma for the body: should it repair the injury or manage the stress of the invasion. It also becomes conflicted because the source of the threat is internal. The nervous system is designed to respond to threats that come primarily from the outside. The natural impulse to fight or flee would not be helpful. As a result, the body during surgery may freeze or shut down.

You know when you are in freeze when you:
· have a unusually slow recovery
· become obsessed about physical symptoms
· frequently feel exhausted after healing has occurred
· can’t remember the events leading up to and following the surgery
· observe that scars appear fresh and inflamed long after the normal healing
· mistakenly believe that things “out there” are threatening or that others want to kill you
· tighten your muscles so much that your immune system becomes compromised and you become sick easily

Anesthesia

To the unconscious mind, the effects of anesthesia, whether administered locally, regionally or generally can appear to threaten your very existence. After all, if you get too much of it, you could die. Anesthesia does not put the part of the brain that knows about survival asleep. This part of the brain recognizes that something has come into the system that should not be there. As with physical injury, the threat is internal and the body will want to get away from it or rid of it. Running and fighting are not options. Instead, your physiology will want to slow. Slowing down to the degree of unconsciousness, however, can be terrifying both to your conscious and unconscious mind because it can feel like you or part of you are going into a state of freeze. When the terror combines with an inability to get rid of the anesthesia trauma can occur.

There are several indicators that you are stuck in a threat response to anesthesia. These include:

· depression
· spacey eyes
· feeling toxic or ill
· poor muscle tone
· sense that time is moving slowly
· chronic diarrhea, urination, coughing, gagging
· emitting an odor of anesthesia or hospital scents
· others noticing that it is hard to follow your train of thought or that they become spacey when you speak
· difficulty in sleeping because of the unconscious belief that it could lead to death

Feeling Under Attack Without a Way Out

Two conditions related to surgery may lead to you feeling attacked without being able to escape. These include being restrained and experiencing pain. When general anesthesia is used without first locally numbing the area, the brain still registers pain. Due to the anesthesia, however, the body cannot move away from this unpleasant sensation. As a result the nervous system freezes. As I noted above, if the freeze continues your nervous system can get stuck in a trauma response.

Symptoms that may appear all the time or just with certain activities that relate to feeling trapped while under attack appear as:
· feeling of shame
· diminished trust in self
· sense of helplessness
· experiencing disturbing dreams
· frequent angry or abusive outbursts
· poor sleep because of high anxiety
· hypersensitivity to smell, touch, light
· inability to express either anger or hurt
· inability to commit to projects or relationships
· thinking the world is scary and you need to be continually on guard
· confusion or fear about the actions of those who helped you during the surgery

High Fever

I have included high fever in the discussion of surgeries because they may accompany the healing process or occur due to an infection following the surgery. High fevers can lead to trauma because of the extreme fear you may feel as you move in and out of altered states of consciousness and experience the intensity of symptoms that accompany fevers. The symptoms include transitioning from feeling extremely cold to hot. You may sweat profusely, tremble, shake violently, become delirious and see or hear things not real, perceive things and people around in bizarre ways and have out-of-body experiences. It may be extremely difficult to surrender to the process and your nervous system gets stuck in fighting it. Consequently, you may become stuck in a threat response.

After surgery, a traumatic response to high fever can appear as:

· chills
· sweating
· trembling or shaking
· abrupt changes in body temperature
· an inability to describe what happened during the high fever

Emotional Pain

Prior to and following surgery you may feel emotionally vulnerable. You may be emotionally overwhelmed following a traumatic event, such as an accident or attack that precipitated the need for surgery. Even when the surgery is planned, the recognition of how it can change your physical appearance or functioning can be very stressful and challenge how you relate to others. In the ideal world, you will have all the supportive helpers and competent care that you need and deserve. This, however, is not always the case. Family and friends may be too anxious or distant to be helpful. Helping professionals make mistakes and the surgical outcome may leave you in a worse condition than before the surgery. All these factors can act as emotional stressors and tax the most resilient nervous systems.

The hurt and fear from the recent surgery or when it is compounded by unresolved traumas from previous surgeries, accidents, assaults, and abuse, can lead to symptoms of trauma. The emotional wounding may appear as:

· impaired sex drive
· high blood pressure
· unable to concentrate
· anxiety, nervousness
· poor sleep and appetite
· shallow and fast breathing
· anger, rage, self-defensiveness
· distorted sense of space and time
· emotionally distant or numb, sense of not feeling real or alive
· needing to be on guard against abandonment or feeling smothered emotionally

Next Step?

Undergoing surgery can be daunting process. Fortunately there are steps you can take prior to surgery to maximize your ease of recovery and to minimize it becoming a traumatic event. In the next article I will examine four effective steps that can help you to take charge of the process. These will help you to be less vulnerable to experiencing surgery as a threat and causing you to get stuck in trauma.

If, on the other hand, the surgery is over and you are wondering what to do to help yourself or a loved one to recover from a traumatic surgery, you may find help in two forms. These include reading literature about trauma and seeking professional support. Two books that include effective exercises to help readers move through trauma is Waking the Tiger by Dr Peter Levine, PhD and Trauma Through A Child’s Eyes by Maggie Kline and Dr Peter Levine, PhD.

Psychotherapists who understand how surgical trauma affects the physiology and how your body knows how to recover from it are excellent resources. A list of somatically trained therapists throughout the world can be found at The Foundation for Human Enrichment’s website at Trauma Healing.

Trained by the Foundation for Human Enrichment in trauma therapy, I am available to see clients in the greater Denver Colorado area. I offer complimentary 30-minute consultations for you to see if my approach will work for you.