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8 Steps to Prepare For Endometriosis Surgery

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The nature of endometriosis means that as endo women we are often subjected to endure repeated surgeries. Since this is a recurring theme in the lives of many of us, finding a successful strategy in dealing with pre-surgery stress and post-surgery recovery is a vital element for our mental and physical health and should not be overlooked or treated lightly.  

8steps_endosurgery

My journey of recovery from repeated surgeries in 2021 

As much as we all want to avoid surgery at all costs, sometimes the placement of the disease and the pain it causes cannot be helped by natural remedies. In my own experience, natural remedies for endometriosis have helped me get rid of the pain and reduced it significantly, however, controlling one’s symptoms doesn’t always go parallel with stopping the disease progression.

Beginning of the year 2021, I underwent a 9-hour long surgery for endometriosis, which didn’t only involve the traditional reproductive areas but also a significant portion of the bowel resection. Despite the length of the surgery and its extensive scope and very questionable outcome (as I was told), I managed to get out of the hospital much quicker than the doctors expected and regained almost full mobility within 2 weeks (to the point of doing light yoga exercises). After three months I was back on the operating table, however, to close a stoma that was a result of the first surgery.

Here again, I had to depend on all my knowledge from previous surgeries to ensure a quick recovery. Even though the second surgery was much shorter than the initial one, the fact that both of them were scheduled so close together meant that my body was exhausted and the recovery wasn’t as easy as I thought it would be initially. Regardless of a very tough and bumpy road to recovery and the amount of strain my body had to endure through malnourishment caused by two massive endo tumors that were causing intestinal obstruction, high doses of anesthesia, pain-killers, and antibiotics, and many hours spent on the operating tables; on the grand scale of things I think I managed quite well. Now little over six months since my last surgery I feel better than I ever did before since being diagnosed with endometriosis.

I attribute it of course to the knowledge and perseverance of my surgeons, but also in large part to the pre-surgery preparation on the physical and mental front that I did that helped me pull through these very difficult six months between the two surgeries and a visit to ER a month prior. Now I want to share the strategy with you of what I did to equip you with the knowledge necessary to help you through your difficult times with endo surgery.

Below you’ll find helpful tips on what you can do if you are planning to have endometriosis surgery soon so that you minimize the risks of complications and maximize the speed of your recovery.

 

1. Choose your surgeon carefully

Surgeon

I can’t stress enough how important it is that you select the right specialist to perform your surgery. To properly get rid of the disease in all sites the doctor you select should be skilled not only with properly removing endometriosis – through excision surgery, but also skilled at recognizing endometrial implants beyond the reproductive organs as well.

 The nature of endometriosis causes it to stick to many organs, the most commonplaces being in the peritoneal cavity such as the ovaries, cul-de-sac, fallopian tubes, colon, rectum, and appendix, but endometriosis lesions can also attack other sites as well such as the liver, kidney, gluteal muscles, bladder, diaphragm, and even the lungs (1). 

It’s crucial that you ask your doctor all the vital questions and feel comfortable with the answers you receive. A skilled surgeon should also recommend for you to perform various tests before the surgery in order to plan the scope of it accordingly. It is extremely important in cases when bowel or bladder areas are involved in order for the gynecologist surgeon to have the proper assistance of the general surgeon when necessary. Speaking to your doctor openly about your fertility plans will also ensure that he/she picks the method of surgery that’s most right for you (for example in order to preserve ovarian tissue the surgeon might choose to use a plasma knife rather than perform excision surgery). 

For all the important questions to ask your doctor you can use my 20 Key Questions To Ask Your Endo Surgeon handout to assist you in ensuring you don’t miss anything out. Remember that picking the right specialist will increase your chances of eliminating the cause of your pain, infertility, aid in faster recovery, and lower the speed of recurrence.

I can personally recommend three surgeons, each of whom operated me at different times and who, in my opinion, are extremely competent (on a global scale) in terms of techniques and knowledge in removing endometriosis. 

 2. Help your body with supplements

supplements

Just as much as a proper wholefood endo diet is key to managing the disease, supplementation is the key if you want to reduce post-operative complications and give your body the best chances of recovery afterward. It’s important to raise your body’s immunity to the maximum, replenish your blood supply, as well as provide it with antioxidants and micronutrients for the healing of postoperative wounds and scars. 

Here’s a shortlist of supplements I recommend you take at least a few weeks before your surgery and afterward (as soon as you can eat normally) to help your body manage the post-surgery trauma better.

Vitamin C –  higher doses of this vitamin are required in post-operative patients due to increased oxidative stress caused by surgery. It’s been shown that 500 mg a day reduces postoperative stress in patients (2). Although it is water-soluble and difficult to overdose, the upper limit of this vitamin has been recommended to be 2,000 mg per day (3). If you are preparing for surgery, taking 1,000 mg a day should be your minimum and maintaining it for at least 2 weeks after surgery, although to reduce the chance of endometriosis lesions from reoccurring you should consider adding to your daily regime. 

Vitamin D –  is crucial for bone structure but also for raising our immunity. It has been shown that patients who had lower doses of preoperative serum 25(OH)D less than 30 ng/mL were at a 3- to 4-fold greater risk for surgical site infections (4). It has been proven that women with endometriosis have much lower levels of vitamin D (hypovitaminosis D) than other women which puts them at a higher risk of other diseases as well. (5) If you live in the northern hemisphere where the sun makes its longer appearance only in the summer months or you don’t expose yourself to the sun that much, speak to your doctor and check your vitamin D blood levels. The minimum level you should aim at is 30 ng/ml, but some sources list levels of 50 ng/ml or higher to aid in dealing with endometriosis (6). If you are Vitamin D deficient you might need to take a daily dose of 4,000 IU or more initially and monitor your levels every few months through a blood check-up.  

Iron –  one of the key microelements used in hemoglobin and erythrocytes production (red blood cells) both of which are lost each month with menstruation and during surgeries. Its deficiency may lead to anemia and further health issues (7). Even though a lot of iron is found in red meat, which should be avoided by women with endometriosis, it can be also found in other sources that are safe when on an endo diet, such lentils, red kidney beans, chickpeas, nuts (cashews, almonds), seeds (pumpkin, sesame, flaxseeds), leafy greens (spinach, kale, collard), and whole grains (spelt, amaranth, oats, quinoa). If you are not vegan you can also find iron in eggs and shrimp. To get a good overview of your blood’s condition and check if you need iron supplementation, testing of hemoglobin, hematocrit, and ferritin levels prior and post-surgery is the best way to verify iron deficiency and need for additional supplementation. 

Omega-3 fatty acids (ALA, EPA, DHA) –  during surgery a body is going through a shock of losing blood and cutting out a lot of endometrial tissue. Omega-3 fatty acids can reduce the production of inflammatory substances, such as eicosanoids and cytokines (8). Thanks to its ability to reduce inflammation, omega-3 has been shown not only to reduce the risk of autoimmune diseases but also to reduce the risk of postoperative complications after major surgery. (9) A good source of it are fatty fish, fish oil, flaxseed oil, chia seeds, and walnuts. Supplements based on algae such as the Sunwarrior Brand which are vegan and GMO-free are also a good option to increase your levels before surgery.

Collagen –  a major component of the skin and one that has a direct effect on skin’s elasticity and hydration. In addition to its role in making our skin look youthful, collagen plays a major role in keeping our joints and heart-healthy and preventing bone loss. In terms of pre-surgery preparation collagen supplementation has been shown to reduce hospital stay in burn patients speeding wound healing. (10) This is especially important in endo surgeries with a more extensive scope and larger incisions.

3. Strenghten your pelvic floor and open your hips

Top 8 Yoga Poses

If you are not a yoga practitioner yet it would be of great benefit if you began toning and opening your hip joints as well as strengthening your pelvic floor muscles. Pelvic floor exercises are especially important after surgery to the pelvic region. Strengthening these muscle groups will not only help support the bladder, bowel, and vagina but also help prevent any long-term problems. Some of the yoga poses you might want to try practicing regularly that will help with opening and loosening those areas are listed below. I have organized them in such a way that you can seamlessly move from one pose to another.

Wide-Legged Squat

Wide-Legged Squat (Malasana)

Slowly come into a deep squat by bringing your seat a bit above the ground, adjust your feet as necessary. Bring your hands together at the center, lift your chest and use your elbows to push your thighs further apart. If your heels don’t touch the ground, use a rolled-up blanket. Relax and breathe in this position for a minute.

Butterfly Pose (Baddha Konasana) 

From a seated position, bring the soles of your feet together, close to your pelvis, allowing your knees to fall out to the sides. You can sit on a blanket to help elevate the hips a bit. For a deeper stretch come down with your chest towards your feet. Breathe and relax. Stay in this position for a few minutes.

Endo360Help Butterfly Pose
Endo360Help Happy Baby

Happy Baby (Ananda Balasana) 

Lie on your back. Bend your knees into your belly. Grip your feet with your hands on the inside or the outside of your soles. Open your hips wider than your torso. If you have problems grabbing your feet, hold onto a belt looped over each foot. Breathe. Hold the position for a few minutes.

Bridge Pose (Setu Bandhasana) 

Bend your knees and set your feet on the floor. On an exhale press your feet and arms actively into the floor, push your tailbone upward, and lift the buttocks. Keep your thighs and feet parallel. Clasp the hands below your pelvis and extend through the arms to help you stay on the tops of your shoulders. Stay in the pose for about 1 minute. Release on an exhalation, rolling the spine gently down onto the floor. Repeat a few times.

Endo360Help Bridge Pose
Endo360Help Pigeon Pose

Pigeon Pose (Eka Pada Rajakapotasana) 

Bring your right knee forward in front of the body, next to your right wrist. Your right ankle will be somewhere in front of your left hip. Extend your left leg behind you with the heel pointing to the ceiling. Push yourself on your fingertips off the ground and lengthen your spine. Keep your hips square towards the front of the mat. Make sure not to feel any pain or pinching in your right knee. If you do, adjust your foot. Repeat on each leg.

Runner’s Lunge (Arda Mandalasana) 

Bend the front knee to 90 degrees angle and make sure that the toes are visible so that the knee is stacked over the heel. Lengthen and engage the extended leg. Breathe deeply. Repeat on each leg.

Endo360Help Runner's Lunge
Endo360Help Lizard Pose

Lizard Pose (Utthan Pristhasana) 

Similar pose to Runner’s Lunge, but a bit deeper stretch. Bring the forearms down to the ground next to your foot. Breathe deeply ensuring your chest is forward through the arms. For the Low Lizard pose, you can place your extended leg on the floor similar to the Pigeon pose.

Crescent lunge (Anjaneyasana) 

From a Lizard pose place your knee on the floor. If your knee is sensitive, place a blanket underneath. Take a breath and lengthen your arms over your head. Soften your hips towards the floor, let gravity pull you down. Lift your fingers and chest to the ceiling. Breathe deeply. Repeat on each leg. 

Endo360Help Crescent Lunge
Endo360Help Reclined Butterfly

Reclined butterfly pose (Supta Baddha Konasana) 

Lie on your back. Bring the soles of your feet together as in the seated Butterfly Pose allowing your knees to drop to the floor. Relax your muscles. For extra support, you can place a block under each knee. This is a great position to end your yoga practice with before moving to Shavasana your final relaxation pose.

4. Pump on healthy protein

protein healthy

If you are on a restrictive animal fat diet (veganism, vegetarianism) you want to make sure that before your surgery you pump up some of the protein content in your diet. Some doctors will recommend special high protein shakes, which can provide as much as 20g of protein, as well as amino acids such as L-arginine and L-glutamine. Unfortunately in my experience there is very often milk at the base of these drinks, which is not the best idea in a restrictive endo diet, but also if someone is lactose intolerant. 

Proteins are the building blocks of the body and are especially important post-surgery to repair damaged body tissues. 

A good dietary sources of protein that are safe for endo women (unless you have a specific allergy) are:

  • fish and seafood
  • free-range organic eggs
  • free-range organic poultry
  • oats
  • beans
  • organic tofu 

If you are still worried that you might not be getting enough protein in your diet to aid you through the more demanding times of your surgery, explore the range of flavored protein drinks on the market, some of which are made from rice, pea, or hemp protein. Check out the USDA Organic certified plant-based protein and their amazing flavors from Sunwarrior and Vega.

5. Relax your body and mind

Endo360Help DoTerrra Oils

The time before surgery can be very stressful and full of anxiety for anyone. No matter what thoughts run through your head, keep telling yourself that everything will be just fine. Do your best to do everything to relax as much as possible a few days before your planned surgery. Listen to relaxing music, go on walks in nature, watch comedies to laugh, go to bed early, meditate or pray if that’s within your practice. 

One of the great ways for a relaxing evening and night’s sleep is to diffuse aromatherapy oils in the air and your bath.

Some of the aromatherapy oils that can help with lowering anxiety, aid relaxation, and promote calm sleep are:

  • Lavender
  • Clary Sage
  • Frankincense
  • Ylang-ylang
  • Chamomile
  • Vetiver 
  • Balance ( doTerra Grounding Blend)

I also highly recommend putting 1-2 drops of high-quality CPG aromatherapy essential oils like DoTerra on your wrists and rubbing them gently against each other to inhale and exhale slowly in any stressful situation such as the day before your surgery. I personally did this before each of my recent surgeries, and although much of the stress was still in the mind, the pleasant smell caused it to relax and unwind at least for a brief moment. 

6. Walk the walk

medicationIV

Depending on the scope of your surgery you might be pumped with strong opioid drugs that for the hours after the surgery might alter your normal processing abilities. As ridiculous as it might sound, you should do everything in your power to move the day after the surgery, meaning visiting the bathroom on your own. The first days after the surgery are crucial and the sooner you move from your bed (as hard of a task as it may be if you are hooked up to IV, drain, catheter) the faster you mobilize and the lesser the chance that post-surgery adhesions will form within your abdomen. 

Take it slow and don’t overdo yourself. If you are tired, rest, but remember that the more often you move while still in the hospital, the faster your lungs, lymph nodes will excrete all of the gas remains from the laparoscopy and other medication. You will also regain your mobility faster and recover quicker.

7. Massage your scars

Once your stitches are removed and your wounds heal you can begin with manual mobilization of the scar tissue. Depending on the scope of your surgery and method (laparoscopy or laparotomy) the scars might be smaller or larger. Regardless of the scar size, it is always a good idea to mobilize and massage the scars as soon as you can once your scabs fall off naturally and the wound heals completely.

I prepared a visual of the simple scar massages you can perform at home (recommended by a physiotherapist). Simply follow the instruction and massage your scars as shown by the arrows in the video. It is a good idea to use a scar-removing ointment or gel a few times a day and at night to help with the tissue healing. Many different products on the market can help with that. You should look for the ones that contain Allantoin, Silicone, Heparin, Collagen listed in their ingredients.

Here are some scar gels and creams you might want to try:

8. Visit a physiotherapist

physiotherapy

When your wounds are completely healed and your stitches get removed it is always a good idea to visit a physiotherapist. Not only will they be able to work on helping you get your mobility back and recommend some light exercises based on your body needs but also they can help massage and mobilize your scar tissue beyond what you can do at home manually. This is especially important if you had a laparotomy done or a larger excision had to be made during laparoscopy to remove certain parts of organs (bowel, ovaries, uterus, etc.). 

A good physiotherapist will have a large arsenal of electronic devices at their disposal that can help mobilize, break down and regenerate the deeper layers of the scar tissue to soften, heal it, make it more flexible, and also less visible.

Such devices may include:

Make sure to get recommendations for a good physiotherapist in your area and ask about the devices they use before you make an appointment.

Food for Thought

The nature of endometriosis means that in many cases going through repeated surgeries is simply unavoidable and it is not something that we can directly control. We can, however, control how prepared we are physically and emotionally before the surgery and how well we treat our bodies afterward. The better we are prepared through diet, supplementation, exercise, physiotherapy, mental approach, and most importantly carefully selected surgeon, the bigger the chance that we’ll minimize the complications of the surgery, feeling unwell, and of quick recurrence of our symptoms.

 Your Endosister

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