Medical PTSD: What you need to know before surgery
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- Опубліковано 11 вер 2024
- #ptsd #surgery #anesthesia
Medical PTSD is a condition that can impact patients before, during, and after surgery. Some call it surgery PTSD when it occurs before, during, or after the operating room. It is caused by traumatic memories that are not correctly consolidated in the brain, making them more intense and difficult to process. The diagnosis of medical PTSD can be challenging due to anesthesia, sedatives, pain medications, sleep cycle disruptions, and other factors that can interfere with memory formation. Patients are also vulnerable in medical settings, particularly if they lack advocates to speak up for them. It is important to address medical PTSD before surgery to improve outcomes and promote recovery. Symptoms of medical PTSD can include flashbacks, nightmares, and avoidance behaviors.
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Here's what we'll discuss:
What is PTSD: dysregulated memory consolidation.
Medical PTSD: sometimes it's harder to diagnose because of medications, sedatives, anesthesia, sleep cycle disruptions that occur in medical settings (meds can interfere with our memories and make it harder to diagnose).
Furthermore, we're extra vulnerable in medical settings, especially if we don't have advocates to speak up for us when we're sick. Trauma focused psychotherapy includes effective treatments like prolonged exposure, cognitive processing therapy, narrative exposure therapy, written exposure therapy, and EMDR. Before surgery, exposure therapy in the pre-op room, operating room, and recovery room/hospital can be powerful when guided with the anesthesiologist or surgeon.
Blunting the sympathetic tone associated with each of these exposures is particularly powerful because it can help the memory be less intense and thereby allow for normal consolidation.
Fostering certainty, confidence, and control over the surgery outcomes are important to help empower patients.
The greater the certainty, confidence, and control we feel, the better we are able to relive triggering events with lower risk of a poor outcome, like a panic attack or anesthesia complications.
Fostering curiosity, and speaking to our doctors from a place of inspirational curiosity is critical to fostering the certainty, confidence, and control over our surgery and anesthesia. Speaking to our doctors from a place of curiosity also helps better engage our doctors and relieve tensions that may otherwise arise in the doctor-patient relationship.
SO TRUE. You are a patient advocates dream! My PTSD therapist called my EP before my surgery about my CPTSD/TRAUMA. MY Anesthesiologist was awesome (understanding PTSD). He was AWESOME! He was there for me, literally. Ketimine before Propofol. He even said sweet dreams darlin' , I'm putting the mask on now. B/C of my trauma he informed me of everything, every time someone was about to touch me, ect. GOD bless him.
Wish mine was like that, he told me the anaesthetic was going in my IV not a mask then put a mask on, with no warning while saying the drugs he was putting in and I hear fentanyl and think omg, street drugs, zombies, heroin type med etc and then I'm out
@@misfitm1457 oh honey. I'm so sorry you had to go through that. Fentanyl is safe in a hospital setting, cuz it's given in MCG. Where as street fentanyl is loosely measured in MGs and it's soooo much more than what's safe.
Strangely, I look forward to the anesthesia and being under, cause it's the one time my brain stops thinking, overthinking, dreams...... 😅
Thanks SO much for doing this video doctor, it’s such a serious topic.. After watching, you really made me feel better and more empowered about this upcoming surgery. I can’t tell you how blessed I feel to have connected with you, extremely thankful… be in touch soon 🔜
I've been avoiding a giant hernia repair for 4 years because of ptsd. The hernia is a result of the traumatic c section I had where I had only a lidocaine block and a tiny 1 lb baby wedged transverse under my pubic bone so difficult extraction. Screamed through the whole thing. This was actually my second traumatic c section. So the idea of having incision in the same place with the same recovery terrifies me. And of course reminds me of all of the other trauma associated with having nearly died and babies that nearly died. Even though it's a different circumstance, everything is related in my mind.
0:12 I had kidney stone laser 2 days ago & I have PTSD so I researched it because I'd found I came out of general anesthesia with severe agitated. I followed all the examples you gave & it helped me & the team so much. I don't like being a bad patient. Thank you so much
Thank you SO much for your videos, especially this one. It's made a positive change in my life - you have NO idea! I wish I could tell you - but my surgery yesterday (except for the terrible pain I've been in since then) was a MUCH better experience than I've had in the recent past. Thank you!
Wow! Thank you you are explaining it very well, I learned a lot. 🙏🙏🙏🙏
I let the nurse and anesthesiologist and even fill out on my paperwork I have C-PTSD, anxiety and depression before surgery. I have C-PTSD due to past child abuse and childhood trauma up until age 17, then trauma and C-PTSD was.dug up during 2020-2023 up until I went no contact from certain people. I have an autoimmune disease, Ankylosing Spondylitis, and am immunocompromised. Needless to say, it was pretty traumatic being high-risk with an "invisible" disability during the pandemic. Currently in trauma therapy for C-PTSD. Healing, managing and thriving.
So far, I have not had any questions from the nurses or staff after surgery procedures. I wake up feeling like I woke up from a deep sleep. Except without the dreams. It's kind of nice....
My PTSD is vomiting fainting and 💩ing. Love your videos gives me good education.
I'm happy you're learning! 🧠💪
I recently had to address lack of trust issues with my primary care doctor-- she was completely clueless about empathy with patients. She then chose to fire me-- before I even found a new doctor( I had told her I was looking for someone new). I cannot even figure out how to process this. I have a history of medical PTSD-- starting with c-section in my 20's and more recently when I almost died in 2018-- and was hospitalized due to a severe illness, and underwent sedation for several weeks. I was altered and uncooperative-- I still have a great deal of trauma due to this experience.
thank you!
I have a surgery coming up at a place that refused help after I was patient dumped at another place after a botched / incentivized surgery. This video is somewhat helpful, and it was brave to address this topic as most doctors have difficulty with all this. Most of the suggestions are really good.
However, from my experience, if I can share the total of what happened to me and see how that doctor responds, only then can I usually get comfortable. Saying I am curious how they can help would in no way work for myself. What I need to see is that they can look at what I am sharing, trust that I am begin honest with my experience and still assure me what will happen. The more they put into writing in my medical record, the better. So. if they say if there is any significant pain then I should not go home or something like that and it is in my records... then we should be "better". IF a doctor is defensive about an experience I had, no matter how I present it (the fact I am presenting it is hard enough) then he has as much work to do on himself as I do on me. Wanted to share the other side a bit and thank again you for touching on this topic.
Great live stream man ! I learned so much about PTSD, I don’t have PTSD, I always like to chat and joke with my anesthesiologist when they are putting me to sleep, it helps me to relax! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist!! I can’t drive because of my cerebral palsy, so I’m gonna get my all electric Mercedes EQS and let other people drive it for me
you are the best!
This was the most informative one. Thank you so much Dr. Kaveh
You are very welcome!
Thank you for your time!
I'm kinda glad that I have a few things that are in my favor for not developing medical ptsd- being on the Autism spectrum I do have some ocd and sensory processing issues but I also have several severe chronic pain conditions and issues. As I'm facing a carpal tunnel release and ulnar nerve decompression at the wrist for my left wrist and the slightly traumatic experience from the carpal tunnel release on my right wrist in November (the anesthesia provider could only find one spot for my iv placement-> on top of my foot, BUT the center was running short on lidocaine so they couldn't buffer the propofol and yeah, this had an outcome of burning pain going up my shin that caused me to scream and the only thing that I could think of doing was shoving the OR O² mask even tighter against my face till I passed out and then the next thing I woke up in recovery without pain). So, as I have a port and now know the surgery center policy of not using a port unless the patient has had a chest x-ray for position confirmation of the lumen within 14 days of surgery, I'm taking preemptive action of having that needed chest x-ray done and am bringing a copy of the films on disk and the report on surgery day so I don't go through another experience of that.
As for the chronic pain aspect for management of the post op pain, my surgeon already has my anesthesia preferences written down on my pre-op surgery consent- regional block (unfortunate side effect is that I get a floppy chopstick for an arm and limp noodles for fingers- but most importantly, NO PAIN 🤣🤣🤣) along with sedation so that I don't remember a damned thing. Of course courtesy of my history of walking face first into walls after fentanyl, fentanyl won't be used so my pain management provider and orthopedic surgeon also have orders that I take a dose of my 4mg dilaudid tablet 2 hours before surgery and upon waking up in post-op to dose again and to start manually moving my left arm and fingers using my right hand.
Pain management has also taken preemptive action for the hospital stay (I've got CIDP and surgery will end up triggering an exacerbation which requires acute dosing protocol of IVIG which has to be done in the hospital) so they have reached out to the attending doctor that I'm assigned to to tell him to follow my home protocol of dilaudid (one 4mg tablet allowed every 4 to 6 hours for pain- acute OR chronic) OR set me up on a PCA pump with dosing of .5mg iv dilaudid allowed every 30 minutes and on my last day of the stay to switch me over to my home protocol. This whole mess with the attending provider not being willing (at least since my home protocol was changed to what it is now) has me desperately wishing that I could do "home hospital" but that requires some expensive equipment- a portable heart monitor, continuous pulse oximeter and blood pressure unit in one-> quite like the kind carried by EMS. Of course, in the long run doing home hospital care independently would be DRAMATICALLY cheaper for my health insurance company OR even doing the "partial hospital" route would also be less expensive, but my insurance and neurologist agree on one thing- if I need more than one dose of IVIG for more than one day in a row, then because IVIG is a blood product, despite me never reacting to the IVIG short of a mild headache, it HAS to be done in the hospital and I stay in the hospital until I've finished the acute dosing protocol of doses.
What a fascinating perspective, thanks for sharing!
This man is a genius + an angel! I never want to have anyone but him as my doctor! How can I bring him to Edmonton Canada?!
Thank you I now understand about why my PTSD came back after my last surgery
I'm sorry to hear that :(
I'm in Spain, I am on a waiting list for HoLEP surgery. My urologist surgeon tells me there won't be much pain post surgery. I'm having trouble swallowing this answer. THEN, he tells me after our talk, which he and I recorded, that he may not be the surgeon who will do the surgery. He is the most experienced surgeon and I don't relish the idea of a child freshly graduated, using me as a practice doll for surgery. I live alone. No family. No friends to be at my home to help me the first few days. This is a wind-up. Even the catheter replacement every two months is traumatic. I take some valium and codeine before I get there. I had it without and people really don't understand my hysteria about it. They have never received a catheter. I offer to catheterize them, they decline.
My last surgery I was yelled at by a nurse because I was thrashing after surgery. I don't remember doing it and she had to give me extra meds and was mad at me. I have high opiate tolerance anxiety and PTSD. This just increased my anxiety and has traumatized me more. I have surgery and I am afraid I will be ignored again after telling my anesthesiologist my medical conditions.
I have PTSD from a military dental procedure. I was getting a deep cavity filled in my tooth. They gave me no anesthetic and as they were drilling, I can feel it because the nerves were not dead and then when I complained about it, they said you’re a shoulder suck it up and take it so they did the whole procedure that way, it took many many many many years before I could ever walk through a dental office again, and I tried many times, but the minute I walked into the door and those smells hit me and the sound of the drills. I turned around and walked back out. I just could not do it.
Yes, blown off, dismissed, minimized , denial. Its not good.
I like your dimensional art. Reminds me of a tesseract, depending on how you're looking at it.
I didn't realize until today that I'm dealing with this until I saw another video right before yours. Cripes, no wonder I'm such a mess.
Ok after my surgery, waking up, I was crying and screaming that I wanted to go back! I was just sitting on a porch swing with my late best friend. She was murdered a few years ago. 🎉❤
I didn't have a traumatic experience at all. I feel so stupid for how I feel. I don't have family or friends for support, had no follow up appointment or aftercare instructions and the Surgeon didn't come to see me on the ward. I asked the Anaesthetist how he was going to give me the general anaesthetic, in my IV or the mask. He said the IV. I still don't know why he then put a mask on me. I could hear him saying saline, fentanyl and couldn't say wait, I don't want fentanyl, it's like giving me heroin! I see people on the streets zombies due to that. I have no emotion regulation and am basically not emotionally developed. I had some guy putting the ECG on before I gave permission to touch me which the Nurses said he has to do, even though I said I'm not good with men or people I don't know. Since surgery I've had 2 weeks of chest pain, but idk if this is normal as the risks of general anaesthetic weren't explained to me. The anaesthetist said it'd be spinal then the surgeon came in and asked me to sign for a general, I said the anaesthetist says it's a spinal and he left. In the theatre they'd decided a general, but the first anaesthetist said she'd explain those risks in theatre if it came to that. Nobody did. I was too stressed to think of it. I had one guy fail to get my IV, so then he tries again and another guy grabs my wrist and starts smacking my hand, ofc I realised why but I didn't feel ok with two random guys I don't know grabbing me at all without warning me. Borderline people always have high fight and feel in danger, I like to know what is going to happen so that I can plan what might trigger me and how to avoid that happening, a plan.
I had a bit of a bleed and the surgery ran almost 50% longer than he said it would, only a Haemorrhoidectomy but idk how much a bit of a bleed is. Then 2 days on Urology with everyone refusing to help me when I was bursting to urinate and couldn't without pushing so hard I saw stars, finally after a day they say I have dissolvable stitches, nobody knew if any packing or not. All anyone said was I needed to wait in for a Dr, then when none came I had to stay overnight and by the time of discharge still hadn't seen one.
No idea if the op worked. Part of why I wanted a spinal was to be awake and aware what they were doing to me so I could relax. I had a great experience with a biopsy for suspected cancer as it was a spinal with a wonderful all female surgery team. I will never consent to a general again, no matter what is wrong with me. If a spinal can't be used, I won't have the op no matter what the cost. It was like a production line, they do it every day, I don't even go near another person almost ever. I'm not good with noise, lights, unknowns, men etc. When I had my biopsy, I think it was the anaesthetist was talking to me the whole time, explaining everything, answering questions and before anything was done eg changing bed positon etc they asked or told me what's next.
You and that green mask brilliant thank you
Thank you!
I had a hysterectomy - and then surgery to fix the error that ended up causing more issues and ended up on helicopter to icu with life support and temp paralyzed. Mths icu. I had to relearn breathing and all movements, literrally had to relearn everything. So many surgeries. And more to come. Yup lots of medical ptsd. Physically fit healthy and now permanent disability because of doctors.
Crazy experience.
So sorry. I had a minor op, Haemorrhoidectomy and broke down on day 2 in hospital and now at day 18 I've lost all control over my personality disorder and can't stop crying. It didn't help I've been abused and said I'm ok with men in theatre but not comfortable with them (unless they take time to chat to me and get some rapport). The ecg attaching guy put it on, he did tell me what he'd be doing but didn't wait for consent and did it so fast it shocked me. I don't want random guys touching me, even medically before I have time to say ok, or i'd rather a woman do this. I didn't even realise i'd have an ecg as for a cancer biopsy test I had a heart monitor but that was spinal. Felt like a production line, get them to lie back, wire them up without a word and drug them without asking if ready or saying ok we're about to
Very informative! Thank you! Chris good luck with your healing!
How do you find a trusted person when you meet the anesthesiologist only the night before?
I speak with my patients to BUILD that trust before they're already in the stressful surgery environment
@@MedicalSecrets I must be hard to build trust.
I asked ( in the live feed) about using Bach Rescue Remedy before and after surgery-5 flower essences: Cherry Plum, Clematis, Impatiens, Rock Rose, and Star of Bethlehem. This formula is really helpful so wondering if you feel it is safe before and after surgery?
I wanna know too. ☺️
Also, I like to use homeopathic remedies typically instead of pharmaceuticals.
Im a recovered pain pill addict, MAT for 9yrs, SA victim with PTSD. I stopped the methadone last November to get ready for my double knee replacements this year as well as a hardware removal.
I meet with PACE next Thursday. What should i tell them to have a positive experience?
I don't understand. They always tie my arms, so I wouldn't be able to move. Isn't that done in the USA? how come her arms were free? Thnx ☺️
You can ask the team to unstrap your arms!
Many surgeons do not like patients to ask who ask questions when they want be aware of who does what and why. The under estime the patient.
You should lecture in Paris at IMM in France they need to be trained in communication and consideration.
I’ve been through all the therapies. However, my body continues to react unless I’m really sedated.
Thank you. Do you have training with Bessel Van Der Kolk, "The Body Keeps The Score". I have always talk with the anesthesiologist before surgery finding that the more I can share the better the experience. A light dose of sleeping meds means I will not sleep for 12 to 24 hours after and anti barf meds means I can ride home and not make that roadside stop so I am not car sick.
Ty!
Propanolol oral gives me palpitations and / or tachy. How do we address this?
Knife?? How about scalpel??
That's me.
How do you do this if it's happened so often
How does the patient know what happens?
This is too common!!!
PTSD stands for?
Post traumatic stress disorder
Sorry, Doc. You clearly do not know how to speak to patients who come to you with a traumatic past. They often can do none of the curiosity, the collaboration, and the self-care that you advocate. This is why you see such paradoxical responses from them regarding post-surgical care. I will assure you that Bach Flower Remedy won't address rape at 8. Just saying.
I respect your perspective. However, I respectfully disagree that these options are not available to all patients. PTSD covers a diverse group of patients, and you are right that these tools are not available to many. However, in many health systems, and in many patients' experiences, these resources can be cultivated and empowered
I would've loved this guy as my anaesthetist. I had two, one was a registrar I think and one the consultant and between them they couldn't work out what anaesthetic I should have and neither told me the risks, only that they'd tell me in theatre, I guess they forgot
A lot of empty talking. 30 minutes of time wasted. Medical community doesnt care about you, dont kid yourself.