Functional Forum Podcast: For Doctors, Surgeons and Hospitals

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Functional Forum Podcast: For Doctors, Surgeons and Hospitals

In this podcast, Functional Forum founder, James Maskell, talks with the co-founders of Ready Set Recover to explore how surgery patients and their friends & family, doctors, hospitals, and employers can participate in the process of surgery to make recovery as easy as possible. He asks how this action-oriented online program helps surgical patients take positive steps throughout the surgical and recovery process.

He further dives into why is this program so special for doctors, surgeons and hospitals. How when you have patients that are preparing for surgery, that this is something that you can curate for your community without having to do all the work yourself. 

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5 Ways to Improve Sleep Before Surgery

If you’re tired, everything in life is more difficult and overwhelming. Making sleep a priority will help you improve your sleep and stay positive before your surgery. Here are 5 ways to improve your sleep:

1. Establish an evening routine. When we were children we all had bedtime routines. It’s as essential for us as adults. Our bodies need a transition period that allows us to wind down. Without this transition, we’re not only still in the mode of doing, it’s also difficult to notice we feel tired. An optimal evening routine starts around the same time each night and promotes the relaxation response, rather than than taking us into stressful or excited state which is counter to falling asleep. A hot bath or shower cleanses any remnants of the day, as well as relaxing the body. A few drops of lavender essential oil in the bath or on the shower floor also adds to the restorative experience. Reading a physical book, rather than scrolling through social media or reading on a tablet helps the body prepare for sleep. If you’re used to watching TV in bed, know that this habit is interfering with sleep patterns, even if you regularly fall asleep with the TV on. If your room is very dark and on the cool side, it will be easier to fall asleep.  

2.  Minimize caffeine intake. Improving sleep before surgery means minimizing or eliminating stimulants such as caffeine. Although you might already think twice before drinking a cup of coffee after dinner, caffeinated beverages consumed even in the morning remain in your bloodstream and can affect the quality of your sleep as long as 12-18 hours later. Coffee (even decaffeinated), tea, chocolate, energy drinks and sodas all contain caffeine. If you enjoy hot beverages, consider substitutes like organic herbal tea, organic coffee substitutes like Ayurvedic Roast or Teeccino or hot water with a squeeze of lemon. Infuse cool drinks with fruits like cucumber, lemons, limes, and strawberries, and herbs like mint for wonderful flavored water without the artificial ingredients.

3. Focus on enjoyable activities in the evening that don’t involve technology. Many of us are so accustomed to our devices at all times that we sometimes forget we’re even using them. Improve your sleep before surgery by filling the evening with other enjoyable activities. Along with others or by yourself, practice an instrument, do a craft like knitting or sewing, or play a board game or cards. Take a walk after dinner, and focus on your surroundings. An expansive view of the outside world, rather than looking at a device, is a reminder of the big picture. Even if you live in a city, notice the sky, the changing light, and if possible watch the sunset. This practice sends your body the message that the day is complete, and in the approaching darkness, it’s time to prepare for sleep. And when it’s time for bed, keep a technology free bedroom to remove distractions.

4. Add relaxing breathing techniques. The breath is a powerful tool to improve your sleep and help your body move into the relaxation response, or parasympathetic mode. Simply extend the exhale so it is longer than the inhale to help your body to relax. First, count your breath for a minute or two without changing anything. Then, balance the inhale and exhale for 2 counts each. Repeat for a several rounds. Then start to lengthen the exhale, first to 3 counts, so you’re inhaling for 2 counts and exhaling for 3 counts. If you’re comfortable with this 2:3 rhythm, extend the exhale to four counts so it is twice as long as the inhale (2:4). Place your hands on your body and feel the breath move your belly away from your spine. Set a reminder to do this breath practice regularly before your surgery.

5. During your evening routine, limit the time that you’re thinking about the upcoming surgery. There maybe “what ifs” surrounding surgery that are out of your control. What you can affect is your mindset and your response. If you find yourself ruminating about the surgery before bed, acknowledge this is happening. Give yourself a short, prescribed amount of time, such as five or ten minutes to finish the thoughts. Set your alarm clock for those minutes and when it goes off, that will be your time to stop thinking about your surgery. Tell yourself you are done and it’s time to think of something else. Remember, most, if not all things in life are out of our ultimate control. But we can choose to shift our thoughts. It takes practice, so begin by noticing how often you’re thinking about your upcoming surgery, and when it creates angst, choose to think of something pleasant instead, even for a moment. And if find yourself still lost in your thoughts, stand up and move. By shifting your physical body, you also will also shift what you’re thinking about even for just one moment at a time.

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5 Ways to Stay Positive While Preparing for Your Surgery

  1. Acknowledge this is a difficult time. Recognize that your upcoming surgery is causing a disruption in your regular day to day lifestyle. Your schedule must be changed, there will be everyday things you cannot do for a while, even weeks or months, and you and those around you will need to adapt. Carefully preparing for the time period right after surgery will help your life tremendously. Discuss the situation with those family and friends living close to you so everyone is aware of the situation and time frame, and can make adaptations in their own schedules to make themselves available if need be.
  2. Make a theme for your surgery. Find a positive quote or saying, and if you don’t have one, google some ideas. Print and post in places where you will see it regularly, such as the kitchen, the bathroom, and computer. Take a picture and make it a background on your phone, so the theme becomes a constant reminder. You will repeat this positive saying aloud and to yourself whenever feelings of uncertainty or anxiety arise.

  3. Make sleep a priority. If you’re tired, everything in life becomes more difficult and overwhelming. Not sleeping enough increases feelings of anxiety and irritability, and you’re more likely to be overwhelmed by the prospect of your surgery. Find the extra time for sleep in the evening, and establish a routine where you have a set time to get prepared for bed. Begin to wind down rather than doing “just one more thing”. Read an actual book or magazine rather than on your phone or electronic device to avoid the blue light which disrupts the body’s natural circadian rhythms. You want to be in the best possible condition for your surgery and sleep will get you there.

  4. Surround yourself with positive information. Most of us don’t realize we’re constantly bombarded with negative information through news and social media. Consciously surround yourself with positive messages and inspirational stories. Whether you choose to read or listen to podcasts or audiobooks, your mind and body absorbs every image and word. Ensure most if not all of the information coming in during the days and weeks prior to surgery is positive and hopeful, rather than those which generate fear and upsetting feelings.  Notice if friends and family tend to focus on the negative news and see the cup as half empty. If so, gently ask them to to change the subject for this period of time around your surgery. Focus on the positive and your healing journey ahead.

  5. Enjoy the little things. There’s nothing like a major event, including surgery, to shift one’s mindset. Living in the moment and appreciating small everyday events adds to our happiness and sense of well being. Breathe deeply and nourish yourself in the moment. Get outside and consider the beauty of the natural world that surrounds you. Acknowledge your loved ones, and listen to their voices. Enjoy and savor your food. Wear your favorite special outfits and enjoy your fancy dinner and glassware even if it’s an ordinary day. Now is the time! When we live in the moment more fully we experience the positive in our lives.

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Change Your Internal Clock by 3/13

Sleep is vital to our health and well being, not only when recovering from surgery. Losing a full hour when Daylight Saving Time begins Sunday March 13 at 2AM can be disruptive as even one night of poor sleep can effect our mental and physical health

Spring forward is great news as it extends daylight into the evening hours. However, at least for the next few weeks, it will still be darker in the morning. This time change, like flying to a different time zone, can wreak havoc on our body's internal clock, leading to mental and physical fatigue. Curious about the history of daylight saving time? Click here for some fun facts. 

Here's a simple way to help manage the artificial change of time when "losing" an hour. We can avoid the fatigue and depletion from losing the hour with some simple shifts. These practices also apply when traveling through different time zones.

This method will help you avoid fatigue early next week:  

  • Head to bed ten to fifteen minutes earlier than usual, starting tonight. Each night this week, go to sleep an additional ten minutes earlier. 
  • Arise in the morning ten to fifteen minutes earlier than usual, pushing the time back ten minutes more each day.

If you continue to go to sleep at the same time and just wake up earlier, this technique won't be as effective. Following these steps, by Sunday, you'll have reset your internal clock by about an hour (6 nights of 10 minutes = 1 hour total), and the transition to Daylight Saving Time will be easier. You'll be less likely to depend on caffeine and sugar to feel awake and alert next Monday morning.

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3 Tips to Prepare for Surgery

You learn that you need to have surgery. Uncertainty and fear may arise, and you may feel as though the situation is completely out of your control. Experiencing these thoughts and feelings is common. By beginning to take simple steps at this crucial time, the entire surgery experience will be smoother, simpler and less overwhelming.

Whatever type of surgery your doctor has recommended, during the days and weeks leading up to your surgery, you can take care of yourself and establish healthier lifestyle habits. 

3 Tips to Prepare for Surgery

  1. Put a positive spin on how you talk about your surgery. How you think about surgery will affect your recovery, so consider the story you are telling yourself. Putting a positive spin on your surgery story will change the biochemistry of your body.

  2. Relax. But how, you ask? It could be a formal meditation practice, but doesn’t have to be. Simply watch your breathing as it moves in and out of your body with your hands resting on your lower belly. Inhale the word “healing” and exhale the word “acceptance” as you breathe in and out through your nose.

  3. Add more whole foods to your meals. By adding healthier foods, there will be less room for you to eat heavier, highly processed foods which inhibit your body’s ability to heal. If you’ve found this step difficult in the past, you’re in a unique situation. Knowing your surgery is coming up gives you the perfect opportunity to make a change and that it will ease your recovery when your body is functioning more optimally.

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Sleep is Critical for Recovery. Want Sleep? Turn Off the Screens (Sleep Tip 3)

Sleep Tip Three: Turn off all screens at least an hour before bed, including TV, computer, smartphone and tablets.

Honestly, of all the tips to get a better night’s sleep, this is the most challenging for me. Yet often the hardest habits to break yield the greatest results. There is clear evidence that A) not only are screens disruptive to our biological sleep patterns, but B) they stimulate brain activity, which interferes with our ability to notice when we’re actually tired (see tip 2).

When we get busy on the computer in the evening, we don’t experience the winding down after sunset which we WOULD feel in a natural environment. In The New Yorker, Maria Konnikova writes that after a week long camping trip…“Not only did the time outside, in the absence of artificial light and alarm clocks, make it easier for people to fall asleep, it made it easier for them to wake up”.

With too much mental stimulation in the evening, the brain gets “fired up.” In addition, once in bed, make the room as DARK as possible, covering up any lights, especially those from a clock or phone. For those of you with kids, read this interesting post by a mother of five who doesn’t use night lights, because they are shown to interfere with deep sleep.

The importance of sleep cannot be over emphasized, especially when recovering from surgery. With all that your body is doing to try to get back to better, turning off screens is one small thing you can control to help it focus on what is important to your healing. So remember - turn it all off way before you want to go to sleep. Give your brain the wind down time it needs and deserves.

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Are You Tired? Can You Tell? (Sleep Tip 2)

I've written about one of the best ways to improve your sleep, which starts with eating an earlier, lighter dinner. The second sleep tip is to notice WHEN ARE YOU TIRED IN THE EVENING? This might sound ridiculously obvious, but in fact, there are a number of habitual reasons that we don’t notice when we’re tired at night. Number one is relying on stimulants like sugar and caffeine in the morning and throughout the day in order to fight feelings of fatigue. It’s a vicious cycle; due to not getting enough quantity or quality sleep, we’re tired, and then use sugar and/or caffeine, two factors which give us a false increase in energy, interfering with our ability to notice when we’re tired at night.

Maybe you remember a time when you were a kid (or more recently!), and were so tired you literally couldn’t keep your eyes open any longer. When I was about six I fell fast asleep right at the dinner table in a fine restaurant. (Although I don’t remember at all, my parents are still talking about the incident). As adults, our bodies are really not that different, but if we habitually depend on sugar and caffeine, especially in the afternoon or after a typically late dinner, we might not feel the depth of our fatigue. When eating a late dinner, which was covered in Sleep Tip #1, we’re often simply too full to go to sleep, and watch TV, get on the computer or start cleaning. In turn, that stimulates the brain and the nervous system, and we no longer FEEL tired. Have you ever fallen asleep with the TV on? Were you on the couch or in bed? Basically either way, there’s no doubt that you WERE TIRED!

When we eat an earlier, lighter dinner, skip any habitual alcohol, caffeine and sugar, and really listen to our body's cues, we notice there’s a natural winding down in the evening. There are many physical, emotional and mental signs your body needs sleep. Any yawning, “tired eyes”, lethargy or aches in the lower extremities. 

So especially during this time when your body needs to recover, look for the signs that it is time to sleep rather than taking on one more thing to do before going to bed. Small changes, like having an earlier, lighter dinner, and listening to your body when it's tired, will not only make you feel better in the short term, but help your overall recovery as well. And when you are back to better, EVERYTHING in your life will seems better. 

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If it All Starts with a Good Night's Sleep, How Do I Get One?

Sleep is essential to our health. The Center for Disease Control reports that "Insufficient Sleep is A Public Health Epidemic" and contributes to chronic diseases like hypertension, depression, diabetes and obesity. The stakes of poor sleep are huge. Especially when preparing for or recovering from surgery. Dr. David Schulman, the Medical directory of the Emory Clinic Sleep labs says, "If you're chronically sleep deprived, you can't tell when you're sleepy. You lose the ability to detect how tired you are." In another study reported in the New York Times, Maggie Jones writes, "In other words, the sleep-deprived among us are lousy judges of our own sleep needs. We are not nearly as sharp as we think we are." As if that's not enough, people most likely overestimate how much they sleep, as they tend to report the time spent in bed, not time actually spent asleep. Carving out enough time to sleep is important, but what can you do to optimize your sleep?

Number One: Eat an Earlier, Lighter Dinner

We must take a series of actions that starts well before we get into bed to promote a good night's sleep. For most of us, our largest meal is in the evening, at the end of the day. It's cultural, it's habitual, and based on the fact that we're all busy during the day. Dinner has also become often the only time to connect with friends and family.

BY (Before Yoga), when I worked in corporate America, 3-4 nights a week I'd get to the gym at 6pm, and THEN go meet up at a restaurant around 8pm. By the time I was actually eating it was even 8:30 or 9pm. I'd get home and it was at least 11pm before getting to bed, before an alarm would awaken me around 6am. That's fine, you might think, of seven hours of sleep. It could be on the low end of quantity needed for some, but it's not only the hours we spend asleep, it's also WHAT TIME that sleep takes place, that effects the quality of sleep. So in the example above there are less than two hours to digest a big, heavy meal (about two courses plus a shared dessert). But to digest a meal of this size, our bodies need at least three to four hours.

Eating too late may actually make us feel more awake, when our body is really ready to go to sleep. Eating sugar or drinking caffeinated beverages at ANY time during the day may cause us to miss our body's signals that it's tired. So although we feel may feel awake, at a much deeper level, our bodies are TIRED. Then, when we do go to sleep with a full stomach, a few things happen. Being upright after eating allows the digestive system to move in the right direction, which is downwards, therefore lying down interferes with optimal digestion, not to mention it's uncomfortable. Number two, our body does not have the chance to do the deeper work of rest and repair that should be taking place while we sleep, (especially between the hours of 10pm and 2am), because it's too busy digesting the late dinner. 

By becoming more aware about day-to-day ways you can set yourself up to succeed. So ask yourself, how do you feel in the morning after eating a big meal just a couple of hours before bed. How long does it take to fall asleep? Do you awaken in the middle of the night, or stay asleep? How do you feel in the morning, including your joints, your mood and digestion?  

The next time you know you'll be home for the entire evening, try an experiment. Have your main meal, like a regular dinner, at lunchtime. In the evening, as early as possible, have a big bowl of soup. You might notice you're less hungry for a large meal in the evening when your appetite has been satisfied by a bigger lunch. After the lighter dinner, notice the quality of your sleep, how your energy is the following morning and throughout the day.

Making a series of small changes makes a big difference in your health and well being, so begin by eating larger lunches and smaller dinners just once or twice a week. As often as you can on other nights, eat dinner just 15 minutes earlier. And consider socializing in other ways than around meals. These days, I'm more likely to meet friends for a walk in the park with our dogs, or take a yoga class together, rather than just meeting for dinner. After all, it's really about the company, not just the food.

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