Stay engaged as you wait for elective surgery

The list of things people want to do once the stay-at-home orders are relaxed is constantly growing. For some, this list might include scheduling an elective procedure that was postponed due to the COVID-19 pandemic. A Baylor College of Medicine orthopedic surgeon and bariatric surgeon offer some tips to maintain good health while you wait for your procedure to occur.

Orthopedic surgery

“It’s the same advice we would give patients while they’re waiting for surgery at any time, which is to try not to aggravate the condition,” said Dr. Bruce Moseley, an orthopedic surgeon in the Joseph Barnhart Department of Orthopedic Surgery at Baylor College of Medicine.

How to avoid doing that depends on the condition and what type of surgery is going to take place, Moseley said. For example, if the surgery is for an ACL injury, the advice would be avoid playing sports, but riding an exercise bike or walking for exercise would still be allowed. For someone with an arthritic knee who is waiting on a knee replacement procedure in order to be more active, exercising in a pool or on a stationary bike might be the best options.

No matter the type of orthopedic procedure, Moseley advises that patients try to maintain a healthy diet and lifestyle while they wait for their surgery.

“While you are waiting for elective surgery is not the time to go on a strict diet or start an extensive new exercise program, but you can still maintain your normal fitness level,” he said.

Moseley said that he is able to conduct video visits for the majority of his patients, but is still able to see patients in person for follow-up care post-surgery or for a serious injury, such as a broken arm. He also has been able to take on new patients and do a video visit before deciding if the patient needs to come in person for an appointment. Tests and prescriptions also can be ordered following a virtual visit.

In emergency situations where a patient’s injuries would negatively impact their health, Moseley said that orthopedic surgeons still are allowed to operate.

Because most of the procedures that orthopedic surgeons perform are to try to relieve pain, management of the pain while waiting for surgery is important. For this, Moseley recommends the RICE (rest, ice, compression, elevation) method and can guide patients on taking non-narcotic pain medications, such as acetaminophen.

Many post-op patients also can be seen via video visits and surgeons can visually inspect them to see how they are progressing. However, for patients who could potentially have a lack of progress or a complication without an in-person visit, Moseley said that he still sees them in person.

Bariatric surgery

“We want our patients to remain engaged right now and follow the same types of healthy habits they were working on and developing before the onset of COVID,” said Dr. S. Julie-Ann Lloyd, assistant professor in the Michael E. DeBakey Department of Surgery at Baylor.

She advises her patients to avoid the traps of snacking too much or being inactive because they are at home.

Because grocery supply may be limited, she suggests that patients plan ahead of time to think about the types of healthy meals they want to prepare. She said patients should continue to follow all of the guidelines they have learned through their nutrition visits.

If patients do visit the grocery store or go outside for a daily walk, she recommends that they follow the CDC guidelines of social distancing and wearing face masks. Patients who are not able to go outside should try to move around as much as possible. Lloyd suggests taking a break to walk around every hour. She also suggested that patients look into various programs and gyms that are offering free online classes right now.

Lloyd said that their clinic is offering telehealth visits for all levels of support that patients might need through this process.

For post-op patients, Lloyd is able to check in via video visits to ask how they are doing with their diet, weight and activity levels. She said that she asks post-op patients who have scales at home to weigh themselves about once a week to continue to track their progress.

Fluid, protein and vitamin intake are extremely important for patients recovering from bariatric surgery, Lloyd said. Post-op patients should be drinking at least 64 ounces of fluid per day so that they do not get dehydrated. It’s also critical that they continuously hydrate throughout the day – their stomach cannot accommodate just drinking a glass of water after several hours of being outdoors. Patients also should be getting at least 60 grams of protein a day so that they do not lose muscle mass after their procedure.

If a post-op patient experiences symptoms such as high fever, difficulty with keeping foods or drinks down (nausea, vomiting, persistent diarrhea), abdominal pain, pain in legs that might suggest blood clot, difficulty breathing or any other unusual significant symptoms, they should contact their bariatric surgeon immediately.

“We’re learning that obesity may be one of the biggest risk factors for poor outcomes from COVID-19, so our patient population is particularly vulnerable. Patients with obesity often have other weight-related comorbidities such as diabetes and high blood pressure, which also put them at risk for developing severe disease from the virus,” Lloyd said.

For patients interested in having bariatric surgery, Lloyd said that her team is still conducting regular online seminars and is offering virtual Q&A sessions. Support groups also are now available online.   

She said they are able to see some patients in clinic on a selected basis and if there is a true emergency, they would be able to take the patient to the hospital if needed.

For pre-op and post-op patients, Lloyd said to consider finding an accountability partner or keeping a log of their activity and food intake so they are aware of their habits and can change them, as needed. She also recommends staying in touch with family and friends, while following social distancing guidelines, to avoid feelings of isolation.

“We really need to continue our healthy coping mechanisms as much as possible during this challenging time,” she said.