Posts Tagged ‘Pain Control’

Preparing Estelle for Surgery by Rubin Battino, M.S. Yellow Springs, Ohio Estimated reading time: 7 minutes, 21 seconds.

Estelle is a friend who at age 75 was diagnosed with breast cancer. She knew that I had done volunteer work with people who have life­ threatening diseases. The first session was devoted to going over the kinds of things I do to help people. For instance, teaching them how to relax and meditate, guided imagery for healing, and asking direct questions about living wills and medical treatment. Considering the information Estelle provided, I prepared two 15- minute guided imagery tapes for her. I used the first session to elicit information about past surgical experiences and any fears Estelle had about the upcoming surgery. I told her about research which indicated that while under anesthesia patients can hear what is said in the operating room. Using the information she gave to me I led her through a hypnotic session centered on preparation for surgery.

Typically, the hypnotic session is divided into four parts: (1) relax­ation/induction, (2) pre-op sugges­tions (e.g., knowing when to go to her safe haven within her mind), (3) sug­gestions that incorporate statements given to the surgeon to say during the operation, and (4) post-op sugges­tions for comfortable and rapid heal­ing. Each suggestion is designed to function during the post-hypnotic surgery experience. A certain amount of dissociation and time distortion are built into the process (e.g., how sur­prisingly fast the entire experience will occur).

At the second session she told me her surgical lumpectomy and nodal dissection were scheduled for two weeks hence.

At the third session Estelle was given a 30-minute tape to prepare her for surgery. The same information was recorded on both sides. We talked about the upcoming surgery and related matters. We completed a hypnotic session similar to the one on the tape. I also gave Estelle copies of a letter I had written to her surgeon. Estelle was to decide the most appro­priate time to give the letter to her surgeon.

The letter was in two parts. The first part gave information relating to my work with Estelle and additional background about my qualification. The second part follows:

”There is a great deal of evidence that patients, even under the surgical plane of anesthesia, can hear things that are said in the OR. It is felt that if the surgeon (or an assistant known to the patient) makes encouraging and healing comments directly to the patient during the surgery, that this has a beneficial effect on outcomes and recovery. This has been both my personal experience and that of a number of people I have advised. To this end, you will find enclosed a brief set of directions and some sim­ple statements that we hope you will be willing to say to Estelle at appro­priate times during the surgery. These statements need to be made only a few times, and should always be pref­aced by using Estelle’s name so that she knows the message is directed to her; and ended with a “Thank you,” so that she knows the message is over. Estelle has an audiotape to lis­ten to in advance of the surgery. The statements are: 1) Estelle, please slow down (or stop) the bleeding where I am working. Thank you. 2) Estelle, please relax your muscles in this area. Thank you. 3) Estelle, this is going very well. Thank you. 4) Estelle, you will heal surprisingly quickly. Thank you. 5) Estelle, you will be surprisingly comfortable and at ease after this. Thank you. 6) Estelle, your recovery will be very rapid. Thank you.”

This preparation procedure has worked well for my clients. One friend said that the hysterectomy she dreaded was “almost pleasant.” Estelle’s comments were, “I was sure this works for other people, but not for me. It was after the first medita­tion you led me through that I became convinced this stuff would work. I found the imagery tapes so wonderful and always fell into the deepest sleep. By the time I got the surgery tape I was ready for it, and listened to it every day for nine days. I was listen­ing to it for the three quarters of an hour when they were injecting the dye into me in the hospital. The tape worked – I was able to relax. I only felt nausea briefly afterwards. The anesthetist read the messages during my surgery. The head nurse was very impressed. I would recommend this highly and have told all of my friends…”

Discussion

by Susan A. Adams, M.Ed., NCC Doctoral Student in Counseling Texas A&M University

Stress and fear can be damaging to our bodies under normal circum­stances, but when a person is facing a battle with a life-threatening disease or surgery, it can further complicate the individual’s natural ability to heal. Spera and Lanto (1997) note, “stress not only contributes to health problems but is frequently caused by them. This isn’t surprising, of course, if the health problem in question is serious” (p. 31). Although we readily recognize stress and its subsequent effects on daily living, the level of stress may be raised significantly when radical surgery becomes neces­sary.

Estelle, an older woman diag­nosed with breast cancer, sought the assistance of Rubin Battino to prepare for her upcoming surgery. She was familiar with his work and felt it would be a beneficial element for success in her anticipated appoint­ment with the surgeon’s knife. After completing three sessions, Estelle was armed with three tapes and a let­ter for her doctor containing six state­ments to be read during surgery.

Each of those sessions served a specific purpose and had a definitive goal. The first concentrated on the methods of relaxation through medi­tation and using guided imagery to facilitate the healing process. Battino prepared two 15-minute tapes for this purpose.

Sessions Two and Three, which were preparatory for surgery, were focused on different aspects of the surgery process. The second session was used for Battino to discover and explore Estelle’s previous experi­ences with surgery and any fears she might have about the anticipated breast cancer surgery. This session’s agenda also included a hypnotic ele­ment. Hypnosis, according to Woolfolk and Richardson (1978) is defined as an “altered state of con­sciousness that results from focusing awareness on a set of suggestions and allowing oneself to be receptive to those suggestions – all while allow­ing free rein to one’s powers of imag­ination” (p. 157). Battino divided the hypnotic experience into four parts: (1) relaxation induction; (2) pre-op suggestions; (3) operation suggestions; and (4) post-op suggestions to impact the patient’s recovery and healing. Included in this hypnotic ses­sion were dissociation and time dis­tortion elements suggesting that the healing experience would be surpris­ingly rapid.

By including these suggested activities, the patient is empowered to focus on things she had some control over – her own state of relaxation. It can be difficult to venture into unfa­miliar territory and recognize there are so many elements beyond the control of the individual. However, these activities were designed to sug­gest some degree of control over her impending situation. Two of the suggestions Spera and Lanto (1997) offer to assist individuals in coping effec­tively with stress are “put your thoughts and feelings into words,” and “use mental rehearsal to pave the way for success” (p. 146). These are methods incorporated in this case.

In addition, Battino indicated that patients can hear what is being said while they are under anesthesia, so he prepared a letter for her doctor. This letter contained six specific statements, which were included in the case report, to be read while the surgery was being performed. The doctor was instructed to begin each of the statements with Estelle’s name and conclude with “thank you.” This was to indicate the statement was addressed to her and now that mes­sage was ended.

Estelle  admitted  skepticism ini­tially, but after experiencing the relaxation  from  the  first  imagery tapes, she became convinced of their effectiveness. As preparation for the surgery, she utilized the surgery tape for nine days and then again for three quarters of an hour when the dye was being injected prior to the actual surgery. This was effective in inducing relaxation, and the patient indicated only brief  nausea  afterward.  The  statements  were read during the surgery by the anesthetist. Estelle felt it was successful and would recommend it to others .

Although Battino did not address the post-op healing process in his case report, be did  provide  clues  throughout the article about the receptiveness of the patient and  the impact the various tapes and imagery techniques bad on her mental state prior to and during surgery. These activities provided some degree of  participation  on  Estelle’s  part toward her healing, and this empowerment appeared to have a positive mental impact.

References:

Spera, S. & Lanto, S. (1997). Beat stress with Strength a Survival Guide for Work and Life. Indianapolis, Ind.: Park Avenue Productions.

Woolfolk, R. L. & Richardson, F. C. (1978). Stress, Sanity, & Survival. New York: Sovereign Books.