Surgery – The AIP Way, Part I

I’ve had four abdominal surgeries in my lifetime. One emergency Caesar section and three laparoscopic surgeries to diagnose and treat endometriosis. Of my four surgeries, two were performed since I adopted the Autoimmune Protocol as my primary autoimmune disease management tool. Being able to compare the first two surgeries, to the last two surgeries, noting positive differences in my research, preparation, and recovery, has inspired me to write a small blog series about “AIP surgery” for all of you.

While not every autoimmune disease is aggressive enough to require surgical intervention, some are. For instance Crohn’s disease, among others, can be this serious. Even outside of our autoimmune diseases, the possibility of surgery for minor and major reasons is something many of us will need to navigate at some point in our lives. I felt having some practical guidance on this could benefit the community. Part I of this series will focus on the research and pre-surgery preparation process (be aware that all my guidance here is based on a planned procedure).

Let’s begin with the research process. I find that there are three broad categories of research you’ll need to conduct if a planned surgery is in your future:

1. Making the decision to have surgery
2. Learning about the procedure
3. Learning about costs and healthcare coverage

When making your decision to have surgery, here are the areas to investigate:

• Guidance from your primary care provider, specialist, and surgeon
  • While your primary care provider may not have expertise in the specific medical issue or surgery, they likely know you well and can discuss the procedure with that in mind.
• A second opinion from another qualified surgeon
• Timing
  • Is it possible to delay or better to act quickly?
• Discussing implications with family members and/or support network
  • It’s important to consider how this will impact them and clarify what support you will need.

When learning about the procedure, here are the areas to investigate:

• Surgeon selection
  • You will want to discuss their skill level. Questions to ask are:
    • What is your training and background?
    • How often do you perform the procedure?
    • What are your success rates in treating this issue?
    • What is your experience with very complex or chronic cases?
  • You will also want to evaluate their bedside manner, ask about the follow-up care they give, assess how busy their schedule is, and whether should you travel for greater expertise.
• Risks/benefits
• Basic understanding of the techniques used
  • Your surgeon should be able to communicate clearly in lay-person terms how the surgery will be performed.
• In or out-patient
  • Is this procedure relatively simple or will you require a hospital stay as part of recovery?
• Average length of hospital stay for in-patient
  • This is important for your own planning on many levels.
• What is considered a full recovery and average time frame to reach it
  • It’s important to understand what your surgeon will consider a full recovery and what kind of milestones are involved in reaching recovery.

When learning about costs and healthcare coverage, here are the areas to investigate:

• Average total costs for the procedure
  • It’s often difficult to get hard numbers in our healthcare system, but try to get estimates on the surgeon, anesthesia, operating room, pathology, and hospital stay costs. This can be an anxiety-producing exercise, but in the long-run having a grasp on financial matters pertaining to your surgery will ease stress.
• Health insurance coverage
  • Let’s be honest, the often purposely inconsistent nature of the health insurance system makes it very complex to navigate, but you will want to do your best to understand your coverage for major medical expenses, like surgery. You will want to ask the following questions of your insurance company:
    • Is prior-authorization required?
    • Are the surgeon, anesthesiologist, laboratories, and hospital in or out-of-network? If out-of-network, how is coverage handled?
    • Are there any aspects of the procedure that may not be covered?
• Reduced prices or payment plans
  • Ask the providers involved about reduced prices or payment plans for any charges not covered after insurance or if you are a “cash” patient.
• Explore leave from work, if necessary
  • Your employer might have short term and long term disability policies, which are paid or unpaid. If you will need that recovery time, make sure you understand what the policies cover and what you need to do to qualify.
• Possible travel expenses
  • In some cases, traveling for expert care is the right decision. You’ll want to explore travel costs, like airfare or fuel, lodging, and food, and create a budget for those expenses. Be sure to keep track of them too, because they may be tax-deductible.

Let’s move to the pre-surgery preparation process.

In general, there are four broad categories of preparation that most will tackle when facing surgery:

1. Nourishing the body
2. Arranging support
3. Planning with the medical team
4. Preparing for the procedure

When it comes to nourishing your body to be in the best possible shape for surgery itself and to aid recovery later, these are the steps to consider:

• Return to elimination phase of AIP for a few weeks to 30 days prior (depending on level of invasiveness)
  • If you are still in elimination phase, this is an unnecessary step, but either way give significant focus to nutrient-density. You will be helping to bring inflammation down and load your body with the vitamins and minerals necessary for major wound healing.
• Add targeted supplements 30-90 days prior to procedure
  • Supplements to consider are those that aid wound healing, decrease inflammation, and/or support detoxification. However, do not take this step without discussing it in detail with your medical team, since some supplements are contradicted prior to surgery (for instance, if they decrease clotting ability, etc.)
• Adjust your schedule a few weeks to 30 days prior to allow maximum time for rest
  • It is very tempting to work like crazy right up until a surgery in anticipation of the time off following, but resting as much as you can will help your body be in an ideal state for quick healing, rather than already depleted going in.
• Begin working on mindset and stress management a few weeks to 30 days prior
  • Try things like positive visualization for successful outcomes, prayer, meditation, etc. Again, the idea is to go into the surgery in an ideal state to support quick healing. If you are working from an already depleted state, you will take longer to recover.
• Incorporate gentle movement into your pre-surgery routine
  • Again, you don’t want to tax your body ahead of time, but having some gentle routines in place is especially important since you may be somewhat restricted temporarily following the procedure.
• Prepare and freeze AIP meals or ask others to help you with AIP food during recovery
  • Having a plan in place for post-surgery food will reduce a lot of anxiety and allow you to focus on rest.

Next, you’ll be arranging support for yourself. Surgery is not a small undertaking, having help in place is necessary. You’ll want to consider these steps:

• Arrange for recovery time and support roles
  • This seems obvious, but can get overlooked. Be sure that you’ve scheduled enough time off and addressed any responsibilities at work, so you won’t need to think about it while you are out. Also, try to anticipate what you’ll need help with and arrange ahead of time with your family and extended support network to have specific people filling those roles.
• Add a counselor, health coach, or other complementary care person to your team
  • Especially if you are feeling very overwhelmed about surgery preparation or extremely anxious or upset about the procedure itself, it can be helpful to have professionals to bolster you.
• Assess gaps in your support
  • Once you’ve arranged most of the support necessary, re-evaluate to be sure you don’t have any gaps in both practical and emotional support. Again, surgery is not a small undertaking, the right help and care around you is vital. If there are any unmet needs, reach out for help.

As surgery gets closer, you will want to do some detailed planning with your medical team. You’ll want to consider these steps:

• Discuss any concerns, questions, or requests you have
  • You might want to discuss any conditions that may affect procedure outcomes (like clotting issues) or make requests on how things will be handled once you are under anesthesia. For instance, I asked that my surgeons discuss with my husband beforehand if they feel an organ should be removed (it is not uncommon for endometriosis to irreparably damage ovaries, fallopian tubes, the appendix, etc.).
• Discuss your dietary plan during recovery
  • If you can follow an AIP template post-surgery, that is ideal, but it is not what will be offered in the hospital. You will need to plan to bring in your own food and it is important that it progresses as your surgeon requires. For instance, they may have milestones for progressing to solid foods or wish for you to avoid certain foods.
• Discuss how pain management will be handled post-surgery
  • Ask your doctors to explain the risks and benefits of the drugs they will be giving you to manage pain. If you’d prefer alternatives, ask about those options, but (and I cannot emphasize this enough) DO NOT be a martyr. Pain management is critical to a smooth recovery and a little planning can help you and your doctors approach it thoughtfully.
• Get an advanced care directive and will in place
  • This sounds a bit scary, but this is a very wise step. All surgeries carry some risk and having these documents in place could dramatically decrease suffering for your loved ones should a worst-case scenario arise.

Finally, in the last 48 hours or so before surgery you’ll start preparing for the procedure. You’ll want to consider these steps:

• Navigate bowel prep
  • If bowel prep (completely cleaning the intestines of stool to minimize risks) is required, ask about alternatives where possible for the formula. Sometimes more gentle options might be possible, however, don’t underestimate the importance of this process. If you must take harsh medications to cleanse the GI tract, the benefits outweigh the risks here! Keep in mind that you can replace things like Gatorade (encouraged for electrolyte replacement) with coconut water, broth, ginger tea with collagen, and other AIP-friendly options.
• Hospital bag and storage
  • Decide on what you’ll be taking to the hospital with you, pre-pack, and arrange for storage of valuables with staff or family members.
• Transportation and after-care
  • If this is an out-patient procedure, make sure you have transportation to and from arranged and that you and a caretaker understand after-care.

Surgery can be scary and overwhelming, but hopefully this guide helps you feel more targeted about making the decision and getting ready. I have found over my many surgeries, that the more research and careful preparation I do, the less anxious I am and the better my healing on the other side. Continue reading Part II on surgery recovery!