Polio Place

Mickie McGraw, Ventilator-Assisted Living, Volume 29, Number 4

Over the past ten years, I have faced several surgeries including gall bladder removal, a mastectomy and kidney stone removal. As a person with significant respiratory weakness resulting from polio, I often found I had more concerns about complications related to my breathing than most other aspects of the surgeries. I contracted polio in 1953 and have used some sort of nocturnal ventilation from the outset - I currently use a PLV-100 positive pressure ventilator with an Oracle face mask to sleep.

However, with each surgery I gained experience in how to better prepare for the procedure and how to handle my breathing issues related to anesthesia and various other aspects of the surgeries. Following are a few of the things that I have done to minimize complications and maximize my recovery, which I hope will be helpful to others going through similar situations:

INFORM YOURSELF - Talk to your personal physician and the surgeon. Honestly discuss your concerns and questions regarding the procedure. Reach out to friends and peers with similar physical problems, who can offer advice based on their personal experience. Contact post-polio experts and your peers through resources such as Post-Polio Health International and IVUN.

Read the current literature on anesthesia risks for post-polio patients, such as the one by Dr. Selma Harrison Calmes, titled "Anesthesia Update: Separating Fact from Fear,” which I found extremely informative. The information gained through all of these sources will help you organize your thoughts and questions. I know from personal experience it helped me a great deal!

INFORM YOUR SURGICAL TEAM - Prepare an "info packet" for your surgeon and anesthetist, which includes your post-polio medical history, your respiratory equipment settings, your questions regarding your upcoming surgery and relevant articles on surgical procedures for persons with respiratory issues. Take this packet to your pre-op appointment and on the day of your surgery, to be used if needed.

You often do not get to meet the anesthetist who will be present at your surgery until the day of your operation, so this packet can be very helpful. Since I had all my surgeries at the same medical center, even though different anesthetists did each surgery, they were able to use the information from this packet and the protocols from my previous surgeries, which had become a part of my medical record there.

DEVELOP POSITIVE WORKING RELATIONSHIPS - On the day of your surgery, introduce your medical team to the person with you, who knows about your personal care and special needs and will answer questions for you when you can’t. Review the overall surgical plan, especially as it relates to the anesthetic and such things as positioning and transfer to the operating table and extubation after the operation. For instance, as a post-polio patient I have a greater sensitivity to muscle relaxants, so half the usual dose is recommended.

In my case, the anesthetist also used a faster acting anesthetic, so I was able to be awakened more quickly and was extubated in the operating room and put on my ventilator there. Each person's physical and anesthesia needs differ, but there is a great deal of information available to help you and your physician decide on the course that is best for you.

I hope these few suggestions are helpful to others facing surgery, which can understandably evoke real anxiety or fear. I found that, when I took some control and became a part of my own "medical team," I was treated with respect by the physicians involved and felt much more comfortable throughout each experience. The collaborative relationships I developed led to better communication overall and resulted in positive surgical outcomes.

Mickie McGraw, MA, BFA, ATR-BC, is an Art Therapy Consultant/Educator/Clinician who co-founded the Art Therapy Studio at MetroHealth, Cleveland, Ohio, in 1967.

http://polioplace.org/living-with-polio/anesthesia-update-separating-fac...