Today in clinic, the theme seemed to be pre-hab. I had a few patients that had been sent to me by my orthopaedic colleagues. I love these consultations. But because it’s on my mind, I’m re-sharing the story below:
Fádo fádo, when I was a newly qualified doc, one day on rounds, the consultant asked me to take a patient for a walk. I did not want to take a patient for a walk. Now, it’s not that I didn’t like the patient. if you know anything about hospital doctors, it is that these doctors have lists upon lists of never ending and urgent tasks. And unlike Grey’s Anatomy where there are only doctors to do every hospital task, Irish hospitals do have teams allied health professionals who are far more skilled than a doctor at mobilizing patients.
However, in the Bad Old Days, consultants might ask the youngest of their colleagues to take on any number of ridiculous tasks. Yes, it was bad as you are thinking. I had been requested to do everything from screening phone calls to washing a particular consultant’s mid-life crisis car (Note: I did not wash that car.)
So, back to the patient. I’ll call the patient John – though, as you might imagine, that’s not really his name. John had been in hospital for about a week, and we now knew that he needed Major Surgery. The Consultant was worried that John’s heart and lungs would not be able to cope with the anaesthesia. So, he told me to take John to the back stairs and go for a walk up a flight of stairs and see how’d he get on. (If you are wondering if there are better ways to assess this –yes, yes there are. Even then.)
So, later that morning I went back to the ward, and John and I went for a walk up the back stairs. Unlike the car incident, reluctance to find time to take a patient for a walk was not a hill I was prepared to die on during next evening rounds. So, what happened? I’ll be honest: John didn’t do so well at this. I was a bit worried now. John needed this Major Surgery, and if either consultant – surgeon and anaesthetist – weren’t happy that he was fit for it, would he get it? Then, like the car washing thing, the consultant forgot all about the whole taking-John-for-a-walk and never asked later that day.
Knowing that the Consultant was likely to remember this at some point on the twice-daily rounds, I decided that I’d give John another crack at this walking up the stairs thing. So, the next day, we did it twice more. And we did it every day for the days while John was in hospital. John started taking walks around the hospital by himself as well. Actually, a lot of walks. He was bored, and I had shown him my favourite spots to look out over the River Lee. As we came to the end of the second week, John was getting better at the stairs. Far less breathless and lower heart rate. We sent him home, and booked him to come back in for the Major Surgery in a few weeks time. John asked me as he got ready to go if he should keep walking at home. I told him it couldn’t hurt.
In a few weeks’ time, I saw John for in a pre-assessment clinic leading up to the Major Surgery. John had given it socks at home, apparently, according to his wife. The initial breathless walk up the stairs and prospect of upcoming surgery had frightened him. We checked his ECG and Chest Xray. We measured his resting heart rate and blood pressure. The heart rate at least looked better than it had when I’d first met John. The consultant anaesthetist was happy enough to proceed with John’s case, and a few days later John had the Major Surgery without major incident.
That was my first encounter – serendipitous as the situation was – with “pre-hab”. Prehabilitation wasn’t really a thing in those days as it is now. Prehabilitation is getting your body and mind ready for upcoming treatments for the best possible outcome. In the many years since I met John, I have learned much, much more about Prehabilitation, or Pre-hab. It is now a major part of my practice. Prehab has been shown to help patients leave hospital sooner after surgery, reduce side effects from treatment and reduce complications from surgery, cope better with the side effects of cancer treatment, have better outcomes, and give patients more options where possible
FAQs
Who can be assessed for Prehabilitation?
Anyone, really. Patients who have upcoming elective surgery or other treatments, such as chemotherapy.Patients who have been advised to lose weight or stop smoking before treatment or surgery. Ppatients who have been told they may need to consider surgery or a treatment in coming months are included in this.
When do I start Prehab?
The earlier the better. Patients who have at least 12 weeks will have the best outcome, however 2-4 weeks can make a difference for patients, especially for patients who need to stop smoking as part of their pre-hab.
Who is involved in my care?
It depends on the individual patient need. Patients may also need input from chartered physiotherapists, registered dietitians, or clinical psychology.
Do I need to be referred?
You can be referred, but many of my patients self-refer, especially if the recommendation was “try to lose some weight” before the surgery or the next appointment. However, if you self-refer, I will ask that we coordinate care with your hospital team.
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