It is possible to get fit again even after being knocked about by chemotherapy. Below is not rocket science but here are a few things you can do to prepare.
Eat nutritious, healthy food to build up strength and if you have lost weight during chemo, gaining a few pounds won’t do you any harm. My favourites at this time were homemade cottage and shepherd’s pies fortified with pureed veg, followed by homemade trifles that really hit the spot. I also indulged in Complan drinks, which are very calorific and full of vitamins, however I only really liked the strawberry and banana flavours. In the run up to surgery, be mindful that you will no longer be eating large portions so relish the food you are eating. As far as possible, make them your favourites all or most of the time (eg I loved chilli but spicy food burns a bit now) and eat mindfully to savour the flavours and quantity, especially the last meal on the evening before surgery.
If you are a fan of the gym – get yourself down there as often as you can. I am not such a person so instead I chose to walk several miles, a few times a week and went back to my pilates classes. These built up stamina and also increased my core strength. Anything to build muscle and increase cardiovascular fitness is perfect. This was a top tip from another oesoph patient. It is important to build up the muscles in the arms and shoulders using weights. The incisions and post-op epidural knock out your core and even though you can move your legs, it is very difficult to push yourself up the bed with your legs – your arms will take the brunt of this for the first few days after surgery so strong arms are recommended. This is the regimen I followed and I used 2x3kg hand weights but any weight will do. If you are put off by the video, read what she says in the description.
Baseline blood tests
If you like numbers and like to measure stuff, then this is for you. With a normal sized stomach one would hope that optimal nutrients are being absorbed so getting a baseline set of labs will show you the values normal to you. I got a full set of bloods done before surgery to ensure that levels were all optimal. I got another set done a few weeks post op to ensure that any developing deficiencies could be spotted quickly and I asked the hospital and my GP for a printout of all tests. The key ones are calcium, iron, ferritin, magnesium, vitamin B12, folate as well as liver and kidney function and a full blood count – you could throw in a HbA1c if you have or are concerned about diabetes. In addition, I get my vitamin D levels checked every autumn in case I need to supplement over winter. GPs can test for vitamin D but the NHS run Black Country Pathology Services lab in Birmingham are excellent and offer a service to the public. This involves a simple and inexpensive blood spot test you can do at home. The results are usually back within a week.
Incentive spirometer exercises as per the iCOUGH protocol
Lung complications are very common after abdominal surgery so in an attempt to address these, the critical care team at Central Manchester University Hospitals joined up with Boston Medical Center and developed the iCOUGH protocol. Part of this was to use a spirometer several times a day before surgery to build up lung capacity. You have to breathe in through the mouthpiece deeply and sufficiently to lift all three balls in their chambers (demonstrated in this video). The physiotherapists also encourage its use in hospital and I continued to use it when I went home. If your hospital does not issue these spirometers, the one pictured above can be bought online.
I have already covered post-op sleep here but it is a good idea to keep your sleep pattern optimal in the weeks running up to surgery. Also enjoy sleeping flat as you probably will not be able to do this afterwards.
Keeping busy stops you dwelling on the operation. I wanted to grab some normality before my surgery so I went back to work as this made the time fly by. Other people may choose to go on holiday or resume something that was part of their normal routine before chemotherapy. Other things to consider are complementary therapies, mindfulness and counselling. Local Maggies centres are great places that offer all of the above.
Catch up with people you like and do something you enjoy
This is a great time to catch up with your favourite people and see a film or just go out for a meal or have a good natter. It is also a great way to pass the time and also gain their support. The more support you have the better as you may be grounded for a few weeks after your op and not be feeling yourself.
Link up with people who have gone through the same thing
Your hospital should provide the general facts about surgery but for the qualitative stuff, the best source is the people who have been through it. There are a number of patient groups across the country you could contact. These are largely run under the auspices of the Oesophageal Patients Association but could be run by Macmillan nurses from your local hospital. In addition, there is a Facebook page and an online OPA forum on healthunlocked. There is also a very active forum on the Macmillan website.
Put your affairs in order
The chances are, you will be fine but it is worth taking stock and checking your will is up to date and still reflects your wishes. Talking to your family about any requests you want carrying out may also be a good idea. You can meet with a solicitor at a Maggies centre to help you compose a will if you have not written one. I got quite stressed about things at this time but after I got a couple of key things done, I felt so much better.
Deny yourself nothing
This one is more uplifting and can not be stressed enough. Facing an oesophagectomy is no one’s idea of fun and the post-op recovery period is long and uncertain. I’m not saying run your bank account dry and load up the old credit cards – everything within reason here. However if you have the means and there is a pair of shoes or a gadget you fancy or something you have been meaning to buy – get it – you won’t regret it. This is a time to be ultra kind to yourself and cut yourself some slack.