WEBVTT
00:00:00.239 --> 00:00:02.080
If the tone is right, okay.
00:00:02.319 --> 00:00:09.599
I think the tone's right, you know, if I'm standing, let's say this is you and you're in the bed and we're gonna have this surgery soon and I'm standing there going, you know what?
00:00:09.679 --> 00:00:14.640
It's the best thing ever happened in my life, I'm up hell walking and do have never looked back, and it's absolutely amazing.
00:00:14.720 --> 00:00:15.279
Do you know what?
00:00:15.359 --> 00:00:18.160
Everybody in the world should have them because they're the best things ever.
00:00:18.320 --> 00:00:22.640
Um that forced positivity is not useful.
00:00:33.119 --> 00:00:37.600
Okay, so welcome to today's episode in the Econ IQ podcast.
00:00:37.759 --> 00:00:41.119
Um, we're joined today by Brona Stamars, leading psychotherapist.
00:00:41.280 --> 00:00:42.560
You're very, very welcome, Brona.
00:00:42.880 --> 00:00:43.359
Thanks, Marie.
00:00:43.520 --> 00:00:44.159
Good to be here.
00:00:44.560 --> 00:00:55.920
So, in this episode, Brona, we're turning our attention to pre-surgery anxiety and and really how patients cope or the coping skills that they they can hopefully achieve pre-surgery.
00:00:56.079 --> 00:01:08.640
Um I suppose we want to look at things like changes in lifestyle, independence, and managing practical aspects of stomach care and how these can sometimes feel overwhelming for patients.
00:01:09.200 --> 00:01:13.200
Yeah, and there's that piece of the unknown, I suppose, when they're facing surgery.
00:01:13.359 --> 00:01:25.599
So, Bruno, with that in mind, I have a question for you today from um a patient, and I've lived with IBD for years, and now I'm about to have stoma surgery while juggling work and a busy family life.
00:01:25.840 --> 00:01:28.879
How do I support my mental well-being so I can cope afterwards?
00:01:28.959 --> 00:01:30.000
Is the question.
00:01:30.480 --> 00:01:31.760
Interesting question.
00:01:31.920 --> 00:01:33.680
Uh, so first of all, it's lovely to be here.
00:01:33.760 --> 00:01:36.879
Thank you for the invitation to come and talk to you.
00:01:37.120 --> 00:01:46.879
Um, I guess for um someone in that pre-surgery stage, uh, uncertainty is the big issue.
00:01:47.040 --> 00:01:50.959
Uh and our brains do not like uncertainty.
00:01:51.120 --> 00:02:00.879
Uh, we like even if we know that something's gonna happen and we don't like it, at least our brains can compare prepare.
00:02:00.959 --> 00:02:03.040
Like, I I know I'm gonna have to do that.
00:02:03.599 --> 00:02:16.000
Um, I suppose with after the surgery, there's a lot of unknowns for the person, so it's very difficult to go, what is this gonna look like and what's it gonna be like from how I'm gonna feel about it?
00:02:16.080 --> 00:02:30.240
So I'd say the uncertainty generates an awful lot of anxiety for uh this person, and uh I suppose realistic preparation is is very useful psychologically.
00:02:30.319 --> 00:02:36.560
So, for example, maybe uh you know, having a conversation with a stoma nurse beforehand.
00:02:36.719 --> 00:02:46.879
So let's say Marie, that's you, and you're you're coming to my bedside just to say hello, and that continuity for after surgery can be useful in terms of the reassurance.
00:02:46.960 --> 00:03:03.360
So after I wake up from surgery, um, there's this nurse standing there, and I've never met her before, but actually that that can be helpful that oh, there there's support that's going to be available, and it's it's you that so something like that can be useful.
00:03:03.439 --> 00:03:06.479
And um Brona, sorry, I might just add in.
00:03:06.560 --> 00:03:14.879
I think that's where for nurses even to see the absolute importance of that preoperative counselling when they can do it as well, and the importance of that meeting beforehand.
00:03:15.280 --> 00:03:16.000
Would you agree?
00:03:16.319 --> 00:03:28.319
Yeah, um it's just putting uh a face there so that it's not some stranger looking down on you when I'm waking up from the surgery, um, that it's just such an important thing.
00:03:28.400 --> 00:03:34.400
Um and then preparation, clear information about um likelihoods.
00:03:34.560 --> 00:03:44.319
Now I'm not medically trained, so I don't know what the the ins and outs of those conversations are, um, and what the person can expect uh can be useful as well.
00:03:44.560 --> 00:03:50.479
And I suppose um normalizing the anxiety is really important.
00:03:50.960 --> 00:03:57.360
You know, if someone wasn't anxious before surgery, you'd be going, Why are they not anxious?
00:03:57.520 --> 00:04:11.680
It's one of the most vulnerable times in a person's life where if they're going through surgery, if you think about it, you are um going to be unconscious and someone's gonna be standing with a scalpel in their hand, cutting you open.
00:04:11.759 --> 00:04:15.039
I mean, there's little that's more vulnerable than that.
00:04:15.199 --> 00:04:26.480
So for anybody, even if it's an an elective surgery for you know um plastic surgery or something like a cosmetic surgery, um, and I'm choosing to want it, I still will probably feel anxious about it.
00:04:26.639 --> 00:04:56.399
Um so for a lot of people, maybe they're not choosing this as well, so there's even a lot more anxiety and there's a lot more uncertainty, and and um and normalizing that that you even just saying to the the person, you know, there are so many unknowns for you, and um this is not something that you're choosing, or you you know, you're doing this because you're so unwell, it has to happen, or because you've cancer and we we've got to do it.
00:04:56.560 --> 00:05:08.959
And when someone um has to have a surgery, which is very often what happens, um the fact that I didn't choose this can make me even more anxious at all.
00:05:09.199 --> 00:05:19.120
Um so yeah, the the the uncertainty will maybe be helped by a lot of clear information, realistic expectations, and that planned support as well.
00:05:19.759 --> 00:05:23.920
So here's what's gonna happen after your surgery.
00:05:24.079 --> 00:05:33.600
I'm going to call and we're gonna talk about this, and I'll show you how this is done, and um it's it's a bit like the anxious child going to school, you know.
00:05:33.680 --> 00:05:51.279
If if mom or dad says, So after school we're gonna have this for your dinner and we're gonna watch this movie, and we're gonna do this this evening, the person, you know, that little child goes to school going, Oh, I can tolerate this anxiety because I know that there's a life after it that's going to be okay.
00:05:51.439 --> 00:05:59.839
So knowing that I feel very uncertain, but this stoma nurse doesn't seem to be uncertain, so I actually feel really assured.
00:06:00.000 --> 00:06:02.480
So things like that can be really useful as well.
00:06:02.800 --> 00:06:10.160
Yeah, and I guess I think for this particular patient, they've had a long history of inflammatory bile disease, they've struggled with their disease.
00:06:10.560 --> 00:06:24.079
Um whereas you know, they're possibly more ready than the person who's either having an emergency surgery or maybe have developed a rectal cancer and require surgery, their anxiety could be at different levels.
00:06:24.560 --> 00:06:25.279
For sure.
00:06:25.439 --> 00:06:41.199
So um you know, the word that you say the readiness is a big thing and and the planning of it that uh like a lot of people after when they've had maybe the ABD, they they will say, like, why did I not have this years ago?
00:06:41.279 --> 00:07:32.639
and I'm uh you know and and it's actually uh the the lease of life that they are going to have, and so there can be a lot of optimism, optimism going for the surgery, um, and they've been reading up on it, they've been talking about it, they've maybe going to council and all sorts of stuff, versus the anxiety of someone who's been told that in 24 hours or in three hours you're having a surgery, or they've had a diagnosis of cancer, and um, and here's what we have to do, and it's it's gonna happen, you know, psychologically not being able to adjust, and there are pros and cons for both because if someone has the long, like like the person who is given that question, that long trajectory of the IBD, and they've been suffering for a long time, and this has been maybe an inevitability that they've been thinking about, they've been putting it off, or they've been talking to the consultant about it.
00:07:32.879 --> 00:07:38.240
Um, there could be a lot of low-grade anxiety happening for a long time.
00:07:38.480 --> 00:07:45.279
Whereas actually, you know, you you you've got the cancer diagnosis, and someone says we're gonna have to do the surgery and we're gonna have a stoma.
00:07:45.839 --> 00:07:58.800
The there there's like uh an acute trauma there and an awful lot of shock, but actually, maybe it's not a lot of anxiety in terms of they don't have time for that pre-op anxiety as well.
00:07:58.959 --> 00:08:07.920
This person is just and and also um they're they're in this place where they're not able to process so much, you're just going with the flow.
00:08:08.000 --> 00:08:12.639
People will often talk after the like of that kind of you know emergency situation.
00:08:12.959 --> 00:08:29.120
That um I I just was an automatic pilot and I didn't know what and so what will happen then is maybe that person will not feel anxious because they're in shock, and they'll say, you know, doctor, do whatever you have to do, that's absolutely fine.
00:08:29.279 --> 00:08:37.519
And it's months later when the shock wears off, um, we we'll see maybe that post-surgery anxiety, which might be more common than the pre.
00:08:37.840 --> 00:08:45.679
Um and in a case like that, you may only have pre pre-sur um surgery, you know, half an hour before they have the anesthetic, whatever.
00:08:45.759 --> 00:08:56.080
So the qualities of that are are different, and I suppose it really depends on the the level of uncertainty that is the context around it.
00:08:56.399 --> 00:09:03.600
Yeah, and I think that's a really, really good point is the individualized pathways that different patients are going to go on.
00:09:04.000 --> 00:09:07.600
So that patient, like in this question, has time to prepare.
00:09:07.679 --> 00:09:13.679
Yeah, and in that piece, maybe this is the challenging piece for her because she has it's the unknown around it.
00:09:13.840 --> 00:09:23.919
Whereas for somebody else, maybe it's this isn't the challenging piece because you don't have time to worry or to be anxious about it, and it's afterwards then where they might require more support.
00:09:24.159 --> 00:09:25.679
Would do you agree with that, Brona?
00:09:25.919 --> 00:09:27.600
Or what's your opinion on that?
00:09:28.080 --> 00:09:44.080
Yeah, um like I was saying there, the actually um you know, that person who has a long time to prepare, there's a whole lot of what-ifs and possibilities, and the the brain has more time to process the uncertainty and to sit with the uncertainty.
00:09:44.240 --> 00:09:57.279
So I I would imagine even though there may be a lot of relief that I'm actually going to have this now, their anxiety is possibly lower grade but longer, and maybe more of a an issue as well.
00:09:57.919 --> 00:10:07.840
What's your thoughts, Bruna, on excuse me, introducing somebody pre-op to we call them like a an ostomy volunteer.
00:10:07.919 --> 00:10:17.120
So someone who's gone through surgery, coped extremely well, and they're willing to to come and meet with somebody who's about to have surgery.
00:10:17.440 --> 00:10:20.080
What what are your thoughts in relation to that?
00:10:20.720 --> 00:10:22.799
I think that's a great idea.
00:10:22.960 --> 00:10:28.799
I think the the stoma nurse come and talking, and this this person who's been through it themselves come and talking.
00:10:29.200 --> 00:10:32.639
If the tone is right, I think the tone's right, you know.
00:10:32.799 --> 00:10:40.159
If I'm standing, let's say this is you and you're in the bed and we're gonna have this surgery soon, and I'm standing there going, you know what, it's the best thing ever happened in my life.
00:10:40.240 --> 00:10:43.600
I'm uphill walking and do have a never look back, and it's absolutely amazing.
00:10:43.759 --> 00:10:51.279
Do you know what everybody in the world should have them because they're the best things ever, and that forced positivity is not useful.
00:10:51.360 --> 00:11:03.759
And that I suppose we run the risk sometimes with the volunteers that um you know, the the the way that I correlate it is the the you know advertisements for period products.
00:11:04.240 --> 00:11:08.799
When you have your period, it is the best, funnest time of your life.
00:11:09.039 --> 00:11:13.039
Wear your white clothes and abseil down mountains and stuff like that.
00:11:13.120 --> 00:11:14.960
And actually, the reality is very different.
00:11:15.039 --> 00:11:18.960
You're sitting with a hot water bottle, the cramps, it's it's not pleasant.
00:11:19.200 --> 00:11:29.360
Um so a person's experience can be very invalidated with that positivity that this is actually gonna and it's been no bother at all to you.
00:11:29.519 --> 00:11:47.200
So I said, you know, you're you're overlooking the vulnerability, you're overlooking the uncertainty, and just saying to someone, you know, yeah, I imagine you feel really anxious and and it's really scary, and that that can actually reassure better than the amazing life that you're gonna have afterwards.
00:11:47.360 --> 00:11:58.480
Yeah, so I I think it would be worth checking out what pitch the volunteer is coming with, actually, as a stoma nurse, and and indeed the stoma nurse themselves as well.
00:11:58.960 --> 00:12:01.440
Yeah, I think that's a really, really good point in there.
00:12:01.519 --> 00:12:10.159
It's making sure that and as much as possible that who you're putting together match and align with that as well, and that can be a real challenge for nurses, can't it?
00:12:10.480 --> 00:12:30.399
Yeah, and and finding the balance as well, because you don't want someone going, God, it was terrible and awful, and my life's a misery since that that just you know it's it's hard, it's worth it, it'll be okay, reassurance, um, injecting a bit of positivity, but not what's called toxic positivity.
00:12:31.279 --> 00:12:44.159
And I'm thinking about um, you know, what what do you think about bringing in a partner or if it's a parent of a young child, um the parents about to have surgery?
00:12:44.320 --> 00:12:51.120
You know, what are your thoughts when it comes to stomach care nurses getting involved more with the family in that pre-operative stage?
00:12:52.320 --> 00:13:05.759
In in what way to to do Well to just I'm just thinking, you know, do you feel it's appropriate to bring the partner in as well when you're you know for stomachare nurse having that conversation with them or just what what are your thoughts?
00:13:06.080 --> 00:13:08.080
Yeah, and again it would depend on who the partner is.
00:13:08.159 --> 00:13:13.279
You know, if you've met the partner first and you think, yeah, they're really supportive or these kids are really on board or whatever, that'd be great.
00:13:13.440 --> 00:13:20.240
If it was maybe a a a partner that you had doubts about, or that maybe you kind of think this person feels unsafe with their partner, whatever.
00:13:20.399 --> 00:13:26.799
But I what I would be saying to the stoma nurse is um you're you're all eyes on support.
00:13:26.879 --> 00:13:31.600
So if there's if there's support available and feels appropriate, that would be great.
00:13:31.759 --> 00:13:43.120
And even having a quick conversation with the partner to say, you know, we're gonna be focusing on on support, but validation and and talk the partner for five minutes beforehand through.
00:13:43.279 --> 00:13:49.840
It's important to not be too positive, but to be reassuring and and say, you know, it's normal to feel anxious, and I'll be here for you.
00:13:49.919 --> 00:13:59.360
So the stoma nurse is going like afterwards, I'll be here, I'll be meeting, you'll be coming around, we'll be doing this, that, or the other, and then the partner going, Yeah, and I'm gonna be here as well, and you you're not gonna be in your own.
00:13:59.600 --> 00:14:01.120
That could be really useful.
00:14:01.279 --> 00:14:01.919
Yeah, yeah.
00:14:02.240 --> 00:14:11.279
That follows on to my next point around with with this patient in particular, who obviously does have a busy family life, and that might mean that they've young children.
00:14:11.519 --> 00:14:22.639
So I guess it's about setting realistic expectations for afterwards with that as well, that they've a plan in place to even to have support around them for the children and considering lifting and all of that.
00:14:22.720 --> 00:14:25.840
So maybe that's would that be part of it as well, the pre-operative stage?
00:14:26.159 --> 00:14:33.120
Very much those realistic expectations around um how they're going to maybe be psychologically, be physically as well.
00:14:33.200 --> 00:14:50.080
And again, that's not my area of expertise, but that uh that sense of um adjusting and taking taking that time to heal, like after surgery, people are not able to bounce back immediately, particularly if the busyness.
00:14:50.320 --> 00:15:00.240
Um so you you know, maybe that patient in particular has a busy family life, you know, supporting them to get a bit of support around that if that's possible.
00:15:00.480 --> 00:15:10.399
And but also the psychological, like you're you'll you know, it's a major trauma to a person physiologically and psychologically to go through a uh surgery.
00:15:10.559 --> 00:15:28.879
Um you're not just gonna bounce back to the old self, and very often after a major surgery, people talk about feeling different, like that old self isn't who I am anymore, and because particularly with the like of a stoma surgery, we're we're talking maybe a whole new aspect of identity that's emerging.
00:15:28.960 --> 00:15:32.159
So yeah, that that realistic piece is important.
00:15:32.320 --> 00:15:59.039
Uh now to be fair, I would caution around doing a lot of that pro pre-surgery because you could bamboozle a person, there's so much there to so maybe you know the first part might be getting them through the surgery and a little bit about real expect re um realistic expectations, and we'll support you and we just take it a baby step at a time after the surgery, and otherwise they could feel very flooded.
00:15:59.919 --> 00:16:19.360
Yeah, and I s when even depending on the stage that their children are at, would you say that's a conversation to have with the children before or after the surgery that when from your from your experience and managing children and adolescent expectations, when do you think is best to have that conversation with the children?
00:16:19.679 --> 00:16:31.679
Um well f it depends on the the age of the children as well, but typically with children, if a parent is going through something like a surgery, like you know, there's a lot of vulnerability there, there's a lot of insecurity for a child.
00:16:32.159 --> 00:16:43.039
Again, I might do that kind of baby steps with them and say, you know, that this is a big surgery, and afterwards your mum's gonna have a stoma bag and it's gonna take a whole lot of adjustment, it'll be lots of stuff.
00:16:43.120 --> 00:16:48.799
Um, but you know, she's gonna be she's in safe hands and she's gonna be okay, and all the rest of it.
00:16:48.960 --> 00:17:03.759
And I think that it's enough for that child to realise that mommy's gonna survive this, and then afterwards we can have conversations about now that mommy's got the bag, here's you know, um and that it like stages of adjustment would be useful.
00:17:04.079 --> 00:17:06.400
I think I really like your phrase just baby steps.
00:17:06.880 --> 00:17:07.759
Yeah, yeah.
00:17:08.319 --> 00:17:14.799
I think that brings a close to this episode, and thank you so much for your expertise.
00:17:14.960 --> 00:17:23.599
And what I've really taken from it is the importance of preparation when possible, realistic expectations, but keeping them within baby steps as well and not overloading.
00:17:23.759 --> 00:17:24.880
Um, what about you, Marie?
00:17:25.119 --> 00:17:26.640
Yeah, no, I've thoroughly enjoyed it.
00:17:26.720 --> 00:17:28.880
Thank you so much, Rona, for for joining us today.
00:17:29.200 --> 00:17:29.680
Thank you, folks.
00:17:29.839 --> 00:17:30.720
Thank you for having me.
00:17:30.960 --> 00:17:31.680
Thank you.
00:00:00.239 --> 00:00:02.080
If the tone is right, okay.
00:00:02.319 --> 00:00:09.599
I think the tone's right, you know, if I'm standing, let's say this is you and you're in the bed and we're gonna have this surgery soon and I'm standing there going, you know what?
00:00:09.679 --> 00:00:14.640
It's the best thing ever happened in my life, I'm up hell walking and do have never looked back, and it's absolutely amazing.
00:00:14.720 --> 00:00:15.279
Do you know what?
00:00:15.359 --> 00:00:18.160
Everybody in the world should have them because they're the best things ever.
00:00:18.320 --> 00:00:22.640
Um that forced positivity is not useful.
00:00:33.119 --> 00:00:37.600
Okay, so welcome to today's episode in the Econ IQ podcast.
00:00:37.759 --> 00:00:41.119
Um, we're joined today by Brona Stamars, leading psychotherapist.
00:00:41.280 --> 00:00:42.560
You're very, very welcome, Brona.
00:00:42.880 --> 00:00:43.359
Thanks, Marie.
00:00:43.520 --> 00:00:44.159
Good to be here.
00:00:44.560 --> 00:00:55.920
So, in this episode, Brona, we're turning our attention to pre-surgery anxiety and and really how patients cope or the coping skills that they they can hopefully achieve pre-surgery.
00:00:56.079 --> 00:01:08.640
Um I suppose we want to look at things like changes in lifestyle, independence, and managing practical aspects of stomach care and how these can sometimes feel overwhelming for patients.
00:01:09.200 --> 00:01:13.200
Yeah, and there's that piece of the unknown, I suppose, when they're facing surgery.
00:01:13.359 --> 00:01:25.599
So, Bruno, with that in mind, I have a question for you today from um a patient, and I've lived with IBD for years, and now I'm about to have stoma surgery while juggling work and a busy family life.
00:01:25.840 --> 00:01:28.879
How do I support my mental well-being so I can cope afterwards?
00:01:28.959 --> 00:01:30.000
Is the question.
00:01:30.480 --> 00:01:31.760
Interesting question.
00:01:31.920 --> 00:01:33.680
Uh, so first of all, it's lovely to be here.
00:01:33.760 --> 00:01:36.879
Thank you for the invitation to come and talk to you.
00:01:37.120 --> 00:01:46.879
Um, I guess for um someone in that pre-surgery stage, uh, uncertainty is the big issue.
00:01:47.040 --> 00:01:50.959
Uh and our brains do not like uncertainty.
00:01:51.120 --> 00:02:00.879
Uh, we like even if we know that something's gonna happen and we don't like it, at least our brains can compare prepare.
00:02:00.959 --> 00:02:03.040
Like, I I know I'm gonna have to do that.
00:02:03.599 --> 00:02:16.000
Um, I suppose with after the surgery, there's a lot of unknowns for the person, so it's very difficult to go, what is this gonna look like and what's it gonna be like from how I'm gonna feel about it?
00:02:16.080 --> 00:02:30.240
So I'd say the uncertainty generates an awful lot of anxiety for uh this person, and uh I suppose realistic preparation is is very useful psychologically.
00:02:30.319 --> 00:02:36.560
So, for example, maybe uh you know, having a conversation with a stoma nurse beforehand.
00:02:36.719 --> 00:02:46.879
So let's say Marie, that's you, and you're you're coming to my bedside just to say hello, and that continuity for after surgery can be useful in terms of the reassurance.
00:02:46.960 --> 00:03:03.360
So after I wake up from surgery, um, there's this nurse standing there, and I've never met her before, but actually that that can be helpful that oh, there there's support that's going to be available, and it's it's you that so something like that can be useful.
00:03:03.439 --> 00:03:06.479
And um Brona, sorry, I might just add in.
00:03:06.560 --> 00:03:14.879
I think that's where for nurses even to see the absolute importance of that preoperative counselling when they can do it as well, and the importance of that meeting beforehand.
00:03:15.280 --> 00:03:16.000
Would you agree?
00:03:16.319 --> 00:03:28.319
Yeah, um it's just putting uh a face there so that it's not some stranger looking down on you when I'm waking up from the surgery, um, that it's just such an important thing.
00:03:28.400 --> 00:03:34.400
Um and then preparation, clear information about um likelihoods.
00:03:34.560 --> 00:03:44.319
Now I'm not medically trained, so I don't know what the the ins and outs of those conversations are, um, and what the person can expect uh can be useful as well.
00:03:44.560 --> 00:03:50.479
And I suppose um normalizing the anxiety is really important.
00:03:50.960 --> 00:03:57.360
You know, if someone wasn't anxious before surgery, you'd be going, Why are they not anxious?
00:03:57.520 --> 00:04:11.680
It's one of the most vulnerable times in a person's life where if they're going through surgery, if you think about it, you are um going to be unconscious and someone's gonna be standing with a scalpel in their hand, cutting you open.
00:04:11.759 --> 00:04:15.039
I mean, there's little that's more vulnerable than that.
00:04:15.199 --> 00:04:26.480
So for anybody, even if it's an an elective surgery for you know um plastic surgery or something like a cosmetic surgery, um, and I'm choosing to want it, I still will probably feel anxious about it.
00:04:26.639 --> 00:04:56.399
Um so for a lot of people, maybe they're not choosing this as well, so there's even a lot more anxiety and there's a lot more uncertainty, and and um and normalizing that that you even just saying to the the person, you know, there are so many unknowns for you, and um this is not something that you're choosing, or you you know, you're doing this because you're so unwell, it has to happen, or because you've cancer and we we've got to do it.
00:04:56.560 --> 00:05:08.959
And when someone um has to have a surgery, which is very often what happens, um the fact that I didn't choose this can make me even more anxious at all.
00:05:09.199 --> 00:05:19.120
Um so yeah, the the the uncertainty will maybe be helped by a lot of clear information, realistic expectations, and that planned support as well.
00:05:19.759 --> 00:05:23.920
So here's what's gonna happen after your surgery.
00:05:24.079 --> 00:05:33.600
I'm going to call and we're gonna talk about this, and I'll show you how this is done, and um it's it's a bit like the anxious child going to school, you know.
00:05:33.680 --> 00:05:51.279
If if mom or dad says, So after school we're gonna have this for your dinner and we're gonna watch this movie, and we're gonna do this this evening, the person, you know, that little child goes to school going, Oh, I can tolerate this anxiety because I know that there's a life after it that's going to be okay.
00:05:51.439 --> 00:05:59.839
So knowing that I feel very uncertain, but this stoma nurse doesn't seem to be uncertain, so I actually feel really assured.
00:06:00.000 --> 00:06:02.480
So things like that can be really useful as well.
00:06:02.800 --> 00:06:10.160
Yeah, and I guess I think for this particular patient, they've had a long history of inflammatory bile disease, they've struggled with their disease.
00:06:10.560 --> 00:06:24.079
Um whereas you know, they're possibly more ready than the person who's either having an emergency surgery or maybe have developed a rectal cancer and require surgery, their anxiety could be at different levels.
00:06:24.560 --> 00:06:25.279
For sure.
00:06:25.439 --> 00:06:41.199
So um you know, the word that you say the readiness is a big thing and and the planning of it that uh like a lot of people after when they've had maybe the ABD, they they will say, like, why did I not have this years ago?
00:06:41.279 --> 00:07:32.639
and I'm uh you know and and it's actually uh the the lease of life that they are going to have, and so there can be a lot of optimism, optimism going for the surgery, um, and they've been reading up on it, they've been talking about it, they've maybe going to council and all sorts of stuff, versus the anxiety of someone who's been told that in 24 hours or in three hours you're having a surgery, or they've had a diagnosis of cancer, and um, and here's what we have to do, and it's it's gonna happen, you know, psychologically not being able to adjust, and there are pros and cons for both because if someone has the long, like like the person who is given that question, that long trajectory of the IBD, and they've been suffering for a long time, and this has been maybe an inevitability that they've been thinking about, they've been putting it off, or they've been talking to the consultant about it.
00:07:32.879 --> 00:07:38.240
Um, there could be a lot of low-grade anxiety happening for a long time.
00:07:38.480 --> 00:07:45.279
Whereas actually, you know, you you you've got the cancer diagnosis, and someone says we're gonna have to do the surgery and we're gonna have a stoma.
00:07:45.839 --> 00:07:58.800
The there there's like uh an acute trauma there and an awful lot of shock, but actually, maybe it's not a lot of anxiety in terms of they don't have time for that pre-op anxiety as well.
00:07:58.959 --> 00:08:07.920
This person is just and and also um they're they're in this place where they're not able to process so much, you're just going with the flow.
00:08:08.000 --> 00:08:12.639
People will often talk after the like of that kind of you know emergency situation.
00:08:12.959 --> 00:08:29.120
That um I I just was an automatic pilot and I didn't know what and so what will happen then is maybe that person will not feel anxious because they're in shock, and they'll say, you know, doctor, do whatever you have to do, that's absolutely fine.
00:08:29.279 --> 00:08:37.519
And it's months later when the shock wears off, um, we we'll see maybe that post-surgery anxiety, which might be more common than the pre.
00:08:37.840 --> 00:08:45.679
Um and in a case like that, you may only have pre pre-sur um surgery, you know, half an hour before they have the anesthetic, whatever.
00:08:45.759 --> 00:08:56.080
So the qualities of that are are different, and I suppose it really depends on the the level of uncertainty that is the context around it.
00:08:56.399 --> 00:09:03.600
Yeah, and I think that's a really, really good point is the individualized pathways that different patients are going to go on.
00:09:04.000 --> 00:09:07.600
So that patient, like in this question, has time to prepare.
00:09:07.679 --> 00:09:13.679
Yeah, and in that piece, maybe this is the challenging piece for her because she has it's the unknown around it.
00:09:13.840 --> 00:09:23.919
Whereas for somebody else, maybe it's this isn't the challenging piece because you don't have time to worry or to be anxious about it, and it's afterwards then where they might require more support.
00:09:24.159 --> 00:09:25.679
Would do you agree with that, Brona?
00:09:25.919 --> 00:09:27.600
Or what's your opinion on that?
00:09:28.080 --> 00:09:44.080
Yeah, um like I was saying there, the actually um you know, that person who has a long time to prepare, there's a whole lot of what-ifs and possibilities, and the the brain has more time to process the uncertainty and to sit with the uncertainty.
00:09:44.240 --> 00:09:57.279
So I I would imagine even though there may be a lot of relief that I'm actually going to have this now, their anxiety is possibly lower grade but longer, and maybe more of a an issue as well.
00:09:57.919 --> 00:10:07.840
What's your thoughts, Bruna, on excuse me, introducing somebody pre-op to we call them like a an ostomy volunteer.
00:10:07.919 --> 00:10:17.120
So someone who's gone through surgery, coped extremely well, and they're willing to to come and meet with somebody who's about to have surgery.
00:10:17.440 --> 00:10:20.080
What what are your thoughts in relation to that?
00:10:20.720 --> 00:10:22.799
I think that's a great idea.
00:10:22.960 --> 00:10:28.799
I think the the stoma nurse come and talking, and this this person who's been through it themselves come and talking.
00:10:29.200 --> 00:10:32.639
If the tone is right, I think the tone's right, you know.
00:10:32.799 --> 00:10:40.159
If I'm standing, let's say this is you and you're in the bed and we're gonna have this surgery soon, and I'm standing there going, you know what, it's the best thing ever happened in my life.
00:10:40.240 --> 00:10:43.600
I'm uphill walking and do have a never look back, and it's absolutely amazing.
00:10:43.759 --> 00:10:51.279
Do you know what everybody in the world should have them because they're the best things ever, and that forced positivity is not useful.
00:10:51.360 --> 00:11:03.759
And that I suppose we run the risk sometimes with the volunteers that um you know, the the the way that I correlate it is the the you know advertisements for period products.
00:11:04.240 --> 00:11:08.799
When you have your period, it is the best, funnest time of your life.
00:11:09.039 --> 00:11:13.039
Wear your white clothes and abseil down mountains and stuff like that.
00:11:13.120 --> 00:11:14.960
And actually, the reality is very different.
00:11:15.039 --> 00:11:18.960
You're sitting with a hot water bottle, the cramps, it's it's not pleasant.
00:11:19.200 --> 00:11:29.360
Um so a person's experience can be very invalidated with that positivity that this is actually gonna and it's been no bother at all to you.
00:11:29.519 --> 00:11:47.200
So I said, you know, you're you're overlooking the vulnerability, you're overlooking the uncertainty, and just saying to someone, you know, yeah, I imagine you feel really anxious and and it's really scary, and that that can actually reassure better than the amazing life that you're gonna have afterwards.
00:11:47.360 --> 00:11:58.480
Yeah, so I I think it would be worth checking out what pitch the volunteer is coming with, actually, as a stoma nurse, and and indeed the stoma nurse themselves as well.
00:11:58.960 --> 00:12:01.440
Yeah, I think that's a really, really good point in there.
00:12:01.519 --> 00:12:10.159
It's making sure that and as much as possible that who you're putting together match and align with that as well, and that can be a real challenge for nurses, can't it?
00:12:10.480 --> 00:12:30.399
Yeah, and and finding the balance as well, because you don't want someone going, God, it was terrible and awful, and my life's a misery since that that just you know it's it's hard, it's worth it, it'll be okay, reassurance, um, injecting a bit of positivity, but not what's called toxic positivity.
00:12:31.279 --> 00:12:44.159
And I'm thinking about um, you know, what what do you think about bringing in a partner or if it's a parent of a young child, um the parents about to have surgery?
00:12:44.320 --> 00:12:51.120
You know, what are your thoughts when it comes to stomach care nurses getting involved more with the family in that pre-operative stage?
00:12:52.320 --> 00:13:05.759
In in what way to to do Well to just I'm just thinking, you know, do you feel it's appropriate to bring the partner in as well when you're you know for stomachare nurse having that conversation with them or just what what are your thoughts?
00:13:06.080 --> 00:13:08.080
Yeah, and again it would depend on who the partner is.
00:13:08.159 --> 00:13:13.279
You know, if you've met the partner first and you think, yeah, they're really supportive or these kids are really on board or whatever, that'd be great.
00:13:13.440 --> 00:13:20.240
If it was maybe a a a partner that you had doubts about, or that maybe you kind of think this person feels unsafe with their partner, whatever.
00:13:20.399 --> 00:13:26.799
But I what I would be saying to the stoma nurse is um you're you're all eyes on support.
00:13:26.879 --> 00:13:31.600
So if there's if there's support available and feels appropriate, that would be great.
00:13:31.759 --> 00:13:43.120
And even having a quick conversation with the partner to say, you know, we're gonna be focusing on on support, but validation and and talk the partner for five minutes beforehand through.
00:13:43.279 --> 00:13:49.840
It's important to not be too positive, but to be reassuring and and say, you know, it's normal to feel anxious, and I'll be here for you.
00:13:49.919 --> 00:13:59.360
So the stoma nurse is going like afterwards, I'll be here, I'll be meeting, you'll be coming around, we'll be doing this, that, or the other, and then the partner going, Yeah, and I'm gonna be here as well, and you you're not gonna be in your own.
00:13:59.600 --> 00:14:01.120
That could be really useful.
00:14:01.279 --> 00:14:01.919
Yeah, yeah.
00:14:02.240 --> 00:14:11.279
That follows on to my next point around with with this patient in particular, who obviously does have a busy family life, and that might mean that they've young children.
00:14:11.519 --> 00:14:22.639
So I guess it's about setting realistic expectations for afterwards with that as well, that they've a plan in place to even to have support around them for the children and considering lifting and all of that.
00:14:22.720 --> 00:14:25.840
So maybe that's would that be part of it as well, the pre-operative stage?
00:14:26.159 --> 00:14:33.120
Very much those realistic expectations around um how they're going to maybe be psychologically, be physically as well.
00:14:33.200 --> 00:14:50.080
And again, that's not my area of expertise, but that uh that sense of um adjusting and taking taking that time to heal, like after surgery, people are not able to bounce back immediately, particularly if the busyness.
00:14:50.320 --> 00:15:00.240
Um so you you know, maybe that patient in particular has a busy family life, you know, supporting them to get a bit of support around that if that's possible.
00:15:00.480 --> 00:15:10.399
And but also the psychological, like you're you'll you know, it's a major trauma to a person physiologically and psychologically to go through a uh surgery.
00:15:10.559 --> 00:15:28.879
Um you're not just gonna bounce back to the old self, and very often after a major surgery, people talk about feeling different, like that old self isn't who I am anymore, and because particularly with the like of a stoma surgery, we're we're talking maybe a whole new aspect of identity that's emerging.
00:15:28.960 --> 00:15:32.159
So yeah, that that realistic piece is important.
00:15:32.320 --> 00:15:59.039
Uh now to be fair, I would caution around doing a lot of that pro pre-surgery because you could bamboozle a person, there's so much there to so maybe you know the first part might be getting them through the surgery and a little bit about real expect re um realistic expectations, and we'll support you and we just take it a baby step at a time after the surgery, and otherwise they could feel very flooded.
00:15:59.919 --> 00:16:19.360
Yeah, and I s when even depending on the stage that their children are at, would you say that's a conversation to have with the children before or after the surgery that when from your from your experience and managing children and adolescent expectations, when do you think is best to have that conversation with the children?
00:16:19.679 --> 00:16:31.679
Um well f it depends on the the age of the children as well, but typically with children, if a parent is going through something like a surgery, like you know, there's a lot of vulnerability there, there's a lot of insecurity for a child.
00:16:32.159 --> 00:16:43.039
Again, I might do that kind of baby steps with them and say, you know, that this is a big surgery, and afterwards your mum's gonna have a stoma bag and it's gonna take a whole lot of adjustment, it'll be lots of stuff.
00:16:43.120 --> 00:16:48.799
Um, but you know, she's gonna be she's in safe hands and she's gonna be okay, and all the rest of it.
00:16:48.960 --> 00:17:03.759
And I think that it's enough for that child to realise that mommy's gonna survive this, and then afterwards we can have conversations about now that mommy's got the bag, here's you know, um and that it like stages of adjustment would be useful.
00:17:04.079 --> 00:17:06.400
I think I really like your phrase just baby steps.
00:17:06.880 --> 00:17:07.759
Yeah, yeah.
00:17:08.319 --> 00:17:14.799
I think that brings a close to this episode, and thank you so much for your expertise.
00:17:14.960 --> 00:17:23.599
And what I've really taken from it is the importance of preparation when possible, realistic expectations, but keeping them within baby steps as well and not overloading.
00:17:23.759 --> 00:17:24.880
Um, what about you, Marie?
00:17:25.119 --> 00:17:26.640
Yeah, no, I've thoroughly enjoyed it.
00:17:26.720 --> 00:17:28.880
Thank you so much, Rona, for for joining us today.
00:17:29.200 --> 00:17:29.680
Thank you, folks.
00:17:29.839 --> 00:17:30.720
Thank you for having me.
00:17:30.960 --> 00:17:31.680
Thank you.
