Wednesday, March 12, 2008
In response to comments and questions I sometimes get, and in followup to a recent post, I'll say something I frequently said to my patients, usually when asked if it's normal not to be fully recovered from surgery in such-and-such a time. As a corollary, I've often heard "I'm a quick healer," or "I'm a slow healer." Whereas there's no doubt that many things affect healing time, such as general health, age, nutritional status, and maybe, as we heard, attitude/emotional status, healing is a complex, organized, and orderly process which proceeds as it will, over many months. I acknowledge I wrote about this in a slightly different context, here. (In blogging, any old idea is better than none. Isn't it? Plus, I still get questions about it; so either they aren't scouring the archives or I'm a bad explainer...)
I liked to point out to patients that the healing process takes three weeks just to crank into gear. As in the above-referenced post about the healing ridge, so it is that inside, where you can't see it, operated tissues thicken up over time, become hard and unyielding: the places where bowel is sewed or stapled may become a little tight for a while, like a donut swelling and making its hole smaller. Everywhere we worked -- the place where the gallbladder used to be, the surfaces from which we pulled up the bowel -- these changes are going on and rendering those tissues distinctly abnormal. And although these things begin to recede within a few weeks, it's a year or more before the last vestiges of healing are entirely quiescent (which, as I pointed out previously, is why an incision usually remains reddish for that long.) All this requires energy. That means the burning of extra calories; the body is at work inside. So yeah: it's normal to feel tired after surgery for several weeks.
There's no doubt some people recover more quickly than others. To figure out why is probably impossible: factors such as "attitude" (referred to in a recent post) are hard to quantify; and it could be that little things going on inside, such as subclinical (meaning not enough to be diagnosed) infection, or having more beat-up tissues requiring repair or resorption, could account for some differences. It may be splitting hairs, but I'd suggest there's a difference between "healing" and "recovery." Healing goes in in pretty much the same way for most people, absent adverse factors: at any given time from surgery, a biopsy of a wound (for example) would show the same changes in anyone. But some will be back at work or roller skating, and some won't. When people asked how long it'd take to be fully healed, I tended to take the question literally, and give them a mini-dose of the physiological spiel -- but briefly, since I knew it wasn't what they were really asking. Then we'd talk about recovery, and I'd tell them what to expect.
It's a small point. Strictly speaking, I reject the concept of a "quick healer." You can't speed the endogenous process. But there's no doubt some people make a more rapid recovery than others. To them I'd often say, "I wish I could figure out what you have and bottle it, and give it to some of my other patients."
[See, the dog is a Blue Heeler.]