MOVE BREATHE EAT RELAX
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1 MOVE BREATHE EAT RELAX Helping you prepare for your surgery
2 Welcome to the Michigan Surgical & Health Optimization Program (MSHOP) To complete your enrollment, or to ask questions about MSHOP, please call MSHOP Website: My MSHOP Login: Password: Contents Welcome 1 Getting Started 2 MOVE 5 BREATHE 8 EAT 10 RELAX 12 Appendix A 13 MSHOP was developed based on research that shows patients who are stronger before surgery do better after, and that even simple walking exercise can help train you for surgery. We welcome this opportunity to partner with you in your care. Your commitment to this program will improve your surgical experience! The MSHOP s goal is for you to be as healthy as you can be before having surgery. This may shorten your hospital stay, lower your chances of any surgical complications, and speed up your recovery time. This book contains information and tools to help you get started. Your next steps should be to: Review this book. Watch the DVD. Go to our website for more helpful hints, and to see your progress. Clip on the pedometer and start walking! MSHOP focuses on four ways you can improve your health: 1. Move Increase physical activity. You have been given a pedometer to wear and track your steps. 2. Breathe You have been given an Incentive Spirometer to use for a few weeks before your surgery (or sooner if you are still smoking). If you smoke, now is the best time to quit. 3. Eat Focus on proper nutrition. Make healthy, balanced food choices before and after your surgery. 4. Relax Practice relaxation techniques. Managing or decreasing your stress will help in your recovery. You have the power to improve your surgical outcomes. We wish you good health, a speedy recovery, and a continued healthy lifestyle after your operation! Sincerely, The MSHOP Team 1
3 Getting Started How do you wish to receive your reminders? By joining the MSHOP program, you have agreed to track the number of daily steps you take and your incentive spirometer use, and report them back to our program. MSHOP will provide a reminder via the method and the time you chose. You can track your numbers using three different methods: 1. Daily text message You can track your steps and spirometer use by responding to a text message you will receive each day from the MSHOP system, Each day the text will ask you to record your steps (and spirometer use) from the day before. Note: you must enter your numbers before the next text comes in. OR 2. Daily phone call You can track your steps and spirometer use by responding to the phone call and entering the number at the prompt. The call will come from , the MSHOP system. If you miss the call, you can call back to report your activity, but you must do this from the same phone you are receiving calls on, and before the next call comes in. Note: the system will only accept a number OR 3. Weekly reminder You can choose to receive an that will remind you to go to the MSHOP website ( com) to track your steps and spirometer use. This method allows you to enter more than one day at a time. How to log onto the MSHOP website The MSHOP website allows you to: Log more than one day at a time as well as track any missed days of activity. Change the method of contact or time of day you prefer to be contacted. Track your progress! Find more MSHOP tips and tools. To log in Go to Click on Login at the top right corner: Use your address, if you provided one when you signed up, or the MSHOP Login ID you were given. Enter your password. If you forgot your password click forgot password and you will be ed instructions to change it. Helpful Hint: If you chose the text message or the phone call, you can still go into the website to enter missed days and to track your progress! 2 3
4 Using the website tracker Once you have logged in you will see a screen that looks like this: You can view your progress on the graphs. To log steps, you can enter a single day, or several days at a time. Click in the date field to choose the day you want to enter, and then enter the number of steps in the steps box. To log spirometer use, follow the same instructions lower on the page. Report your total number of breaths taken with the spirometer, your daily goal is 30. To make changes to your notifications, in the top menu bar click the gear icon and select My Profile to change your password or how you want to receive your reminders. MOVE The walking program Research shows that getting more physical activity before surgery can lower your risk for problems after surgery. It may even help you get out of the hospital sooner. Walking is a great way to improve your fitness level before surgery. Even if you start walking just a few weeks before surgery, it can make a big difference. Your MSHOP kit includes a pedometer that looks like this: Wear this pedometer every day, from now until your surgery, and use it to track how many steps you take each day. What are the benefits of a walking program? More energy Stronger muscles, less stiffness in joints Better appetite More positive outlook, less stress Faster recovery Less chance of surgical complications How long should you walk? If you are new to exercise/walking: 1. Start with 5-10 minutes at a time, or less if needed. 2. Try to walk a little longer each time. 3. Try to work up to a total of 30 minutes per day, on most days of the week. This can be divided up into shorter sessions at different times during the day. 4. Listen to your body! If you become short of breath, slow down or divide up your time. You should be able to carry on a conversation while walking. 4 5
5 If you walk or exercise regularly: 1. Use the pedometer to see how many steps you take on a normal day. 2. Try to increase your steps by every few days. This will mean adding 5-10 extra minutes each day. Your goal is to increase the number of steps you take each day from now until your surgery! A good walking program includes: 1. Warm Up: walk slowly for the first few minutes. This will help your heart, lungs, muscles and joints get ready for exercise. 2. Peak Activity: walk a little more quickly, without getting too short of breath. You should still be able to carry on a conversation. (Walking at a moderate intensity has been defined as walking at least 100 steps a minute, however, do what is comfortable for you.) 3. Cool Down: walk slowly again for a few minutes, until your breathing returns to normal. Your body needs this time to cool down so you do not become stiff and sore. Walking tips Wear comfortable shoes. Make sure they are shock-absorbent and have a skid-proof sole, especially if you plan to do indoor walking. Walking or running shoes are good choices. Pumping your arms as you walk will increase the intensity of the walk. Pace yourself. Plan your route so you can get home easily if you become tired steps is about one mile. Helpful hints The pedometer package contains the items shown here. Your pedometer should already be set up for you. However, there are detailed instructions included in the pedometer package, or you can reference the Pedometer Quick Start Guide found on page 13. The pedometer screen will go blank after a while, but the pedometer is still working. To see your current step count, push the mem button once. To find the number of steps you took on a previous day, simply push the mem button additional times to go back. The pedometer will reset to 0 every night at midnight, but it will keep the last seven days in its memory. If you have steps you wish to enter, you can log in to the website at Using your pedometer Using the pedometer is very easy. It can be worn on your waist band or clipped to a pocket, or can even be placed inside a pocket. 6 7
6 BREATHE Exercise your lungs Using the incentive spirometer before your surgery reduces your risk of breathing problems afterwards, including pneumonia. The spirometer also improves your lung function. Start using the spirometer two weeks before your surgery date. At that time your reminder (call/text/ ) will start to ask you how many breaths you took with the spirometer, each day. How to use your incentive spirometer 1. Sit up straight, without slouching. 2. Taking in a deep breath, blow all the air out of your lungs. 3. Place the mouthpiece in your mouth, sealing your lips tightly around it. 4. Breathe in slowly and deeply through your mouth. Focus on keeping the yellow valve in the best or better range on the left side of the device. 5. Once your lungs are full, remove the mouthpiece from your mouth and breathe out normally. 6. Rest for a few seconds and then repeat. 7. After 10 breaths, practice coughing to make sure your lungs are clear. 8. Your goal is 30 breaths per day. Repeat the set of 10 breaths three times each day to reach your goal. Helpful hints Watch the spirometer section of the DVD to see a demo! If you feel lightheaded or dizzy using the spirometer, stop and breathe normally for a few minutes. If you are in pain, you may need to take pain medication before your breathing exercises. It is hard to take deep breaths if you are feeling pain. You may find it helpful to use your spirometer while watching TV, during commercial breaks! 8 If you smoke, start using your spirometer the day you receive it! The most important thing you can do to improve your surgery outcomes is to quit smoking. Why should you quit smoking before surgery? Smoking makes it harder to be put to sleep for surgery. Your surgical incision will take longer to heal if you smoke, and you are more likely to have problems such as an infection at the surgical site. Your heart has to work harder when you smoke. Helpful tips to make quitting easier: Set a quit date. Talk to your regular doctor about prescription medicine or a nicotine replacement to help you handle the physical urge to smoke. Ask about smoking cessation programs that are available at your hospital or in your community. You can also go online to find helpful resources. Ask your friends and family for support in quitting. Stick with your plan to quit even after you leave the hospital. If you slip and start smoking again, don t quit quitting! Set a new date to give up smoking! For more information, contact MHealthy Tobacco Consultation Service (TCS) at , or quitsmoking@med. umich.edu On-Line Resources Phone Resources QUIT NOW ( ) If you have a smartphone, there are many mobile apps that can help you quit. 9
7 EAT Healthy nutrition before surgery Healthy eating plays an important role in your healing process. Eating a balanced diet before (and after) your surgery is important to make sure that your body will: Handle the stress of the surgery Heal quickly without any complications You should follow the nutrition instructions provided by your doctor and medical team, but here are some basic guidelines for good nutrition before surgery: Protein Known as the building blocks for cells and tissues. Protein is VITAL to your recovery. Eat at least 1 high-protein food with each of your three meals, every day before your surgery. See examples of high-protein foods on page 11. Calcium Dairy foods contain the highest levels of calcium, but if you are lactose intolerant, or want to avoid dairy, there are several good options for getting calcium. Examples include: calcium fortified cereal, spinach, sardines or instant oatmeal. Eat or drink at least 3 servings a day. Vitamins and Minerals They help your immune system and cell, tissue, and bone growth. Eating a variety of foods from each food group and at least four fruits and vegetables a day will give you the vitamins and minerals that you need. This is especially important before your surgery. This is one way to picture what a balanced diet looks like: Fruits and/or vegetables should make up half of what you eat. Eat smaller amounts of grains like breads, cereals, pasta, rice, pancakes, or biscuits, and smaller portions of meat. After surgery: high protein foods for healing After surgery, focus on getting enough protein. This will help you heal faster and maintain your muscle mass during your recovery. If you do not feel hungry, try to eat the protein part of your meal first, and try to eat four to five high protein foods each day. This usually means at least one high protein food each time you eat. Examples of high protein foods Meats Lean beef Lean pork Chicken or turkey Any fish or shellfish Dairy Foods Skim or lowfat milk Greek yogurt Cheese Cottage cheese Other Beans Tofu Eggs Nuts and seeds (incl. peanut butter) 10 11
8 RELAX Did you know that stress affects how well you do during and after your surgery? Managing the stress of preparing for and going through surgery can be challenging. However, there are some things that you can do to help reduce your stress. Strategies for reducing stress Deep breathing - Set aside a few minutes each day to sit quietly, listen to the sound of your own breathing, and focus on taking deep breaths. You can do this while using your Spirometer as well. Sleep - Aim for 6-8 hours of sleep a night. Getting enough sleep helps your mind to focus, gives you energy and helps your body and your immune system to work at its best. Find a support system - Make time to see your friends and family. Ask them to help support you in your new healthy habits. Meditate - It can be as simple as sitting quietly and focusing on positive thoughts, your breathing or an image. There are websites and smartphone apps that can be helpful as well, search methods of relaxation. Laugh - It releases tension and brings about positive physical changes in your body. Get active - Walking will not only help you feel less stress, but will also help you meet your goals for the program. Think positively - Positive self-talk can help you feel less stressed. When you have a stressful or negative thought, take a moment to consider whether the thought is a reasonable one. Try to reframe the negative thought into something more positive. For example, It will take me months to recover from this surgery, might be replaced with, I am doing everything I can to make my surgery go well. Joining MSHOP will help me take control of my recovery. Appendix A Pedometer Quick Start Guide There are detailed instructions included in the packaging, however, here is a quick start guide: 1. Remove the film covering on the pedometer. If you want to wear the pedometer clipped to your clothes, slide the pedometer into the grey clip that came with it. If you prefer to put the pedometer in your pocket, you may choose to leave the clip off, but be careful it does not fall out. 2. Press and hold one of the buttons marked: set, mode, or mem, until the screen blinks and you see all 8 s across the display. Then let go. 3. You will see, inch cm flashing on the screen. This is the first of several choices you will need to make. Note that the mode and mem buttons also contain up and down arrows. Push either the up or down arrow until you see inch, and then push set to confirm. 4. You will next choose if you prefer to see distance in km or mile. Push the up or down arrow until you see your choice, and push set to choose h will flash on the screen, which tells you the pedometer is set to military time. Press one of the arrows to switch to a 12 hour clock, and confirm by pushing set. 6. Next you will see 28 flashing on the screen. This is the default stride length programmed by the manufacturer. Push set to accept this stride length. 7. Finally, you will see 12:01 with the 12 flashing. Push the up or down arrows (to set the hour, push set and then repeat to set the minutes and whether it is currently AM or PM. 8. The pedometer should show 0 steps and you are ready to go
9 This publication was made possible by Grant Number 1C1CMS33140 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. Executive Officers of the University of Michigan Health System: Marschall S. Runge, M.D., Ph.D., Executive Vice President for Medical Affairs, Dean, University of Michigan Medical School; David A. Spahlinger, M.D., Executive Vice Dean of Clinical Affairs, President, Clinical Enterprise; Kathleen Potempa, Ph.D., Dean, School of Nursing. Regents of the University of Michigan: Michael J. Behm, Mark J. Bernstein, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mark S. Schlissel, ex officio. A Non-discriminatory, Affirmative Action Employer Regents of the University of Michigan.
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