MedStar Health Blog

Most of us have entered year three of the COVID-19 pandemic asking the same question: Will this ever end? Combined with increasing civil unrest and natural disasters, the pandemic has contributed to higher rates of stress, anxiety, depression, frustration, grief, weariness, and loneliness. 

It’s a lot to handle, no matter your social status, profession, or overall health. The good news is there are steps you can take to feel less overwhelmed and more in control of your thoughts and behavior. 

Though none of us know what daily life will look like after the pandemic, it’s unlikely that we’ll fully return to “how things used to be.” The unknown can be scary—but it’s also an opportunity for improvement. 

Following are eight ways to boost your well-being by strengthening your mental health and likely your physical health as well. If you’re struggling with sadness, stress, or anything between, pick a few that feel simple to do. Then build from there.

If you’re having suicidal thoughts, call 911 or the National Suicide Prevention Lifeline: 800-273-8255.

Related reading: How to Deal with Re-entry Anxiety and Post-pandemic Stress

1. Perform small acts of kindness.

I often tell patients that supporting others is an excellent way to be kind to yourself; helping people has been shown to increase happiness. It can give you a sense of belonging and connectedness, which often helps people feel more purpose.

With ongoing suffering due to the pandemic, small acts of kindness are more important than ever. You can show support in many ways:

• Compliment family, friends, and even strangers.
• Hold doors open for others.
• If you can afford it, tip generously. 
• Donate food or money to food pantries.
• Say “thank you” more often. 
• Offer to deliver groceries or perform outdoor chores for your neighbor.
• Find different ways you can contribute to your community.
  

I like to bake cookies and deliver them unexpectedly to colleagues. Showing kindness to others can help you feel less lonely and more connected to others by releasing hormones in your brain that stimulate satisfaction and pleasure.

Related reading: Gratitude Matters: Saying Thanks to Caregivers

2. Move every day.

Regular movement is good for both the body and mind. It’s especially important for people who have transitioned to working from home and tend to stay in one place for eight to 10 hours a day. 

You don’t have to start a strenuous exercise routine to reset your mind and release endorphins—chemicals in your brain that produce positive feelings. For example, I take a walk around the koi ponds at MedStar Washington Hospital Center over lunch almost every day. And I keep light weights in my office to lift while I’m on phone calls.

Start with building a few walks around the block into your daily schedule or making time for outdoor hobbies such as fishing or crabbing (when it warms up a bit). These activities can reduce stress, increase energy, and improve your overall well-being.

3. Get a good night’s sleep.

The better you sleep, the better you’ll feel. Poor sleep can increase mental distress and contribute to physical ailments, such as high blood pressure. To improve your sleep:

• Turn off the TV and stay off your phone an hour before going to bed. The artificial light and constant stimulation make it harder to fall and stay asleep.
• Don’t try to force sleep. If you’re in bed and can’t fall asleep, get up and do a calming activity such as reading or working on a puzzle before trying again.
• Talk with your doctor about sleep medication that might help—many prescription and over-the-counter drugs are effective.

Related reading: 8 Ways to Deal with Insomnia and Form Better Sleeping Habits

4. Spend time with animals.

Whether you’re partial to cats, dogs, or horses, spending time with animals can raise levels of oxytocin, a hormone that gives you that “warm and fuzzy” feeling. This calming effect can be especially helpful for people who don’t feel comfortable talking about their feelings; the presence of a beloved pet can help them feel more at ease.

People who have pets also tend to feel less lonely. If you don’t have one but enjoy being around animals, consider volunteering at an animal shelter to help reduce stress—and benefit from the additional mood boost of providing a service to others.

5. Eat a healthy diet.

A well-balanced diet can do wonders for your mood. Foods rich in antioxidants, vitamins, fiber, and protein can help you feel energetic, while foods loaded with sugar and saturated fat can leave you feeling sluggish. 

Our understanding of the connection between nutrition and mental health is only just beginning, but more research is pointing to diet as an important factor in managing mental health disorders. Eating more omega-3 fatty acids, produce, fish, and legumes, and fewer processed foods has been linked to a decrease in depression, for example. 

I’m not suggesting anyone hop on the latest diet fad. Instead, add more plant-based foods to your plate, such as broccoli, leafy greens, fruits, beans, legumes, lentils, seeds, and nuts. These eating habits are associated with better heart health and weight management, so it’s a win-win for your overall health!

Related reading: Eating Mindfully for Better Health

6. Relieve stress with meditation and yoga.

Meditation—training the mind to focus and stay present for a certain amount of time—takes practice to master. Try sitting in silence for 10 minutes a day with your eyes closed to observe how you feel mentally and physically; awareness is the goal. 

Consistently meditating can help reduce long-term stress; you’ll learn to recognize and manage feelings in the moment instead of letting your emotions take control.

Yoga adds stretching and breathing exercises to meditation to help you focus on developing a better understanding of the mind-body connection and improve mindfulness. 

Regular practice can help you improve your ability to recognize how you experience and respond to stress. Studies have shown that even just one hour-long session a week can decrease symptoms of depression and anxiety.

Related reading: Stress As Dangerous As High Cholesterol and Blood Pressure

Talk therapy is what people usually picture as “talking with a therapist.” Patients regularly meet with a trained mental health professional who can help them acknowledge and analyze thought patterns, behaviors, and environmental factors that might be symptoms of or contributors to negative moods and feelings. 

An increase in the number of people seeking mental health treatment has created longer wait times to see mental health professionals. However, many types of talk therapy are available from several sources. If possible, meet with different providers, from psychologists or psychiatrists to licensed therapists or clinical social workers, in a variety of formats to determine what works best for you. 

Don’t wait for an appointment if you’re having suicidal thoughts. Call 911 or the National Suicide Prevention Lifeline.

Related reading: 6 Signs You Should Be Concerned About Your Mental Health

8. Consider talking with your doctor about medications for anxiety and stress. 

Medication can be incredibly effective at reducing symptoms for some patients. Primary care physicians prescribe many drugs for anxiety and depression, so talk with your provider about medication options that might work for you.

Related reading: Recognizing and Treating Depression in Hospital Patients

Focus on what you can control.

If you find yourself feeling overwhelmed by stress, grief, anxiety, or other negative emotions, focus on what you can control. For example, you can’t control how other people’s behavior is contributing to the ongoing spread of COVID-19, but you can control what kind of mask you wear and where you wear it.

It can be tempting to turn to unhealthy habits when life feels out of control, such as drug or alcohol use or spending too much time in front of the TV. Instead, make a list of reasonable actions you will take to feel better every day or week, such as calling a friend or taking a walk before, during, or after work.

Everyone experiences emotions differently, so don’t feel bad about whatever you’re feeling. Instead, talk with your doctor or other trusted colleagues about developing a strategy that includes a unique combination of actions and treatment methods that will help you live as healthy and happy as possible during the next year—and many more to come.

Related reading: How Prioritizing Your Wellness Benefits Those Around You

Blood pressure is the force of blood pushing against the walls of your arteries. When the force is consistently higher than normal, it’s called hypertension, or high blood pressure. If you have high blood pressure, your heart has to work harder to pump blood, and this increased exertion can cause serious damage to the heart, kidneys, and eyes.

High blood pressure is a common health condition that affects nearly half of adults in the United States, according to the Centers for Disease Control and Prevention. Because many people with the condition don’t have symptoms of high blood pressure, it’s not always detected early when lifestyle modifications may help to manage it. When you don’t have symptoms, you don’t know to seek treatment, which is why hypertension is known as the "silent killer".

While the disease isn't always preventable, there are things you can do to lower your risk or manage it so uncontrolled high blood pressure doesn't lead to a fatal disease. Here is everything you need to know about living with or preventing high blood pressure.

Factors that increase your risk of high blood pressure.

We can't typically pinpoint one primary cause of high blood pressure, but we know that there are a variety of factors that can increase your risk of developing the condition. Some risk factors are out of your control, like having a family history of the disease and getting older. Other risks can be adjusted based on your lifestyle choices, like your activity level and nutrition. The following risk factors increase your chances of developing high blood pressure:

• An unhealthy diet that consists of food high in sodium
• Being age 40 or older
• Persistent stress
• Excessive alcohol consumption
• Smoking
• Family history of high blood pressure

Sometimes underlying medical conditions, like adrenal disorders, kidney disease, or obstructive sleep apnea, can cause high blood pressure, too. Called secondary hypertension, this type of high blood pressure may develop more suddenly. Women who are pregnant may also be at an increased risk of developing hypertension.

Many people don't have symptoms until hypertension begins wreaking havoc on their organs.

If you don’t regularly get your blood pressure checked by visiting your primary care doctor, you may not know you have hypertension. Like other diseases, high blood pressure doesn’t always result in symptoms until it’s had a long time to develop and damage internal organs. Many hypertension symptoms can be signs of something else, which is why it's important to establish a relationship with a primary care provider who knows what to look for. The following symptoms may be signs of persistent high blood pressure, especially if the condition has been affecting your body unknowingly for a long time:

• Headache
• Nosebleeds
• Irregular heartbeat
• Blood in urine
• Chest pain
• Exhaustion
• Worsening changes to your vision
  
  

Getting your blood pressure checked regularly can help you stay on top of your health.

Like other diseases, early detection of hypertension is critical to preventing long-term damage to your body. One of the best ways to maintain a healthy heart and stay on top of your blood pressure is to regularly get it checked by your primary care provider. That's typically the first thing we'll do at your appointment. You can also easily monitor your blood pressure at home.

A blood pressure reading consists of two numbers that measure how much pressure your blood exerts against the artery walls while the heart is beating  (systolic blood pressure) and while the heart is at rest between beats (diastolic blood pressure). The top number is your systolic pressure and the bottom number is your diastolic pressure. The American Heart Association recognizes the following ranges to indicate whether your blood pressure is healthy or unhealthy.

• Normal: Less than 120 / less than 80 mm Hg
• Elevated: 120-129 / less than 80 mm Hg
• Hypertension (stage 1): 130-139 / 80-89 mm Hg
• Hypertension (stage 2): 140 or higher / 90 or higher mm Hg
• Hypertensive crisis: Higher than 180 / higher than 120 mm Hg

If you have elevated blood pressure, we'll make a note of it and check it at subsequent appointments over the next few weeks. If you have high blood pressure readings on three separate occasions, your doctor will diagnose you with hypertension. If you ever have a critically high blood pressure reading, your doctor may diagnose you with severe hypertension which warrants immediate treatment.

Treating high blood pressure with the DASH diet, medication, and more.

For many patients, I recommend trying non-invasive approaches first to lower high blood pressure. For example, achieving a healthy body-mass index (BMI) may help resolve hypertension. Men should aim for a healthy BMI of less than 30, while women should aim to maintain a BMI between 25 to 27.

Regular exercise and a healthy diet can help, and the DASH (Dietary Approaches to Stop Hypertension) diet is a common approach to eating that can lower or prevent high blood pressure. DASH involves eating foods that are rich in calcium, potassium, and magnesium, which help to control blood pressure, while limiting foods that are high in added sugars, saturated fat, and sodium. The healthy-eating strategy incorporates a variety of foods in the right portion sizes so that you consume the appropriate nutrients throughout the day.

Many times, lifestyle modifications are enough to normalize your blood pressure. For others, blood pressure medication is necessary to keep your condition under control. If you're diagnosed with hypertension, taking steps to lower your blood pressure is important so that it doesn’t lead to a fatal event like stroke or heart attack, which are the leading causes of death in the United States.

Your foot is composed of 26 bones, 30 joints, and more than one hundred ligaments, muscles, and tendons that work together to provide stability, balance, and support as you move. When any one of those become damaged, it's harder for the foot to function as it's designed. If you develop pain in your foot or ankle, you quickly realize the important role your feet play in enabling you to live an independent life doing the things you enjoy.

Anyone can potentially experience foot or ankle pain in their lifetime, whether you're an adolescent athlete or an older adult. Sometimes pain is caused by an injury, like an ankle sprain, while other times repeated wear and tear over time causes painful conditions, like arthritis or tendonitis in the foot. Certain parts of the foot are at a greater risk of injury because of the amount of pressure they carry. Your Achilles tendon, for example, can hold up to 10x your bodyweight, making it more susceptible to damage.

If you have intense pain in your feet or ankles, you don't have to live with it. There is a wide range of treatment options that can alleviate your pain and get you back to the activities you love, whether that's taking your dog for a walk or running 5 miles.

Seek care if your pain is limiting your ability to participate in your daily activities.

Foot or ankle pain can often be attributed to a broken bone (fracture), arthritis, tendinitis, or deformity. Everybody has a different pain tolerance, and sometimes pain in the foot may subside with rest and time. But when severe pain in your feet or ankles prevents you from doing the things you enjoy, you should talk to an orthopedist with specialized training in treating the feet and ankles. It's better to get your feet evaluated earlier before your pain worsens and causes further damage. A foot and ankle specialist can recommend a variety of non-invasive treatment options or determine if you may need surgery to relieve pain.

A weight-bearing x-ray may help determine the cause of your pain.

 At your orthopedist's office, a foot and ankle expert will start your evaluation with an x-ray that can rule out certain conditions, like arthritis or stress fractures. The imaging can also determine if there is any misalignment in the bones of the foot which may contribute to discomfort. At MedStar Health, we also have access to advanced weight-bearing computed tomography (CT) technology, which produces an incredibly detailed image of your feet while you're standing. This kind of imaging technology isn't available everywhere, and we’re proud to be ahead of the current standard of care for our patients.

While imaging helps us easily diagnose if you have a broken ankle or a fracture in your foot, sometimes we can't determine the exact cause of your foot and ankle pain with the x-ray alone. That's why we'll ask questions about your symptoms, the location and frequency of your pain, and the kind of pain you're feeling. For example, heel pain may indicate a different issue than a sharp pain near your big toe.

Common causes of pain in the feet and ankles.

Men and women of all ages are susceptible to unexpected foot and ankle injuries, like sprained ankles, torn ligaments, and foot fractures. Likewise, anyone can develop painful conditions in the feet caused by repetitive motion, such as plantar fasciitis or rheumatoid arthritis. Abnormal anatomy, like having flat feet, can also cause pain in the ankle joints, on the bottom of the feet, or on the inside of the foot, depending on the individual. Men tend to rupture their Achilles heel five to six times more than women. On the other hand, women may be at an increased risk for bunions or a pinched nerve on the ball of the foot or toes (called Morton's neuroma) which causes radiating pain between the third and fourth toes. Narrow shoes with tall heels can contribute to these conditions.

In other cases, untreated ankle or foot injuries may lead to problems in the foot. For example, people may experience ankle instability if they had a sprained ankle in the past that didn't heal correctly. This can cause the ligaments to stretch out, which makes the ankle feel like it's "giving way", or loose. As a result, they are more likely to sprain it again or develop early arthritis, which may require more aggressive treatment.

Recovery time varies by individual and surgery type, but a successful outcome requires a commitment to following your doctor’s instructions. Some, but not all, procedures will require you to stay off your feet for the recommended period of time and not bear any weight on the leg you were operated on. You'll need to plan ahead for things like getting a ride (if you aren't able to walk, you can't drive), and navigating your home if you have stairs. But sacrificing your independence for a few weeks may ensure you're able to return to the activities you love without pain.

Every January, our Nutrition team answers an influx of questions from patients resolving to improve their health and lose weight in the new year. Intermittent fasting—a dietary approach that cycles between periods of fasting and eating—has become one of the most popular diet trends.

While celebrities including Jimmy Kimmel and Jennifer Aniston have created a buzz about the weight loss benefits of intermittent fasting, people have fasted for religious reasons for centuries. 

Clinical research on intermittent fasting is limited—and mixed. Some studies have shown that it can lead to improved health and mild or moderate weight loss. Others suggest that fasting has no significant long-term health benefits.

If you’re considering intermittent fasting to improve your overall health or lose weight, it’s important to understand:

• The plan’s basic principles  
• How to find accurate information about intermittent fasting
• That everyone responds differently to eating patterns

Intermittent fasting is not a quick fix for weight loss (there’s no such thing) or a plan that “allows” you to eat large amounts of processed or fast foods within limited time frames. Knowing how to start fasting and what guidance to follow can be confusing; there’s no shortage of advice available from both medical professionals and non-experts.

To help you learn how to incorporate it into your life safely, I’ve answered the five most common questions I get about intermittent fasting as a registered dietitian.

Related reading: Mindful Eating for Healthy Weight Loss

1. Is there a ‘right way’ to fast?

Intermittent fasting is popular because it's less about what you eat and more about when. Most people in the U.S. eat during a 12-hour window each day: 8 a.m. to 8 p.m., for example. Intermittent fasting changes this pattern by limiting the eating window or restricting calories during certain days. 

But there’s no “right” way to fast. People choose different patterns based on their lifestyle and preferences. Here are four methods to consider.

• 5:2 diet: With this approach, you eat as you normally would for five days each week. For the two remaining days—which are typically non-consecutive—you consume between 500 and 600 calories. On these days, choose low-carb, high-fiber foods, such as vegetables; grilled or steamed fish; boiled eggs; natural yogurt; low-calorie soups; and black coffee or tea. This approach tends to help those who respond best to only having to follow the “rules” during these two days. 
• Alternate-day fasting: A subset of the 5:2 diet, this plan alternates a “feast” day with a “fast” day every other day. Like the 5:2 plan, you consume 600 calories or less on fast days. 
• Circadian fasting: This pattern aligns your eating schedule with your natural hormone cycles. Our circadian rhythm—the body’s 24-hour clock—controls our sleep, digestion, hormones, and stress levels. Time your meals for early in the day when your energy levels are likely to be higher. Fast when the sun goes down and your energy decreases and digestion slows.
• 16:8 diet: This time-restricted approach is best for people who like routine. You choose an eight-hour eating window each day and consume most of your calories in the middle of the day. Some people skip breakfast, eat from noon to 8 p.m., and then fast until noon the next day. Others may eat from 10 a.m. until 6 p.m. Combined with regular exercise, this method has been linked to reduced fat mass and body weight and can be easier to follow consistently than more restrictive patterns.
  

I recommend trying different patterns to see which one—if any—works best for your lifestyle.

When combined with endurance exercise, most of these approaches can result in significant weight loss and help lower the risk of heart disease. They have also been linked to improved insulin sensitivity and blood pressure.

2. Can I eat whatever I want on non-fasting days?

Like any successful diet plan, no foods are off limits for intermittent fasters. But we always recommend that you eat more fruits and vegetables and fewer processed foods, whether or not you are trying to lose weight. 

Eating more plant-based foods rich in nutrients, vitamins, and minerals helps keep your immune system healthy. It also reduces your risk of chronic inflammation, which is associated with diseases such as diabetes, heart disease, liver disease, and several types of cancer.

While many people try fasting to improve their health, some try fasting to lose weight. We rarely recommend that weight loss be the primary goal of a diet plan, as studies show this approach typically does not result in long-term weight loss or improvements in health. In fact, it often negatively impacts mental health. But if you’re fasting to lose or maintain your weight, even if it’s not the primary goal, you should also be mindful of the amount of food you eat. 

Some people who choose more restrictive patterns of intermittent fasting eat more than they normally would on non-fasting days in anticipation of—or to make up for—eating less on fasting days. Because they’re consuming the same number of calories overall, their weight stays the same. 

Related reading: Fight Harmful Inflammation with These 10 Healthy Eating Tips

3. What are the health benefits of intermittent fasting?

When people fast, the body swaps its source of energy from glucose to ketones. This process, combined with exercise, is known as metabolic switching. Theoretically, it can change your body by flushing out damaged cells and replacing them with newer, healthier cells, making it possible to lose weight and reap long-lasting health benefits such as:

• Improved sleep
• Reduced inflammation
• Strengthened immune system
• Improved insulin sensitivity
• Increased energy
• Decreased blood pressure
• Improved digestion

Keep in mind that some people only experience one or two of these health benefits—or none at all. Everybody’s metabolism functions differently, and you might need to eat more often than someone else. 

I know people who say fasting helps them feel more energetic and other people who tried fasting and said it made them feel anxious and jittery. If any diet plan makes you feel worse mentally or physically, it is not safe to continue.

It usually takes two to four weeks for your body to become accustomed to new eating habits. Any side effects you may experience when you start fasting, such as headaches or irritability, usually disappear after a week or two. But if you’re miserable a week in, don’t force yourself to keep going. Accept that it’s simply not the right eating plan for you.

4. Is intermittent fasting sustainable?

The flexibility of intermittent fasting patterns makes it easier than other diet plans to stick to long term. If you’re eating a balanced diet, sleeping well, exercising, and in good health overall, it’s perfectly safe to fast long term, as long as you remain in good health, both physically and mentally. 

There’s not a lot of long-term research or peer-reviewed studies about fasting. However, studies have shown that the 5:2 diet often results in short-term weight loss because people have a hard time sticking to it over time.

The 16:8 method is often easier to maintain than the 5:2 plan because you’re eating every day. Yet even this approach can be difficult when you factor in weekends; some people fast only during the work week. The key is choosing a pattern that’s easily sustainable for your particular lifestyle.

5. Who should not try intermittent fasting? 

While intermittent fasting can be tailored to individual lifestyles, it is not safe for certain populations, including:

• Anyone under age 18. Their metabolism and hunger cues are not fully developed.
• People who are prone to restrictive eating patterns or have a history of eating disorders. Fasting can lead to or exacerbate binging and starving, over-restricting food intake, or eating/food anxiety.
• Those who need to take medication with food at specific times.
• People who are pregnant or breastfeeding. Fasting can cause low blood sugar. Plus, growing and feeding a baby requires sufficient—not restricted—calorie intake.
• Anyone who becomes irritable, shaky, or anxious when they don't eat for a certain amount of time. 
• People prone to constipation. While some report improved digestion after intermittent fasting, others have experienced constipation.

If you fall into one of these categories and want to change your diet, talk with your primary doctor or a registered dietitian about sustainable ways to do so safely. People with any type of health condition should not try intermittent fasting or any other diet plan without close monitoring by their doctor.

Many “wellness experts” provide well-meaning advice about intermittent fasting that can be harmful. In addition to speaking with a professional, when seeking more information:

• Ensure research you read is peer-reviewed from a trusted source (such as the National Institutes of Health or a peer-reviewed medical journal).
• View online searches with skepticism. If an “expert” is only presenting the benefits of a diet plan and also selling that diet plan, the information should be taken with a grain of salt. Many websites want to sell you a diet they claim is easy and magical for weight loss. However, in most cases the only loss you’ll see is in your wallet.

Bottom line: Intermittent fasting isn’t for everyone.

It can be easy to get swept into someone else’s excitement about a diet that works for them. But don’t get discouraged if you don’t experience the same results or if you find it difficult to stick to full-time intermittent fasting.

I’ve tried—and enjoyed—intermittent fasting in the past, but it wasn’t conducive to my lifestyle long term. When changing your eating habits for better health or weight loss, do what works best for you with the guidance of a credible medical professional who knows your medical history.

People generally don’t think about their digestive system—until it stops working properly. Then its impacts on daily life quickly become evident.

Any type of digestive malfunction can be distressing, so I understand why patients are often concerned after a gastrointestinal (GI) cancer diagnosis. However, misinformation about what caused their cancer and what treatment will be like can add unnecessary stress to the emotional burden they already carry.

GI cancer includes several types of cancer that develop in organs throughout the digestive system, such as the:

• Colon
• Esophagus 
• Liver
• Pancreas
• Stomach

These cancers comprise 26% of cancer cases worldwide and 35% of all cancer-related deaths. Symptoms for each type of GI cancer vary but typically include indigestion, weight loss, abdominal pain, nausea, and changes in bowel movements.  

Treatment usually requires surgery and sometimes chemotherapy or radiation. Though the experience is not easy or comfortable, advanced treatment gives many patients longer, healthier, and higher-quality lives. 

Knowing the truth about GI cancer diagnosis, treatment, and survivorship can help families spend less time worrying and focus more energy on healing. Here are five common myths—debunked—about GI cancer.

• Fewer complications
• Shorter hospital stays (and sometimes no hospital stay)
• Less pain during and after surgery
• More positive patient experiences
• Better long-term results

ERAS protocols are evidence-based, meaning they've been peer-reviewed and proven successful in real-life surgeries. While the "fast-track" recovery strategies aren't new to orthopedic surgery, they've only recently been applied to spinal surgery under the care of experienced teams trained to implement modern ERAS principles. Teamwork is critical to expedited recovery, requiring collaboration between the patient and specialists across different disciplines before, during, and after the procedure.

Patients play a critical role in enhancing spine surgery recovery.

Under ERAS protocols for spine surgery, your recovery plan begins before you even step foot in the operating room. At MedStar Orthopaedic Institute in Baltimore, we provide every patient with preoperative education and counseling designed to educate the patient on what to expect. Many patients share that going through the program helps them to feel equipped to be active participants in the healing process.

Patients are also asked to participate in pre-surgery rehabilitation, or prehab. The prehab program improves the body's overall strength and function before surgery, allowing you to return to resume activity faster and more easily afterward. Every patient also benefits from a virtual consultation with our acute pain service. During the telemedicine visit, patients are asked about any current medications as well as their pain tolerance and goals. This information helps your care team anticipate your needs on the day of and the weeks after surgery.

Modifying lifestyle habits before spine surgery can also lead to an expedited recovery, and patients are encouraged to:

• Optimize their nutrition
• Achieve a healthy body mass index (BMI)
• Minimize or eliminate opioid, alcohol, and nicotine use
  

Patients don't have to make these changes alone, as each patient is matched to a care coordinator who will help you navigate your surgical preparation and recovery. Our care coordinators are specially-trained healthcare professionals who work closely with your physician and care team to help you return to your active life as seamlessly as possible. Together, you'll develop a plan for rehabilitation that will help you reach your goals after surgery. 

During surgery, your multidisciplinary team proactively manages pain and the risk of complications.

A lot has changed when it comes to back surgery. Traditionally, patients were required to fast before undergoing an operation on the spine. Now, evidence proves that food and drink help to prevent your gastrointestinal system from shutting down during a procedure. Your care team will give you instructions for when you should stop eating and drinking before arriving at pre-op. In general, most patients are able to drink clear liquids up to two hours before surgery and solids up to six hours beforehand. Some patients benefit from a carb-loaded drink given once they arrive for surgery.

There will be a team of medical professionals invested in your surgery, including your surgeon, an anesthesiologist, nurses, physical and occupational therapists, and counselors. When you arrive for your procedure, you'll meet with an anesthesiologist or nurse who will give you analgesics to help manage your pain and your body's stress response before you go into surgery. Whether you're having spinal fusion surgery or another type, back or neck surgery is major surgery that puts stress on the body. By using a combination of oral pain medication like Tylenol, non-steroidal anti-inflammatory drugs, and Gabapentin before the procedure begins, you're less likely to need opioid medications after surgery.

During surgery, your surgeon and anesthesiologist work together to minimize blood loss that could lead to anemia. You'll also receive a regional or local anesthetic (pain medication injections) directly to the surgical site, which helps to control pain during the procedure. This multimodal approach to pain control results in earlier mobility, less pain, and minimized need for narcotics to manage pain following surgery. And, unlike other surgical procedures, most patients don't need a catheter, eliminating your risk of developing a urinary tract infection (UTI).

Contemporary strategies for post-operative care significantly reduce nausea and vomiting, thereby speeding up recovery.

In the past, patients weren't allowed to eat or drink until a day after surgery which meant that their gastrointestinal function was at risk for a partial or complete shutdown. As a result, nearly 50 percent of patients experienced nausea and vomiting that led to a prolonged hospital stay and recovery.

ERAS principles after surgery encourage patients to eat and drink early, which helps to expedite the return of gastrointestinal function. In combination with other strategies, this helps to minimize nausea and vomiting and speeds up recovery because you can regain strength more quickly with good nutrition. Your anesthesiologist will continue to help control your pain using the same multimodal approach applied during surgery. Research suggests that patients who participated in ERAS protocols were dramatically less likely to need pain medicine one month after surgery.