August 6, 2025 • 42 mins
Nurse Samantha Graham joins Speaking of Women's Health Podcast Host Dr. Holly Thacker to share her expansive nursing knowledge and provide essential guidance on preparing for surgery and breastfeeding success. Sam offers both professional insights and personal experiences to help patients navigate important healthcare moments with confidence.
- Various nursing career pathways from nursing assistants to advanced practice nurses
- Flexibility of nursing careers for work-life balance
- Critical importance of following pre-operative instructions precisely
- Special considerations for patients on weight loss medications before surgery
- Why honesty about tobacco, alcohol use, and medications is crucial for surgical safety
- Pre-surgical preparation including bathing protocols and avoiding shaving\
- Importance of having support persons during hospital stays
- Differences between local and general anesthesia options
- Practical breastfeeding advice focused on baby's needs rather than social media expectations
- Realistic approach to breastfeeding challenges and support resources
Visit speakingofwomenshealth.com for additional resources on breastfeeding and preparing for surgery.
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Holly L. Thacker, MD (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker.
Back in our sunflower house fora new podcast with a very
special guest.
I am so happy to welcome NurseSamantha Graham.
I met her almost it's been adecade ago.
(00:25):
She was my lead nurse in ourCenter for Specialized Women's
Health.
I just love her and she wasborn two weeks after my older
son, stetson, who's been on thispodcast, and I never fail to
let my son Stetson know how muchSam has beat him in terms of
marriage and buying a house andhaving her first child.
(00:46):
Anyway, it's so wonderful tohave Sam here in the Sunflower
House and I want to tell you alittle bit about her.
She earned her Bachelor ofScience in Nursing at Muskegum
University.
She then went on to earn aMaster's of science in
management and leadership andshe did work in our Center for
(01:09):
Specialized Women's Health andshe's now a preoperative nurse
educator at Cleveland Clinic andshe personally came in to do my
pre-op nursing when I had majorsurgery a few years ago and
just recently, my husband.
She wasn't even scheduled towork and she came in.
That is dedication.
(01:30):
Everybody would want a nurse,just like Samantha Graham.
So welcome Samantha.
We're so excited to have you asa guest here to talk about a
lot of important topics.
Samantha Graham (01:42):
Thank you, thank you.
I'm super excited to be welcomeon this.
I can't wait to talk about allthese great events or great
topics and things like that.
Holly L. Thacker, MD (01:50):
So Sam is a busy, busy woman married to a
very handsome man.
She's got a wonderful family inNortheast Ohio and she's the
mom of two boys, eight years old, because of course she beat
Stetson by four years, becauseArtemis is just four, almost
five, and she is a five-year-oldtoo, so she is just full of
(02:15):
energy and she gets up at thecrack of dawn to run.
In fact, in the hospital I raninto her, I think, at like five
in the morning because she wasgoing to the gym.
So we want to talk about a lotof different things.
This is airing in August, whichis Breastfeeding Awareness Month
, and so Sam's been abreastfeeding mom.
She's helped a lot ofcolleagues and friends and
(02:37):
family with breastfeeding, and Imainly also want to focus on
her current expertise in termsof just a career in nursing,
what goes into being a nurseeducator, and also just a little
bit about just preoperativepreparation and preparing for
that, because that is such a bigdeal and some people may get
(02:59):
out of this life without havingany major surgery, but most
people don't.
So I first want to start off byasking you how did you decide
to get into nursing?
Samantha Graham (03:10):
Oh geez, I decided to go into nursing when
I was taking care of my elderlygrandfather, just really taking
care of him alongside my mother,dialysis, his diabetes, his
cancer diagnosis, my mom'scancer diagnosis.
At a really young age Iremember people taking care of
my mom through her major lifesurgery and I just knew right
(03:30):
away that was something I wantedto do.
Holly L. Thacker, MD (03:33):
Well, it's a great field, and do you think
it's a good field for peoplewho want some flexibility, they
want to raise a family and stillhave a very fascinating,
interesting, helpful, demandingcareer?
Samantha Graham (03:45):
Absolutely.
I agree wholeheartedly that youcan get out of nursing whatever
you put into it.
As I still teach nursingclasses in the evenings, I say I
tell everybody the world isyour oyster, whatever schedule
you want, wherever you want towork, wherever location, it's
out there and it's available.
So you're.
You want to be a mom, so youwant to spend time with your
(04:06):
kids.
There's weekender programs,there's night shift, there's day
shift, there's part-time,there's per diem.
In today's world, the job isavailable as long as you want it
.
Holly L. Thacker, MD (04:18):
Well, that's fabulous.
Talk a little bit about all thedifferent types of nurses there
are.
I mean, my mother was a nurse,she was an RN.
Talk about LPN versus medicalassistant and techs versus RN
versus BSN, et cetera.
Samantha Graham (04:37):
Yeah, this is great topic because a lot of the
times our high school studentscome through and they want to
know as well.
Where should I start?
Definitely, the nurse's aide ismore doing the patient care
aspect of the vital signs, theassisted daily living of help
feeding, help, dressing, helpwith their everyday activities.
(04:59):
An MA or a medical assistanthelps the physicians or the LIPs
in the office.
They help with their rooming,their patients, their vital
signs, their testing whenthey've taken their last
medications, immunizations.
That is more AIDS or nurses'AIDS and MAs is much less.
(05:21):
More certificate schooling,more technical schooling.
Those degrees you can get veryquickly, some even right out of
high school.
Some high school programsaround here offer those, which
is a great opportunity to getinto health care at a very young
age, getting that seniorityvery quickly in the hospital
area and then hopefully going toan area that offers tuition
(05:43):
reimbursement for you to go toschool.
We're very fortunate in theCleveland area for all of our
surrounding areas to do that.
Lpn is typically a year to a15-month program, more of a
certificate program as well.
The pendulum swings both waysof where do LPNs work.
We're seeing them more in thehospitals.
We see them in the outpatientsetting.
(06:04):
We're seeing them even in theORs.
They're typically they werearound for labor and delivery
and now they're everywhere.
They're a great asset to thenursing family because we all
were in the team nursing aspectRN there are a couple of
different RNs.
You can get your associates, youcan get your bachelors.
That associate's degree is twoyears, typically 15 months to
(06:28):
two years, and that bachelor'sdegree is that four-year degree.
It just again kind of depends.
If you are, you know, can youafford that four-year degree?
Are you going to go to atwo-year degree and then get a
job where they pay for you toreturn to school to get your
bachelor's degree?
You know, like I said, as longas you're motivated and you want
it, you can absolutely achieveit.
(06:48):
There's so many programs outthere, online and in person or
at night or weekend programs,and then those higher level
degrees of NP, msn or nursepractitioner, a master's of
science of nursing, a doctorateof nurse practicing and even a
PhD.
So we can go all the way up oryou can just start at the bottom
(07:10):
as well, and those are greatopportunities within healthcare
that have so much jobavailability now.
Holly L. Thacker, MD (07:19):
Well, I started in high school as a
candy striper and then Irealized I could get hired as a
nursing assistant.
And boy, what a great exposurethat was as a high school
student working alongside thenurses, going from surgical
floors to medical floors, evento labor and delivery.
So I really kind of got exposedat a really young age and felt
(07:42):
very comfortable in the hospitalsetting, which, of course, the
hospital setting can be sointimidating to people who
aren't used to it, particularlyif they're ill or their loved
one is ill.
And I do think that all thesedifferent entry positions are
really great and they'recertainly in demand.
And isn't nursing faculty andteaching, like you're doing,
(08:04):
quite in demand?
I thought that the current cropof nurse educators a lot of
them are aging into retirement.
Samantha Graham (08:11):
Absolutely.
The need for qualified nursinginstructors is huge, especially
in our Cleveland area area.
I'm not sure around the wholeUnited States, but we have so
many great nursing programs inour Northeast Ohio area that are
in need of good instructors.
A couple of reasons youmentioned the aging retirement
(08:35):
age of people retiring and thenyou need a certain amount of
years of experience before youcan teach.
So making sure you have thosecouple of years underneath your
belt you know really becoming acontent expert in your area or
your field of nursing thatyou're in before you can go into
that college experience.
To be able to teach an RN class, you have to be master's
(09:00):
prepared.
To be able to teach a clinicalthough take students into your
facility you do have to bebachelor's prepared.
So there is some extraschooling that is required to be
able to go into the classroom.
Holly L. Thacker, MD (09:12):
Very interesting and I guess we can
tell our listeners.
You moved on from the Centerfor Specialized Women's Health
because you personally wantedflexibility based on hours.
I so wanted them to be able tolet you do remote work.
You know for a lot of it, youknow just based on your
children's schedule, but itcertainly seems like it's worked
(09:33):
out really well for you to.
It's like broadened your wholecareer experience.
Samantha Graham (09:40):
Oh, a hundred percent.
I'm doing research, I'mpublishing within the Cleveland
Clinic, I'm going to conferencesand speaking at podiums.
In regards to the specialtynurses, I'm certified in two
different areas ofperianesthesia nursing.
It's a good feeling and my cupis full and I will like coming
(10:00):
to work.
I tell everybody that I love myfamily, but I love coming to
work.
It's a good feeling.
I miss women's health.
I will tell everybody that,through and through every
semester, every student I comeacross, my previous life is all
in women's health.
I would go back tomorrow.
I would have gone backyesterday if the schedule would
have permitted or life wouldhave permitted, because my heart
(10:22):
really is in women's health.
But I still can do that withall my patients, even in it's so
wonderful and it's so great.
Holly L. Thacker, MD (10:32):
It is wonderful to have a passion and
enjoy work for so many reasons,and I know your patients know
because you just radiate it.
So let's move on to talk alittle bit about getting
mentally and physically preparedfor surgery, and you can
obviously talk about it from alot of different perspectives.
(10:52):
As a daughter who've taken careof you know your mother, who
had such major surgery, and youknow she did so well and that
was such a big deal.
You've also undergone it as amom with you know, with one of
your sons, and I know I have too, and that's just terrifying to
be on the other side.
In fact, they had me apply thegas mask to my baby Stetson
(11:15):
actually, and his body goes limpbefore they could do a lacrimal
gland procedure underanesthesia and then just for the
adult personally undergoingdifferent types of surgery.
So why don't you talk aboutjust those perspectives as well
as making sure that you as thecaregiver or you as the patient
(11:36):
are kind of healthy and readyfor surgery?
Samantha Graham (11:39):
The first thing that I really want to emphasize
for patients or anybody goingto surgery is have your
questions answered before you goto the hospital.
I cannot tell you how manytimes patients come in and they
simple question of is my surgeongood?
Or they want to be reassured,I'm sure, or just do you know my
(12:02):
surgeon?
Or asking me questionsspecifically about their
procedure, and I had to, youknow, remind them I'm not in the
room with you.
Would you like for me to getyour surgeon or whoever's going
to be in the room with you tocome and answer those questions?
I like to tell people to makesure you any questions, comments
or concerns, contact thatdoctor's office.
(12:22):
Set up the appointmentvirtually in person.
My chart message, whatever youneed to do so that you come in
with a peace of mind and theconfidence that you made the
right decision and that you arethere for the right reasons.
I also like to tell everybodyto know their pre-op
instructions is huge.
I know that is a big topic withour IV shortages post the
(12:46):
hurricanes.
Anesthesia guidelines are alittle always changing.
New medications hit the market.
The weight loss medications hitthe market.
The weight loss medications hitthe market.
We're seeing those affectinganesthesia.
Holly L. Thacker, MD (12:59):
Tell us about that, because weight and
weight loss information ismidlife women's number one
concern.
Even though it's not amenopausal symptom, ladies, but
it's something that pretty muchall women are interested in, and
it kind of peaks at midlifewhen the metabolism slows down
due to age.
Samantha Graham (13:16):
So often patients who are on these weight
loss injections or medications,they are very scared to have
surgery.
Because the first thing we tellthem is, depending on what type
of surgery they're having done.
If it's more minimal, you knowyou have to hold it for at least
a week.
But if it's more if you werehaving that abdominal surgery, a
longer procedure it is you haveto hold that injection for two
(13:38):
weeks.
And when you're on it for weightloss medication, for weight
loss reasons, often people getnervous.
They're nervous that they'regoing to gain weight back,
they're worried that they'regoing to get that hunger back or
they're worried that, whateverthey're thinking about it.
And so when I, when we tellpatients like you need to stop
your injection two weeks beforeor one week before, they're
(14:00):
right away.
Well, when can I start it?
Right back up or whatever?
You know, whatever the case maybe, and I know they're so
nervous and it's that's aconversation you need to have
with your doctor after theprocedure.
You know as you're restartingall your medications after the
procedure.
You know as you're restartingall your medications after the
procedure.
Holly L. Thacker, MD (14:15):
But those weight loss meds are huge.
What's amazing to me is that Imean, I always ask my patients
in the outpatient area bring inall your medicines and
supplements.
And they'll say, well, justlook on the chart, or they can't
remember, or they're not sure.
And even over-the-countersupplements some of them have to
be stopped before surgery.
They can have potent drug-drugor drug-food et cetera
(14:36):
interactions.
And really being on top of whatyou're taking, when you have to
stop, when you have to startand I think there might even be
some physicians who want theirpatients off those GLP
inhibitors even more than twoweeks, because they can really
paralyze the stomach, which ifthere's food in the stomach and
(14:56):
it's supposed to be empty andyou get intubated because you're
going under general anesthesia,if you aspirate that into your
lung you can die.
So it's really serious to likepay attention to what they tell
you to do or not to do.
Samantha Graham (15:11):
And answer the nurse honestly yes, yes,
especially with thosesupplements that you mentioned.
A couple of reasons yes, theyinteract with anesthesia.
Certain also have bleedingeffects.
Again, if we're creating a holein your body or a cavity in
your body, we want to make surethat we know we can keep your
bleeding under control.
So that's another thing wherewe're like, if you are on a
(15:34):
blood thinner or if you are onheart medication or if you have
actual diabetes, we want to makesure that you are optimized for
your procedure this day ofsurgery.
So following those instructionsare so important.
When we have those GLPmedications or those weight loss
medications and thatanesthesiologist does go and put
that tube down your throat,they're literally seeing whole
(15:58):
meals that aren't digested atall yet, oh my, and it's very
dangerous.
And so there's a reason we'renot just telling, we're just not
trying to make your life, youknow, unfortunate or whatever
the case may be.
But when you say, bring in yourmedications, well, it's in the
chart, whatever the case may be.
But when you say bring in yourmedications, well, it's in the
chart.
We are seeing a lot of med spas, a lot of holistic
(16:22):
practitioners out in thecommunities that don't speak
with our electronic medicalrecord, so we don't know.
So when we're asking, sometimespatients do get a little
frustrated or anxious about it.
Why are you asking me thesequestions?
Holly L. Thacker, MD (16:31):
It's just we want to keep you safe, that's
all we care about Absolutelythat is so important and even
dietary instruction, and we havesome information on our
speakingofwomenshealthcom siteand you're actually listening to
our Speaking of Women's Healthpodcast.
I'm the host, dr Holly Thacker,the executive director.
Host Dr Holly Thacker, theexecutive director, and we are
(16:53):
speaking with nurse SamanthaGraham, who is an expert in a
lot of areas in terms of nursingcareer, nursing education,
preoperative nursing care andalso breastfeeding that we'll
touch on.
So on our website,speakingofwomenshealthcom, which
(17:18):
you can bookmark or look up, wehave a whole column of foods
that interact with medicines andit's interesting because to me
as a patient, I got instructionslike certain foods not to eat
before surgery because there'slike, for instance, in white
potatoes there's a substancethat can prolong the effects of
anesthesia.
So like a sweet potato was fine,but not a white potato of
(17:38):
anesthesia.
So like a sweet potato was finebut not a white potato.
And there's foods and justherbs and supplements that might
thin the blood and blood lossis like a real big concern
because some surgeries areobviously a lot bloodier than
others, just like blood clotsare.
If you're immobilized underanesthesia, having major
abdominal, pelvic or extremitysurgery, that can certainly be a
(17:59):
risk and both bleeding to deathand having blood clots, as well
as infections and anesthesiacomplications, are kind of the
big things on the nurses, thephysicians, the whole medical
team and hopefully the patient'smind the whole medical team and
hopefully the patient's mind.
So one of the things they hadmy husband do was swab his nose
(18:19):
before surgery to see if he wasa carrier, a staff or strep.
Do you want to talk about thatand why people have to?
Samantha Graham (18:25):
pay attention.
The research on that isactually still kind of new.
It's always evolving in regardsto staff and MRSA, which are
really serious complicationsthat you can get after surgery
in your surgical site,infections which we know cost
the patients time and money andcost hospitals time and money.
(18:45):
So if we can prevent that witha simple nose swab prior to
surgery to see are you a carrierfor it, and if you do, that
doesn't mean you're dirty or any, because sometimes patients
think that, oh my goodness, Ihave, I had it, or that I,
whatever.
No, it's just an extraprecaution, just like a simple
wash that we give our body justto make sure we're clean.
(19:06):
We're going to put on thatantibiotic up your nose five
days before surgery and the dayof surgery just again to ward
off, like I tell everybody thoseevil infections that we don't
want.
Holly L. Thacker, MD (19:20):
Yeah, because antibiotic-resistant
infections can be deadly or cannecessitate, like six weeks or
more of home IV antibiotics.
Talk to us about the bathingand the shaving.
Some people are told not toshave or not to get pedicures or
not to have, you know, cool,funky nail polish, as well as
the special wipes and thingsthat people might need to do of
(19:40):
their body or body parts beforesurgery.
Samantha Graham (19:44):
Yeah.
So bathing certain physiciansorder certain baths or
preparation to surgery.
So we might do a Hibiclens or achlorhexidine bath or we might
give you special towelettes thatyou wipe each body part with,
one wipe on each body part.
Again, that's an extraprotective barrier that we are
doing to help get rid of anypotential infection that you may
(20:05):
have brewing on your skin.
You know your skin is yourlargest organ and we're going to
create like a cut or somethingwith surgery, with that.
As far as not all surgeriesneed a special body prep, but a
lot of surgeons do ask, if notto at least do a dial wash.
(20:26):
We say that because you knowthe bath and body works or
whatever is out there reallyquite aren't that great at
getting microorganisms off theskin.
The biggest complaint patientscome in and saying my skin is so
dry or it's so itchy becauseit's so dry.
It isn't.
It's not, it's not moisturizing.
Again, it's stripping that skin, making sure we're getting it
(20:48):
nice and clean.
As far as you know the nailpolish and the pedicures and the
shaving, I like to telleverybody when you're going into
surgery, less is more right.
So a pedicure they're cuttingyour cuticles, things like that
we.
Or nail polish on your toes,we're checking circulation,
(21:09):
we're making sure that you'restill perfusing your blood
throughout your entire body, aswell as making sure you're
having good pulses and thingslike that.
So if we don't know what youlook like prior to surgery or
what your nail bed looks likeprior to surgery, we're going to
have a hard time looking at itpostoperatively as well.
When you're under anesthesia.
All we can do is look at youbecause you can't tell us what's
(21:31):
going on.
So we really want to keep yousafe with our monitoring system.
So if you have, you know, a bigfunky nail on there or some
thick nail polish, with ourupdated medical technology can
the monitors go over your fingerand you're fine?
Absolutely.
But again it's looking at thatnail bed, looking to see are you
perfusing?
Well, that we're really lookingfor.
As far as shaving, again thatless is more.
(21:52):
When you're shaving, you knowit doesn't matter how good you
are.
You're nervous for surgery,things like that.
You might nick the skin andthen that is another portal for
an infection.
If we have to shave beforesurgery, we have our razors back
in the OR where we handle itfor you.
So don't worry about that.
It's included in the cost.
Holly L. Thacker, MD (22:11):
That's good.
You get that in the cost.
You know, I tell womenfrequently who do like shaving
of their vulva area just becausethey don't want pubic hair,
that like we don't shave thepubic hair before pelvic surgery
because it revs up morebacteria and so when they're
shaving it at home they're alsoincreasing their risk of ingrown
(22:32):
hairs, infection and just morebacteria.
So some people think it'scleaner, but a lot of times it's
certainly it's not.
And in terms of following theinstructions about not eating or
drinking or what medicines totake or what medicines not to
take, that is so important and Iknow different surgeons,
depending on the procedure, havesome different recommendations.
(22:55):
Like I was surprised that theysaid if you regularly drink
coffee and you think you'regoing to get a caffeine
withdrawal headache, you couldhave a little sip of black
coffee on the morning of surgery.
But I was just talking to oneof my friends who went in for
just a screening colonoscopywhich is under conscious
sedation, not general anesthesia, and they delayed his
colonoscopy by several hoursbecause he had had a cup of
(23:18):
coffee.
So you know, you might've beenable to have a sip of coffee one
day but not the next.
So you really have to followthat.
Do you want to talk abouttobacco and alcohol and being
honest and why those thingsreally make such a big
difference?
Samantha Graham (23:35):
Especially when we're talking about certain
procedures such as orthopedic orjoint replacements, or when
we're talking about bone.
Alcohol, tobacco can absolutelyhinder your healing process and
if we're putting somethingartificial in your body and
you're already compromised fromthe alcohol or tobacco, it can
really hinder your healing orrejection of that joint
(23:56):
potentially.
Being honest, sometimes can becumbersome to patients, because
some surgeons won't really wantto do surgery on a patient that
is a really chronic nicotine oralcohol abuse because of their
risk of an unsuccessful surgery,exactly.
(24:17):
And so some doctors go as faras ordering a nicotine test.
Absolutely, I see that, yes,they will offer the nicotine
sensation.
They just don't.
They still are helping you.
They're not just sending you onyour way and telling you quit
smoking and come back.
They're trying to get you theresources.
They're trying to make youoptimize for surgery.
It's not that they don't wantto, they just want.
(24:39):
Like I said, we just all wantto keep you safe.
Holly L. Thacker, MD (24:42):
Years ago I used to do preoperative you
know, medical assessments beforesurgery in our pre-op clinic
before I opened our center forspecialized women's health and
you always wanted that patientmedically optimized and I always
hated to have to tell thepatient and also call the
surgeon to say this person justhad a heart attack, so their
(25:02):
elective cosmetic surgery reallyneeds to be delayed until
everything has stabilized withtheir cardiac situation.
And speaking of cosmetic typeprocedures, which you know a lot
of women and some men areinterested in is I do know
several plastic surgeons whowill not operate on anyone who
has any nicotine in their systembecause the skin healing is so
(25:25):
bad.
And so even if you're going infor something that isn't
cosmetic, you know.
If it's an internal surgery,you want everything to heal
right, even if it's not cosmetic, that's for darn sure.
Because repeat surgeries andfailed surgeries, failed devices
it can be really terrible andreally nasty.
Samantha Graham (25:45):
For sure and even to making sure your
diabetes is managed.
If you have poor or if you havea high A1C, again that high
sugar infection breeds on thathigh blood sugar.
So making sure as well,patients that come in for
surgery, we do a day of surgeryblood sugar test just to make
sure you're not too high andyou're not too low, and we're
(26:08):
not judging or seeing ooh, whatdid you eat last night?
Again, we're making sure thatyour level is just right for
that good surgery time and forthat wound healing
post-operatively.
Holly L. Thacker, MD (26:20):
That is so important and I tell patients
who get serious diagnoses andtheir attention of trying to be
healthy is really more focused.
You know, with new cancerpatients, any serious condition
that even just changing yourdiet strictly in a few weeks or
a few days can make such a bigdifference.
(26:41):
Taking out those carbs andeating heart, healthy fats and
proteins and just only gettingcomplex carbs can dramatically
drop your blood sugar.
So even if you previouslyweren't well controlled, even if
you had diabetic complications,it can really improve your
chances of responding to themedical therapy and the surgical
therapy so much better.
(27:01):
And a lot of people think, oh,it's too late or I'm addicted.
And with the alcohol it can bereally serious if you do have
alcohol dependence and you don'tlet your health team know that.
Because if you're out of it andyou're post-op and you start
going through alcohol withdrawal, that can be deadly deadly, as
well as the bleeding risk withalcohol.
Samantha Graham (27:23):
There's that bleeding risk.
That is that waking up withthose DTs or those deliriousness
that we see patients come outof and that we don't know.
Some people are very highfunctioning with their alcohol
abuse or sometimes it's.
Whatever the case may be, wereally try to make sure that we
address it.
But because, again, that safetyis huge for post-op, you know
(27:49):
everybody has a plan and youknow if you're.
If you don't tell yourhealthcare providing team you
know what it is, what's going onthen you know it can have some
issues in the back end.
Holly L. Thacker, MD (28:01):
Now things like contact lenses.
People who are so used towearing contact lenses sometimes
they wear them overnight.
What do you tell them aboutthose things?
Hearing aids, contact lenses,assisted devices?
Samantha Graham (28:13):
Yeah, absolutely, good question Right
away Any dentures, hearing aids,contact lenses?
Again, that less is more,because in our area you do not
allow any assisted devices orhearing aids, or dentures or
(28:41):
contact lenses, anything in theoperating room.
Now, in the pre-op setting,while we're asking you your
questions, while we're gettingyou ready, while you're still
sitting with your loved ones.
Absolutely, but when we weregoing into the operating room we
were putting you to sleep Againwhen your eyes are rolling back
.
We don't want to have themstuck back there.
We don't want to have a cornealabrasion afterwards.
Hearing aids and dentures andeven contacts are very expensive
(29:05):
.
We want to give them to yourloved ones so they keep it safe.
We don't want it gettinghustled and bustled with the
changing of the beds and goingback to your bed and it's
sitting in a hallway.
God forbid anything happens.
So, yeah, we just let keep allyour belongings with your family
.
Now, if their patient cannothear, cannot see without their
contacts, or they cannot hearwithout their hearing aids, we
(29:28):
will do the safety huddle at thebedside while they have those
devices, with anesthesia, withsurgeon, with your OR team, and
then right after surgery, wemark in the chart to have your
loved one bring them back to youwhen you're awake.
So I don't.
People often wonder.
My husband has never seen mewithout my dentures, so I don't
want my husband to see mewithout my dentures.
I'll put it on the chart.
(29:48):
We'll have the PACU nurse comeand bring your dentures right
after surgery Once you're awakeand stable.
Absolutely, you know that.
You can look on Google orYouTube.
You know some patients nottelling their anesthesiologist
that they have dentures and thedentures have been down their
throat while they intubate apatient.
So absolutely they have to comeout.
(30:09):
Any.
We asked do you have any loosechips, wiggly teeth, thing like
that, or dentures?
Holly L. Thacker, MD (30:15):
because as they're putting that tube down,
it's a big tube and if it goesdown that throat we're in some
issues, yes, and so for peoplethat know they have to have
elective surgery and obviouslyemergency surgery is just a
totally different ballgame, butmost surgeries are scheduled,
most surgeries are elective.
I think that for patients tosee their ophthalmologist, to
(30:37):
see their internist or primarycare doctor to get a dental
checkup and take care of aninfection or a tooth that might
need to be pulled um, to gettheir health maintenance if they
haven't had their mammogram orcolonoscopy or blood work, and
to really work on getting thatblood sugar and all their
metabolic indices, it's justreally.
It's like you're kind ofpreparing for a marathon.
(31:01):
So, we talked about all thethings people should bring to
the hospital.
What are a couple of thingsthat absolutely the patient
should bring with them when theyshow up at the hospital that
they should not bring?
Samantha Graham (31:10):
with them.
No, they should.
They should their medications.
I know we are a hospital, wewill minister our medication.
But if you, we, if you don'tknow your dosage, if it's not in
there correctly or if you gotit changed from a different
provider, we don't know yoursupplements like or whatever,
whatever medicines you're on,bring those.
(31:32):
Your living will, your medicalpower attorney, needs to be
scanned in prior to surgery.
Living will, your medical powerof attorney needs to be scanned
in prior to surgery.
These conversations also shouldbe having prior to you coming
to the hospital.
We do sign a lot of medicalpower, our living will, medical
power of attorneys right beforesurgery.
I do witness a lot of them.
But those are bestconversations to be having to
(31:55):
have already all signed, sealed,delivered prior to surgery and
have.
Most important is have yoursupport person with you.
Unfortunately, with COVID wenobody was allowed to come into
the hospital, which is a veryunfortunate time for us in a
whole Our patients, us everybody, whole our patients, us
(32:20):
everybody.
But have that support personwith you is really important so
that when you can't talk foryourself, somebody is there to
talk for you and support you.
Holly L. Thacker, MD (32:25):
That's very important and I know my
husband was so used to hiswedding ring, his watch.
You have to leave all of thosevaluables at home, even though
it feels like you're naked.
You just keep them in at home.
But they do want your photo IDbecause there have been some
cases of people showing up forother people's surgeries to get
so insurance fraud is real.
(32:46):
Yeah, so they do want yourinsurance card and your photo ID
.
But other than that, really youwant to be traveling light.
So what tell us aboutanesthesia?
And some people, of course,have have local anesthesia where
they get sedation as, asopposed to general anesthesia.
Some of our listeners may notreally understand that
difference.
Samantha Graham (33:06):
So local anesthesia is when they are able
to do a minimal invasivesurgery that has a quick
recovery time and or a quickprocedure time.
An example like that a carpaltunnel procedure, maybe a
manipulation of a joint or ashoulder what else?
A colonoscopy?
(33:26):
Those are those minimalinvasive surgeries that we will
just do light sedation.
Or we could do something like aperipheral nerve block, where
we can block that extremity sothat that patient cannot feel
the area while the surgeon isdoing the procedure.
Don't worry, you're notcompletely awake.
There are some othermedications that we can give
(33:47):
through your IV so that youdon't even know your own name,
so that you're nice and out ofit, because some patients are
like I don't want to hear, Idon't want to see, I don't want
to know anything, and that'scompletely fine.
Those are also for patientsthat maybe have that heart
condition or have that othercomorbidity where they're not a
good candidate for generalanesthetic.
(34:07):
Now, when we're talking about ageneral anesthetic, that is
that when you were putting youto sleep and that patient is
getting intubated by theanesthesia provider.
Other things that we can do areepidurals during surgery,
spinals during surgery.
I know we hear those a lotduring labor and delivery.
We still do those on ourpatients prior to surgery.
(34:27):
So some of our hip replacementpatients get a spinal just to
help with pain control aftersurgery.
So when the pain team comes inand talks to you and they're
like, well, why do I need that?
Or why do I need my whole armIf I'm still, they still might
go to sleep Again, a lot of thatthat pain control for during
the procedure and even after theprocedure that are some great
(34:50):
options to decrease the amountof narcotics and opioids that
you need after the procedure.
Holly L. Thacker, MD (34:56):
Yes, those local blocks, and some of them,
can last for quite a long time,but you have to kind of be
prepared when they wear off.
And then I know some patientswho get claustrophobic if they
can't feel like a limb and theyspecifically don't want the
block and they'd rather dealwith more pain.
But the whole opiates they cancause constipation if they're
(35:21):
not used appropriately or usedtoo long addiction.
So trying to use as manycomfort and other additive ways
of dealing with pain I think isso important and I think a lot
of people just they underrate itbut it can really make a big
difference.
Samantha Graham (35:39):
Yeah, we absolutely have had patients who
come in and say I hate thatnumbness and tingling feeling.
I'd rather have pain.
And that's okay.
It's not for everybody.
Holly L. Thacker, MD (35:47):
Yes, and that's why it's so important to
talk to your whole healthcareteam and get things sorted out
well in advance.
So I want to switch topics, um,and get some of your insider
tips on breastfeeding.
It's Breastfeeding AwarenessMonth.
You've been a very successfulbreastfeeder and it's certainly
so helpful for women's health,weight loss, reducing breast
(36:08):
cancer, it's good for bonding,it's good for the baby.
Certainly, not everyone can doit and everything has to be
individualized.
But give us some advice andtips and everything has to be
individualized.
Samantha Graham (36:18):
But give us some advice and tips.
I often would tell other moms,family members, friends, you
know, go into it open-minded.
It is not the movies, it is notthe books, it is not the way
even maybe yourgreat-grandmother told you it
was.
That's not how it was.
For me it's hard, it is.
(36:39):
I right away did not feel likeit was natural.
Both of my kids had tongue ties.
Do you remember?
Holly L. Thacker, MD (36:45):
I mean it was you had to figure out the
problem.
Yes, and get your own lactationconsultant, as I recall.
Samantha Graham (36:52):
Yes, I had to go outside the health system, I
had to find a specialist to helpme.
But again, being your ownadvocate and know what you are
doing is right and know who toreach out to your lactation
consultants, your OB, you're notalone, that is the biggest
thing.
Call me, all my friends, callme, text me in the middle of the
night, I don't care, I'll helpyou do this because it's a
(37:15):
learning curve for you and thebaby, you know, especially if
you've never done it before.
And often I can speak fromexperience too.
No, two kids are the same.
No, my one son was a greatbreastfeeder and my other son
could well, he was lazy andcould care less.
So that in itself is hard.
I often tell new moms, likebrand new moms, don't care about
(37:37):
pumping.
I think I had to tell yourdaughter-in-law that like no, no
, no, don't start pumping rightaway.
Too soon, yeah, too soon.
You know we are hyper fixatedon social media and people
showing their refrigerators andfreezers and deep freezers full
of breast milk.
That is amazing, awesome, butyou just need enough to feed
(38:00):
that baby.
So don't worry about feedingyour freezer.
Feed your baby, feed on demand.
Enjoy your maternity leave, forhowever long it may be for you,
enjoy this bonding time.
Don't stress over your supply.
Your baby will let you know.
Is your baby pooping and peeing?
Is your baby sleeping?
You are succeeding atbreastfeeding.
So the STEM like the, you know,the social media, the family, I
(38:24):
just I remember all thecomments myself of, well, what
am I going to be able to feedthe baby?
Or or how much do you pump?
Or, you know, it's all thethings and it's you know.
You will get those maternalinstincts.
It's the best thing.
It's hard, it's hard work, butit's so rewarding.
(38:45):
The bonding, like Dr Thackersaid, is something unmatched.
Holly L. Thacker, MD (38:51):
Well, I'm glad that there wasn't all this
social media of people showingtheir pictures of milk back when
I was doing it, because I onlymade just barely enough.
We used to call it liquid gold,like how dare anybody spill it?
And so much of the equipmentlike there was someone on our
team the other day who came toour center meeting and was
pumping under the clothes withlike a portable pump pumper
(39:15):
right during the meeting and Ithought, boy, that's very
efficient.
So some of these new thingsthat they have.
I mean it's not like you needso much equipment if you're just
with your baby and not awayfrom your baby.
Less this can be more, butthere is a lot of assisted
devices, any websites or anyresources.
I mean you can go tospeakingwomenshealthcom.
We actually had a really greatcolumn last year on
(39:37):
breastfeeding, so we do haveresources on our website, but
any other tips or places thatyou found particularly helpful.
Samantha Graham (39:46):
I honestly found whatever was helpful for
me was going through mylactation consultant, seeing
what your health insurancecovers, because a lot of those
portable devices and things likethat are sometimes a money grab
because you might not need allof that, but I had my babies in
a world where the portableweren't an option.
Now they are an option, whichis great.
(40:07):
So going through your lactationconsultant because will you be
away from your baby, like yousaid?
Will you be more at home?
Do you need more of that Hakaor that, that suction cup that
just is collecting while you'renursing on the other breast, or
do you really?
Are you going to be at workeight hours a day connected to a
pump and do you are you able tosit down and pump?
(40:28):
So there are multiple different,like the Medela websites, the
different breastfeeding websitesthat are available to see what
is.
It's not a one size fits all,which is great, but you know you
just got to know what kind oflifestyle will you have and it's
okay not to know until you getthere.
Sometimes you see on, like thebaby registries, the hands-free
(40:51):
and then the one that youconnect, and then this, and then
that I'm like you know it'sgreat to be prepared, but you
know you won't know until youget there.
Holly L. Thacker, MD (41:00):
So I think the takeaway is you can be a
lot more prepared for surgeryupcoming surgery than you can
for having a baby.
Samantha Graham (41:11):
At least for me , that's how I felt.
Holly L. Thacker, MD (41:13):
Yeah, I think that's how it is for a lot
of women, so, but the prize isyou have a baby.
So thank you, samantha, so muchfor joining us on this podcast
on Speaking of Women's Health,and thanks to our listeners for
tuning in.
We're so grateful for yoursupport and please share it.
Give us a five-star rating and,in order to catch all the
(41:37):
latest and not miss any podcast,hit, subscribe or follow.
Thanks again for listening andwe'll see you next time in the
Sunflower House.
Remember, be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker.
Back in our sunflower house fora new podcast with a very
special guest.
I am so happy to welcome NurseSamantha Graham.
I met her almost it's been adecade ago.
(00:25):
She was my lead nurse in ourCenter for Specialized Women's
Health.
I just love her and she wasborn two weeks after my older
son, stetson, who's been on thispodcast, and I never fail to
let my son Stetson know how muchSam has beat him in terms of
marriage and buying a house andhaving her first child.
(00:46):
Anyway, it's so wonderful tohave Sam here in the Sunflower
House and I want to tell you alittle bit about her.
She earned her Bachelor ofScience in Nursing at Muskegum
University.
She then went on to earn aMaster's of science in
management and leadership andshe did work in our Center for
(01:09):
Specialized Women's Health andshe's now a preoperative nurse
educator at Cleveland Clinic andshe personally came in to do my
pre-op nursing when I had majorsurgery a few years ago and
just recently, my husband.
She wasn't even scheduled towork and she came in.
That is dedication.
(01:30):
Everybody would want a nurse,just like Samantha Graham.
So welcome Samantha.
We're so excited to have you asa guest here to talk about a
lot of important topics.
Samantha Graham (01:42):
Thank you, thank you.
I'm super excited to be welcomeon this.
I can't wait to talk about allthese great events or great
topics and things like that.
Holly L. Thacker, MD (01:50):
So Sam is a busy, busy woman married to a
very handsome man.
She's got a wonderful family inNortheast Ohio and she's the
mom of two boys, eight years old, because of course she beat
Stetson by four years, becauseArtemis is just four, almost
five, and she is a five-year-oldtoo, so she is just full of
(02:15):
energy and she gets up at thecrack of dawn to run.
In fact, in the hospital I raninto her, I think, at like five
in the morning because she wasgoing to the gym.
So we want to talk about a lotof different things.
This is airing in August, whichis Breastfeeding Awareness Month
, and so Sam's been abreastfeeding mom.
She's helped a lot ofcolleagues and friends and
(02:37):
family with breastfeeding, and Imainly also want to focus on
her current expertise in termsof just a career in nursing,
what goes into being a nurseeducator, and also just a little
bit about just preoperativepreparation and preparing for
that, because that is such a bigdeal and some people may get
(02:59):
out of this life without havingany major surgery, but most
people don't.
So I first want to start off byasking you how did you decide
to get into nursing?
Samantha Graham (03:10):
Oh geez, I decided to go into nursing when
I was taking care of my elderlygrandfather, just really taking
care of him alongside my mother,dialysis, his diabetes, his
cancer diagnosis, my mom'scancer diagnosis.
At a really young age Iremember people taking care of
my mom through her major lifesurgery and I just knew right
(03:30):
away that was something I wantedto do.
Holly L. Thacker, MD (03:33):
Well, it's a great field, and do you think
it's a good field for peoplewho want some flexibility, they
want to raise a family and stillhave a very fascinating,
interesting, helpful, demandingcareer?
Samantha Graham (03:45):
Absolutely.
I agree wholeheartedly that youcan get out of nursing whatever
you put into it.
As I still teach nursingclasses in the evenings, I say I
tell everybody the world isyour oyster, whatever schedule
you want, wherever you want towork, wherever location, it's
out there and it's available.
So you're.
You want to be a mom, so youwant to spend time with your
(04:06):
kids.
There's weekender programs,there's night shift, there's day
shift, there's part-time,there's per diem.
In today's world, the job isavailable as long as you want it
.
Holly L. Thacker, MD (04:18):
Well, that's fabulous.
Talk a little bit about all thedifferent types of nurses there
are.
I mean, my mother was a nurse,she was an RN.
Talk about LPN versus medicalassistant and techs versus RN
versus BSN, et cetera.
Samantha Graham (04:37):
Yeah, this is great topic because a lot of the
times our high school studentscome through and they want to
know as well.
Where should I start?
Definitely, the nurse's aide ismore doing the patient care
aspect of the vital signs, theassisted daily living of help
feeding, help, dressing, helpwith their everyday activities.
(04:59):
An MA or a medical assistanthelps the physicians or the LIPs
in the office.
They help with their rooming,their patients, their vital
signs, their testing whenthey've taken their last
medications, immunizations.
That is more AIDS or nurses'AIDS and MAs is much less.
(05:21):
More certificate schooling,more technical schooling.
Those degrees you can get veryquickly, some even right out of
high school.
Some high school programsaround here offer those, which
is a great opportunity to getinto health care at a very young
age, getting that seniorityvery quickly in the hospital
area and then hopefully going toan area that offers tuition
(05:43):
reimbursement for you to go toschool.
We're very fortunate in theCleveland area for all of our
surrounding areas to do that.
Lpn is typically a year to a15-month program, more of a
certificate program as well.
The pendulum swings both waysof where do LPNs work.
We're seeing them more in thehospitals.
We see them in the outpatientsetting.
(06:04):
We're seeing them even in theORs.
They're typically they werearound for labor and delivery
and now they're everywhere.
They're a great asset to thenursing family because we all
were in the team nursing aspectRN there are a couple of
different RNs.
You can get your associates, youcan get your bachelors.
That associate's degree is twoyears, typically 15 months to
(06:28):
two years, and that bachelor'sdegree is that four-year degree.
It just again kind of depends.
If you are, you know, can youafford that four-year degree?
Are you going to go to atwo-year degree and then get a
job where they pay for you toreturn to school to get your
bachelor's degree?
You know, like I said, as longas you're motivated and you want
it, you can absolutely achieveit.
(06:48):
There's so many programs outthere, online and in person or
at night or weekend programs,and then those higher level
degrees of NP, msn or nursepractitioner, a master's of
science of nursing, a doctorateof nurse practicing and even a
PhD.
So we can go all the way up oryou can just start at the bottom
(07:10):
as well, and those are greatopportunities within healthcare
that have so much jobavailability now.
Holly L. Thacker, MD (07:19):
Well, I started in high school as a
candy striper and then Irealized I could get hired as a
nursing assistant.
And boy, what a great exposurethat was as a high school
student working alongside thenurses, going from surgical
floors to medical floors, evento labor and delivery.
So I really kind of got exposedat a really young age and felt
(07:42):
very comfortable in the hospitalsetting, which, of course, the
hospital setting can be sointimidating to people who
aren't used to it, particularlyif they're ill or their loved
one is ill.
And I do think that all thesedifferent entry positions are
really great and they'recertainly in demand.
And isn't nursing faculty andteaching, like you're doing,
(08:04):
quite in demand?
I thought that the current cropof nurse educators a lot of
them are aging into retirement.
Samantha Graham (08:11):
Absolutely.
The need for qualified nursinginstructors is huge, especially
in our Cleveland area area.
I'm not sure around the wholeUnited States, but we have so
many great nursing programs inour Northeast Ohio area that are
in need of good instructors.
A couple of reasons youmentioned the aging retirement
(08:35):
age of people retiring and thenyou need a certain amount of
years of experience before youcan teach.
So making sure you have thosecouple of years underneath your
belt you know really becoming acontent expert in your area or
your field of nursing thatyou're in before you can go into
that college experience.
To be able to teach an RN class, you have to be master's
(09:00):
prepared.
To be able to teach a clinicalthough take students into your
facility you do have to bebachelor's prepared.
So there is some extraschooling that is required to be
able to go into the classroom.
Holly L. Thacker, MD (09:12):
Very interesting and I guess we can
tell our listeners.
You moved on from the Centerfor Specialized Women's Health
because you personally wantedflexibility based on hours.
I so wanted them to be able tolet you do remote work.
You know for a lot of it, youknow just based on your
children's schedule, but itcertainly seems like it's worked
(09:33):
out really well for you to.
It's like broadened your wholecareer experience.
Samantha Graham (09:40):
Oh, a hundred percent.
I'm doing research, I'mpublishing within the Cleveland
Clinic, I'm going to conferencesand speaking at podiums.
In regards to the specialtynurses, I'm certified in two
different areas ofperianesthesia nursing.
It's a good feeling and my cupis full and I will like coming
(10:00):
to work.
I tell everybody that I love myfamily, but I love coming to
work.
It's a good feeling.
I miss women's health.
I will tell everybody that,through and through every
semester, every student I comeacross, my previous life is all
in women's health.
I would go back tomorrow.
I would have gone backyesterday if the schedule would
have permitted or life wouldhave permitted, because my heart
(10:22):
really is in women's health.
But I still can do that withall my patients, even in it's so
wonderful and it's so great.
Holly L. Thacker, MD (10:32):
It is wonderful to have a passion and
enjoy work for so many reasons,and I know your patients know
because you just radiate it.
So let's move on to talk alittle bit about getting
mentally and physically preparedfor surgery, and you can
obviously talk about it from alot of different perspectives.
(10:52):
As a daughter who've taken careof you know your mother, who
had such major surgery, and youknow she did so well and that
was such a big deal.
You've also undergone it as amom with you know, with one of
your sons, and I know I have too, and that's just terrifying to
be on the other side.
In fact, they had me apply thegas mask to my baby Stetson
(11:15):
actually, and his body goes limpbefore they could do a lacrimal
gland procedure underanesthesia and then just for the
adult personally undergoingdifferent types of surgery.
So why don't you talk aboutjust those perspectives as well
as making sure that you as thecaregiver or you as the patient
(11:36):
are kind of healthy and readyfor surgery?
Samantha Graham (11:39):
The first thing that I really want to emphasize
for patients or anybody goingto surgery is have your
questions answered before you goto the hospital.
I cannot tell you how manytimes patients come in and they
simple question of is my surgeongood?
Or they want to be reassured,I'm sure, or just do you know my
(12:02):
surgeon?
Or asking me questionsspecifically about their
procedure, and I had to, youknow, remind them I'm not in the
room with you.
Would you like for me to getyour surgeon or whoever's going
to be in the room with you tocome and answer those questions?
I like to tell people to makesure you any questions, comments
or concerns, contact thatdoctor's office.
(12:22):
Set up the appointmentvirtually in person.
My chart message, whatever youneed to do so that you come in
with a peace of mind and theconfidence that you made the
right decision and that you arethere for the right reasons.
I also like to tell everybodyto know their pre-op
instructions is huge.
I know that is a big topic withour IV shortages post the
(12:46):
hurricanes.
Anesthesia guidelines are alittle always changing.
New medications hit the market.
The weight loss medications hitthe market.
The weight loss medications hitthe market.
We're seeing those affectinganesthesia.
Holly L. Thacker, MD (12:59):
Tell us about that, because weight and
weight loss information ismidlife women's number one
concern.
Even though it's not amenopausal symptom, ladies, but
it's something that pretty muchall women are interested in, and
it kind of peaks at midlifewhen the metabolism slows down
due to age.
Samantha Graham (13:16):
So often patients who are on these weight
loss injections or medications,they are very scared to have
surgery.
Because the first thing we tellthem is, depending on what type
of surgery they're having done.
If it's more minimal, you knowyou have to hold it for at least
a week.
But if it's more if you werehaving that abdominal surgery, a
longer procedure it is you haveto hold that injection for two
(13:38):
weeks.
And when you're on it for weightloss medication, for weight
loss reasons, often people getnervous.
They're nervous that they'regoing to gain weight back,
they're worried that they'regoing to get that hunger back or
they're worried that, whateverthey're thinking about it.
And so when I, when we tellpatients like you need to stop
your injection two weeks beforeor one week before, they're
(14:00):
right away.
Well, when can I start it?
Right back up or whatever?
You know, whatever the case maybe, and I know they're so
nervous and it's that's aconversation you need to have
with your doctor after theprocedure.
You know as you're restartingall your medications after the
procedure.
You know as you're restartingall your medications after the
procedure.
Holly L. Thacker, MD (14:15):
But those weight loss meds are huge.
What's amazing to me is that Imean, I always ask my patients
in the outpatient area bring inall your medicines and
supplements.
And they'll say, well, justlook on the chart, or they can't
remember, or they're not sure.
And even over-the-countersupplements some of them have to
be stopped before surgery.
They can have potent drug-drugor drug-food et cetera
(14:36):
interactions.
And really being on top of whatyou're taking, when you have to
stop, when you have to startand I think there might even be
some physicians who want theirpatients off those GLP
inhibitors even more than twoweeks, because they can really
paralyze the stomach, which ifthere's food in the stomach and
(14:56):
it's supposed to be empty andyou get intubated because you're
going under general anesthesia,if you aspirate that into your
lung you can die.
So it's really serious to likepay attention to what they tell
you to do or not to do.
Samantha Graham (15:11):
And answer the nurse honestly yes, yes,
especially with thosesupplements that you mentioned.
A couple of reasons yes, theyinteract with anesthesia.
Certain also have bleedingeffects.
Again, if we're creating a holein your body or a cavity in
your body, we want to make surethat we know we can keep your
bleeding under control.
So that's another thing wherewe're like, if you are on a
(15:34):
blood thinner or if you are onheart medication or if you have
actual diabetes, we want to makesure that you are optimized for
your procedure this day ofsurgery.
So following those instructionsare so important.
When we have those GLPmedications or those weight loss
medications and thatanesthesiologist does go and put
that tube down your throat,they're literally seeing whole
(15:58):
meals that aren't digested atall yet, oh my, and it's very
dangerous.
And so there's a reason we'renot just telling, we're just not
trying to make your life, youknow, unfortunate or whatever
the case may be.
But when you say, bring in yourmedications, well, it's in the
chart, whatever the case may be.
But when you say bring in yourmedications, well, it's in the
chart.
We are seeing a lot of med spas, a lot of holistic
(16:22):
practitioners out in thecommunities that don't speak
with our electronic medicalrecord, so we don't know.
So when we're asking, sometimespatients do get a little
frustrated or anxious about it.
Why are you asking me thesequestions?
Holly L. Thacker, MD (16:31):
It's just we want to keep you safe, that's
all we care about Absolutelythat is so important and even
dietary instruction, and we havesome information on our
speakingofwomenshealthcom siteand you're actually listening to
our Speaking of Women's Healthpodcast.
I'm the host, dr Holly Thacker,the executive director.
Host Dr Holly Thacker, theexecutive director, and we are
(16:53):
speaking with nurse SamanthaGraham, who is an expert in a
lot of areas in terms of nursingcareer, nursing education,
preoperative nursing care andalso breastfeeding that we'll
touch on.
So on our website,speakingofwomenshealthcom, which
(17:18):
you can bookmark or look up, wehave a whole column of foods
that interact with medicines andit's interesting because to me
as a patient, I got instructionslike certain foods not to eat
before surgery because there'slike, for instance, in white
potatoes there's a substancethat can prolong the effects of
anesthesia.
So like a sweet potato was fine,but not a white potato of
(17:38):
anesthesia.
So like a sweet potato was finebut not a white potato.
And there's foods and justherbs and supplements that might
thin the blood and blood lossis like a real big concern
because some surgeries areobviously a lot bloodier than
others, just like blood clotsare.
If you're immobilized underanesthesia, having major
abdominal, pelvic or extremitysurgery, that can certainly be a
(17:59):
risk and both bleeding to deathand having blood clots, as well
as infections and anesthesiacomplications, are kind of the
big things on the nurses, thephysicians, the whole medical
team and hopefully the patient'smind the whole medical team and
hopefully the patient's mind.
So one of the things they hadmy husband do was swab his nose
(18:19):
before surgery to see if he wasa carrier, a staff or strep.
Do you want to talk about thatand why people have to?
Samantha Graham (18:25):
pay attention.
The research on that isactually still kind of new.
It's always evolving in regardsto staff and MRSA, which are
really serious complicationsthat you can get after surgery
in your surgical site,infections which we know cost
the patients time and money andcost hospitals time and money.
(18:45):
So if we can prevent that witha simple nose swab prior to
surgery to see are you a carrierfor it, and if you do, that
doesn't mean you're dirty or any, because sometimes patients
think that, oh my goodness, Ihave, I had it, or that I,
whatever.
No, it's just an extraprecaution, just like a simple
wash that we give our body justto make sure we're clean.
(19:06):
We're going to put on thatantibiotic up your nose five
days before surgery and the dayof surgery just again to ward
off, like I tell everybody thoseevil infections that we don't
want.
Holly L. Thacker, MD (19:20):
Yeah, because antibiotic-resistant
infections can be deadly or cannecessitate, like six weeks or
more of home IV antibiotics.
Talk to us about the bathingand the shaving.
Some people are told not toshave or not to get pedicures or
not to have, you know, cool,funky nail polish, as well as
the special wipes and thingsthat people might need to do of
(19:40):
their body or body parts beforesurgery.
Samantha Graham (19:44):
Yeah.
So bathing certain physiciansorder certain baths or
preparation to surgery.
So we might do a Hibiclens or achlorhexidine bath or we might
give you special towelettes thatyou wipe each body part with,
one wipe on each body part.
Again, that's an extraprotective barrier that we are
doing to help get rid of anypotential infection that you may
(20:05):
have brewing on your skin.
You know your skin is yourlargest organ and we're going to
create like a cut or somethingwith surgery, with that.
As far as not all surgeriesneed a special body prep, but a
lot of surgeons do ask, if notto at least do a dial wash.
(20:26):
We say that because you knowthe bath and body works or
whatever is out there reallyquite aren't that great at
getting microorganisms off theskin.
The biggest complaint patientscome in and saying my skin is so
dry or it's so itchy becauseit's so dry.
It isn't.
It's not, it's not moisturizing.
Again, it's stripping that skin, making sure we're getting it
(20:48):
nice and clean.
As far as you know the nailpolish and the pedicures and the
shaving, I like to telleverybody when you're going into
surgery, less is more right.
So a pedicure they're cuttingyour cuticles, things like that
we.
Or nail polish on your toes,we're checking circulation,
(21:09):
we're making sure that you'restill perfusing your blood
throughout your entire body, aswell as making sure you're
having good pulses and thingslike that.
So if we don't know what youlook like prior to surgery or
what your nail bed looks likeprior to surgery, we're going to
have a hard time looking at itpostoperatively as well.
When you're under anesthesia.
All we can do is look at youbecause you can't tell us what's
(21:31):
going on.
So we really want to keep yousafe with our monitoring system.
So if you have, you know, a bigfunky nail on there or some
thick nail polish, with ourupdated medical technology can
the monitors go over your fingerand you're fine?
Absolutely.
But again it's looking at thatnail bed, looking to see are you
perfusing?
Well, that we're really lookingfor.
As far as shaving, again thatless is more.
(21:52):
When you're shaving, you knowit doesn't matter how good you
are.
You're nervous for surgery,things like that.
You might nick the skin andthen that is another portal for
an infection.
If we have to shave beforesurgery, we have our razors back
in the OR where we handle itfor you.
So don't worry about that.
It's included in the cost.
Holly L. Thacker, MD (22:11):
That's good.
You get that in the cost.
You know, I tell womenfrequently who do like shaving
of their vulva area just becausethey don't want pubic hair,
that like we don't shave thepubic hair before pelvic surgery
because it revs up morebacteria and so when they're
shaving it at home they're alsoincreasing their risk of ingrown
(22:32):
hairs, infection and just morebacteria.
So some people think it'scleaner, but a lot of times it's
certainly it's not.
And in terms of following theinstructions about not eating or
drinking or what medicines totake or what medicines not to
take, that is so important and Iknow different surgeons,
depending on the procedure, havesome different recommendations.
(22:55):
Like I was surprised that theysaid if you regularly drink
coffee and you think you'regoing to get a caffeine
withdrawal headache, you couldhave a little sip of black
coffee on the morning of surgery.
But I was just talking to oneof my friends who went in for
just a screening colonoscopywhich is under conscious
sedation, not general anesthesia, and they delayed his
colonoscopy by several hoursbecause he had had a cup of
(23:18):
coffee.
So you know, you might've beenable to have a sip of coffee one
day but not the next.
So you really have to followthat.
Do you want to talk abouttobacco and alcohol and being
honest and why those thingsreally make such a big
difference?
Samantha Graham (23:35):
Especially when we're talking about certain
procedures such as orthopedic orjoint replacements, or when
we're talking about bone.
Alcohol, tobacco can absolutelyhinder your healing process and
if we're putting somethingartificial in your body and
you're already compromised fromthe alcohol or tobacco, it can
really hinder your healing orrejection of that joint
(23:56):
potentially.
Being honest, sometimes can becumbersome to patients, because
some surgeons won't really wantto do surgery on a patient that
is a really chronic nicotine oralcohol abuse because of their
risk of an unsuccessful surgery,exactly.
(24:17):
And so some doctors go as faras ordering a nicotine test.
Absolutely, I see that, yes,they will offer the nicotine
sensation.
They just don't.
They still are helping you.
They're not just sending you onyour way and telling you quit
smoking and come back.
They're trying to get you theresources.
They're trying to make youoptimize for surgery.
It's not that they don't wantto, they just want.
(24:39):
Like I said, we just all wantto keep you safe.
Holly L. Thacker, MD (24:42):
Years ago I used to do preoperative you
know, medical assessments beforesurgery in our pre-op clinic
before I opened our center forspecialized women's health and
you always wanted that patientmedically optimized and I always
hated to have to tell thepatient and also call the
surgeon to say this person justhad a heart attack, so their
(25:02):
elective cosmetic surgery reallyneeds to be delayed until
everything has stabilized withtheir cardiac situation.
And speaking of cosmetic typeprocedures, which you know a lot
of women and some men areinterested in is I do know
several plastic surgeons whowill not operate on anyone who
has any nicotine in their systembecause the skin healing is so
(25:25):
bad.
And so even if you're going infor something that isn't
cosmetic, you know.
If it's an internal surgery,you want everything to heal
right, even if it's not cosmetic, that's for darn sure.
Because repeat surgeries andfailed surgeries, failed devices
it can be really terrible andreally nasty.
Samantha Graham (25:45):
For sure and even to making sure your
diabetes is managed.
If you have poor or if you havea high A1C, again that high
sugar infection breeds on thathigh blood sugar.
So making sure as well,patients that come in for
surgery, we do a day of surgeryblood sugar test just to make
sure you're not too high andyou're not too low, and we're
(26:08):
not judging or seeing ooh, whatdid you eat last night?
Again, we're making sure thatyour level is just right for
that good surgery time and forthat wound healing
post-operatively.
Holly L. Thacker, MD (26:20):
That is so important and I tell patients
who get serious diagnoses andtheir attention of trying to be
healthy is really more focused.
You know, with new cancerpatients, any serious condition
that even just changing yourdiet strictly in a few weeks or
a few days can make such a bigdifference.
(26:41):
Taking out those carbs andeating heart, healthy fats and
proteins and just only gettingcomplex carbs can dramatically
drop your blood sugar.
So even if you previouslyweren't well controlled, even if
you had diabetic complications,it can really improve your
chances of responding to themedical therapy and the surgical
therapy so much better.
(27:01):
And a lot of people think, oh,it's too late or I'm addicted.
And with the alcohol it can bereally serious if you do have
alcohol dependence and you don'tlet your health team know that.
Because if you're out of it andyou're post-op and you start
going through alcohol withdrawal, that can be deadly deadly, as
well as the bleeding risk withalcohol.
Samantha Graham (27:23):
There's that bleeding risk.
That is that waking up withthose DTs or those deliriousness
that we see patients come outof and that we don't know.
Some people are very highfunctioning with their alcohol
abuse or sometimes it's.
Whatever the case may be, wereally try to make sure that we
address it.
But because, again, that safetyis huge for post-op, you know
(27:49):
everybody has a plan and youknow if you're.
If you don't tell yourhealthcare providing team you
know what it is, what's going onthen you know it can have some
issues in the back end.
Holly L. Thacker, MD (28:01):
Now things like contact lenses.
People who are so used towearing contact lenses sometimes
they wear them overnight.
What do you tell them aboutthose things?
Hearing aids, contact lenses,assisted devices?
Samantha Graham (28:13):
Yeah, absolutely, good question Right
away Any dentures, hearing aids,contact lenses?
Again, that less is more,because in our area you do not
allow any assisted devices orhearing aids, or dentures or
(28:41):
contact lenses, anything in theoperating room.
Now, in the pre-op setting,while we're asking you your
questions, while we're gettingyou ready, while you're still
sitting with your loved ones.
Absolutely, but when we weregoing into the operating room we
were putting you to sleep Againwhen your eyes are rolling back
.
We don't want to have themstuck back there.
We don't want to have a cornealabrasion afterwards.
Hearing aids and dentures andeven contacts are very expensive
(29:05):
.
We want to give them to yourloved ones so they keep it safe.
We don't want it gettinghustled and bustled with the
changing of the beds and goingback to your bed and it's
sitting in a hallway.
God forbid anything happens.
So, yeah, we just let keep allyour belongings with your family
.
Now, if their patient cannothear, cannot see without their
contacts, or they cannot hearwithout their hearing aids, we
(29:28):
will do the safety huddle at thebedside while they have those
devices, with anesthesia, withsurgeon, with your OR team, and
then right after surgery, wemark in the chart to have your
loved one bring them back to youwhen you're awake.
So I don't.
People often wonder.
My husband has never seen mewithout my dentures, so I don't
want my husband to see mewithout my dentures.
I'll put it on the chart.
(29:48):
We'll have the PACU nurse comeand bring your dentures right
after surgery Once you're awakeand stable.
Absolutely, you know that.
You can look on Google orYouTube.
You know some patients nottelling their anesthesiologist
that they have dentures and thedentures have been down their
throat while they intubate apatient.
So absolutely they have to comeout.
(30:09):
Any.
We asked do you have any loosechips, wiggly teeth, thing like
that, or dentures?
Holly L. Thacker, MD (30:15):
because as they're putting that tube down,
it's a big tube and if it goesdown that throat we're in some
issues, yes, and so for peoplethat know they have to have
elective surgery and obviouslyemergency surgery is just a
totally different ballgame, butmost surgeries are scheduled,
most surgeries are elective.
I think that for patients tosee their ophthalmologist, to
(30:37):
see their internist or primarycare doctor to get a dental
checkup and take care of aninfection or a tooth that might
need to be pulled um, to gettheir health maintenance if they
haven't had their mammogram orcolonoscopy or blood work, and
to really work on getting thatblood sugar and all their
metabolic indices, it's justreally.
It's like you're kind ofpreparing for a marathon.
(31:01):
So, we talked about all thethings people should bring to
the hospital.
What are a couple of thingsthat absolutely the patient
should bring with them when theyshow up at the hospital that
they should not bring?
Samantha Graham (31:10):
with them.
No, they should.
They should their medications.
I know we are a hospital, wewill minister our medication.
But if you, we, if you don'tknow your dosage, if it's not in
there correctly or if you gotit changed from a different
provider, we don't know yoursupplements like or whatever,
whatever medicines you're on,bring those.
(31:32):
Your living will, your medicalpower attorney, needs to be
scanned in prior to surgery.
Living will, your medical powerof attorney needs to be scanned
in prior to surgery.
These conversations also shouldbe having prior to you coming
to the hospital.
We do sign a lot of medicalpower, our living will, medical
power of attorneys right beforesurgery.
I do witness a lot of them.
But those are bestconversations to be having to
(31:55):
have already all signed, sealed,delivered prior to surgery and
have.
Most important is have yoursupport person with you.
Unfortunately, with COVID wenobody was allowed to come into
the hospital, which is a veryunfortunate time for us in a
whole Our patients, us everybody, whole our patients, us
(32:20):
everybody.
But have that support personwith you is really important so
that when you can't talk foryourself, somebody is there to
talk for you and support you.
Holly L. Thacker, MD (32:25):
That's very important and I know my
husband was so used to hiswedding ring, his watch.
You have to leave all of thosevaluables at home, even though
it feels like you're naked.
You just keep them in at home.
But they do want your photo IDbecause there have been some
cases of people showing up forother people's surgeries to get
so insurance fraud is real.
(32:46):
Yeah, so they do want yourinsurance card and your photo ID
.
But other than that, really youwant to be traveling light.
So what tell us aboutanesthesia?
And some people, of course,have have local anesthesia where
they get sedation as, asopposed to general anesthesia.
Some of our listeners may notreally understand that
difference.
Samantha Graham (33:06):
So local anesthesia is when they are able
to do a minimal invasivesurgery that has a quick
recovery time and or a quickprocedure time.
An example like that a carpaltunnel procedure, maybe a
manipulation of a joint or ashoulder what else?
A colonoscopy?
(33:26):
Those are those minimalinvasive surgeries that we will
just do light sedation.
Or we could do something like aperipheral nerve block, where
we can block that extremity sothat that patient cannot feel
the area while the surgeon isdoing the procedure.
Don't worry, you're notcompletely awake.
There are some othermedications that we can give
(33:47):
through your IV so that youdon't even know your own name,
so that you're nice and out ofit, because some patients are
like I don't want to hear, Idon't want to see, I don't want
to know anything, and that'scompletely fine.
Those are also for patientsthat maybe have that heart
condition or have that othercomorbidity where they're not a
good candidate for generalanesthetic.
(34:07):
Now, when we're talking about ageneral anesthetic, that is
that when you were putting youto sleep and that patient is
getting intubated by theanesthesia provider.
Other things that we can do areepidurals during surgery,
spinals during surgery.
I know we hear those a lotduring labor and delivery.
We still do those on ourpatients prior to surgery.
(34:27):
So some of our hip replacementpatients get a spinal just to
help with pain control aftersurgery.
So when the pain team comes inand talks to you and they're
like, well, why do I need that?
Or why do I need my whole armIf I'm still, they still might
go to sleep Again, a lot of thatthat pain control for during
the procedure and even after theprocedure that are some great
(34:50):
options to decrease the amountof narcotics and opioids that
you need after the procedure.
Holly L. Thacker, MD (34:56):
Yes, those local blocks, and some of them,
can last for quite a long time,but you have to kind of be
prepared when they wear off.
And then I know some patientswho get claustrophobic if they
can't feel like a limb and theyspecifically don't want the
block and they'd rather dealwith more pain.
But the whole opiates they cancause constipation if they're
(35:21):
not used appropriately or usedtoo long addiction.
So trying to use as manycomfort and other additive ways
of dealing with pain I think isso important and I think a lot
of people just they underrate itbut it can really make a big
difference.
Samantha Graham (35:39):
Yeah, we absolutely have had patients who
come in and say I hate thatnumbness and tingling feeling.
I'd rather have pain.
And that's okay.
It's not for everybody.
Holly L. Thacker, MD (35:47):
Yes, and that's why it's so important to
talk to your whole healthcareteam and get things sorted out
well in advance.
So I want to switch topics, um,and get some of your insider
tips on breastfeeding.
It's Breastfeeding AwarenessMonth.
You've been a very successfulbreastfeeder and it's certainly
so helpful for women's health,weight loss, reducing breast
(36:08):
cancer, it's good for bonding,it's good for the baby.
Certainly, not everyone can doit and everything has to be
individualized.
But give us some advice andtips and everything has to be
individualized.
Samantha Graham (36:18):
But give us some advice and tips.
I often would tell other moms,family members, friends, you
know, go into it open-minded.
It is not the movies, it is notthe books, it is not the way
even maybe yourgreat-grandmother told you it
was.
That's not how it was.
For me it's hard, it is.
(36:39):
I right away did not feel likeit was natural.
Both of my kids had tongue ties.
Do you remember?
Holly L. Thacker, MD (36:45):
I mean it was you had to figure out the
problem.
Yes, and get your own lactationconsultant, as I recall.
Samantha Graham (36:52):
Yes, I had to go outside the health system, I
had to find a specialist to helpme.
But again, being your ownadvocate and know what you are
doing is right and know who toreach out to your lactation
consultants, your OB, you're notalone, that is the biggest
thing.
Call me, all my friends, callme, text me in the middle of the
night, I don't care, I'll helpyou do this because it's a
(37:15):
learning curve for you and thebaby, you know, especially if
you've never done it before.
And often I can speak fromexperience too.
No, two kids are the same.
No, my one son was a greatbreastfeeder and my other son
could well, he was lazy andcould care less.
So that in itself is hard.
I often tell new moms, likebrand new moms, don't care about
(37:37):
pumping.
I think I had to tell yourdaughter-in-law that like no, no
, no, don't start pumping rightaway.
Too soon, yeah, too soon.
You know we are hyper fixatedon social media and people
showing their refrigerators andfreezers and deep freezers full
of breast milk.
That is amazing, awesome, butyou just need enough to feed
(38:00):
that baby.
So don't worry about feedingyour freezer.
Feed your baby, feed on demand.
Enjoy your maternity leave, forhowever long it may be for you,
enjoy this bonding time.
Don't stress over your supply.
Your baby will let you know.
Is your baby pooping and peeing?
Is your baby sleeping?
You are succeeding atbreastfeeding.
So the STEM like the, you know,the social media, the family, I
(38:24):
just I remember all thecomments myself of, well, what
am I going to be able to feedthe baby?
Or or how much do you pump?
Or, you know, it's all thethings and it's you know.
You will get those maternalinstincts.
It's the best thing.
It's hard, it's hard work, butit's so rewarding.
(38:45):
The bonding, like Dr Thackersaid, is something unmatched.
Holly L. Thacker, MD (38:51):
Well, I'm glad that there wasn't all this
social media of people showingtheir pictures of milk back when
I was doing it, because I onlymade just barely enough.
We used to call it liquid gold,like how dare anybody spill it?
And so much of the equipmentlike there was someone on our
team the other day who came toour center meeting and was
pumping under the clothes withlike a portable pump pumper
(39:15):
right during the meeting and Ithought, boy, that's very
efficient.
So some of these new thingsthat they have.
I mean it's not like you needso much equipment if you're just
with your baby and not awayfrom your baby.
Less this can be more, butthere is a lot of assisted
devices, any websites or anyresources.
I mean you can go tospeakingwomenshealthcom.
We actually had a really greatcolumn last year on
(39:37):
breastfeeding, so we do haveresources on our website, but
any other tips or places thatyou found particularly helpful.
Samantha Graham (39:46):
I honestly found whatever was helpful for
me was going through mylactation consultant, seeing
what your health insurancecovers, because a lot of those
portable devices and things likethat are sometimes a money grab
because you might not need allof that, but I had my babies in
a world where the portableweren't an option.
Now they are an option, whichis great.
(40:07):
So going through your lactationconsultant because will you be
away from your baby, like yousaid?
Will you be more at home?
Do you need more of that Hakaor that, that suction cup that
just is collecting while you'renursing on the other breast, or
do you really?
Are you going to be at workeight hours a day connected to a
pump and do you are you able tosit down and pump?
(40:28):
So there are multiple different,like the Medela websites, the
different breastfeeding websitesthat are available to see what
is.
It's not a one size fits all,which is great, but you know you
just got to know what kind oflifestyle will you have and it's
okay not to know until you getthere.
Sometimes you see on, like thebaby registries, the hands-free
(40:51):
and then the one that youconnect, and then this, and then
that I'm like you know it'sgreat to be prepared, but you
know you won't know until youget there.
Holly L. Thacker, MD (41:00):
So I think the takeaway is you can be a
lot more prepared for surgeryupcoming surgery than you can
for having a baby.
Samantha Graham (41:11):
At least for me , that's how I felt.
Holly L. Thacker, MD (41:13):
Yeah, I think that's how it is for a lot
of women, so, but the prize isyou have a baby.
So thank you, samantha, so muchfor joining us on this podcast
on Speaking of Women's Health,and thanks to our listeners for
tuning in.
We're so grateful for yoursupport and please share it.
Give us a five-star rating and,in order to catch all the
(41:37):
latest and not miss any podcast,hit, subscribe or follow.
Thanks again for listening andwe'll see you next time in the
Sunflower House.
Remember, be strong, be healthyand be in charge.
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