A few months ago I decided I'd train for a marathon. I knew it would be challenging, but as a psychologist, denial had been part of my game plan. I'd been debating this for years - Should I or shouldn't I? "Too young, better to wait until older", I'd been told for years. A friend asked, "Don't you want that quality of life now, instead of waiting until you're older?" I sure did. Why suffer now if I don't have to. So, having made up my mind, I was scheduled for a total knee replacement. If this was going to be like a marathon (never having run one!) I knew I had to prepare emotionally, physically and practically. While the Magazine lately has had so many columns dealing with stories of ill health, I hope this will be an inspiration to others striving for "well-being", as were my breast cancer columns back in 2014.

As the proud owner of a new titanium knee joint, I hope these reflections will be helpful for those considering any surgery (or other medical intervention), and for their loved ones who are so important in the healing process.

Before surgery

1. Prepare. This is a marathon; good runners don't just wake up on race day and run. They train! Be informed whenever possible. Choose a medical team you have faith in and trust. Decide who will help you in the training (preparation) and post marathon (recovery) phases - your caregivers. You'll feel blessed by their presence and grateful for all they do and appreciate their being your advocates in hospital and at home. Do whatever you can beforehand to strengthen your body. Exercise, a healthy diet, reading up on what to expect and preparing your post-surgical environment in advance are essential to your recovery.
2. Remind yourself every morning how appreciative you are for the progress you made yesterday. Each small step gets you that much closer to where you want to be. There's much to do: pre-operative tests, insurance forms, preparation for returning home, family, work, and many other issues that can become overwhelming and take over your life.

Surgery

1. You must go into surgery feeling calm. While this may sound impossible it really isn't. Make time to learn proper breathing techniques. They'll help you. Be positive, think about calming scenes, your grandchildren or people who make you smile. Be in the moment, relax and leave it to the experts. It's perfectly normal to feel somewhat anxious. We often fear the unknown. Make peace with your fears in advance so that you can lower your anxiety.

After the surgery

1. Remind yourself that you did it! In many ways the worst is behind you, even if you feel run over by a truck and totally dependent on others. Be proud of yourself. There's still much work to be done and you'll need endurance, but you're well on your way to becoming a champion. The marathon's still underway, but you've come this far and are in for the long haul.
2. Keep informed. Learn about the drugs you'll be offered and decide what's right for you. Though you'll want to take what you need, drugs have side effects. There's a fine balance between taking what you need in order to participate in your rehabilitation, do post-surgical exercises, and not be in pain, but not so much that you feel unwell or too tired to move. You need to learn about your body's response to pain and know that you'll do better by taking medication at the earliest signs of pain rather than waiting until it becomes unbearable. You want to be on top of your pain. Still, you don't want to take more than you need. I observed in the hospital that the more anxious the patient, the more medication they needed, and the less well they performed their exercises. It is important not to fear pain but rather to work with it, through breathing. Your state of calm will greatly affect your journey into healing.
3. Be patient with yourself. Your body's been through a major trauma and bodily functions slow down. Your initial inability to do seemingly simple things may surprise you. You can't imagine how exhausting surgery, and being in the hospital, are and how much mental and physical energy you've expended. I was shocked that for a few days I could barely lift my leg. It felt like a dead weight. There's much you can plan for and much you can't be prepared for, and you may not know which will be which. You can only control things so much. Go easy on yourself. It's not unusual to feel down or even depressed.
4. Focus on the positive. While there may be many things you can't do currently, there are many things that you can do. Remember, you're essentially a healthy person who underwent a surgical procedure. Not every day will be great; some days you may need to take things hour by hour. Make sure your expectations are realistic.

At home

1. Normalize. Routine is important. Get up, shower, dress in "real" clothes, put on lipstick, open the windows and "fake it till you make it". The more you see yourself as a "poor me" patient the less focused you'll be on moving on. Remind yourself that this phase shall pass.
2. Compete with yourself trying to do more each day but recognize sometimes the healing process involves two steps forward and one step back. Just before surgery, I saw a video on my orthopedist's Facebook page of a woman dancing with her husband three days after surgery. Arriving home late after being discharged from the hospital on day three I was desperate to climb into bed when I remembered this video. I so did not feel like her, but was determined to send our children a video of their parents dancing. I hardly moved my feet but the children thought this was amazing. The next day, I could barely move!
3. Small things can feel big and big accomplishments may go unnoticed. Realizing I couldn't get in and out of bed without waking my husband to lift my leg, my amazing physiotherapist taught me to use a belt, tie or towel under my foot to lift my leg. The resulting new-found independence felt amazing. A basket on my walker enabled me to carry things from place to place. One day I couldn't stand the dirt on my floor; while no one else noticed, I did. On the scale of importance it didn't register, but I managed to take my walker to the broom closet and clean, making me very happy.
4. Choose good caregivers. They are essential to your recovery so ensure you treat them well. They too need care as looking after us, even for a short time, is physically and emotionally exhausting. We joke that we'd never have guessed it but my husband was amazing. Sure he lost it when, already having no time for himself, I requested one thing too many. That's to be expected. Initially you may not be able to do much and will be very dependent, but your goal is to become independent as quickly as possible. I promise; it's the best thing for you and everyone else.
5. People want to visit, you may want them to, and it's good for you. You can't imagine, though, how exhausting it can be to carry on a conversation or sit in one place for 20 minutes when you first come home. Limit the number of visits and keep them short at first because you need time to rest, exercise and heal. By nighttime you may be quite uncomfortable and not up for visitors. Take people up on their offers to help, shop, bring you whatever you need, or to walk with you. You'll need it. Ask visitors to call ahead as things come up or you may be tired. Don't let anyone visit you if they or their family are unwell. Getting sick now is not what you need. If visitors seem pressed for time or constantly on their phone, you may not feel good and wonder why they actually came over.
6. You'll experience acts of kindness from people you might expect but also from those that will surprise you and that you barely know. Angels arrived daily with home cooked meals, healthy food, cookies, chocolate, lotions and potions, a story, or a hug, just to help a bit and make me feel better. Some visitors sat right next to me, and absorbed every word of conversation. They were amazing listeners. Initially after surgery, you may find yourself quite boring- repeating your story to anyone who asks, but as you heal you'll be happy to get outside of yourself and actually listen to others. That's real progress! Focus on noticing all that others are doing to help you. It'd so easy to take it for granted.

Recovery is a slow process that takes more time than we think it will or are prepared for. It's easy and natural to get frustrated and make unreasonable demands on yourself and others. Don't let the stories and trajectory of others upset you. Everyone is individual in their response to pain, and healing. By being aware of the many factors involved in your healing, you'll be on your way to better health. My goal of running the marathon was to cross the finish line, not to come in first place. As you complete your personal challenge, you are indeed a winner.