Latest / Tremor & Parkinson's Surgery Explained with Dr. Wu / After DBS Surgery: What to Expect During Recovery

Transcript

After DBS Surgery: What to Expect During Recovery · Tremor & Parkinson's Surgery Explained with Dr. Wu

• 0:00
  SPEAKER_00: If you are preparing for DBS surgery, you probably want to know what recovery actually looks like.
• 0:04
  SPEAKER_00: The good news is that for most patients, it's much more straightforward than they imagined.
• 0:08
  SPEAKER_00: I'm Dr.
• 0:08
  SPEAKER_00: Chin Yan Wu and I'm a neurosurgeon specializing in deep brain stimulation.
• 0:13
  SPEAKER_00: In this video, I'll walk you through the first night, the first few weeks, and what happens when we begin programming the device.
• 0:18
  SPEAKER_00: Before we get into the at-home instructions, your own discharge paperwork should always come first.
• 0:24
  SPEAKER_00: The details can vary from patient to patient, from center to center, but I'll share what we typically see in my practice.
• 0:31
  SPEAKER_00: Now, after the operation, you'll wake up in the recovery area while the anesthesia wears off.
• 0:36
  SPEAKER_00: At that time, the team will monitor your blood pressure, your heart rate, your neurological function, your pain level, make sure that dressings are in place over your surgical incisions.
• 0:46
  SPEAKER_00: Now, most of our patients do not need to stay in the intensive care unit.
• 0:50
  SPEAKER_00: They move from the recovery area to a regular hospital room where we continue monitoring them overnight.
• 0:55
  SPEAKER_00: We also obtain imaging before you leave the hospital, usually a CAT scan to make sure that the electrodes are again in the right place and there are no unexpected concerns after the surgery.
• 1:06
  SPEAKER_00: If all looks well from that standpoint, most patients go home the following day.
• 1:11
  SPEAKER_00: And that generally surprises people.
• 1:13
  SPEAKER_00: They hear brain surgery and expect to spend a week or more in the hospital.
• 1:17
  SPEAKER_00: But with modern asleep DBS, the hospital stay is usually much shorter.
• 1:22
  SPEAKER_00: But going home the next day does not necessarily mean you should expect to feel 100% normal.
• 1:27
  SPEAKER_00: It means that you're medically stable and ready to continue recovering at home.
• 1:31
  SPEAKER_00: Now, in the first few days, most patients describe soreness rather than pain.
• 1:35
  SPEAKER_00: And there are several places where you may feel it.
• 1:38
  SPEAKER_00: Now, interestingly, most people have relatively little pain around the scalp incisions at the top of the head.
• 1:43
  SPEAKER_00: Most of the soreness is really around the intermediate incision here that we use for tunneling where the extension wires pass beneath the skin and at the incision near the collarbone where the battery is implanted.
• 1:54
  SPEAKER_00: So some soreness in the head, neck, or chest is normal and expected.
• 1:58
  SPEAKER_00: And these will usually last only a few days or so.
• 2:01
  SPEAKER_00: You'll receive pain medication in the hospital and your team will also give you instructions for managing discomfort after you go home.
• 2:08
  SPEAKER_00: I want to make sure that you don't automatically reach for things like ibuprofen, motrin, alleve, neproxin, or aspirin, or any anti-inflammatory medications until your surgeon tells you it's okay to do so.
• 2:21
  SPEAKER_00: And that's because there is an increased risk of bleeding with a lot of these medications.
• 2:25
  SPEAKER_00: You will just have had electrodes placed into the brain, and we certainly don't want to increase the risk of bleeding in that scenario.
• 2:32
  SPEAKER_00: In my practice, most patients are able to manage their pain just fine with Tylenol alone.
• 2:37
  SPEAKER_00: Now, in addition to the discomfort from the implant itself, some patients might notice swelling around one or both eyes a few days after the surgery.
• 2:44
  SPEAKER_00: And that can look alarming when you aren't expecting it.
• 2:47
  SPEAKER_00: And in many patients, this is normal postoperative swelling and usually improves within a few days to a week or so.
• 2:54
  SPEAKER_00: Now, even if you're not one of those older patients, you will just have undergone a surgery.
• 2:58
  SPEAKER_00: So fatigue is very normal.
• 3:00
  SPEAKER_00: You may be home quickly, but your body is still recovering from both the surgery and the anesthesia.
• 3:06
  SPEAKER_00: So your energy may be inconsistent.
• 3:08
  SPEAKER_00: You may feel good for part of the day and then suddenly need to rest.
• 3:11
  SPEAKER_00: So listen to your body and rest when you need to rest.
• 3:14
  SPEAKER_00: For some patients, the fatigue only lasts a short time.
• 3:17
  SPEAKER_00: For others, it can continue for several weeks.
• 3:19
  SPEAKER_00: The important thing is to rest when you need to without spending the entire day in bed.
• 3:23
  SPEAKER_00: I want you to be as active as possible.
• 3:25
  SPEAKER_00: That means walking, doing regular daily activities from the beginning, and pretty much getting back to your normal as soon as possible.
• 3:32
  SPEAKER_00: Now, one of the most important things you can do after DBS surgery is keep the incisions clean.
• 3:37
  SPEAKER_00: This is the area where patients sometimes run into trouble.
• 3:40
  SPEAKER_00: On the one hand, I want to make sure that you do not pick at the stitches, don't pull off the scabs.
• 3:45
  SPEAKER_00: It seems like something that I shouldn't have to say, but I do because I see it.
• 3:48
  SPEAKER_00: Don't poke at them, don't prod up them, don't scratch them.
• 3:51
  SPEAKER_00: The incisions need time to heal.
• 3:53
  SPEAKER_00: Now, on the other hand, some are so afraid of touching the incisions that they don't clean them or take proper care of them.
• 3:59
  SPEAKER_00: Then dry blood or scabbing begins to build up.
• 4:02
  SPEAKER_00: And that can make the incisions harder to inspect and may actually interfere with the normal healing process.
• 4:08
  SPEAKER_00: So here's what I really want you to understand.
• 4:10
  SPEAKER_00: Do not be afraid to clean the incisions.
• 4:12
  SPEAKER_00: You need to be gentle, but you also need to clean them thoroughly.
• 4:15
  SPEAKER_00: It's a balance just like everything in life.
• 4:17
  SPEAKER_00: I use three small incisions in the head, and these are closed with sutures that are not dissolvable.
• 4:22
  SPEAKER_00: So you'll return to the office about two weeks after surgery for a post-operative visit to have those sutures removed.
• 4:28
  SPEAKER_00: I perform minimal shave so that you'll still have hair around the incisions if you had hair around the incisions before.
• 4:34
  SPEAKER_00: There will usually not be a wrap or dressing around your head.
• 4:38
  SPEAKER_00: I usually just place ointment over the scalp incisions and those will wash off over time.
• 4:42
  SPEAKER_00: The chest incision is closed a little differently.
• 4:44
  SPEAKER_00: The sutures are dissolvable and underneath the skin, what we call subcuticular suture.
• 4:49
  SPEAKER_00: Those will dissolve on their own.
• 4:50
  SPEAKER_00: There may be a couple knots that are on the outside that may need to be clipped at the time of your post-op visit.
• 4:56
  SPEAKER_00: This incision will also be covered with what we call stereo strips, and stereo strips are small adhesive strips placed across the incisions to support the incision while it heals.
• 5:05
  SPEAKER_00: There will also be a dressing placed over the stair strips.
• 5:07
  SPEAKER_00: The outer dressing comes off after two days, but the stereo strips, those stickers, leave those alone.
• 5:13
  SPEAKER_00: They will gradually loosen and fall off on their own.
• 5:15
  SPEAKER_00: I don't want you to pull them off.
• 5:16
  SPEAKER_00: When they're ready to come off, when the edges start peeling up, then they are ready to be taken off or will fall off on their own.
• 5:23
  SPEAKER_00: Once you're allowed to shower, which is typically 48 hours after surgery, all the incisions should be washed.
• 5:28
  SPEAKER_00: The head incisions should be washed every day.
• 5:31
  SPEAKER_00: You can use regular gentle shampoo, and some find that if it's a little irritating, baby shampoo can be less abrasive.
• 5:37
  SPEAKER_00: But certainly you need to wash those incisions, all three of them.
• 5:40
  SPEAKER_00: The two at the top and the one on the side.
• 5:42
  SPEAKER_00: Don't scrub those incisions with your fingernails like you would normally do with your hair.
• 5:46
  SPEAKER_00: I know uh we're used to scrubbing the scalp with our nails when we wash our hair, but instead, in this scenario, use either a flat palm or the soft pads of your fingers to gently rub across all three incisions.
• 5:58
  SPEAKER_00: You want the soap and water to loosen any dry blood or buildup without scraping or irritating the skin.
• 6:04
  SPEAKER_00: Because I use a minimal shave, you may need to carefully part the hair around the incisions so you can see the scalp incisions and make sure that you dry them very thoroughly with a towel.
• 6:13
  SPEAKER_00: I don't want you to leave wet hair pressed against the incision, and I also don't want you to use a blow dryer directly over the surgical air because that heat is not good for the initial healing process.
• 6:22
  SPEAKER_00: The hardware of the DBS system should never be visible.
• 6:25
  SPEAKER_00: You should not see a wire, an anchor, an extension, a screw, anything like that.
• 6:31
  SPEAKER_00: Everything should remain completely covered by the skin.
• 6:33
  SPEAKER_00: If you can see any part of the hardware, please contact the surgical team immediately.
• 6:37
  SPEAKER_00: Also, I don't want you to submerge the incisions in a bathtub pool, hot tub, lake, ocean, any body water for at least four to six weeks.
• 6:46
  SPEAKER_00: So don't do that until we give you the okay.
• 6:48
  SPEAKER_00: Again, that can impair wound healing up front.
• 6:51
  SPEAKER_00: We want to make sure that wound is well healed before you go and submerge those incisions entirely.
• 6:56
  SPEAKER_00: So not until your surgical team has cleared you, should you get into a bath, hot tub, etc.
• 7:01
  SPEAKER_00: Another thing to avoid up front are hair dyes or other chemical hair treatments.
• 7:05
  SPEAKER_00: And my preference is to avoid this for six weeks after surgery.
• 7:09
  SPEAKER_00: And again, that depends on your wound healing.
• 7:11
  SPEAKER_00: I want to make sure those wounds are healed before we start letting you put hair dyes or chemicals into your hair.
• 7:16
  SPEAKER_00: Now, from an activity standpoint, during the first two weeks, we want patients moving but not straining.
• 7:22
  SPEAKER_00: Again, balance.
• 7:23
  SPEAKER_00: I encourage you to walk as much as you can comfortably tolerate.
• 7:26
  SPEAKER_00: And the main restriction in this early period is heavy lifting.
• 7:29
  SPEAKER_00: I recommend not lifting more than five pounds for the first one to two weeks.
• 7:33
  SPEAKER_00: Five pounds is roughly the weight of a full carton of milk, so that's a good point of reference.
• 7:37
  SPEAKER_00: And so that means no heavy grocery bags, no lifting children or pets, and no rushing back to your usual workout.
• 7:44
  SPEAKER_00: After that, you can gradually increase your activity.
• 7:46
  SPEAKER_00: Most patients are back to the regular activities by about two weeks, and by around four weeks, many are back to essentially everything, depending on what the activity involves.
• 7:54
  SPEAKER_00: As you start moving a little bit more, you may feel the extension wires beneath the skin along the side of your neck as it leads to the battery.
• 8:01
  SPEAKER_00: And this concerns some patients, and people become nervous about that sensation and stop turning their neck or moving.
• 8:07
  SPEAKER_00: And that's usually not helpful.
• 8:08
  SPEAKER_00: The hardware is designed to tolerate normal neck movement.
• 8:12
  SPEAKER_00: So gently turning your head from side to side like this, that can help keep things loose and make sure too much scar tissue doesn't build up around the electrode as it does heal.
• 8:22
  SPEAKER_00: What we do not want early on is forceful, rapid, or repetitive movements.
• 8:26
  SPEAKER_00: So move normally, but do so gently and cautiously.
• 8:30
  SPEAKER_00: You don't need to stretch aggressively or force your neck through painful range of motions.
• 8:34
  SPEAKER_00: Just move like you would on a day-to-day basis.
• 8:37
  SPEAKER_00: Now, some patients with Parkinson's may gain weight during the months after DBS, but this does not happen to everyone.
• 8:43
  SPEAKER_00: When it happens, occurs because as your symptoms improve and your medications change, your daily activity may also change.
• 8:49
  SPEAKER_00: So as your surgeon clears you, getting back to your regular walking and exercise can help.
• 8:54
  SPEAKER_00: Another common question I get is when can I drive?
• 8:57
  SPEAKER_00: In my practice, patients are generally not allowed to drive during the first two weeks after surgery.
• 9:01
  SPEAKER_00: It's really more of a precaution than anything else.
• 9:04
  SPEAKER_00: So you can ride as a passenger as soon as you feel comfortable, but before you return to driving, make sure your surgeon has cleared you and you're no longer taking any medication that affects your alertness or ability to drive normally.
• 9:15
  SPEAKER_00: Now, Parkinson's symptoms itself may also affect whether driving is safe.
• 9:19
  SPEAKER_00: So this decision may involve both the surgical team as well as your movement disorder specialists.
• 9:24
  SPEAKER_00: Now, another thing that patients are not always prepared for is something I alluded to a little bit ago, in that you can feel parts of the DBS system underneath your skin.
• 9:33
  SPEAKER_00: And you may feel small bumps at the top of the head where the wires go into the skull, a bump on the side where the extension wire is, and a bump certainly at the chest.
• 9:45
  SPEAKER_00: The hardware over the years and as the technology has gotten better has become smaller and lower profile over time, but it is not invisible to the touch.
• 9:53
  SPEAKER_00: And because it is smaller than nothing, it is something that you will certainly notice.
• 9:58
  SPEAKER_00: So even though someone looking at you may not recognize that there's something there, it's something in the early going that patients will be more aware of and will generally get used to over time.
• 10:09
  SPEAKER_00: If an area becomes increasingly painful, red, warm, swollen, or begins draining, please contact the surgical team right away.
• 10:18
  SPEAKER_00: You should also receive an identification card with information about the DBS system.
• 10:22
  SPEAKER_00: And I recommend that you keep that card with you in your purse or your wallet so that you have it available, specifically when you go to another doctor or your dentist or if you end up in an emergency department or need an MRI and an imaging setter.
• 10:37
  SPEAKER_00: This gives all the information about the implant to those healthcare professionals.
• 10:42
  SPEAKER_00: Now, DBS is certainly different from a lot of other procedures because when we implant the device, we do all this work to get all the hardware in the right place, but then we don't turn it on.
• 10:53
  SPEAKER_00: So the hardware may be fully implanted, but the treatment still has yet to be delivered through programming.
• 10:59
  SPEAKER_00: And in our practice and in the majority of practices, the DBS system is usually left off for approximately four weeks after surgery.
• 11:07
  SPEAKER_00: And that gives the brain time to heal and allows the electrodes to become more stable before stimulation is adjusted.
• 11:12
  SPEAKER_00: During that period, you'll generally continue following your medication plan provided by your neurologist or movement disorder specialist.
• 11:19
  SPEAKER_00: Make sure not to stop or reduce your Parkinson's medication on your own.
• 11:23
  SPEAKER_00: It's important to remember that you are not waiting because the surgery failed.
• 11:27
  SPEAKER_00: You're waiting because turning on the device is a separate step in the treatment and the delivery of DBS therapy.
• 11:33
  SPEAKER_00: Now, some patients may actually notice that their tremor or other symptoms improve temporarily right after surgery, even when the device is off.
• 11:41
  SPEAKER_00: And this can happen because placing the electrode temporarily affects the surrounding brain tissue.
• 11:45
  SPEAKER_00: It bruises it to a small degree.
• 11:47
  SPEAKER_00: And this is called a microlesioning effect.
• 11:50
  SPEAKER_00: And some may refer to this or you may have heard it called the honeymoon effect.
• 11:54
  SPEAKER_00: And this improvement may last for days or sometimes several weeks.
• 11:58
  SPEAKER_00: But because it's only a little bit of bruising around that area, that benefit usually fades and it usually fades before programming begins.
• 12:06
  SPEAKER_00: And that's actually another reason why we typically wait, because in order to really get the best start on programming, we want to see your symptoms at their worst, not programming on top of this potential honeymoon or microlesioning effect.
• 12:19
  SPEAKER_00: If you've had the benefit of the honeymoon effect, sometimes what patients notice is that they're doing pretty well right after surgery, but then after a couple weeks, they are doing quote unquote worse.
• 12:30
  SPEAKER_00: But in talking with them more or talking with their family members, what has actually probably happened is that they get a little bit better from the insertion through this microlesioning effect.
• 12:40
  SPEAKER_00: And then in the couple weeks after when that goes away, they return to their pre-operative condition, which was worse than what they were just experiencing.
• 12:49
  SPEAKER_00: And we can tell that this is probably the case because once we turn the stimulation actually on and start programming, patients do well once again.
• 12:57
  SPEAKER_00: So let's talk about that programming process and what happens at that first programming visit.
• 13:02
  SPEAKER_00: That programming visit is typically with your movement disorder specialists, and at that time they will turn on the device and begin testing the stimulation.
• 13:10
  SPEAKER_00: That first programming, if it's being done for Parkinson's disease, is usually done with you off of your medication.
• 13:16
  SPEAKER_00: That means you'll receive instructions about when to stop holding your medications before the appointment.
• 13:21
  SPEAKER_00: It's usually not taking your morning dose or even skipping a dose at night so that we can make sure all the medications have washed out of your system.
• 13:29
  SPEAKER_00: And unfortunately, you're gonna be at your worst when you come to that initial programming visit.
• 13:34
  SPEAKER_00: So certainly you'll need someone to help take you there.
• 13:37
  SPEAKER_00: We usually try to do those early in the morning so you're not suffering through the majority of the day.
• 13:42
  SPEAKER_00: But at that initial programming, the movement disorder specialist will be able to see you without medication masking them and then start turning on the stimulator to see which contacts on the electrode are most effective for treating your symptoms.
• 13:56
  SPEAKER_00: They may then change the strength of the stimulation, other parameters called pulse width and frequency, and ultimately watch what happens to your symptoms.
• 14:04
  SPEAKER_00: Does the tremor improve?
• 14:06
  SPEAKER_00: Does stiffness change?
• 14:07
  SPEAKER_00: Does movement become easier?
• 14:09
  SPEAKER_00: Also, we look for side effects.
• 14:11
  SPEAKER_00: Are there side effects at a particular setting?
• 14:13
  SPEAKER_00: Because our goal is to find the largest therapeutic window, ultimately, where we can get good stimulation and good therapeutic effect while avoiding unwanted side effects.
• 14:23
  SPEAKER_00: Now, after that initial programming, you will usually take your Parkinson's medication again, and then we can see how the stimulation and medication work together.
• 14:30
  SPEAKER_00: So taking your medication in the office, we usually will have to wait 30 minutes, 45 minutes, whatever it is that it takes for those medications to really kick in, and then see how both the medication and the stimulator work together.
• 14:43
  SPEAKER_00: And based off of that, additional adjustments may be made as necessary.
• 14:47
  SPEAKER_00: And this is really an exciting day.
• 14:49
  SPEAKER_00: Most patients make a meaningful and very noticeable improvement on that first day during that first programming visit.
• 14:56
  SPEAKER_00: But whether you have a large step forward or incremental benefit, most will require several appointments before the settings are really optimized and dialed into where they really need to be.
• 15:08
  SPEAKER_00: And that's normal.
• 15:09
  SPEAKER_00: Just remember that that initial programming, the first setting, is really just a starting point.
• 15:14
  SPEAKER_00: It's not necessarily the finished treatment.
• 15:16
  SPEAKER_00: After that initial programming, depending on the practice, visits are often scheduled every four to six weeks during this early optimization period.
• 15:24
  SPEAKER_00: And that gives you enough time to live with each setting to see how it works, see how it affects your daily routine.
• 15:29
  SPEAKER_00: Other thing that I also want to make you aware of is that it's also normal after that initial program that it might be after a week or two that it seems to be quote unquote less effective.
• 15:39
  SPEAKER_00: Because the healing process is not complete, there's actually scar tissue that continues to form along the electrodes as your body is walling off the implant from the rest of the brain and the rest of the body.
• 15:51
  SPEAKER_00: And really, because of this dynamic interaction between the biological process of the implant being uh walled off and scar forming and healing happening in the brain, as well as the programming that's happening and you learning how to live with the device and all these different things that we're getting used to.
• 16:07
  SPEAKER_00: The programming process typically takes about three to six months to optimize.
• 16:11
  SPEAKER_00: So I try to emphasize that this is not a one and done, it is a process.
• 16:16
  SPEAKER_00: You have to be patient.
• 16:17
  SPEAKER_00: We're all human, we want things done right away.
• 16:19
  SPEAKER_00: But with DBS, please trust the process to a degree.
• 16:23
  SPEAKER_00: Understand that you're gonna have improvement over time, and it might take three to six months after that initial program to really dial into settings for all the reasons I just mentioned.
• 16:32
  SPEAKER_00: Now, once the stimulation settings and medication plan are stable, the visits usually become less frequent and return to your regular routine, and that's usually visiting your neurologist or movement disorder specialists one or two times a year.
• 16:44
  SPEAKER_00: Again, this is why DBS should be viewed as a process rather than a one-day procedure.
• 16:49
  SPEAKER_00: It's an investment.
• 16:50
  SPEAKER_00: The surgeon places the electrodes accurately.
• 16:52
  SPEAKER_00: The programming team then determines how to use these electrodes most effectively for the individual patient.
• 16:57
  SPEAKER_00: Now I've just talked about the regular postoperative course and what to expect, but what if something goes wrong?
• 17:03
  SPEAKER_00: What if something goes awry?
• 17:04
  SPEAKER_00: When should you call the surgeon?
• 17:06
  SPEAKER_00: Now, as I mentioned or at least alluded to, most postoperative symptoms improve as the body heals.
• 17:12
  SPEAKER_00: And as we discussed earlier, some soreness, fatigue, eye swelling, and temporary confusion can be part of the normal postoperative course.
• 17:19
  SPEAKER_00: But there are certainly signs that should prompt a call to the surgical team.
• 17:23
  SPEAKER_00: So I recommend that you contact the office if you develop a fever, chills, or flu-like symptoms.
• 17:28
  SPEAKER_00: Certainly call if you have worsening headaches and again watch the incisions for increasing redness, warmth, swelling, tenderness, drainage, or any opening in the skin.
• 17:39
  SPEAKER_00: You should also call for new numbness or tingling, weakness, or another sudden neurological change.
• 17:46
  SPEAKER_00: Also pay attention to changes in mood, thinking, or behavior.
• 17:50
  SPEAKER_00: And this might be something that you notice or your family member notices.
• 17:53
  SPEAKER_00: Call your surgical team if you or your family notice that you are unusually depressed, extremely anxious, agitated, confused, impulsive, unusually energetic or barely sleeping.
• 18:04
  SPEAKER_00: These changes may be related to a medication adjustment, or they may be related to the stimulation, or they may be a sign of something else that needs to be investigated.
• 18:12
  SPEAKER_00: Don't try to sort that out on your own.
• 18:14
  SPEAKER_00: Let your team know so that we can try to figure things out for you.
• 18:17
  SPEAKER_00: Also, seek help immediately if you have thoughts of harming yourself.
• 18:20
  SPEAKER_00: Now, that is a long list of things to watch for, but I don't want that list to leave you with the wrong impression.
• 18:26
  SPEAKER_00: I don't want it to be a reason that you don't consider DBS surgery or back out from DBS surgery.
• 18:31
  SPEAKER_00: I want to get back to the idea that DBS surgery is generally safe and serious complications are very uncommon.
• 18:38
  SPEAKER_00: The reason we review these warning signs is not because we expect them to happen or even because they happen with any frequency.
• 18:45
  SPEAKER_00: It's because if something does happen, recognizing a problem early allows us to address it quickly.
• 18:50
  SPEAKER_00: So if you remember anything at all, simply remember call if you're unsure or concerned about how you're doing after DBS surgery.
• 18:58
  SPEAKER_00: Patients sometimes delay because they don't want to bother the office or because they're worried that they are overreacting.
• 19:04
  SPEAKER_00: Let us be the judge of that.
• 19:05
  SPEAKER_00: We've done this a lot and your surgical team will have similar experience.
• 19:10
  SPEAKER_00: So we would rather hear from you early and determine that everything is healing normally and everything is okay and that we can reassure you, but would rather do that than have you wait on a possible infection or neurological problem or medication-related issue.
• 19:24
  SPEAKER_00: So how long do we have to be vigilant for?
• 19:25
  SPEAKER_00: Patients often ask me, how long is the recovery?
• 19:28
  SPEAKER_00: And really the answer depends on what you mean by recovery.
• 19:31
  SPEAKER_00: Most patients are back to most of their normal activities by about two weeks.
• 19:35
  SPEAKER_00: And by around one month, many are essentially back to everything they were doing before surgery.
• 19:40
  SPEAKER_00: But that doesn't always necessarily mean that they feel completely like themselves yet.
• 19:44
  SPEAKER_00: On average, it may take about four to six weeks for your energy, your sleep, soreness, overall sense of normalcy to settle down, basically to the point where you have effectively forgotten that you had the surgery and you don't have any soreness or pains to remind you of the procedure.
• 20:00
  SPEAKER_00: Then there's the programming process that I just talked about.
• 20:02
  SPEAKER_00: Most patients begin programming again within the first few weeks.
• 20:05
  SPEAKER_00: And after the first programming visit, many patients are already doing more than they could before surgery.
• 20:10
  SPEAKER_00: But the full benefit usually doesn't happen immediately.
• 20:13
  SPEAKER_00: Again, it takes three to six months to fully optimize the settings and the medication plan.
• 20:17
  SPEAKER_00: So hopefully you've gotten the sense that getting a DBS system implanted is a process.
• 20:22
  SPEAKER_00: The operation itself is only one part of the DBS treatment.
• 20:26
  SPEAKER_00: The first few weeks are about healing the incisions, gradually returning to normal activity and giving the brain time to recover.
• 20:33
  SPEAKER_00: So do not judge the final result by how you're feeling during the first week and don't even judge it by the first programming appointment.
• 20:40
  SPEAKER_00: If you're still deciding whether the timing is right for DBS, watch this video next when people with Parkinson's should begin considering surgery.
• 20:47
  SPEAKER_00: If you would like to speak with someone from our team about DBS or another treatment option for Parkinson's or central tremor, please feel free to reach out using the email address below.