POP Clinic: getting you ready for the big day
The POP Clinic, or Happy Clinic as patients call it, doesn’t look like your typical medical unit. Equipped with a small gym and an assessment room, this place usually leaves patients who come in and out of it with a smile on their face.
But why so, would you ask? Probably because they get a feeling of empowerment and positivity through this wonderful initiative lead by anesthesiologist Dr. Carli and his team at the Montreal General Hospital.
The Peri Operative Program (POP) is an important part of the Enhanced Recovery After Surgery (ERAS) pathway.
The Clinic started as a program to help cancer patients prepare for their surgeries. The idea was that the fitter you were before undergoing surgery, the faster you would recover after and get back to your regular activities. For patients who were elderly, frail or at risk because of their weight or their heart, the program was a way to get access to the surgery they needed by meeting the criteria set by their surgeons.
It’s based on three pillars: exercise, nutrition and psychological care. Patients who are referred to the clinic get access to a nutritionist, a kinesiologist and a nurse specialist in psycho-education and supportive counselling to help them improve their condition in the weeks preceding their surgery.
Preparation is key
Just like a marathon, a surgery represents a shock to the body, and to be able to face it, one must prepare in advance. Patients referred to the POP clinic usually have 4 weeks to get ready, and since their body is going to lose a lot of muscle mass during recovery, muscle gain prior to the surgery becomes even more important.
That is why the POP team offers tools to its patients, like a personalised nutritional plan and exercise program that they can chose to do at home or at the hospital, in the POP gym. Since this moment also proves to be very stressful for most, the patients get relaxation and meditation exercises to help them reduce their stress level. In one word, they empower their patients. They use the time where they would usually feel powerless and stressed to have them regain some control over their life.
When patients undergo surgery, it takes them on average 3 to 6 months to recover to their baseline functional status. With the POP prehabilitation program, 60% of the patients will go back to their original status only 1 month after surgery, which is an impressive improvement.
The Montreal General Hospital is the only one in North America to offer such a clinic and there are only a few other places in the world offering it. At the moment, its activities are funded through a gala held every year in February and other donations from partners such as the Montreal General Hospital Foundation.
Pennie is a former patient of the POP clinic. She came to meet us on the 10th floor her cane in hand and a contagious smile on the face.
She talked with high respect and gratitude about Dr. Carli and his team and the wonderful job they did, not only getting her ready for surgery, but also analysing her situation as a whole and sending her to the right resources for help.
‟They saved my life” she says. ‟When I first came in here, I was so weak I had to use a wheelchair. They sat with me, we did an assessment, they gave me whey protein and advices on what to eat and what to avoid in order to get stronger, and they built a whole exercise program that was designed for me, not too hard but just hard enough to build some muscles. They also referred me to a hematologist whose treatments helped me get back on my feet.”
Pennie had a colorectal cancer and her tumor was bleeding, causing her to be very week. Probably too week to undergo the surgery she needed to fight the disease, but thanks to the POP Clinic and its devoted team, she is now in better shape than before, as she continues to follow their advice two years after surgery.
‟Their program embraces all of the person, and not only the cancer. All the work they do is to build the body up, so that when we go to have the operation, we are prepared for it much better than somebody who doesn’t have this benefit. I went through my operation like a breeze and afterwards it was a breeze even though I experienced some pain. I came out on a Monday and on the Saturday I was at Brome Fair. I was hobbling but I was there!”
Dr. Carli’s POP Clinic at the Montreal General Hospital has a goal: to empower patients and give them a sense of control in the period before surgery. This concept is based on three central pillars: physical activity, nutrition and mental wellbeing.