Surgery
Minding Your Mending
No doubt about it: Surgery is a major insult to your body. Even though it's done with the best of intentions and in a clean environment, your body needs to put out extra effort to mend from even minor surgery. And while you're recuperating, you're more vulnerable than usual to pneumonia, bedsores, urinary tract infections and other kinds of infections.
That's why good nutrition is vital both before and after surgery. "It gives your body the building blocks to fight off infection, replenish lost blood and mend tissues, all things that can help you heal as quickly as possible with the least pain and discomfort," explains Ray C. Wunderlich, Jr., M.D., author of Natural Alternatives to Antibiotics and a doctor in St. Petersburg, Florida, who practices nutritional/preventive medicine and health promotion.
Medical experts are well aware that every single nutrient your body normally needs is also needed when you're facing surgery, including everything from calories and protein to copper and vitamin B6. "Keep in mind that every person's condition when undergoing surgery is different, so the types of vitamins and minerals that your doctor prescribes for you, if any, will depend on your own particular case," says Joanne Curran-Celentano, R.D., Ph.D., professor of nutritional sciences at the University of New Hampshire in Durham. "Because of the wide range of problems and conditions surrounding surgery, it is recommended that anyone who is about to undergo surgery check with his doctor before taking any kind of supplementation."
Not all doctors have the same approach to nutritional therapy and surgery. If you are facing surgery and want to pay special attention to nutrients that might be helpful, you'll have to find a doctor who uses methods that you feel most comfortable with.
Here are a few key nutrients that some doctors believe are important for getting your body on the high road to healing.
Vitamin C Speeds Healing
Doctors know that any kind of trauma, including surgery, can pull the plug on your vitamin C stores. After surgery, blood levels of vitamin C drop rapidly. And it's no secret that a vitamin C deficiency makes wounds heal slower. Delayed healing was noted hundreds of years ago in sailors with scurvy, a mystery disease at the time that turned out to be nothing more than severe vitamin C deficiency. "Today, it's more likely that people simply won't be getting enough vitamin C for optimum healing," Dr. Wunderlich says.
Many studies have shown that vitamin C is essential for the body to produce wound-healing collagen, which provides the basic structure for many tissues, including skin, bone and blood vessels. Vitamin C is also needed for the skin to produce elastin, a tissue that lets wounds stretch without breaking.
Vitamin C also helps maintain a healthy immune system, vital for anyone who's undergoing surgery, Dr. Wunderlich says.
One study, by Russian researchers, found that people who had gallbladder surgery who received 200 to 250 milligrams of supplemental vitamin C a day were able to leave the hospital one or two days earlier compared with people who simply got their vitamin C from foods.
At most hospitals, you're expected to get your vitamin C from foods such as citrus juices and fruits. Eight ounces of orange juice, for instance, offers about 124 milligrams, while one orange has about 70 milligrams.
Some doctors, however, recommend amounts of vitamin C that are much higher than you normally obtain from foods alone. Dr Wunderlich believes this to be especially important when you're recovering from surgery.
He tells his patients that "if you can take 1,000 milligrams of buffered or esterified vitamin C every eight hours for two weeks before and several weeks after surgery, you'll most likely be able to keep the vitamin C in your blood at a level that promotes optimum healing." Some people experience diarrhea and other digestive discomforts from such high levels of vitamin C. Buffered vitamin C and esterified vitamin C (a slow-release form) are easier on the stomach, says Dr. Wunderlich. Vitamin C can interfere with the results of certain diagnostic blood and urine tests, however, so it's important that you discuss supplementation with your doctor.
He also recommends 1,000 milligrams of bioflavonoids a day to some of his patients. These chemical compounds are related to vitamin C and are often found in the same foods as the vitamin, especially citrus fruits. Dr. Wunderlich maintains that bioflavonoids can help maintain blood vessel strength and control inflammation.
| Taking Your Supplements to the Hospital You do everything possible to stay healthy, including taking supplements. So when you have to go into the hospital for surgery, you take your supplements with you. But the next thing you know, someone is telling you not to take them, and you're left wondering why. The deal is this: "You just can't take whatever pills you were taking outside the hospital, even if they are vitamins," explains Alexandra Gekas, executive director of the National Society for Patient Representation and Consumer Affairs of the National Hospital Association. "Vitamins are considered medications, and in the hospital, you need your doctor's approval for every medication you take." So how do you operate in this environment? "It's in your best interest to keep your doctor and other caregivers as informed as possible about what you're taking, in order to avoid any possible complications," says Gekas. Before your surgery, she suggests, get your doctor's approval for whatever supplements you want to take. Ask him to write his approval on your hospital chart. Then if anyone questions your taking them, refer that person to your chart. Do note, though, that orders for "nothing by mouth" prior to surgery apply to everything--including supplements. |
| Finding Healthy Hospital Fare Is hospital food really so bad? The answer you get depends on whom you ask. "It's not as bad as it used to be, but at most hospitals, there's still room for improvement," says Don Miller, R.D., a San Diego dietitian and chef who helps hospital kitchen staffs make their foods tasty and attractive. These days, any hospital can come up with a low-fat, low-sodium, diabetic or vegetarian meal without having to order out, Miller says. The problem is, sometimes it just doesn't taste good. Miller reports that new trends in the hospital industry are changing the way that foods look and taste. Instead of finding mushy string beans, wilted lettuce or processed meats, you might find steamed vegetables, a hearty romaine lettuce salad or brown rice, Miller says. And you can select from items on your menu to come up with the most nutrient-packed choices. Look for these staples, offered in most hospitals: yogurt, whole-wheat bread, spinach, carrots, broccoli, orange or grapefruit juice, V-8 or vegetable juice, oatmeal, bran cereal, fruits, beans, skim milk, stewed prunes, baked potatoes, baked or broiled fish and chicken. If you're concerned that a family member or friend who's in the hospital isn't eating, visit at mealtime to help, suggests Melanie Roberts Afrikian, a nutrition consultant in private practice in Wakefield, Massachusetts. "If you can't do that, ask the nursing staff to make that sure they help," she says. |
| Food Factors Protein, fiber and other components of foods are just as important to recuperation as vitamins and minerals. Here's what the doctor orders. Find a friend in fiber. As people recovering from surgery know, moving the bowels is a much-anticipated event, and it's one that has to be initiated if it doesn't happen on its own. "That's why fiber is so important," says Joanne Driver, R.D., a dietitian in the critical care and surgical units of Marquette General Hospital in Michigan. "I suggest prunes, prune juice, fruits, vegetables, legumes, whole grains--the kind of fiber that is beneficial in preventing constipation," she says. If your bowels need more help, try psyllium, another kind of fiber (found in Metamucil and similar bulk laxatives). Keep on sippin'. Some experts recommend drinking the equivalent of six to eight eight-ounce glasses of fluids a day unless your doctor tells you that you need to restrict fluids. It helps prevent dehydration, helps the fiber work better and flushes out the bladder, which is prone to infection if you've had a urinary catheter. Eat light and eat often. People recovering from surgery naturally prefer small, light meals, and that's what patients should be served, Driver says. "Don't try to coax someone to fill up on a regular-size meal; it will just make him uncomfortable." Serve five or six mini-meals a day, she suggests. Old favorites include whole-wheat toast, custard, pudding, yogurt, fruits, sherbet, soup, half-sandwiches and fortified shakes. |
Vitamin A Mends Skin
Vitamin A has been called the skin vitamin, and with good reason. At burn centers such as Shriners Burns Institute in Cincinnati, large amounts of vitamin A are added to liquid formulas designed to help prevent infection and promote the growth of new skin.
In studies with laboratory animals, vitamin A enhances healing that has been retarded by steroid drugs, immune suppression, diabetes or radiation, reports Thomas K. Hunt, M.D., professor of surgery at the University of California, San Francisco.
"Vitamin A works in many different ways," Dr. Hunt says. "It's required for cell growth and differentiation, or the ability of a cell to mature into its final form. This is important for the generation of new tissues." Vitamin A also seems to activate the production of connective tissue, including collagen, and to promote the growth of new blood vessels, he explains. That's important for nourishing newly forming tissues.
"Adequate vitamin A really is essential for anyone undergoing surgery," Dr. Wunderlich agrees. He recommends up to 25,000 international units of water-soluble vitamin A (available in health food stores) for certain patients undergoing surgery. Vitamin A can be toxic in doses exceeding 15,000 international units daily and has been found to cause birth defects in doses of 10,000 international units daily when taken during early pregnancy. For this reason, the dosage of vitamin A recommended here should be taken only under medical supervision, especially if you are a woman of childbearing age. And you should not use this therapy if you are pregnant.
Studies show that most people get about 5,000 international units a day from foods such as carrots, eggs and vitamin Afortified milk.
Zinc Zeros In on Tissue Repair
Medical research shows that in people who are low in zinc, supplements can dramatically speed up the healing of surgical incisions. In a study by researchers at Wright-Patterson Air Force Base in Ohio, people taking 220 milligrams of zinc sulfate three times a day were completely healed in roughly 46 days, while a group taking no zinc required about 80 days to heal.
Zinc, like vitamins A and C, is needed in the body for many things, Dr. Wunderlich says. It's necessary for the production of collagen, the connective tissue that allows scars to form. It interacts with vitamin A, making the vitamin available for use. And it plays a vital role in immune function.
The people most likely to be short on zinc include those who've lost lots of fluid, those who've lost weight because of loss of appetite, those who've experienced loss of taste and those who've been getting lots of colds and infections, says Keith Watson, D.O., professor of surgery and associate dean for clinical affairs at the University of Osteopathic Medicine and Health Sciences in Des Moines, Iowa. "In addition to slow healing," he says, "bedsores, skin changes and depression can also be signs of zinc deficiency."
It's hard to determine if someone is actually short on zinc, Dr. Watson says. "So we may give a patient zinc and other nutrients, since an isolated deficiency is rare," he says. "Then if he doesn't soon start improving, we'll check his zinc status to see if the amount we are giving is bringing the patient's blood level back to normal."
Dr. Wunderlich recommends 15 milligrams of zinc citrate (an easily absorbed form) twice daily to a number of his patients undergoing surgery. It's best to take this much zinc only under your doctor's care, as amounts exceeding 15 milligrams daily can be toxic.
Vitamin E: For Healing Hearts
Some doctors add vitamin E to their on-the-mend menus, especially for people who've had heart surgery. There's some evidence that vitamin E helps stop the process of atherosclerosis, or the buildup of fatty deposits in arteries. And one study, by researchers at the University of Toronto, suggests that it can also help limit tissue damage during coronary bypass surgery.
In this study, half of a group of people undergoing bypass surgery took vitamin E before their operations. The other half took placebos (blank pills). After the surgery, the people taking 300 international units of vitamin E for two weeks prior to surgery had "small but significant" improvement in heart function compared with the people taking the placebos.
"Heart cells can be damaged when their blood supply is cut off and then restarted, a condition called reperfusion injury," says Donald Mickle, M.D., professor of clinical biochemistry at the University of Toronto and one of the study's authors. When oxygenated blood circulates through the oxygen-deprived heart, free radicals can form and can injure the heart cells, he says. (Free radicals are unstable molecules that steal electrons from your body's healthy molecules to balance themselves.)
Vitamin E is known as an antioxidant. In the right place at the right time, it neutralizes harmful free radicals by giving up its own electrons, sparing healthy molecules from harm.
"Our study suggests that for people at high risk--those with unstable angina, for instance--treatment with vitamin E prior to bypass surgery may be of benefit," Dr. Mickle says. (For people who require immediate surgery, a water-soluble form of vitamin E that can be given intravenously just prior to or during surgery is being developed, he says.)
Doctors who recommend vitamin E to their surgery patients often prescribe about 400 international units of vitamin E daily. Don't take more than 600 international units without your doctor's okay, especially if you've had a stroke or bleeding problems in the past. "In large amounts, I'd say more than 800 international units, vitamin E can enhance bleeding problems," Dr. Wunderlich says. If you're taking anticoagulants, it's best not to take vitamin E supplements.
In fact, when you're going into surgery, it's a good idea to be aware of any and all nutritional therapy you are taking that might interfere with blood clotting, Dr. Wunderlich advises. "Some of my heart patients take garlic for their conditions, and since garlic can cause bleeding problems, I recommend stopping the garlic for a few weeks prior to surgery," he says.
"Remember, taking any kind of supplementation may interfere with your surgical procedure and recovery," says Dr. Curran-Celentano. "To be safe, take supplements only under medical supervision." A few weeks prior to surgery, you might want to discuss any supplements you've been taking with your doctor.
The most commonly offered bit of advice, from doctors and dietitians alike? Ask your doctor about taking a multivitamin/mineral supplement that provides the Daily Value of every essential nutrient. And if necessary, get enough protein and calories by adding nutritional liquids to your menu.
| Prescriptions for Healing Every nutrient is important when it comes to bouncing back from surgery. The problem is that nutrient needs vary widely depending upon your current nutritional status and the kind of procedure that you'll be having. Your best bet is to have a frank discussion about nutrition with your doctor well before your surgery. Many doctors recommend that their patients take |
