Is there an upcoming surgery in your future? If so, get your body and mind ready with these recommendations to help you heal more more quickly, have less pain and decrease your risk of surgery-related complications.
Preparing Your MIND:
Did you know that STRESS can slow healing, impair your immune system, increase systemic inflammation and post-operative pain?
This is why I strongly recommend that you start a stress reduction program at least 1-2 weeks before surgery (4-weeks before surgery would be ideal.)
Studies have proven that patients heal faster, have less anxiety and post-operative pain when they prepare before surgery using simple, easy-to-learn techniques such as guided imagery and meditation.
The best products I have found are these:
Prepare For Surgery, Heal Faster (clinically proven in multiple studies). Suggestion: Many patients have found it very beneficial to listen to these soundtracks with headphones during their surgery. Ask your surgeon if they will allow you to do that.
Brain Evolution System (Awesome product that helps put you into a deep meditative state quickly and easily without years of meditation experience or training needed.)
If you want to get the greatest benefit from these products do BOTH. You will end up using the Brain Evolution System product after your surgery.
Get Adequate Sleep:
Sleep is essential for helping you maintain low levels of inflammation and stress hormones in your body (both are risk factors for delayed wound healing and cancer progression.) Additionally, not getting enough sleep can also impair your immune system making you more susceptible to infections.
I recommend you get at least 6-7 hours of sleep every night.
Preparing Your Body:
Decrease Your Risk Of Bleeding:
You want to make sure you do NOT have an increased risk of bleeding during and after surgery, so I recommend you stop taking any supplements 2-weeks before surgery and stay off of them for 2-weeks after surgery.
**To be safe, always discuss this with your surgeon to find out if they want you to remain off these supplements for longer.
This list is some of the more common supplements that are known to increase your risk of bleeding:
- Vitamin E
- Omega 3 Fatty Acids
- Gingko Biloba
- Dong Quai
- Ephedra (also called ma-huang)
- St John’s Wort
- Saw Palmetto
- Reishi Mushrooms (Ganoderma lucidum)
Decrease Your Risk Of Other Surgical Or Anesthesia Complications:
This is a list of some of the more commonly used supplements that are known to cause various other surgical or anesthesia-related complications. You will want to stop these 2-weeks before surgery.
- Echinacea: If you have liver disease and you have anesthesia while taking echinacea, you could end up with liver damage.
Ephedra: When combined with some anesthesia drugs, it can cause high blood pressure and abnormal heart rhythms.
- Garlic: Garlic can increase the effects of medications used to control blood sugar, blood thinners and some over-the-counter pain relievers.
Ginkgo: Ginkgo biloba may make the sedation effects of anesthesia last longer.
- Ginseng: During surgery ginseng may cause high blood pressure and a rapid heart rate.
Kava: Kava may be dangerous for people having surgery because of its interactions with numerous drugs.
- St. John’s Wort: St. John’s wort may interfere with some anesthesia drugs and make it harder for you recover from the effects of anesthesia.
Valerian: This herb may increase the effects of anesthesia and make it more difficult to wake up after surgery. It may also cause irregular heart rhythms.
**This is far from a complete list of supplements to discontinue before (and for a couple weeks after surgery) so always discuss your use of supplements with your surgeon, integrative oncologist and/or pharmacist.
Wikipedia has one of the best lists I have found on potential supplement reactions.
Feed Your Tissues:
It’s very important to give your body the nutritional building blocks and resources it will need after surgery to heal, fight off infections and build new tissue.
I recommend that you to start loading up 4-weeks before surgery on these nutritional compounds (through food or supplements) and then continue with them for at least 4-8 weeks after surgery.
**Before you take any supplement it is very important that you first discuss this with your physicians.
Vitamin C: Contributes to the strength of healing wounds and is necessary to build collagen throughout the body. Vitamin C is also a powerful antioxidant that supports the immune response. (Dose: 1000-4000 mg per day “liposomal” vitamin C).
Coenzyme Q10: Coenzyme Q10 (CoQ10) is an antioxidant molecule that is important in cellular energy metabolism. Studies have shown that levels of CoQ10 drop during and after surgery indicating that it gets rapid used up in the process of neutralizing large amounts of free radicals produced as a result of tissue injury and systemic stress. (Dose: 300 mg per day of “Ubiquinol”).
Vitamin A: Supports immune system functioning and wound healing. Also required for bone development. (Dose: 25,000 IU per day).
Zinc: An important mineral used in enzymatic reactions involved in tissue and wound healing (i.e. collagen production), regeneration and repair. Zinc also functions as an antioxidant in tissues. (Dose: 30 mg per day).
L-Arginine and L-Glutamine: These amino acids are key protein building blocks that have been shown in studies to improve surgical wound healing, decrease systemic inflammation and improve immune function. (Dose of L-Arginine: 2000-9000 mg per day in divided doses, Dose of L-Glutamine: 1000-3000 mg per day).
Lipoic Acid: Studies have found that lipoic acid increased the healing of skin wounds by protecting skin cells from surgical-induced free radical damage. The most biologically active form is R-Lipoic Acid (Dose: 300-600 mg per day).
Whole Food: You certainly can get all of these nutrients (and MANY more) through your food if you consume a wide variety and large quantities of organic produce and/or grass fed meat. In fact, this is by far my preference if you can do it. Most people can’t which is why I often recommend supplements.
Plant Protein Powder: You want to load your body with all of the essential amino acids it needs to rebuild tissues and support the immune system. High quality, complete, plant-based protein powders are a great way to make sure you are getting everything you need. Simply mix the powder into a glass of water or blend it in your smoothie each day. (Dose: 17 grams or more per day)
Juicing & Blending: To make it easier for you to consume large quantities of phytonutrients in one serving I often recommend you juice and/or blend (smoothies). Make sure you juice or blend various produce varieties each day or you will miss out on essential micronutrients and important anticancer compounds.
Green Drink Powder: If you can’t find the time to either eat lots (at least 5-8 servings) of produce every day or juice or blend then you need to drink a glass of this green stuff. Green drink powders are often made of dried, powdered whole plant food or extracts containing numerous grasses, seeds, nuts, fruits and vegetables. These powders are so chock-full of micronutrients (and often pre- and probiotics) that you may not even need to take any other vitamin or mineral supplements. Just mix one scoop of the green powder into a glass of water or into your smoothie each day.
Hold These Until After Surgery:
Omega-3 fatty acids: Starting 2 weeks after surgery (first make sure it is okay with your surgeon) I recommend consuming foods rich in omega-3 fatty acids (or taking an omega-3 fatty acid supplement). Studies show these essential fatty acids reduce the production of cytokines (proteins which increase systemic inflammation and free radical production) which can impair wound healing and immune strength. There are some experts who do not believe that omega-3 fatty acid supplements increase bleeding risks, but I would be cautious and assume they could. (Dose: 2,000 mg per day EPA/DHA).
Vitamin E: Starting 2-weeks after surgery (first make sure it is okay with your surgeon) it is should be safe to start supplementing with this antioxidant vitamin. Studies suggest that vitamin E may reduce tissue damage caused by free radicals due to surgically induced inflammation. It’s important to only use “mixed” tocopherols and not just the synthetic alpha-tocopherol. (Dose: 400 IU per day “mixed” tocopherols).
Control Your Blood Sugars:
It is very important that if you have problems with glucose control (i.e. diabetes, pre-diabetes) that you discuss with your doctor how to get this under the best control possible before surgery. This can take weeks-to-months so it is important to address this as soon as possible.
Studies show that surgery causes insulin to not work as well as it should (“insulin resistance”) leading to elevated blood sugar levels during and after surgery which increases the risks of postoperative complications and death.
We also know that cancer loves sugar and insulin.
I check all of my patients for insulin resistance, as almost every day I discover healthy-appearing individuals with lab results that clearly indicate they have insulin resistance.
All my patients with insulin resistance get placed on the IOE Premium Program to help optimize their blood sugars and insulin levels.
Prehabilitation or “Prehab” (Get In Better Shape Before Surgery):
If you want to recover more quickly after surgery I highly recommend you look into cancer prehabilitation.
Cancer “prehab” is about getting you in the best possible shape for cancer treatment. These programs aim to prevent or lessen the severity of possible treatment-related side effects that could lead to later disability. They identify any of your current impairments (such as, pain, limited mobility, neuropathy, etc.) and provide you with customized treatments and strategies to reduce the risk and severity of potential future impairments.
Not only does cancer prehab focus on aerobic & strength conditioning, but research shows that it can improve outcomes in those with specific cancers:
- Swallowing exercises before surgery for head or neck cancer
- Smoking cessation to improve breathing function before lung cancer surgery
- Pelvic floor exercises to reduce problems with urinary incontinence after surgery for prostate cancer.
Get A Baseline Lymphedema Assessment:
If you are going to be undergoing surgery to the breast, arm or leg you could be at risk of developing a condition called “lymphedema.” This commonly presents with swelling or heaviness in the affected arm or leg anytime after surgery (days-to-years later). Some surgeries disrupt the lymphatic vessels in the legs or arms (this is particularly common with surgery to the lymph nodes under the arm, called the “axilla”) causing a back-up of lymphatic fluid in the limb.
It is very important that lymphedema is detected as soon as possible so that you can get treatment for it. The sooner you detect and treat lymphedema the better your chances of being able to reverse the symptoms. If it is diagnosed months to years after its onset it can be very difficult to treat and can put you at risk for serious problems (such as infections).
I recommend that all patients who are going to be undergoing a surgery that may cause lymphedema (breast cancer surgery is the most common cause) get a baseline assessment of their potentially affected limb BEFORE surgery so they can be followed for any changes that may occur over time.
Discuss with your surgeon whether you might be at risk of developing lymphedema after surgery.
Anesthesia Choices Could Improve Your Cancer Outcomes:
Some fascinating studies have been published recently which suggest the type of pain control you get during and after surgery may impact your cancer outcomes.
- One study found that the addition of a local anesthetic to general anesthesia during breast cancer surgery reduced breast cancer recurrences and death by greater than 60%!! Many surgeons rely solely on general anesthesia for breast cancer surgery and do not use local anesthetic. (Data: 6-year follow-up found that 13% of patients who got general and local anesthesia had their cancer recur versus 37% general anesthesia alone. And 10% of those in the combination group died compared to 32% of those given general anesthesia alone.)
- Opioid drugs (i.e. morphine, morphine, methadone, Buprenorphine, hydrocodone, and oxycodone) promote breast tumor growth in rodent studies and suppresses the immune system in humans (Reference)
- Pain from surgery increases the risk of cancer spread (reference). This is believed to be associated with the negative effects of stress on the immune system and increased systemic inflammation, both factors which can are associated with cancer progression. This is an important reason to keep pain under control.
The use of epidural (a form of “regional”) anesthesia alone (without “general” anesthesia) reduces the body’s stress response from surgery. In addition, regional anesthesia decreases the amount of inhaled anesthetics (used in “general” anesthesia) and opioids (i.e. morphine, etc.) you may need during surgery, both of which impair the immune system. Studies have found that epidural analgesia may improve cancer outcomes.
In a study of a group of men undergoing prostate cancer surgery under general anesthesia with morphine analgesia as compared with general anesthesia combined with epidural analgesia found that the epidural technique was associated with a 57% lower risk in prostate cancer recurrence. (reference). Other studies have not found a difference, so this remains an area of controversy.
Dr. Lawenda’s Bottom Line:
By its very nature surgery causes trauma to the body. Add some stress, anxiety and pain to the mix and you have the perfect storm of inflammation, oxidative stress (free radical production), immune suppression and insulin resistance. Each of these have individually been shown to be associated with worse cancer and surgical outcomes (i.e. extended periods of pain, limited range of motion, increased risk of infections and blood clots, etc.)
In my opinion it is essential that if you have the benefit of time to prepare BEFORE surgery you will do much better than someone who doesn’t.
There is a lot you can do and I encourage you to discuss all of the above recommendations with your surgeon or integrative oncologist as soon as possible.