READERS SUMMARY:
What might you consider pre and post op before your surgery?
These all need to be cleared with your surgeon before starting!
In an ideal situation, patients undergoing surgery will have adequate time before the operation to prepare themselves emotionally and physically. This preparation will likely include dietary supplementation, as well as mental and emotional preparation. The healthier patients are when they go into surgery, the healthier they are likely to be during the postoperative phase. If they are a progressive patient suggest some brain training pre-op with biofeedback or transcendental meditation. It has an amazing effect of decreasing the need for post-op narcotic pain meds for pain control. The fewer pain meds one takes, the fewer complications one will face too. It also will not induce post op hormone changes.
I also recommend that patients with poor glucose control discuss intensive insulin therapy with the surgeon before surgery. Specifically adding 500 mgs of reservatrol for 2 weeks prior to and after the surgery can cut insulin needs as well. Studies indicate that surgery-induced insulin resistance, leading to elevated glucose levels during surgery, raises the risk of complications and death. Intensive insulin therapy, a procedure in which glucose levels are closely monitored during surgery, can help reduce complications and lower the risk of death (van den Berghe et al 2001). The recommended glucose range is between 80 mg/dL and 120 mg/dL. However, this practice is not standard in hospitals and requires intensive administration from nurses and other members of the surgical team. Nevertheless, because of the benefits, patients may want to discuss intensive insulin therapy with their surgical team to see if it is warranted. Ironically, my own hospital won’t follow through with my recommendations via the pharmacy so I have to do this for each one of my patients individually as we talk about perioperative care. I handle this best by trying to solve their diabetes before I operate on them if they are willing to do the things needed for success.
I also advocate bagging the body part that is going to be physically cut by the surgeon with ice packs for 45 min to an hour a day two weeks prior to surgery. If this is a fusion operation the cold also induced BMP-7 and BMP-2 to form bone more easily. Cold thermogenesis actually is a great treatment for osteoporosis. It is hard to do this on frank osteopenic because they have high omega six tissue levels, and most cannot handle the cold acutely unless they listen to me pre-op. Sadly, few do in my experience.
If the sun is out, try to get that body part being cut on in the sun to raise the tissues melatonin level to improve mitochondrial biology for recovery. I give my own patients specifics based upon their work up with me.
I also think you need to turn off all lights in your environment as soon as the sun sets two weeks prior to surgery and not use LED or artificial light products at all. I asked them to consider using eye masks when they sleep. Extra steps are to consider cooling mattress pads to sleep on pre and post op are great ideas. I also advocate using sleep domes that produce calming sounds to bring upon the onset of sleep faster. I also want them to bring it to the hospital if they buy it to use. I tell them all that I want them out of the hospital fast because it is among the worst environments to sleep in because of the artificial lights, noises, and constant waking up from the staff to do vitals and other things that the hospital makes the nurses perform upon patients.
I also asked them to double their use of Vitamin D3 and DHEA two weeks prior to surgery, if they are on these meds. The same is true for progesterone or pregnenolone. If they are going to be an inpatient in the hospital more than one night, I want them to bring their DHEA, Vitamin D3, pregnenolone, progesterone and estrogen with them in case I decide to dose it post op. We do not need testosterone because we can dose that IM for men. For women with patches, we ask them to bring them to the hospital. IF there are other regimens they are on, I tell them to bring their supplements to the hospital. I also tell the family to bring good food from home and avoid the hospital food like the plague! If you eat it you will have more pain postoperatively and you will be more likely to come back to the hospital for some other neolithic disease in the future.
Patients may also want to discuss aspirin therapy before surgery. Aspirin is a well-known antiplatelet that is used for prevention of heart attack and to mitigate the damage of ongoing heart attacks. Me, I like the combo of fish oils and reservatol better because most of the surgeries I do use bone and grafts and aspirin inhibits the formation of bone post op. So I don’t recommend any NSAIDs or aspirin for that reason. If however, I am not doing bone grafting or brain surgery I am OK with aspirin. Some studies have suggested that aspirin therapy may benefit certain patients before surgery, especially heart patients and those undergoing carotid endarterectomy (Mangano DT 2002). However, because aspirin affects the blood’s ability to clot, no surgery patients should begin aspirin therapy unless under the direct supervision of their surgical team.
Other nutrients might also be helpful before and after surgery that I use often depending upon the case:
EPA/DHA (1400 milligrams (mg) EPA and 1000 mg DHA daily (for DDD/DJD I add 500 mgs of Krill oil too for some based upon context)
Arginine (3000 to 12,000 mg daily (in three divided doses for one-month post-op)
Glutamine (1000 to 3000 mg daily depending upon the surgical wound
Vitamin C (2000 to 3000 mg daily (start before surgery 7 days and end 14 days later)
Vitamin E (400 international units (IU) daily (with at least 200 mg gamma tocopherol)
Vitamin A (25,000 IU daily (7 days post only) (I like the use of liver more)
Alpha-Lipoic acid (150 to 300 mg daily (start 2 weeks prior to surgery and go one month after)
CoQ10 (300 mg daily (older patients and bigger cases I use a higher dose)
Zinc (30 mg daily
Melatonin (300 mcg to 10 mg, usually taken before bedtime; begin with the smallest possible dose (only meant for 7 days post op)
Curcumin (800 to 1600 mg daily, 500 mgs of trans-resveratrol a day for one-month post surgery
Fat/Protein (derived from unprocessed grass fed whey ) (up to 60 grams (g) daily
Importantly, the surgeon should be aware of any dietary supplements that are consumed. Some supplements, such as vitamin E, Krill and Fish oil, Ginkgo biloba, increase the risk of bleeding during surgery. Many physicians will recommend that patients discontinue these supplements up to 14 days before surgery. Some surgeons will not recommend this because of their experience with the supplements is deep in surgical patients. I have this experience so I look at this a lot differently than most surgeons.
If you are having any back surgery you need to make sure two weeks pre-op you drink 1-1.5 gallons of non fluoridated polar water daily. I would also make sure your vitamin D level is stout at 70-100 ng/dl and you should consider getting your skin into the sun if you’re in the summer or spring months pre-op. When I get to EMF-7 you’ll see why the photoelectric effect is important for surgical healing.
Awesome post Dr. Kruse. Will you be talking more about the use (or disuse) of artificial lighting during the Paleo Summit? I have had delayed phase sleep syndrome for years but sometimes when I just stay away from artificial lighting when its dark (i.e. just thinking/meditating in the dark) I'll often go to sleep as soon as 10-11pm. whereas my usual sleep time in college was like 4am. I think sleep is such a critical factor that is often even underrated by the Paleo community, and I look forward to what you'll have to say.
@Daniel H I will talk about what ever people want. I will have my note pad and I will be taking notes. You tell me what you might want to me talk about and if I can I will. I am an open book in Austin. Come get some.
I agree 100% Doc. The hospital is the worst place in the world to get rest.
@Jim…….its a good place to get sick. Just look at the food they serve. It is like a guarantee for you to come back.
awesome post, Jack. Will be sharing this info with my surgical patients, and perhaps i will share it with the neurosurgeon that I most commonly refer to out here in CA (Joe Welsh).
@Lisa DC your wish is my command………..to write
You are a true treasure! I had a discectomy last year and wish I knew all of these things. I did stop my fish oil out of pure fear from what I read and what was directed by my doc. I still have back issues (which is so frustrating because I am only 38 and weigh 145 lbs) but since discovering my vitamin d deficiency (thanks to you) I feel like just getting the right supplements is actually making my back feel better. The freezing cold baths also seem to completely make pain go away for many hours!!
@Brenda I am glad to help. Today you called me a treasure while in other places I got called a charlatan. I kinda like that. Paleo Ying and Yang I guess. I am in balance.
All right I'm in the perfect place for cold therapy I'm in western Washington state it's friggen 30° F right now and I'm going outside in thin lounging pants… you just need to move up here and be my doctor… oh that's right you're a surgeon and I don't need surgery they just can't tell me for sure what's wrong with me! I swear I'm gonna go postal on Group Death… oh was that my outloud typing??? LOL
I am a night shift (yeah I know, I have decided to come off nights as soon as possible, though I have always been a night owl, mom even said I kicked WAY more at night when she was pregnant!) ICU nurse. Interupted sleep is a HUGE problem, although one that it seems they are at least starting to make an attempt to address. Which leads to the ICU psychosis. I often half-joking tell patinets we wake them up so much because if we didn't, they would get good rest and get better, and that is no way to make money. I truly hope you can make a large impact on the medical community and the way they think, you and other paleo oriented MD's. Do you teach, take on residents, etc? I would love to see you spread your enthusiasm for questioning the status-quo to young residents. In that vein, I think for your book, and blog, the idea of going with the bullet points to make things simple for those that wish that, and then below that, the in depth medical/scientific stuff, is the way to go. I understad the need to simplify to get across to a broad audiance, but if you want to change the professionals point of view, which you have said you do, you HAVE to show them you know what you are talking about, you need to talk to the professional on his/her level. Plus, for the reader like me, it challenges our level of understanding, makes us learn and understand better. We may have to read, re-read, and look things up, but in the end, we will be better for it on a personal level, and have a greater ability to affect change in others, because of what we lean. Just my 2 cents, and thanks for all the work, can't wait for what is in store for 2012!
@Steve I talk to anyone who wants to listen or to learn. I find when I meet people like them they often teach me more than I give to them. Yesterday I gave a lecture to our ICU nurses about circadian biology and vitamin D, cancer, and how it ties into leptin biology and its role in epigenetics. The fellows and residents stopped and listened too. If you mind is open and you want to hear my thoughts I will talk to you. That is why I answer questions here. I find the most critical people in life tend to be the people who have small minds that lead to smaller thoughts and critical words because they have not yet contemplated the entirety of the argument……….I always say wait until someone explains themselves, ponder it, and then reply. There is wisdom in that.
Thanks so much for this post! My hubby had a major spinal fusion (front and back – ribs to pelvis) last March and now needs a hip replacement (avascular necrosis of the femur head – stage IV) just 10 months later. Trying to find the cause as we are sure the spinal surgery is connected. None of the major known causes apply (diabetes, alchoholism, etc) and the hip was fine prior to the spine surgery. He has eaten primally since the surgery with about all the supps you reccomend.
We are ~ 1month out from hip replacement surgery. What should we test for now to find or prevent further issues? Have you seen or known of this complication from spinal fusion?
@Mud yes the link is likely a cratered hormone response. My bet is an acute severe pregnenlone steal. They probably did not see it because we are not taught to look for it. Two of my cases that I am presenting at Paleo fx has this exact problem…….so you will be interested in it.
Can you suggest a link between pregnenlone steal and the necrosis of the femur head? Is it possible that other bones/body parts are also having this issue? How to test for other necrosis?
@mud pretty easy high cortisol drives the bone loss and the rest of the system causes decreased DHEA which destroy sleep so you fail in autopahgy to recycle proteins…….then the low sex steroid hormones further demolish the bone density and decrease the lean muscle mass to decrease both bone and muscle strength around the joint. I see this 5 times a day.
In 1999 I had bilateral hip replacements; in the run-up to the surgeries I was advised by a woman who had just had some VERY expensive plastic surgery done about her surgeon’s pre-op protocol: high dose Vit C, D, EPA/DHA, arnica, zinc … I happened to be taking DHEA at the time along w/ some other supplements and didn’t dc them for the surgeries. Was out of the hospital in 3 days after the first, 2 days for the second, minimal pain meds and was my surgeon’s poster child for super recoveries. Followed the same pattern for foot surgery last October, which went well too — wish I’d had your suggestions about the hormones and the rest for that one, but c’est la vie. Much of surgical success is patient attention to pre-op preparation, and post-op rehab. Cutters can do only so much — the rest is up to us.
This is very interesting. My 15yo son will be undergoing ACL reconstruction. He weighs about 115#, how might you adjust your recommendations for him? Thanks in advance for your insight.
@Marc go to an online PDR and convert the dosages……for kids. I no longer operate on kids.
Thanks–will do.
On 3/28 my 19 y.o. daughter was riding an ATV and collided with a Suburban. She sustained fractures to left tibia and fibula, degloving, extensive loss and damage of soft tissue. First washout looked good, second showed infection and more dead tissue removed. With the third washout today she was infection free and plastic surgeon was able to locate a good artery and an adequate vein for a muscle flap. A nail was inserted into tibia successfully and they are doing the muscle flap as I type. If this is successful extensive skin grafts are next. My question is would you change or add to the above recommendations? She as had very little nutritional support this past week. Three of the surgical teams were agreeable to considering ordering the supplements I will suggest. I am planning to bring in as many meals as I can. (How, I don’t know as my freezer stocked with local grass-fed beef is 60 miles from the medical center!) thank you so
@Karen so sorry to hear this about your daughter. I would bring this to the attn of the surgeons and and let them OK it……I think it would be find to do. Make sure you bring her food from home. Hospital food will surely hurt her flaps.
Much!
Thank you! Will do (PS-blood flow to flap is good thus far)
@Karen CT can decrease flow to flap so this needs to be cleared with surgeons…….but use of kril and/or fish oil will help…….but surgeons are very scared of them…….because they dont use them. I use them all the time with surgery so I have a big comfort level with them
I’m having procedures done to my saphenous veins, bad valves and varicose veins, (V-NUS closure and removal of some of them) and I found out yesterday that my deep vein has bad valves as well. I’m taking fish oil, krill oil, resveratrol, K2, multi vitamin, 10,000 D3, and keto diet.
What can I do to improve the function of my deep vein valves? I’m figuring CT will help some, other suggestions please? Is this lack of nerve function?
Thanks!
Megan
@Megan make sure you let the vascular surgeon know about the fish oil and krill……those may need to stop before that kind of surgery. I’d increase the K2 doses for the valve issues……CT on the legs will help huge.
Thank you!
Hi! I am 20 years old have Crohn’s Disease just this last year started reading into paleo and everything and started the diet but in July I had to have Core decompression surgery due to AVN bilaterally and the surgery failed. So September 26th I am having my first Total hip replacement because the Femoral Head collapsed and I am a friend of Steve Wrights he pointed me to you and I want to use CT for pre and post op just dont really know where to start. I also have an Ice machine I used for my shoulder surgery recovery was thinking I could utilize that as well? Just wondering your opinion on this idea and how I should approach it. I have 2 weeks So im trying to lock things down. Thanks!
@Aaron…….you must read BG 12 when it goes live…….and you would do well to listen to the Sept webinar. Become aware of what you might not know.
Hi Dr Kruse, 2 weeks ago I had breast implant replacement, 3 hernias fixed and abdominal plasty. I’m recovering really fast and doing well. Today I walked for 40 mins. Ive been taking vitamin C, D, ALA, zinc, curcumin, arnica. I have an infrared sauna at home( with different lights color settings) when do you think it will be safe to start using the sauna?
What about a vibration board? ( I have the vibration plate from Bulletproof)
I listen to some of your podcast interviews and read some of your articles. I can’t thank you enough for sharing so much information!!!
I would not use a vibration board if I was in your shoes for healing or ever. What you might want to consider is looking into photobiomodulation at 613.5 and 623.5 nm in the red spectrum and in the far-red between 667.5 and 683.7 nm. There are two near infrared maxima that have been shown to be helpful in the peak positions in the range 750.7-772.3 nm and 812.5-846.0 nm,
My partner is about to have surgery for the bunion he has developed on the big toe of his left foot. My understanding is that they will make a small incision, break his toe and reset it. He will have a pin placed there temporarily.
I have a Quantlet. I am setting up a custom protocol that is all red and all infrared, continuous, for 60 minutes. I want to use this on the foot post-op to assist with healing. Do you think this might be helpful? Also, I wonder about using it peri-operatively?
Thank you Jack!
It depends upon his anatomy. The device is optimized for the wrist but if it fits it is worth a try.