How to Best Prepare for Surgery?

Scott S. Russo M.D.

Many patients coming to surgery are not mentally, physically, or nutritionally prepared to recover after such an important event.  Two out of every three patients coming in for gastrointestinal surgery are malnourished at the time of surgery. We know that if somebody is malnourished, they have a three times greater risk of a surgical complication. There is research to suggest that a malnourished patient has a five times greater likelihood of dying than someone who is well nourished.

The Nutrifuel® Pre and Post Surgery Optimization plan and Nutrifuel® Surgical Supplement Kit helps you prepare for the stress of surgery with the potential to minimize complications, shorten hospital stay and restore normal function more quickly.

What does Surgery do to your body?

Surgery in fact injures your body with the intent to fix a critical problem. It causes serious metabolic and physiologic changes which may slow your recovery. Because of the need to heal tissues, your body will break down muscle to release proteins important for wound healing. This in turn can affect other body systems and lengthen the recovery process. Training the mind for healing, physical conditioning, the Mediterranean diet, and nutritional supplementation has the potential to enhance your recovery, lessen the risks associated with surgery while shortening your hospital stay.

Preparing Mentally and Physically for Surgery

How do you prepare the mind for the stress of surgery and to enhance healing?

Courage is not the absence of fear but the ability to standup in the face of pain, suffering or health challenges.

In the face of injury, illness, or the need for surgery we can’t always control the outcome, but we can develop and strengthen our ability to deal with it. Below are 5 key areas for preparing your mental state that will allow you to be more resilient when challenged with injury, illness, or surgery. They will lead you to deepen your wisdom around health and wellness and to integrate these skills into to your recovery.

The Big 5 of Recovery:

• Setting your intention- the process for finding your “why” and identifying roadblocks for recovery.
• Mindfulness and breath control- manage your bodies arousal state
• Learning attention control- developing positivity while crushing fear
• Visualization- learning to see your recovery before it happens and to picture a vibrant healthy you
• Goal setting- What do you have to so right now to improve the chances of an excellent outcome

 These can be found in the monograph “Preparing your mind for Healing”. Go to

nutrifuelnutrition.com and subscribe to digitally download your copy. Please check your spam folder in case it was placed there by mistake.

How do you prepare the body for the stress of surgery and to enhance healing?

Physical conditioning helps prepare your body for surgery and recovery. It should focus on several key areas with guidance ideally from a physical therapist, kinesiologist, or exercise specialist with prior approval from your physician.  Areas of focus should include aerobic fitness to include lung training, resistance, or muscle strength training as well as balance training to prevent falls after surgery. There should be a clear exercise plan including the specific exercises, frequency (days, reps, sets), intensity, and the advancement of the training. A good general guideline for the preoperative exercise program should be 6-8 weeks in duration. There should be 2-3 sessions per week with each training session approximately one hour and should include a warmup and cool down period.

Guided basic cardiopulmonary exercise program:

 (3+ times/ week) to include journaling. Have a physical therapist or skilled trainer assess the patient, design, and implement the preoperative program.

Example:

1. Assessment to determine patient’s capacity for mild to moderate exercise.
2. Do “Preparing your mind for healing” mindfulness and positivity exercises.
3. Warm-up
4. Heel raises
5. Bicycle or upper body ergometry- (5 minutes 3x/day increasing 1 minute per session per week)
6. Step-ups
7. Chair squats
8. Alternating seated knee extension and flexion
9. Seated flutter kicks
10. Prone spine extensions
11. Walking program (15 minutes/session)
12. Cool down
13. Journal experience

Using diet and nutritional supplements to improve healing

The way we fuel our bodies is critical to how we recovery from the trauma of surgery. Nutrifuel nutrition has a dietitian available for presurgical consultation. Consulting with the dietitian provides professional nutrition education and puts in place a plan that promotes optimal healing after surgery.  Nutrifuel utilizes the Mediterranean diet as a foundational approach to fueling the body in preparation for the stress of surgery. Eating Mediterranean involves a diet rich in vegetables(root), fruits, whole grains, legumes, seeds, nuts. Other key aspects of this diet are a moderate intake of seafood, dairy and poultry while limiting inflammation causing red meat and desserts.

Filling in the gaps of the “standard American diet” and completing the preoperative preparation process is the Nutrifuel® Nutrition pre- and post-surgical supplement kit.  This unique kit provides professional grade supplements which support the body in several key areas. It provides protein in the form of amino acids as well as 13 vitamins and 15 minerals critical for muscular function, bone health and wound healing. It strengthens our immune system while potentially lowering the risks of surgical complications.  As patients today are challenged by the effects of a poor diet, generalized societal stress, and overall poor lifestyle behaviors. Nutrifuel Nutrition has created a surgical supplement kit designed to buffer these negative factors and prepare you to recover from surgery, illness, or injury.  This kit is composed of seven key nutritional supplements each designed to impact specific body systems.

The Nutrifuel® Nutrition Surgical Optimization Plan

Preoperative

Six-eight weeks Before Surgery: Health and Weight optimization using the Mediterranean diet

Three Weeks Before Surgery: A full week of supplements as well as the Mediterranean diet.

Two Weeks Before Surgery:  A full week of supplements as well as the Mediterranean diet.

One week before Surgery: Most hospital systems request that a patient hold all nutritional supplementations while the patient continues the Mediterranean diet.

Postoperative

After Surgery: Resume Supplementation immediately upon discharge from the hospital and continue for the next two weeks, providing a total of four weeks of nutritional optimization. Our fat emulsified Vitamin D will provide additional supplementation for several weeks upon discharge and should be taken till finished.

Nutrifuel® Pre- and Post-Surgical Supplement kit

• Osteo Health Complete: This multivitamin, multimineral, and phytonutrient is composed of 13 vitamins and 15 minerals. As a surgical prep and recovery supplement, it contains copper and iron for post-operative blood restoration. Wound healing is a critical piece of the post-operative experience, and our multivitamin provides ample amounts of Vitamins A, C, E, and the minerals zinc, selenium, and iron.

• Amino complete: is a concentrated form of amino acids known for wound healing. It is well known that the stress of surgery causes proteins to be broken down and hyperglycemia to occur putting prediabetic and diabetic patients at higher risk of complications.  It's rapidly absorbed from the gastrointestinal tract improving digestion and amino acid availability and protects the body from breaking down key proteins needed for other important bodily processes like blood clotting, muscle function, immune and cardiovascular function.

• EFA Restore: This is our essential fatty acid blend and includes a combination of fish oil, flaxseed oil, and borage oil providing a balance of Omega’s 3,6 and 9. These fatty acids are critical building blocks for the structural components of cells, tissues, and organs. Several of these fatty acids are not able to be manufactured within the body and are considered essential and are only able to be obtained through diet and supplementation. They are important mediators of inflammation and can also impact the negative effects of cancers by helping patients maintain their lean muscle mass. Omega-six fatty acids are important in the early aspects of wound healing. Omega-three fatty acids are critical for the later stages of healing and general health while lowering inflammation.

• Immuno Support: This is a complex oligopolysaccharide that passes through the upper gastrointestinal tract into the colon where it feeds the patient’s normal gut bacteria resulting in the formation and release of butyrate.  Butyrate helps strengthen the immune system by feeding the gut lining cells and maintaining the integrity of the epithelial barrier. With the use of this supplement there can be increased Natural killer cell cytotoxicity whose inactivity has been associated with the chronic diseases of cancer, chronic fatigue, and various autoimmune disorders. Additional benefits are the lessening of constipation and regulation of bowel movements.

• Probiotic Plus:  This supplement is a synbiotic or a combination of pre and probiotics.  Probiotics are live microorganisms whose purpose is to improve the health and wellness of the host. With illness, injury, and the stress of surgery a patient’s gastrointestinal tract can become damaged and cease to function normally leading to the overgrowth of unhealthy bacteria. The use of broad-spectrum antibiotics can impact up to 30% of a patient’s normal gut flora taking up to months or even years to recover.  However, the use of pre and pro and prebiotics can strengthen the immune system through the gut-associated lymphoid tissue (GALT) lessening the risk of postoperative complications like infection. We can also see improved functioning of the gastrointestinal tract and the way in which food is digested and nutrients are absorbed.

• Digestive Support: This is a combination of digestive enzymes and acids designed to impact the body’s ability to digest and absorb proteins and B vitamins.  Acid and enzyme secretion often decreases as people age and in some situations may result in bacterial overgrowth in the stomach and possibly the small intestine. Low or absent stomach acid can significantly impact calcium absorption and raise the risk of osteoporosis. This is not uncommon in patients that have undergone removal of part of their stomach or have had gastric bypass surgery. This supplement is contraindicated in individuals with an active ulcer, in doses outside of the recommended amount, and in patients with a prior or current allergic reaction.

• Vitamin D3 Restore: The uniqueness of this supplement is its fat emulsified nature resulting in enhanced absorption. Vitamin D3 is known to affect calcium and phosphate metabolism supporting bone health and lessening the risk of osteopenia and osteoporosis.  Vitamin D insufficiency or deficiency is common worldwide. Current research is exploring the benefits of vitamin D on our immune system, the prevention, and treatment of cancer, viral respiratory infections, and most importantly its impact on chronic inflammation.  Especially pertinent to Orthopaedics and spine surgery is the common finding of insufficiency or deficiency in the presurgical evaluation of patients. So presurgical optimization of a person’s vitamin D level is critical for the healing of the skeletal system.