Before Surgery: What You Should Know Before Going Under The Knife
A friend of mine named Sylvia has been scheduled for some fairly routine surgery. But ‘routine’ doesn’t mean ‘easy,’ and she’s understandably apprehensive. She and I talked about a recent e-Alert ‘How to boost immunity following surgery’ (02/08/03), in which US physician Dr Allan Spreen, gave his insights on five immuno-nutrients that have been shown to improve immune system function after surgery.
Wanting to prepare herself as best she can for the procedure, she also asked me about an e-Alert she had read last spring in which Dr. Spreen recommended discontinuing vitamin C before surgery.
She wondered if I had more information on the topic, so I asked Dr. Spreen to revisit the subject of ‘C’ and surgery, and to give his opinion on modifying the use of any other supplements before or after a surgical procedure.
Going under
As Dr. Spreen has told us in the past, high levels of vitamin C can complicate the anaesthesia process. Here’s how Dr. Spreen explains the interaction:
‘The specifics of vitamin C apply to the mega-vitamin takers. Very high doses of C over time cause the body to ‘awaken’ dormant enzyme systems that more fully utilise high doses of the nutrient. If you take low doses, the body shuts these pathways down for your benefit. If it didn’t it would too rapidly empty the body’s ‘C pipeline’ and you’d be constantly deficient.
‘For those people I tell them to TAPER the C over time, reaching nearly zero just before surgery (not weeks before). This is because such high doses are good enough detoxifiers that more anaesthetic drugs may be necessary for the anaesthesiologist to keep you under. BUT, the absolute INSTANT you tolerate oral intake, you jack the C back up to heroic levels. Surgery is one of the biggest stresses the body can endure.’
The herb question
In one of the commentaries I found on the immuno-nutrients report that appeared in the British Medical Journal, osteopathic physician Dr. Joseph Mercola stated his opinion that herbal supplements should be discontinued prior to surgery, noting that some of these supplements are powerful enough to function like drugs.
I asked Dr. Spreen about the herbal issue, and he agreed with Dr. Mercola… to a point.
‘Yes, herbs are like drugs. The simple reason is that no drug companies design their drugs using mere brilliance. Pharmaceutical developers get their ideas from herbal effects, then try to alter the molecule enough to patent the thing (and cause all sorts of toxic side effects), hoping it’ll still do what the herb did, without killing you first.
‘The developers are good, however, at picking good herbs. Proscar is an excellent example. It is a derivative of the herb Serenoa repens (saw palmetto), which does work against benign enlargement of the prostate (better than Proscar), and with no side effects. Of course, the drug company will admit neither detail.
‘As to when, and whether, to quit a herb, the situation is much the same as with prescription drugs. You should seek advice from someone educated in the agent’s effects to know whether to stop it and when (or whether to increase it and how much!). I’d certainly never stop my saw palmetto weeks before surgery (or the day before, or ever).’
Beyond vitamin C
Returning to the subject of non-herbal supplements, Dr. Spreen had this final note:
‘Surgery is a major stress, and for that reason you want the maximum dose of nutrients for the body to choose from for the repair function. Vitamin C, and probably NAC should be discontinued (my sister-in-law required half-again as much medication to put her under as she was pumping the vitamin C heavily as ‘insurance’… the anaesthesiologist even commented on it).
However, the instant I could hold something down I’d be right back at them (and tons of other supplements) full force – C, A, E, B-complex, NAC, alpha lipoic acid, milk thistle extract, zinc, essential fatty acids, and others.’
Don’t forget the aspirin
I’m sure that Sylvia’s doctor and surgeon have already discussed whatever medications and supplements she may currently be taking. It’s important to be forthcoming on this subject with your doctors as far in advance of the surgery as possible.
And when I say ‘medications,’ that includes aspirin and other over-the-counter anti-inflammatory medications. Most patients are advised that any sort of ‘aspirin therapy’ for heart health should be discontinued well before surgery to minimise bleeding. The question is; when should you begin taking aspirin again?
In the case of coronary bypass surgery, this question was addressed by a 2002 study of more than 5,000 coronary bypass patients. As reported in the New England Journal of Medicine, the use of aspirin immediately after bypass surgery was associated with a 48 percent reduction in ischaemic complications and a 50 percent reduction in the incidence of stroke.
The current rule of thumb is to avoid aspirin for the first 24 hours after bypass surgery because aspirin increases the risk of bleeding. However, in an editorial accompanying the study, Dr. Eric J. Topol of the Cleveland Clinic Foundation called the findings ‘powerful.’ Based on the study, Dr. Topol believes aspirin should be given within the first six hours after surgery.
Fortunately my friend isn’t faced with bypass surgery. But for those who are contemplating such a procedure, before your surgery, make sure your doctor is aware of this important study about how aspirin may increase your chances of a successful recuperation.
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Great article and very useful information. Thank you. I will use this for when I go to have my knee replacement operation.