Surgery risk, danger, benefit, supplement and herbal use before, by Ray Sahelian, M.D.
February 20 2016

Surgery is the medical specialty that treats diseases or injuries by an operation and instrumental treatment. Surgeons may be physicians, dentists, or veterinarians who specialize in these operations.

Supplement  and herbal medicine use before surgery
I'm going in for hip replacement surgery and of course the surgeon says "No herbal supplements, vitamins, and NSAID's a week or two prior to surgery. I do understand. I'm wondering if it true that herbs, vitamins, and supplement would be a bad idea to continue taking up to the day of surgery?
    A. It is a good idea to stop all herbs, vitamins, and supplement a few days before surgery since we don't know the full interactions of supplements and analgesics, anesthesia, and bleeding / clotting issues. Many herbs have anti clotting effects - I have a list of some nutrients and herbal products that act against blood clotting.

My son will be having major knee surgery on Dec 21 2009. He is 20 years old. What herbs or supplements do you recommend for pre-surgery preparation and also post-surgery help?
    We don't suggest taking any herbs or supplements before or immediately after surgery since little research is available to determine whether they would help or hurt, and much may depend on the type of surgery being done and the overall health of the person. Certainly a young person is not likely to need any supplements before or soon after surgery as long as this person has a normal diet without obvious nutritional deficiencies.

Hi, I was just wondering what supplements may be good to take post spine surgery?
   I am not aware of any that that have been proven beyond doubt to be necessary in those with a normal, healthy diet in order to speed healing. Some people advocate vitamin C, bromelain, chlorella, quercetin, zinc, etc. Probiotics could be of help in those who have received antibiotics.

Risk, danger, caution, adverse events
The risk of venous thromboembolism (VTE) after surgery is probably higher and longer lasting than previously thought. December 4th Online First issue of BMJ. Thigh-length compression stockings reduce DVT rates in immobilized patients. Postop hyperglycemia linked to wound infection risk.

Physical frailty among older people who have elective surgery is linked to a greater risk of death one year later.

Antibiotic before surgery
One dose of an antibiotic just before surgery is as good as several spread over 24 hours to fight infections at the operation site.

Anticoagulant therapy after knee and hip surgery
Anticoagulant prophylaxis treatment after hip and knee arthroplasty fails to completely prevent pulmonary embolism  and may actually increase all-cause mortality. Clin Orthop Relat Res 2008;466:714-721.

Appendix
The chance of having an appendix removed unnecessarily has plummeted since the mid 1990s in the United States, possibly because more doctors are using CT scans to confirm appendicitis diagnoses before doing exploratory surgery.

Bariatric, for weight loss
Due to increasing knowledge from long term follow up of surgically treated obese patients there is a growing body of evidence that frequently there is necessity of reoperations and of substitution both of trace elementsand of minerals or vitamins due to their hampered enteral resorption. Additionally therapy of surgery induced endocrine alterations not seldom is necessary.

Weight-loss surgery patients who don't take prescribed vitamin and mineral supplements could put themselves at risk for vision problems. Digestive system changes caused by the surgery can reduce nutrient absorption from food.

Weight-loss surgery appears to prolong life for severely obese adults.

One in five adolescents report poor mental health 2 years after gastric bypass surgery.

Back Surgery
Two big government-funded studies on back surgery for painful herniated disks show no clear-cut reason to choose an operation over other treatment. The pain and physical function of the patients, who were suffering from a condition called sciatica, improved significantly after two years whether or not they had back surgery. However, neither strategy offered complete relief. The condition involves disk cartilage bulging between vertebrae in the lower spine and pressing against a nerve. It can cause excruciating burning pain called sciatica, radiating from the lower back into the legs; patients often have difficulty walking. About 250,000 Americans have disk surgery for sciatica each year, while another quarter-million instead choose physical therapy, painkillers or rest until they feel better.

Breast cancer surgery
Following surgery for breast cancer, many women will experience arm swelling - a bothersome condition known as lymphedema.

Breast implant surgery
Women who get cosmetic breast implants are nearly three times as likely to commit suicide as other women. Some women who get implants may have psychiatric problems to start with, perhaps linked with lower self-esteem or body image disorders. Women with breast implants also have a higher risk of death from alcohol and drug use. Women who have breast implant surgery do not have an increase in the risk of death from cancer, including breast cancer.

Cleft palate
Q. Thank you so much for sharing your knowledge so that others, including myself, may benefit from your work. My 3 month old nephew needs surgery for a cleft lip/palate. Although I know you can not recommend specific items, I was wondering if there is any information regarding supplements which may help the body cope with the stress of surgery.
   A. I am not aware of any specific nutritional supplements that would help post surgery. The emphasis should be on a healthy diet and providing the environment for deep sleep.

Cosmetic
Less than 10 percent of adults in the US has ever had some type of cosmetic surgery, yet almost twice as many hope to do so at some point in the future. Trends have changed significantly since the 1960s and 1970s when cosmetic surgery was "rarely talked about, said" Jeff Knezovich, executive vice president of the American Academy of Cosmetic Surgery (AACS), which sponsored the survey.
   Cosmetic surgery is altering not just how people look but how they feel by changing perceptions of middle age. Global research group AC Nielsen surveyed people in 42 countries and found 60 percent of Americans, the world's biggest consumers of cosmetic surgery and anti-aging skin care, believe their sixties are the new middle age. On a global scale, three out of five consumers believed forties was the new thirties.

Popular cosmetic surgery procedures in 2007
The most popular cosmetic surgical procedure in 2007 was liposuction, with half a million operations performed. Other top cosmetic surgery procedures include breast augmentation, eyelid surgery, abdominoplasty (better known as a tummy tuck), and breast reduction.
   Botox injections is the most popular nonsurgical procedure with3 million treatments. Hyaluronic acid injections are the next most popular with roughly half the number of Botox procedures. Other procedures are laser hair removal, microdermabrasion, and laser skin resurfacing.

Epilepsy surgery
Severe epilepsy that can't be controlled with anti-seizure medication may require a brain operation, but in such cases there's apparently a trade-off. Surgery, especially on the left temporal lobe, can results in long-term loss of verbal memory.

Heart surgery
People who learned about relaxed breathing and received soothing touch and music before heart surgery were more likely to be alive 6 months after the procedure, suggesting that these additional steps help speed recovery. About one in 10 heart surgery patients has persistent pain for up to two years after the operation,  CMAJ (Canadian Medical Association Journal), news release, Feb. 24, 2014.

Mental impairment is a known risk following coronary bypass surgery, and now researchers have found that the procedure may hasten the emergence of Alzheimer's disease. The results of a large study indicate that the risk of developing Alzheimer's disease within five years is 70 percent higher following coronary artery bypass grafting (CABG) than after percutaneous coronary angioplasty (PCTA). Both procedures are used in heart disease to deal with restoring blood flow to the heart when coronary arteries become blocked.

Hernia surgery
Q. Can you advise what supplement to take before hernia surgery, a supplement that does not thin the blood?
   A. It would be best to avoid all supplements at least 2 days before surgery, including hernia surgery.

Triggers for a hiatal hernia include: Coughing, vomiting, straining to have a bowel movement, sudden physical exertion and pregnancy.

Hysterectomy
Women who have a hysterectomy have more problems with daily activities like climbing stairs and carrying groceries than women who go through a natural menopause. This is true regardless of whether women are taking hormone replacement therapy. A hysterectomy is the surgical removal of the uterus. It may be performed to treat cancer or certain other conditions, like endometriosis, fibroids or persistent vaginal bleeding.
   When women have a hysterectomy for a non-cancerous condition, their doctor may suggest having their healthy ovaries removed as well. This is called prophylactic oophorectomy. The idea is that the ovary surgery removal is done with the hope of lowering future risk of ovarian cancer, and to avoid further surgeries for problems like benign ovarian growths. About 300,000 such surgeries are performed each year in the US. But for women at average risk of ovarian cancer, there is a lack of evidence of benefit from removal of the ovaries. Therefore, for the vast majority of women who don't have a high ovarian cancer risk, removal of the ovaries during hysterectomy surgery does not appear to be justified. Cochrane Library, online July 16, 2008.

For hysterectomy patients who are not at high risk for ovarian cancer, removing the ovaries does not improve survival and may adversely impact long-term health. Oophorectomy at the time of hysterectomy for benign disease is often done to prevent the future development of ovarian cancer. While this practice can prevent the malignancy, there is also evidence that early surgical menopause increases the risk of coronary heart disease. Obstetrics Gynecology 2009, April.

Knee surgery
Surgery may not be the best option for certain sports-related knee injuries, particularly anterior cruciate ligament (ACL) tears. This type of knee surgery could lead to the development of early arthritis, particularly when the athlete returns to the playing field soon after repair.

People over age 60 who have surgery to replace a worn-out hip or knee have a significantly higher risk of having a heart attack after their surgeries.
   People who have total hip or knee replacement surgery have a risk of a heart attack more than eight times greater in the first 30 days after total knee replacement surgery compared to people who didn't have the procedure. The risk of a heart attack was four times greater during the month following total hip replacement surgery.

Patients with milder knee osteoarthritis symptoms before undergoing total knee replacement surgery gain less benefit from the operation than those with severe symptoms.

The number of total knee replacement surgeries in the United States are on the rise, the demand seems to parallel the rise in overweight and obesity in America.

Most people who've had surgery to repair a torn anterior cruciate ligament (ACL) do well at the 6-week mark with a simple neoprene knee sleeve rather than an expensive functional knee brace.

Athletes who have anterior cruciate ligament (ACL) reconstruction surgery are several times more likely to suffer another ACL injury within two years than someone who has never had such an injury.

Laparoscopic Gastric Banding Surgery
Laparoscopic gastric banding surgery leads to weight loss and a proportional decrease in plasma leptin. Laparoscopic gastric banding surgery works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term.

Micronutrient Deficiencies After Laparoscopic Gastric Bypass: Recommendations.
Obes Surg. 2008. Department of Surgery, Beijing Shijitan Hospital, 100038, Beijing, China,
The aim of this study was to evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y gastric bypass surgery. We retrospectively reviewed 121 patients diagnosed with morbid obesity who undertook laparoscopic Roux-en-Y gastric bypass surgery and evaluated the serum iron (Fe), calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B(12) (VitB(12)), and parathormone (PTH) measured at 6, 12, and 24 months after laparoscopic Roux-en-Y gastric bypass surgery. During a follow-up period of 69 months, a cohort of 121 patients, 40 men and 81 women, underwent laparoscopic Roux-en-Y gastric bypass surgery, a mean age of 46 years. Within the following 2 years, the serum Fe, Ca, Zn, Se, Vit A, Vit D, and VitB12 had normalized. The serum zinc, Se, and Vitamin A of some patients decreased but were nearly normal. In contrast, serum PTH remained continuously at a higher level than normal. This study confirms that laparoscopic Roux-en-Y gastric bypass surgery is a reliable and safe weight loss method for the patients suffering from morbid obesity. After surgery, serum Ca, Zn, and Se metabolisms and PTH levels are altered in these patients. Therefore, multi-vitamin and mineral supplementation are strongly recommended in all patients after laparoscopic Roux-en-Y gastric bypass surgery.

Shoulder injury
A common shoulder injury that is usually repaired with surgery can heal just as well with nonsurgical treatment. Those who decide against surgery for a dislocated shoulder joint develop fewer complications and get back to work sooner. But, surgery patients seem more satisfied with the appearance of their shoulder after treatment.

Weight loss or Obesity surgery
As weight-loss surgery for morbid obesity has become more and more common, so too have the plastic surgery procedures many people need afterward. While obesity surgery can spur massive weight loss, it leaves many people with folds of excess, loose skin. The problem is more than a cosmetic issue, as the hanging skin can be painful and susceptible to infection. So for many people, obesity surgery is only the first in a series of surgical procedures. A traditional "tummy tuck" is not enough, and patients need a belt lipectomy, in which excess skin around the whole circumference of the waist and hips is removed. In addition, both women and men often have sagging in the breast area. For men, surgeons will remove the excess skin and underlying tissue, while many women opt for breast implants in addition to a breast lift. Other problems after obesity surgery include flabby skin on the upper arms that cause a "bat wing" appearance when the arms are lifted, as well as excess skin hanging from the thighs. Again, the surgical solution is to remove the excess skin and tissue. The formation of kidney stones and the risk of stones appears to be increased in patients who undergo bariatric surgery for morbid obesity.
   People 65 years of age or older may think twice about having weight loss surgery. In a review of more than 25,000 weight-loss operations, also referred to as bariatric surgery, performed nationwide in 2001 and 2002, complications rose as people aged, and showed a "steep increase" after age 65.
   Patients who have undergone gastric bypass surgery for obesity have higher breath-alcohol levels after drinking the same amount as other people -- and it takes much longer for their levels to return to zero.
   As a treatment for severe obesity, obesity surgery is associated with a significant reduction in long-term mortality.
   Morbidly obese patients who lose 5% to 10% of their excess body weight prior to gastric bypass surgery can significantly reduce their length of hospital stay and hasten weight loss after the operation.
   The most common form of diabetes, type 2, disappears in most obese diabetics after weight-loss surgery.
   Weight-loss surgery may help obese women lower their risk of developing cancer. In one study, women who had weight-loss surgery were 40 percent less likely to develop cancer during a 10-year study.

Obesity surgery complication
Some obese people who have weight-loss surgery, particularly younger women, develop a neurological condition most often seen in severe alcoholics and linked to a vitamin deficiency. A study in the journal Neurology described the cases of 27 women and five men who developed the condition, Wernicke encephalopathy, after bariatric surgery. Nearly all had experienced frequent vomiting in the weeks after obesity surgery. Two patients died. Wernicke encephalopathy can develop when the body does not get enough vitamin B1, also known as thiamine. It affects the brain and nervous system, with symptoms including double vision, eye movement abnormalities, unsteady walking, memory loss and hallucinations.

The dramatic and sustained increase in bone turnover that occurs following surgery for obesity results into a significantly increased risk of fractures, especially in the hands and feet.

Male to female surgery
Most people who undergo male-to-female sex change surgery are satisfied with the results.

Patellofemoral pain syndrome surgery
Patellofemoral pain syndrome leads to chronic pain in or around the knee cap, also called the patella. People who suffer chronic knee pain known as patellofemoral pain syndrome are unlikely to get any more benefits from surgery than from home-based exercises and conservative treatments like rest, ice and exercise therapy.

Plastic surgery
Undergoing cosmetic surgery performed by someone who's improperly trained can result in scarring, burning and, in some cases, even death. The American Society of Dermatologic Surgery (ASDS) has a public safety campaign in response to what it calls the "alarming national trend" of non-physicians performing procedures such as Botox injections, laser hair removal, microdermabrasion and chemical peels.
     Part of the reason for this campaign is, of course, due to financial reasons since non-physicians do take a bite of the profit form cosmetic surgeons. However, it is quite likely that non-physicians are likely to have a higher rate of surgical complications.

Prostate surgery
Removal of the prostate, a procedure known as radical prostatectomy, and the surrounding lymph nodes may be adequate treatment for advanced prostate cancer. While adding radiation therapy may reduce the risk that the cancer will return, it does not seem to improve overall survival. In approximately one third to one half of men treated with prostate surgery, some cancer remains outside the gland. How best to treat these men is a continuing subject of debate, Dr. Ian M. Thompson, Jr., and his associates point out in the Journal of the American Medical Association. To address the issue, Dr. Thompson, at the University of Texas Health Science Center at San Antonio, and his associates initiated a trial in which adjuvant radiation therapy was compared with observation for patients with advanced prostate cancer. With this type of cancer, the disease has spread to tissues near the prostate, but has not "metastasized" to distant parts of the body. The subjects had undergone prostate surgery called radical prostatectomy and lymph node removal and had a negative bone scan, but were found to have cancer outside the prostate. During follow-up, 35 percent of men in the radiation group developed metastatic disease or died, compared with 43 percent of those in the observation-only group - which is not significantly different from a statistical standpoint. The overall survival periods in each group were similar too, at about 14 years. Complications, including rectal and urinary problems, were twice as frequent in the radiation group. Based on these findings, Thompson's group suggests that an approach involving surveillance of PSA level with delayed radiotherapy if it rises "may be a reasonable alternative."Journal of the American Medical Association, November 15, 2006.

Shoulder surgery
Following a sports-related shoulder injury, the likelihood that a person will be able to throw or hit a ball as well as they once did depends on their ability to sense the position of their injured arm at the shoulder joint. While most shoulder surgeries are deemed a success, only about half of the patients are able to return to their previous level of sports activity. Overhead activities, such throwing, tennis and volleyball, are associated with injuries leading to shoulder instability. Patients be cautioned that corrective surgery will help, but they may not be restored to previous sports performance levels.

Spinal stenosis surgery
As a treatment for symptomatic lumbar spinal stenosis, decompressive surgery provides greater pain relief and functional improvements than does nonsurgical care. Still, watchful waiting can be a safe and viable option.

Tonsil surgery - when is it necessary?
Children with sleep disordered breathing who undergo adenotonsillectomy - removal of the tonsils and adenoids by surgery sleep better and their behavior improves. Children with sleep disordered breathing have an increased risk for attention-deficit hyperactivity disorder (ADHD) and poor school performance. Sleep disordered breathing involves a range of breathing disorders, from snoring to obstructive sleep apnea syndrome, a condition in which the patient stops and starts breathing many times over the course of the night. One side effect of obstructive sleep apnea syndrome is chronic fatigue during the day. Sometimes the problem is due to enlarged tonsils and adenoids, masses of tissue that help catch incoming germs; the tonsils are located in the back of the throat, while the adenoids dwell behind the nose.

Removing the tonsils of children with mild or moderate throat infections has fewer health benefits than simply watching and waiting, In a Dutch study involving 300 children ages 2 to 8 years advised to have their tonsils out, those who avoided surgery had fewer annual visits to doctors due to fevers and throat infections. Tonsillectomy is one of the most frequently performed surgical procedures for children. Young patients have traditionally had their tonsils removed to relieve repeated throat infections and related fevers.

Q. My bed wetting has been cured by removing tonsils which caused obstructive sleep apnea which went undiagnosed for 20 years. Problem was immediately corrected after surgery.

Questions
Iíve been searching all over the internet to see which of my supplements are safe to take leading up to surgery. (The MD says nothing. Not even a multiple vitamin) One of your contributors had a list of herbs etc. he is taking for blood thinning, and thatís exactly what I need. Normally, all the sites stop at the major ones like garlic and fish oil, but his entry was very helpful.
   It is a good idea to stop supplements a few days before surgery.