The best way to prepare for surgery is a few weeks before rather than the night before the procedure. I believe that you can affect the outcome of your surgery by preparing well in advance. For example, maximizing your nutrition, taking vitamins and stopping harmful habits such as smoking can have a positive impact on the outcome of your procedure. In addition there are medications and supplements that you should be aware of which can impact your surgery in a negative way.
SMOKING, NUTRITION, GI TRACT OPTIMIZATION
Did you know that smokers have a higher incidence of non-unions or delayed unions? Smoking affects blood flow at the capillary level and in turn this affects the flow of oxygen and nutrients to bone and to skin. Smokers will tend to have wound healing problems as well. There are some fractures that are affected so profoundly smoking that some surgeons will refuse to operate on a patient who smokes. When I mean smoking I am referring to cigarettes, cigars, pipes and marijuana.
After surgery your body will be utilizing more of its energy to heal. It is the main reason why post operative patients feel tired and weak. It is essential that your body has protein and vitamins to help rebuild and provide you the energy needed to heal. I recommend that my patients take Vitamin C, Zinc and a multivitamin a couple of weeks before and after surgery. These supplements are knows to help with wound healing and immunity. It may be helpful to take 1000 mg of Calcium per day and extra vitamin D to help with bone healing. I recommend increasing protein intake with protein powder added to fresh juice. Chelated Zinc may absorb a little better than non chelated.
Alcohol intake can have negative effects on your liver and in turn can affect almost everything else. For example abnormal liver function can affect the function and breakdown of anesthetic and the antibiotics you are given during your surgery. Alcohol can affect platelet function negatively thereby lead to increased bleeding. Chronic alcohol abuse can ultimately lead to poor protein production which affects antibiotic production.
Your gut is your friend, be kind to it! Your Gastrointestinal (GI) tract is also important prior and after surgery. Post op patients will usually experience some level of constipation due to the pain medications and sedentary activity. Sometimes patients will actually develop loose stools or diarrhea secondary to antibiotics. Adding to your GI distress is bland hospital food and the stress of simply undergoing surgery. Your GI tract is also affected by immobility. I recommend taking care of your GI tract with good nutrition, probiotics and exercise. You can add fiber to your diet by eating salads, fruits, chia seeds or supplemental fiber. Your GI tract in combination with the liver is designed to remove toxins from your system. Greens, including seaweed and chia seeds, can help bind and remove toxins. Walking even if you are on crutches will help with GI activity and decrease constipation.
If you are having work on your cartilage it may be beneficial to supplement your diet with Glucosamine and Chondroitin. Because these supplements can affect coagulation and post op bleeding, you should probably stop them 2 weeks prior to surgery and re start them one week later.
OVER THE COUNTER MEDS
There are over the counter medications and supplements which may affect bleeding during and after surgery. These medications affect the function of your platelets. Some of these such as aspirin must be stopped 2 weeks prior to your surgery. If aspirin is stopped 1 week prior to surgery your surgeon might have problems controlling small bleeders leading to a bloodier post op wound. On the other hand anti-inflammatory medications also known as NSAIDS, such as Advil or Aleve can usually be stopped 1 week prior to surgery and restarted 1 week later. So remember if the medication contains Salicyilate (Aspirin) you can usually stop it 2 weeks prior and restarted 1 week later. Some aspirin and NSAID containing medications include: Advil, Childrens Aspirin, Fiorinal, Tolectin, Amigesic, Coricidin, Anacin, Exedrin, Toradol, Anaprox, Phenylbutazone, Mefanamic, Piroxicam, Anaproxin, Ansaid, garlic capsules, Mobidin, Predisone *, Quagesic, Daypro, Relafen, Trigesic, Argesic, Genpril, Motrin, Trilisate, Arthra G, Genprin, Nabumetone, Tusal, Arthropan, Nalfon, Robasissal, Vanquish, ASA, Gingko Biloba, DIGesic, Goodys, Naproxen, Naprosyn, Roxiprin, Vit E, Ascodeen, Dipyridamole, Haltran, Rufen, Voltaren, Ascriptin, Disalcid, Halfprin, Norgesic, Saleto, Warfarin, Aspergum, Divalproex, Ibuprin, Norwich, Salflex, Willow Bark, Aspirin, Doans Pills, Ibuprofen, Nuprin, Salsalate, Zactrin, BC Powder, Dolobid, Ibuprohm, Ocufen, Salsitab, Zorprin, Baby Aspirin, Dristan, indamethasone, Orudis, Sineoff, Bayer, Easprin, Indocin, Oruvail, SineAid, Brufen, Ecotrin, Oxyphenbutazone, Thiosalicylate, Bufferin, Empirin, Ketoprofen, Oxybutazone, SomaCompound, Butazolidin, Emprazil, Ketorolac, Oxaprozin, Sulindac, Celebrex, Endodan, Lortab ASA, Oxalid, Supac, Cheracol, Equagesic, Lodine, Aleve, Tanacetum, Magan, Pamprin, Synalgos, Tanacetum, Bismal, Percodan, Persantine, Meclofen, Meclofenamate, Fenoprofen, Feverfew, Congespirin, Clinoril, Alcohol, Alka seltzer and Fenoprofen.
PREDNISONE AND OTHER RHEUMATOLOGICAL MEDS
Prednisone is commonly used to treat inflammatory conditions such as rheumatoid arthritis and lupus. This medication is a potent anti-inflammatory and immune suppressor. Prednisone cannot be suddenly stopped. If you do it can create a lethal problem related to a sudden drop, or crash, of blood pressure after your surgery. You have to tell your surgeon you are taking prednisone prior to surgery so that appropriate medical precautions can be taken.
Methotrexate and other rheumatoid medication (TNF Inhibitors) also require special handling. These drugs are potent immune system suppressors and therefore can predispose you to serious post op infections. They include Enbrel, Cimzia, Humira, Rermicade, and Simponi. Due to the increased risk of post op infection, some surgeons will want you off Methotrexate and other anti-rheumatologic meds many weeks prior to surgery. I recommend you talk to your rheumatologist to get his or her input. Once you are off these meds your general joint pain will increase so you will need a backup plan.
ANTI-PLATELET MEDS
Similar to aspirin there are prescription medications intended to affect platelet function and your coagulation (clotting) system . These drugs as used to treat atrial fibrillation, stroke or post heart valve surgery. These drugs are also stopped prior to surgery however they require your cardiologist or internist to orchestrate the schedule for stopping and starting. These drugs include: Coumadin, Heparin, Aggrastat, Aggrenox, Agrylin, Anagrelide, Brilinta, Cilostazol, Clopidogrel, Dipyridamote, Effient, Integrilin, Persantine, Plavix, Pletal, Reopro, Ticlid, and Ticlopidine.
SUPPLEMENTS
Certain supplements can also have a negative effect on bleeding. You should avoid the following 2 weeks prior and 1 week after your surgery.
| Vitamin E, Marine Fatty Acids, Omega-3 Fish Oil Supplements | increase risk of bleeding | |
| Chondroitin | increases risk of bleeding | |
| Echinacea | reduces immunosuppressant effectiveness – may cause allergic reactions | |
| Ephedra (Ma Huang) | affects cardiovascular function, may cause cardiomyopathy or thrombotic stroke | |
| Garlic | increases risk of bleeding | |
| Glucosamine | mimic human insulin and may artificially cause hypoglycemia during surgery | |
| Ginkgo | increases risk of bleeding | |
| Ginseng | may cause hypoglycemia and increases risk of bleeding | |
| Kava | compounds anesthetic effect | |
| St. John’s Wort | induces cytochrome enzymes, inhibiting effects of many surgical drugs | |
| Valerian | compounds anesthetic effect, may build tolerance |
If you have any questions about your medications the best thing to do is ask your surgeon or primary care doc. The above information is pretty much a rough outline. You really need to get the info from your surgeon. Often times the instructions for pre and post op medication management is individualized. There are times that your surgeon will want you off the aspirin or NSAID for longer period, especially if he or she noted a lot of bleeding or is going to expect a lot of bleeding. Also there is research showing that NSAIDS can affect bone healing so your surgeon may want you off the NSAID until the fracture or fusion has taken. Also patients who are on anti-platelet drugs may need to be restart on their meds sooner so as to avoid cardiac problems. These are some reason why it is imperative to consult with your surgeon.
I hope this information was helpful. Good luck on your upcoming surgery.
Steve A. Mora, M.D.
Orange County Orthopedic Surgeon Specializing in Sports Medicine, Knee, Shoulder and Elbow.
For appointments please call 714 639-3750