A few things I wish I knew before surgery

Post-op constipation is real.

The combination of narcotic pain medications, decreased activity, and poor dietary intake can lead to some serious constipation, so drink all the water, eat all the fiber, and walk, walk, walk. Unless you have other medical issues, you’ll need 2-3 liters of water (sorry, your coffee doesn’t count), and 20-30 grams of fiber every day. For reference, a serving of bran cereal has about 5.5 grams; fiber supplements like Metamucil can help you meet your goal and are actually pretty tasty these days.

As for walking, we like our patients up and walking the same evening of surgery (but always defer to your doctor’s instructions). Walking not only staves off constipation, it’ll also help prevent potentially fatal blood clots, so win-win.

What you eat, drink, and do can affect wound healing.

We already discussed the copious amounts of water and fiber you’ll be consuming, but there are other nutrients you’ll need to be aware of to help maximize your recovery. Low fat protein, zinc, calcium, and vitamins C & D are important factors in wound healing. And while it’s always better to get your nutrients from whole food sources, supplements may be beneficial to some people. Try a calorie tracking app on your phone to see how your nutritional intake stacks up.

On the flip side, there are a few things you should avoid, as they are known to delay or complicate wound healing. Nicotine is the biggest “NO” out there, but you should also monitor your intake of caffeine (like that coffee we talked about), alcohol, and excessive salt and sugar. A balanced diet of fresh fruits, veggies, and lean protein is almost always best.

What about lymphatic massage? We get asked this a lot. Lymphatic massage purportedly helps relieve pain and swelling, break up scar tissue, and improve blood flow to the area, thus promoting healing. There isn’t much data available to back up these claims, but some people swear by it (while others find it painful). We tell our patients they are welcome to try it if they’re interested, but we can’t promise any specific results from it.

Post-procedure depression can happen.

A lot goes into your emotional wellbeing after surgery, such as a personal history of depression/anxiety, reaction to medications, concerns about recovery, feelings of guilt for depending on others, or financial stress. For some people, these negative emotions can linger to become post-op depression. If you can’t shake the negativity or if you’re having excessive fatigue, changes in appetite or sleep, increased irritability, or any other symptom of depression, it’s important to get the help you need. Talk to your doctor if you have concerns about post-operative depression.

Good help will be invaluable and meal prep is a life saver.

In the days leading up to your surgery, go over your needs and expectations during recovery with your primary caregiver. Will you need dressings or other supplies? Get them now. Depending on the surgery, you might want to have gauze, medical tape (look for soft fabric or paper tape, not plastic), and maybe some “chux”/puppy pee pads  – those absorbent pads you can put down to catch drainage, etc. Have some gloves available if you need help with dressing changes. Check with your doctor to see what you might need. Don’t forget your personal hygiene needs during this time as well. You might want to pick up some dry shampoo, baby wipes, or body powder if full showers are limited. A bidet attachment on your toilet might be worth the investment – they’re under $50 and easy to install. Do you have periods? Stock up on your supplies and discuss any assistance you’ll need with your caregiver.

Also use this time to meal prep – whip up some big pans of lasagna or casserole to freeze for later. Stock up on easy to eat, nutritious foods like whole grain toast with peanut butter, soups, and produce. If you know you’re prone to nausea, crackers and ginger ale are good to have on hand. Fresh out of anesthesia, the B.R.A.T. (bananas, rice, applesauce, and toast) diet is nutritious and easy to digest.

One last consideration is maneuverability in your home. If you’re going to need assistance – whether it’s another person or it’s equipment like a walker or crutches – you’ll probably need to make space. Take some time to move trip hazards like area rugs or power cords and consider if you’ll need things like grab bars in your shower or near your toilet.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Postop Recovery Tips first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

1. Avoid opioid overdose and addiction

The current opioid crisis has contributed to over $55 billion in health and social costs. Could marijuana use after surgery ironically be the answer to the opioid crisis in America?  When you consider the following facts, it’s not such an unreasonable conclusion. In this recent study, most consumers try opioids (Percocet, Vicodin, etc) for the first time after undergoing surgery. Of those, 6% continue using opioids for at least three months after surgery. So what if those patients were never offered opioids in the first place? What if they were given a pain prescription for marijuana instead?

There’s reason to believe the replacement of opioids with marijuana can reduce dependency on opioids. According to this study in JAMA Internal Medicine, “Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.” The article goes on to say, “In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected…”

And it’s not just the risk of dependency that’s concerning. There’s also the risk of an accidental overdose. I prescribe Percocet for all of my postop patients. Usually there’s not a problem with dependency or overdose but an overdose occurred once, and once is enough. Instead of taking their Percocet “prn pain,” the patient took their pain medication around the clock. When combined with the fact that the patient was opioid naive, their respiratory rate dropped and had to go to the hospital. The patient recovered without any need for reversal medications like Narcan but obviously it was a scary, avoidable situation for the patient and family (and me).

In contrast to opioids, the risk of overdose with marijuana is impossible because according to the National Cancer Institute, “cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration.” In other words, my patient whose respirations slowed from Percocet would not have had the same experience with marijuana.

Additionally, opioid addiction can be evident in other ways. As I wrote in this post, opioid addicted patients can skewer their doctor with a negative Yelp review if they don’t receive the meds they demand. While this could also occur if a doctor doesn’t refill a patient’s marijuana prescription, that is less of a problem since recreational marijuana use is becoming more prevalent in several states (Oregon, Washington, California and Colorado to name a few).

2. Decrease pain and increase appetite

In addition to the benefit of avoiding an overdose, marijuana decreases pain and increases the appetite. Increasing appetite for chemotherapy patients is well documented but the importance of eating after any major operation can’t be overstated. Consuming foods high in protein contributes to wound healing. Marijuana clearly reduces pain, nausea and vomiting whereas opioids can actually increase nausea and vomiting.

For those of you worried about prescribing a medication that will make patients “high,” there’s an alternative that can avoid that stigma.

3. CBD vs THC

Cannabidiol, also known as CBD, is one of many active ingredients in marijuana. The more commonly known chemical compound is THC – tetrahydrocannabinol – the psychoactive ingredient in marijuana. As explained in this article here, CBD, in appropriate ratios can actually counteract the negative effects of THC. So by using a marijuana strain that is relatively higher in CBD than THC, the typical paranoia and euphoric effects of the marijuana high are less. At the same time, the beneficial effects of less pain, nausea and vomiting are still present.

4. Lack of nicotine avoids issues of wound healing associated with cigarettes and other tobacco products

As noted here, nicotine before or after surgery can constrict blood vessels and adversely affect wound healing. Marijuana on the other hand does not contain nicotine. Additionally, the risk of lung cancer seen with tobacco products doesn’t translate to marijuana either. According to this article,

“Marijuana use also was not associated with tobacco-related cancers or with cancer of the following sites: colorectal, lung, melanoma, prostate, breast, cervix. Among nonsmokers of tobacco cigarettes, ever having used marijuana was associated with increased risk of prostate cancer (RR = 3.1, CI = 1.0-9.5) and nearly significantly increased risk of cervical cancer (RR = 1.4, CI = 1.0-2.1).”

5. No constipation

With either short or prolonged use of opioids, patients complain of constipation. This is a vicious cycle. As patients take more opioids for pain, the resulting constipation can cause more pain and the cycle begins anew. That is not an issue with marijuana.

Conclusion

Granted, the use of marijuana to control pain postoperatively only pertains to the states where it is legal. In a situation where there is a process for obtaining marijuana, the stigma is less. Whereas, in states where medical marijuana is not approved, going to a drug dealer to fill your prescription is obviously a non-starter for most consumers. And exceedingly awkward for law-abiding citizens.

So, should you use medical marijuana postop instead of opioids? That’s a decision for you and your doctor. However, the point is that this is a legally viable option in many states and no longer on the fringes of society.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post 5 reasons to consider rolling a joint after surgery! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.