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Considerations for Recovery for Post-Operative and Acute Injury Care: A Complimentary and Traditional Chinese Medical Accompaniment
By John Porter D.PSc, Dipl. OM, LMT, Kine.
Recovering from surgery is not just a matter of keeping the wound clean and adhering to a pain control and physical therapy plans as prescribed by your doctor. In fact, your lifestyle and dietary considerations may be more important than the ‘standard care’ in aiding and speeding your recovery, especially in the long term. Traditional Chinese medicine and Ayurveda hold many commonalities in recovering from trauma and surgery. The following are recommendations that have been passed down in the classic literature over the last 5000 years and presented here as a compiled attempt to meet the choices and demands of modern western life. It the original texts, the takeaway is that attention to these guidelines is of highest priority to fully recover from trauma or an operative procedure. To the best of your ability, do not ‘cherry pick’ from the list only the things you are familiar with or seem most familiar. Recovery is inclusive to Body, Mind and Spirit and so are these recommendations. Perhaps ironically, not paying attention to some of these recommendations in the first place may have led to the need for surgery.
In the Ayurvedic classic, Sushrut Samhita, the type of care, both for oneself and for care givers, is outlined in detail. For quick application we are covering subjects somewhat broadly. Detailed points can be found in the clinical care section, or Vranitopasan of the Sushrut Samhita. Cleanliness • Try to keep not only your surgical incisions clean, but make sure your room, bath and house are kept clean as well. When possible, avoid direct wind, direct sun and contact with insects. Sleep • Sleep should be done as much as possible at night. While recovery requires rest, there are biological ‘times of day’ for certain metabolic functions and getting on a regular sleep cycle that matches these can make a significant difference in recovery time because your energy is being used in the proper hierarchy on a metabolic level when sleep is regular. We now know that sleep, and the cycles within sleep, are the most healing times for not only our bodies but our minds as well and there can be no substitute or shortcutting when addressing sleep.
Mental State and Mindfullness • Try to maintain gentle, non-strenuous movement in your recovery. While you should not sit, stand, or even walk for long periods, you do not want to be idle. When you move, do so with intention, taking your time, feeling what is changing in your pain, range of motion and general physiology. Pay attention to things like thirst, hunger, signs of heat or cold at the injury site or elsewhere in the body, etc. Even if you are a in great shape and an athlete, recovering from surgery is not like recovering from workouts or competition. It is a completely different type of healing on a much higher priority level. If you overexert, the body will take that healing energy and move it to the musculature because it thinks you are under threat of additional injury. It metabolically ‘thinks’ “Why else would you want to exert yourself after being cut open? Reverse the metabolic engines!” Included in exertion is sexual activity. While the body does not think you are under threat of additional trauma, the same energy for healing is diverted for sexual activity and is therefore contraindicated for the same reasons. • Just as the physiology is in turmoil following surgery, the mind can be equally taxed and subject to flare-ups, down-turns, lethargy and excitability. This means that mental states and situations that result in altercations, and excessive thinking about negative situations like jealousy, anger, fear, grief and worry should be avoided. When they must be considered, the first thing to do is take a deep breath before responding or reacting, even if that reaction is only a mental one. Secondly, recognize the fact that you may not be at your best mentally, and try to hold that in thought as you choose a response. If you have a mindfulness or meditation practice, this is the perfect time practice.
Dietary Considerations
Diet after surgery is of utmost consideration. What you take in is the raw material used by your cells to repair. Initially your will want to strictly avoid foods that promote phlegm and turbidity, and what is referred to in the Yellow Emperor’s Classic as ‘a preponderance of yin’. Both TCM and Ayurveda use the analogy of a cookpot as our energy conversion center. It encompasses an area about the size of the stomach, pancreas and spleen. For good health, the food cannot be undercooked, it will provide no nutrition. Increasing or stabilizing (metabolic) fire and proper fluids (water) helps balance this. Antagonistically, cold foods (including refined sugar) turbid and fatty foods slow and counteract the nutritive ‘fires’ that are so essential to breaking down our food choices, no matter how poor they may be at times. Therefore, diet becomes the key to healing. A “well-balanced cookpot” with proper heat and water that is given easily digestible foods becomes the analogy for an optimally healing body.
Always have a continuous supply of herbal tea and warm beverages. For optimal effect on the lymphatic and sub-dermal layers, take small drinks every 15 to 30 minutes. DO NOT SUBSTITUTE OTHER SUPPLEMENTS in place of tea or warm drinks. For example, green tea is high in antioxidants and other detoxifying components that serve well when placed in a daily routine, even in large volumes. Conversely, you should NOT take concentrated green tea extracts. For starters, these have been shown to impair liver function with longitudinal use. Fresh is always better and you should be getting 3-4 cups of green tea a day. Again, small sips throughout the day served hot to warm is best.
•Always have a steady supply of clean, room temperature water and keep sipping that if tea is not available or you not getting at least ½ ounce of water per pound of bodyweight a day, including tea.
• Always avoid cold, raw or processed and packaged food. This includes cold drinks, iced smoothies, prepared/frozen meals, etc. It is possible that your gut will not have enough warmth or motive energy to digest raw foods, such as salads, vegetables, and cold beans and peas. This especially includes refined sugar, perhaps the most toxic addition to a recovery plan.
• Tastes/Quality of food: Avoid sour, salty and pungent tasting foods. Generally, these foods are aggravating to the lining of the stomach and intestines, where your healing processes start.
• Flours/Pasta/Bread: Avoid refined flours, even gluten free alternatives. They slow down the digestive process. You may find this hard at times, but the energy your body must divert from healing to break down these dense and rich foods can be disruptive to the entire healing process. You can introduce these items back into your diet slowly as your recover.
• Meats and Proteins: Avoid meats, especially dried or fatty meats, shellfish and pork. There is quite a bit of reference across disciplines about the medicinal benefits of well-prepared chicken soup! (From scratch, not a can or box) According to some ayurvedic texts, goat is OK, but don’t start eating it for the first time when you are on the mend. A good lean meat like bison in small quantities and very well cooked can also be a better option here in the US. You can also get plenty of highly digestible protein by making any variation of Kitchudisha instead. (see below)
• Dairy: Avoid dairy products, especially because most contain hidden sugars. In ayurvedic texts, ghee is acceptable, but the above advice for meat is equally applicable here. If ghee isn’t a part of your regular diet, now may not be the time to start adding it to your diet. If you do not like ghee and insist on dairy, try goat milk or goat yogurt in small quantities. It is easier to digest than dairy milk products.
• Alcohol: Avoid all alcohol. Alcohol can severely stunt healing at surgical sites, depresses the immune system and can severely alter the healing processes of the liver.
• Kitchari, or Kitchadi as your main meal of the day. This Ayurvedic staple typically made with mung bean (yellow split pea, or daal), and/or basmati rice. It is easy to prepare, can be varied to taste and preferences and is a great vehicle for additional healing herbs to get into your diet. Kichari is considered to be soothing to the digestive system and is considered a full protein meal. Cick HERE for a link to a great starter recipe from the YogaHealer.
• Vegetable juices/smoothies. This is NOT your Vita-mix cold smoothie with added yogurt, bananas and honey (although honey is good and will be discussed later). These are vegetables, and small amount of fruits that will deliver enzymes, vitamins and minerals to your cells. By drinking them as a smoothie, you save your digestive system much work in breaking down fibrous plant cell walls to get at the goodies inside. (This is also why raw foods are NOT recommended in post-op recovery. Sometimes it takes more energy to break these cells down then is gained by doing so.)
• Soups: Up soup's place in the menu. Soups, in addition to, or perhaps as a break from, Kitchari are easy to digest, can be packed with vegetables and herbs, and are just plain comforting when we are not at our best. Try to include fresh soup in your diet for at least one meal a day, even after you have healed.
• Grains/Beans. Rice, puffed rice, mung bean daal, popcorn and course ground corn, black beans, split pea, and some other grains can be used in moderation.
• Honey. Honey is a true gift from nature. Including honey in your recovery will aid in many other functions not only on a gut level, but as an enhancement for certain other herbal components to your diet such as cinnamon and astragalus. Include about 4 Tablespoons of honey in your daily diet. In addition, you can use honey topically where it works like a band-aid, keeping the area moist, protecting from infection and relieving inflammation. For the most inclusive information on honey, visit the WebMD page by clicking here. Only use honey if the wound can be cleaned without causing bleeding or painful wincing. Note: DO NOT give honey to infant children.
Supplementation
The following guidelines and recommendations come from TCM and Ayurveda, but also include many common sense recommendations from what we now know about the healing process on a microscopic level. Remember, a supplement is a supplement, meaning ‘to go with’, not ‘as much as you can’ or ‘in a concentrated form’. Pick food first if it contains these nutrients, but the same cooking rules outlined above still apply.
• Vitamin C enhances white blood cell formation, increases antibody production, and raises interferon levels. Additionally, vitamin C helps metabolize anesthetics and may reduce postsurgical bleeding, say researchers from the Gundersen Lutheran Medical Center in La Crosse Wisconsin.
• Vitamin A is a potent antioxidant to enhance immune response and guard against infection. Antibiotics can interfere with the absorption of vitamin A, it’s important to increase the amount you take while recuperating. But, do not take it for an extended period or over 10,0000 IU per day for more than a week. The liver will respond poorly to extended use of vitamin A.Fortunately, beta-carotene found in the whole food is not toxic and can be eaten in bulk to convert in the liver.
• Aloe Vera: Aloe can be taken internally or applied topically. For scarring, aloe is a moisturizer, bacteria protector, cleaner and repair medium. Internally, it can keep the digestive system running properly and often help overcome the tendency toward constipation that can accompany post-surgical anesthesia and constipation.
• Glutamine and arginine, available as a combo at most health stores in capsule form (try to avoid fillers) can also boost immunity. Arginine seems to boost blood albumin and both combined have clinical evidence to reduce infection rates. Take as directed on the supplement.
• Reishi mushroom (Ganoderma lucidum) has been shown to stimulate immunity. Miatake mushroom (Grifola frondosa) is an adaptogen. Combined, the polysaccharides that are in these two fungi act as a metabolic regulator for the immune response to infection.
• Bromelain, an enzyme from the stem of the pineapple seems to inhibit platelet aggregation. Studies show that the effects on pain, swelling and healing time were all improvements and had no side effects that are typically seen with NSAID’s.
• Ashwagandha root (Withania somnifera) Among the myriad benefits of ashwagandha to your overall health, the alkaloids are sedative, reduce blood pressure, and lower the heart rate. Research in 1970 showed that withanolides, which are similar to the body’s own steroid hormones, are anti-inflammatory. It can even be used externally for inflammation at a wound site, but taking 1-3 grams per day mixed into a vegetable smoothie or added to food like Kitchari, or by capsule, is recommended. Because it tends to be a cooler herb and helps regulate sleep and digestion. If you begin to develop a loose stool or diarrhea, discontinue ashawagandha until the condition clears up.
• Astragalus (Astragolus propinquus or Huang Qi): Another incredible herb of which you may consume up to 10 grams per day as long as you are not suffering from an acute illness like influenza or rhinitis (But this level is built up to over time). Astragalus is clinically proven to enhance the immune system, providing defense against colds and flues, seasonal allergies, hypertension, fatigue, asthma, anemia, weak limbs and even cancer!
• Dong Quai (Angelica senensis). A tonic, blood tonic, antispasmodic, sedative, emmenagogue, analgesic, and mild laxative. Often called “the female ginseng.” Though dong quai has no specific hormonal action, it exerts a regulating and normalizing influence on hormonal production through its positive action on the liver and endocrine system. Research has shown that the whole plant, including the rhizome, strengthens liver function and the whole rhizome has an antibiotic effect. In TCM the following are listed for Dang Quai: Indications: irregular, insufficient, profuse, painful and otherwise abnormal menstruation; premenstrual syndrome; headaches; pain from traumatic injury or surgical wounds; paralysis; poor appetite; cancer; empty blood. Contraindications: diarrhea. Dosage can be from 500 mg to 2 grams per day and should be scaled back if diarrhea occurs.
• Devil’s Claw (Harpagophytum procumbens) has been clinically shown to reduce sensations of pain in 30% of people who take it.
• Turmeric: Turmeric is a blood mover, anti-hypertensive and anti-coagulant, along with several other amazing properties attributed to long term use of this herb. 500 milligrams to 1 gram daily is the most common recommendation and be certain to have a small amount of black pepper with it (10 mg pepper, or about 2 peppercorns equivalent) with every dose of turmeric. If you are on statins or blood pressure medications, be certain to check with your doctor before usingturmeric as it is often just as effective as drugs at reducing cholesterol and blood pressure and you don’t want to ‘double-up’ on any medication.
• Probiotics. The use of probiotics in recovery from surgery is very important, especially if antibiotics were part of your pre-surgical preparation or post-surgical prescription. 10-20 billion cultures of bifodobacteria and acidophilus should be added to your diet. Do not use any probiotic with more than 4 strains as the gut likes simplicity and too many competing ‘biotics’ are for a digestive system in top condition, which takes time. If you are new to probiotics, start with a low ( low-dose (about ½ for 1 week). Those just recovering from surgery start small and increase across the first couple of weeks after undergoing to surgery or taking competing antibiotics. (They should not be taken together)
Acupuncture and Massage Therapy
The benefits of using acupuncture and massage therapy to assist with pain management, speed recovery and restore full range of motion and health are well documented over centuries. These are among the well documented benefits of Traditional Chinese medicine:
• Acupuncture can be started immediately after surgery to restore qi and blood to the injured area, reduce sensations of pain and calm the nervous system. If pain is a major component of your recovery, acupuncture may be indicated on a more frequent basis, for example 2 days per week. As your recover to full function, and even if pain is no longer an issue, acupuncture will still decrease lost work time, boost immune response and speed healing with regular sessions. Even if you have a cast or bandage covering a wound, acupuncture can be (and often is) done on points distal to the site of direct injury, and the effects are usually immediate. Talk to your acupuncturist about treatment protocol, frequency, duration and goals. Often, in addition to treating for post-operative related pain and stagnation, acupuncture addresses secondary symptoms such as sleep disturbance, agitation, gastro-intestinal discomfort, headaches and side effects from any prescription or OTC drugs that may be being taken with or without prescription from an M.D.
• Bodywork, or massage therapy has myriad effects on circulatory, endocrine and lymphatic function. Depending on the individual, these can be quite profound. Typically, massage can start as soon as three weeks or six weeks after a procedure, determination of which is usually made by the surgeon. In my practice, getting acupuncture and bodywork on the same day can really give a client a good benchmark for their overall progress in recovery because the immediate relief of symptoms provided by these therapies allows for a ‘fresh’ observation compared to when they entered the office, or against the previous session, hour or week.
Massage is also an excellent adjunct to surgery as a long-term preventative measure. Besides helping release restricted muscle and scar tissue for full range of motion at and distal to a surgical site, the benefits of bodywork on a regular basis help prevent movement related injury from reoccurring, regulate body systems that may have contributed to the need for surgery in the first place and improve stress related effects of day to day life. While it is hard to quantify how many times you didn’t fall, how much your range of motion improved versus doing little or nothing, or how many colds or flus you avoided by having your immune system boosted and balanced, those that incorporate massage into their recovery programs and life in general can attest to these benefits. Here is a brief list of the benefits of regular massage therapy:
• Decreased anxiety.
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue. Some of the mechanisms of reaching the above are: • Alleviate pain and improve range of motion.
• Ease medication dependence
• Enhance immunity by stimulating lymph flow—the body’s natural defense system.
• Exercise and stretch weak, tight, or atrophied muscles
• Help athletes of any level prepare for, and recover from, strenuous workouts.
• Improve the condition of the body’s largest organ—the skin.
• Increase joint flexibility.
• Lessen depression and anxiety
• Promote tissue regeneration, reducing scar tissue and stretch marks
• Pump oxygen and nutrients into tissues and vital organs, improving circulation.
• Reduce post-surgery adhesions and swelling.
• Reduce spasms and cramping
• Relax and soften injured, tired, and overused muscles
• Release endorphins—amino acids that work as the body’s natural painkiller.
Meditation and Visualization
While recovering from any surgery or illness, there is usually plenty of time to turn your thoughts inward. You do not have to be a seasoned mindfulness practitioner or sit in a lotus position while reciting mantras and opening your third eye to cosmic influences. However, there IS much to be realized in the practice of meditation for healing. Clinical studies show an increase in return to normal function of an injured area, reduced pain, reduced fatigue and better rest among many other benefits of 20 to 40 minutes of visualization per day. In practice, this usually appears and centering yourself and relaxing your breath. Once you have managed to calm your thoughts, take an inward approach to your attention. Feel any discomfort you may have. Where is it? Does it feel hot, cold, stagnant, sharp? Try to pinpoint it. (This will often be elusive. The point seems to move as the mind concentrates on the quality of sensation). If you are too uncomfortable, change your position to one in which discomfort is minimized and return to feeling your breath. Next, picture whatever your best healing scenario looks like and get into that mental movie. Some people picture a healing place in nature they have been or seen. They bathe the area in healing water, soak up sun and clean air directly into the injury and mentally bathe the area in light, or cold, or heat, counteracting the quality of the discomfort, injury or pain. Others bring in tiny constructions crews to the injury site (and elsewhere throughout the body) and visualize the demolition, clearing and rebuilding of tissue, the production of raw materials, transport of debris to the liver, kidneys and skin for elimination and many other familiar processes we don’t usually associate with metabolic function but see in the rhythm of life every day. The possibilities for positive visualization and meditation are endless. It is not uncommon for the recovering patient to become very comfortable with this state of mindfulness and/or meditation and they practice it any chance they get. It provides awareness, relief, calmness and self-control or the signals our body produces in response to trauma of many sorts. Perhaps most definitive of the link between mind body and spirit, this type of exercise is shown to cut recovery times, increase positive mental states and attitudes toward healing and reduce anxiety.
In general, with visualization or mediation, but certainly in recovery, DO NOT try to visualize or meditate on something far into the future. For example, don’t visualize running a marathon, or climbing Mount Everest a day after extensive hip surgery. It is fine to daydream or project yourself into these situations as goals of recovery, but studies have shown that incremental visualization has a positive effect, while those missing the ‘detail’ work of mindful recovery often show little or slightly negative results. This research is well documented in very beneficial applications of pseudo-meditative sciences like Mental Contrasting with Implementation Intentions, or the WOOP method, which has been proven to help people achieve goals dealing with all aspects of life. Here is a link to a great WOOP website.
Tapping or EFT (Emotional Freedom Technique) If you really want to potentially take healing to new level, consider Tapping. Tapping, or Emotional Freedom Technique (EFT) is a combination of ancient Chinese acupressure and modern psychology that works to physically alter your brain, energy systems and body simultaneously. The practice consists of tapping with your fingertips on specific meridian points while talking through traumatic memories (at any level) and a wide range of emotions. The basic technique requires you to focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything that’s bothering you. While maintaining your mental focus on this issue, use your fingertips to tap 5-7 times each on 9 of the body’s meridian points. Tapping on these meridian points – while concentrating on accepting and resolving the negative emotion – will access your body’s energy, restoring it to a balanced state.
Tapping is simple and painless. It can be learned by anyone. And you can apply it to yourself, whenever you want, wherever you are. It’s less expensive and less time consuming. It can be used with specific emotional intent towards your own unique life challenges and experiences. Most importantly, it gives you the power to heal yourself, putting control over your destiny back into your own hands.To see a demonstration of tapping from the world renowned Mercola Institute click HERE. There is also plenty of introductory materials here to start your journey into Tapping today.
The above information is intended to cover items and issues often overlooked or not addressed at all in standard ‘western’ post-surgical recovery. It is variable by individual and always being updated and revised as additional information and clinical trials evolve to solidify scientific recommendations. Please address any questions, comments or revision suggestions to [email protected]. and East to West Therapeutics, LLC. Updated March 2020. All rights reserved.
Disclaimer: The information provided in this article is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should not use the information in this article for self-diagnosis or to replace any prescriptive medication. You should consult with a health care professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem, suffer from allergies, are pregnant or nursing.
By John Porter D.PSc, Dipl. OM, LMT, Kine.
Recovering from surgery is not just a matter of keeping the wound clean and adhering to a pain control and physical therapy plans as prescribed by your doctor. In fact, your lifestyle and dietary considerations may be more important than the ‘standard care’ in aiding and speeding your recovery, especially in the long term. Traditional Chinese medicine and Ayurveda hold many commonalities in recovering from trauma and surgery. The following are recommendations that have been passed down in the classic literature over the last 5000 years and presented here as a compiled attempt to meet the choices and demands of modern western life. It the original texts, the takeaway is that attention to these guidelines is of highest priority to fully recover from trauma or an operative procedure. To the best of your ability, do not ‘cherry pick’ from the list only the things you are familiar with or seem most familiar. Recovery is inclusive to Body, Mind and Spirit and so are these recommendations. Perhaps ironically, not paying attention to some of these recommendations in the first place may have led to the need for surgery.
In the Ayurvedic classic, Sushrut Samhita, the type of care, both for oneself and for care givers, is outlined in detail. For quick application we are covering subjects somewhat broadly. Detailed points can be found in the clinical care section, or Vranitopasan of the Sushrut Samhita. Cleanliness • Try to keep not only your surgical incisions clean, but make sure your room, bath and house are kept clean as well. When possible, avoid direct wind, direct sun and contact with insects. Sleep • Sleep should be done as much as possible at night. While recovery requires rest, there are biological ‘times of day’ for certain metabolic functions and getting on a regular sleep cycle that matches these can make a significant difference in recovery time because your energy is being used in the proper hierarchy on a metabolic level when sleep is regular. We now know that sleep, and the cycles within sleep, are the most healing times for not only our bodies but our minds as well and there can be no substitute or shortcutting when addressing sleep.
Mental State and Mindfullness • Try to maintain gentle, non-strenuous movement in your recovery. While you should not sit, stand, or even walk for long periods, you do not want to be idle. When you move, do so with intention, taking your time, feeling what is changing in your pain, range of motion and general physiology. Pay attention to things like thirst, hunger, signs of heat or cold at the injury site or elsewhere in the body, etc. Even if you are a in great shape and an athlete, recovering from surgery is not like recovering from workouts or competition. It is a completely different type of healing on a much higher priority level. If you overexert, the body will take that healing energy and move it to the musculature because it thinks you are under threat of additional injury. It metabolically ‘thinks’ “Why else would you want to exert yourself after being cut open? Reverse the metabolic engines!” Included in exertion is sexual activity. While the body does not think you are under threat of additional trauma, the same energy for healing is diverted for sexual activity and is therefore contraindicated for the same reasons. • Just as the physiology is in turmoil following surgery, the mind can be equally taxed and subject to flare-ups, down-turns, lethargy and excitability. This means that mental states and situations that result in altercations, and excessive thinking about negative situations like jealousy, anger, fear, grief and worry should be avoided. When they must be considered, the first thing to do is take a deep breath before responding or reacting, even if that reaction is only a mental one. Secondly, recognize the fact that you may not be at your best mentally, and try to hold that in thought as you choose a response. If you have a mindfulness or meditation practice, this is the perfect time practice.
Dietary Considerations
Diet after surgery is of utmost consideration. What you take in is the raw material used by your cells to repair. Initially your will want to strictly avoid foods that promote phlegm and turbidity, and what is referred to in the Yellow Emperor’s Classic as ‘a preponderance of yin’. Both TCM and Ayurveda use the analogy of a cookpot as our energy conversion center. It encompasses an area about the size of the stomach, pancreas and spleen. For good health, the food cannot be undercooked, it will provide no nutrition. Increasing or stabilizing (metabolic) fire and proper fluids (water) helps balance this. Antagonistically, cold foods (including refined sugar) turbid and fatty foods slow and counteract the nutritive ‘fires’ that are so essential to breaking down our food choices, no matter how poor they may be at times. Therefore, diet becomes the key to healing. A “well-balanced cookpot” with proper heat and water that is given easily digestible foods becomes the analogy for an optimally healing body.
Always have a continuous supply of herbal tea and warm beverages. For optimal effect on the lymphatic and sub-dermal layers, take small drinks every 15 to 30 minutes. DO NOT SUBSTITUTE OTHER SUPPLEMENTS in place of tea or warm drinks. For example, green tea is high in antioxidants and other detoxifying components that serve well when placed in a daily routine, even in large volumes. Conversely, you should NOT take concentrated green tea extracts. For starters, these have been shown to impair liver function with longitudinal use. Fresh is always better and you should be getting 3-4 cups of green tea a day. Again, small sips throughout the day served hot to warm is best.
•Always have a steady supply of clean, room temperature water and keep sipping that if tea is not available or you not getting at least ½ ounce of water per pound of bodyweight a day, including tea.
• Always avoid cold, raw or processed and packaged food. This includes cold drinks, iced smoothies, prepared/frozen meals, etc. It is possible that your gut will not have enough warmth or motive energy to digest raw foods, such as salads, vegetables, and cold beans and peas. This especially includes refined sugar, perhaps the most toxic addition to a recovery plan.
• Tastes/Quality of food: Avoid sour, salty and pungent tasting foods. Generally, these foods are aggravating to the lining of the stomach and intestines, where your healing processes start.
• Flours/Pasta/Bread: Avoid refined flours, even gluten free alternatives. They slow down the digestive process. You may find this hard at times, but the energy your body must divert from healing to break down these dense and rich foods can be disruptive to the entire healing process. You can introduce these items back into your diet slowly as your recover.
• Meats and Proteins: Avoid meats, especially dried or fatty meats, shellfish and pork. There is quite a bit of reference across disciplines about the medicinal benefits of well-prepared chicken soup! (From scratch, not a can or box) According to some ayurvedic texts, goat is OK, but don’t start eating it for the first time when you are on the mend. A good lean meat like bison in small quantities and very well cooked can also be a better option here in the US. You can also get plenty of highly digestible protein by making any variation of Kitchudisha instead. (see below)
• Dairy: Avoid dairy products, especially because most contain hidden sugars. In ayurvedic texts, ghee is acceptable, but the above advice for meat is equally applicable here. If ghee isn’t a part of your regular diet, now may not be the time to start adding it to your diet. If you do not like ghee and insist on dairy, try goat milk or goat yogurt in small quantities. It is easier to digest than dairy milk products.
• Alcohol: Avoid all alcohol. Alcohol can severely stunt healing at surgical sites, depresses the immune system and can severely alter the healing processes of the liver.
• Kitchari, or Kitchadi as your main meal of the day. This Ayurvedic staple typically made with mung bean (yellow split pea, or daal), and/or basmati rice. It is easy to prepare, can be varied to taste and preferences and is a great vehicle for additional healing herbs to get into your diet. Kichari is considered to be soothing to the digestive system and is considered a full protein meal. Cick HERE for a link to a great starter recipe from the YogaHealer.
• Vegetable juices/smoothies. This is NOT your Vita-mix cold smoothie with added yogurt, bananas and honey (although honey is good and will be discussed later). These are vegetables, and small amount of fruits that will deliver enzymes, vitamins and minerals to your cells. By drinking them as a smoothie, you save your digestive system much work in breaking down fibrous plant cell walls to get at the goodies inside. (This is also why raw foods are NOT recommended in post-op recovery. Sometimes it takes more energy to break these cells down then is gained by doing so.)
• Soups: Up soup's place in the menu. Soups, in addition to, or perhaps as a break from, Kitchari are easy to digest, can be packed with vegetables and herbs, and are just plain comforting when we are not at our best. Try to include fresh soup in your diet for at least one meal a day, even after you have healed.
• Grains/Beans. Rice, puffed rice, mung bean daal, popcorn and course ground corn, black beans, split pea, and some other grains can be used in moderation.
• Honey. Honey is a true gift from nature. Including honey in your recovery will aid in many other functions not only on a gut level, but as an enhancement for certain other herbal components to your diet such as cinnamon and astragalus. Include about 4 Tablespoons of honey in your daily diet. In addition, you can use honey topically where it works like a band-aid, keeping the area moist, protecting from infection and relieving inflammation. For the most inclusive information on honey, visit the WebMD page by clicking here. Only use honey if the wound can be cleaned without causing bleeding or painful wincing. Note: DO NOT give honey to infant children.
Supplementation
The following guidelines and recommendations come from TCM and Ayurveda, but also include many common sense recommendations from what we now know about the healing process on a microscopic level. Remember, a supplement is a supplement, meaning ‘to go with’, not ‘as much as you can’ or ‘in a concentrated form’. Pick food first if it contains these nutrients, but the same cooking rules outlined above still apply.
• Vitamin C enhances white blood cell formation, increases antibody production, and raises interferon levels. Additionally, vitamin C helps metabolize anesthetics and may reduce postsurgical bleeding, say researchers from the Gundersen Lutheran Medical Center in La Crosse Wisconsin.
• Vitamin A is a potent antioxidant to enhance immune response and guard against infection. Antibiotics can interfere with the absorption of vitamin A, it’s important to increase the amount you take while recuperating. But, do not take it for an extended period or over 10,0000 IU per day for more than a week. The liver will respond poorly to extended use of vitamin A.Fortunately, beta-carotene found in the whole food is not toxic and can be eaten in bulk to convert in the liver.
• Aloe Vera: Aloe can be taken internally or applied topically. For scarring, aloe is a moisturizer, bacteria protector, cleaner and repair medium. Internally, it can keep the digestive system running properly and often help overcome the tendency toward constipation that can accompany post-surgical anesthesia and constipation.
• Glutamine and arginine, available as a combo at most health stores in capsule form (try to avoid fillers) can also boost immunity. Arginine seems to boost blood albumin and both combined have clinical evidence to reduce infection rates. Take as directed on the supplement.
• Reishi mushroom (Ganoderma lucidum) has been shown to stimulate immunity. Miatake mushroom (Grifola frondosa) is an adaptogen. Combined, the polysaccharides that are in these two fungi act as a metabolic regulator for the immune response to infection.
• Bromelain, an enzyme from the stem of the pineapple seems to inhibit platelet aggregation. Studies show that the effects on pain, swelling and healing time were all improvements and had no side effects that are typically seen with NSAID’s.
• Ashwagandha root (Withania somnifera) Among the myriad benefits of ashwagandha to your overall health, the alkaloids are sedative, reduce blood pressure, and lower the heart rate. Research in 1970 showed that withanolides, which are similar to the body’s own steroid hormones, are anti-inflammatory. It can even be used externally for inflammation at a wound site, but taking 1-3 grams per day mixed into a vegetable smoothie or added to food like Kitchari, or by capsule, is recommended. Because it tends to be a cooler herb and helps regulate sleep and digestion. If you begin to develop a loose stool or diarrhea, discontinue ashawagandha until the condition clears up.
• Astragalus (Astragolus propinquus or Huang Qi): Another incredible herb of which you may consume up to 10 grams per day as long as you are not suffering from an acute illness like influenza or rhinitis (But this level is built up to over time). Astragalus is clinically proven to enhance the immune system, providing defense against colds and flues, seasonal allergies, hypertension, fatigue, asthma, anemia, weak limbs and even cancer!
• Dong Quai (Angelica senensis). A tonic, blood tonic, antispasmodic, sedative, emmenagogue, analgesic, and mild laxative. Often called “the female ginseng.” Though dong quai has no specific hormonal action, it exerts a regulating and normalizing influence on hormonal production through its positive action on the liver and endocrine system. Research has shown that the whole plant, including the rhizome, strengthens liver function and the whole rhizome has an antibiotic effect. In TCM the following are listed for Dang Quai: Indications: irregular, insufficient, profuse, painful and otherwise abnormal menstruation; premenstrual syndrome; headaches; pain from traumatic injury or surgical wounds; paralysis; poor appetite; cancer; empty blood. Contraindications: diarrhea. Dosage can be from 500 mg to 2 grams per day and should be scaled back if diarrhea occurs.
• Devil’s Claw (Harpagophytum procumbens) has been clinically shown to reduce sensations of pain in 30% of people who take it.
• Turmeric: Turmeric is a blood mover, anti-hypertensive and anti-coagulant, along with several other amazing properties attributed to long term use of this herb. 500 milligrams to 1 gram daily is the most common recommendation and be certain to have a small amount of black pepper with it (10 mg pepper, or about 2 peppercorns equivalent) with every dose of turmeric. If you are on statins or blood pressure medications, be certain to check with your doctor before usingturmeric as it is often just as effective as drugs at reducing cholesterol and blood pressure and you don’t want to ‘double-up’ on any medication.
• Probiotics. The use of probiotics in recovery from surgery is very important, especially if antibiotics were part of your pre-surgical preparation or post-surgical prescription. 10-20 billion cultures of bifodobacteria and acidophilus should be added to your diet. Do not use any probiotic with more than 4 strains as the gut likes simplicity and too many competing ‘biotics’ are for a digestive system in top condition, which takes time. If you are new to probiotics, start with a low ( low-dose (about ½ for 1 week). Those just recovering from surgery start small and increase across the first couple of weeks after undergoing to surgery or taking competing antibiotics. (They should not be taken together)
Acupuncture and Massage Therapy
The benefits of using acupuncture and massage therapy to assist with pain management, speed recovery and restore full range of motion and health are well documented over centuries. These are among the well documented benefits of Traditional Chinese medicine:
• Acupuncture can be started immediately after surgery to restore qi and blood to the injured area, reduce sensations of pain and calm the nervous system. If pain is a major component of your recovery, acupuncture may be indicated on a more frequent basis, for example 2 days per week. As your recover to full function, and even if pain is no longer an issue, acupuncture will still decrease lost work time, boost immune response and speed healing with regular sessions. Even if you have a cast or bandage covering a wound, acupuncture can be (and often is) done on points distal to the site of direct injury, and the effects are usually immediate. Talk to your acupuncturist about treatment protocol, frequency, duration and goals. Often, in addition to treating for post-operative related pain and stagnation, acupuncture addresses secondary symptoms such as sleep disturbance, agitation, gastro-intestinal discomfort, headaches and side effects from any prescription or OTC drugs that may be being taken with or without prescription from an M.D.
• Bodywork, or massage therapy has myriad effects on circulatory, endocrine and lymphatic function. Depending on the individual, these can be quite profound. Typically, massage can start as soon as three weeks or six weeks after a procedure, determination of which is usually made by the surgeon. In my practice, getting acupuncture and bodywork on the same day can really give a client a good benchmark for their overall progress in recovery because the immediate relief of symptoms provided by these therapies allows for a ‘fresh’ observation compared to when they entered the office, or against the previous session, hour or week.
Massage is also an excellent adjunct to surgery as a long-term preventative measure. Besides helping release restricted muscle and scar tissue for full range of motion at and distal to a surgical site, the benefits of bodywork on a regular basis help prevent movement related injury from reoccurring, regulate body systems that may have contributed to the need for surgery in the first place and improve stress related effects of day to day life. While it is hard to quantify how many times you didn’t fall, how much your range of motion improved versus doing little or nothing, or how many colds or flus you avoided by having your immune system boosted and balanced, those that incorporate massage into their recovery programs and life in general can attest to these benefits. Here is a brief list of the benefits of regular massage therapy:
• Decreased anxiety.
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue. Some of the mechanisms of reaching the above are: • Alleviate pain and improve range of motion.
• Ease medication dependence
• Enhance immunity by stimulating lymph flow—the body’s natural defense system.
• Exercise and stretch weak, tight, or atrophied muscles
• Help athletes of any level prepare for, and recover from, strenuous workouts.
• Improve the condition of the body’s largest organ—the skin.
• Increase joint flexibility.
• Lessen depression and anxiety
• Promote tissue regeneration, reducing scar tissue and stretch marks
• Pump oxygen and nutrients into tissues and vital organs, improving circulation.
• Reduce post-surgery adhesions and swelling.
• Reduce spasms and cramping
• Relax and soften injured, tired, and overused muscles
• Release endorphins—amino acids that work as the body’s natural painkiller.
Meditation and Visualization
While recovering from any surgery or illness, there is usually plenty of time to turn your thoughts inward. You do not have to be a seasoned mindfulness practitioner or sit in a lotus position while reciting mantras and opening your third eye to cosmic influences. However, there IS much to be realized in the practice of meditation for healing. Clinical studies show an increase in return to normal function of an injured area, reduced pain, reduced fatigue and better rest among many other benefits of 20 to 40 minutes of visualization per day. In practice, this usually appears and centering yourself and relaxing your breath. Once you have managed to calm your thoughts, take an inward approach to your attention. Feel any discomfort you may have. Where is it? Does it feel hot, cold, stagnant, sharp? Try to pinpoint it. (This will often be elusive. The point seems to move as the mind concentrates on the quality of sensation). If you are too uncomfortable, change your position to one in which discomfort is minimized and return to feeling your breath. Next, picture whatever your best healing scenario looks like and get into that mental movie. Some people picture a healing place in nature they have been or seen. They bathe the area in healing water, soak up sun and clean air directly into the injury and mentally bathe the area in light, or cold, or heat, counteracting the quality of the discomfort, injury or pain. Others bring in tiny constructions crews to the injury site (and elsewhere throughout the body) and visualize the demolition, clearing and rebuilding of tissue, the production of raw materials, transport of debris to the liver, kidneys and skin for elimination and many other familiar processes we don’t usually associate with metabolic function but see in the rhythm of life every day. The possibilities for positive visualization and meditation are endless. It is not uncommon for the recovering patient to become very comfortable with this state of mindfulness and/or meditation and they practice it any chance they get. It provides awareness, relief, calmness and self-control or the signals our body produces in response to trauma of many sorts. Perhaps most definitive of the link between mind body and spirit, this type of exercise is shown to cut recovery times, increase positive mental states and attitudes toward healing and reduce anxiety.
In general, with visualization or mediation, but certainly in recovery, DO NOT try to visualize or meditate on something far into the future. For example, don’t visualize running a marathon, or climbing Mount Everest a day after extensive hip surgery. It is fine to daydream or project yourself into these situations as goals of recovery, but studies have shown that incremental visualization has a positive effect, while those missing the ‘detail’ work of mindful recovery often show little or slightly negative results. This research is well documented in very beneficial applications of pseudo-meditative sciences like Mental Contrasting with Implementation Intentions, or the WOOP method, which has been proven to help people achieve goals dealing with all aspects of life. Here is a link to a great WOOP website.
Tapping or EFT (Emotional Freedom Technique) If you really want to potentially take healing to new level, consider Tapping. Tapping, or Emotional Freedom Technique (EFT) is a combination of ancient Chinese acupressure and modern psychology that works to physically alter your brain, energy systems and body simultaneously. The practice consists of tapping with your fingertips on specific meridian points while talking through traumatic memories (at any level) and a wide range of emotions. The basic technique requires you to focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything that’s bothering you. While maintaining your mental focus on this issue, use your fingertips to tap 5-7 times each on 9 of the body’s meridian points. Tapping on these meridian points – while concentrating on accepting and resolving the negative emotion – will access your body’s energy, restoring it to a balanced state.
Tapping is simple and painless. It can be learned by anyone. And you can apply it to yourself, whenever you want, wherever you are. It’s less expensive and less time consuming. It can be used with specific emotional intent towards your own unique life challenges and experiences. Most importantly, it gives you the power to heal yourself, putting control over your destiny back into your own hands.To see a demonstration of tapping from the world renowned Mercola Institute click HERE. There is also plenty of introductory materials here to start your journey into Tapping today.
The above information is intended to cover items and issues often overlooked or not addressed at all in standard ‘western’ post-surgical recovery. It is variable by individual and always being updated and revised as additional information and clinical trials evolve to solidify scientific recommendations. Please address any questions, comments or revision suggestions to [email protected]. and East to West Therapeutics, LLC. Updated March 2020. All rights reserved.
Disclaimer: The information provided in this article is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should not use the information in this article for self-diagnosis or to replace any prescriptive medication. You should consult with a health care professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem, suffer from allergies, are pregnant or nursing.