& CENTRAL COMPOUNDING
For more information about these community pharmacy/ education/wellness centers, contact:
Jennifer Burch, PharmD
Sejjal Patel, PharmD
Jhuvon Francis, PharmD
Erika Kelly, PharmD
Chad Palumbo, PharmD
2609 North Duke Street, Suite 103
Durham, NC 27704
Telephone: (919) 220-5121
Fax: (919) 220-6307
CENTRAL COMPOUNDING CENTER
6224 Fayetteville Road, Suite 104
Durham, NC 27713
Telephone: (919) 484-7600
Call to schedule a consultation with our pharmacists
Before and After Surgery
“The nutritional choices we make before and after surgery,” says Dr. Burch, “play a powerful role in minimizing the traumatic impact of surgery and improving recovery time. While each patient should consider their unique personal needs, such as allergies, the following guidelines can be a useful tool in planning for a successful surgery.”
PRE-OPERATIVE NUTRITION: Two to four weeks before surgery, a number of lifestyle adjustments can contribute significantly to a healthy surgical experience. These include drinking plenty of water, consuming a sufficient amount of protein, and supportive supplements such as vitamin C, zinc, and Coenyme Q10.
ONE WEEK PRE-SURGERY: In the days immediately before surgery, it’s important to avoid the foods and supplements that may interfere with anesthesia, bleeding time, immune function, and healing time. Among the foods and supplements to avoid:
- Vitamin E, vitamin C, vitamin K, B vitamins, fish oils and all herbal supplements.
- Aspirin and all other NSAIDs
- Foods that may have negative effect on anesthesia or bleeding time (e.g., green tea, garlic, ginger, flaxseed, tomatoes); and foods that can suppress immune function (e.g., refined sugar).
- Limit “neurotoxic” items such as alcohol, caffeine, aspartame, and MSG; and reduce or eliminate known or potentially allergenic foods (e.g., eggs, soy, and peanuts)
POST-OPERATIVE NUTRITION: Nutritional choices should support the immune system, and reduce pain, inflammation, and swelling. So, although pre-operative supplements can be resumed, sugar, allergenic foods, caffeine, and alcohol should continue to be avoided. In the first 72 hours post-operatively, foods should be bland, soft, and easy to digest; and wait 72 hours before resuming vitamin E, vitamin C, vitamin K, fish oils, and multivitamins. During recovery, it’s important to avoid inflammatory foods (such as fried foods and refined sugars), and to emphasize anti-inflammatory foods. Continue zinc, glutamine, arginine coq10 and probiotics. Special supplements—such as bromelain and arnica montana—have anti-inflammatory properties that can dramatically reduce post-operative swelling and bruising.
For pharmacist Jennifer Burch of Central Compounding Center in Durham, surgery—and all its challenges and benefits—has to be considered through the lens of body chemistry. “Surgery of any kind,” she says, “is a traumatic experience. So, achieving the best possible outcome for any surgery begins with understanding how everything you ingest—food, supplements, medications—affects how your body will respond to the trauma of surgery.”
“In preparing for surgery,” says Dr. Burch, “the goal is to optimize the surgical experience and stimulate the body’s healing capacities. And your body’s chemistry is critically important in meeting that goal. It can increase or reduce inflammation; it can slow or accelerate the healing process; and it can compound or mitigate pain and other side effects. Happily, preparing your body chemistry is not difficult, and the nutritional choices you make can have a tremendous impact on how quickly you heal.
“There are specific supplements and foods that support recovery and others that interfere with healing (see box), but generally speaking, preparing your body chemistry means avoiding inflammatory foods—which interfere with healing—and ensuring that you have adequate hydration and protein intake, as well as the micronutrients that support your immune system.”
Nutritional considerations are equally important post-surgery, notes Dr. Burch, “as they can have a significant impact on how quickly your body heals, by supporting your immune system, and by reducing pain, inflammation, and swelling.”
Beyond nutrition, full recovery from surgery often involves other issues. “Pain relief is often a significant concern post-surgery,” says Dr. Burch, “and some surgeries will require long-term adjustments to medications. For some patients, scar removal or coping with post-anesthesia ‘brain fog’ might be important challenges. In all these instances, a compounding pharmacist can be a valuable resource.
“For example, we’re increasingly seeing patients who have had gastric bypass surgery, and as a consequence, their pharmaceutical needs have changed—sometimes dramatically. Such surgical changes often mean that they will be unable to absorb their vitamins or medications as in the past. So, we need to find alternative ways of delivering medications and supplements—which could mean turning their pills into liquids, or providing a transdermal medication.”
“Another example where we often provide post-surgical support,” says Dr. Burch, “is to help people who want to reduce or repair the scars resulting from the surgical incision. We’re able to compound medications that can help with wound healing and prevent or reduce scarring. However, one of the most remarkable advancements we’ve seen is a proprietary, silicone-based product called PracaSil®-Plus, which is sold over-the-counter, without a prescription, and does an extraordinary job of reducing scars—even old scars. It’s applied topically and can be used immediately after surgery, as soon as the patient gets the stitches out. I’ve been amazed at the results that many of our patients—including my mom—have had with this product.”
Post-Surgery Pain Management
“Surgery—inevitably—involves pain,” observes Dr. Burch, “so managing that pain is a critically important part of recovery. It’s also true that the epidemic of opioid addiction and abuse in the United States has made pain management particularly challenging, since many of the opioids—codeine, Vicodin, Oxycontin, and Percocet—are commonly used for post-surgical pain. Finding alternatives to these medications is increasingly important.
“Of course, this is a challenge not only for surgical patients,” adds Dr. Burch, “but for managing chronic pain. So, it has been an important focus of our compounding pharmacy to develop customized strategies that either augment a patient’s current pain program or work in lieu of opioid treatment.
“One effective option that is used frequently for pain relief—particularly for fibromyalgia or any painful autoimmune illness—is Low-Dose Naltrexone (LDN), a medication that has multiple mechanisms of action that regulate inflammation and pain. We always start patients on the lowest dose, and then slowly increase it. That customization is critically important; by compounding medications we can find the right dosage to meet the needs of the individual patient.”
Another approach to non-opioid pain relief Dr. Burch has found to be very effective is CBD oil. This is hemp-derived cannabidiol oil—not medical marijuana; there is no psychoactive effect in using CBD oil.
“Pain relief has been impressive with CBD,” reports Dr. Burch. “However, there are important cautions. This product is sold over-the-counter everywhere—you can buy it on Amazon or at the gas station. But what’s critically important is the quality of the product. Probably 30-40 percent of what’s on the market may not even contain CBD, or contains CBD that’s tainted with additives, or contaminant pesticides, or heavy metals. Remember this is derived from the hemp plant—so where and how those plants are grown affects the quality of the CBD oil.
“Both of our pharmacies carry CBD oil,” notes Dr. Burch. “And I’ve vetted the quality of our CBD products and they’re good preparations with good quality control. Equally important: we don’t just sell these products, we work with our clients to determine the effective dosages required.”