You Are What You Eat
Nutrition is one of the most important factors affecting how well you recover from an operation. Healthy nutrition before an operation, as measured by good levels of a protein in the blood called albumin, has been clearly shown to improve healing after operations and to reduce the chance of wound infections. Likewise, maintaining good nutrition after an operation is also essential.
What happens if your nutrition isn’t good enough? There are a few strategies that your medical team can use to help improve your nutrition. Which one is best depends on how well you’re able to eat – or whether you’re able to eat at all.
Before Surgery: Is Your Nutrition Adequate?
Figuring out whether you are eating enough, and digesting enough of the food you eat, is an important part of the assessment your surgeon will do before you have an operation. Before your operation, be sure to tell your surgeon if you have been losing weight or having frequent nausea, vomiting, or diarrhea. If your nutrition is a concern, your surgeon may order labs to check your albumin and other nutrition values before scheduling you for an operation.
What if Your Nutrition Needs Supplementation?
If your nutrition needs improvement, either before or after surgery, your surgeon may recommend that you see a dietician to help better understand what you’re eating and how you can improve your diet. The dietician may order additional lab tests, and will probably ask you (or your nurse, if you’re in the hospital) to keep a food diary for calories counts. From there, the dietician and your medical team can recommend a variety of treatments.
Treatments to Improve Nutrition
Nutritional supplements: If your diet lacks enough calories, or especially enough protein, one of the best ways to improve this is through high-protein, high-calorie nutritional shakes, such as Ensure or Boost. These supplements pack lots of nutrition into a very small volume, so even without a great appetite, you can get the nutrients you need.
Appetite enhancers: If you can tolerate food but don’t have an appetite, there are certain drugs that will stimulate appetite. The most common of these is called Marinol. It’s typically given to cancer patients with severely reduced appetite and serious weight loss, but the medication is used in other areas of medicine as well.
Enteral (also called tube) feeding: For patients who can’t swallow, or can’t swallow enough, their medical team may recommend feeding through a tube. There are different tubes designed for different conditions. For example, for patients who are expected to need a tube for just a short time (a few days), the preferred tube is a small, soft tube that goes through the nose and down into the stomach or small bowel (called naso-gastric or naso-jejunal feedings tubes).
For patients who are expected to need tube feeding for longer periods, most surgeons prefer tubes that go into the stomach through the abdominal wall. These tubes, called gastrostomy tubes, last much longer and are less likely to become dislodged. Although the placement is more complicated, they are much more easily managed and more comfortable for patients in the long term.
Gastrostomy tubes are usually placed by gastroenterologists or interventional radiologists while the patient is under mild anesthetic, but in some cases may be done by a surgeon in the operating room and require a general anesthetic. Patients with gastrostomy tubes can learn to manage their own feeding tube at home, and the tubes can be easily removed in the clinic when no longer needed.
Total Parenteral Nutrition (TPN): What if you can’t eat at all? A healthy, well-nourished person can go about seven days without serious consequences from not eating, as long as they’re getting IV fluid and a little bit of IV sugar. After that, the body starts digesting muscle for fuel. To avoid this, patients who can’t eat after surgery (usually because of an intestinal operation with delayed return of intestinal function), may need to get nutrition by vein – this is called total parenteral nutrition or TPN.
TPN requires placement of a special form of long-term IV catheter called a PICC (peripherally inserted central catheter) line. Although there are some significant risks to long-term use, TPN can be an important temporary nutrition source. Some patients with severe intestinal problems can even be on TPN for years. Patients can receive TPN at home, usually overnight while they are sleeping.
As with most things in surgery, good nutritional preparation and effective communication with your medical team about your nutritional status is the best way to avoid problems before, during, and after your operation. This post should provide you with some basic terms and definitions, but be sure to talk to your medical team about any concerns you have about your nutrition around the time of surgery.
This story originally appeared in the Health Dialog Care Compass Blog.
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