A Functional Medicine Post-Operative Protocol

Millions of surgeries occur in the United States annually, the most common being lens and cataract procedures, tonsillectomy, and hernia repair. Personal factors and underlying medical conditions can impede post-surgical healing, leading to postoperative complications and prolonged hospital stays. An integrative treatment protocol that targets cellular and physiologic mechanisms to regulate inflammation and immune function can improve surgical outcomes and encourage a speedy recovery.

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What is a Post-Operative Protocol?

A post-operative protocol is a nutritional program emphasizing nutrients that promote healing and reduce scar formation after surgery. Individuals who follow a post-operative protocol may heal faster than expected, with less pain, swelling, and surgical complications.

Functional Medicine Labs to Order Before Surgery

Functional medicine labs help practitioners personalize treatment options for their patients. Below are some of the most common labs ordered for patients scheduled for surgery.

Complete Blood Count (CBC)

A CBC screens for anemia or other red blood cell disorders, immune dysfunction, and clotting disorders. Additionally, a CBC can screen for nutritional deficiencies, as some vitamins and minerals can lead to changes in blood cells measured on this panel. Reversing potential anemias and treating infections before surgery will enhance recovery post-operatively. Additionally, bleeding or clotting disorders can pose a risk for patients planning to undergo surgical procedures; this panel provides valuable information to the surgeon to prevent danger for this patient population.

Comprehensive Metabolic Panel (CMP)

A CMP includes 14 biomarkers that assess blood glucose, electrolytes, liver function, and kidney function. This test is a comprehensive health screening tool that can help detect imbalances and health conditions that hold the potential to complicate surgery and recovery.

Hemoglobin A1c (HbA1c)

HbA1c is a 3-month blood sugar average and is the biomarker used to diagnose diabetes. Research shows a clear correlation between blood glucose and wound healing. Patients with type 1 and type 2 diabetes are at higher risk of poor wound healing and infection at the surgical site because high blood sugars impair white blood cell function and good blood circulation. (1)

Thyroid Panel

Optimal thyroid function is imperative during the pre and post-operative periods because thyroid hormones impact the physiology of metabolism, heart function, the nervous system, immune function, and muscle strength. A complete thyroid panel assesses the thyroid axis to screen for subclinical and overt thyroid dysfunction.

Iron Panel

It is important to diagnose and treat iron deficiency prior to surgery. Iron deficiency can contribute to iron deficiency anemia (IDA), poor collagen synthesis, and hypothyroidism. A complete iron panel, including serum iron, ferritin, transferrin, iron saturation, and total iron binding capacity, offers a comprehensive analysis of the body's iron status and utilization.

Comprehensive Nutritional Analysis

A comprehensive nutritional analysis, like Genova's NutrEval, goes beyond iron to screen for insufficiencies and deficiencies in vitamins, minerals, antioxidants, fatty acids, and amino acids critical to the healing process.

Other Lab Tests to Check

In addition to the labs mentioned above, patients should follow their surgeon's advice and complete any requested pre-operative blood work and testing. These tests are important for a comprehensive health analysis to ensure the best surgical outcomes and patient safety. Commonly ordered tests, in addition to a CBC, CMP, and HbA1c, include a chest x-ray and an electrocardiogram (ECG).

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Functional Medicine Treatment Protocol for Post-Operative Recovery

A personalized treatment protocol can be prescribed based on an extensive intake and lab results. Below is an example of a post-operative recovery protocol for patients scheduled for surgery.

Therapeutic Diet and Nutrition Considerations for Post-Operative Recovery

Good nutrition is the foundation of a healthy immune system. You may notice that appetite is suppressed after surgery, so making mindful dietary choices to choose nutrient-dense foods and maximizing intake when your appetite is good are important. A plant-based diet provides the proper phytonutrients, vitamins, and minerals to build and repair damaged tissues and support the immune system to prevent infection. Incorporating high-protein foods into the diet (e.g., dairy, lean meats, seafood, bone broth, legumes) ensures you meet increased energy requirements during the healing state. (10)  

Staying well-hydrated is just as important as staying well-nourished. Dehydration causes the skin to lose elasticity, making it more susceptible to infection and poor healing. Also, dehydration increases the risk of complications like urinary infections and electrolyte imbalance. (10)

Supplements Protocol for Post-Operative Recovery

Nutritional supplements can provide additional protein, vitamins, and minerals that you may be unable to get through diet alone. Below are commonly recommended supplements by functional medicine providers during post-operative recovery.

Arnica

Although homeopathy is controversial, homeopathic Arnica is a traditional remedy for trauma, bruising, and pain. A recent 2021 meta-analysis confirmed homeopathic Arnica's efficacy in preventing sequelae of surgeries, including hematoma, swelling, and patient discomfort, comparable to the effects of standard anti-inflammatory medications (e.g., ibuprofen).

Dose: Homeopathic Arnica 30C; five pellets dissolved under the tongue every 3-4 hours

Duration: 7 days

Multivitamin

A comprehensive, high-potency multivitamin/mineral supplement is an easy way to fill nutritional gaps in the diet and prevent nutritional deficiencies. Multivitamins are safe and inexpensive, and available research suggests their use post-operatively controls pain and speeds recovery.

Dose per label instructions

Duration: 4-6 weeks

Antioxidants

ACES + Zn by Carlson is a comprehensive antioxidant formula that contains vitamins A, C, E, selenium, and zinc. Antioxidants help protect cells from free radical damage and support a healthy immune system. Additionally, vitamin C is an essential cofactor for collagen synthesis, and zinc is a crucial mineral for wound healing. (2-6)

Dose: take two soft gels three times daily with food

Duration: Begin three days after surgery, and continue for one month

Vitamin D

Vitamin D plays a vital role in many aspects of healing, including cell proliferation, neuromuscular and immune function, bone remodeling, and glucose metabolism. Low vitamin D status is associated with worse surgical outcomes in patients.

Dose: 5,000-10,000 IU of vitamin D3 daily, depending on preoperative vitamin D status

Duration: 1 month

Flavonoids

Flavonoids are natural plant compounds with a high antioxidant capacity, capable of reducing reactive oxygen species and promoting cardiovascular health. Over 5,000 plant flavonoid compounds exist in food, including anthocyanidins, flavan-3-ols, flavanones, flavones, and flavonols. Supplementing with Fruit Anthocyanins provides anti-inflammatory and antimicrobial properties, supports soft tissue integrity, and promotes healthy circulation. (7-9)

Dose: 1 tbsp daily

Duration: 1 month

Bromelain

Bromelain is a type of proteolytic enzyme concentrated from the pineapple plant that can reduce pain, inflammation, and swelling at the surgical site and prevent scar tissue formation.

Dose: 500 mg three times daily on an empty stomach

Duration: Start as soon as possible after surgery and continue until the bottle is finished.

Probiotics

Your surgeon may prescribe prophylactic antibiotics before or after surgery to prevent infection. Taking a probiotic alongside antibiotics can replenish beneficial intestinal bacteria and prevent antibiotic-associated gastrointestinal side effects like diarrhea.

Dose: 5-10 billion CFU daily; take at least two hours away from antibiotics

Duration: Start the same day you start the antibiotic and continue 2-4 weeks after the course of antibiotics has finished.

When to Retest Labs

Patients should plan to continue the post-operative protocol for 4-6 weeks after surgery to optimize healing. Labs can be repeated during this timeframe to assess health status and revise the treatment plan as needed. Patients should always follow up with their doctors sooner if they experience any complications or unexpected side effects during the post-operative recovery period.

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Summary

Healing from surgery can be a long, difficult process that can be complicated by underlying medical conditions and nutrient deficiencies. Consider scheduling an appointment with a functional doctor if you've got a future surgery scheduled. Functional doctors interpret lab results with a more scrutinizing eye to differentiate between normal and optimal values to optimize health at the cellular level before surgery. Based on labs and patient history, a treatment protocol can be customized to meet an individual's increased energy demands and support the innate healing mechanisms post-operatively. A post-operative recovery plan encourages faster recovery and prevents potential adverse outcomes that can occur after surgery.