A cut above: kinder surgery; herbs, vitamins and stress reduction can help speed your recovery - Natural Remedies - includes related article about getting meatless meals in the hospital

Even the healthiest among us are sometimes confronted with an indisputable need for surgery. It could result from a life-threatening emergency: acute appendicitis or injuries sustained in a car crash, or it could be something less urgent such as torn knee ligaments.

For those who prefer to use natural medicine, the prospect of surgery can be more upsetting than for those who do not; after all, it means using conventional medicine at its most extreme. However, just because we find ourselves at the mercy of the scalpel doesn't mean we must feel entirely helpless. The surgeon may be in charge of the operating room, but as patients, we're in charge of a more important arena: our bodies. Even in the face of surgery, we can use a variety of natural means to reduce pre- and post-surgical stress, boost the immune system and speed healing. These measures, in turn, can help make the surgery experience more positive and raise the odds of a successful outcome.

Ideally, you will have ample time to prepare for your operation. However, even those who require immediate surgery can use the treatments that follow with a little hell) from family or friends.

NUTRITION COUNTS

Virtually all nutrients play at least some role in helping the body prepare for and bounce back from a trauma such as surgery, but some are more important than others. One study on vitamin A, for instance, showed that massive doses help maintain proper immune function. Other studies have shown that vitamin A helps speed wound healing, especially when the body faces extra stressors including diabetes or radiation treatments. Vitamin C aids in the production of collagen, a protein essential for wound healing. It also facilitates the delivery of leukocytes to the site of a wound, thus boosting immunity to infection. Zinc, too, is required for proper wound healing. It was used topically as far back as 1,5OO B.C. by the Egyptians, and to this day bandages often contain zinc oxide to help speed healing. It is also well-documented that people with zinc deficiencies experience delayed wound closure and an increased susceptibility to infection.

Alan Gaby, M.D., president of the American Holistic Medical Association and co-author of the monthly newsletter Nutrition and Healing, includes all the aforementioned nutrients in a protocol he recommends to patients headed for the operating room. "I inevitably hear from patients, `My surgeon never saw anybody heal so fast,'" Gaby says. He cautions, however, that anyone who decides to follow this protocol or take extra supplements do so only under medical supervision. Supplements can have a significant impact on your condition (some, for example, thin the blood or interfere with the absorption of medication) and it's therefore imperative that you consult your surgeon before taking anything.

Gaby suggests patients begin taking these supplements at least two weeks before surgery, then continue taking them for four weeks after the operation. The nutrients he recommends are: 25,000 international units (IU) of vitamin A a day; 1,000 milligrams (mg.) of vitamin C three times a day; 400 IU of vitamin E a day; and 30 mg. of zinc one or two times a day. In addition, Gaby says patients should take high-potency B-complex vitamin and multi-mineral supplements.

Gaby and other nutrition experts also recommend taking bioflavonoids; research has found them to be powerful anti-inflammatory agents that strengthen the integrity of tissue as it heals. There are more than 500 varieties of bioflavonoids, which occur naturally in fruits, vegetables, nuts, seeds and leaves. Many varieties of bioflavonoids are available in supplement form; they are sometimes referred to as vitamin P. Don Brown, N.D., a naturopathic physician, who is editor of the journal Quarterly Review of Natural Medicine and author of Herbal Prescriptions for Better Health (Prima, 1996), recommends the bioflavonoid quercetin -- 500 mg. twice a day for several days before surgery and several days after.

Other nutrients to keep in mind are amino acids, the basic building blocks of proteins. According to Eric R. Braverman, M.D., in his book The Healing Nutrients Within (Keats Publishing Inc., 1987), studies have shown that branched-chain amino acids are in great demand when the body undergoes any kind of stress including surgery, injury and infection. Isoleucine, leucine and valine are all branched-chain amino acids; wheat germ and some cheeses are good dietary sources. Particularly good for wound healing, says Braverman, is the amino acid arginine (nuts, eggs, milk and cheese contain high concentrations of this). Cysteine, methionine and proline aid in wound healing as well.

Many nutrition experts recommend bromelain, an extract from pineapple, which Ron Reichert, N.D., a contributor to the Quarterly Review of Natural Medicine, calls the "best thing" to promote wound healing. Bromelain contains a high concentration of the enzyme protease, a known anti-inflammatory agent. If you take bromelain supplements, look for a tablets that contain at least 1,200 gelatin digestive units (GDU) or 1,600 milk clotting units (MCU), Reichert says, noting that anything lower may lack sufficient potency. (GDU indicates that a product may contain gelatin -- a substance derived from animal sources. Some companies make bromelain using agar-agar or another plant product; the label will state whether the product is vegetarian. Products with the MCU designation contain dairy.) He also cautions patients not to take bromelain immediately after surgery because it can increase bleeding time; wait at least 24 hours and then take 400 mg. to 600 mg. a day for 10 days, preferably in three separate doses between meals. Another warning: People who have ulcers or know that they are allergic to pineapple should not take bromelain.

HEALING WITH HERBS

Herbs may seem to be an incongruous adjunct to the modern scalpel, but a number of them have been shown to be beneficial in aiding patients undergoing surgery. One such herb is ginger (Zingiber officinale), whose use in the prevention of post-operative nausea, a common complication of general anesthesia, has been the subject of several studies. A study in the journal Anaesthesia concluded that 1 g. of powdered ginger root given to 120 women undergoing surgery worked better than both a conventional anti-nausea drug, metoclopramide, and a placebo. Brown recommends taking 2SO mg. four times a day in tablets or capsules for two or three days before and after surgery. He cautions, however, that ginger can contribute to increased bleeding in people taking blood-thinning medications.

To speed wound healing, Brown and Reichert both recommend a popular Chinese herb, gotu kola (Centella asiatica). Gotu kola contains triterpenoids, compounds that aid in the prevention of scar tissue, Reichert says. Dosages vary depending on the strength of the gotu kola extract. For gotu kola labeled "40 percent asiaticoside extract," a commonly available potency, the appropriate daily dosage is anywhere between 60 mg. and 120 mg. for a few days before surgery and for several weeks afterward, Brown says.

Doctors sometimes prescribe blood thinners to surgery patients to prevent the formation of blood clots. Blood-thinning agents occur naturally in garlic, onions, turmeric and ginger, says Kathi Keville, author of Herbs for Health and Healing (Rodale Press, 1996). If your doctor recommends blood-thinners, says Keville, "you can bring a little shaker of herbs with you to the hospital. Nobody will object if you put a little curry [powder] on the food."

LOWERING THE STRESS FACTOR

Until now, we've focused on natural remedies for the body, but the mind is an equally important player when it comes to healing. Studies have shown that patients who are more relaxed and better informed about upcoming surgery are more likely to enjoy a successful outcome.

There are many ways to reduce stress before, after and even during surgery. In a Nursing Times study, a researcher massaged 24 heart patients with different essential oils of lavender; each patient received a 20-minute massage on the second and third day after surgery. One species of lavender -- lavandula burnatii -- was almost twice as effective as the other species -- Lavandula angustifolia -- in lowering anxiety.

To make your own massage oil with lavender, Keville recommends using one-eighth teaspoon of pure essential oil of lavender with four ounces of vegetable oil. To ease post-surgical depression and fatigue, Keville also recommends inhaling the scent of peppermint, eucalyptus or cinnamon. You may follow this recipe to make massage oil with these essential oils. Keville says that popping a peppermint breath mint, drinking peppermint tea or inhaling the aroma of anything with cinnamon in it also will be effective.

At Columbia-Presbyterian Medical Center in New York City, staff at the Complementary Care Center are experimenting with a number of approaches to reduce pre- and post-surgical mental stress, including hypnosis and music therapy. One published study by the center found that self-hypnosis taught to patients the night before heart surgery was linked with a decrease in levels of anxiety and stress. For the study, patients were asked to practice the self-hypnosis techniques hourly the right prior to surgery and as often as possible post-operatively. The techniques included envisioning working with the surgeon to keep the incision free of infection; minimize bleeding; reduce pain and discomfort; and maintain normal blood pressure.

Other studies have shown that patients, even when they are unconscious, remember some of what they hear in the operating room. That is why patients at the Complementary Care Center also are given tapes of music to listen to during surgery. Most of the tapes contain soothing New Age-style music and reassuring voice-overs that tell the patient all is going well, says Mehmet C. Oz, M.D., executive director of the center.

Bob Berkey, 20, who underwent open-heart surgery at Columbia-presbyterian medical center earlier this year, says he listened to the tapes almost continuously before, during and after the operation, and they definitely helped him recover. "I was relaxed even with all the commotion going on," he recalls. "ICU is a terrible place to be. You're totally disoriented. You can't distinguish between night and day. You've got a tube down your throat. But it was so easy to get comfortable with the tapes. "

The center also offers yoga and massage therapy, both of which Oz believes help patients physically and mentally. While Oz and other like-minded surgeons continue to explore the potential benefits of these therapies, patients can take advantage of them immediately. "I don't know of any patient that has been hurt by these modalities," points out Oz. Safe and effective -- what more could you ask for from any medicine?

How to Get Meatless Meals in the Hospital

Hospital food often leaves much to be desired -- and that's especially true for vegetarians. The first challenge is getting the hospital staff to understand your dietary needs. Once you're over that hurdle, though, there are usually only a few non-meat options, which typically feature cheese.

If possible, you might consider having surgery at one of the 80-plus Seventh-day Adventist (SDA) hospitals around the country; look for a surgeon with admitting privileges. This Christian religion encourages its adherents to follow a vegetarian diet, which is the standard bill of fare at SDA hospitals. In fact, at some of these hospitals, patients are allowed to have meat only if their doctor approves.

What can you do to get the food you want at other hospitals? Tricia Middaugh, R.D., manager of clinical nutrition services at Thomas Jefferson University Hospital in Philadelphia, offers this advice:

* If the surgery is elective, call the hospital in advance and speak with the director of nutrition services or someone in the patient advocate's office. Tell this person you're a vegetarian (be specific: ovo-lacto, vegan, etc.) and ask him or her to read or mail you a copy of the vegetarian offerings so that you can pick your meals in advance.

* Talk to your attending physician about your diet. Your doctor has the final word on what you eat.

* Often doctors put post-surgery patients on a clear liquid diet as a transition to solid foods. State plainly that you don't want meat-based broths or gelatin. Fruit juices will do just as well.

* Expect mistakes. Even if you've made your wishes clear, the first meal often slips through the cracks. You have the right to ask for something else. Staff will usually accommodate requests, although you'll probably end up with a cold entree, like a cheese platter.

* Following an emergency admission, communicate your needs to whomever attends you at bedside. If you're unable to speak, a friend or relative should make the request for you.

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