Boosting your nutrition for surgery

Building oneself up for elective surgery is a situation in which an interdisciplinary approach should be taken and should be well supervised by the physician and /or nutritionist.

Included in this article are recommendations in five important areas to fortify your body for bloodless procedure.

Protein

Proteins are important in cell formation and maintenance.  Adequate protein levels are important in wound healing, as well. The RDA is 63 gramss per day for men amd 50 grams per day for women. You can obtain protein by eating nuts, beans, meats, fish, tofu, eggs and poultry.

One serving of protein is two to three ounces of any of the above.

Iron

In preparation for surgery, it is recommended to consume   the RDA amount of 10 milligrams per day for men and 15 milligrans per day for women (due to menstrual blood loss).

Sources of iron are organ meats such as liver, kidneys, egg yolks.  If a deficieny exists check with your physician or nutritionist for supplements.

Vitamins

Folic acid and B12 are important in building red blood cell, which carry oxygen.  Some sources are mets, beans, green vegetables, nuts and cantaloupes.

Also important are zinc and vitamin C for wound healting.  Vitamin C also helps control amount of blood lost. Vitamin C may be obtained in citrus fruits such as oranges, grapefruits and lemons.  Zinc is found in green leafy vegetables.  Check with your physician about supplements before taking them.

Vitamins and medicines that are contraindicated

Certain supplements are contraindicated prior to surgery, as they promote bleeding.  Check with your physician or nutritionist regarding their ingestion. The foods include, garlic,soy, flax, fish oil, and omega 3's. 

Blood thinners, aspirin and anti-inflammatories are contraindicated before surgery.  Check with your physician for specific instructions for discontinuance.

Source:

Winkler, Mary, RD, "How to prepare nutritionally for surgery" http://www.bloodlessmedicine.org/

What is Hemodilution?

Hemodilution is one of the techniques used to eliminate the needs for a blood transfusion.  Many Jehovah's Witnesses have accepted this procedure - under strict guidelines , to uphold their belief in the sanctity of blood. Others, for fear of blood transmitted diseases, have likewise requested and accepted this blood conservation technique.

In this article we will take a look at what this procedure is and what is involved.


What is hemodilution?

Acute normovolemic hemodilution, ANH, is a blood conservation technique that was introduced in the 1970's.  This procedure entails removing blood from a patient either before or immediately after the induction of anesthesia during surgery. The procedure involves the maintenance of isovolemia using a crystalloid and/or colloid replacement.  The amount of blood removed is usually is one to three units (450 ml approximately is one unit. Or about one half a liter bottle of soda.) 

The blood is then anticoagulated and maintained in the operation room for up to eight hours.  Is is then reinfused into the patient as needed during the surgical procedure. (Please note that Jehovah's Witnesses will not allow the blood to be saved for a later procedure, due to their belief in the sanctity of blood.  The blood must  remain part of a continuous closed circuit.)

Who can accept this procedure?

ANH should be used by patients with a good hematocrit and who are expected to lose more than two units (900ml) of blood during surgery.  It is better tolerated in young, healthy people but has been used in the elderly, depening on the procedure.

Hemodilution would be contraindicated in the following procedures:

Cardiac disease
Impaired renal function
Baseline Hgb less than 11g/dl
Low concentration of coagulation proteins
Inadequate vascular access
Absence of adequate monitoring

Finally, hemodilution may be used alone, or in combination with other blood conservation techniques.

Vocabulary

Anticoagulant - A substance that prevents the blood from clotting.
Colloid - A substance microscopically dispersed evenly throughout another.
Crystalloid - A substance that can pass through a semi-permeable membrance and crystallize.
Hematocrit - Ratio of volume occupied by packed red blood cells to volume of whole blood.
Isovolemia - Maintaining the same volume.  In this situation, the volume of fluid in the body.


Sources:

Silverglied, Arthur, MD "Acute normovolemic intraoperative hemodilution" http://www.uptodate.com/

The link between artificial sweeteners and early labor

 America loves artificial sweeteners even though the jury is still out regarding all the side effects and health dangers inherent with its use.. It seems that almost every day information is being released about the potential and grave dangers related to artificial sweeteners and our health.

The latest study that's just come to my attention is one that is features in the American Journal of Clinical Nutrition regarding a Denmark study that shows that the use of artificial sweeteners during pregnancy may increase the incidence of pre-term labor, which is defined as labor before 37 weeks. (www.marchofdimes.com) Women who drink over one can of artificially sweetened pop are at risk.

The pregnancy complication may arise due to the metabolites of aspartame, acesulfame-K, saccharim and cyclamate; all of which are artificial sweeteners. DNA damage may also occur; it has been reported  that saccharin may cause more problem than aspartame. (Corsi, Hector, August 25, 2010,  "Artificial sweeteners may incrase the risk of pre-term delivery." http://www.technorati.com/, website)

Pregnancy is a time when a woman should try to stick to the care of her "whole" person and practive calmness is mind, spirit and body.  Certainly, a woman should not attempt to drastically alter the diet, but the focus should be on natural foods with the elimination of as many unnatural and chemical additives in the diet as possible.


Sources:

Corsi, Hector, August 25, 2010 "Artrificials sweeteners may incrase the risk of pre-term labor" http://www.technorati.com/ (website).

http://www.marchofdimes.com/

The dangers of sucralose, saccharin and aspartame

For Americans, artificial sweeteners have become synonymous with weight loss and health consciousness. When you think of diet programs and "eating healthy," most people include artificial sweeteners as the alternative to sugar. However, much debate continues regarding their regular usage.  

Despite the ongoing controversy, they are found in products from soda to vitamins. Many questions remain unanswered as to how these products reach the supermarket shelves given that adverse reactions are being regularly reported to the FDA.
 
This article will take a look at two of the most popular products, aspartame, and sucralose; the third, saccharin, will briefly be considered as its usage has declined since the 1960's when studies reached the public about the association of cancer in test animals.
 
Why are artificial sweeteners bad?
 
According to Miranda Khan's interview with health expert, Dr. David Friedman from "The Balancing Act" on "Lifetime TV," artificial sweeteners are just that-artificial. Anything that is made in a laboratory consists of chemicals which will always be harder to digest. These chemicals have been known to cause imbalances in the body such as:
 
-Depression
-Joint pain
-Alzheimer's
-Parkinson's disease
-Cancer
-Death
 
Dr. Friedman reports that these artificial sweeteners stimulate the appetite which contributes to obesity.
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Further, in an 8 year study performed by the University of Texas, participants who regularly drank diet soft drinks were noted to have a 41% increase in obesity. These chemicals cause craving of carbohydrates which contribute to weight gain.
 
Sucralose
 
In the same interview, Dr. Friedman points out that sucralose is made with chemically modified real sugar. What chemical is it modified with, you might ask? The answer is acetone. This is the same chemical that is used in nail polish remover. Now, can you imagine putting that into your body? Further chemicals include: benzene, which is a carcinogen found in oil and gasoline; another is methanol or wood alcohol which is used in windshield wiper fluid and anti-freeze. Finally, the last chemical is formaldehyde, which I am sure that almost everyone knows is used to preserve dead things.
 
Aspartame
 
Aspartame is probably the most popular sweetener on the market right now, but questions have been raised by many health professionals and consumer protections groups as to how this got FDA approval for human consumption.
 
Dr. Friedman notes that the FDA receives numerous complaints as to the side effects caused by aspartame which include:
 
-Memory loss
-Headache
-seizures
-insomnia
-dizziness
-weight gain
-fatigue
 
In addition to this list, there are at least 92 other side effects that have been associated with long term
aspartame use.
 
Aspartame is also found in many packaged products that we, the trusting consumers probably have never checked the labels for. Such as:
 
Sodas
Breath mints
Gum
Teas
Pharmaceuticals-vitamins, cough syrups
Wine coolers
Yogurt
Coffee
Cereal
 
Saccharin
 
The last of the deadly three: saccharin.
 
As far as the chemical composition of saccharin, it is made from coal/tar derivatives which has no food value at all. It is also made with ammonia.
 
Saccharin received a lot of notoriety in the late 1960's for its association with cancer in test animals. So public use is on the decline.
 
 
Alternatives
 
For your family's safety, research your choice of sweetener. Many people opt for more natural substances such as stevia and agave. But, each individual has their own unique health challenges, so recommendations are difficult to make.

As a final thought, just because a sweetener has been approved by the FDA, still take time to check it out. Consumers should always read and research all new products, whether natural or artificial, to ensure personal and family safety.

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Volume expanders and blood loss

Much research is being conducted into the safe alternatives to blood transfusions. This article will present some of the alternatives being used now as volume expanders and fluid replacements. Substitute blood and others are being studied that hold much promise for the future.

Volume expanders

Volume expanders may be used in acute traumatic blood loss. The greatest need at this time is to stop bleeding and replace volume to prevent circulatory collapse and shock. By providing volume expanders, the remaining red blood cells in the body can still carry oxygen to the tissue of the body. In this process, amazing circulatory compensatory mechanisms take place: the heart pumps a larger quantity of blood with each beat thus delivering oxygen to tissue and organs of the body. With these compensations taking place, a patient can survive with a hemoglobin level one-third that of a healthy person. (“Alternatives to blood transfusions” http://www.wikipedia.com/).


Below is a list of volume expanders that may be used as fluid replacements and may avoid blood transfusions. The first group that will be looked at is crystalloids.

A. Crystalloids -

0.9 Normal sodium (NaCl)  is equivalent to the sodium content in body fluids. This fluid increase the oncotic pressure in the intravascular space - water moves into the intravascular space to increase blood volume.

Lactated Ringer’s is a fluid and electrolyte replenisher that similarly increases the oncotic pressure in the intravascular space - again,  fluid is drawn into the vascular space.

B. Colloids -

Haemaccel is used as a plasma volume substitute in the initial treatment of hypovolemic shock due to hemorrhage or crush injuries.
Produces a significant increase in blood volume, heart output, urine output and oxygen transport.

Gelofusin - Contains modified fluid gelatin which behaves in a similar way to natural plasma albumin.

It is used for shock caused by a reduction in the volume of blood due to excessive blood loss. (“What are non-blood volume expanders?” bloodlessmedicine.org).

Dextran


Large molecules composed of chains of sugar molecules. These are formed as a means of storing food by bacteria and yeast. In purified form, certain dextrans can be used IV to expand a patient’s blood voume in medical emergencies where blood pressure drops to dangerously low levels. (“What are non-blood volume expanders?” bloodless medicine.org).




Hetastarch and Pentastarch

Are solutions of large molecules composed of many smaller molecules. They act by holding blood within the blood vessel thereby expanding blood volume and help maintain blood pressure. These substances also, do not contribute to the blood’s oxygen carrying capacity.

The drawback of volume expanders such as normal saline and lactated ringer’s is that they do nothing to assist in the oxygen carrying capacity of blood. Also, these substances flow in and out of the blood vessels they may initially provide volume expansion, the fluids eventually move out of the blood vessels. (“The right plasma volume expanders” nursing times.com)



Vocabulary

Colloid - is a substance that is microscopically dispersed throughout another one.

Crystalloid - is a substance that in solution can pass through a semi-permeable membrane.

hypovolemia - loss of blood volume.
Intravascular blood - blood volume inside the blood vessels.

Oncotic pressure - Pressure exerted by proteins in blood plasma that tends to pull water into the circulatory system.

Volume expanders - Expands the amount of circulating in the blood volume. Without adequate volume shock and circulatory collapse could occur.

(definitions: med-dictionary.com)

Great and tasty alternatives to milk for the lactose intolerant

Okay, so you know that you are lactose intolerant. As many as 60% if Newark's residents also complain of the uncomfortable gas, bloating, diarrhea and nausea when consuming dairy products.  Does this sentence you to a life of  pain and suffering whenever you have a craving for ice cream, or a bowl or cereal?

Not necessarily, there are a number of tasty new substitutions and alternatives for those with this common problem.  Look at Newark's supermarkets, drug stores and health food stores and you will see shelves of lactaid, the enzyme that aids in the digestion of milk, and popular milk alternatives.  

What are the substitutes?

There are many digestive aids for the consumption of milk and milk products.  However, there is a growing array of popular grain products from which grain milk which is made, that offers a tasty and healthful alternative to milk and dairy. 

Below is a list of some of the more common ones.  

Rice Milk Ice Cream

This is a delicious alternative to ice cream for the lactose intolerant.  It is lactose free and generally allergy free for even the most sensitive people.  Often sweetened with natural sweeteners such as organic brown rice syrup or organic agave syrup.(Agave is a plus as a sweetener since it has a low glycemic index-under 30 and is 40% sweetener than white sugar.  Allaboutagave.com).  It has a light and creamy  texture like ice cream.  1/2 cup contains about 170 calories and only has about 0.5 grams of saturated fat.  "Taste the Dream" produces many flavors such as orange vanilla swirl, mint carob chip, carob almond, cocoa marble fudge and cookies 'n dream.  Most large health food supermarkets carry the different flaovrs such as "Whole Foods."

Almond Milk

Another tasty alternative to cow's milk that is high in protein. Has about 60 calories per serving.   Also comes in vanilla flavor.  Care should be give by the diet conscious however because it is higher in fat than rice milk.  Almond milk also comes fortified with vitamins B-12, vitamin D and calcium.  Contains antioxidants vitamins A and E.  Those who are allergic to nut should exercise caution.  Can also be a little gassy.(Silkpurealmond.com).

Rice Milk

Another wonderful dairy product substitute that does not contain lactose and is very low in fat.  It has less protein than almond milk but is also higher in carbohydrates.  Great for people who have allergies since rice products usually do not cause allergic reactions in most people.  One serving has about eighty calories. Comes in many flavors.  Is also often fortified with calcium and vitamin B-12.

Soy milk

Very popular and is made by soaking the soy beans in water and then grinding them.  Is also often vitamin fortified.  Contains many phytochemicals that are helpful in fighting osteoporosis, aging and heart disease.  However, new studies raised the question as to whether soy has certain natural chemicals  that mimic estrogen and may possibly be linked to breast cancers in some women.  If you are considering trying it, talk with your nutritionist or doctor first.


Oat milk

Light texture with a sweet and mild taste.  It is easily made by grinding up oats and stirring in water.  Oat milk is recommended for the morning cereal, baked goods and other uses where you would use milk.  

So, there you have it.  Above is a list of some of the popular lactose-free substitutes and alternatives. AS with most things, keep your eyes peeled for the new products that are hitting the market.  And, of course, enjoy-they are really delicious.

What you need to know about blood transfusions

Let's look at some of the factors that doctors look at when deciding to give a blood transfusion.  Assuming that this is not an emergency situation, and the patient  is having elective or a non-emergency surgery, the doctor wants to get a look at your lab work.  The information that will follow pertains specifically to your CBC.    This information tells the doctor about the: hemoglobin, hematocrit, white blood cells, red blood cells and platelets, specifically as related to transfusion decision making. Not to simplify a really complex decision such as transfusion because obviously, a lot of factors are involved. Let's look a little closer.

CBC - what information does it yield?

Hemoglobin is the protein in the red blood cell that carries oxygen to the body's cells and tissues. Normal ranges are roughly 13 - 18 grams of hemoglobin in every 100 cubic centimeters of blood for a male, and 12 -16 grams of hemoglobin in every 100 cubic centimeters of blood for a female.  So, just to make lab results jargon clearer, if your doctor were to say that you (a male)  have a hemoglobin of 2, well, you know that this is a cause for concern. You're probably bleeding somewhere.   In the past, hemoglobin (hgb) of 10 was the golden standard for transfusion for surgery.  It has now been found that this is not true.

Another thing that the doctor looks at is the hematocrit which is the concentration of red blood cells in a given amount of blood.  This is usually expressed as a per cent.  Normal ranges are roughly 45-62% for a male and 37-48% for a female. The hematocrit is the proportion by volume of the blood that consists of red blood cells.  Example, 25% means that 25 milliliters of blood per 100 ml consists of RBC. Again, the further the number is from normal, the more the cause for concern.

Platelets are another factor that can influence transfusions. Platelets are the smallest cell-like structures in the blood and are important for clotting. They are expressed as 150,000 - 450,000 per microliter.

Red blood cells are very important as these are the oxygen containing cells of the blood. Normal ranges are 4.2 - 6.9 million/cu mm. Packed red blood cells would most likely be used in traumatic blood loss.

White blood cells are usually involved in fighting infection.  Transfusions are rarely given for these.  Normal ranges are 4,300 -10,800 cells per cu mm. ("Blood transfusions" www.medicinenet.com/hematocrit/article.htm)

Types of transfusions

Whole Blood Transfusion Reasons - This is rare now.  This is blood with all of its components - red blood cells, platelets, plasma, etc.

Packed red blood cells are given to increase the oxygen-carrying capacity of the patient's blood.  This could be low due to loss of blood during trauma, surgery or bleeding internally.

Platelets are transfused when there are problems with clotting.

Fresh frozen plasma may be used to treat an overdose of coumadin, warfarin or other blood thinners.  These problems are diagnosed in the PT (Prothrombin time) or APTT (Activated partial thromboplastin time).

Cryoprecipitate Transfusions are usually given to replace specific clotting factors such as Factor VIII or Factor XIII deficiency.

White blood cell transfusion are given when the body does not respond to appropriate antibiotic treatment.  This is very rare though. ("Blood transfusions" http://www.medicinenet.com/

Summarizing it all

The next article will be discussing some of the basic types of volume replacement as a subsitute for blood.