How to Support Your Clients to Prepare For and Recovery From Surgery with Dr. Rebecca Knackstedt

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. So today on the Integrative Women’s Health podcast. I am excited to share with you, Dr. Rebecca Knackstedt. And I’m going to dig in and read her bio for a moment, because it’s very impressive. And I love it when surgeons are thinking outside of the box to help their clients prepare for and recover from surgery, not just thinking about the surgical experience.

Dr. Jessica Drummond 00:01:30 So doctor next, Ed is a board certified plastic surgeon. She specializes in implant based and micro surgical based breast cancer reconstruction or breast reconstruction post breast cancer. She’s currently an assistant professor in plastic and reconstructive surgery at Duke University. She completed her MD PhD at the Medical University of South Carolina, where her PhD thesis focused on vitamin D and inflammation. We’re going to talk a lot about vitamin D. In this episode, she pursued an integrated plastic surgery residency and microsurgery fellowship at the Cleveland Clinic, during which she also became certified in functional medicine. Her research interests are rehabilitation for breast cancer, particularly for women undergoing neoadjuvant chemotherapy. She’s published over 90 peer reviewed studies and has given numerous local and national lectures on her research. And what you’re going to learn today is all about how she and I think about preparing for and helping people recover from surgeries with better outcomes, with fewer complications. And I really think this is a golden opportunity for every women’s health or wellness coach in our community whose clients have a need for any kind of surgery.

Dr. Jessica Drummond 00:02:56 There is almost no one unless you’re dealing with specific orthopedic injuries or you’re a professional athlete or, you know, a high level amateur athlete. Almost no one is getting adequate pre-op care. From C-sections to endometriosis surgery to hysterectomy to breast cancer gender affirming care. I mean, very, very few people are getting any good pre hab. And we’re going to talk about the research that people don’t need months and months, although if they can get that, that’s really beneficial in my experience. But sometimes these surgeries are more emergent. If they’re cancer surgeries then in as little as five days you can help your clients optimize outcomes. So I just want to throw it out there that this is a business idea that is waiting to take off. If you are a physical occupational therapist, women’s health coach, Acupuncturist, chiropractor, naturopathic physician. I mean, there are so many gaps in pre-op and post-op care and recovery. We have to think not just of physical health, but social health, economic health, mental and emotional health on both ends.

Dr. Jessica Drummond 00:04:14 Pre and post op, you know anxiety can actually worsen surgical outcomes. So this is a really important topic. And while the research is limited and doctor next I was sharing with me how challenging it really is now to get any grant funding in these areas. There’s still some that we know and we can extrapolate from other surgical areas that is really beneficial. So dive in and I will see you on the other side where I’m going to give you just a couple of key tips that I want you to take back to your practice. If any of your clients are needing to prepare for or recover from surgery. Let’s get into it. Hi and welcome back to the Integrative Women’s Health Podcast. I am here with Doctor Rebecca Stead, and we are going to talk all about pre and post recovery and preparation for and recovery for surgeries that are not always considered. When we think about pre-op and post-op care from a holistic, integrative and rehab perspective. We often will think about that for orthopedic injuries. But in my career, I’ve struggled to even see us giving great pre-op and post-op care for C-sections, never mind in breast cancer or endometriosis.

Dr. Jessica Drummond 00:05:43 So Dr. Knackstedt, has done a lot of work and is still a practicing surgeon at Duke in North Carolina on this idea of preparing her patients for better surgical outcomes by doing all this work before and after surgery. So welcome.

Dr. Rebecca Knackstedt 00:06:02 Thank you so much for having me. I’m really looking forward to this discussion.

Dr. Jessica Drummond 00:06:06 So you’ve done a lot of research in this area or looked at a lot of research in this area. Tell me some of the most surprising things you’ve discovered when you looked at how preparing someone for surgery can really shift their outcomes short term and long term.

Dr. Rebecca Knackstedt 00:06:26 This all kind of goes back to my PhD, which was in vitamin D and had a heavy emphasis on nutrition, which I kind of just let go of during my residency training. During residency training. You don’t have time to think about that. You’re not really taking ownership of the patients. But when I started my own practice and really got to know my patients and saw anecdotally how lifestyle factors would impact surgical outcomes. I brought back my nutrition training and started to implement really just nutrition advice for my patients, and I thought that that was going to be the game changer.

Dr. Rebecca Knackstedt 00:07:01 I thought that just nutrition was the answer. And as I started to read more in the literature and look outside of even the plastic surgery literature, I found that it really was a holistic approach that was needed in order to optimize my patients, and that was part of the reason why I decided to be trained in functional medicine as well, because that really encourages you to have a holistic approach to patient care. So now I realize that it is nutrition, but it’s also things like stress and anxiety management, sleep optimization, discussing what their social support is before and after surgery. That is really all critical for optimizing outcomes and ensuring a smooth recovery after surgery.

Dr. Jessica Drummond 00:07:46 So in an ideal world, what kind of team would a person have? Who is preparing for breast cancer surgery or dermatological surgery? Surgeries we maybe don’t think of outside of sports related surgeries.

Dr. Rebecca Knackstedt 00:08:00 I think in an ideal world, first off, would have more time to prepare for surgery, which sometimes we do and sometimes we don’t. So in an ideal world, I think you’d have increased time to prepare for surgery.

Dr. Rebecca Knackstedt 00:08:11 But then the team would be your surgeon and the healthcare providers that are going to be working on you during surgery. But then I think it would also be nutritionists and dietitians talking about optimal nutrition psychologists or psychiatrists talking about stress and sleep and anxiety. Social workers to discuss things like social support and financial burden of surgery. And probably more I’m not thinking of. But these are not part of a patient’s routine health care providers before and after surgery, as you know.

Dr. Jessica Drummond 00:08:44 Yeah, absolutely. So what are some of the biggest needle movers in terms of nutrients, or is there a certain amount of sleep quality or sleep? Hours, say, for the three months prior to surgery? If we’re talking about an elective surgery, obviously in cancer we don’t always have that much time. But even if we had two weeks.

Dr. Rebecca Knackstedt 00:09:06 One of the most important points that the literature gives us is that even five days of preparation before surgery can make a difference. That should be reassuring to patients that even if they don’t have a lot of time even doing simple things like optimizing nutrition, targeted supplementation can make a big difference even in five days.

Dr. Rebecca Knackstedt 00:09:28 If you have longer to prepare, that’s great and we can work on more aspects of your recovery. One of the main points, I believe, is often misunderstood or misconstrued, especially in social media, is that when we talk about nutrition or targeted supplementation. It’s not just bringing your lab values to a normal level. So even if a patient is not protein deficient or vitamin D deficient, the studies indicate that you still benefit from protein supplementation, vitamin D supplementation. And that’s because having surgery is such a stress on your body. It requires so much more than what you require on a day to day basis. So even if you’re in wonderful health and you have a great diet before surgery. Studies indicate that you could still benefit from targeted supplementation.

Dr. Jessica Drummond 00:10:22 And so specifically that would be boosting your protein intake. Optimizing your vitamin D from like 30 ish to more like 85 or 90. Yeah. Yes. Any other specific nutrients?

Dr. Rebecca Knackstedt 00:10:37 The ones that have the most evidence are protein, because surgery is such a catabolic experience and requires so much protein to heal all of your wounds.

Dr. Rebecca Knackstedt 00:10:46 And, Mouch, your immune response and monitor inflammation. Another one is probiotics. Probiotics have shown in very well done studies to decrease pretty much every complication after surgery, including infectious complications. So probiotics are one of the main ones I recommend.

Dr. Jessica Drummond 00:11:03 Which strains which probiotics in particular?

Dr. Rebecca Knackstedt 00:11:06 Excellent question. And this is probably one of the main questions my patients ask me. It actually doesn’t seem to matter.

Dr. Jessica Drummond 00:11:13 Oh wow.

Dr. Rebecca Knackstedt 00:11:14 Which is surprising. Yeah. It would also reassuring because it takes a little bit of stress off of when you’re choosing a probiotic. But what the studies show is that the strains seem to matter less than the jokes. So as long as you’re getting about 10 billion CFU a day, which is a high dose, that seems to be the level that is necessary to prevent post-operative complications.

Dr. Jessica Drummond 00:11:37 So 10 billion and even, you know, there’s lots of probiotics on the market that are a standard kind of combination of Bifidobacterium species and Lactobacillus species. So that might be a good place to start.

Dr. Rebecca Knackstedt 00:11:51 And most of the studies did use some combination of the bifidobacteria, the lactobacilli and potentially some Saccharomyces or other various strains, but those were the most common ones in the meta analyses.

Dr. Jessica Drummond 00:12:03 That’s great. And so just having those three nutraceuticals on board could help reduce complications. Anything else that you saw in the literature in terms of nutrients.

Dr. Rebecca Knackstedt 00:12:13 The other two that have the most literature to support them would be arginine and glutamine, which are conditionally essential amino acids, meaning that on a day to day basis, our body can produce enough to keep up with demands. But after times of stress like surgery, your body simply can’t produce enough, and the amino acids are the building blocks for protein. So amino acids such as arginine and glutamine, they’ve been very well studied in the headed neck literature and have shown to decrease post-operative complications. The other one is somewhat surprisingly. Fish oils. Fish oils are omega three fatty acids, which are anti-inflammatory. And patients have been told for years to stop taking them before surgery because of the risk of bleeding. This has thankfully been disproven, and meta analyses showing that it does not increase the risk of surgical bleeding. So that is another supplement that I recommend to my patients to modulate the inflammatory response after surgery.

Dr. Jessica Drummond 00:13:12 Yeah. That’s great. There was a really good research done in the military that showed up to like nine grams of fish oil did not increase bleeding risk even in like TBI.

Dr. Rebecca Knackstedt 00:13:22 So which is a very high dose.

Dr. Jessica Drummond 00:13:25 Yeah, absolutely. Is there anything you do recommend people stop? Because that is one thing we tend to do for our endometriosis patients is because the literature is fairly limited prior to surgery. We usually limit supplements or actually discontinue most supplements just because we don’t have a lot of literature on the bleeding risks. About a week to two weeks pre-op. Anything that you particularly want your clients to stop.

Dr. Rebecca Knackstedt 00:13:54 That’s a very good question and an important point. And even at an academic center, our anesthesiologist will typically tell patients to stop supplements for about five days before surgery. And to your point, we just don’t have literature for most supplements. There are some supplements we know are unsafe to take before surgery. The ones that come to mind are vitamin E, which is known to increase bleeding risk. Ginkgo, Saint John’s warts, and anti-inflammatories like Tylenol, ibuprofen can also thin the blood and lead to increased bleeding, either in surgery or immediately thereafter.

Dr. Jessica Drummond 00:14:30 The other question I have about L-arginine is there is some data looking at L-arginine as to actually exacerbating mortality risks if people have cardiovascular events while they’re taking L-arginine. So I worry a little bit about that in terms of people that may or may not be like super heart healthy going into breast cancer surgery, given the risk to the heart of chemotherapy. Is there any way that you help to modulate or mitigate that risk, or are there just certain patients that you maybe wouldn’t use? L-arginine.

Dr. Rebecca Knackstedt 00:15:03 For all of my supplements, especially if I have them taking the supplements during chemotherapy. I always get buy in from the medical oncologist, because the number one goal during chemotherapy is to shrink your cancer or get rid of the cancer completely. And I don’t want to interfere with that. As always, I tell my patients to talk to their medical provider about supplements, but most healthcare providers don’t know a lot about supplements because we’re just not taught it. Most of my patients, if they’re coming to me, if they’ve made it to my clinic, they’ve pretty much passed the medical clearance for needing reconstruction.

Dr. Rebecca Knackstedt 00:15:37 I don’t tend to see the sickest of the sick or the patients who aren’t medically fit enough to have reconstruction, so it’s really not a concern for most of my patients. But that’s absolutely a concern for some unwell patients that it might not be good to take even for a short period of time.

Dr. Jessica Drummond 00:15:55 Yeah. Yeah. Well, and I think that goes back to the real benefit of having a team approach around pre-op care, you know, mobility. Another thing that I think has been so valuable for my patients preparing for primarily endometriosis surgeries or excision surgeries or hysterectomy or even breast cancer is vagus nerve toning. And, you know, you talked briefly about stress management. What are some of the things you do to mitigate anxiety? Because obviously the more kind of nervous system regulation we have pre-op, the A smoother. The surgical experience will be.

Dr. Rebecca Knackstedt 00:16:36 The average patient that comes into my clinic for their first discussion about breast reconstruction, where they’ve just been given a diagnosis of breast cancer, and maybe they’ve even started their chemotherapy journey.

Dr. Rebecca Knackstedt 00:16:47 They are in fight or flight mode. Their bodies are so stressed out they’re not sleeping as well, which worsens their stress and anxiety. And then they come to my clinic and I give them this buffet list of options of reconstruction, which for some patients worsens their stress and anxiety. My number one go to is a referral to therapy and counseling, and we’re lucky at an academic center that we have counselors and therapists that specialize in breast cancer care and can have those very specific conversations with breast cancer patients. I think the other thing to keep in mind is that there’s very low risk endeavors that have been shown in the literature to decrease stress and anxiety. So things like yoga, meditation, Acupuncture, guided breathing, easy things that patients can download an app on their phone for free and do those activities. I haven’t actually ventured into the vagus nerve stimulation. We don’t really have anyone here that offers that, but I think that that would be another really great option, especially for patients that are really struggling with stress and anxiety before and after surgery.

Dr. Jessica Drummond 00:17:53 Yeah, and I think everything you mentioned is really valuable vagus nerve toning and nervous system regulation. That doesn’t necessarily need any additional devices. I mean, obviously they exist and sometimes they’re valuable. But breathwork often works really well. You know, tai chi yoga. So that’s great. Have there been any studies done that essentially compared head to head, like people that had a similar surgery without pre-op care versus with even just five days of pre-op care? What are the outcomes differences?

Dr. Rebecca Knackstedt 00:18:30 Says the areas of surgery that have been most well studied in rehabilitation are hernia surgery. That’s really where rehabilitation started. ENT or head and neck surgery and cardiac rehabilitation. And those have routinely shown time and time again that just five days of rehabilitation, which is usually nutrition and maybe a little bit of exercise preconditioning, can decrease pretty much all complications after surgery. There was a beautiful study that was just published two months ago in the anesthesia literature, and what they looked at was every study that’s ever been done using any facet of rehabilitation, whether it was just exercise, just nutrition or some combination thereof, and looked at outcomes.

Dr. Rebecca Knackstedt 00:19:18 And what they found was that any rehabilitation decreased at least one post-operative complication, whether it was a wound healing issue, a length of stay in the hospital. Readmission. And this study looked at 186 studies with over 15,000 patients. This was a huge study. I think the take home message from that should be really empowering to patients that even if you can do just one thing before surgery, you’re probably going to improve some aspect of your surgical either recovery or decrease your chance of having some complication.

Dr. Jessica Drummond 00:19:54 That’s really amazing. Thank you for sharing that research. I think it’s so encouraging for our community and our students and graduates because most of them, many of them have private practices that are working with people who might be having either procedures or surgeries, whether it’s for fertility or cancers. Really, there are quite a gamut of kind of women’s surgeries that could be happening. So you could really build a whole practice around helping people prepare for and recover from surgery. Because I think that’s just a huge gap in the health care system in general.

Dr. Rebecca Knackstedt 00:20:34 It’s a huge gap, and it’s a gap for a couple of reasons. One is we’re not taught nutrition and medical school. We’re not taught lifestyle interventions in medical school. So most traditionally trained doctors don’t have that background of knowledge to discuss with patients or even realize that those things will impact post-operative outcomes. The second thing is insurance. Insurance will not pay for most of these things. Insurance will pay for my patients to have some supplements after surgery, but not before surgery. There’s just such a disconnect in what insurance will pay for and won’t pay for, even though there are studies showing the cost effectiveness of doing it before surgery, which is a huge shame.

Dr. Jessica Drummond 00:21:19 Yeah, absolutely. Because the cost of readmission of infection, you know, is obviously a lot more expensive than even three months of good health coaching. Yeah, exactly. So let’s talk about after surgery. So in your practice, what are some of the kinds of things that women who have breast reconstruction need to pay attention to post-op, and what could they prepare? You know, a lot of the things we do in endometriosis is have several weeks of casseroles and soups and bone broths and, you know, your supplements ready to go and your movement plan.

Dr. Jessica Drummond 00:21:57 How do they prepare post-op?

Dr. Rebecca Knackstedt 00:21:59 I love that advice. And I like in preparing for surgery, like preparing for a marathon. You can run a marathon without training, but it’s going to be miserable. You can have surgery without doing any prep work. It just won’t be as smooth or as complication free potentially, if you would have infected a little bit before surgery. So I think that some of the things that patients can do to make their post-operative recovery more smooth is exactly what you mentioned. Thinking about things as simple as meal plans, meal delivery, having meals prepared already, having your laundry caught up. Things like that that you don’t think about. But I will put you on activity restrictions for six weeks that don’t allow you to do laundry. Don’t allow you to do grocery shopping or meal prep to the way that you’re used to it. So I think that’s the first thing. The second thing is that almost every patient after surgery struggles with sleep. There’s so many things associated with surgery that negatively impacts sleep the general anesthesia, the pain, the narcotics, the sleeping restrictions, that discomfort from inflammation.

Dr. Rebecca Knackstedt 00:23:02 So having a sleep hygiene routine set before surgery, whether it’s a certain time that you go to bed, lights out, blue light blocking glasses. Noise reducing headphones. Having that set before surgery is going to make your transition post-surgery that much easier.

Dr. Jessica Drummond 00:23:20 Yeah, and especially those first couple days in the hospital, it’s even worse. So getting back to your own bed as soon as you can. And so when you think about the wound care post-op, when we’re talking about the actual skin health, is there anything in particular that you’ve found to be beneficial to that skin healing, particularly for women who are in, you know, an estrogen restricted state because either they’re put into a menopausal state because of their cancer or that’s just how old they are, and they can’t tolerate hormones, or their hormones are too low level to really keep the skin very nourished.

Dr. Rebecca Knackstedt 00:24:00 As plastic surgeons, we think a lot about scars. We think a lot about incisions and making them beautiful. I think there’s a couple things, both that I can do as a surgeon and that the patient can do to help make that scar as beautiful as possible.

Dr. Rebecca Knackstedt 00:24:15 So the first is what I do in surgery then, is just adhere to good surgical principles, trying to make things not under tension. And then what a patient can do after surgery is the most important thing, I think is adhering to post-operative activity restrictions, which is so hard for patients that want to get back to baseline. They feel good, they want to do the activities that they feel like doing. But if you move that incision area too much, too early, it can lead to issues wound healing and widen scars. What the literature shows is that there’s really only a couple things that you can do to help scars heal well. One is silicone sheeting or silicone gels, which need to be worn about 24 hours a day, not always very well tolerated or convenient, depending on where the scar is located on your body. The second is sunscreen. Sunscreen for the first year after surgery, if you don’t use sunscreen, even under a light T-shirt, you can get a really darkening of the scar, which really doesn’t fade.

Dr. Rebecca Knackstedt 00:25:17 And interestingly, onion extract. Onion extract has showed to be one of the ointments that seems to help with scar healing. I also have my patients do scar massage as soon as we take off their post-operative dressing. At about three weeks after surgery, we start doing aggressive scar massage once a day, and we do that for a full year.

Dr. Jessica Drummond 00:25:36 That’s fantastic. Yeah, I think physical therapists and occupational therapists are great kind of referral partners for scar care. Pro tip on the silicone sheets, you can actually get them now on Amazon. There’s one company called Sica Care that I’ve used for 25 years. Now that you can reuse that over and over. So it’s a lot less expensive. And it’s funny you say about onion. So as a kid I was a gymnast. And you know, you get tears on your hands from bars over and over. And we used to sleep at night with half an onion and socks over our eyes.

Dr. Rebecca Knackstedt 00:26:13 So and it was actually evidence based, so you just didn’t even know it.

Dr. Jessica Drummond 00:26:16 I know, Who knows? So when you’re talking about post-op recovery. Anything else that you want your clients to start doing? And when it comes to return to activities, when it comes to lowering that pneumonia risk any like breathwork patterns or pacing of exercise.

Dr. Rebecca Knackstedt 00:26:39 The number one thing you could do is walk after surgery. Typically, I tell my patients to not elevate their heart rate for a few to several weeks after surgery. So no rigorous activity, but at least getting up and walking once an hour, taking those deep breaths when they’re in the hospital that have an incentive spirometer which they’ll actually go home with. And I encourage them to do that at least several times an hour. But just getting up and moving is the number one thing you can do to really prevent pneumonia and encourage that deep breathing. I also have a very low threshold to refer my patients to physical therapy. I love referring my patients to physical therapy. I think it makes a world of a difference. So when I lift my activity restrictions, whether it’s two, four, six weeks after surgery, if they don’t almost immediately bounce back to baseline, I recommend a physical therapy, even one visit to get some activities that they could do at home.

Dr. Rebecca Knackstedt 00:27:32 And I have found that that makes a world of a difference for patients.

Dr. Jessica Drummond 00:27:36 That’s wonderful. So in an ideal scenario, you have anywhere from five days to three months to optimize sleep and anxiety and nutrition and nutrient excessive sufficiency, not just baseline sufficiency. And then ideally, a calm, clear surgery. No, no drama there. And then pretty quickly after people are getting up and moving around but not pushing. How do you talk to your clients? You know, women are usually doing a lot. And I agree with you that the hardest thing is actually to slow down the pace enough to have a more optimal recovery. Are there any kind of words of wisdom that seem to resonate with your clients about that pace of recovery?

Dr. Rebecca Knackstedt 00:28:30 It is hard, and most of my patients are women, but you’re right, they are sometimes the primary caregiver of their children, and they want to lift their child up after surgery and they can’t for a few weeks, which is really hard on both the mom, the child, and just that interaction.

Dr. Rebecca Knackstedt 00:28:49 I think the main thing is I have very long discussions with my patients about what is the right surgery for them at this point in their lives, so we can do some fairly non-invasive, not big surgeries for breast reconstruction, or we can do really, really big surgeries that have a much longer recovery and are much more invasive. And for some of my patients who are young women with young kids and a busy career. It’s just not the right point now for them to have that bigger surgery. So at least for breast reconstruction, I talked to him about this is a lifetime journey. And even though you might want this bigger surgery for the longer recovery, it just might not be right right now. So I think just an open line of discussion with your provider. And I’ve loved when patients I ask my patients what their hobbies are. And I ask them who lives with them at home, because that gives an insight as to what’s important to them and what they want to get back to as soon as possible.

Dr. Rebecca Knackstedt 00:29:46 And I allow that to help guide our decision making.

Dr. Jessica Drummond 00:29:49 Excellent, I love that. So is there anything else you want to share about this passion of yours around optimizing surgical outcomes?

Dr. Rebecca Knackstedt 00:29:59 I would say that the only other thing that we haven’t talked about is just lean muscle mass. And this is one of those things that I came to late in my practice as to recognizing the importance of it, and it was through patient discussions. I always knew that surgery was a catabolic state and that it required protein for healing. So when I thought about optimizing a patient for surgery, I would just tell them, increase your muscle. So resistance training aerobic activities increase protein intake. But what patients told me after surgery was that they needed more targeted muscle development for pre operatively to optimize their functionality postoperatively, which I never really considered. So if I’m doing a breast reconstruction on someone and I tell them, be careful with your arm activities for the first 4 to 6 weeks, they do need to strengthen their arms, but what they really need to work on is their core and their leg muscles, because that’s how they’re going to be transferring.

Dr. Rebecca Knackstedt 00:30:55 That’s how they’re going to be getting out of bed. So that was a really eye opening moment for me. And so now when I talk to patients about preparing for surgery, it’s the general idea of nutrition and supplementation and exercise, but also Specific for that surgery that they’re having. What they should particularly focus on.

Dr. Jessica Drummond 00:31:14 Right. And certainly areas of compensation, if they’re not going to be able to use their arms for a while and they may lose that muscle mass to some extent. Exactly. So how are you going to get around that? And this is where I think OT can also be really helpful. What other tools can they use? What other strategies, whether it’s tables or reachers or lots of things, in addition to if we have the time prior to surgery, really building up physical strength because yeah, you’re going to lose some of it. I mean, the data about bed rest somewhat applies to people who just have mitigated activity in general.

Dr. Rebecca Knackstedt 00:31:52 Yeah, there are studies in healthy adults showing that just a few days of bed rest can decrease your lead muscle mass by about 4%, and that’s without the catabolism of surgery.

Dr. Rebecca Knackstedt 00:32:03 So that lean muscle mass is dipped into very quickly and very rapidly after surgery.

Dr. Jessica Drummond 00:32:10 Yeah, absolutely. Well, if people want, you know, are in this position themselves where they either need reconstructive surgery or they have friends or family members, where can people find you and learn more about your surgical practice?

Dr. Rebecca Knackstedt 00:32:27 So I started an Instagram channel to really just spread the word to patients everywhere and health care providers. It’s at surgical underscore recovery that’s also on TikTok and YouTube with the same handle. But I love hearing what patients want to learn about. So feel free to send me a message if there’s a topic that I haven’t addressed. But this is really just an exciting time to be in this area because there are so many unanswered questions, and we’re really just starting to scratch the surface of understanding how best to prepare patients for surgery.

Dr. Jessica Drummond 00:33:00 Excellent. Well, thank you so much for your time. This has been really valuable to take a moment to see While the research is limited, there is some and we need to start there.

Dr. Rebecca Knackstedt 00:33:11 Yes. Thank you so much for having me.

Dr. Jessica Drummond 00:33:13 Thank you. That was such an enlightening conversation, because I’m so thrilled to know from someone who’s knee deep in the research, that there is evidence that the rehabilitation and the post-op care that our clients get makes a massive difference. It makes a significant difference to even their basic surgical outcomes, limiting the need for readmission, limiting post op complications. And it’s often very simple things. Nutrient optimization, meal planning, post-op, you know, things like bone broth and a little bit of extra protein support, optimizing vitamin D and specific amino acids and Oxidants, things that make a lot of sense for us. Right. And so what I would really encourage you to do is look at your client population and think about, are there any surgeries that may be common for them? Even labor and delivery on a C-section. And in fact, I think labor and delivery is one of the most underserved because, as we used to always say at the Women’s Hospital of Texas, not only is C-section the most major abdominal surgery, where you get hardly any rehab unless the Pts are banging down the doors, right? You also are sent home with a newborn to care for, right? So there’s a lot going on.

Dr. Jessica Drummond 00:34:44 Emotional, social need for support, need for financial resources. So think very holistically for your clients and help them get prepared, even if they never end up needing surgery. The more physiologically resilient they are and the more resilient they are holistically on all levels, social and emotional with their communities, in collaboration with others to help out with the activities of daily living that people may be limited from being able to do for up to a couple of months. How could your clients be prepared for that in advance, even if they happen to need an emergent surgery? Let’s say they just have an injury during a car accident or an athletic injury. How could they be prepared for any surgery at any time? Hopefully they won’t need it, but better to be safe than sorry. So think about just a couple key things. Nutrient optimization, nourishment, meal planning, and the basics of foundational nervous system regulation and movement that will get most of your clients light years ahead of your average person having to have surgery and will give them far better outcomes.

Dr. Jessica Drummond 00:36:03 And then if your clients are likely to have surgery. How could you take your program to the next level to help them have the best possible outcomes and hopefully avoid needing any additional surgeries or having additional complications? I hope you enjoyed that interview and I look forward to seeing you next week. Have a great week! Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.