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Surgery/Hospitalization Tips for E4s

Posted: Sat Apr 19, 2014 11:20 am
by Julie G
While all is fresh in my mind, following a recent surgery and hospitalization; I thought I'd throw out a few ideas for other E4s facing the same.

-Even though my surgeon had a complete list of all of my supplements, he NEVER asked me to stop taking them :? I had a consult with him 10 days prior to surgery and I asked at that time if I should stop taking supplements that could thin my blood. He was taken aback...perhaps at his own failure to address this. My guess is that he wasn't used to patients taking so many supplements, nor being so aware of their impact. FWIW, these are the ones I stopped prior to surgery and resumed a few days after: fish oil, circumin, Nrf2, ALCAR, ALA, NAC, citicoline, vitamin E, aspirin, reservatrol, vinpocetine, ubiquitol. (I also stopped Mk7, but that probably wasn't necessary.) You will most likely automatically be given inflatable boots to prevent a blood clot during surgery and throughout your whole stay. ASK for them, if you're not. They're a really good idea especially when your body is used to supplements that naturally thin the blood.

-General anesthesia is generally not considered a good idea for E4s. I realize alternatives may not be an option for some surgeries. Ask your surgeon. Luckily, mine was open to exploring different avenues to better protect my 4/4 brain. General anesthesia is fairly traumatic (even without the E4 variable) and recovery is much easier if you can avoid it.

-Begin a discussion with your anesthesiologist days (not minutes- as is common practice) before surgery. I called my hospital, asked for the surgery coordinator, and tried to track down whom would be acting as my anesthesiologist. Once identified, I requested a phone consult. Just like my surgeon, the anesthesiologist was open to avoiding general anesthesia given my greater preponderance for cognitive impairment. She got creative and settled on a combo spinal & epidural. The spinal gives greater numbness for major surgeries (good,) but the med wears off after a set time (around 3 hours- bad.) Not knowing if my doc would encounter complications, increasing surgery time; they compromised by adding the epidural component so more meds could be added as necessary. This is the first time this technique had been used at my hospital; hope other patients will now benefit.

-Being awake for a long surgery presents challenges; mainly conquering nerves and dealing with awareness of complications- like the need for a blood transfusion, etc. I began listening to an excellent meditation, guided imagery, affirmation, soothing music download several weeks before: It was extremely helpful, equivalent to strong relaxation/pain medication. My anesthesiologist also used very light IV profofol per the Sieber protocol I was awake, relaxed, cooperative, etc. The surgeons, attendees, anesthesiologist and recovery nurse were all shocked at how smoothly the actual surgery went and how alert I remained throughout. Unfortunately, I still experienced severe post-operative shivering/tremors (as had happened in previous surgeries.) I had always attributed this to general anesthesia, but perhaps not... My hospital had me wear a gown that was insulated and had attachments for heating hoses. That, along with many hot blankets, helped.

-Another major pitfall for me was avoiding sugar. I'm convinced that glycemic control is imperative for E4s in preventing AD/CVD and in reducing general inflammation. Seems to me that this would be MORE important, not less important, in preparation for surgery. I've worked very hard to maintain low blood glucose that rarely spikes. I was asked to do a bowel prep, in conjunction with a clear diet, the day before surgery. A clear diet is supposed to provide around 1500 calories of mainly simple sugar: jello, fruit juices, Popsicles, etc. NONE of which I choose to eat. I had the option of fasting, but I knew I would also be denied food the day of the surgery. I opted to sip organic broths. Once cooled, I got calories by adding EVOO. Ingenuity is the mother of invention ;) This technique is non-physician approved...but got the job done. I had to drink several bottles of magnesium citrate. Sucrose/sugar is a major ingredient. I found alternatives that used saccharine- meh, but avoided the BG spike.

-In the hospital, sugar was pushed with great regularity :shock: In recovery, I could sip Sprite or ginger ale. Following surgery, I was offered jello, applesauce, pudding, ice cream. I was hungry and after several hours negotiated some broth and added my own EVOO (smuggled in a small glass bottle in my purse.) Once I was cleared for a soft diet, I could easily avoid sugar: eggs, veggies, lean soft meats, etc. and get adequate calories. I was able to limit carbs by explaining I was gluten-free. At one point, I was given a sugar IV. I asked for a regular one, but was denied per my surgeon's orders. Learn from my mistake and discuss your anti-AD diet regimen with your surgeon prior to your surgery/hospital stay...didn't realize it was necessary, but he/she really controls your healthcare the entire time you're hospitalized.

-Lastly, having a support person along, who was aware of my medical history/dietary needs, was great. I quietly and assertively negotiated for what I needed, but greatly appreciated my husband's back-up when necessary. On my last day in the hospital, a dietician, noticing my small stature and refined carb limitation, came to my room with the USRDA food pyramid for a quick tutorial :roll: (CR is a part of my anti-AD regimen, but I still maintain a healthy 18.5 BMI.) She concluded by asking me pointed questions about my weight, referencing anorexia. My husband smoothly brushed her off, joking that he had a hard time earning enough money to feed me as I eat so much & effusively complimented her on the amazing hospital food. This is the same man who chases off visiting Mormans by answering the door in his boxers with a big smile :lol: (Forgive my diversion, but those nice boys can run.)

It's sad that that hospitals, which are supposed to be places of healing, can turn into minefields for E4s. I thought I'd share my recent experiences in an effort to help others. PLEASE share your experiences/tips. The more of us who do, will better help protect the next E4, who finds themselves needing surgery and/or a hospitalization.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Apr 19, 2014 4:23 pm
by KatieS
Big thanks Juliegee for such a comprehensive post. So much echoes my experiences, but you are so courageous to assert questions, problem solve the sugar, not to mention the fortitude to remain awake during a long surgery. Well, I'm inspired to follow these suggestions with a future knee replacement.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Apr 19, 2014 6:17 pm
by Kathleen1
Julie...THANK YOU....what a useful post.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Apr 19, 2014 11:48 pm
by Gilgamesh
Wow -- J, your post goes at the top of my "Pre surgery considerations.doc" file. Thanks!

Re: Surgery/Hospitalization Tips for E4s

Posted: Sun Apr 20, 2014 12:07 pm
by pal
Julie, sending you warmest wishes for a very speedy recovery. Thank you for an incredibly helpful post.

And many thanks to you and others who set up this fantastic website and to everyone here for all their support and informative posts. It is so very much appreciated.

I’m glad you were able to avoid general anesthesia. For those who have to undergo general anesthesia and have not seen this before, here are Harvard Professor Rudy Tanzi’s comments:

I’m telling my own family and friends to avoid isoflurane, said Rudy Tanzi of the Massachusetts General Hospital in Boston, referring to a common inhalation anesthetic. Tanzi’s mother had several surgeries including hip and knee replacements when she was in her early seventies. She always experienced a few days of mild delirium following an operation—until the most recent surgery, when Tanzi asked the anesthesiologist to swap isoflurane for desflurane. Following that procedure, his mother awoke clearheaded, “like nothing happened,” Tanzi recalled. When she heard it was 7:30, she demanded he turn on the TV because the Red Sox were playing and she wanted to see David “Big Papi” Ortiz. “It’s an n of one, but it’s my mother, so it counts for a lot,” Tanzi said.

From Cure Alzheimer’s 2011 symposium:
Animal studies suggest that the general anesthetic isoflurane can induce Alzheimer’s-like changes in the brain. This finding was pioneered in Dr. Tanzi’s lab. Please note that to date these are animal studies only, and are only now being tested in humans who undergo surgery. These effects have not yet been confirmed in human studies. Dr. Tanzi personally recommends to family members and friends that they choose the anesthetic desflurane instead of isoflurane in consultation with their doctor prior to general surgery.

Further research on this topic:

Re: Surgery/Hospitalization Tips for E4s

Posted: Sun Apr 20, 2014 6:18 pm
by Julie G
Excellent info, Pal; thanks for sharing. Hopefully, this will help future E4s facing surgery. I haven't seen you posting before- a warm welcome :D

Re: Surgery/Hospitalization Tips for E4s

Posted: Mon Apr 21, 2014 10:52 am
by pal
Thanks Julie for the warm welcome and for posting so soon after your surgery. I hope the pain is subsiding and that you feel better soon.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Feb 28, 2015 4:07 pm
by circular
Thanks very much for this reference post, which I've now saved in a prominent, easy-to-access place. I do wonder though about that first article in that the abstract doesn't say for how long cognition was affected in the E4 elderly. I wonder if it was temporary. Not that I just love chemical cocktails coursing through my veins, but if someone is really going to need it, maybe we don't have firm evidence that it has a lasting effect on our E4 cognition???

I also worry about post-operative nausea (although no planned surgeries I may have to have one in the not too distant future). My mother has had it in spades several times and I have a gene that predisposes me to it. Certain anesthesia medicines cause it more than others, but I don't recall which ones. Of course when nauseous they will really push ginger ale, jello etc. Your broth solution is great if the hospital will comply, or have some homemade that someone can bring in and heat in the microwave at the hospital.

Anyway, any advice on how to avoid PO nausea -- i.e. what specifically to ask the anesthesiologist for -- would be great here too.

Posted: Sat Feb 28, 2015 5:04 pm
by Stavia
Ondansetron without a doubt for the nausea. Its not an anticholinergic. In my country its now first line for nausea and even in little kiddies with gastroenteritis.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Feb 28, 2015 7:15 pm
by pgf54
Julie I have thought about all the issues you mention, from anaesthesia to dextrose infusions to hospital food and its all very worrying if you have to be hospitalized.
Four years ago prior to knowing my Apoe status I was referred to an orthopaedic surgeon for a torn meniscus in my knee.
At the time I had read and was aware of the negative effects of anaesthesia on anyone , particularly more so with the older person. I broached the subject of an alternative to anaesthesia and he retorted he had never heard of such a thing , nor did he have time to discuss it and wasn't I aware there was a waiting room full of people and I was holding them up.
There were other rudeness issues which left me feeling absolutely deflated/demoralised. I wrote an official letter of complaint and said he was obviously practicing conveyor belt surgery and so on threatening to report him to the medical board over the other issues. ( Incidentally the knee healed itself with time........)
The point here being it may be possible in America, especially if you shop around and pay , but in other countries you are likely to be told no way, particularly if you are in the public health system. In Australia I believe we have an excellent health care system, ( the surgeons operating in the public system are often also the same private surgeons from the private system, its just money gets the job done quicker) however its all time and money and unless you have the money to pay privately and shop around you are not likely to be entertained. We don't have the population . It is still very much you don't question but do as you are told. From what's put in your infusion to your medications and treatment. Drs were seen as Gods and their advice abided by whatever and that is slow to change over here Just look at the problem I had to get basic blood tests......
I will do my best to stay well and out of hospital because not being in control of my body , not being the driver at the wheel scares me...........