BrainChocolate

Today I want to tackle what I believe to be the single most important factor of a good recovery. Surprisingly, though they are important in a different way, I’m actually not going to repeat “diet and exercise” for billion-and-second time. It’s is even more important than that.

You need to know everything you possibly can about your particular procedure how to recover–your surgeon is by far the best resource you have (as is your specialist if you have one). I’ve heard it said many a time in the last three months by doctors, nurses, etc that people tend to do much better after surgery the second time around because they are better informed and know what to expect. Very true in my case.

Here’s the list of questions I brought with me to ask my surgeon (you can find the answers to these questions in the post of my surgeon Q&A session here).

If you’re not having lung surgery take the general idea of each question and apply it to your own situation. It’s very important that you understand what’s going on before surgery so you don’t worry, stress, and guard after it–this is a serious problem for a lot of people but there’s no way to anticipate it until it’s too late. Well, I mean, aside from asking your doctor every question you can possibly think of.

-Misc

*Does sleeping position have any effect on how well the lung sticks?
*Does protein powder help tissue healing?
*Can/should I take my liquid multivitamin?
*Is caffeine in tea bad?

-Pain control

*I have low pain tolerance but pain meds cause severe constipation–had to have hernia surgery last time. Start taking something before surgery?
*Will I have an epidural?
*Will I have a urinary catheter? Last time I had 12 different ones–I’d like just one. They eventually left one in while I was at home. Would leaving it in for that long cause damage?
*Can you OK Anti-nausea medication before-hand? Certain narcotics make me nauseous.

-Physiology/Healing

*How do I differentiate healing pain from pain that’s actually doing damage?
*How long until incision is healed? Will using abs/back muscles to get out of bed hurt it? Last time using abdominal, even to lift my head, was very painful.
*What is the likelihood of you having to cut a rib, how long will it take to heal? What activities will hinder it from healing?
*Will you operate through the same to ribs as the first time? (I’d like to minimize nerve damage)
*How long after the surgery until the lung adheres to the chest wall such that it won’t be easily dislodged?
*Any chance of motor nerve damage?
*Does posture have an effect on healing? Last time I was bent over slightly for quite a while.
*What are the breathing exercises I’ll be doing and can I overdo it?

-Physical activity

*How soon after surgery should I start walking?
*Once at home, how often should I be walking and how far/fast?
*Should I try to increase distance AND speed everyday?
*Last time when I walked, it was sharp pain and got worse as my heart rate went up–can having elevated heart rate be bad/what is considered straining/what is max heart rate?
*How far should I be walking after one week at home? Two weeks?
*When should I start cardio (on elliptical)? When should I start weights?
*What can/should I be doing to exercise core muscles?
*How much should I be using my left arm the first couple of weeks after surgery, and the first month?
*When I do stretches I’m worried about tearing a muscle or pulling the lung away from the chest wall. Is this possible and if not, what’s the physiology behind it?
*Last physical therapist was so-so, do you know any that specialize in post-lung surgery recovery?

Photo credit Robert S. Donovan

Diet and exercise: the two things that make the biggest impact on your healthy, quality of life, and are massively important to how quickly you recover from a surgery. I’ve gone over the basics of setting up an effective exercise routine. Now it’s time to talk about what to put into your body to fuel everyday activity and anatomical repair.

Protein

Intake volumes

Under normal circumstances, the average active person requires about 1.0 g of protein for every 1.0 kg of body weight. For us Americans, that translates to:

45 grams for a 100 pound person
54 grams for a 120 pound person
68 grams for a 150 pound person
82 grams for a 180 pound person

However, protein requirements generally double from this during the first few weeks after surgery—time frames vary based on the amount of physical trauma to the tissue. (Note: 3 oz. of meat, half cup of tofu, and one cup of beans each contain roughly 20 grams of protein)

90 grams for a 100 pound person
104 grams for a 120 pound person
136 grams for a 150 pound person
164 grams for a 180 pound person

Complete vs. Incomplete

Not all proteins are created equal. Proteins are made up of a string of amino acids; the building blocks of the body. Without them, we wouldn’t be able to repair tissue, build muscle, etc. The body can create or modify a number of these amino acids on its own (inessential amino acids) but there are some that the body cannot make and therefore needs to get through food (essential amino acids).

“Complete proteins” contain all of the amino acids needed to build new tissue while “incomplete proteins” lack one or more essential amino acids. This is very important because if you’re only eating incomplete proteins, you won’t heal as quickly or as well.

However, this should only be a concern if you’re vegetarian since most meats are complete proteins–if you eat about 2 servings of meat per week you should be fine. Otherwise, combine various grains, legumes, and nuts to create complete proteins (e.x. tofu, rice+beans, peanut butter+whole wheat bread, or google “vegetarian complete proteins” for ideas).

Carbs

What You Should Know

Carbohydrates are your body’s main source of energy and your brain’s only source of energy–technically we’re talking about glucose, which is the fuel your body ends up with after processing carbohydrates, so just be aware of that. This is, of course, why low/no-carb diets are so dangerous and why they’re notoriously associated with severe headaches.

Carbs aren’t evil, you gain weight when you eat more carbs, protein, or fat than your body needs, so long story short: don’t eat more than your body needs if you’re trying to lose weight (check out the handy Resources page for tools and calculators to figure out what percentage of macro-nutrients you should be eating or shoot me an email at Nathan[at]brainchocolateblog.com).

On the other hand, if you’re skinny and will be having a surgery that involves an extended recovery, your focus should be on gaining both muscle weight and fat weight. Muscle is important because you’ll unavoidably lose muscle mass during your recover; check out “How to Exercise Before and After Surgery.” Fat weight is important for those among us who tend toward the lower end of the scale because it often takes a while to gain your appetite back after surgery; it’s not uncommon to lose 10+ pounds after surgery. Of course, weight variation tends to be the opposite with average to overweight people, but you know your body best–and I have smart readers–so you can figure it out.

Carbs are a good way to gain fat weight and are also the fuel by which the body builds muscle with protein, but there’s one last thing you should know about carbs, at least for now:

Complex vs. Simple

In a nutshell, complex carbs provide you with a slower release of energy with a higher nutritional content and therefore may result in less weight gain than simple carbs (of course, in moderation). Examples include whole grain breads, legumes (beans, lentils, etc), and most pasta. Simple carbs provide you with energy relatively fast but are less nutritionally dense. Examples include white bread, oatmeal, potatoes, bagels, and so on.

There are of course exceptions with rules on the flip side, but generally, complex carbs should be your default source of carbohydrates and simple cars should be used primarily for the following: 2-3 hours pre-exercise, 0-2 hours post-exercise, or if you’re trying to gain fat weight. Note: DO NOT use carbs as a crutch to gain long-term weight as that is not healthy–instead, use simple carbs to fuel your matabolism and gain lean muscle weight through exercise (a post on muscle weight gain will be up in the near future).

Now, why shouldn’t you just gain fat weight with fat?

Fat

The big one! Sorry, I had to… But it is. American diet culture is particularly obsessed with “watching how much fat we eat” but despite this, the US is still by far the fattest country in the world and blah blah stuffyouhaveheardbefore blah blah.

Here’s what you need to know:

Saturated vs. Unsaturated

Saturated fat gets a bad rap–we usually told it’s bad and to avoid it at all costs but in reality, the jury is still out. As for temporary pre-surgery weight gain, it’s best to pair unsaturated fats with carbs (simple if you’re in a hurry, but your body will thank you for complex carbs). However, one thing’s for sure: AVOID TRANS FAT LIKE THE PLAGUE. Yes, like the plague. Or your favorite STD. Or better yet, avoid trans fat like trans fat. It effectively doesn’t exist in nature (humans manufacture it mostly in the form of “(partially) hydrogenated _______ oil”) and raises “bad” cholesterol (LDL) and lowers “good” cholesterol (HDL).

So what?

“In the context of a typical Western diet, shifting some of your fat intake from saturated fats (from animals) to polyunsaturated fats (from vegetable oils) appears to have some advantages in terms of heart health. But I would argue that monounsaturated fats (olive oil) and omega-3 fat (fish and flax) are even better replacements.”

-Monica Reinagel, M.S., LD/N

So how much of what should you eat and what’s the bottom line?

Conclusion

You can figure it all out in less than 20 minutes–this has an unbelievable payoff, especially if you’ll be recovering from surgery, so be sure to take a few minutes to do it.

1. Enter your basic body stats here and it will give you a detailed breakdown of what proportions you should be eating of what.
2. Do a quick check here to see how much fat is in the foods you eat that don’t come with nutritional data.
3. Depending on how well you want to take care of yourself, do one of the following
   a. Write down the number of grams of protein/carbs/fat you should be eating and keep a mental tally throughout the day for a few days to get a sense for how you’re doing.b. Keep a log for one week of the foods you eat and their nutritional content (name of food, grams of protein/fat/carbs) then total them up at the end of the week and compare to your target.
4. If the numbers are way out of whack and you need to change your diet, at least temporarily, check out these seven fast, tasty, healthy dishes.

Music may improve your emotional intelligence, increase your concentration, develop language skills, and a myriad of other things…but did you know it can actually help you relax when you’re completely knocked out during surgery? (Click each of the previous links to learn more)

Because I’ve always been obsessed with music, I know exactly how the many genres and bands I listen to affect me psychologically, emotionally, motivationally, etc.

Need to relax and in the mood for something beautiful? “Sunset Road” or  “More Love” by Bela Fleck and the Flecktones. Need to relax but feeling a little more contemplative? “Respiration” by Blackstar feat. Common or “Joe Metro” by Blue Scholars. How about getting motivated for a refreshing workout? “September” and “Serpentine Fire” by Earth, Wind, and Fire. Want to improve your mile-time without realizing your working harder? Flip the iPod to the playlist with “Where Do I Hide” by Nickelback and “Chop Suey” by System of a Down.

Of course, unless you have similar taste in music to me, your preferences will vary. If that’s the case, it doesn’t take long to throw together some playlists of your own in the same way that I have. Like anything you do that requires any degree judgment on your part (in this case, picking which songs fit), there are certain mental processing rules that you use to determine what makes the cut and what doesn’t. Below, I’ve distilled the processing rules that I implicitly use to decide what music to add to which playlist and why.

Putting together playlists is something most people can do on their own, but the following steps may help save you the frustration of stale, monotonous, and uninspiring playlists that can plague your iPod even if you like all the songs.

Seven Processing Rules for Effective Playlist Creation

1. What are the three top states that I’m most often in or want to put myself into? (Note: a “state” is just a term for an all encompassing feeling including general outlook, mood, motivation level, energy level, etc.)

• *Relaxed, motivated to exercise, lighthearted optimism.

2. What genres of music generally correspond to these states? (i.e., when I’m in a certain state, which genres best sustain it?)

• *Motivation to exercise= 90s alternative rock, Kanye-style hip hop, dance/party music.
  *Lighthearted optimism= High production value: jazz fusion, hip hop in major keys, late 80s/90s pop, funk.
  *Relaxed=Mellow jazz fusion, underground hip hop, instrumental guitar, classical.

If you have similar taste in music to me (which is likely if you’re in your teens or 20s) then check out my playlists. Click the name of each playlist below to view a screen shot of it.

Sleep
Relaxing Classical
Relaxing Hip Hop
Relaxing Jazz
Daytime Classical
Daytime Hip Hop
Daytime Jazz
Daytime Mixed
Daytime Rock
Motivation Mix
Workout 1
Workout 2
Workout 3
Workout 4
Workout 5
Workout 6
Workout 7

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[Be sure to talk to your doctor so you know what you can and can't do before exercising!]

This last time around, three weeks after my last collapse I started getting ready for my surgery—at that point, I had three weeks to get ready. After my first surgery (VATS/pleurodesis) I was very slow to bounce back, to say the least, and didn’t do any sort of real exercise for probably about a year. That was a major mistake but this time I’m doing it right.

Since I have experience with good (so far…) and bad recoveries, I put together this video and information below to give you what I wish I had.

Real Quick…

Surgery comes with all kinds of weird internal sensations that  you’ve never felt before and that result from nerve and muscle damage. If you’re doctor says “you can do anything you feel comfortable doing, just don’t lift more than 5 pounds with your surgery-side arm for six weeks” then don’t obsess over muscle twinges and pains as long as you’re sticking to what the doc says. If the pain or sensation is sudden or out of the ordinary and something definitely feels wrong, call an advice nurse but for the most part, if the surgeon says you’re solid, you are.

Now, to get to the good stuff…

Click Here to continue reading…

As you know, breathing is pretty important.

Because of our many stresses and worries we’ve started breathing mostly from our chest—shallow chest-breathing is a stress response—and it’s become what feels most natural. Unfortunately for us, this isn’t good for our lungs or body since it allows carbon dioxide to build up and significantly impacts our performance in everything from exercise to playing or singing music. It’s also not how we naturally breathe; watch a baby and you’ll see that he/she breathes from the diaphragm.

Breathing is especially important after surgery because anesthesia depresses respiration and can easily lead to lung problems like pneumonia or a collapsed lung. If you’ve had lung surgery, there should be absolutely nothing more important to you right now than breathing correctly. So, with this in mind, here’s how to do it:

[Scroll over the white dots on the video status bar to browse through and jump to certain topics—after pressing play.]

Below is the video that shows good breathing technique. There are a lot of bad videos out there—I tried to choose the least weird/patronizing of them:

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Username: brainchocolate
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Posted by Nathan Schmitt