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.

Sigumchi Namul (Korean Spinach Salad)

This is super healthy, quick to make, very tasty, and makes a great side to pretty much any meal. Add a teaspoon of flaxseed oil to a serving right before you eat for some good fat.

-18 oz. (510 g.) Spinach (Skip step 1 if you buy frozen spinach)
-1 Tbsp Soy Sauce
-1 Tbsp Sesame oil
-2 tspn sesame seeds
-1/2 clove garlic, or powder to taste
-Salt/pepper to taste

1. Wash spinach and cut off the stems if you buy in a bunch. Boil water and drop spinach in, stirring for ~20 seconds before removing to strainer (this is called blanching) and drenching with cold water to stop the cooking process.

2. Squeeze as much water out of the spinach as you can but don’t handle it too much–5 seconds per handful of spinach.

3. Add seasoning and mix thoroughly.

Those of you who have had lung surgery know all about how much more difficult physical activity can be for quite a while after you’re “healed up.” Walking is hard and talking at the same time can even be difficult. Then come the cramps, bubbling, and “discomfort,’ which is really not a good word for it since it makes you scared that something might be wrong.

I’ve talked a lot about diet/exercise and the importance of planning it out before hand: you wouldn’t drive a car in New York City before spending hours learning the traffic rules and how to control you car because you would probably get seriously injured. Same goes for surgery, but this might even be more important because how you recover from surgery shapes the vision you have of yourself and the labels you go by.

I have experienced spontaneous pneumothoraces, but I am not “someone who gets spontaneous pneumothoraces.” Both convey the same information, but if you refer to yourself as the latter, you’re personally identifying yourself in terms of an event completely out of your control. After lung surgery, you notice that people generally can’t fathom what it’s like to have this kind of surgery by the kinds of questions they ask you: “Want to run a 5k with me this summer?” “Why don’t we walk to the grocery store and instead of driving today?” and “Can you do this dishes?”

It’s pretty obvious to anyone who has had lung surgery why these somewhat standard questions often seem completely unreasonable requests. Or maybe you’re friends have been weirded out because you can’t talk while you walk because you have to focus on breathing. No matter what the question or situation, the whether your identify yourself as having had experienced pneumothoraces or as “someone who gets pneumothoraces,” makes a night and day difference in how you react to them and therefore how you shape your life in light of them.

If you’re “someone who gets pneumothoraces,” you get frustrated with people for not understanding your condition and making all these unreasonable requests without stopping to think about how it might be much more difficult for you to do the same thing that they can do without giving it a second thought.

If you’re someone who has experienced a pneumothorax, these questions and situations are challenges that have been issued to you and goals to work toward–they’re a motivation to do the work that needs to be done to get to the point where you don’t think twice about answering those questions in the affirmative.

Click here to visit my donation page for the American Lung Association in Oregon. Donations are completely secure (I don’t see any of your information) and any amount is great.

I don’t get anything for any of this, I just think taking action is the most important thing you can do, whether it’s helping others directly or fund-raising–they actually don’t even know I’m raising money for them…yet…

By donating you also become a part of something much bigger than yourself: a people-powered movement towards cleaner, healthier air. Isn’t social media just amazing? Haha…on to the details…

Contest

Donate and follow these quick instructions to enter into a drawing for a free copy of “The Four Hour Work Week: Expanded and Updated Edition” by Tim Ferriss (published December 2009).

Shoot me an email (Nathan@brainchocolateblog [dot] com) with (1) your name; (2) how much you donated; and (3) a personal message, dedication, or anything you want to be posted publicly on my blog—no commercial plugs please. If you win, I’ll contact you via the email address you send me your massage with, so that’s an important step. Contest ends 03/21/2010.

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