Holistic Approach Optimizes Orthopedic Surgery Outcome

Dennis Gates, M

TUCSON—Simple lifestyle interventions and pre-op touch therapies can improve outcomes of joint and skeletal surgery, said Dennis Gates, MD, a Chicago-based orthopedic surgeon who has found that holistic medicine has much to offer his patients.

Speaking at the annual meeting of the American Holistic Medical Association, Dr. Gates described his preoperative strategy, an approach he terms “orthowellness.”

Orthopedic surgeons have been fairly slow in incorporating natural medicine, he admitted. “We are superbly trained as technicians. I have personally done over 1,500 total hip replacements and 2,500 total knees. But I started really looking at my patients, and I found that the majority of them are overweight, out of shape, highly stressed, and have poor nutritional status,” said Dr. Gates. He added that all of these factors can contribute to poor post-operative outcomes.

The preoperative period is an excellent opportunity to teach patients about their own role in their health or illness, and to help them embrace healthier ways of living. Not only will this increase the odds of a successful surgery and reduce the chances of complications, it occasionally has profound and lasting effects on a patient’s life.

Dr. Gates recommended the following preoperative approach. While it is specific to orthopedic surgery, many of its components could be beneficial in other surgical situations.

Smoking Cessation: “I will not operate on someone who is still smoking,” said Dr. Gates, adding that a growing number of orthopedic and spine surgeons feel similarly. Nicotine causes capillary vasoconstriction and actually reduces capillary number, resulting in slower bone and tissue healing and increased risk of non-union following skeletal surgery.

Limit Sugar and Fat: A fat-rich, high-glycemic diet is bad for many reasons, not the least of which is that it correlates with slower wound healing and slower recovery. It is well known that diabetics, especially if uncontrolled, heal much more slowly and with higher infection rates. Dr. Gates has found the same holds true for non-diabetic patients who habitually eat a lot of sugar.

“They also need a lighter diet, so their bowels will work better. One of the biggest complications of surgery is constipation, which can be quite miserable.” One week prior to surgery, Dr. Gates asks his patients to follow a low-glycemic, low fat diet, and to continue this for at least two weeks after the operation. Whether this will lead to permanent dietary improvements is questionable, but he has found that, “almost everyone can do it for a week.”

Bolster Nutritional Status: One need not go wild with dietary supplements, but Dr. Gates has found that vitamin C, 1,000 mg/day, along with a good multivitamin containing minerals, twice daily, can promote faster healing and reduce the likelihood of non-union.

Mild Exercise: Brief daily sessions of stretching and exercise can do wonders both for the affected body part and for the person’s general physical condition. It need not be elaborate, and should not exceed a patient’s limits: walking, exer-cycling, or simple strength training with 5 lb dumbbells are all good options. The point is to get the person moving.

Dr. Gates insists his patients exercise at least once daily for a full week prior to the operation. “It improves the muscle tone around the affected area, increases stamina, increases ligament strength, and stimulates small vessel growth and collateral circulation.”

Bodywork: Dr. Gates has found a technique called Zero Balancing to be highly beneficial for his patients. Developed by internist/osteopath Dr. Fritz Smith, it is a combination of pressure point activation, ligament stretching and therapeutic touch. “I never used to believe in the whole ‘energy medicine’ idea. I thought it was cookoo, until Dr. Smith demonstrated this for me.” In addition to having obvious physical effects, Zero Balancing fosters the patient’s mind-body connection.

“Zero Balancing produces a profound relaxation,” Dr. Gates said, adding that he learned how to do the technique, and has used it on patients in the operating room. He has gathered data, which he plans to publish, indicating that Zero Balancing correlates with reductions in intraoperative anesthetic and post-op analgesic medication use. (To learn more about the Zero Balancing technique, visit: www.zerobalancing.com)

Stress Reduction & Spiritual Work: Emotional stress certainly does not help the healing process. Dr. Gates recommends patients rest, meditate, and—if they are so inclined—pray twice daily. He also suggests that they try to make amends with at least one person with whom they’ve had difficulty prior to the operation.

“When I talk to patients about this, they look at me kind of funny. But you really need your rest and peace prior to a major operation.” Making amends helps resolve old emotional stresses, it also gets the patient focused on someone outside themselves, thus strengthening interpersonal connections and psychosocial support.

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