Preoperatively factors such as body weight fluctuation, intake of vitamins, Chinese herbs and other remedies are evaluated. It is important that you make your doctor aware of all medication herbs and other remedies you are taking whether or not you feel it is related to the surgery you are contemplating. A number of potentially harmful nutitional; restriction regimens and dietary supplements are currently quite popular.
Patient should begin all purpose vitamin 2-4 weeks preoperatively . They need to begin taking 1000 mg of vitamin C twice daily, preferably longer 1-2 weeks preoperatively and two weeks postoperatively. In the immunocompromised patient who was not pregnant some advise to take 25,000 IU of vitamin A daily for one week preoperatively and one week postoperatively to enhance the immune system.
It has been reported that some patients taking herbs, Chinese medications and megadoses of vitamins have swelling and bruising greater then would normally be expected.
Patients don’t always think that their herbal teas or vitamins as medications or even as supplements. A number of agents have been evaluated very carefully for their effects on bleeding. Among these is vitamin E; it effects platelet adhesion so it’s use should be discontinued before surgery. Those patients who are taking a multivitamin that contains 20 to 40 IU af vitamin E need not worry however. Those patients taking 200 to 400 IU daily should stop taking all vitamin E except for that found in there multivitamin. Patients should also discontinue garlic, which affects platelets function blood clotting. Patients who consume a lot of garlic, such as some ethnic groups, would probably need to decrease the amount of raw garlic in their diet.
Fish oil has also been shown to affect bleeding. Some unusual teas, such as woodruff and Tonka bean, would need to be stopped because these agent can cause bleeding problems. Curcumin is actually a good anti inflammatory agent but it does have some anti platelet affects. In addition, someone taking penicillin, a cephalosporin or some psychiatric medication might experience anti platelet effects. Bleeding could be a problem is these were combined with those nutritional supplements mentioned so these patients should stop taking these supplements about one week preoperatively.
Bromelain has been shown to resolve= experimental bruising more rapidly than groups not taking this preparation, and the patient would need to begin taking two days prior to surgery and as soon as possible after surgery for one week or until the bruising resolves. Bromelain comes from the pineapple plant and it reduces bruising and swelling significantly. It comes in capsules and can be found in health food stores and needs to be taken on an empty stomach.
Another rather impressive agent is the homeopathic remedy arnica which helps to reduce soft tissue swelling and ecchymosis. A suggested regimen recommends taking30 cc of arnica two days preoperatively, 200 C one day preoperatively, another 200 C one help to one hour preoperatively and four doses of 200 C every four hours as soon as possible after surgery. No one knows precisely how arnica acts but it is known to affect blood vessels in some way that prevents or rapidly relieves bruising.
It is important not to confuse homeopathic remedies with other medications-specifically herbs or Chinese medicines. The arnica homeopathic remedy is very different from the herbal agent arnica. The homeopathic remedy is a diluted and potenized form of arnica.
There is no convincing evidence that topical agents such as aloe veragel and vitamin E, improve scarring but they are probably not harmful as long as the wound is closed.