Clinicians Concerned About Bleeding And Other Complications
By Joy Daughtery Dickinson, Executive Editor
Herbal supplements are falling under increased scrutiny. In the fall, The Childrens Hospital of Philadelphia became the first hospital in the United States to enact a policy to discourage patients from using dietary supplements without a doctors provision.
CHOP announced that it no longer will include most dietary supplements on its formulary. The hospital explained that the Food and Drug Administration does not routinely review the manufacturing of dietary supplements, and therefore cannot guarantee their safety and effectiveness. Potential risks include contamination, mislabeling, interactions with medications, or potential unforeseen adverse effects, CHOP said in a released statement.1 The policy does acknowledge that certain medical conditions might require vitamin or nutrient supplements, and a very limited number of acceptable products are listed, said Sarah Erush, PharmD, BCPS, pharmacy clinical manager and a member of the hospitals Therapeutic Standards Committee.
Such a strong stand against supplements has caught the attention of outpatient surgery managers, particularly since so many surgery patients take supplements. In fact, a recent study reported that about half of patients having facial cosmetic surgery are taking herbal and other supplements.2
Vitamins And Supplements To Avoid Before Surgery
While vitamins and supplements can provide a healthy balance to overall health, using certain ones before surgery can have adverse, and even dangerous, effects. Most physicians will provide patients with a list of things they can or cannot do prior to surgery and usually, this will include a list of medications they should avoid within the two weeks leading up to surgery. It is important that if a patient is taking herbal supplements or vitamins to discuss their use with their doctor to determine whether or not it is safe to continue taking them leading up to surgery.
Here are a few of the common vitamins and supplements to avoid before surgery.
Surgery Patients Unaware Of Herbal Risk
Many Don’t Know That Some Herbal Supplements Before Surgery Raise Risk of Bleeding
April 16, 2009 — Most patients facing elective surgery still don’t tell their surgeons or anesthesiologists about herbal supplements they are taking many doctors still don’t ask, and the failure to communicate can have a big impact on surgical risk.
Even though they might say “natural” or “herbal” on the bottle, commonly used herbal remedies such as ginkgo biloba, ginseng, garlic, or echinacea can be dangerous when used in the days before surgery, plastic surgeon David J Rowe, MD, writes in the latest issue of the Aesthetic Surgery Journal.
Yet studies suggest as many as 70% of patients don’t tell their doctors they are taking herbal supplements, he tells WebMD.
“There are a lot of reasons for this,” he says. “Patients may think their doctors don’t know anything about herbal supplements or they might believe their doctors will consider the use of these products ‘quack’ therapy.”
It is important that patients tell their doctors about all the medications they are taking, including herbal supplements, before surgery. And doctors should provide patients with a list of supplements to avoid, Rowe says.
In a survey of plastic surgery patients published in February 2006, 55% reported taking at least one herbal supplement on a daily basis.
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Here Are Some Of The Possible Side Effects Or Interactions With Anesthesia Medicines When Taking These Popular Herbals Medicines
Black cohosh: This herbal may interact with anesthesia medicines and cause a low blood pressure or increased risk of bleeding.
Echinacea: Because echinacea is believed to boost the immune system, transplant patients should avoid this herbal both before and after surgery. Long-term use of echinacea can also result in liver damage, which may increase the effects of some medicines used during anesthesia.
Ephedra : Ephedra can cause serious heart and blood pressure effects. In combination with anesthesia medicines, its can cause life-threatening or fatal heart irregularities, elevated blood pressure, and a dangerous rise in body temperature.
Feverfew: Combined with anesthesia medicines, this herbal may cause prolonged bleeding during and after surgery and migraine headaches, anxiety, and insomnia after surgery.
Garlic: This common cooking ingredient can increase the blood pressure and the risk of bleeding during and after surgery. It should be stopped a full week prior to surgery.
Ginger: Although this herbal medicine stimulates the gastrointestinal tract, there is no increased risk for nausea and vomiting after surgery. However, ginger increases the amount of time it takes for blood to clot, so it should be stopped before surgery, especially by those who also take certain pain relievers such as ibuprofen, ginkgo biloba, or warfarin .
Hoodia: This herbal medicine causes changes in the blood sugar and increases the risk of bad side effects involving the heart.
You May Need To Stop Taking Blood Thinners Certain Painkillers Herbs And Supplements To Reduce Your Risk For Bleeding
No one wants to have surgery, even minor surgery, but sometimes minor procedures, such as a tooth extraction or a colonoscopy, are unavoidable. When that happens, you may hear that it’s important to stop taking certain medications. Understanding exactly which drugs to suspend and when can be confusing. “I get a lot of questions about this,” says Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.
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Answer: Why No Vitamin E Before Surgery How Long Before Should I Stop
Vitamin E taken orally can cause increased bleeding during and after surgery. For this reason, it is usually stopped 2 weeks prior to any procedure. Postoperatively, it can be resumed after an appropriate time. Vitamin E can be beneficial for wound healing, so eating a healthy diet is important. For scars, though, topically applied medical grade silicone is the best. Foods rich in Vit E are nuts, seeds, and avocados. Follow the instructions given to you by your plastic surgeon. He or she will be able to answer your questions more specifically.
Stop Taking Herbal Medicines 1 To 2 Weeks Before Surgery
Herbal medicines may interact with the medicines used during anesthesia or cause other problems during the surgical procedure or your recovery. Some of the bad side effects when taking herbals prior to surgery include increased bleeding, heart and blood pressure changes, longer sedation than desired, and changes in the way other medicines react in the body. To be safe, people who know they are going to have surgery should stop taking all herbal medicines 1 to 2 weeks before the procedure, according to the American Society of Anesthesiologists. This general timeframe errs on the side of caution, as the effects of many herbals are short-lived after stopping their use. Be sure to let your surgeon and anesthesiologist know if you have been taking an herbal medicine and when you stopped taking it before surgery.
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Your Health Is What Matters Most
Proper nutrition is essential to fuel normal functioning of human anatomy, including beating of the heart and respiration of the lungs. Nutrient needs are altered when additional stress is placed on the body, including growth spurts, exercise, injuries, sickness, and pregnancy/lactation. Surgery is particularly stressful as incisions are created and the body works to heal its wounds. The best pre-operative nutrition will help the immune system fight against infection and prevent and treat excess blood loss. Research has demonstrated that optimal recovery, including the best possible results seen in the shortest time period, is achieved when particular dietary and supplement regimens are followed. Specific nutrients are needed to repair skin, blood vessels, nerves, and even muscles and bones. Read below to learn more.
Key Papers By Dr Cathcart:
The method of determining proper doses of vitamin C for treatment of diseases by titrating to bowel tolerance. Australian Nurses Journal 9:9-13 March, 1980. Also in: Journal of Orthomolecular Psychiatry 10:125-132, 1981.
Vitamin C, titration to bowel tolerance, anascorbemia, and acute induced scurvy. Medical Hypothesis 7:1359-1376, 1981.
The third face of vitamin C. J Orthomolecular Med, 7:4, p 197-200, 1992. and also at
Hickey DS, Roberts HJ, Cathcart RF. Dynamic flow: A new model for ascorbate. J Orthomolecular Med, 20:4, p 237-244, 2005.
Links to additional writings by Dr. Cathcart:
Saul AW. Vitamin C high-dose therapy for major diseases.
For many more papers on vitamin C therapy as used for many years by many physicians:
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Inform Your Doctorabout Supplements
While most supplements should be safe and beneficial to take as youre preparing for surgery, there are some supplements that could actually harm your recovery process. For example, certain herbal supplements and over-the-counter drugs can reduce your bodys ability to clot the blood – an essential component of a smooth recovery. Other supplements can interact negatively with other medications your surgeon may recommend for your healing process.
Your doctor would be more than happy to recommend certain vitamins and minerals to promote healing and can tell you which supplements to avoid or discontinue while leading up to surgery. You should bring up supplements during your pre-op consultation to make sure there are no delays, as it can take a week or more for any medications to fully leave your system.
Vitamin C Before Surgery
When used in typical dosages, ascorbic acid is not believed to increase the risk of bleeding or to interact with anesthesia. Should you avoid vitamin C before surgery? Even though most avoid lists dont mention it, ask your doctor since each patient and operation has unique circumstances.
Some doctors actually recommend using more of it before and/or after surgery.
The ascorbic acid dosing page of the Mayo Clinic website reports that:
For heart conditions, 2 grams of vitamin C has been given by mouth before surgery, followed by 1 gram daily for five days.
Research from a university in Tokyo found that blood serum levels of vitamin C falls after surgeries. To normalize them and reduce oxidative stress, they say:
In uncomplicated surgical patients, more than 500 mg/day of vitamin C may be required, with much higher doses in surgical intensive care unit patients.
To be clear, both of those are reporting research and neither should be construed as advice. More research is needed to determine whether or not its beneficial to take more vitamin C prior to surgery.
Risks and complications aside, taking excessive amounts is probably not a good idea regardless. There are side effects of vitamin C, such as kidney stones with long-term high dosages, and when in the presence of certain minerals, acting as a pro-oxidant .
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Supplements To Avoid Before Surgery
Surgery can be a stressful time for your body. To avoid any complications, you will want to ask if there are any supplements you should avoid before surgery. Your doctor may give you a list of medications you should stop taking, but some supplements can increase the risk of complications too. There may even be a possibility of drug interactions between anesthesia and medications used in surgery with supplements you may be using. This article will give you a list of some supplements that may cause surgical complications.
Answer: Which Vitamins To Stop Before Surgery
Based on the list you provide I would say Vit C, probiotics and iron are the only ones I am not concerned about. I would however stop all others, especially a multivitamin, and omega oils. That being said you need to ask your PS which vitamins/supplements they want you to stop. Every physician might have their own protocol.
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Supplements Recommended Before And After Surgery Include:
Vitamin A: 10,00025,000 immunizing units per day, beginning a week before surgery. This vitamin supports immune system functioning and aids collagen strength.
Vitamin C: 5001,000 mg per day, beginning at least 1 week before surgery. Vitamin C is necessary to build and rebuild collagen throughout the body. Vitamin C is also a powerful antioxidant that supports the immune response and speeds up surgical recovery.
Bromelain: 5001,000 mg per day, beginning a week before surgery
Omega-3 fatty acids: Pre-surgical use is controversial. Some studies have shown them to be very beneficial in increasing immune function, while others indicate that they may increase bleeding. It is best to wait until after your surgical procedure to start taking omega-3 so that you can avoid any unforeseen complications.
Perioperative zinc supplementation: 15-30 mg daily is recommended, with higher levels in patients who have conditions that promote zinc deficiency . Zinc is an important trace mineral for DNA synthesis, cell division, and protein synthesis. Zinc decreases inflammation during the healing phase, as it is used in enzymatic reactions involved in tissue and wound healing, regeneration, and repair.
One of the easiest ways to prepare your body before and after plastic surgery is to drink plenty of water. Water is necessary because it aids digestion, ridding the body of toxins, wastes, and impurities, while preventing constipation and bloating.
Stopping Vitamins Before Surgery
Although vitamin supplements are often a healthy choice, there are several you’ll need to avoid before surgery. In particular, you need to avoid taking vitamins that may affect or alter your body’s ability to clot blood. There is also some concern that your vitamins and supplements may interact with other medications you’re taking, affect your cardiovascular health or prolong the effects of anesthesia.
For instance, vitamin E is an essential nutrient that also acts as an antioxidant. This nutrient also contributes to a healthy immune system and cardiovascular system function. However, the National Institutes of Health have reported that large amounts of vitamin E can increase your risk of bleeding, especially if your vitamin K levels are low.
The American Society of Anesthesiologists and Stanford University School of Medicine’s Department of Otolaryngology specifically recommend avoiding vitamin E before surgery because it can increase the likelihood of bleeding and cause issues with your blood pressure. You may need to stop taking this nutrient up to seven days before surgery.
Stanford University School of Medicine’s Department of Otolaryngology also recommends avoiding vitamin C before surgery. This nutrient may interact with a variety of medications like antiviral drugs and blood thinners. You should consult with your doctor about potential interactions between nutrient supplements and any medications you’re currently taking or may need to take following your surgery.
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Answer: Vitamin E Before Surgery
Hi there and thanks for your question! Supplements such as Vitamin E or fish oil can increase your risk of bleeding during and after surgery. Increased bleeding after surgery can lead to the formation of a hematoma and increased risk of swelling/bruising. I recommend stopping any blood-thinning medications such as aspirin, motrin, advil, fish oil, and vitamin E for 2 weeks prior and 2 weeks after surgery. Each surgeon differs in their pre and post op protocol. I suggest speaking to your doctor in advance to ensure a smooth recovery. Hope this helps and best of luck!
Foods To Boost Your Health Before And After Surgery
It is possible to speed your recovery and healing from surgery with healthy snacks and meals. Before you have surgery include the following foods in your diet to optimize your recovery:
Have more questions about pre-surgical nutrition? Schedule a consultation with a registered dietitian from our nutrition team!
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Why You Should Stop Taking Supplements Before Surgery
When filling out paperwork in a doctors office, do you ever list your vitamins and supplements in the space dedicated to current medications? If you are like most patients, the answer is likely no. But that innocent lack of disclosure could adversely affect your care. In the case of cosmetic surgery, it could negatively impact your results.
In todays wellness era, the question certainly needs to be rephrased. From a multivitamin to adaptogenic herbs, tonics, tinctures, everything you put into your mouth on a daily basis is of great interest to your provider. The general rule when it comes to cosmetic surgery is to steer clear of taking vitamins and supplements pre-op to minimize bleeding, which, in turn, will help to keep bruising and swelling at a minimum, too .
But that is not to say all supplements are off limits. Before a cosmetic procedure, your provider will go over a pre- and post-op checklist to ensure the treatment is safe and effective. Pre- and post-op instructions are a crucial step in the overall outcome of your surgical procedure, says Lesley Rabach, MD, a double board certified facial plastic and reconstructive surgeon and co-founder of LM Medical in New York City. I can do my job to get the best outcome for my patients, but I need my patients to commit to following the directions for optimal results. Its a two-way street.
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Supplements And Surgical Impact
Take these steps to avoid problems
Patients often think of supplements as safe and natural products, so they often dont think to list these products when their physicians ask what medications or drugs theyre taking.
“A lot of people dont recognize that what they buy in a health food store and another store is a medication, even though taking that, they want a medical benefit,” Matarasso says. “We specifically advise about health food stores.”
He asks patients about their use of prescriptions, over-the-counter medications, and dietary supplements. “We want to know anything they put in their mouth that they consider helpful to their health,” he says.
Guyuron uses a questionnaire that asks patients what they are taking, including pharmaceutical products and herbal medications. He specifically asks, “What herbal supplements do you consume?”
“Otherwise, its not on their radar,” he says. They dont consider the herbal product to be a medication, so unless you ask for that information specifically, they wont volunteer that they take some herbal products, Guyuron says.
Dombrowski asks the question in an even more general manner. “I always ask my patients, cosmetic surgery or just outpatient surgery, what pills do you take? Pills. Then I also remind them: This is what I mean: vitamin, supplement, and any medication you get from your doctor.”
Explain to patients why