Going “under the knife” can be anxiety-provoking and life-disrupting for anyone, especially those of us who rely primarily on natural medicine. How that hospitals are catching up on their pandemic backlog of surgeries, I’ve had several requests from friends, clients, and student for tips on what herbs they can and can’t take and how to support healing. So, I’ve decided to dust off and update this article I wrote for Herb Quarterly back in 2015 while recuperating from back-to-back surgeries.

In my own life, I’ve breezed through three urgent and unexpected laparoscopic abdominal surgeries. I approached the first two surgeries (within two weeks of each other for “stage 3 ovarian cancer” that fortunately turned out to be a benign tumor) with much trepidation but put into practice all the good habits I’d learned throughout my herbal studies. Fortunately, with a little extra effort and good communication with your medical team, there’s quite a bit you can do naturally alongside conventional care to prepare for a smooth surgery and promote a speedy recovery. Having everything ready to go before you enter the operating room ensures a pleasant, nurturing recuperation.

Working with Your Health Care Team

Most hospitals offer guidance and guidelines pre- and post-surgery, and you should advocate for yourself and ask for more information if your doctors are not automatically forthcoming. (They’re busy and overwhelmed like the rest of us!) Every surgery and individual is different. Here are some things you’ll want to know:

1. When (or if you need to) stop taking herbs, supplements, and medications. Blood thinners (medications, many pain relievers including ibuprofen, vitamin E, many herbs including garlic, ginger, ginkgo, fish oil, reishi, dong quai, and turmeric) are the primary concern; however, your medical practitioners will probably want to avoid anything non-essential that may interact with anesthesia and other medications during and after surgery (particularly St. John’s wort and other CYP-interacting herbs and herbal sedatives like valerian and kava). I generally recommend clients stop taking all herbs and supplements one to two weeks prior to surgery to be on the safe side, but your natural care provider may offer more specific individualized advice. Tylenol (acetaminophen) is one of the few pain relievers allowed before surgery, but be sure not to exceed maximum dose (see the Post Surgery Pain Relief), and know that it may also be given to you during surgery. Homeopathic remedies, flower essences, and inhaled aromatherapy are generally very safe. Heed any recommendations regarding when to stop food and drink before surgery.
2. How long recuperation will take, including how much time you should take off from work. Give yourself extra time to be safe, and recruit friends or family to be your caregivers for the first few days at least.
3. What kinds of activities are discouraged after surgery, and for how long. This includes heavy lifting (ask how much weight should be avoided, for how long… and don’t be surprised if you get slightly different answers from different sources), driving, and even things like taking baths, swimming, wearing tampons, and having sex. Obey their recommendations – it’s in your best interest!
4. Dietary restrictions pre and post surgery. You’ll generally need to stop food or drink at midnight (or eight hours) before surgery, though specific clear fluids might be okay up to four hours prior. Alcohol and smoking may also be discouraged leading up to surgery and in recuperation because they can increase complications and slow healing.
5. Any concerns regarding anesthesia including nausea control and a family history of malignant hyperthermia. Homeopathic nux vomica can be taken pre and post surgery for nausea. Although ginger capsules can be effective, their blood thinning effects make it more appropriate after surgery. Ask if it’s okay to bring crystalized ginger or ginger candies with you to take when you wake up.
6. Recommendations for showering or bathing before surgery, including the need for special soap. (The recommended antibacterial soap gives me hives – thankfully I tried a small patch test first – and I have done just fine using Dr. Bronner’s bar soap instead, but I can’t promise it’s safe for everyone.) Avoid applying lotions, deodorant, etc. the morning before surgery.

I hate early mornings, but if you can possibly get in for the first surgery of the day, do it. Later surgery times will often get delayed, leaving you anxious, bored, and starving as you wait for your surgeon to get to you. If your hospital is far away, consider staying at a nearby hotel the night before. No one needs the stress of a pre-sunrise three-hour drive in rush-hour traffic on your way to Boston the day of surgery!

Before Surgery: What Can You Take and Do

Generally, you’ll want to stop taking all herbal remedies one to two weeks prior to surgery or as directed by your doctor and/or natural care practitioner (as discussed above). This helps avoid blood-thinning effects and herb-anesthesia-drug interactions. That said, homeopathic remedies like arnica and flower essences like Rescue Remedy are perfectly fine up until your pre-surgery fasting time. In fact, it’s a good idea to take homeopathic arnica tablets before surgery, upon waking, and three times a day during recuperation. Several studies have found that arnica reduces bruising and swelling while speeding recovery. Although other studies found it less effective, homeopathic arnica is safe and worth trying. For stress, alongside flower essences like Rescue Remedy (which can be ingested or sprayed into the air), consider aromatic essential oils like lavender. Several studies have shown that inhaled lavender eases anxiety and pain. Ask your medical team if you can put a drop on a tissue that you can bring into surgery with you. (I’ve also learned to give in an accept the anti-anxiety meds in my IV as they’re wheeling me into the surgical room.) Let your medical team know if you’re claustrophobic or anxious – they can help ease you into things like breathing into the mask.

Those are the basics, but there’s much more you can do from a big-picture perspective in the weeks and days before surgery, especially if you have lots of time to prepare.

You want to do everything you can to reduce inflammation and give your body the nutrients it needs to heal wounds.

1. In the weeks before surgery, eat a nutrient-dense healthy diet rich in anti-inflammatory foods, emphasize a rainbow of vegetables, dark greens, and berries. While you should always aim for a balance of quality protein, carbs, and fat for every meal and snack, aim to minimize the carb portion while boosting the protein. That’s because the sugar and insulin spike associated with carbs increases inflammation, and protein helps balance it out. Protein from nuts, seeds, chicken, beans, and fish will also provide amino acids that serve as building blocks for good connective tissue and wound repair.
2. Prepare food for post-surgery like broth, roasted chicken, zucchini, soup, rice, crackers.
3. Limit or avoid alcohol and sugar (and smoking, of course!) since these tend to aggravate inflammation, reduce immune function, and impair the healing response.
4. Exercise regularly to reduce inflammation, reduce stress, and promote good circulation.
5. Get plenty of rest and stay well hydrated.
6. Meditation, time spent outdoors, and breathing exercises (like this one) help ease anxiety and promote the healing response.

Packing Your Surgery Bag

Bring a list of medications and allergies, your name, and date of birth (plus any medical record numbers) with you the day of surgery. Stick a note on it (or you!) with any additional concerns you may have, and don’t hesitate to voice them to everyone who comes through the room. Try not to pack light but bring a few comfort basics. Leave anything valuable – like jewelry – at home.

• Cell phone with ear buds and charger/power pack for communication, music, and entertainment
• A granola bar or other nonperishable snack… sometimes you get out of surgery starving and the cafeteria is closed
• Something to read, reading glasses
• Cough drops (I love Ricola), ginger candies/crystalized ginger, homeopathic arnica, any other useful remedies*
• Comfy, baggy clothes to go home in
• If spending the night: eye mask, ear plugs, soothing music via earbuds, CPAP machine, basic toiletries

*Check hospital policies. Depending on the type of surgery and if you’re on medications post-surgery, they will probably not want you to be taking a slew of herbal remedies or supplements while you’re in the hospital. Some hospitals have fragrance-free policies. 

Going Into Surgery During a Pandemic

Because surgery isn’t stressful enough, now we’re also concerned about COVID-19. And due to the pandemic, most hospitals won’t allow family members to enter the hospital at all, so you’re on your own. Look for and follow guidelines like which doors to enter, make sure to put a mask and use sanitizer, and follow directions for pre-surgery COVID tests.

We have no idea yet what will or won't help us fight COVID infections. But, I personally also took elderberry syrup (which has a low interaction risk) before my fast began pre-surgery and after I got out of surgery. If you’re not on post-surgery medications, echinacea (which has a moderate interaction risk) should be safe after surgery. If you have several weeks or months before surgery to plan, consider daily immune tonics like astragalus, reishi, or other medicinal mushrooms. Check with your herbalist, naturopathic doctor, or pharmacist to ensure these are safe alongside any regular medications you might be on and listen to your body -- if you feel worse after taking them, they might not be right for you. For more of my thoughts on immune and and respiratory support, elderberry, and COVID, click here.

Post Surgery Basics

Stock your fridge with healthy foods that you’ll enjoy eating post surgery. You’re likely to have a sensitive stomach, dry sore throat, cough, and constipation and will also want to promote wound healing while reducing inflammation. I find it useful to roast a chicken and make chicken broth a day or two earlier. Miso soup is a nice vegan alternative. Other soothing foods include a light chicken soup made with grated zucchini and brown rice with a little butter, and fresh ginger-honey-lemon tea. Don’t hesitate to ask friends and family to bring specific dishes that are healthy, anti-inflammatory, and appealing to you. Cookbooks by Rebecca Katz are excellent, as are the recipes at eatingwell.com, soups, stews, Indian, Thai, and authentic Asian dishes (not standard Chinese restaurant fare). See more on nutrition in the wound healing section.

Keep ginger capsules on hand for post-surgery nausea and pain control, taking one or two every four hours or as needed. Have a bag or two of all-natural menthol (such as Ricola) or pine cough drops, cherry bark syrup, and/or a jar of honey at the ready. If you wore a scopolamine patch for nausea, your mouth will be incredibly dry, and the breathing tube during surgery can irritate your throat. Coughing while sore from surgery is not fun, and these remedies quell the cough reflex. Consider dissolving a cough drop in a little water to sip for faster action. That said, coughing up phlegm post surgery is important to reduce the risk of pneumonia --  if your medical team didn’t give you tips on how to safely cough after surgery, check this out.

Move and Rest: Surgery recuperation time is a careful balance of lots of rest and TLC with regular gentle movement. Always listen to your medical team’s direction regarding activity limitations, movement, and physical therapy. In most cases gentle movement like walking is ok and will actually promote a speedier, better recovery. Don’t push it, and listen to your body. Start slow and gradually build. If physical therapy is recommended, do it. Complete bedrest is rarely recommended and can actually reduce the healing response and put you at risk for serious issues like blood clots. Spend time relaxing or gently moving in nature or looking out at nature through a window – this has also been shown to support recovery and decrease anxiety. Taking walks out in the yard and nearby park were tremendously useful for me. On my latest surgery (which was more significant), I walked gently around the yard and house and had my husband link arms with me on the trails to help prevent any clumsy trips over rocks and roots that might injure me.

Post Surgery Constipation Relief

Anesthesia shuts down your digestive system temporarily, which can cause severe constipation, which is also a side effect of narcotic pain relievers. This is particularly painful after abdominal surgery. One of the recommendations everyone gave me was. “Take a laxative… take several different kinds!” I was able to get by with broth and prunes after my short first surgery, but I was not so lucky after the second. For the third, I was well stocked with and grateful for magnesium and senna-based laxatives. Although I’m generally not a fan of stimulant laxatives, post-surgery is the exception. My doctors recommended a combination of senna and docusate sodium, which is readily available at pharmacies. In natural food stores, you can seek out Swiss Kriss (senna), Traditional Medicinals Smooth Move tea, or something similar made with senna or cascara. Take it before bed the night after surgery, then twice a day as needed until things get back to normal and you’re off of opiate pain relievers. Laxatives aren’t particularly dangerous, but your body will quickly get dependent on them. You can also support healthy elimination by drinking plenty of warm fluids, taking bitter digestive herbs, slimy herb tea or gruel (slippery elm, marshmallow root), eating prunes, moving regularly, and using mid-range laxatives like magnesium, triphala, or yellow dock… but this might not cut it in severe constipation.

Post Surgery Pain & Inflammation Relief

You can usually resume herbs after surgery. If your doctor recommends blood-thinning pain relievers like ibuprofen, then herbs like ginger and turmeric will be fine. (Still watch for interactions with any pharmaceuticals you’re still taking.) Because narcotic pain relievers are dangerously addictive (not to mention constipating), the sooner you’re comfortably off of them, the better. If you take NSAIDs like ibuprofen for pain relief, consider taking DGL licorice chewable tablets, marshmallow root or leaf (tea, powder in water/food, or capsules), and/or oat milk (I'm fond of Oatly brand) with it to minimize the risk of stomach upset, reflux, and ulcers. If you take acetaminophen, be very aware of maximum dose and avoid combining it with alcohol because it can be incredibly liver toxic and deadly in high doses. The FDA recommends no more than 4,000 mg in a 24-hour span of time, and some doctors feel that should be closer to 3,000 – neither is hard to reach with extra-strength pills. With these conventional pain relievers, it’s safer to combine them than to exceed the dose of one type. Call your doctor if you have questions or are unsure of what conventional pain relievers you can safely take after surgery.

Natural and herbal pain relievers can be used to reduce or eliminate your need for conventional pain relievers. Alongside arnica, consider taking ginger and/or turmeric capsules (or a combination product like Zyflamend) to reduce inflammation and pain. Magnesium citrate powder mixed in water (or capsules) can help relax muscle tension while acting as a gentle laxative. At bedtime, consider herbs that simultaneously reduce pain while making you sleepy: California poppy, valerian, wild lettuce, and hops work well as tinctures or capsules, but they may interact with narcotics and other medications. Tart cherry juice drunk twice daily helps reduce inflammation and may also improve your quality of sleep with a low risk for herb-drug interactions.

You may also want to support the clearance of anesthesia and medication taken in during surgery. Milk thistle standardized capsules are our best ally for healing and protecting the liver while promoting healthy detoxification. Other great herbs for liver support and detoxification include turmeric, schizandra, dandelion, artichoke, and burdock. These bitter-tasting herbs will also help turn your digestive system back on, increase appetite, and indirectly get the bowels working again.

Internal & Topical Wound Care

Reducing inflammation and eating a nutrient-dense diet as we have discussed previously will both help your body repair from surgery more quickly. Your body does most of its healing while you sleep, so give yourself plenty of time to rest during recuperation, including longer bedtimes than your usual. Regular, gentle exercise like walking (or as recommended by your doctor) will also decrease inflammation while improving blood flow and the healing response.

Internally, you can additionally support healing with vitamin C and vitamin C-rich foods and herbs (rose hips, citrus, fresh fruits and vegetables), silica (cartilage/gelatin-rich bone broth, horsetail, nettle, and oat straw strong nourishing infusions, decoctions, or broths, rice, flax seed, whole grain organic corn), and protein (dark leafy greens, nuts, seeds, beans, chicken, fish). Also consider eating or consuming gotu kola leaves in supplement form. This multifaceted Ayurvedic herb improves connective tissue integrity, wound healing, circulation, and capillary and blood vessel strength. Side benefits include reduced anxiety, reduced stress, and improved brain function.

Follow your doctor’s advice regarding the care of your surgical incisions, including when to remove bandages, how best to keep them clean and dry, how long to avoid baths and swimming, and when you can safely apply herbal healing ointments. You may need to wait until things are partially healed to begin applying them – often once the new pink skin has begun to form and the wound has fully closed – two or more times daily. Great candidates to speed and encourage a good healing response while reducing scar formation include lavender essential oil, St. John’s wort infused oil, calendula infused oil, gotu kola preparations, and vitamin E oil. In spite of its reputation for wounds, I don’t recommend comfrey because I believe it’s too fast and not sophisticated enough, potentially encouraging thick scars.

Alert your doctor and address signs of infection immediately.

 

As a big believer in integrative care, I recognize that surgery and conventional medications may sometimes be necessary. By utilizing natural therapies alongside your care, you can improve your comfort level and recuperation. Wishing speedy healing to you!

 

Clinical herbalist Maria Noël Groves sees clients and teaches classes at Wintergreen Botanicals Herbal Clinic & Education Center in Allenstown, New Hampshire.

The statements made on this blog have not been evaluated by the FDA and are not intended to diagnose, prescribe, recommend, treat, cure, or offer medical advice. Please see your health care practitioner for help regarding choices and to avoid herb-drug interactions.

This is general information that may or may not apply to you -- talk to your herbalist or naturopathic doctor for customized advice and always keep your doctor in the loop.
Do your research before taking a new herb, and listen to your body!

The article originally appeared in Herb Quarterly magazine.

Featured photo of gotu kola by. Maria Noël Groves.