How to Prepare Your Body for Surgery: Protein, Prehab and the 5 Days That Change Your Recovery | Dr. Rebecca Knackstedt

Rebecca Knackstedt (0:00)

Sleep and stress and social support. There are evidence-based things that we can be doing to help patients heal. There are studies showing that if you invest in prehabilitation, you actually save money on that patient, avoiding complications, prolonged hospital stays, emergency room visits. So it's once again a shift from this reactionary type health care to preventative health care.

Gabrielle Lyon (0:23)

We know that this improves patient outcomes both physically but also mentally. Why is it not standard of care?

Rebecca Knackstedt (0:31)

A lot of challenges that need to be overcome before this is standard of care.

Gabrielle Lyon (0:34)

But you're hopeful.

Rebecca Knackstedt (0:36)

I'm hopeful. What's terrifying is that I'm seeing more and more young women, premenopausal women in my clinic with a diagnosis of breast cancer. There are certainly things that we know increase your risk of breast cancer. So things like BMI, family history, genetic predispositions. But one of the biggest things that I talk to patients about is breast cancer.

Gabrielle Lyon (1:07)

She's a plastic and reconstruction micro surgeon who occupies an unusual position in academic medicine. She is simultaneously a Duke faculty surgeon operating on breast cancer patients, an MD-PhD researcher, and a functional medicine provider, which we're going to talk about. Whose primary research interest is, get this, surgical prehabilitation with nutrition, supplementation, and exercise. This combination, as you know, is rare. She's built her research career on the argument that those weeks pre-surgical and probably also post-surgical are really the intersection of intervention. And the patients have far more influence over their surgical outcomes than they've been told.

Welcome to the show.

Rebecca Knackstedt (2:05)

Thank you so much for having me.

Gabrielle Lyon (2:06)

Surgery, typically, we think about as very invasive and a heavy burden to the patient. We don't really think about before surgery.

But you've spent your career and obviously as you continue your career with a different frame of reference that pre-surgical intervention, meaning before surgery, what patients do before, influences outcomes after.

Rebecca Knackstedt (2:30)

Yeah. It's such an important topic. And it's something that patients are not aware of, surgeons aren't aware of. It's a conversation that all patients should be having with their surgeons. And it's conversations that aren't happening.

Gabrielle Lyon (2:42)

Also it's not really taught about. And you did. Tell us a little bit about your training.

Rebecca Knackstedt (2:47)

So I did my plastic surgery residency at Cleveland Clinic. And I did a microsurgery fellowship as well. And while I was there, I was doing research with the functional medicine department, looking at a study in prehabilitation. And while I was doing it, I decided to become certified. So I took the classes, I did the exam. And that process just really solidified my desire and goal to view patients holistically. And as a surgeon, think about all of the aspects of my patients that are going to impact their surgical outcomes, apart from just what I do as a surgeon.

Gabrielle Lyon (3:18)

The real unique component here is for the audience, when they hear functional medicine, if you Google functional medicine, you see people that are not qualified, that are putting on their website or putting on various social media, functional medicine with the word medicine practitioner.

Rebecca Knackstedt (3:38)

Right.

Gabrielle Lyon (3:39)

I would love, because again, we have lots of academics that listen to the show, I'd love for you to explain what functional medicine is, how that plays a role into your thinking, because again, it's wonderful when someone who comes from a traditional academic institution like Duke or Cleveland Clinic, both top tier, are interfacing with this idea of functional medicine.

Rebecca Knackstedt (4:03)

Functional medicine really is just the belief that all aspects of health and wellness are interconnected. You can't just treat someone's blood pressure with a medicine, you should think about their diet and their exercise and their sleep and their stress, because those things impact their blood pressure. So functional medicine is just a more holistic look at patients. The challenge of functional medicine, what you were alluding to, is that a lot of different providers can become certified in functional medicine. You don't have to be an MD, a PhD, a DO.

So your background of training is very, very different. When I did my functional medicine training, I had already completed my MD, my PhD, I was almost done with my residency. So I had a very different background than someone comes in from not as rigorous of a background in medical training.

Gabrielle Lyon (4:49)

Or any background in medical training.

Rebecca Knackstedt (4:52)

Very true.

Gabrielle Lyon (4:53)

It really does a disservice because basically what we're talking about is there is the traditional medical care, which thank goodness that we have, for example, you do breast reconstruction post surgery, post mastectomy, which you're going to share a little bit about your training. But the people that listen to this podcast also want health and wellness. They want to understand what they can do, where the evidence is versus spending time doing things that maybe it doesn't have any outcome. Was there a moment in your traditional medical training that you just thought, we are just doing this totally wrong because you were still training at the time where they put patients on bed rest?