Optimize Surgery Recovery: An Integrative Approach

[00:00:00] Tina:So one of the biggest things we do before surgery is make sure people aren't taking things that block the clotting of their blood because you need to clot in order to heal from a surgery, right?

So don't get in the way of clotting, but also don't get in the way of inflammation for that first week, maybe even 10 days after the surgery because inflammation is your friend at that moment in time. 

[00:00:18] Tina: I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

[00:00:22] Leah: and I'm Dr Leah Sherman and on the cancer insider

[00:00:26] Tina: And we're two naturopathic doctors who practice integrative cancer care 

[00:00:30] Leah: But we're not your doctors

[00:00:32] Tina: This is for education entertainment and informational purposes only

[00:00:37] Leah: do not apply any of this information without first speaking to your doctor

[00:00:41] Tina: The views and opinions expressed on this podcast by the hosts and their guests are solely their own

[00:00:47] Leah: Welcome to the cancer pod 

[00:00:56] Leah: , ​Hey Tina. 

[00:00:58] Tina: Hi, Leah.

[00:00:59] Leah: today we're gonna cover something that we haven't, we haven't talked about side effects or supplements or all kinds of things that we used to talk about. So, today we're gonna talk about surgical support.

[00:01:09] Tina:Yeah, I think it's interesting since surgery is such, you know, it's one of the three primaries that we've had around for, you know, forever in cancer care, but we haven't even

touched on it. 

[00:01:17] Leah: haven't talked about radiation either. Radiation support specifically, I mean, it's

probably mixed in as is, um, you know, surgery and radiation support probably are within other episodes. But yeah, I just thought this is just something, it's something that I did and that the, one of the cancer centers where I worked also had a protocol, which I know I've mentioned before, but we actually had a protocol for, mostly for abdominal surgeries.

[00:01:44] Tina:Yeah, I think that's where there's the most. 

[00:01:46] squadcaster-1ejg_1_01-15-2026_105120: most. 

[00:01:47] Tina:Evidence in most clinical studies with humans showing macronutrients and micronutrients and how they affect recovery and infection risk and all that

stuff. Mm-hmm.

[00:01:55] Leah: I, I still would the, I would work with the dieticians and we would make sure that were nutritionally sound and, you know, just kind of had a plan 

[00:02:07] Tina:Mm-hmm. 

[00:02:07] Leah: into and then coming out of surgery.

[00:02:10] Tina:Yeah. Yeah. Ideally, 

[00:02:12] squadcaster-1ejg_1_01-15-2026_105120: pre-surgery, 

[00:02:13] Tina:seeing people. At least a few weeks before they go in is ideal. And depending on their state and their, their health, more time is better. Getting people ready and prepped and replete instead of depleted in

nutrients. Yeah, 

[00:02:28] Leah: I would see patients. 

[00:02:29] Tina:I. 

[00:02:30] Leah: At the cancer center in Arizona, we would see them from when they first came in. And so if we knew that surgery was probably on the table we would make sure that person wasn't smoking. And I mean that's, that's one of the biggest things that you can do is to quit smoking prior to any 

[00:02:46] Tina:yeah. 

[00:02:47] Leah: because smoking does impede healing.

[00:02:52] Tina:Mm-hmm.

[00:02:53] Leah: And we would often see complications with patients who hadn't quit smoking. 

[00:02:59] Tina:Yeah, that makes sense because the, when you inhale the, the smoke, you're basically increasing the oxidation throughout the body and yeah, I could see how smoking would impair healing. Just in a general sense,

[00:03:12] Leah: So I would have 

patients who, I would have patients who, were having surgeries for breast cancer and I would notice that the patients who smoked had far more complications 

[00:03:23] Tina:Hmm. 

[00:03:23] Leah: who didn't smoke. So, and 

[00:03:24] Tina: Yeah. 

[00:03:25] Leah: that people who didn't smoke didn't have complications 'cause it can happen to anyone.

But yeah, the smoking definitely. We would have to send them to like wound care and stuff, the wound care nurse. So,

[00:03:36] Tina: Yes.

Yeah. So in, 

[00:03:38] Leah: who's listening to us still smokes. Um, definitely stop.

[00:03:42] Tina: yeah, this is one of those times where your population of my population differs. right? 

So in a private clinic, in a small town in Oregon. I had most people, I would say very, very few people were still smoking. Most people who were coming to see a naturopathic physician had already stopped smoking, even if they just did it recently.

But they knew that that was gonna be something I was gonna ask them. And they were like, I'm gonna do this. I'm gonna, before I even walked through that door. But very few people had actually a recent habit of smoking, even I would say less than 10%.

So it wasn't the average patient who walked into my office, I

don't think. And they were highly motivated

And already taking care of

themselves. 

[00:04:18] Leah: just see the general public. So, um, 

[00:04:21] Tina: Yes. 

[00:04:21] Leah: a more,

[00:04:24] Tina: Yeah,

[00:04:24] Leah: know, diverse.

[00:04:26] Tina: I think it just represented the general public more than

my patients did. 'cause mine were mostly women too. And obviously it's 50 50 in our population, but women are more likely to seek out a naturopathic doctor. That's always been

the case. 

[00:04:37] Leah: And depending on which oncologist I worked with, when I worked with one of them, I saw a lot of patients with prostate cancer, so I would see like a variety of patients. I mean, I saw breast, gi,

[00:04:46] Tina: Yeah.

Yes. 

[00:04:48] Leah: of patients. So I.

[00:04:50] Tina: Where my prostate cancer patients, I would say seven outta 10 of them were brought in by their wives or, or someone, another female in their life, like three outta 10, probably self-selected, and and were proactive and came to see naturopath. But I would say seven outta 10 were dragged in. Not against their will so much as not exactly.

They didn't have the buy-in. They didn't come in saying, you know, I'm looking to actively change my habits. They were like, my wife is making me come here. I'll do what she says. Basically, you know, tell her what to cook 'cause she's gonna feed me. That's basically, I mean, honestly, that was probably half of my prostate cancer patients. I know it's a sexist thing, but it's just the way it is. I mean, I'm not condoning it, I'm just telling you. 

Anyhow,

[00:05:32] Tina:back

to surgery. 

[00:05:32] Leah: back to bringing it back around. So, yeah, so making sure that somebody is like nutritionally sound like nutritionally fit, you know? I mean, there are some patients with cancer who, because of the cancer process are malnourished or because of the treatments that they've received beforehand 

[00:05:51] Tina:Yeah. 

[00:05:52] Leah: And so I think that's the number one priority. Is just making sure that you're able to get in nutrition no matter how you get it in.

[00:06:02] Tina:I agree. Yeah. there is also, now when people have cancer, let's say they have a colorectal cancer and they've got some metastasis to the liver or somewhere else, there is also some surgeries happening just to control metastatic disease. So sometimes they've already had a colorectal cancer surgery or even an upper GI surgery, and maybe absorption of certain nutrient is impaired because of what was removed. or their ability to eat is impaired or something and just, no, just being replete. When I say replete, that just means replenished, think replenished, um, replete in nutrients, going into any surgery. 

It 

is always gonna help prevent infection on the other side of it 

[00:06:47] Leah: wound healing as well.

[00:06:50] Tina:and facilitate wound healing where you need nutrients to heal that. That wound

site. Yeah. 

[00:06:54] Leah: And so our dieticians would talk specifically about, you know, different foods to eat and then they had a product. The only one there, there are a bunch of products out there that are specific for, um, for surgery. 

[00:07:07] Tina:Mm-hmm. 

[00:07:07] Leah: Um, the one that I think that was mostly used was one called Impact. 

[00:07:12] Tina:Oh, okay. 

[00:07:14] Leah: but it just has 

[00:07:15] Tina:Mm-hmm. 

[00:07:15] Leah: arginine and omega threes and protein and then some other nutrients in there.

I can't remember what it had offhand. 

[00:07:23] Tina:Yeah.

[00:07:23] Leah: some glutamine in there.

[00:07:26] Tina:Yep. I think I, I think that's what the studies indicate, that perioperatively meaning. Somewhere around the time of surgery if, if people are given arginine, glutamine and Omega-3 fatty acids, they have less infections at the surgical site and better, um, recovery and just reduced severe reactions that require further hospitalizations. So, and that's for major. And I think a lot of studies are done on the abdominal surgeries because that's kind of, it makes sense. It's a ma it's always a major surgery 'cause you're working on the gastrointestinal tract. I mean, other than just removing the gallbladder, which is, or the appendix, but if you're working on the tube itself, anywhere from the mouth to the anus, if you're removing part of the tube, then it's going to impair

your 

[00:08:15] Leah: on what part of the gastrointestinal tract is removed 

Um, it can 

[00:08:22] Tina:Yeah. 

[00:08:22] Leah: additional deficiencies. 

[00:08:24] Tina:Yeah. 

[00:08:25] Leah: have a chart like. An image on my, uh, bulletin board in my office, that was just a really simplistic picture of the GI tract, and it had at what point different nutrients were absorbed, and so then I could just kind 

[00:08:39] Tina:Yeah. 

[00:08:40] Leah: cheat sheet.

[00:08:41] Tina:Yeah. Yeah. I think that's, that's a really good tool to have. I think that's something people should look at if they have had a surgical removal of any part of their GI tract, is to look at one of those. I would, Encourage people not to use an AI made one because they are wrong. I've seen AI images of that on social media, LinkedIn,

namely, and I was like, Hmm, that's actually not accurate.

So go back back to an original like actual publication that had been peer reviewed so people looked at it and double checked it. Um, but yeah, those images are really helpful just to see like if you had surgery. Removed your ileum. They can look at the chart and just say, okay, that's what was being, that is what is being absorbed there normally, so you might just have a higher need for that nutrient, whatever the nutrient is.

[00:09:25] Leah: So, specific nutrients that I think of, I always think of like the fat-soluble vitamins, you know, especially like, I think there's a lot of evidence around vitamin D

[00:09:33] Tina:Mm-hmm.

[00:09:35] Leah: and mostly because a lot of patients in general are deficient in vitamin D.

[00:09:41] Tina:Yes, absolutely 

[00:09:42] Leah: up to a. A healthy level. It doesn't need to be like a hundred or something. Um, I think people are done making that recommendation. I remember for a while that was a really big, kind of holistic recommendation. It was like, get your vitamin D over a hundred. Don't do that.

[00:09:57] Tina:no. And here in the States it's nanograms.

It, it's in, in Canada, it's micromolar amounts, so the, the numbers change. But for us, in the US we're looking at a range. Ideally a range between 40 to 60 would be like high, normal, adequate. If you push it too high, now we know that there could be consequences to that, especially for certain cancers like prostate cancer. so we don't want to do supra physiological doses. The physiology is such that 60 should be probably about right, although there is an exception. Studies show that when you had it higher than 60 for aromatase inhibitor induced arthralgia, which is joint pain, I should say, um, that it improved it so. You know, there might be a little wiggle room there if you're doing it for symptom management, but you don't wanna go too, too high because then you can screw up your calcium. So

Yeah.

we'll just, we'll just leave it at that. 'cause we do have an entire episode on calcium

And vitamin D 

[00:10:57] Leah: well, right? 

[00:10:58] Tina:go back and listen to those if you wanna know all the facts about around that. But we'll leave it at that for now. And can I say one more thing? I think you're right. This A, D, E, and K, all the fat soluble nutrients or vitamins I should say. Those aren't all the nutrients. There are other nutrients that are fat soluble. Um, but those are the vitamins. If someone is taking a vitamin D in a capsule and they're taking it down and they're not absorbing it and their labs don't change, then that's a decent way to figure out that they're probably not absorbing 

fat 

soluble. Vitamins. So if someone has a low D on their labs, on their blood work, takes vitamin D orally in a pill, doesn't go anywhere. When you redo it, then you start to say, Hmm, maybe they're not absorbing the A, the E or the K either. We don't know, but I get suspicious assuming the vitamin D was a good quality. All right. That's it. I like to put those in there because this is like what happens to people. I've had, I had probably half of my patients, their deed went nowhere when they took one nowhere. And so I would give them drops under their tongue, um, instead of taking a pill because clearly they weren't absorbing it. And then I would be concerned about their other, the A, A, E, and K. So I'm saying that 'cause vitamin D is probably the one that is most well studied as far as nutrient deficiencies and outcomes. So outcomes in cancer are better when you're, when you have sufficient vitamin D.

[00:12:22] Leah: I think that the number one thing that if I had a patient that wasn't having adequate levels. Blood levels of vitamin D, and this is a way of me segue to our next nutrient is , I would make sure that they were doing it with some sort of healthy fat or if they were taking an Omega-3 to take it at the same time as an Omega-3.

Because you need that fat to absorb fat soluble vitamins, so you make sure you take it with food because sometimes people just take a handful of pills with coffee the morning, you know? it's, it's 

[00:12:52] Tina:Yeah. 

[00:12:53] Leah: they do. So, I think omega threes is probably one of the most controversial of nutrients that, you know in the surgery world because for the longest time patients were told to discontinue taking any sort of fish oil and they still are, patients are still being 

told, Do not take fish oil.

[00:13:12] Tina:Mm-hmm.

[00:13:13] Leah: And looking at those studies, GI surgeries are the subject of a lot of these studies in terms of what nutrients help with surgical outcomes. There was no evidence at all to discontinue taking omega 

[00:13:27] Tina:Right.

[00:13:28] Leah: And I mean, it was kind of emphasized like when part of a, you know, when part of a balanced breakfast, when part of a balanced nutritional program.

 so like not to like overdo and take a ton of them, but if you incorporate especially Omega-3 foods, 

[00:13:42] Tina:Yeah. 

Yes,

[00:13:44] squadcaster-1ejg_1_01-15-2026_105120: I, 

[00:13:44] Leah: or 

[00:13:45] Tina:I, 

[00:13:45] Leah: um, you know, any of those cold water fishes are, are good. 

[00:13:49] Tina:yeah. And that's the ideal way. To get it in. I think

yes, we do have to do supplements. Yes, the supplements are for people who can't or won't do the

foods. Yeah.

[00:14:01] Leah: So making sure that you are taking in, , a lot of those types of foods. this is like a, this is a best of episode 'cause we did, we did an episode on omega threes. And so you can listen to that episode, um, for more resources on, you know, where to find those omega threes in your food.

. Yeah, I think that's something that is kind of shifting.

[00:14:22] Tina:I think so. Yeah. Because even in the conventional world there are combinations of AR and glutamine and Omega-3 fatty acids

that are being used for surgical recovery. So I think, I think it's getting more acceptance by the conventional world. We've been looking at it our whole careers and you know, so I'm going back 25 years. We were already looking at it and the reason is Omega-3 fatty acid. Provide the molecules that help resolve inflammation. So in order, I mean it's okay to be inflamed. You actually have to be, have some inflammation in a wound site in order to heal it. But it needs to be resolved as well. You don't want it perpetual, ongoing.

Inflammation is not good. You want it to resolve. And so Omega-3 fatty acids provide the precursors to the molecules that resolve the inflammation. So. Yes, absolutely requisite. And you know, I came across another stat, and not to change the subject, but is this really, really common to be nutrient deficient if somebody is elderly? So 40 to 50% of older surgical patients are devoid of one nutrient or another. I don't know if, I didn't go into details in this paper I was reading, but it was, I'm gonna guess at some of the big dogs like zinc or vitamin C or Omega-3 fatty acids, kind of the things that we need a lot of to recover on the other side.

[00:15:34] Leah: in school they used to talk about the tea and toast diet, right? Like you get older and your appetite goes down and you're not eating, 

[00:15:40] Tina:Yeah, 

[00:15:41] Leah: you know, as 

[00:15:42] Tina:I 

[00:15:43] Leah: meal with lots of antioxidants. 'cause you need those too. You know, you need the food like berries and all those colorful fruits and vegetables.

[00:15:52] squadcaster-1ejg_1_01-15-2026_105120: Yeah. 

[00:15:52] Tina:And you know, I 

[00:15:54] squadcaster-1ejg_1_01-15-2026_105120: looked 

[00:15:54] Tina:at the literature really like Fine Tooth combed it quite a few years ago now. But at the time I remember distinctly is when it came to vitamins, specifically vitamins, whether we're talking about water soluble or fat soluble. when it came to vitamins, , only vitamin A was shown to really have a role in, in giving more than just a daily allowance.

And every I've read the nutrient was you had worse outcomes if you were deficient in. Vitamin C, zinc, folate, like fill in the blank. You need to go into surgery, making sure you have enough of them, but huge doses. Mega dosing doesn't do you any good. The only vitamin that came up as helpful, and it was actually on the other side of surgery, vitamin A on the other side of surgery, but we have to be careful with vitamin and A not to pump too much of that because eventually the liver pays a price.

[00:16:44] Leah: Yeah, and a lot of would even just become nauseated. 'cause there used to be that formula. There used to be that like supplement formula that was really popular. I dunno how many years 

[00:16:55] Tina:Which one?

Hmm. 

[00:16:56] Leah: but it was like specific for like surgical support, 

[00:16:59] Tina:Oh. 

[00:16:59] Leah: and post-surgical support.

And it had a lot of vitamin A and you were only supposed to take it for a set period of time, 

[00:17:05] Tina:Mm-hmm. 

[00:17:06] Leah: of people would become nauseated even if they took it with food. It just, So,

[00:17:11] Tina:Oh,

okay. 

[00:17:12] Leah: but yeah, definitely a lot of foods Have those nutrients like zinc and a and, and it's so, you know, it's so easy to say like, oh, make sure that you're eating all these foods.

But if you're coming out of chemo or radiation and your appetite isn't that 

[00:17:25] Tina:Yeah, 

[00:17:26] Leah: I think that's where like things like smoothies come in.

[00:17:28] Tina:and I, you know, there's, I think a multivitamin, not a

megadose one, but just a 

[00:17:33] Leah: as well. I mean, yeah, 

[00:17:34] Tina:yeah. 

[00:17:35] Leah: just one that has, like you said, like, like just the really basic amounts. Not one where you need to take four capsules daily or something. 

[00:17:43] Tina:Right? 

[00:17:44] Leah: of those, like one a day that maybe isn't a tablet. ' cause 

[00:17:47] Tina:Yes. 

[00:17:48] Leah: don't necessarily dissolve and some of those products just aren't.

that great quality. but I would even recommend gummies. 

[00:17:58] Tina:You would. 

[00:17:59] Leah: I mean, if somebody just didn't, couldn't do capsules. I mean, there's some gummies. I mean, they're higher in sugar, but you know, it's like if someone's gonna take it, then take it

[00:18:06] Tina:Yeah. Maybe for something essential, but hard to get in food like zinc,

[00:18:11] Leah: well, like a gummy 

[00:18:12] Tina:you know? Yeah.

[00:18:14] Leah: they're, then they're not like, so like, they're like, oh, I, I have to take four of these a day. Hmm. Tasty.

[00:18:20] Tina:Hmm. Yeah,

[00:18:21] Leah: you know,

[00:18:22] Tina:like, like a

little candy, 

[00:18:23] Leah: it's a little reward. But yeah, so like definitely doing super basic multivitamin I think is good before 

[00:18:30] Tina:Yeah, 

[00:18:31] Leah: after surgery.

[00:18:32] Tina:yeah. And after surgery, you know, it's an interesting thing, uh, like I just mentioned, inflammation is required. 

Well, 

first, the very first thing is where they did the surgery, you need to. Produce clots. So clotting is required. So one of the biggest things we do before surgery is make sure people aren't taking things that block the clotting of their blood because you need to clot in order to heal from a surgery, right?

So don't get in the way of clotting, but also don't get in the way of inflammation for that first week, maybe even 10 days after the surgery because inflammation is your friend at that moment in time. So I was always someone who was like, I know you wanna take, you know, anti-inflammatories and you wanna heal and you read everything online about taking curcumin or. Other things that are anti-inflammatory after surgery. But wait minimum one week, maybe if it's a big surgery, two weeks, let the inflammation do its thing, which is to call in immune cells and have a nice strong immune reaction to make sure you don't get an infection. 'cause you don't wanna dampen inflammation when it is appropriate.

And that is when the, that first week or two after surgery, depending on the size of the surgery. So that was one of the things I always talk to people about. 'cause I don't think that it's clear out there in if Dr. Google and such, I don't think anyone really talks about. The phases of, you know, healing like blood clot first, inflammation next, then you start to heal the wound. 

[00:19:47] Leah: they do go over medications, you know, make sure that you stop certain medications and that all of that has gone over and they're often, patients are often told to discontinue All supplements as well. 

[00:19:58] Tina:Mm-hmm. 

[00:19:59] Leah: a multivitamin. But if you can, you were saying, start this weeks before 

[00:20:05] Tina:Yeah. 

[00:20:05] Leah: then when you stop, then you just continue if you're able to continue those foods.

we're not gonna necessarily talk about like post-surgery. Like if it's a, you know, gastrointestinal surgery and you're on specific diets, we're not gonna go into that. Like we're. You're 

[00:20:20] Tina:Right. 

[00:20:20] Leah: to eat certain things following surgery. Like that's not the we're doing, we're just doing kind of more of the support.

[00:20:26] Tina:Oh, you're referring to specialty diets like

the low residue diet. 

[00:20:30] Leah: of those things. Yeah. Where or where people are told, you know, your NPO for however long following a certain surgery. Like, 

[00:20:36] Tina:Yeah, 

[00:20:36] Leah: be like, well, I saw this podcast where they said you take these vitamin, like, don't, like, don't do that. And that's not, we're talking, we're, we're 

[00:20:44] Tina:no. And 

[00:20:45] Leah: here.

[00:20:46] Tina:yeah. Yes, we're doing a general thing, and if you are doing a specialty diet of any kind, you should be under the direction of. Uh, dietician, nutritionist, naturopath, somebody who knows it well and practices it a lot. So therapeutic diets. I would put low residue diet right in there. 

[00:21:03] Leah: Uh, yeah, I, I would 

[00:21:05] Tina:yeah, 

[00:21:05] Leah: a dietician 

[00:21:06] Tina:Yeah. But I think that of all therapeutic diets, I don't care if someone's doing a ketogenic diet, a vegan diet, like somebody should be looking at nutrient intake and making sure that it's still healthy. Because a lot of therapeutic diets should not be. Done without some supervision to make sure that you don't, um, push your body into a, a more 

[00:21:24] squadcaster-1ejg_1_01-15-2026_105120: trouble, you

[00:21:25] Leah: or 

[00:21:25] squadcaster-1ejg_1_01-15-2026_105120: thinking

[00:21:26] Leah: a more deficient 

[00:21:26] Tina:Yeah. Yeah. Deficiencies, uric acid, stones, I mean, all sorts of things that can happen with various therapeutic diets are never, when I say that, I 

mean their diets that generally speaking, most people do for an interim, like a 

timeframe, and 

then stop doing it. Some people do ketogenic diets in perpetuity, which is fine as long as they get labs done and meet all their nutrient requisites.

It can be

done, 

[00:21:50] Leah: I have another 

nutrient that I wanna mention, 

and I guess it's a nutrient.

Well, we're, well, it's a food, I think eating probiotic foods, a variety of probiotic foods. Not taking a probiotic, but eating yogurt and fermented foods.

[00:22:07] Tina:Mm-hmm.

Keefer, 

[00:22:10] Leah: sauerkraut, kimchi. Hmm. Yeah. All of those. Eating those as part of your diet.

[00:22:16] Tina:Mm-hmm.

[00:22:16] Leah: Perioperatively, look at that word.

yeah, I think that's 

[00:22:19] Tina:Mm-hmm. 

[00:22:20] Leah: as well because there have been some studies showing that probiotics, especially with getting all those antibiotics and stuff while you're in the hospital and 

[00:22:26] Tina:Yes. 

[00:22:27] Leah: all of that. So, yeah, definitely doing probiotic foods I think is important.

[00:22:32] Tina:Yeah. And, and as one goes into surgery. Yes, going in as healthy as possible and those antibiotics are gonna be almost inevitable for some of the large surgeries. I mean, you have to do them, um, and they will throw off your gut. So yeah, doing anything you can to keep that in balance is a good idea. And we should all be eating something that's fermented every day anyways, if possible.

[00:22:52] Leah: Yeah. So then 

[00:22:53] Tina:Right. I mean, we should all be eating. 

[00:22:54] Leah: probiotic intake. No, I just, but it, 

[00:22:56] Tina:yeah, 

[00:22:57] Leah: is something that I think people just don't necessarily think about. So if you're not

[00:23:00] Tina:Yeah.

[00:23:01] Leah: typically eating those kinds of foods, you know, try to incorporate them into your diet.

[00:23:06] Tina:Yeah. Yeah. And then stick to that habit

afterwards. 

[00:23:09] Leah: if you don't have an appetite and all you're doing is getting down smoothies, you can throw some yogurt in or keefer in a smoothie.

[00:23:15] Tina:Yeah, that's

a good point. And you can also, you know, if you, I think a little bit of vitamin C and zinc is not a bad idea, and vitamin C goes into a smoothie easily. I mean, you're already doing berries, which have some, but if you wanna open up a capsule and throw it in your smoothie.

Or buy a powder.

Vitamin C is an easy one to,

to increase.

Um, and it's needed.

[00:23:34] Leah: Yeah. Yeah. 'cause it helps with collagen formation and wound 

[00:23:37] Tina:Yes, 

[00:23:38] Leah: mentioned zinc and I, think we did an episode on zinc, maybe.

[00:23:42] Tina:I think, I think we did. Yes, 

[00:23:45] Leah: But, um, if you are taking any sort of supplement that has zinc in it, I mean, zinc comes in nuts and seeds and a variety of foods.

But if you are taking a supplement, make sure you take it with food because it also can cause a lot of nausea.

[00:24:02] Tina:yes, yes. Yeah. Unfortunately, in nature, the, the largest concentration happens to be, uh, clams and oysters and things that little. Crustaceans on the bottom there, which is also where a lot of our heavy metals and, and you know, kind of toxic compounds can live. So if you do get it from shellfish, then uh, be careful that it's cleanly sourced.

[00:24:24] Leah: yeah, I'm just thinking about like if you're coming out of chemo. Maybe you might not have a taste for shellfish. I don't know. But that's why I always like 

[00:24:31] Tina:Well, yeah, yeah, yeah, 

[00:24:34] Leah: that

[00:24:35] Tina:yeah.

[00:24:36] Leah: are, are nice sources of that. Um, 

[00:24:39] Tina:I. 

[00:24:39] Leah: think of any other nutrients?

[00:24:41] Tina:Nutrient wise, vitamins and minerals 

less 

so I'm thinking about quercetin and rutin and those, those are bioflavonoids that are needed and have been shown to be helpful for healing of tissue. So I did I would routinely do a supplement that had quercetin in it. on the other side of surgery. I didn't care so much going into the surgery, but there's evidence coming on on the other side of it that it. Promotes proper healing. 

And 

I remember coming across one study that was specific to people who tend to form keloids. So if you're a keloid former, which is basically a, a scar, you know, a scarification on the, on the skin and it ends up being kind of a convex, right? quercetin was shown to lessen keloid formation in people come recovering from surgery.

So I thought that was kind of like, I would just put it in there as a routine piece. For recovery.

[00:25:34] Leah: Oh, and that kind of takes, there's one more major nutrient, which we haven't discussed, but talking about the quercetin. there was some research looking into taking vitamin C, reducing the risk of complex regional pain syndromes.

[00:25:51] Tina:Hmm.

[00:25:52] Leah: like you mentioned, like maybe taking a little additional vitamin C is a pretty good thing because that can 

[00:25:57] Tina:Yeah. 

[00:25:58] Leah: after surgeries.

And so making sure that you are getting in a lot of those vitamin C rich foods and then maybe taking an extra supplement, 

[00:26:04] Tina:Yeah.

[00:26:05] Leah: be an important thing to do. Um, can you guess the ones, the one nutrient we did not discuss that is probably the most important.

[00:26:14] squadcaster-1ejg_1_01-15-2026_105120: Most 

[00:26:14] Tina:important. Most

important, besides

protein. we, said protein, right? 

[00:26:20] Leah: about protein?

[00:26:21] Tina:Oh, I guess we

didn't. 

[00:26:23] Leah: protein?

[00:26:24] Tina:we did it. We did it kind of in a backdoor

way, 

 so protein would probably be the most important. And so that's where in one of those, um, you're not able to take in or, you know, like the volume of food for whatever reason, finding like a really good, supplemental protein source. Like, 

Yep. 

[00:26:47] squadcaster-1ejg_1_01-15-2026_105120: I. 

[00:26:47] Leah: Orain, I like Kate's farm.

I think Kate's farm is still out there.

[00:26:50] Tina:Yep. And the nice thing about those is insurance will cover them sometimes. And I know Kate's Farm will work with people to help get insurance to cover it as a medical food.

Both of those do. Yeah. So you can call their 800 number. They're both very, you know, open and try and, and advocate for patients because they want to sell their product, but also because they believe in what they're

doing.

So. Yeah. 

[00:27:11] Leah: and then I know Orgain also has like a way based one as well, 

[00:27:15] Tina:Yeah, and and collagen is one. We should talk about two because it has almost all of the amino acids, but it is missing one essential amino acid, which is why we don't consider it a protein supplementation. Collagen hydrolyzed collagen, which means they've broken down a long collagen molecule into pieces, and they're usually. Two, three, maybe a few more peptides, uh, amino acids. So you've got peptides that come outta the collagen. That's what hydrolyzed collagen is, is small chains of amino acids. It's missing tryptophan, so we can't call it a protein supplement because you need tryptophan. but that said, collagen has its own possible role here in increasing the manufacturing of, 

of 

more collagen, basically working on the fibroblasts to help collagen get laid down in your own body. There's 27 different types of collagen in the body. So what collagen does is some of those two and three, uh, amino acid chains, those little dye and tripeptides go in and tell your system to make more.

So through your fibroblasts, it actually signals the fibroblasts. They can say, go ahead and make more collagen in this tissue. And whether that's, you know, like I said, there's 27 different types of collagen. so. How it doesn't, it's not, there is no, uh, it's not as exact as a drug, but I can tell you that that is what happens with collagen.

It does help collagen begets collagen.

[00:28:39] Leah: and there is a product that probably is also covered by, I don't know of insurance, but at least your FSA will cover it and it's Juven

[00:28:49] Tina:Mm-hmm.

[00:28:49] Leah: and I actually took that around all of my breast surgeries.

[00:28:54] Tina:Okay.

[00:28:54] Leah: It was something that would definitely recommend for, you know, patients getting even larger surgeries and that has collagen, it has a bunch of nutrients in it, and they're flavored, which I did not try.

But then there's the unflavored and I would just put that in a smoothie and you gotta drink it fast 'cause collagen congeals, and so it 

[00:29:13] Tina:Yes. 

[00:29:14] Leah: this gelatinous. So if you don't like really slug it back, it's a little hard to take. But 

[00:29:19] Tina:yeah, 

[00:29:20] Leah: I, I thought was a great product.

[00:29:22] Tina:And for those the other nutrients, I just wanna put an honorable mention, 'cause I kind of said it in a indirect way, like go in, replete in everything but the other nutrients. We're not gonna give a lot of time to magnesium. You need some copper, you need some vitamin E. Those nutrients are absolutely necessary for healing a wound. So depletion or, or, or deficiency of any of these nutrients is gonna be the worst thing to happen. Deficiency in protein or any of the vitamins and minerals. So without going into great detail on those, 'cause again, we have whole episodes on some of those. but suffice to say, go in making sure there is no, there is no deficiency of any nutrients and you should come out the other side in better shape than those who don't pay attention to that. 

[00:30:10] Leah: you know, some of those nutrients that you just mentioned, the, the minor ones. Again, I don't know why I'm stuck on nuts and seeds, I think, 'cause I have a little bowl out in the counter that has a bunch of mixed nuts in it, so I'm obsessed right now. um, yeah, a lot of those are found in nuts and seeds.

So

[00:30:24] Tina:Mm-hmm.

[00:30:24] Leah: you go. Blend those into your, your magical surgical smoothie.

[00:30:29] Tina:Yeah. And fresh is best with nuts and seeds. So wherever you live, look nearby. So walnuts, pecans. What, what grows near you can actually, you can often get those from local purveyors? I don't know, just in season and, and those oils are still intact,

right? so my,

[00:30:47] Leah: mine,

[00:30:48] Tina:yeah.

[00:30:48] Leah: When you open up a package, if you're not able to get them. Fresh 

[00:30:52] Tina:Hazelnuts. 

[00:30:53] Leah: from a, hazelnut farmer in Oregon. Just, put 'em in a jar or in a bag and stick 'em in your fridge to, 

[00:30:59] Tina:Yeah. But there's. Yeah, and, and like flax seeds too, like if you, if it, if they smell off, then they are off,

then don't eat 'em. 

[00:31:07] Leah: The ground ones. Yeah. The, the, the whole ones for, those don't need to be in the fridge, but we 

[00:31:13] Tina:I, right.

[00:31:15] Leah: Wow. This 

[00:31:15] Tina:I, this is what happens when you

have a, this is what you have, there are over a hundred episodes. I guess. We've talked about a

lot of things in detail. 

[00:31:22] Leah: putting 'em all together. This is the compilation.

[00:31:24] Tina:This

is it. 

[00:31:25] Leah: one thing I think that isn't talked about a lot, and it was something that I did experience personally as well as with my patients, is exercise physical therapy or occupational therapy 

[00:31:36] Tina:Mm-hmm. Yeah.

[00:31:38] Leah: I think one of the best things that I was offered I had neuropathy following chemo and so I was working with PT and OT anyways. And because you know, you're a fall risk with neuropathy and then after 

[00:31:54] Tina:Yeah. 

[00:31:55] Leah: fall risk. So they also worked with, and you know, they actually came to my room while I was still inpatient because back then you would be impatient for a day following 

[00:32:05] Tina:Mm-hmm. Yeah. 

[00:32:06] Leah: they were like, we're putting her, we're locking her up. But they had these devices to show me like, you can't reach your arm up. You can't put your socks on. And so they showed me ways of 

[00:32:19] Tina:Hmm. 

[00:32:20] Leah: around that. 

[00:32:22] Tina:Oh, interesting. 

[00:32:23] Leah: helped, because after surgery, once you're allowed to put your arms up, like they gave you the exercises to crawling up the wall like in the shower for mobility in your shoulder, because with 

[00:32:34] Tina:Yep. 

[00:32:35] Leah: and upper body surgeries, that is often an issue.

And 

[00:32:38] Tina:Mm-hmm. 

[00:32:39] Leah: seeing if you can get a referral. You know, a lot of surgeries, not just breast surgeries, but there are other surgeries where you're at risk for lymphedema. So like if you had radiation to your head and neck, or you're getting a head and neck surgery, you can get lymphedema 

[00:32:53] Tina:Yeah. 

[00:32:53] Leah: and then for in, you know, in your, in the lower part of your body, if you're having a gynecologic surgery, you may be at risk also if they're removing lymph 

[00:33:02] Tina:Yep. 

[00:33:02] Leah: So being proactive.

[00:33:06] Tina:Mm-hmm.

[00:33:07] Leah: If you are told there's a possible risk and trying to meet with physical and occupational therapy before and after.

[00:33:14] Tina:I think that's a really good idea. I think. Uh, before especially 'cause after you're kind of recovering, right? I mean, it's a little hard. I think doing a little prep before and having them tell you and knowing what to watch out for and already having a relationship with the therapist. I think those, I think it's a really good idea. Um, and they might give you some, like you said, some things to do before just to prep for the surgery.

[00:33:37] Leah: and I think that that was one of the things that I really. about where I was working was I was able to refer people to, even to Lake Speech therapy 

[00:33:48] Tina:Mm-hmm. 

[00:33:48] Leah: they be familiar with speech therapy if it was gonna affect their swallowing afterwards.

You know, they would establish a relationship beforehand and kind of be prepared for what they were about to, you 

[00:33:59] Tina:Yeah. And I think the most important thing when you have to advocate for yourself, which is, you know, you and I had the privilege of working for hospitals that were very proactive and very patient centered, and people who are in community clinics around the country, and I'm sure around the world, don't get that kind of proactive personalized attention. So advocating is something that I think is best done by a loved one. You know, if you can delegate, whether that's your spouse, your mother, your sister, your brother, your daughter, it doesn't matter. But somebody who is good at advocating already 'cause these people exist and then just having them advocate for you and with you kind of helps. It helps a lot. 'cause I think it's exhausting to help to self advocate all the time.

[00:34:46] Leah: Oh, absolutely. Because I feel like as a cancer patient, you are doing that Anyways.

[00:34:51] Tina:Yeah. Yeah, I mean, 'cause as we're talking about this, I'm thinking, you know, there's only so much bandwidth someone has to do these things. I mean, you have to actually be the participant in going to see the therapist and stuff. So be nice if, if there is a small hurdle to getting that order from your doctor or however you have to obtain it, wherever you are, if someone else is doing that for you or, and with you.

Um. Because it's just on a to-do list. It just, it gets too overwhelming, I think.

Yeah. 

[00:35:18] Leah: And then even, you know, talking to someone, because there are more and more cancer centers that are starting these, um, you. Know cancer specific exercise programs and so

[00:35:27] Tina:Mm-hmm.

[00:35:27] Leah: you, if you are getting a surgery where you're restricted in any way, your muscles will start to decondition. And so making sure that you are, if you are able and you're cleared to work on.

training, you know, doing some aerobic exercise, whether it's 

[00:35:46] Tina:Mm-hmm. 

[00:35:47] Leah: um, cycling, with the 

[00:35:49] Tina:Yeah. 

[00:35:50] Leah: it could even be like resistance spans. And then 

[00:35:53] Tina:Yeah. 

[00:35:53] Leah: on balance as well, because sometimes you take medications after surgery and it could, you know, make you off balance or just for whatever reason.

So, doing a well-rounded exercise program, I.

[00:36:05] Tina:Yeah, I agree. And, and they're still being researched. So there are exercise programs out there within the oncology sphere, where people can partake for free or even get paid to be part of the research. Depending where you are. So if your community clinic is doing the treatment, that's fine. You can just look to see if there's an academic center nearby.

If you have a city center or a large college, they're most likely to be doing it. Um, so yeah, look, look around, you know, clinical trials.gov and put in some key words like exercise. Put your can under your cancer, um, and start looking to see if there's somebody nearby doing it. 'cause there, there's a lot of research going on in this field right

now. 

[00:36:44] Leah: really hot right now.

[00:36:46] Tina:Yeah.

[00:36:46] Leah: , And then kind of on the opposite side of exercise would be certain energy conservation techniques and the one that I always remembered that I was given. Was, you know, like having a sort of a bar stool that you could pull up when you're doing things like doing the dishes or like sitting down when you're folding clothes, like

[00:37:03] Tina:Hmm. 

[00:37:03] Leah: using your energy sparingly because 

[00:37:06] Tina:Mm-hmm. 

[00:37:08] Leah: it is exhausting and it 

[00:37:10] Tina:Yeah, 

[00:37:11] Leah: a while to recover.

And so kind of focusing, you know, like exercise is good, but so is energy conservation.

[00:37:18] Tina:it's interesting that you say that 'cause I distinctly remember it's very frustrating when people don't get their energy back as quickly as

they'd like to. but what you cannot see. Is how much energy it takes to heal from your treatment. I don't care if it's chemo radiation or surgery, and in this case we're talking about surgery, but it's an extraordinary amount of energy as in ATP as in sugars and amino acids and the cellular, you know, actual manufacturing of new cells to lay them down and recover your 

 red blood cell counts and your white blood cells are working hard, like they're, and they're getting. Pulled outta your system by your spleen and you know, there's a lot, lot, lot going on that you cannot perceive, but you do indirectly in being tired. And so if you are tired, you do need to listen to your body and, and if it's energy packets in a day, I do like that idea of energy packets. A lot of them are being used just to heal, so it leaves you with less energy packets to do your day-to-day activities. So you do, I think that's a good idea. Be careful, don't, don't push it too hard because then you're gonna leave the healing. Packets

wanting, right? So if you push yourself too hard, you're not gonna heal

well. Yeah.

[00:38:26] Leah: And I, I actually recently saw a post on some social media app about someone was saying that they were recovering from surgery and how long, you know, how long is this gonna take for me to start to feel kind of 

[00:38:39] Tina:Yeah. 

[00:38:40] Leah: And I think that's what kind of inspired me for this episode was 

[00:38:43] Tina:Mm-hmm. 

[00:38:43] Leah: really haven't talked about that.

I do wanna add in. Some like hot tips for like when you're in the hospital,

[00:38:50] Tina:Mm-hmm. Okay.

[00:38:51] Leah: so I recommend that everyone bring in eye mask and earplugs 

[00:38:56] Tina:Oh yeah. 

[00:38:58] Leah: never get dark if you're gonna be inpatient for a while. And yeah, earplugs, there's always some sort of noise. You can also freak 

[00:39:06] Tina:Yeah, 

[00:39:06] Leah: because you have earplugs 

[00:39:07] Tina:I, 

[00:39:08] Leah: and they try to wake you to take your blood pressure in the middle of the night and then you don't stir and they kind of freak out.

So, um, let them know that you're gonna be wearing earplugs.

[00:39:16] Tina:yeah. Right.

[00:39:17] Leah: 'cause Yeah, I did that to my nurses, so 

[00:39:20] Tina:Now that's a really, that is a good one. 'cause sleep is so important about in, in recovering. So yes, our body repairs tissue and does it's, most of it's repair work and replenishment while we sleep. So without sleep you are more likely to have infections 'cause it's immune suppressive to be sleep deprived and you're more likely to have complications in general.

So yeah, sleep.

Good idea. 

[00:39:45] Leah: Like I said, especially if you're gonna be inpatient. something else that I brought in with me inpatient, um, was a peppermint essential pe peppermint oil inhaler. That helps with 

[00:39:56] Tina:Mm-hmm. Mm-hmm. 

[00:39:58] Leah: and I'm so glad I had that. I also. Asked my husband to make sure there was ginger ale nearby

[00:40:06] Tina:Mm-hmm.

[00:40:07] Leah: just in case, and I needed it.

I mean, I just 

[00:40:10] Tina:Yeah. 

[00:40:10] Leah: like in this delirium, and like I said, they, they, uh, admitted me because I was so nauseated after surgery from the anesthesia,

[00:40:20] Tina:Yeah.

[00:40:20] Leah: and I was just like. Like, oh, I think I'm gonna get sick. Do you have ginger ale? Like, just in this like complete delirium. Like, and they did like, so make sure that 

[00:40:29] Tina:Yeah, 

[00:40:29] Leah: your caregiver for 

[00:40:30] Tina:I, 

[00:40:31] Leah: if you can take things by mouth afterwards, obviously that's the big thing.

[00:40:36] Tina:yeah. 

[00:40:36] Leah: where your surgery is. But yeah, see if they can have like ginger ale or ginger tea or something available for you to kind 

[00:40:43] Tina:Yeah. 

[00:40:43] Leah: I mean, I have medications too. There are definitely medications, but I. Was having complications from my medications. I was so 

[00:40:51] Tina:Yeah, 

[00:40:52] Leah: So yeah, I just 

[00:40:53] Tina:I,

[00:40:53] squadcaster-1ejg_1_01-15-2026_105120: I, 

[00:40:53] Leah: a little bit of ginger ale and then I had my peppermint inhaler and that actually helped.

And the fewer 

[00:40:58] Tina:yeah. 

[00:40:58] Leah: take, you know, 

[00:41:00] Tina:Yep. 

[00:41:01] Leah: that you need to take, you know, if you need them, obviously take them. 

[00:41:04] Tina:Yes, of course. Yeah.

[00:41:05] Leah: And then there was something else that our dieticians recommended for patients. And again, this is all if you could take things by mouth after surgery, but if you are constipated after surgery, depending on your, your surgeries, obviously ask before you do this.

But chewing gum post-surgery can help with stimulating your gut and, having a 

[00:41:25] Tina:Yeah, 

[00:41:26] Leah: So that's, that's something else that taking a lot of pain meds, you could try chewing some gum. 

[00:41:31] Tina:that's a good idea. 

[00:41:33] Leah: and then acupuncture, we always forget acupuncture, but acupuncture, before and after surgery I think is really helpful.

After surgery can help with pain and and it helps reduce anxiety even before surgery. they don't typically do that 

[00:41:48] Tina:Yep. 

[00:41:48] Leah: hospitals and they don't typically do that inpatient. But yeah, getting acupuncture, once again, I'm gonna use that word, perioperatively. 

[00:41:59] Tina:Mm-hmm. 

[00:41:59] Leah: really helpful.

[00:42:01] Tina:Yeah, I like, I like all of those and 

ginger 

people, which we've, we've mentioned here before on other episodes, ginger people make a bunch of different products from chews to little sodas and ginger. People use real ginger in their products. I think they, they make the Jen engines the little hard

candies. 

[00:42:19] Leah: favorite, 'cause we used to have those at the cancer center and I didn't really care for those. My 

[00:42:23] Tina:Mm-hmm. Mm. 

[00:42:25] Leah: drops, I think are delicious.

[00:42:27] Tina:Yeah. The Jen engines are intense.

[00:42:29] Leah: And there are they?

[00:42:29] Tina:They're almost

hot. 

[00:42:31] Leah: And 

[00:42:31] Tina:The, 

[00:42:31] Leah: they're, yeah. The tummy drops too. I, that's my, that's my favorite. Um,

[00:42:37] Tina:yeah. Remember reed's

ginger ale? 

[00:42:39] Leah: It's still around.

[00:42:40] Tina:Is it

still around? Oh, okay.

[00:42:43] Leah: Uh, you're not gonna 

[00:42:44] Tina:I haven't seen it. 

[00:42:45] Leah: any hospitals. I think. I, I wonder if they used to have that at CTCA. I can't remember. , And then. Something else that I was reading that could be very helpful.

And this is all, you know, this is all part of when you go to a multidisciplinary integrative cancer center, you will find a lot of these things. But even somebody like a mind body counselor, 

[00:43:06] Tina:Yeah,

[00:43:07] Leah: on your surgery, there's a lot of stuff around that. And so dealing with that psychosocial aspect.

[00:43:14] Tina:I

agree. 

[00:43:15] Leah: before and after surgery is so important,

[00:43:19] Tina:Yeah.

[00:43:19] Leah: that's something we don't really talk a ton about on this podcast. I think we need to like, find more 

[00:43:24] Tina:Yeah. 

[00:43:24] Leah: of, you know, to go there. 

[00:43:26] Tina:You know, what'd be nice to talk to is an anesthesiologist. I'd be interested to know exactly like how does that, what happens when we go on,

So, so do you know one,

maybe we should get that person on the show. 

[00:43:37] Leah: a friend of mine from when I was in the fifth grade. Yeah.

[00:43:42] Tina:That's

awesome 

[00:43:42] Leah: I can ask her. Totally. I know 

[00:43:45] Tina:because, so it's an interesting thing. I mean, I've had surgeries before and only once have I had to go under, but I found that that was the most stress inducing part of the entire thing. Not the surgery, not even the recovery. I didn't like the idea of being completely outta control and under somebody's somebody else's control.

[00:44:01] Leah: interesting.

[00:44:02] Tina:I didn't. Being under and being completely out is what freaked me out more than anything

else. 

[00:44:08] Leah: See, I was excited 'cause I'd never been, people were like, you never had anesthesia, you know, anesthesia for dental worker, nothing. And so 

[00:44:15] Tina:mm 

[00:44:15] Leah: like, oh. Doing that countdown. When you're like 

[00:44:19] Tina:Oh. 

[00:44:20] Leah: and they're like, countdown and you're trying to fight, you're like, whatever, 

[00:44:23] Tina:Oh yeah. See? 

[00:44:27] Leah: You 

[00:44:27] Tina:Yeah. Hmm. 

[00:44:28] Leah: everything I could possibly remember before I went 

[00:44:32] Tina:Yeah. That's funny. No, in the, in the recovery room, I was sitting bolt upright watching my, my numbers. The nurse finally came over, she's like, we're watching. 'cause my O2 SATs kept going down. And so I was like, what? Like I was, I needed to be in control of the situation, even though I wasn't at all. So, yeah. It's a, it's a control thing for sure,

for me, like 

[00:44:52] Leah: think people just in general, I mean, it is scary. The thought of being put under is scary if you've never had anesthesia. 

[00:44:58] Tina:is. 

[00:44:58] Leah: you know, people hear stories and people love to tell you stories. So, but even that, like, you know, having a a, having a mastectomy,

[00:45:08] Tina:Yeah.

[00:45:08] Leah: having sort of surgery.

[00:45:10] Tina:Well that's layered with so many

other, 

[00:45:13] Leah: you know, and 

[00:45:13] Tina:yeah. 

[00:45:14] Leah: having, you know, GI surgeries and having a hysterectomy, you know, all 

[00:45:19] Tina:Yeah. 

[00:45:19] Leah: types of surgeries, there's a lot of stuff behind that. And so finding somebody that you can speak with, whether they're somebody who is at the cancer center where you are, or finding someone outside, um, I think that's a really important aspect that also people don't always talk about around surgeries.

[00:45:37] Tina:It's one of those things that I kind of wish was just part and parcel with seeing your oncologist.

[00:45:42] Leah: I thought it 

[00:45:42] Tina:it's not. even, it isn't. No, 

[00:45:45] Leah: that's the, that's the problem with me working in integrative cancer centers is that it is.

[00:45:50] Tina:Yes it is in integrative cancer centers, but it's not in general. And most people could use it and sometimes not just the patient could use it, but their loved ones too. There's, you know, cancer's kind of something that affects

everybody in the house. 

Um, 

so it feels like. Even if there's no perceived problem, no need for it.

It should be something that people, you know, see their oncologist same day or same week. You go see the, whoever they have for that, the counselor or social worker, whatever they are, however they're trained for mind body stuff and just, just to establish the relationship so that that person can then say, I'm here if you need me, and if you wanna talk, I will be your sounding board.

And just like.

just establish it because that meeting, that first meeting, I think is the biggest hurdle. And then after that people, you know, the doors open. 

[00:46:37] Leah: And so I think even at integrative cancer centers, it's available, but you might have to request it. I don't think it's an 

[00:46:42] Tina:Yeah, 

[00:46:43] Leah: referral. So really, again, advocating 

[00:46:45] Tina:it's not. 

[00:46:45] Leah: and making sure that you do see someone, because I really find that so shocking that that's not available because my, that's my, my integrative bubble that I live in.

[00:46:57] Tina:Yeah. 

[00:46:57] Leah: was, that's just, it's given so.

[00:47:00] Tina:Yeah. And true integrative cancer centers like you and I have worked at when it was Cancer Treatment Centers of America, or you were in, in the Goshen system I

think. Right. So, they're hard to come by True integrative cancer centers. I mean, city of Hope who, um, now is Cancer treatment Centers became part of the City

of Hope system. I think they still practice what we are familiar with under the

right. 

[00:47:22] Leah: but I don't know what the, um. It used to be part of your, your first, your intake 

[00:47:28] Tina:Oh, 

[00:47:28] Leah: all of these people, and I don't think it's part anymore. 

[00:47:31] Tina:okay. 

[00:47:32] Leah: get a referral, 

[00:47:34] Tina:Yeah, 

[00:47:35] Leah: if it's part of it. Whereas at Goshen, Mind body was definitely part of your kind of intake. I, but again, I 

[00:47:42] Tina:yeah. 

[00:47:43] Leah: I'm long established at City of Hope, and so I'm, I'm beyond that, you know, that's, that's for the new patients.

[00:47:48] Tina:Yeah. 

[00:47:49] Leah: I'm not, I'm not familiar with how they're doing their intakes, but yeah, I think you can kind of create your own little integrative center if they have them, you know, like 

[00:47:58] Tina:Yeah, 

[00:47:59] Leah: integrative bubble. Um, by, by making, by advocating for yourself and to get these referrals.

[00:48:05] Tina:that's what patients did. 'cause I had my outpatient clinic, I was a naturopath and we had a dietician or nutritionist, depending. And then we had, I had a couple counselors in town that people could talk to. Um, one was specifically for, for marriage problems that happen in when people are going through treatment.

So I thought that was a

really interesting, I mean, referral because it's very unique challenges to a marriage. Um, there's a lot to unpack for that counselor. And then he was a NCI kind of researcher too, in addition to being a counselor. So it was an excellent, um, person on the team. And that's exactly what people said.

You know, they would, they created a team, they had a medical oncologist. They had me, they might have had another oncologist or surgeon, whatever, in the, the center, a nutritionist and then whoever else they wanted, acupuncture, yoga, tai chi, qigong, whatever they

like to do for body, you know, mind, body stuff. Um, yeah, it was, it was really nice because they, they saw it as they were in control. And here are, here's my healthcare team working

with me. And, and we all had the patient's, you know, interest at heart. So it was easy to, to keep. going forward and, and just never bucking heads because we had a patient in common, so we all want the same

thing. So it was really unifying

too. Yeah.

[00:49:21] Leah: And then, yeah, you do feel supported all around.

[00:49:23] Tina:Yeah. Most, that's the most important part, right? Is that the patient feels like they're getting the best of all the worlds and, and I think it helped. Outcomes. I know it did. I know it did. It wasn't even. I think it did. I know it did. So people definitely fared better when they put a team together.

[00:49:40] Leah: so. What we've talked about today, what we've covered are, you know, your macro and micronutrients that are important for recovery, from surgery and, 

starting these beforehand and then when you are able, when you're cleared to continue them afterwards. And we talked about, Exercise, physical and occupational therapy, perioperatively, I, I count how many times I say that word. It's, I'm so impressed that I'm able to say it. Um, and one thing I didn't really mention, but also try to see if, when you see PT in all of these, you know, services, like try to get a baseline 

[00:50:19] Tina:Mm-hmm. 

[00:50:19] Leah: when someone says, oh, I'm not feeling like I'm improving.

[00:50:23] Tina:Right,

[00:50:23] Leah: be like, no, actually you are, you know, so, 

[00:50:26] Tina:right. 

[00:50:26] Leah: a baseline measurement's important. and yeah, looking to get that, the mind body 

[00:50:33] Tina:Mm-hmm. 

[00:50:33] Leah: as well, I think is important. What?

[00:50:35] Tina:Yeah, there's actually, there's plenty of studies to back you up

on that. 

[00:50:40] Leah: uh, there's actually like guided imagery after surgery 

[00:50:44] Tina:Mm-hmm. 

[00:50:44] Leah: with. With pain. 

[00:50:46] Tina:Yeah. In 2025, there was a couple of studies showing that depression, anxiety, and perception of pain all went down. Whether people did Tai Chi or Qigong or whatever they did for their, like just to center themselves.

[00:51:00] Leah: great forms of movement that help with flexibility and balance as well. 

[00:51:05] Tina:Mm-hmm. 

[00:51:05] Leah: um,

[00:51:07] Tina:Yeah,

[00:51:08] Leah: is that a good summary? I can't remember what we talked about.

[00:51:11] Tina:that was, I'll call it the high points.

It wasn't a detailed summary, but we hit the,

Those are the high points. 

[00:51:16] Leah: All right,

[00:51:17] Tina:Yeah, that's, that's what, um, rewind is good for. People could always rewind if they didn't

catch something. 

[00:51:22] Leah: So on that note, I'm Dr. Leah Sherman,

[00:51:25] Tina: And I'm Dr.

Tina Kaczor, 

[00:51:26] Leah: the Cancer Pod. 

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