FreeWill88 said...
....................................
Wondering if others have thoughts on this? Taking the surgery decision as a given -- would you stick with April 6, defer to mid-May, or wait even longer to see how the pandemic continues to develop? Obviously it'll be my call and my doc's to make, but I'd be grateful for any feedback.
Is surgery a given? Leaving aside at the moment all of the debates of surgery vs RT as first line treatment, it is certain that your body's immune system will be under major stress during, and for some time after, surgery. If you are exposed to Covid-19, you certainly want your immune system at peak performance in hopes of fighting off infection, or if infected recovering from the disease.
I hesitate to say this, but I must, so please just forgive me in advance, brothers. And I realize I might be wrong. But, since vitamin C is a major player with the function of our immune systems, personally, I would at least consider(but ask your doctors of course) plenty of Vitamin C, preferably liposomal(assuming you can even find either kind now) both for the days before and after surgery. High blood levels of vitamin D3 are not going to hurt in that department either. If interested, a few studies re: Vit C are supplied below, if not,
just skip it, or just read what is emphasized in bold. I feel they indicate, overall, that keeping vitamin C levels up, especially while recovering from surgery, harms little or nothing and may well be helpful. You can decide, along with your doctors advice. This is out of Japan, but I think they also have fully modern medicine there, just like here:
https://www.ncbi.nlm.nih.gov/pubmed/20689415"Format: Abstract
Send to
Curr Opin Clin Nutr Metab Care. 2010 Nov;13(6):669-76. doi: 10.1097/MCO.0b013e32833e05bc.
Vitamin C requirement in surgical patients.
***ushima R1, Yamazaki E.
Author information
1
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
[email protected]Abstract
PURPOSE OF REVIEW:
To summarize recent findings on vitamin C status and assess the requirement and optimal dose of supplementation in surgical patients.
RECENT FINDINGS:
Blood vitamin C concentration falls after uncomplicated surgery and further decreases in surgical intensive care unit patients. The decline may be owing to increased demand caused by increased oxidative stress. To normalize plasma vitamin C concentration, much higher doses than the recommended daily allowance or doses recommended in parenteral nutrition guidelines are needed in these patients. 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. In uncomplicated gastrointestinal surgery, continuous parenteral administration of 500 mg/day of vitamin C reduced postoperative oxidative stress as manifested by reduced urinary excretion of isoprostane. In some studies, postoperative atrial fibrillation was prevented after cardiac surgery by perioperative vitamin C supplementation. In critically ill patients, some prospective randomized controlled trials support parenteral supplementation of high doses of vitamin C, E and trace elements.
SUMMARY:
Vitamin C requirement is increased in surgical patients, and the potential advantage of supplementation is to increase the plasma and tissue levels of vitamin C and thereby reduce oxidative stress. Although some clinical benefits of high-dose vitamin C supplementation have been shown in the critically ill, the optimal dose for supplementation and the clinical benefits remain to be investigated in surgical patients........."
This one is out of Germany and Canada. Results are mixed:
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6115862/"
1.4. Current Evidence of Vitamin C in Critically Ill Patients
Sepsis, trauma, burn and surgery are causes of systemic inflammatory responses and can lead to similar pathologies in the human body, including microvascular dysfunction, refractory vasodilatation, endothelial barrier dysfunction, edema and disseminated intravascular coagulation [45]. Vitamin C concentrations are lowered in critical illness [46], in patients recovering from surgery [47,48], in patients after cardiac surgery [49] and especially in patients heading towards multi-organ failure [19,50].
Fowler et al observed a lower rate of organ dysfunction as assessed by the sequential organ failure assessment (SOFA) score and a reduced 28-day mortality after the application of vitamin C in patients with sepsis and multi-organ-failure, whereas an influence on the ICU-LOS was not observed [51]. Zabet et al. demonstrated in 2016 patients a significantly reduced mean vasopressor demand and shorter duration of vasopressor therapy and reduced mortality in 28 septic patients receiving vitamin C [52]. In 2002, Nathens et al. observed a decreased risk of pneumonia, acute respiratory distress syndrome (ARDS) and a tendency towards lower alveolar inflammation in a randomized controlled trial (RCT) of antioxidant supplementation (1 g vitamin C and 1.000 IU vitamin E intravenously three times per day for up to 28 days) in mostly trauma patients (n = 595), although the results of this RCT did not reach statistical significance [53]. In severe burn patients, ascorbic acid reduced fluid demand and increased urine production, in a retrospective review by Kahn et al. [54] and in an RCT by Tanaka et al. [55]. In fact, the application of vitamin C is frequently considered in the treatment of severe burn patients [56]. While an overview of the influence of vitamin C on organ dysfunction is summarized in Table 1, Section 2 will take a closer look at each individual organ system..............
5. Practical Approach to Vitamin C Supplementation
5.1. Risks and Side Effects
As demonstrated above, many studies have supplemented vitamin C,
but significant adverse effects on patients in short term use have not yet been reported. This is true for low, as well as for dosages of 200 mg/kg/day and up to extremely high dosages of 1500 mg/kg three times a week in cancer patients [49]. Possible adverse effects are related to dosage, enteral route, and duration of vitamin C supplementation and include:
Diarrhea and abdominal bloating [27]
False negative tests for gastrointestinal occult bleeding [27]
Aggravation of iron overload in patients with hemochromatosis or other diseases requiring frequent blood transfusions, such as thalassemia major and sideroblastic anemia [27]............................"
https://www.ncbi.nlm.nih.gov/pubmed/30934660 "Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis................In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003).
In six trials, orally administered vitamin C in doses of 1⁻3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail..."
A different view:
https://www.ncbi.nlm.nih.gov/pubmed/30839358"CONCLUSIONS:
In a mixed population of ICU patients, vitamin C administration is associated with no significant effect on survival, length of ICU or hospital stay. In cardiac surgery, beneficial effects on postoperative atrial fibrillation, ICU or hospital length of stay remain unclear.
However, the quality and quantity of evidence is still insufficient to draw firm conclusions, not supporting neither discouraging the systematic administration of vitamin C in these populations. Vitamin C remains an attractive intervention for future investigations aimed to improve clinical outcome."Finally, in treatment of Sepsis(many Covid-19 victims are dying of sepsis):
https://journal.chestnet.org/article/s0012-3692(16)62564-3/fulltext"The pr
opensity adjusted odds of mortality in the patients treated with the vitamin C protocol was 0.13 (95% CI, 0.04-0.48; P = .002). The Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure. All patients in the treatment group were weaned off vasopressors, a mean of 18.3 ± 9.8 h after starting treatment with the vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 h in the control group (P < .001).
Conclusions
Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, are effective in preventing progressive organ dysfunction, including acute kidney injury, and in reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings............".