What happens to the body when the host has no time to prepare?
I am a 69-year-old white female in relatively good health and not on any prescription drugs who had a robotic cholecystectomy in March. I am one of the unfortunate ones that was diagnosed with postcholecystectomy syndrome post-op. Ten days ago, I had a sudden onset of excruciating pain in my lower abdomen and thigh and went to the ER. I ended up having an obturator hernia with a piece of small bowel trapped inside and underwent emergency surgery to repair the hernia and relieve the blockage. Every day feels like a slog. I am off narcotics and just taking Tylenol. I walk twice a day in the sun. I’m eating four meals a day to try to gain some weight. I’m sleeping about 6 to 7 hours a night. I pray and meditate. I still feel like crap. Are there any other suggestions for the postoperative period other than what I’ve been doing or is it just tincture of time as one of my favorite intensivists used to say?
I wrote this piece with cancer surgery in mind, where the goal is blunting a metastatic window. Recovery from postcholecystectomy syndrome is a different beast, more about your gut adapting to losing the gallbladder's bile reservoir. This is not medical advice, but things I would explore with your own doctor: smaller lower-fat meals, digestive support like ox bile or enzymes, soluble fiber, and a look at whether bile acid malabsorption is driving symptoms. Pharm options I would raise with your physician: a bile acid sequestrant like cholestyramine or colesevelam if bile acid diarrhea is driving it, an antispasmodic like dicyclohexamine or hyoscine for cramping, and a short trial of a PPI or bile acid supplement depending on whether your symptoms point to acid or bile.
Excellent perspective! As a physician-scientist, I think the perioperative period is one of the most underappreciated windows in cancer care. While surgery is often the cornerstone of curative treatment for solid tumors, the days before and after an operation also represent a period of profound physiological change that can influence recovery and, potentially, long-term outcomes.
The body’s response to surgery involves coordinated immune activation, inflammation, wound healing, metabolic adaptation, and neuroendocrine signaling. Optimizing factors such as nutritional status, physical conditioning (“prehabilitation”), glycemic control, sleep, and postoperative mobilization can improve resilience and reduce complications. Increasingly, research is exploring how this perioperative environment may also influence tumor biology, although many questions remain about which interventions meaningfully affect recurrence and survival.
I also appreciate the growing emphasis on preparing patients rather than simply operating on them. Surgery shouldn’t be viewed as a single event but as one phase within a continuum of care. Helping patients enter the operating room in the best possible physiological condition may be just as important as the technical success of the procedure itself.
The future of surgical oncology will likely become increasingly personalized, integrating molecular tumor profiling, perioperative optimization, enhanced recovery protocols, and precision supportive care. It’s an exciting shift from focusing solely on removing the tumor to optimizing the biology of the patient throughout the entire treatment journey.
Yes to prehabilitation re-framing! WSurgery is one phase in a continuum, not a standalone event. I believe the next real gains come from optimizing the patient's biology around the operation, not just the technical resection. Thanks for adding this.
Thanks for sharing this. I haven’t looked at the research on this yet but it made me think chemo might do something similar. My tumor markers spiked right after chemo and then dropped back down a week or two later, even though they weren’t high to begin with.
Something I’ve been wondering about is propranolol. It’s mentioned everywhere but hardly anyone talks about the fact that it’s a blood pressure medication. In my case it made my blood pressure go up and down because it’s so short-acting. It has to be taken twice a day (unless it’s a time-released version which doesn’t exist in all countries). How does this effect come into play then when it comes to surgery and anesthesia?
Great questions!!! Chemo can do the same: dying tumor cells dump their contents into the blood, so markers flare for a week or two before dropping. On propranolol, the short half-life and BP swings are exactly why the trial protocol used the slow-release form, titrated up to surgery day and tapered after, all anesthesia-supervised. Never stop it abruptly around surgery, since rebound is riskier than staying on it.
Nice article and agree there may be an important signal here. If I have any reason to prescribe propranolol around surgery I’m typically doing that, also carefully thinking about anesthesia risks for folks with cardiac conduction issues or borderline BP.
Agree we need to move forward with bigger studies. I think we could ask one of the ctDNA companies like Natera to sponsor something like this. They are already doing major studies with celecoxib in the colorectal cancer setting. They would have a vested interest in anything that shows ctDNA clearance is improved as we know that correlates with outcome.
Otherwise, The funders would probably need to be the NCI, cooperative groups, major cancer foundations, or philanthropy specifically interested in high-value low-cost interventions.
Love the Natera angle! I didn’t know about their research with celecoxib in colorectal, adding a beta blocker arm is a small ask with real upside for them and us/me. Thanks for reading and your thoughtfulness, always!
What happens to the body when the host has no time to prepare?
I am a 69-year-old white female in relatively good health and not on any prescription drugs who had a robotic cholecystectomy in March. I am one of the unfortunate ones that was diagnosed with postcholecystectomy syndrome post-op. Ten days ago, I had a sudden onset of excruciating pain in my lower abdomen and thigh and went to the ER. I ended up having an obturator hernia with a piece of small bowel trapped inside and underwent emergency surgery to repair the hernia and relieve the blockage. Every day feels like a slog. I am off narcotics and just taking Tylenol. I walk twice a day in the sun. I’m eating four meals a day to try to gain some weight. I’m sleeping about 6 to 7 hours a night. I pray and meditate. I still feel like crap. Are there any other suggestions for the postoperative period other than what I’ve been doing or is it just tincture of time as one of my favorite intensivists used to say?
I am so sorry you are dealing with this now!
I wrote this piece with cancer surgery in mind, where the goal is blunting a metastatic window. Recovery from postcholecystectomy syndrome is a different beast, more about your gut adapting to losing the gallbladder's bile reservoir. This is not medical advice, but things I would explore with your own doctor: smaller lower-fat meals, digestive support like ox bile or enzymes, soluble fiber, and a look at whether bile acid malabsorption is driving symptoms. Pharm options I would raise with your physician: a bile acid sequestrant like cholestyramine or colesevelam if bile acid diarrhea is driving it, an antispasmodic like dicyclohexamine or hyoscine for cramping, and a short trial of a PPI or bile acid supplement depending on whether your symptoms point to acid or bile.
Thank you so much.
My brother-in-law has metastatic kidney cancer, and I am passing along your column to his wife who does a lot of research for him.
He is having a Y 90 procedure at Emory next week because he has a pretty significant liver metastasis.
Excellent perspective! As a physician-scientist, I think the perioperative period is one of the most underappreciated windows in cancer care. While surgery is often the cornerstone of curative treatment for solid tumors, the days before and after an operation also represent a period of profound physiological change that can influence recovery and, potentially, long-term outcomes.
The body’s response to surgery involves coordinated immune activation, inflammation, wound healing, metabolic adaptation, and neuroendocrine signaling. Optimizing factors such as nutritional status, physical conditioning (“prehabilitation”), glycemic control, sleep, and postoperative mobilization can improve resilience and reduce complications. Increasingly, research is exploring how this perioperative environment may also influence tumor biology, although many questions remain about which interventions meaningfully affect recurrence and survival.
I also appreciate the growing emphasis on preparing patients rather than simply operating on them. Surgery shouldn’t be viewed as a single event but as one phase within a continuum of care. Helping patients enter the operating room in the best possible physiological condition may be just as important as the technical success of the procedure itself.
The future of surgical oncology will likely become increasingly personalized, integrating molecular tumor profiling, perioperative optimization, enhanced recovery protocols, and precision supportive care. It’s an exciting shift from focusing solely on removing the tumor to optimizing the biology of the patient throughout the entire treatment journey.
Thanks again!
Yes to prehabilitation re-framing! WSurgery is one phase in a continuum, not a standalone event. I believe the next real gains come from optimizing the patient's biology around the operation, not just the technical resection. Thanks for adding this.
Thanks for sharing this. I haven’t looked at the research on this yet but it made me think chemo might do something similar. My tumor markers spiked right after chemo and then dropped back down a week or two later, even though they weren’t high to begin with.
Something I’ve been wondering about is propranolol. It’s mentioned everywhere but hardly anyone talks about the fact that it’s a blood pressure medication. In my case it made my blood pressure go up and down because it’s so short-acting. It has to be taken twice a day (unless it’s a time-released version which doesn’t exist in all countries). How does this effect come into play then when it comes to surgery and anesthesia?
Great questions!!! Chemo can do the same: dying tumor cells dump their contents into the blood, so markers flare for a week or two before dropping. On propranolol, the short half-life and BP swings are exactly why the trial protocol used the slow-release form, titrated up to surgery day and tapered after, all anesthesia-supervised. Never stop it abruptly around surgery, since rebound is riskier than staying on it.
Thanks for clarifying. I regret to this day doing the one and only chemo that nearly killed me and shed CTCs into the bloodstream.
Nice article and agree there may be an important signal here. If I have any reason to prescribe propranolol around surgery I’m typically doing that, also carefully thinking about anesthesia risks for folks with cardiac conduction issues or borderline BP.
Agree we need to move forward with bigger studies. I think we could ask one of the ctDNA companies like Natera to sponsor something like this. They are already doing major studies with celecoxib in the colorectal cancer setting. They would have a vested interest in anything that shows ctDNA clearance is improved as we know that correlates with outcome.
Otherwise, The funders would probably need to be the NCI, cooperative groups, major cancer foundations, or philanthropy specifically interested in high-value low-cost interventions.
Love the Natera angle! I didn’t know about their research with celecoxib in colorectal, adding a beta blocker arm is a small ask with real upside for them and us/me. Thanks for reading and your thoughtfulness, always!
They have been a fabulous company to work with. Here’s one of the studies I’m referencing:
https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FNews-NSAID