Mushroom safety; medical folk advice; eating after surgery: Upstate Medical University's HealthLink on Air for Sunday, June 23, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a medical toxicologist urges caution in eating mushrooms, since edible varieties can resemble toxic ones.

Michael Hodgman, MD: ... One of the most important pieces of information that we want to know at the poison center, if somebody has an illness following a meal that had a mushroom in it is the time to the onset of the GI (gastrointestinal) symptoms. ...

Host Amber Smith: An incoming medical student wonders whether "starve a fever, feed a cold" is good advice.

Sonia Seth: ... It actually came up in the 1500s and was based off the idea that food generates warmth in the body and would help heat up the body during a cold, and avoiding food would remedy a fever. ...

Host Amber Smith: And a researcher addresses when it's safe to eat food after head and neck surgery.

All that, plus a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll hear about a paper that examined whether "starve a fever, feed a cold" is good advice. Then we'll learn what researchers say about when you can eat food after head and neck surgery. But first, a medical toxicologist explains why to avoid the white mushrooms you find growing in your yard this time of year.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Many toxic mushrooms closely resemble edible mushrooms, and for help understanding the differences, I'm turning to Dr. Michael Hodgman. He's a medical toxicologist at Upstate, working in emergency medicine and the Upstate New York Poison Center.

Welcome back to "HealthLink on Air," Dr. Hodgman.

Michael Hodgman, MD: Thank you, Amber. It's a pleasure to be here.

Host Amber Smith: Now, people can buy several varieties of mushrooms at grocery stores. Can we assume that all of those are edible and safe?

Michael Hodgman, MD: Yeah. The varieties that you'll find in a store are safe. Those are typically cultivated mushrooms, and basically you can be very comfortable that those are safe.

I would be more cautious of someone like if you go to a farm stand or a farmers market that is selling mushrooms that have been foraged. I would be sure that, if someone's selling a mushroom there, ideally it's been something cultivated by someone who knows what they're doing. I would be very, very careful about buying a foraged mushroom from somebody that you don't know or don't trust.

But the store-bought ones: slam dunk. They're safe. One thing to remember with them, though, is like any other fruit you buy at a store, you want to wash them thoroughly before cooking them.

What percent of mushrooms are of a toxic variety?

That might depend on how you define toxic. I mean, there are many mushrooms that will give people gastrointestinal symptoms, perhaps some cramping, nausea, maybe some vomiting or diarrhea. And that's a pretty large group.

The ones that cause more serious toxicity, the ones that can lead to liver damage or liver failure, kidney injury, muscle injury, or the ones that have neurologic effects, those are ones that make up a very small percentage of the total number of mushrooms out there. I mean, there's thousands of species of mushrooms, and those ones that are the really, really dangerous ones, the ones that we worry most about at the poison center, they make up a minority of the mushrooms out there.

Host Amber Smith: How many calls about mushrooms does the poison center get, typically?

Michael Hodgman, MD: We get, over the course of a year, maybe about 150, 140 calls yearly. I just looked at this recently, and that's about the average over the last six years. And we're coming right into the season when we're going to start getting those calls because we get about 80% of our calls between June and October. So this is really, we're going into the peak mushroom season.

Host Amber Smith: And are the calls about someone who's ingested mushrooms and now they're not feeling well, or are they asking you for help determining whether the mushroom is safe?

Michael Hodgman, MD: We do not provide advice on whether a mushroom is safe or not. In fact, anybody who has a question like that, we would advise them to basically stay away from it. The majority of our calls are exploratory behavior by children 5 years or younger. And I'd say about half of our calls are basically in that 5 years and younger age group. And that's usually somebody out in the, a child out in the yard that takes a taste of a mushroom growing out in the yard. And those are usually what we call the little brown mushrooms. And those are the ones that if they're going to cause any symptoms at all, are usually ones that may cause a little bit of GI (gastrointestinal) upset.

Host Amber Smith: So do you ask the callers to save any of the mushroom that wasn't eaten so that it can be identified later if the person gets really sick from it?

Michael Hodgman, MD: Yes. Yes, we do. And there's some important things there, if we're saving a mushroom for further identification. What I should say is in most of these children, these younger children that get into it, those are for the most part we can -- poison information specialists in the poison center -- we can manage those at home with a follow-up call and make some decisions there.

When we need, when we have real concerns about the mushroom exposure, it's best to have an uncooked specimen, and with that uncooked specimen, storing it in a paper bag, not a plastic bag, because it'll decompose more rapidly if it's not allowed to breathe. And also, if you're sending a photograph of it, it's a good idea to put a coin or a ruler or something next to the mushroom so that we can get a sense of the size of it if we're even trying to make a preliminary assessment of what it might be, based on a photograph that might be sent to us.

But for storage, if we need to ship it somewhere to have a mycologist (mushroom expert) do a more definitive identification of it, it's best to store it in a paper, in a paper bag that's just loosely closed.

Host Amber Smith: What is the most dangerous or the most feared mushroom in Central New York?

Michael Hodgman, MD: In Upstate, in fact in New York and the Northeast, and probably everywhere in the United States, the most feared mushroom is from the genus Amanita. And the Amanita mushrooms, many of them contain what are called Amanita toxins, and the Amanita toxins are the ones that can cause profound liver injury and, at times, even lead to liver failure. And it can be a very challenging thing to manage.

Host Amber Smith: What does that mushroom look like?

Michael Hodgman, MD: That is a mushroom -- again, I don't want to get into ... . mushroom identification should be, people who do it regularly should really learn from somebody else who's experienced. But those are typically the ones we see in Upstate New York that are all white. They'll start coming out here in midsummer and all the way into fall. And they typically are all white. They may start with looking like just a small bulb coming out of the ground. And then as they grow up, the cap opens up, and those are the most dangerous ones in Upstate New York.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with medical toxicologist, Dr. Michael Hodgman about mushrooms.

So when we say a mushroom is toxic, is it toxic to handle or touch, or only to ingest?

Michael Hodgman, MD: For the most part, most mushrooms, the toxicity is from ingesting. There are some, such as puffballs -- if you may have seen those dried puffballs that when they pop and they release their spores in the air -- some people may have developed some respiratory symptoms associated with one of those. But basically, when we're worried about mushroom toxicity, we're worried about ingestion.

Host Amber Smith: So how soon after ingestion would a person maybe develop symptoms, and why is this important for you at the poison center to know about that?

Michael Hodgman, MD: One of the most important things, pieces of information that we want to know at the poison center if somebody has an illness following a meal that had a mushroom in it is the time to the onset of the GI (gastrointestinal) symptoms. Most of the mushrooms that are just, you might call the simple GI mushrooms that are going to give persons a GI illness, those tend to come on within the first 90 minutes up to a couple hours after ingesting. So it's a relatively early onset of GI illness, and it typically isn't that severe, and it'll typically settle down within five or six hours or so.

In contrast to that, the Amanita-containing mushrooms that contain the Amanita toxin, their characteristic is the GI symptoms don't start until about five or six hours after the meal, after the ingestion. And so if somebody calls us and they have had this delayed onset of gastrointestinal symptoms, we get really, really worried that this might be an Amanita toxin.

Now the other time we'll get worried is, people sometimes mix mushrooms. And so they may have mixed in one that gives you the early GI symptoms with one with an Amanita in it as well. So the person that develops the early GI symptoms, but they don't get better, six hours, seven hours, and they still have a lot of GI symptoms, we get worried there, too.

Host Amber Smith: So are those people the ones that are told to go to the emergency department?

Michael Hodgman, MD: Absolutely. Absolutely. If we have a suspicion of an Amanita toxin, we want to start treatment as soon as we can because unfortunately we don't have any magic bullet that prevents the liver injury that's already happened. We have medications that may ameliorate it, may reduce the amount of toxicity and may help the liver recover a bit. But again, the sooner we start treatment, the better.

Host Amber Smith: Now, some people are interested in and involved in foraging mushrooms on their own from their yard or from the wild. Is that something that can be done safely?

Michael Hodgman, MD: Well, in the right circumstances. What I would say is ... the short answer would be, unless you have some experience with a more experienced forager, I would avoid it. But I think the best way to learn is not just, I mean, field guides are helpful. They can be really, really helpful. You know, there's online tutorials that you can look at, field guides. There's even some apps for phones now where you can take a picture of the mushroom, and it'll tell you what it is.

But I wouldn't rely on any of those. And in fact, one real question I would say is that, there was a study done last year with the phone apps, and the scary thing was, is they were no better than about 50% to 60% accurate at identifying these mushrooms that could be liver toxic. And so I wouldn't trust any of those. So as I said, those are all good, useful tools, but for somebody getting started, I think they're tools that you use with somebody that's an experienced forager or mycologist, because there are look-alikes out there, and the look-alikes can fool you.

You know, one unfortunate example we see in Upstate New York, or actually see everywhere in the U.S., is a recent immigrant from another country may see a mushroom here. It looks identical to one that was very edible in their home country. But it's not the same mushroom, not the same species, here in the U.S. And we've had some unfortunate cases of liver injury from consuming an Amanita-containing mushroom in scenarios like that.

Host Amber Smith: So toxic mushrooms don't have any features that you can look for that would distinguish them or that would tell a novice that they're toxic, it sounds like?

Michael Hodgman, MD: Not really. I mean, again, there are morphologic features, and as I said, any white mushroom in New York, just stay away from. Chances are it's an Amanita-containing one. But there's other things you can look at. We can look at the pattern of the gills on the underside, if the gill's attached to the stalk or not? Is the mushroom hollow or solid if we crush it? Is there a color that the the skin takes on when it's crushed? Those are all tools in the field that people will use. And then there's other fancier things that can be done later on to investigate mushrooms. But I think those are the typical field ones that are used.

Host Amber Smith: Now, what about, we've heard of hallucinogenic mushrooms. Are those considered toxic? And, do they grow in the wild, randomly?

Michael Hodgman, MD: Well, probably the most common hallucinogenic mushroom is in the group, the Psilocybe group that contains psilocybin, which is an LSD-like compound that naturally occurs in these mushrooms. And they grow in the wild. In the United States, probably their most prominent area they grow is up in the Pacific Northwest. But these are a mushroom that have a predilection to growing in pastures with cow dung and things like that. And so, in the southeastern U.S., Psilocybe species are pretty common as well. I don't know if they grow in the wild in New York, but that's just really my lack of knowing that.

Psilocybin is becoming more and more in the press. I'm sure a lot of people listening to this have read about them. And psilocybin, you can buy it online now, perhaps illicitly, here in New York state, but -- and that's probably addressing your question -- what's being sold is probably, for the most, part cultivated psilocybin, but it does grow in the wild.

Host Amber Smith: Now, you mentioned mushrooms needing to be washed before you eat them or prepare them. If you have a toxic mushroom and you wash it and you cook it, will that get rid of the toxins?

Michael Hodgman, MD: No. That's an important point you bring up there, is, cooking a mushroom that contains the Amanita toxins, cooking does not inactivate the toxin.

I mean, there are mushrooms, even edible mushrooms, where you should cook them. Morels are a delicacy that grow in the late spring in much of the country, and even those should be cooked. You can get some GI illness if you don't. But for these, for some of the dangerous mushrooms that can cause liver injury or muscle injury or kidney injury, cooking does not inactivate the toxins. So never assume the cooking is going to make it safe.

Host Amber Smith: All right, well that's important information. I appreciate you making time for this interview, Dr. Hodgman.

Michael Hodgman, MD: Oh, you're quite welcome. And thank you for having me.

Host Amber Smith: My guest has been medical toxicologist Dr. Michael Hodgman from Upstate's department of emergency medicine and the Upstate New York Poison Center. I'm Amber Smith for Upstate's "HealthLink on Air."

Should you starve a fever and feed a cold, or not? Next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air." What helps a person heal when they're sick with a fever or a cold -- making sure to eat or cutting back on food? We'll explore which nutritional strategies are recommended with Sonia Seth. She's starting medical school in Upstate Medical University's Norton College of Medicine, and she contributed to a research paper that was published in Current Nutrition Reports.

Welcome to "HealthLink on Air," Ms. Seth.

Sonia Seth: Thank you so much. I'm so excited to be here.

Host Amber Smith: The old adage -- "feed a fever, starve a cold," or maybe it's the other way around -- but what prompted your research team to look into this?

Sonia Seth: My research team was myself and three other physicians, and the team met via the Nestle Nutrition Institute Clinical Nutrition Fellowship for physicians. The idea for the article basically emerged from their discussions in the program. And the old saying goes, "starve a fever and feed a cold," and it actually came up in the 1500s and was based off the idea that food generates warmth in the body and would help heat up the body during a cold, and avoiding food would remedy a fever.

And so we wanted to do a deep dive into the literature to understand the scientific consensus on this topic, because it could indicate that different forms of infection require different nutritional management strategies. And there was even more interest into the topic since the COVID pandemic. And so that kind of prompted us to look into bacterial versus viral infections. And so it was definitely a very interesting and timely topic as well.

Host Amber Smith: Your paper outlines data that suggested low glucose intake helps in bacterial diseases, but it can hurt in overwhelming viral infections. So, help us understand what that means.

Sonia Seth: To start very simply, glucose is a monosaccharide, which means it's a single unit of carbohydrates. So grains, fruits, baked goods, these things all have glucose. And we have different processes in our bodies that break break down glucose into energy. And different pathogenic organisms can basically take advantage of these processes. For more context, fevers are usually bacterial. Colds are generally viral.

Host Amber Smith: I see. So let's get into macronutrients versus micronutrients. Is glucose both of those things?

Sonia Seth: Macronutrients can be broken down into carbohydrates, lipids, meaning fats, and proteins. Whereas micronutrients are vitamins and minerals.

And so to break that down a bit further, macronutrients I said were carbs, proteins and fats. So carbs are our body's main source of energy. They come from thing like things like bread and rice, veggies, for example. Protein is important in building and repairing tissues. It's also found in our hair and our muscles and comes from things like meat. And then fats are for long-term energy. They also have other functions, like hormone production, but healthy fats are found in oils, fish, for example.

And then micronutrients are, as I said, vitamins and minerals. So vitamins are organic compounds. Minerals are inorganic. And both of these have a really big impact on immune function as well. So, for example, with vitamins, vitamin K, it really helps prevent inflammation-induced host damage. And then minerals are things like zinc, which are important for enhancing macrophage and neutrophil function. And these two things are immune cells that basically help fight infection.

Host Amber Smith: So are micronutrients, do they help us recover from a fever or a cold?

Sonia Seth: Yeah. Yeah, they do.

Host Amber Smith: And getting back to the finding about low glucose intake helping in bacterial diseases. So that really would help a fever, and it would not help a virus?

Sonia Seth: Yeah, there's a lot of different findings in the literature, and not all of them agree. And so we don't have a clear-cut, cookie-cutter answer for that. It's a bit unclear. But different studies say different things, and maybe we'll get into that a bit later.

Host Amber Smith: What are host interactions, and how do they differ involving viruses and bacteria?

Sonia Seth: Host interactions basically describes how pathogens interact with the host and how they sustain themselves. And it's different between bacteria and viruses. So with bacteria, there are different components in the cell wall. Some of the terms are peptidoglycans, lipoic acid, and these things are attributed to the effects of sickness.

Viruses are a bit different in the sense that they can't really reproduce on their own, and so they basically hijack the host, or the human's mechanisms, and rely on that for things like viral replication, like the replication of their DNA or RNA, and the formation of the proteins that they need to survive. And a lot of viruses will disrupt the energy-producing mechanisms of the host as well.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with incoming Upstate medical student Sonia Seth. She was part of a research paper published in Current Nutrition Reports that reviewed and compared nutritional strategies in people with bacterial infections or viral infections.

Well, I'd like to understand how your research was done. You were part of a team. Did this involve many hours in a library?

Sonia Seth: Yeah. And our team was remote, so we met via Zoom discussions, as we often do these days. We worked together for a couple months, maybe like six or so months, to really go through what's been published in the (medical) literature. We looked for anything that gave us more insights into how nutrition affects the outcomes for bacterial or viral infections.

Host Amber Smith: Did the pandemic help or hurt your research project?

Sonia Seth: I would say it helped in the sense that, with the onset of the pandemic, there were a lot of studies that came out on COVID-19. So for example, with sepsis, which is when the infection gets so bad that the individual may experience things like organ dysfunction and a lot of life-threatening conditions. That was mainly studied in the context of bacterial infections before the pandemic, but with the onset of the pandemic, there was a lot more studies being done on viral sepsis. And some studies even suggested that early feeding in viral sepsis is beneficial, and that was mainly studied with respect to COVID.

Host Amber Smith: Now you mentioned that some of your research, you found contradicting information. What do you do with that, and how do you come to a conclusion?

Sonia Seth: Yeah, I think in those cases, the conclusion is that more research is needed. There were certain aspects where we could be more conclusive. I'll kind of break down what we found, and I'll categorize it into three different sections.

So, first we looked at the impact of host (the human) baseline nutritional status, which is basically the nutritional state of the host before infection. And we broke this down into moderate caloric restriction and long-term caloric restriction. Moderate caloric restriction was interesting to us because there have been studies done that show that moderate caloric restriction can increase longevity in different animal studies. And with respect to our topic, we saw that different markers of immune function are actually improved during moderate caloric restriction.

When we think of long-term caloric restriction -- and that can be, like, 20 weeks of caloric restriction before the organism is infected -- that generally increased susceptibility, both in terms of bacterial and viral infections. So those were pretty concrete findings that came out of the paper.

We also looked at diet-induced obesity, which is basically the opposite of caloric restriction. It's overconsumption of calories, more than the organism needs. And that really reduced resistance, both in bacterial and viral infections, and irrespective of whether it was moderate or long-term diet-induced obesity. And so these findings were, again, nutritional state before infection.

The second topic I'll dive into was nutritional state during acute infection. And this is where it gets a bit context dependent, and more research is needed to kind of solidify the findings in this area. But we saw that, for bacterial infections, for example, it's not universal. The effective feeding is not universal for all bacterial pathogens. And the results for caloric restriction during acute infection varied in scenarios comparing the same host to two different bacterial strains, and in scenarios comparing different hosts to the same strains. So, it's very context dependent, still, is what we can take from that. And with regard to viral infections, during acute infections, we generally saw that research on humans with viral infections, generally they benefit from early feeding. But we need more studies in this area, again.

And then the third really interesting finding from the paper was that microbe therapy can be really beneficial both in bacterial and viral infection.

Host Amber Smith: Well, let me ask you, do the nutritional needs, does it depend more on the host or the person, or on the particular virus or bacteria, or are both equal when you decide whether to feed it or starve it?

Sonia Seth: Yeah, that's a great question. And I would say it's hard to say, with all the different factors involved. The metabolic effects of sepsis, for example, are really context dependent. And there's various host-specific factors like baseline nutritional status, immune status, different comorbidities (additional problems) that come into play. And then there's illness variables, which is like the phase duration and severity of the illness that play a role.

And this is all in addition to whether the infection is bacterial or viral or fungi. And so with all these factors, I would say it's hard to say and probably depends on the host and the type of infectious agent.

Host Amber Smith: Now you said microbe therapy. What is microbe therapy, and how does it work with viruses and bacteria?

Sonia Seth: This is probably my favorite topic to delve into in this paper. So in our gut, we have a lot of different bacteria that keep us healthy, and microbe therapy refers to the idea of supplementing your gut microbiome with good bacteria. And there's a lot of studies that have been done that show microbe therapy is really beneficial in different disease states. And one study specifically focused on COVID-19, and they showed that because of the gut-lung access -- which basically describes how metabolites produced in the gut can modulate immune system activity in the lungs -- because of this gut-lung axis, supplementing the gut with good bacteria can really enhance the immune response to infection, specifically with COVID-19.

And also, the impact of microbe therapy has been shown in different viral infections, so with things like HIV and influenza, microbe therapy can definitely reduce susceptibility to disease. And it's not just with viral infections. Microbe therapy can also be beneficial with bacterial infections. So for example, some strains of bacteria, we can call them good. Good bacteria can fight bad bacteria. So one strain of bacteria called Lactobacillus acidophilus counters another strain called H. pylori. And it basically does this by secreting products that make the bad bacteria unstable.

And so it's a really interesting kind of interplay, between these types of bacteria in our gut. And there's a lot of new studies coming out. The gut microbiome is a really hot topic these days, I feel like, and so more studies are definitely needed to understand the effect of probiotics and microbe therapy during active infections, but it's looking really, really promising.

Host Amber Smith: Are probiotics generally used instead of antibiotics or along with them? Because I know with the bacterial infection, oftentimes a person may be prescribed an antibiotic.

Sonia Seth: So my understanding is that the antibiotic is kind of, you can think of it like dropping a bomb in your gut. And the idea is to get rid of a whole range of bacteria with the hope that the bad bacteria will also be killed off. So microbe therapy would be in addition to antibiotics, where you're supplementing the good bacteria and making that environment thrive.

Host Amber Smith: Well, before we wrap up, let me ask you how you got interested in nutrition.

Sonia Seth: I actually grew up pretty overweight, and when I was like 16 or 17, I was diagnosed as pre-diabetic. And then the COVID pandemic hit. I was probably around 19 at the time, and I had so much time to really reevaluate my health. And I started making diet and lifestyle changes that really added up into substantial changes that really altered my health. I ended up losing 20 pounds. But more than like the physical changes, there were a lot of different mental changes that came with that. And I think right now I am in the healthiest state I've ever been in. And so that's why it's such a huge passion of mine. I think not just nutrition, but the whole health and wellness area is very, very interesting to me, and I'm always looking to learn more about the field.

Host Amber Smith: Well, that's exciting. And you'll be starting medical school in the fall. Do you already have an idea of what you want to do with a medical degree?

Sonia Seth: Yeah, I'd love to specialize in gastroenterology. So it's exactly kind of in line with what we've been talking about, but, digestive health I think is very interesting, and I'm hoping that the whole "food is medicine" focus will really accelerate by the time I'm choosing a specialty. And I hope to incorporate that into how I see patients and treat patients.

Host Amber Smith: Well, I appreciate you making time for this interview, Ms. Seth.

Sonia Seth: Thank you so much for having me. It's been fun discussing this paper.

Host Amber Smith: My guest has been Sonia Seth. She's starting this fall as a student at Upstate Medical University's Norton College of Medicine. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- research encourages eating food soon after head and neck surgery.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." It's been thought that people who undergo surgery for head and neck reconstructive surgery are more likely to have complications if they're allowed to eat within the first five days after surgery. An international team of researchers looked into that assumption, and we'll hear what they discovered from my guest, Dr. Hani Aiash. He's the assistant dean for interprofessional research at Upstate's College of Health Professions, and he's senior author of this paper.

Welcome back to "HealthLink on Air," Dr. Aiash.

Hani Aiash, MD, PhD: Thank you, Amber.

Host Amber Smith: Do many surgeons believe patients need to hold off eating for a few days after extensive surgery of the head and neck region?

Hani Aiash, MD, PhD: Yes, Amber. In the past, there was a belief that initiating oral feeding shortly after surgery or removing feeding tubes early, following significant head and neck reconstruction, led to increased complications. In recent years the consensus among experts regarding the perioperative care of individuals undergoing head and neck cancer free tissue flap reconstruction -- as outlined by the (American) Society for Enhanced Recovery (after surgery) -- in 2017 suggests prompt reinitiation of oral feeding following the surgical procedures. However, and because of tradition, patients recovering from reconstructive oral surgery using a free flap in most of the occasions are kept at NPO for six to 12 days.

Host Amber Smith: And NPO means nothing oral, nothing going through their mouth?

Hani Aiash, MD, PhD: Yes.

Host Amber Smith: So is the thinking that the tissue needs time to heal before it's exposed to food and drink?

Hani Aiash, MD, PhD: They were thinking like this, but our study proved that no, you can use the early feeding, and we have a very good outcome after this.

Host Amber Smith: I want to hear more about those results, but let me make sure I understand. Now, the surgeries we're talking about mostly are done to remove cancers?

Hani Aiash, MD, PhD: Yes. Free flap reconstruction is a surgical technique used in various medical specialties, primary and reconstructive surgery particularly, for areas with significant tissue loss or defects. Indication for free flap reconstruction include trauma, removal of tumors, congenital defects, chronic wounds that don't heal properly, or cosmetic reconstruction, to mention some.

Host Amber Smith: And the thinking or the fear of letting people eat soon after the surgery, were patients allowed to receive nutrition some other way than going through the mouth during this time?

Hani Aiash, MD, PhD: Yes. In the old thinking they use parenteral or IV, or sometimes they use nasogastric tube. But to ensure that they receive adequate nutrition,during this time, two main methods are commonly employed -- enteral feeding, which this method involves delivering nutrition directly into the gastrointestinal tract with nasogastric tube, as I told you, or a nasal incisional tube that can be inserted through the nose and down to the stomach or small intestine, respectively. And parenteral nutrition. This involves delivering nutrients directly into the bloodstream by IV (intravenous) lines.

Host Amber Smith: So if a patient needed any of those modes of nutrition, they would be in the hospital during that time, correct?

Hani Aiash, MD, PhD: Yes.

Host Amber Smith: I see. Now your study appears in the journal Maxillofacial Plastic Reconstructive Surgery. What made you decide to examine this issue?

Hani Aiash, MD, PhD: We decided to study this topic, as there is limited research about early feeding shortly after free flap surgery, especially after head and neck cancer. Our study aimed to compile the evidence on the association between early initiation of oral feeding and postoperative complications, like fistula formation, seroma (fluid buildup) development, and flap failure, and the length of this hospital stay in order to suggest implementation of an early oral feeding protocol after free flap reconstruction among head and neck cancer patients.

Host Amber Smith: Now you used a few terms I wanted to ask you to define. You said "fistula" formation. What is a fistula?

Hani Aiash, MD, PhD: The fistula is an unplanned tunnel that forms between two parts of your body that shouldn't be connected. It can happen because of injury, infection or other reasons.

Flap failure occurs when the surgical flap, which is a piece of tissue, moves from one area of the body to another area during surgery, partially or completely separates from its attachment site. It can happen due to various reasons, such as poor blood supply, infection, tension on wounds.

And hematoma is collection of blood, as you know, that accumulates in the tissue of the neck, while a collection of serous fluid, clear and yellowish fluid, that accumulates in the tissue of the neck is a seroma.

And one infection happens when harmful germs like bacteria, get into the cut or scab or surgical incision.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Hani Aiash, assistant dean for interprofessional research at Upstate's College of Health Professions and the lead author for the research paper we're discussing.

Now, your team includes researchers from Saudi Arabia; Peru; Egypt; and Charleston, South Carolina; Reading, Pennsylvania; New York City. You looked back at paperwork for more than a thousand patients. Were all of the patients from those areas?

Hani Aiash, MD, PhD: Our study is a meta-analysis. A meta-analysis is a type of research study that combines data from multiple independent studies on a particular topic to provide a more comprehensive and statistically robust analysis, what we call increasing the power.

We have found new studies about these topics from other countries, like our patients came from New Zealand, U.K., U.S. and China, but we are international team. We are working with many people to get these results, and not related to the sample size from these countries.

Host Amber Smith: And to get the terminology right, early feeding means during the first five days after surgery, and late feeding was five days or later?

Hani Aiash, MD, PhD: You are right. We use the definition of early feeding using a cutoff point of five days, and as outlined in all the study included in our meta-analysis.

Host Amber Smith: Well, let's talk about your findings. Did you find that it makes sense to withhold food from patients for up to five days after head and neck reconstructive surgery?

Hani Aiash, MD, PhD: We have a lot of findings here. We found there is no statistical difference between the complication, between early and late feeding, oral feeding. According to our results, our findings suggest surgeons should consider implementation of early oral feeding protocol after flap reconstructions in patients affected by head and neck cancers.

Also we discovered that there is association between shorter hospital stay.

This can be due to several factors such as faster recovery, as eating shortly after oral surgery helps maintain their nutritional status and energy level, which can aid in the body's healing process, improve patient comfort and satisfaction, promoting psychological well-being, enhancing healing of oral tissue. In these cases they benefit from adequate nutrition to support healing and regeneration.

Proper nutrition can help, also, to reduce postoperative swelling and pain. And early nutrition after surgery is usually associated with decreased risk of complications.

Host Amber Smith: So when we talk about oral feeding, after having a major surgery of the head and neck region, do you start with liquid? Do you start with soft foods? I mean, there's got to be some guidelines, right?

Hani Aiash, MD, PhD: Yes. We begin with liquid. Then we begin gradually to give soft food, then hard food. But usually we begin with liquid and soft food.

Host Amber Smith: So what would you like doctors and patients to take away from your study?

Hani Aiash, MD, PhD: The patient, I will tell them that the main reason for doing research in medicine is to find new ways to improve people's health. This research helps doctors and health care professionals provide the best possible care to you, to the patients, leading to the better outcome and quality of care for everyone. However, when having complex situations such as surgery, the physician assessment of their patient's characteristic is vital for deciding the best outcome based on evidence-based medicine that can be tailored especially, specifically for you.

So the patients listen to the doctors, especially when he applies evidence-based medicine, especially if we have research proof that early oral feeding will help you.

For the doctors, I will tell them that to the best of our knowledge, our study is the first meta-analysis addressing the impact of early oral feeding on various postoperative complications, as well as the duration of hospital stay following free flap reconstruction in head and neck. And I believe it's an excellent article to have a look at it, especially when we prove that there is no difference between complication between early and late oral feeding --but we have also shortened the hospital stay with early oral feeding.

Host Amber Smith: So it sounds like, based on your study, keeping a patient in the hospital just to feed them soon after the surgery isn't the reason you need to do that. There may be other factors that the surgeons can concentrate on, but keeping them with adequate nutrition shouldn't be one of them.

Hani Aiash, MD, PhD: Yes. Usually the decision to stay in the hospital after surgery depends on how well the patient is recovering. As you know, we are doing personalized treatment. You cannot paint all the people with the same brush. This is what we call personalized medicine. We are different, and this is why most patients typically stay in hospital for 10 to 14 days after these surgeries. It really depends on each person's unique situation. Some studies have found that this time can be reduced to as little as six days.

Host Amber Smith: Well, Dr. Aiash, I really appreciate you making time to share your research with us.

Hani Aiash, MD, PhD: Thank you very much, Amber, for inviting me. Thank you for hosting me.

Host Amber Smith: My guest has been Dr. Hani Aiash. He's the assistant dean for interprofessional research in Upstate's College of Health Professions. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Jeffrey Albright from Upstate Medical University. How can we prevent colon cancer?

Jeffrey Albright, MD: There are a number of things we think are probably the contributing factors for why people are getting colon cancer at a younger age. And, there's an interesting link between obesity, so being overweight, and developing cancer at a younger age, and it is for a range of cancers, and colon cancer is just one of them. And so maintaining healthy weight is a very important thing for people to try to do, for a number of different reasons, not just colon cancer, but overall health.

We know that diabetes is associated with both developing colon cancer as well as being overweight. And so, if you're diabetic because of being overweight, that probably also contributes, and so that's kind of a double whammy.

Third thing has to do with diet. And we know that there's some things like eating lots of red meat, especially grilled or fried food, food with a lot of preservatives in it, also are damaging to the lining of the colon and can set off a cascade leading to precancerous changes or cancer.

(Likewise), having a diet that's low in fiber. People talk more and more about the microbiome. So that's the different bacteria and yeast and other things that live on our skin, in our GI (gastrointestinal, or digestive) tract, wherever, that just coexist with us. And what we eat is going to feed the bacteria in our intestine. And if we eat things that cause more inflammation in the lining of the colon, then that's going to make people more prone to developing colon cancer.

And so there's actually been some interesting studies where if you compare people that are on a high-fiber diet, which decreases the inflammation on the colon, and you switch them over to a diet where they eat more of an American type of diet, that causes a lot more inflammation and a change in the microbiome to bacteria that contribute to inflammation and can contribute to cancer.

And so, eating a diet that's high in fiber, high in fruits and vegetables, more limited on things like grilled meats, can definitely impact somebody's potential for getting colon cancer. When we talk about giving people fiber supplements, it's trying to put back into our diet what we normally should be getting. But because American diets have so much processed food, where a lot of that fiber is really taken out, it's tougher to get it just with a normal diet. And so, taking a supplement can put everything back in that we should otherwise be getting. People can start on that in their 20s and 30s and probably have that long-term benefit. There's no harm in taking it for the vast majority of people, so it can be a preventative thing, especially if you're prone to it, and it just helps to keep the colon healthy and happy.

The other thing I'd say for people, aside from diet, is, listen to your doctor. Take these things seriously. It's a whole lot easier to go through the screening tests, even though doing a bowel prep to clean out your intestine for a colonoscopy is not fun, it's not that bad. And it sure beats living with a colostomy or not living because of advanced colon cancer.

Host Amber Smith: You've been listening to colorectal surgeon Jeffrey Albright from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: We lost a stalwart member of our Muse family in 2021, poet Joyce Holmes McAllister. She was a poet who proved that aging need not dim one's perspective or facility with words. Here are the last two poems she sent us. First is "A Question":

I wonder where they went, those 80 years,

In which I claimed each breath, called life my own.

A span of time when challenge held no fear

And youthful feet could feel no aching bone.

If I had known, when young, how life would speed

And leave me here, to grope my way alone,

I would have spent more time, and learned the need

To fence youth in, and keep it for my own.

I wonder if I started now to track,

With careful count, my age to backward time.

Could I keep on until my years subtract

And I am once again, just 29?

But who would know me then, with youthful face,

or minus aging wit, long-practiced grace?

And the second poem is called "things i can't write about":

to feel what it is like

to open the desk drawer,

see the blank checks

still in their box, unused

three years after your death

to wash fresh spinach,

suddenly taste vinegar on my tongue,

remember how you sprinkled it

over young cooked greens, and how i

used only butter

to see the shape of a car,

maybe the same model, year

parked in front of our house,

know someone else will step out,

turn his back, walk away

to stare at the collection of long, slim

note pads, read your name and address

printed at the top in blue; on the bottom

thank you for your continued support of animal wildlife

my writing has always been more about

what I leave out, than what I put in

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," how robots and automated intelligence are assisting in operating rooms. And, what's important to know about vasectomy?

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.