開刀術後身體懶懶沒力氣 你知道嗎？臥床一週 肌肉就少3%！出院後別只會「多躺著休息」動大刀術後腿沒力、手發抖？中醫師教你 從躺到走只要簡單7步驟！｜余雅雯醫師｜她健康 She Health 145

If she can do that smoothly, it means her heart and lungs and her muscle strength are gradually recovering. When older people are ill and bedridden for too long, even a sip of water can make them choke. With sarcopenia, we first notice it in the limbs. But we have muscles throughout our bodies. In older adults, if they keep staying inactive, I worry most about damage to their ability to swallow. Why is muscle loss related to swallowing? Swallowing requires many small muscles around the throat and esophagus to work together. So when muscles weaken, it's not just the limbs. Strength in the throat and its small muscles can decline too. Hello, everyone. I'm Danni. Welcome to Her Health. At the first meal after coming home from the hospital, your hands shake when you pick up chopsticks. After eating, you can't stand up either. Does your family tell you to lie down and rest more? Doctor, is that right? I've seen many patients' families who mean well. When a parent has surgery and comes home from the hospital, they won't let them move. They do almost everything for them. And when the parent wants to walk, they push them in a wheelchair instead. Is that really right? Be careful: the more others do for you, the faster you lose muscle. Today we'll discuss how to eat during the first month after discharge and how to exercise. Finally, the doctor will teach you one key phrase to help you know where to begin. I'm delighted to welcome Dr. Yu from Shangxi Chinese Medicine Clinic. Dr. Yu, long time no see. Hello. Why does this happen? Someone has surgery and leaves the hospital, but then their legs feel weak and their hands shake. How does that happen? According to a research study, if a healthy young man stays in bed for a month— a full month of bed rest— what do you think happens? I think he becomes weak. Right. The numbers from the study were startling. After just one week of bed rest, he has already lost 3% of his muscle mass. In only one week! And in that same week, his muscle strength drops by 7%. This is in a young, healthy man. For an older person, a week in bed after surgery would cause a major loss of strength. Why? They're still eating while in bed. Why do they lose so much muscle? Good question. In Chinese medicine, the spleen governs the muscles. People confined to bed move very little and rarely use their muscles. So their digestion and nutrient transport weaken. That's why many well-meaning family members make them fish soup, such as sea bass soup. But they can absorb only so much. Many people even tell me that after surgery they can't drink it at all, and they can't eat either. Without enough nutrition, the body lacks the building blocks for muscle. Surgery itself also triggers inflammation. The wounds release inflammatory signals that can affect our muscles and cause some damage. If that's the case, muscle mass keeps decreasing, right? If someone develops sarcopenia, what might happen as it progresses? With sarcopenia, we first notice it in the limbs. But we have muscles throughout our bodies. In older adults, if they keep staying inactive, I worry most about damage to their ability to swallow. Why is muscle loss related to swallowing? Swallowing requires many small muscles around the throat and esophagus to work together. So when muscles weaken, it's not just the limbs. Strength in the throat and its small muscles can decline too. That's why you'll find that when older people are ill and bedridden for too long, even a sip of water can make them choke. Their swallowing muscles may stop coordinating properly, making them cough and choke. If this continues, I worry that repeated choking could lead to aspiration pneumonia. In that case, can an older person recover from sarcopenia? Of course. I often advise families to let older relatives move. They can start at any time. With gradual practice, they may regain their previous abilities. Okay, viewers, remember: the doctor says, keep moving. You can start exercising at any time. Your muscles can still recover. Speaking of sarcopenia, older people have more reason to worry, especially after prolonged bed rest. Eventually, they may lose their mobility, right? Right. What do we need to move well? First, muscle strength. Second, balance. Third, our muscles and joints need a good range of motion and flexibility. You'll find that if someone stays still and stiff for too long, they may develop sarcopenia. Their joint mobility also becomes limited. I've even seen older people in long-term care who spent a few weeks in bed and developed contractures in the knees and ankles. A contracture means the joint tightens up. It can take a long time of rehabilitation and exercise to stretch it out again. Some contractures are irreversible. That would be a shame. So it can become that serious? Yes. I've seen older people who want to get up and exercise, but they don't have the strength. They get breathless and break into a sweat. Their blood pressure may not have adjusted yet. So we follow several steps and train gradually. First, we move from lying down to sitting up. Even this step alone can make some people's blood pressure change and leave them dizzy. So first, we help the patient sit safely on the edge of the bed. They practice sitting. Sitting upright is harder than it sounds. It requires core strength and good balance. We train those first. Once that no longer tires them out... Nowadays, there are adjustable beds that can lift them up. But that doesn't use their own strength. So they need to learn to sit up themselves. At first, we can use the adjustable bed to bring them upright and let their blood pressure adjust. Later, when they can gradually sit up themselves, we have them sit at the edge of the bed. That takes their own strength. They engage their core to sit upright. We start by practicing sitting there. The second step is going from sitting to standing. That uses the thigh muscles and shifts the center of gravity. So first, we help them stand upright and steady. Only then do we take them for a walk. Even a few steps count as a walk. So don't rush. I take it step by step. Could they spend a long time at the sitting stage? Possibly. Some people can't even stay seated and slump back onto the bed. It depends on their age and how their strength recovers. If they really can't manage it, we go back to exercises while lying down. They can practice a bridge exercise: bend both knees, place the feet on the bed, and lift the hips. How can they have the strength to lift them? It uses only the most basic muscles. When they sit up, they have to use more muscles throughout the body. But when they're lying down, the rest of the body can relax. They only need the muscles around the hips. Once they're stable, we try sitting them up. So whatever the starting point, we want them to move on their own. Is that the first step toward health? It also builds their confidence. And if they really don't move, as you said, what eventually happens? Sarcopenia and muscle wasting, even joint contractures. Then they really may not be able to walk. To walk properly, we need muscle strength and smooth joint movement. If the joints develop contractures, even sitting or standing is difficult. So to avoid getting to that point, they still need to move. They need to keep trying. I know some older people fear pain. It hurts so much that they refuse. That's why bedside care after surgery is so important. Usually it takes a team. Chinese medicine doctors work with physical therapists and other physicians. We assess their joint range of motion. If mild contractures have already formed, we teach gentle stretches within a range they can tolerate, with stretching and massage. Once the muscles become more supple, we move on to the next exercise. I thought Chinese medicine meant medication. Medication is part of it too. At that stage, the contracture stage you mentioned, many patients also have poor digestion or are very depleted. We work to restore their energy and blood and support their digestion. Chinese medicine focuses on their digestive health to help support the muscles. First, they need to absorb the medicine and nutrients properly. So a good care team can help you recover after surgery and return to normal. Each profession has its strengths. Don't assume an older person must stay still because they fear pain. Please don't. Many specialists can work together to help. Speaking of recovery after surgery, there's another issue. Besides movement, there's eating. Many people can't eat. Others wonder, if I take Western and Chinese medicines, how should I take them? Will they interact? Is it too much to take? If someone truly can't eat solid food, we use liquids. For example, a dietitian may recommend a commercial nutrition drink with balanced nutrients. If they can eat regular food, we begin with simple, light soups, such as mild chicken broth or sea bass soup. Avoid heavy seasoning and excess oil. Start with soup, then soft rice porridge or minced meat for protein, along with starches and other nutrients. In the most serious cases, there's tube feeding. Patients on tube feeding may receive nutrients through a nasogastric tube. First, we make sure they get enough nutrients. Then we may prescribe Chinese herbal medicine in liquid form, if they can swallow it. I imagine recovery is gradual. So can Chinese and Western medicines be taken together? If they're taking medicines that affect circulation or anti-inflammatory drugs, Chinese herbs may interact with them. We separate the doses by about 90 minutes to two hours. So it isn't too burdensome for the patient. Right. Once a patient leaves the hospital and goes home, they can't see a doctor every day. Maybe they go once a week. How can you tell whether they're really recovering at home? How can they assess their own recovery? There are two situations. If they're not too old and can care for themselves, we ask family members to stay with them. We give them some rehabilitation exercises and make sure they take their medicine as directed. With regular movement and medicine, after about two weeks, you should see their strength improve. The second group is older people who can't leave home. They're more advanced in age. Home care services are available for them. A whole team visits them at home, not just doctors. Dietitians and physical therapists also take turns providing care. Wow, that's part of... It's a government long-term care program. You can apply for it. So you apply? Is it difficult? The long-term care program has been improving through versions 2.0 and 3.0. Just call and ask. A care coordinator can explain it in detail. I didn't realize our long-term care was so developed. Yes. It responds to an aging society with more and more older adults. Doctor, please teach everyone the steps of strength training. For patients who've been lying in a hospital bed, getting back to normal activity takes several gradual steps. The first step, as I mentioned, if you can't even sit up, start lying down. Do a bridge exercise. Place your feet flat on the bed, with your knees bent at about 90 degrees. Then lift your hips. This exercise works the core muscles and the hips and helps prevent hip contractures. It's the easiest place to start. Second, once you've practiced that, you can move on to sitting at the edge of the bed. Help them sit there safely. What does this train? The core. The core has to be stable for them to sit steadily. Third, straighten one leg while seated. Once they can sit safely, try raising a leg to 90 degrees, so that it forms a right angle with the lower leg's starting position. This especially works the quadriceps at the front of the thigh, which we mentioned earlier: one of the body's largest muscle groups. Fourth, begin practicing sit-to-stand. For this movement, there are a few key points. Shift your weight forward first, and keep your balance. Standing up and sitting down at the bedside trains the leg muscles and the core muscles of the torso. Finally, once they can stand safely, they can use a walker to walk slowly around the living room. At this stage, pay special attention to their balance. When someone can walk smoothly, they're training muscles throughout the body as well as balance. Once they can do this safely at home, we can move outdoors. Outside, the ground may be uneven and there may be more obstacles. That requires more core strength to avoid obstacles, as well as lung capacity, because they may be more active outdoors. And finally, the seventh step comes after all those exercises are going well: resistance training. For resistance training, you can use things at home, such as plastic bottles or resistance bands. A physical therapist or Chinese medicine doctor can tell you which muscles to train and how. This helps them progress from having very little strength, to sitting and standing, walking, and then strength training. With family support, they can recover faster. Are there acupoints we can massage to help? Yes. I recommend some points on the legs in particular. They stimulate the stomach meridian and the liver, spleen, and kidney meridians, which may improve circulation in the legs. Which points do you recommend? First is Zusanli, or ST36. In Chinese medicine, it's rich in qi and blood and supports nutrient absorption. We often call it the longevity point. Stimulate it regularly. We teach family members to massage it for patients, or patients can tap the point themselves. First, locate the right knee. Find the hollow just below the kneecap. Place four fingers together, with your index finger at that hollow. Four finger-widths down, one finger-width to the side of the shinbone, is the Zusanli point. You can massage it with your thumb or tap it with your fist to stimulate the stomach meridian. The second point is Yanglingquan, or GB34. We associate Yanglingquan with the sinews. In Chinese medicine, that includes ligaments and tendons. They're all part of the sinews. So we stimulate the Yanglingquan point. How do you find it? Feel the outer side of the lower leg for the head of the fibula, the bony bump there. The point is just in front of it. That's Yanglingquan. The third point is Sanyinjiao, or SP6. How do you find it? Find the protruding bone on the inner ankle. Go four finger-widths above it, next to the edge of the shinbone. That's the Sanyinjiao point. As its name suggests, it's where the liver, spleen, and kidney meridians meet. The meridian energy flows downward. You can tap that point or tap along the lower leg. This way, one action stimulates all three meridians. Families should learn this. Then, if a loved one has had surgery and comes home from the hospital, you can massage these points to help their leg muscles recover. Doctor, please also tell us how we can respond to different conditions through diet and make adjustments. Yes. When they come home, many can't eat and are very weak. How do we gradually adjust their diet to help them regain their health? First, restore their digestion. Don't rush to give them rich, oily foods. Rice water is a good place to start. As our grandmothers used to say, when you cook rice porridge, the thick, white liquid on top is a first step in nourishing digestion. When they can start eating some solid food, offer a little porridge or lean meat. Start with quality protein and easy-to-digest starches. Their complexion may improve, and they'll begin to feel hungry. When they ask you for food, it's a sign their digestion is recovering. Next, introduce a more balanced diet, such as dark green vegetables, quality protein, and starches like sweet potatoes. Add foods with more fiber gradually. It depends on the type of fiber. Some is soluble; some isn't. Some foods are easier to digest, like sweet potatoes or ordinary, soft vegetables. Coarse grains, though, have tougher fiber, so avoid them at first. At this stage, Chinese medicine may add a formula such as Four Gentlemen Decoction or Bu Zhong Yi Qi Tang to support energy and circulation. Okay, I see. In the second stage, they can eat more. We give them rice, vegetables, and meat in normal proportions. Choose meats that are easier to digest, especially lighter meats, such as fish, or pork and chicken. Leave harder-to-digest meats, like beef and duck, for later. Okay, step by step. Yes. Is there a drink that could provide protein, help them feel full, and offer enough nutrients to boost their energy? This drink combines food therapy with Chinese medicinal herbs. Many of us have made soy milk. We usually use water, right? I've taken it a step further: use an herbal decoction instead of water. So cook the herbs first? That's right. We use astragalus root. There are several varieties. For boosting energy, use northern astragalus. Add red dates. Cut them open and remove the pits so their components release more easily. Usually we use one liang of each and simmer them in water. Use about 700 milliliters. Once the herbal liquid is ready, add green-kernel black soybeans. Their skins are black, but the inside is green. In Chinese medicine, they nourish the liver and kidneys. Use those black soybeans and black sesame seeds. Put them in a blender, then add the herbal liquid to make a black soybean drink. Even healthy people can drink it. Yes. It's a good source of calcium and, in Chinese medicine, supports the kidneys. As we age, we first see changes in kidney energy. There may be back pain or even hair loss. You can drink this regularly. If you drink it often, is it okay every day? Some people may feel too much internal heat from the red dates or astragalus. In that case, reduce the amount. For example, switch the astragalus to Jin Qi, which tastes sweeter and is less strongly tonic. You can adjust the variety and quantity as needed. Do you teach this recipe to family caregivers too? Yes, I do. That's great. Taiwan's long-term care program can really help older people. Besides these foods, Four Spirits Soup is also a good option. Yes, Four Spirits Soup. Its ingredients include Chinese yam, fox nuts, lotus seeds, and Job's tears. When making it, you don't have to use pig intestines. You can simmer it with pork ribs or chicken. Both taste good. Chicken works well too. You can even add a slice of angelica for flavor. The lotus seeds in particular... Lotus seeds are said to have a calming effect. Many older people have trouble sleeping. Poor sleep can affect how well they take in nutrients. A little lotus seed can help. I see. So Four Spirits Soup is a good option for home care. It's filling, and can be a good source of protein. Yes. We can also suggest using leftover rice to make a nourishing rice drink. All you need is a blender. It's easy to prepare. Take some cooked rice, white or brown rice, even rice left over from the day before. Use about one bowl, then add roughly 500 to 700 milliliters of water. Put it in the blender. To give it more flavor and sweetness, I add some goji berries and red dates. Okay. Goji berries are said to support the liver, kidneys, and eyes. Red dates support energy, blood, and digestion. You can add both. When preparing it, remove the pits from the red dates. Cut them open and take the pits out. That also makes blending easier. Blend these three ingredients with warm water. Give them a good blend, and you'll have a rice drink like soy milk. Is it suitable for someone with diabetes? Probably not as it is. For someone with diabetes, I think we should use mixed grains instead, for more fiber. I would also replace the red dates and goji berries with other herbs, such as astragalus. Astragalus alone can be added for energy. I also want to ask: when patients return home and keep exercising, they may think, I've worked so hard and can finally walk again. How do they maintain that progress and avoid declining again? Regular, measured activity is important. Encourage them to walk and move consistently. Make it enjoyable too. For example, arrange a walk with friends, or have family join them. I think meeting a friend and walking together helps it feel less like a drill. Don't make it feel like a drill. Give them a reason to go out, such as seeing an old friend or shopping at a familiar market with someone. My uncle had a minor stroke. No one noticed for quite a while because he lives alone. So treatment came a little late. Now he's practicing walking, but sometimes he's exhausted and doesn't want to go downstairs. Family encouragement and company can help. Pay attention to his stamina, and keep the exercise within what he can manage. Right, that's important. I'd also like to ask: usually, when someone is ill or has just left the hospital, there's a caregiver beside them. How can they help the patient recover quickly without stepping in too much? Sometimes we worry and do too much for them, which may actually slow their recovery. What do you suggest? I often joke that we shouldn't treat older people like little children. Don't do everything for them. First, ask the care team what the patient can do, then encourage them to do it. As we explained, there are seven stages of exercise. At every stage, help them persevere and use their own strength. Don't take over. People may feel they lack time or want to avoid trouble, so they use a wheelchair instead of letting them walk. Or they worry the person might get lost outside and keep them at home all day. If they remain inactive day after day, over time, their muscles will waste away. Their vitality will decline too, and they may become depressed. That can bring other complications. So remember: for older family members or people recovering after discharge, let them do things themselves, even when it's a little difficult. That effort is worth it. Yes. It can help them live more comfortably in the long run. Right, more independently. Then they won't have to depend on others every day, which is very hard. They may otherwise lose the ability to care for themselves. Yes, especially if you're younger, not an older adult, but middle-aged. After an operation, if you end up unable to care for yourself for a long time, life can feel very discouraging. Yes, it can make you feel years older. That's right. So, in that situation, doctor, what would you encourage both the patient and the caregiver to remember in everyday life? I would say: follow a routine. It doesn't have to be rigid. When it's time to eat, make sure the patient gets the nutrients they need and takes their prescribed medicine. Then follow the planned activities. Help them do what they're able to do. I have several older female patients who can't walk at all. I ask them to sit at the edge of the bed. If they can hold themselves up, even for ten minutes, it means their core muscles got some exercise that day. Family members shouldn't give in too easily or be so worried for them that they don't let them move. If you gently keep them on track with the amount of exercise their care team prescribed, and they can do it smoothly, it means their heart and lungs and their muscle strength are gradually recovering. Have you seen cases where someone is improving but has trouble with bowel movements? For many people, that seems to be a big problem. Yes. Bowel movements depend a lot on intestinal motility. If someone stays in bed without moving and eats very little, there's less stool to pass. They may have bloating and constipation. I usually tell caregivers to gently massage around the navel. Massage around the navel. In Chinese medicine, we may use acupuncture on the abdomen to stimulate intestinal movement. But at home, I suggest learning to do it yourself. The patient can learn too: massage the abdomen clockwise to help the bowels move. Remember, once the patient can sit, stand, and move around, intestinal motility often improves greatly. They can move, then have bowel movements, and eat. Yes: eat, pass stool, and move around. Those are the basics. If they can do all that, there shouldn't be any major problem. Right. They're on the road to recovery. It doesn't sound too difficult. Today, Dr. Yu shared many practical steps. I hope you can use them to help your family and friends as they recover, building strength little by little, until they can care for themselves and enjoy a healthy life. Thank you again, Dr. Yu. Thank you. And thanks to viewers around the world for watching. See you next time. Bye-bye!