This is the podcast, Surgery I See Rounds.

My name's Jeff Guy.

Today I'd like to talk about the issue of metabolism. And metabolism really should be looked at in two elements.

That is the enabalism, the building of new protein, and catabolism, the tearing down of new protein.

Now this discussion is really elemental when we go on to talk in future podcasts about some basics

of nutritional therapy and then get more specific into various ways that we can modify our nutritional therapy to optimize patient

outcomes. And this goes into issues of weaning people from mechanical ventilators, issues of

rehabilitation, getting people back to their pre-morbid condition, doing the things that they

like to do. All too often, in the hospital studying, we allow patients to starve.

And I think that we all feel that we could perhaps all of us lose a few pounds or two,

thinking I could certainly lose five or ten pounds myself.

But the kind of weight that a patient in the hospital loses is significantly different

than the kind of weight that somebody strives to lose or a variation

of their diet or exercise. When you think of an insult, typically a traumatic injury, that

initiates a sequence of events that's very pathological. Now, as somebody who specializes in burns

and has a background in trauma surgery, I'm always looking at the insult as the injury.

Keep in mind that surgery is not a normal phenotype.

Laying down on a table, having somebody cut open your head, your chest, pounding on your bones, rerouting your GI track is not something that

occurs naturally. Surgery is a controlled injury, and depending on the nature of the surgery

and the nature of the surgeon, that injury is more or less controlled. But after you get that

initial insult, you get a primary multi-organ dysfunction. And this is caused by a lot of elements. If you've

looked at, say, the first few chapters of any major surgical textbook, say, for instance, Schwartz,

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