surgical recoveries…

So I have had a fairly annoying  interesting summer: I had knee and shoulder surgery in a 16 day period. First was the right knee, then 16 days later I had left shoulder surgery.  This allowed for a unique “experiment” that I got to run on myself.  On the first surgery I followed the advice (mostly) of the doctors, and on the second surgery I did not follow the advice of the doctors. So this blog will tell you how the two recoveries differed, my protocol, and thoughts about how things were going and other randomness.

*Please note. I am not trying to bash conventional medicine, it obviously is basically magic (seriously, describe it to someone from 299 or even 99 years ago. They would think you were lying).  I also am not suggesting anyone follow this in any way….listen to your doctors! Keep in mind: shoulder and knee surgeries are different, I don’t know if my knee would’ve been better on my protocol or not, and I don’t know if my shoulder would’ve been worse/better/same on protocol from docs.  Please don’t fall into the trap of coming in hating “the man” and just cling to the non-traditional things I tried. I have not proved anything. I just like experimenting on myself, and like being part of a discussion I simply decided to experiment, because discussion is the best way to figure things out along with trial and error. Whether that was smart or not…well read it.

Firstly: WTF happened that I would need surgery? And what was done

• Knee: On Dec 2, 2011 I was pulling wide stance deadlifts and with about 15 degrees left before lock out it felt like someone hit me on the medial side of the
  

  floatie

  

  femur damage

  knee with a hammer. So naturally I finished the pull (475), then dropped it and walked around trying to determine what had just happened. Turns out I suffered a bone bruise…whether this happened before the deadlift or during is open to debate. Regardless the MRI showed a 1 inch bone bruise: RX: stay off of it. I did the best I could, but I was busy traveling and teaching MovNat at that time…so realistically I did myself no favors-that was last week of december. **take home point for you: don’t do MRIs the last week of december because you’ll lose that $500 towards your insurance deductible!**  Fast forward to April, the knee is feeling good, no pain or anything while jumping, climbing stairs, squatting, or for the first time since the injury pulling off the floor.  So I went slow and did some fun lifting for 2 weeks-when all of a sudden after 2 workshops I taught in NYC the knee felt worse than it had in a long time. So I went back to doing very very little, and things worked out so that I ended up leaving movnat, returning home to San Diego to start my own business coaching fitness and movement in San Diego.  I also followed up with another MRI on the knee which showed a ‘HOLE’ in my medial femoral condyle. This was not exciting. The original doctor said I should wait 4 months and do another MRI to see what happens, whether it gets better or worse.  I thought about it, and decided to find another doctor who deals primarily with athletes and not geriatrics/degenerate regular population that doesn’t take movement, health and vitality

  

  tibial plateau after being cleaned up…aka removing rough flaking articular cartilage

  seriously. The second doctor strongly suggested we scope the knee; I agreed this was a good idea so that we could actually see WTF was going on (my surgery actually got moved up because floating cartilage got wedged and I couldn’t straighten or put weight on the leg). In surgery it turned out that the spot on the knee had a pretty good amount of damage to the articular cartilage, but wasn’t actually a hole, I still had half the thickness of my articular cartilage. This was good.  So they cleaned up the medial condyle, the tibial plateau, behind the knee cap (all had rough, fraying articular cartilage), and removed a couple floating pieces of cartilage.

• Shoulder: On April 28, 2012 I went from being very excited, to rather pissed very quickly. I hit a PR on a TGU with a barbell at 70kg on the right side.  I went to match on the left, and as I went to hip bridge, I began to lose the barbell backwards…instead of dumping as I should have, I instinctively pressed it out and at the top I felt a pop. This was not good. The next day I couldn’t really move the arm, and I started with acupuncture and treatment immediately, after having it checked out and they thought it was a rotator cuff tear of some sort. So I took it easy on the shoulder for May and June, it really didn’t hurt me that badly, but I want to be performing and feeling well so we got it checked out with a MRI and it showed a probable labrum tear in addition to me having something called an OS-acromiale. So, surgery was decided on because if I was already rehabbing my knee, lets get a
  

  tool in my shoulder

  

  slap 2

  

  anterior labrum flap & some glenoid fossa issues

  2 for one and also because I was PRing on surgical procedures. #PReveryday  Turned out I had a lot of stuff going on in there: shaved the end of the “loose” acromiale, fixed a minor slap 2 tear, fixed a minor biceps tendon tear, sucked out some bursitis, cleaned up a large tear in the anterior labrum, and also cleaned up some fraying articular cartilage in the glenoid fossa. Yeah, lots of suck.  **second take home. stick to your training plan. especially the proper warm up. I did neither on both injuries and that isn’t gonna happen again.**

Ok-so that’s what I was dealing with, I know, who gives a shit…but I wanted you to hear my sob story.  So here was the suggested post op treatment from Medical people:

1. Eat something light post surgery, like crackers and juice or soda. This was to “not upset my stomach” because the anesthesia often causes nausea.
2. Take the pain meds (norcal, and toradrol) every 4-6 hours. “Stay ahead of the pain” and keep inflammation down is the goal here.
3. Ice for about an hour then take the ice off for an hour and just do that repeatedly (ideally with the ice water circulating machine they sell).  Pain and inflammation management is the goal here.
4. Keep the bandages on, move it as much and early as I can. The quicker you can move the better and faster you recover.

So, for the knee, I did just what was told of me. Except the crackers and sugar water-WTF? I had a steak and eggs instead. The ice I was using felt worthless because the knee bandages were so thick that it took the whole hour to get cold (for the first 2 days at least, then once the bandages were gone it was cold as ice. You know, because it was ice). As far as diet goes, I was 100% primal, whatever that means (for me it means no veggies oils, no gluten, no added sugar*except ice cream during that first surgery*).  My knee got pretty swollen and awfully painful.

knee swelling, 2 days post op

The knee actually got drained after this photo, because I couldn’t move it due to the swelling/pain. I continued with the toradrol for the 5 days it was rx’d for (that’s the maximum legally allowed because it might shut down or damage my liver/kidneys/stomach etc) and continued with the norcal for 8 days post op(norcal=opiod and tylenol combo, they put a ton of tylenol in there so that it can’t be used recreationally or else you’d suffer serious liver damage).  I also kept icing it frequently, and did so for the 20-30 minutes suggested, this time it got really cold because there was no wrapping.  I was on crutches for 4.5 days. The doctors thought I was doing quite well compared to other people, as in my pain seemed less and swelling was less than normal.  I however thought I could do better.

For the shoulder, let me discuss the instructions from the medical community from above-and then say what I did.

• Eat something light post surgery, like crackers and juice or soda. This was to “not upset my stomach” because the anesthesia often causes nausea. Ok, so clearly I wasn’t going to drink sugar water or eat gluten crackers. This was just plain nutty (sugar is inflammatory, and I’ll have bubble guts from gluten). In fact, by the shoulder surgery time had hit I had been doing the Whole30 for 12 days. I also had been on a supplement protocol I put together (below it’s listed) for 4 days before the shoulder surgery. 
• Take the pain meds (norcal, and toradrol) every 4-6 hours. “Stay ahead of the pain” and keep inflammation down is the goal here. Well, I didn’t want to take the toradrol again so soon since it seemed dangerous to do so to me, and because I don’t actually think that smashing inflammation is a good thing in regards to recovery.  Inflammation happens for a reason, and is a natural occurrence. If you stop inflammation unnaturally, you may slow healing processes that go along with that natural response (if you have a normal healthy inflammatory response IMO). By unnaturally I mean with pain meds, which also blocks some healing processes that occur with inflammation.  I think that NSAIDS and ice MAY be warranted for people with perverse inflammatory responses, because in their cases the inflammation they get is really damn high and likely problematic due to the swelling and pain it causes which makes moving the injured area impossible (like my knee) and moving soon seems to be integral and maybe even the most important part of getting use back quickly (more on movement below).  Luckily, due to my diet, lifestyle, and supplement protocol I believe that my inflammatory response is pretty good and is not perverse, therefore: screw the toradrol. The pain meds I didn’t want to take because of the tylenol-so I did cold water extraction on the percocet I was rx’d (this is essentially me playing Walt from Breaking Bad, where I remove the tylenol from the percocet only leaving the opioid)  Also, I actually spent the night of the surgery throwing up, couldn’t keep anything down including pain meds, that was a ton of fun and felt awesome. That was mental conditioning for sure. **take home: pain won’t kill you.**
• Ice for about an hour then take the ice off for an hour and just do that repeatedly (ideally with the ice water circulating machine they sell).  Pain and inflammation management is the goal here. I didn’t ice. At all. There is much debate about icing, is it good? how long? how cold? etc…for the shoulder surgery I decided to test, Please see this from Sir Suppleness.  check out this:

1.  “When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986   CLIFTON–YES! I KNOW THIS IS PROLONGED PERIOD, BUT THAT IS EXACTLY WHAT COMMON MEDICAL PROTOCOL TELLS YOU TO DO…WTF. I BELIEVE IT IS 8-10 MINUTES WHERE THIS NEGATIVE EFFECT STARTS TO OCCUR, SO MAYBE 5-8 MINUTES OF ICE COULD BE BENEFICIAL, BUT LIKELY ONLY FOR SOME PAIN MEDIATION. 

• Keep the bandages on, move it as much and early as I can. The quicker you can move the better and faster you recover. I was supposed to be in a sling for a week, except to take it out and move it as much as I could-but I took the sling off the next day. Also, this time I took the bandages off in order to hook up the marc pro unit I bought, which I wore for about half the day each of the first 4 days post op. And have continued to use for hours each day, especially after my pt drills.  The marc pro does something cool: it gets movement throughout the injured area via muscle stim and that helps the lymphatic system to move fluid out and away from the non moving area.  The lymphatic systems relies on movement to drain, so if you are swollen and in pain you can’t move and therefore you swell and get in more pain and can’t move! The marc pro was very helpful. Hey marc pro, send me some new sticky pads!! I wore the sling the first day, but wasn’t happy about being photographed in it. Also, is the marc pro and long duration usage of other stim devices just a more aggressive “tens” protocol? It definitely seemed to help with pain in the soft tissues, although the shaved bones needed the percocet.
  

  my parents food cupboard makes me mad

Ok, here is the supplement protocol I did starting 4 days before the second surgery on some, and some started day before the first surgery. Some influence from this.

• curica-pain relief
• lots of vitamin c-short term high dosing this to help with immune and my own bodies inflammatory response
• turmeric & bromelain-more turmeric, more
• bone supplement: calcium, magnesium, etc….I had bone injuries, seemed like a good idea.
• magnesium-cause we don’t get enough.
• manganese-important for bone health and healing.
• zinc and copper-all men should take this, you need the copper to ‘balance’ the zinc, as in not get zinc poisoning.
• krill oil-Omega 3’s and astaxanthin. I also took fish oil with each meal after the surgeries, but not for the 7 days before each surgery so that I wouldn’t have trouble clotting. Just being safe.
• vit d @ 50,000 iu/day. Yeah, that’s a lot, I know. So what?
• vit k @ 5 daily servings a day, because vitamin d toxicity seems to be caused by a poor D to K ratio, not total amount of D. And it’s the type from butter, which is better.
• ginger-assist my body’s own inflammatory response-this is a good idea to assist your own body’s response, because in theory this shouldn’t affect the healing agents also traveling to the injured tissues. In theory.
• wobenzyme-systemic enzymes targeting inflammatory response. In theory.
• serrapeptase-the first supplement i’ve ever taken that noticeably abates DOMS post workout for me.  Seriously, BCAAs helped, but serrapeptase kicked some booty.
• sardines-O 3’s, protein…oh yeah. Eat them on planes and piss people off.
• lots of grassfed butter, and egg yolks. Mostly for the arachodonic acid (while AA is inflammatory, it is also needed for healing and anabolism) . Please read this by my buddy the Sock Doc-all about inflammation.

yummy, but no real swelling.

So, you’re wondering, how did the shoulder respond? It basically did not swell-nothing in the hand or arm—compared to the knee where I had swollen foot, toes, and ankle (I iced those too, btw). The incisions on the knee took 2 weeks to fully close on two of the cuts, and one cut today, 4 weeks post op still has a small scab.  The incisions on the shoulder aren’t even noticeable on two of the cuts, and one has a minor scab on the very end of the cut. I keep lying to the physical therapist who asks me if I’m icing, because I’m not. Today I did weight assisted pull-ups at the gym, and that is 12 days post op. This past weekend I had the pleasure of walking around the perform better summit surprising everyone there that I wasn’t limping or in a sling. Hooray for technology, hooray for eating well, and hooray for getting to talk to Gray Cook, Dallas Hartwig, K-Starr, Jon Fass and Doc Cheng regarding the injury and healing.

What now? Physical therapy (and finishing 2 months of that supplement protocol). I have seeked out a class 4 laser in san diego, and am doing the pt at that clinic.  I am supplementing the protocol they give me with my own plan: crawls, carries, and getups supplemented with mwodding, FMS correctives, and manual therapy.  These are developmental movements, surgery changes your body-and I want to develop it back the way it is supposed to, not with external rotation band drills.  I’ll be putting my limbs in place on the ground and moving my body around those fixed points the way that babies do, that’s why I did weight assisted pull-ups and crawling-there is just a fundamentally different way that the body and brain reacts to moving the way we do instinctively vs isolation of muscle actions drills.

Considerations and clarifications

1. I AM NOT A DOCTOR AND THIS IS NOT ADVICE FOR YOU TO FOLLOW.  I AM NOT A PHYSICAL THERAPIST AND YOU SHOULDN’T COPY MY REHAB EITHER. I simply had an opportunity to try this, and share what happened with me.
2. I don’t know if zero ice is the answer, but it sure seems that ice didn’t help me with the first surgery.  Anecdotally, I’ve done ice baths, wraps and all that jazz for years, and have never known if it was beneficial, because I was still damn sore the day after, and I’ve never known if it helped or not.  Now that I’ve read a ton of material about icing, based on Kelly’s video, and Sock Doc’s series, and my own interest in doing this experiment, I don’t think icing is as beneficial as conventional thought says.  The literature has lots of instances of support for not icing, and at best it seems that after 8-10 minutes you start to get opposite (negative) effects from icing….so the 20 minutes icing directions we always get may not be as good an idea as was thought.  Icing for performance may be another story though, if you can keep your body temp lower then your brain/cns doesn’t get as “scared” when working out and you may be able to go longer harder (that cooling of the body can be accomplished with ice in the palms, cold water over the head, and maybe an ice pack across the neck and upper back-but its for cooling the body between/during events, not for actual physical recovery).
3. Post surgery, the best thing you can do is move. You can’t do that if you are in pain or swollen, and that’s why ice was chosen in the past, because it numbed the area, and was thought to help with swelling.  Well we also used to think that the earth was flat and that sat fat was bad…well when something new and better comes along, go for it. Moving heals, my question might be this: if you had the marc pro and it was doing it’s thing, and sprinkled in some brief icing as well, would that be better/worse/same? I dunno. But this no icing thing is intriguing at the very least.
4. If you take anything from this, it’s EAT WELL.  Note that my already good diet was cleaned up even more for the second surgery, and that plus the supplements may have played a huge role in this. I understand there are too many variables to say this is definitive proof that icing is bad, that doc advice is dated, and that a “more natural” way is better.
5. I know my “experiment” is two different joints/areas. One is above the heart, one below, the knee may inherently swell more than the shoulder…blah blah blah.  If anyone makes those claims you have missed the point here.
6. I’m not saying this is a more natural way, that’s why it is in quotations in #3 above.  I’m using a electrical stim device! I’m supplementing!  I’m not doing this to try and be like a caveman, so if any dipshit says that in the comments, I expect it to be in a joking way. I just am being proactive with this statement as to not have to clarify later.
7. When doing surgery, it’s important to remain fashionable. The obvious choice is a V