On hip replacement - post-surgery recovery plan

In preparation of up-coming hip replacement surgery, here's my notes on a recovery plan to ensure that my recovery is as successful as possible.

Supplements

• I'll discuss all of this with the doctor before the surgery.
• Branched Chain Amino Acids (BCAAs). You can find them in the bodybuilder section of the health food store. Make sure your body has the building blocks for repairing muscles, soft tissues etc.
• Continue with Glucosamine, Chondroitin, MSM supplements
• Proteolytic enzymes - improve scar healing and to reduce the time for swelling to subside (see here). Take on an empty stomach. They break down excess fibrin and allow for more clearance of inflammation and a faster healing time
• Vitamin D - mainly from sun. Try to get sunlight every day on lots of the bod. I may even get my vitamin D levels checked beforehand to make sure I've got this 'in the zone'.
• Cod liver oil for Omega-3 and vitamin D.
• Vitamin C is important not only as an overall anti-oxidant (to counter the effects of being in hospital) but also to support collagen formation.
• A good multi-vitamin to make sure I'm getting Vitamins A, E, K2.
• Anti-oxidants. Consider some Bulletproof Glutathione, otherwise CoQ10, alpha-linoleic acid.
• Zinc to assist healing.
• Annual metal detox using a peptide chelator like Metal Free from BodyHealth.com
• Chlorella supplements?
• Probiotics to counter any anti-biotics they may give me.
• Arnica to reduce swelling.
• Maybe turmeric to reduce inflammation. 

Nutrition

• Intermittent fasting (IF), maybe fat-fasting. No protein or carbs until lunchtime. There's certainly evidence to suggest that IF is useful in spinal surgery recovery. I'll do more digging whether it's a good thing for skeletal surgery.
• Bovine collagen in the morning coffee. Give your body the building blocks to repair bones and connective tissues.
• Bone broths, lamb shanks, osso bucco etc. I'm thinking to make a whole load beforehand and freeze it.
• Decent, grass-fed meats - beef, lamb. Tissue healing and repair can temporarily increase your protein needs by about 50 percent.
• Eggs.
• Lots of leafy greens, salads, avocados etc. Veggies with every meal.
• Sauerkraut and/or kobucha - probiotics!
• Some prepared meals in the freezer.
• Butter, coconut oil and Bulletproof Brain Octane for postanesthetic brain recovery. Check the brain health post for more on this.
• Dark chocolate. The darker the better :-)
• Water. Make sure to have a good quality mineral water rather than fluoride-laced tap water.
• Avoid anything inflammatory such as sugar, deep-fried foods and vegetable oils, nightshades.

Training and recovery plan

This definitely starts with pre-surgery preparation. I've got another post in the works about my pre-surgery preparation including exercise, swimming, cold adaptation, saunas etc.

Post-surgery, here's the plan:

• Don't over-do it and go with the flow.
• An in-home physiotherapy program is included as part of the operation package. Hopefully this will be a local physio so I can keep follow-up as necessary.
• Chiropractor. I've been seeing an excellent chiropractor for the past 5 years or so and will want to get back to see him to help ensure good alignment and for him to help in the recovery and wellness process. 
• Swimming - luckily we have our own pool and it'll be summer so I should be able to get in the pool morning, noon and night. How long after the op can I get back in the pool? Will depend on wound healing but as soon as possible. Will work up to longer swimming over time.
• Walks, short to begin with but building up over time. 
• Exercise bike. I'm going to see if I can borrow one rather than having to buy one.
• Strength training using power bands. I'm having good results at the moment (pre-op) using a power band to do a 'deadlift'. It might sound like putting such a lot of load through the lower body would be a bad idea and I think that good form is essential. But it seems to make sure that everything is moving in the right way. When I'm stiff it can help reduce the pain. Nice straight back, neutral neck, take the strain through the 'posterior chain'.
• Ice for pain reduction, swelling reduction. 
• Option 1: Ice packs.
• Option 2: gel wraps like this.
• Option 3: Ice water cold therapy systems like this. 
• Red light therapy - stimulate wound healing.
• Saunas. Cause the release of Heat Stress Hormone, BDNF, dynorphin (an analgesic) and increasing sensitivity to endorphins (happy hormones). Also makes the body produce a greater volume of blood plasma.
• Electrostim. I've got an Omron HV-F127 Electronic Nerve Stimulator to help relieve pain and stimulate muscles.
• Grounding. You may have heard of grounding - connecting directly with the earth to reduce electrical charge on your body. It might sound like hippy nonsense but I have a grounding strip running beneath my sheets to bond me to earth as I sleep (with a 1 megaohm inline resistor so I don't get inadvertently zapped!)

While it's claimed that pulsed electro-magnetic therapy (PEMF) such as Earth Pulse can be beneficial in helping recovery for stress fractures etc, I don't fancy the idea of using PEMF close to a metal implant. 

Home preparation

• Bed hoist trapeze to help getting in and out of bed.
• Sock putter-onner (or just get the kids to help!)
• Raised toilet seat.
• Walker, walking stick, cane - already got.
• Phone charger next to bed (but airplane mode when sleeping). Laptop/iPad. 
• Home delivery. Probably Woolworths Online.
• Entertainment - NetFlix (plus GetFlix to unlock from Aus). I may need to 'up' the broadband limit.
• It'll be summer, so I'll make sure I've got a nice outdoor sitting arrangement so I can enjoy sunshine without getting burnt to a crisp!

Support, timing and work

I'm planning to have the operation after christmas, in the summer holidays. This will mean that the pressure will be off my wife who will be really busy in the run up to christmas. I know I'll be relying a great deal on her and the kids during my recovery so it needs to work for all of us.

Work-wise it's a quiet period as folks take holiday. 

The kids might get bored because I won't be out and about as much as usual. We'll think about this some more.

Putting it all together

That's a lot. I'm sure that when the time comes, things will change. Maybe I won't have time for it all, maybe I just can't be bothered. But at least I'm giving it good consideration beforehand to make sure I've got the best tools and thinking to help.

For the nutrition and supplements, I'll probably put together a chart so I don't have to think too much and can just go by the chart. I'll also check all this with the surgeon beforehand.

Any other thoughts or suggestions? Leave a comment below...

Update 22-Aug-2014

I just came across this great post on Bulletproofexec.com forums describing the effects that active post-operation management can have on recovery. This is exactly what I'm aiming to achieve. To quote:

My long awaited doctor's visit has finally arrived. "Holy Jesus!" the doctor exclaimed. "You are like some kind of superhero...like a wolverine or something." He ran to get his camera.

This is also an excellent post by Ben Greenfield on recovering 'like Wolverine'.

Mitigating the impact of anaesthetic on brain health

Brain support: from left to right: Natures Own High Potency  Brahmi complex, Vitamin C, Thompsons B-complex, Westgold butter, Melrose Cod Liver Oil, Celtic sea salt, coconut butter, Melrose MCT oil, Blooms MSM

Hat tip to this episode and this episode of Bulletproof Radio for bringing up the impact of anaesthetic on brain health.

In the episode with JJ Virgin, they discuss how she helped her son recover from a hit and run and how she recovered quickly from knee surgery.

In the other episode, Steven Fowkes and Dave Asprey discuss, amongst other things, anti-trauma compounds like DMSO that can be protective to the spine in case of a car accident for example.

The effects of anaesthetic on brain health

The administration of general anaesthetic during surgery can also have serious long-term effects on the neural systems in the body, especially the brain. In this post I'm going to investigate what I can about how to mitigate the impact since I've got some surgery coming up. It'll also be interesting to see what I manage to uncover because I've just heard of a friends' daughter who had an accident and was in surgery for 3 hours. Should we be concerned for post-anaesthetic impact and is there anything that she can do now to mitigate the effects?

Severity of anaesthetic

There are different severities of anaesthetic depending on the procedure. The most harmful to brain health is full general anaesthetic.
I believe for my procedure (total hip replacement) that a less severe anaesthetic regime is used, likely spinal block plus sedative. I have heard of people having this done without sedation but I'm not that game!

Bulletproof intermittent fasting

First things first. The brain runs really well on ketones which are produced by the breakdown of fatty acids. You can find plenty of information out there about ketogenic diets so I won't go into the details. Since I've been on a low carb high fat diet for a couple of years now I am fat adapted, so adopting a high-fat ketogenic diet post-surgery should work well. 

To get the maximum benefit will mean an extended 'fasting' period. In this case, I'll be looking at a 'fat fast'. That'll mean that I won't 'eat' until lunchtime and will just have coffee-plus-butter/coconut/MCT for breakfast. Maybe with some collagen powder mixed in.

Coconut oil

Coconut oil is well known for it's positive benefits for brain health. Look for an organic cold-pressed variety. There are plenty. Work your way up to 3-5 tablespoons a day (but do start slowly to avoid gastro upset and disaster-pants!)

[Link to podcast on coconut oil for treating dementia. ]

MCT oil

In addition to raw coconut oil I use MCT oil for mental performance. It's a fraction of coconut oil but is metabolised directly to ketones (and thence energy) and is included in Bulletproof Coffee. I use Melrose MCT oil.
There is a further refinement of MCT which isolates the C-10 fatty acids, most popular brand is Bulletproof Brain Octane which I've heard good things about. I may well give this a try beforehand to see if it's worth using over and above 'standard' MCT oil.

Omega-3

As we all 'know', fish oil is good for you. In fact it's DHA for the brain is the particular form. I'm using cod liver oil to help manage my osteoarthritis since it is also high in vitamin D. 

l-glutamine

 - phosphoserine [3 heaped teaspoons]
[More info to be figure out...]
L-glutamine is the main component of muscle. It's commonly used as a bodybuilding supplement to support muscle preservation when 'cutting'. May be useful post-op to keep muscle tone but doesn't look like it would have much of a brain-support function.

DMSO and MSM

MSM is a somewhat unproven supplement but is popping up as a remedy for arthritis pain. I use it along with my glucosamine/chondroitin supplement. The neuro-protective aspects of MSM are definitely controversial, however it is suggested that DMSO is beneficial in mitigating spinal trauma [DMSO is a solvent related to MSM]. From wikipedia:

The spectrum of biological effects of dimethyl sulfoxide (DMSO) and MSM differ, but those of DMSO may be mediated, at least in part, by MSM.^[

Choline

From wikipedia:

Choline is the precursor for acetylcholine, a neurotransmitter involved with memory; it’s an integral component of two important phospholipids; and the liver uses it to process fats and package lipids.

Dietary sources include liver, eggs, shellfish. Choline may also be used as a dietary supplement in the form of Alpha-GPC / Glycerol Phosphocholine. Suggested dosing (by JJ Virgin) is 3 times a day before and after surgery @ 2000 uGrams.
Will look at e.g. http://www.amazon.com/Now-Foods-Alpha-Veg-Capsules-60-Count/dp/B001RYKA3U/

Smart drugs

I'll do some more digging into this. Suggestion by Dave Asprey is:

piracetam or aniracetam protects your brain from low oxygen states.

and so can have a neuroprotective effect during anaesthetic. Obviously you'd want to know how you react to such substances before dropping them into the mix.

Herbal supplements

I've been enjoying improved mental function by taking a herbal compound of Ginkho,Ginseng, Brahmi once every few days and I shall continue to do so before and after the operation.

Pain relief

After major bone surgery, pain relief is essential. I'm not sure if any of the hard-core meds have any lasting neural impact. My thinking is that I won't be shy about using the pain medication but I won't take them for any longer than I have to and I'm going to do what I can to maximise my recovery post-operation to minimise my exposure to hard pain medications.

Anti-oxidants

If you're having anaesthetics then you're in a hospital environment. You may well be having x-rays and other imaging done, lots of oxidative stress. So a good supply of anti-oxidants is essential - Vitamin C, Co-Q10, alpha-linoleic acid, glutathione.

Vitamin B12

Vitamin B12 is essential for good neural condition so make sure to include a good vitamin B complex.

Others

An operation is a major stress on the body so your adrenals will be working hard. Make sure you're taking a good quality salt to support the adrenals to cope with the stress.

Physical therapies

Saunas and heat exposure can increase levels of Prolactin levels by 10-fold. Prolactin is involved in the process of myelination of nerve cells. Heat stress from a sauna increases brain-derived neurotrophic factor when combined with exercise. BDNF increases the growth of new brain cells and increases the survival of existing brain cells.

For further thought

Will GABA help? https://www.upgradedself.com/bulletproof-gabawave 

Changelog

2-Aug-2014: First published.

17-Aug-2014: Added note on the potential use of sauna.