Two days after I got back from a series of adventures which took me kayaking in Greenland, the Svalbard Islands (near the Arctic), biking in Norway and a great many other places spanning Scandinavia, I visited my VA Clinic. There my RN, Melynda, a marathoner (read: jock) and I reviewed the long list of bumps, bruises, head boinks and sprains I had collected along the way.
After our tally, she asked me if I was remembering to RICE.
You know: Rest, Ice, Compression, Elevate.
I looked at her in surprise.
“That’s old technology,” I said. “Even the doctor who came up with that term doesn’t believe in that any more.” To wit:
“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” — Gabe Mirkin, MD, March 2014
Melynda looked at me sideways, like I didn’t know what I was talking about.
That’s the stinkeye I get from male doctors. That look really gets up my nose. A lot.
I like Melynda. She’s smart. But she’s not up-to-date on her injury care.
“I’ll send you the articles. I”m not making this up.” Later I printed out four articles on the topic and sent them off to her at the clinic. She read them, and will decide for herself whether or not she buys into the new version of how to treat injuries.
Old Habits Die Hard
I’ve been using the new way for a long time. In part because if I twist an ankle in the middle of nowhere I don’t have the luxury of any of those options. I tape up and keep going, because stopping isn’t available, especially if a storm is coming over the mountains. You keep moving. And interestingly, that’s good for the injury unless of course it’s a break. I find that shortly after I injure, if I keep moving, that injury gets a lot better a lot faster. Funny thing about that.
This happened to me as I was descending from Dead Woman’s Pass on the way to Macchu Picchu. The stones on the path are uneven and slick, made smooth by the passage of millions. That, combined with moisture from the low-lying clouds, makes for some dangerous descending.
As any good hiker knows, especially when you’re heading downhill, you have a choice: stop and view the scenery, OR watch where you put your feet. Not both.
I did both. Shoved the toe of my boot between two stones. Gravity did the rest and I went ass over teakettle. The guy right behind me, concerned for my wellbeing, did precisely the same thing. We lay there on the trail laughing at each other. My ankle, however, wasn’t laughing. I’d torn a bunch of ligaments.
Want an Airlift Out?
The guide who was bringing up the rear, Oscar, ran to my side and asked if I needed an airlift. Not on your life. I had a roll of Rocktape. I taped my ankle up snugly, then Oscar and I continued the very long walk to the next campsite.
While my ankle puffed up and hurt, the movement kept me from swelling badly. On top of that, by the next morning, although the bruise was pretty colorful, walking wasn’t an issue. I spent the rest of my month in Peru walking just fine.
Old fashioned coaches, and a lot of athletes still tied to old ways will still ice an injury, while not knowing that doing so prevents the body from healing itself. The body’s inflammatory response to a sprain starts the healing process. RICE prevents it. In other words, you’re keeping your body from doing what it is supremely well- designed to do. In some cases, research shows that icing and resting actually damage the tissue.
So yeah. Your hero LeBron James may ice his elbow. But he’s dumb to do it and it may shorten his career. MLB pitcher still ice their arms. Traditions die very hard. The photo above comes from a soccer site, still advising icing long after it’s been shown to do damage to healing tissues. When up-to-date common sense research demonstrates that a method isn’t working, we need to stop doing it. Your doc may not agree. That means s/he isn’t current. I find that to be very common.
In Spite of Proof….
In an Atlantic article by David Epstein, the author outlines an number of situations where both doctor and patient go awry (https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/). If an injured patient comes in demanding a certain treatment (based on little more than he had heard about it or read about or a buddy of his had it done), sometimes doctors feel pressured to provide the pill or the procedure even if it’s not called for. On the other hand, in a key statement of medicine today the article states:
“According to Vinay Prasad, an oncologist and one of the authors of the Mayo Clinic Proceedings paper, medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof.”
Conservative docs, long accustomed to traditional treatments that may have long since been proven either useless or even dangerous, are loathe to let them go. Such is the power of habit and the ingrained need to be right, whatever the costs. Woe to the patient who has done their research and challenges such a doctor; it’s not a pretty sight.
When We Get in the Way of Healing
The human body is a marvel of engineering. We can heal ourselves from unbelievable illness or injury, especially if we allow the body to do its work. In many cases this is often best served through better dietary and exercise habits. Yet we — both patient and doctor — can get in the way. A cancer patient eating ice cream during chemo is feeding the very cancer cells she is trying to eradicate, for example. Research has long shown that cancer loves sugar. When we feed our body proper nutrition, exercise it properly and support its natural healing processes, it will more often than not behave like the finely-tuned machine it is.
I threw out all my instant ice packs years ago. I carry plenty of Rock Tape, which is my go-to product for supporting me when I blow out an ankle or sprain a knee or crank a wrist. The rest I leave up to Nature and nurture. Minimal sugar, good food choices and keep those body parts moving. Because movement keeps the blood flowing, blood that is full of oxygen and nutrients, and the veins carry away the waste. Overly simplified, surely, but basically that’s your blood at work. Taking care of business.
Walk in Well
As I get ready for rotator cuff surgery in late spring, I am pushing myself at the gym, all core and legs. This way when I walk into the operating theater my body will be fine-tuned and ready to begin healing immediately. Nothing heals like health. Increasingly, though, I can’t turn to my doctors for advice on healthy habits. Too often the first suggestion is a pharmaceutical, then a procedure, whether or not it’s actually warranted. For my medical dollar, these should be the last line of defense after all other remedies haven’t worked. Doctors are no different than the rest of us; they like shiny new objects that promise miracle cures. If it happens to work they get a hero button. Unfortunately if they don’t, then we are effectively the lab rats. It’s far easier to recommend an exciting new procedure or pill — based on a rep’s sales pitch — than to do the hard slogging work of bringing a patient to optimal health the hard way. Which is, take responsibility for our own health.
This of course takes real doctoring. The kind of sleuthing and time intensive work that requires fully understanding the history and environment of a particular patient. Modern medicine doesn’t reward this; it takes too much time. We may wait for two hours in the lobby to see a doc for perhaps five to eight minutes. If that. That’s hardly time to get a holistic understanding of someone’s presenting symptoms. Given that the mind is such a powerful player in our disease patterns, most docs have no clue. It’s hard enough to get one to look you in the eye, much less ask about family dynamics which could be playing a much bigger part in why we have constant migraines.
Today’s doctors receive greater incentives for treating us as though we’re on an assembly line, rather than highly complex, unique universes deserving of individual care. Some get on board, others can’t hack it because they signed up to heal, not hand out pills like Halloween candy. Increasingly, as hospitals have to answer to stakeholders and shareholders, there is pressure on performance and turnover, and ensuring that beds are filled rather than ensuring that the surrounding community doesn’t need hospitalization. A body in a hospital bed is an income stream. An empty bed is a liability. Where is the incentive for wellness?
America Has Lousy Healthcare by Comparison…
to other wealthy nations (https://health.usnews.com/wellness/health-buzz/articles/2017-07-17/report-us-has-the-worst-health-care-system-compared-to-these-countries). I can speak to that directly having been seriously and epically injured in a few other countries. In Iceland, I received the finest healthcare I’ve ever gotten in a hospital (gourmet food and by god you’re allowed to sleep through the entire night, what a pleasant change of pace). I even had fun, which is not a word I normally associate with a hospital stay.
From the simplest injury care to the treatment of chronic diseases to infant mortality, we are in many ways behind the times. What that means for all of us is additional vigilance. Prior to 1973 and Richard Nixon’s pandering to his buddy Edgar Kaiser (of Kaiser Permanente Insurance), it was illegal for the medical industry to be for-profit. The Health Maintenance Organization Act of 1973 opened the evil floodgates, and now we are at the bottom of all rich nations in both care quality and coverage. Here’s a little history: http://www.investmentwatchblog.com/did-you-know-that-before-1973-it-was-illegal-in-the-us-to-profit-off-of-health-care-the-health-maintenance-organization-act-of-1973-passed-by-nixon-changed-everything/.
What Makes a Good Doc
Whether you’ve got a cranked ankle or a cranky aunt who banged her head on the bathroom sink, it behooves us to do our research. A good doc is a learning doc and your health partner. A good doc is committed to making sure you don’t have to come back. A good doc will call you on your dishonesty about what you eat or drink when the test results demonstrate you’ve been less than honest. A good doc will pelt you with questions like a detective. The best docs are willing to not know, and to function in the question.
Our responsibility is to not expect our doctors to have all the answers. That’s not only impossible but also patently unfair. Imagine the surgeon who opens up a patient to find that some of the organs aren’t in the normally-assigned places. It happens. Each of us is just that different. So rather than put undue pressure on our caregivers, let’s shoulder more of the work ourselves. When we’re fully engaged-after all, it IS our body- we make better patients, better partners, and are likely to be far healthier.