I Had Shoulder Surgery, and it COMPLETELY Changed the Way My Left Armpit Smells.

​My cool cousin John is a baseball prodigy – but sadly, he had a bad dislocation this summer, and had to undergo the same shoulder surgery I had a few years ago.
 
Because he loves science, I decided to share a crazy story about my microbiome with him. And because I wish I’d had more/better information about shoulder surgery while I was deciding whether or not to have it (eventually, my body made the decision for me), I’ll conclude with a few thoughts about the pros and cons of the surgery.

​
Having shoulder surgery is a lot less invasive than it used to be. Mine was an arthroscopic, outpatient procedure that probably took three hours beginning-to-end.
 
That part of it was pretty straightforward. I showed up an hour before the surgery, got a few injections, and fell asleep. I don’t really remember waking up – but I do remember that one of the last things my doctor said to me before I left was,
 
“A lot of people get yeast infections after shoulder surgery, so try to keep it as dry as you can.”
 
A yeast infection? That seemed weird…
 
Until about 15 minutes later, when my left pit was already starting to get damp, and the right one was completely dry.
 
Because normally, during the course of your day, you move your arms around pretty continuously. You scratch your head. You reach for your pen. You stretch. And each time you do, air circulates under your arms. It dries things off and cools you down.

When you’re wearing a sling for six weeks, no such circulation happens. Ever. It’s just always damp, dark and warm in your pit. It’s uncomfortable, and it’s one of the suckiest parts of the surgery. 

But at least I got lots of attention from this little one, who wouldn't leave my side for days after the surgery.

​I didn’t end up getting a yeast infection – which didn’t surprise me. I’ve never had any other kind of yeast or fungal infection, so I'm pretty sure I'm less susceptible than others. 
 
But. Something strange happened when I finally took off my sling.
 
I didn’t smell the same. I actually smelled really bad. But only in my left pit.
 
The right one still smelled as glorious as it ever did (see also: I Stopped Wearing Deodorant, and Here’s What Happened to My Love Life, because that is some quality journalism). But the left one… it smelled stinky, and manly, and like a different person.
 
It was trippy. I mean, stinkiness aside, just imagine being alone in your house, and smelling another person you did not recognize. And then realizing that person was you.
 
I can’t explain the exactly what happened -- only that it is related to a change in my microbiome – or the microorganisms that live on my skin and in my gut. (See also: The Biggest Obstacle to Space Travel... Could be Our Microbiome.)
 
The good news is, I was able to (somewhat) correct the stinky microbiome through the following steps:
 
1. I used Hibiclens, an antimicrobial cleaner that bonds to the skin to create a protective, germ-killing field, to wash my left pit in the shower. (Apparently, it's the same stuff surgeons use before surgery. How full-circle!) Full disclosure: I know one microbiologist who recommended against this, and one geneticist who said I totally should.
 
2. I started using shampoo, rather than soap, to wash the right pit. This was at the recommendation of the microbiologist, who informed me that soap can mess up your skin's pH balance (which is bad for the microbiome). But when it comes to healthy hair and scalps, pH is super important, so shampoo is designed to preserve that. I wanted to keep my right pit's microbiome going strong, and this seemed like the best way.
 
(In the same conversation, she told me that, for this reason, it’s kind of bad to wash your dog with human shampoo, since it’s calibrated for human, not dog, skin. That’s why I switched Ruby from Panteen to Nature's Miracle -- except for one unfortunate month, when we were using Sentry Flea and Tick Shampoo.) 

3. After cleansing my left pit with the Hibiclens, I would do daily “transfers,” during which I wiped sweat from my right pit over to the left. Hopefully, with the bad bacteria knocked out, the original microbiome, brought in from the right, would have a chance flourish.
 
This worked – mostly. Once in a while, when I travel to humid locations, I start to smell a hint of the bad biome, so I know it's still around. But for the most part, it seems to be gone.
 
I have no idea how common this is. And it's definitely not a big enough concern to even be a consideration when you're deciding whether or not you want to have a fully-functioning shoulder. I’m mostly sharing the story because it’s interesting. (To me, anyway.)

​***

Can't play sports for four months? You can still go hiking in Joshua Tree! Bring your own water, though, because the park doesn't have any.

Now, for those who are reading this because they’re considering the shoulder surgery, here’s my two cents:
 
I put off the surgery for years, because my original dislocation tore the labrum just enough that the doctor told me, “You’re at the point where 50% of people would have the surgery, and 50% would try to fix it with physical therapy.”
 
I worked really hard in PT – but every time I thought I was making progress and feeling really strong, I’d have another dislocation.
 
After a couple of pretty bad ones, and it got to the point where I’d have dislocations in my sleep. I couldn't sleep with my arms above my head – which is sad, because that’s my favorite way to sleep.
 
Eventually, I had a dislocation that was bad enough to break the socket part of my ball-and-socket joint. The head of my humerus was dented and my labrum was torn. Sometimes, I'd lean forward, and the ball would fall out of the socket.
 
(In my doctor’s words, “Imagine a golf tee with the top of the tee broken off. Imagine trying to balance a golf ball on just the stump. That’s what you’re like right now.”)
 
At that point, PT was no longer an option.
 
I’d been reluctant to have the surgery, because I thought it was better to cure through exercise than through slicing and dicing. Because surgery is expensive. And because it wasn’t clear to me that the surgery would actually help. I knew several whitewater kayakers who'd had dislocations even after the surgery.

(In retrospect, I think their problem is that they brace high -- I've had so many dislocations that I would, intuitively, never do that. I've suffered the consequences. I know what not to do. Whereas they'd only had one dislocation, so they didn't have that learned aversion. I still whitewater kayak sometimes -- I even did my first Class IV this summer. And I've never even had a close call.)

What I learned from this experience:
 
1. Modern medicine is wonderful. It isn’t “always” better to do anything. Surgeries are safer and less invasive than ever, and I regret putting it off as long as I did.

2. People -- even otherwise very smart people -- will say incredibly stupid things. Like, "Oh, modern medicine is a huge, dangerous conspiracy! You should try acupuncture." Don't listen to them. Just because they're smart at some things, doesn't mean they have any understanding whatsoever of science, medicine, data, research, or what medical decision is best for you. 

Also: the difference between "alternative" medicine and medicine... is that medicine has been proven safe and effective, and "alternative" medicine has not. 

3. I didn't used to have health insurance, because I was an invincible 20-something. I never got sick, I never got seriously hurt, and I never visited doctors -- I did a lot of research, and concluded the whole "well-woman" exam is a sham. (I mean, unless you might have STDs or are experiencing symptoms of something.) But then Obama said he would fine people who didn’t have insurance, so I angrily picked an insurance plan -- optimizing, of course, for sports injuries. Since then, I've had one surgery, followed by several months of physical therapy; one shoulder MRI; one really bad finger dislocation (imagine a staircase), followed by x-rays and several months of physical therapy; two head wounds that needed to be stitched up; and one weird rash that I picked up in Central America -- which Google said was either cancer, meningitis, or leprosy. 

So thanks, Obama.

4. The surgery definitely helped, and my only regret is not doing it a year or two sooner. I try not to think about that too much – what’s the point in worrying about something you can’t change? I definitely don’t regret trying PT, though – if you’re at the point where you might be fine without surgery, you should at least try it.
 
But as soon as it became clear that it wasn’t working, I should have had the surgery. It could have stopped me from breaking a bone. It could have made me a stronger, healthier athlete sooner. Plus – let’s be real! – the older you get, the longer it takes you to recover. I probably would have done myself a favor by having the procedure sooner. 

5. If you live in the San Francisco Bay Area, the best possible doctor to do the surgery is Warren King. I did a lot of research before picking my surgeon. In addition to his education, he is also head Orthopedic Surgeon and Chief of Medical Staff for the Oakland Raiders, U.S. Rugby, and College of San Mateo. He's also worked for the S.F. Giants, S.J. Sharks, Golden State Warriors, USA Soccer, San Jose Blackhawks Soccer, Santa Clara University, and S.J. Giants.

I'd read a few reviews that said he had "bad bedside manner." I didn't find this to be the case at all. I showed up at my first appointment ready to stand in front of the door so he couldn't leave until he'd answered all of my questions. That ended up being completely unnecessary. He is kind, thorough and a pleasure to have met. Like, I'm honored that he did my surgery. And because of him, I can do things I never thought I'd be able to do again -- like this: