Total Recovery

Why can't I get better?
Did my doctors miss something?
How can I recover?

According to Dr. Gary Kaplan, conventional thinking about the nature of chronic pain and depression is essentially flawed. Although physicians continue to diagnose conditions like migraines, fibromyalgia, chronic fatigue, chronic back pain, depression, anxiety, and PTSD, a growing body of research shows that these are in fact symptoms of something else—a deep-rooted inflammation in the brain. This inflammation can affect the nervous system for months-even years-to devastating effect.

In Total Recovery, Dr. Kaplan demonstrates that it is possible to quiet the inflammatory state at the root of chronic pain and depression, and lays out a revolutionary new medical approach to ending your suffering and reclaiming your health.“With cutting edge science and clinical expertise, Gary Kaplan has identified the source of the inflammation that keeps patients in an endless cycle of pain and depression. He offers profound insight into the way our life experiences have a cumulative effect on our health. I highly recommend this book to anyone who has suffered without relief or wants a deeper insight into how our bodies work.”—Mark Hyman, M.D., author of the #1 New York Times bestseller The Blood Sugar Solution and chairman of the Institute for Functional Medicine

“In Total Recovery, Gary Kaplan offers a potentially game-changing insight: the neurological key to the inflammation that keeps patients in a perpetual cycle of pain and depression. If you have suffered for years without relief, this remarkable book may change your life.”—Andrew Weil, M.D., founder and director of the Arizona Center for Integrative Medicine at the University of Arizona Health Sciences Center, and author of True Food

“This fascinating book reads like a detective novel, but it’s not fiction. Gary Kaplan is a thoughtful integrative doctor willing to spend hours-even years-getting to the bottom of his patients’ chronic pain and illness. What he has learned could help you.”—Arthur Agatston, M.D., Medical Director of Wellness and Prevention for Baptist Health South Florida and author of The South Beach Diet

“Dr. Kaplan’s book draws on his decades of research and clinical practice offering us paradigm-shifting insights into the causes of chronic pain. I highly recommend this book to the millions of people who live with pain and are seeking new answers.”—Brian Berman, M.D., Professor of Family and Community Medicine and Director of the Center for Integrative Medicine, University of Maryland School of Medicine

“This book reads like a riveting detective story, in which case study after case study leads to one of the most compelling findings in recent medical history. By unveiling and responding to the real culprit in chronic pain, Dr. Kaplan’s Total Recovery represents a radical shift in understanding illness and the path to optimal health.”—Tara Brach, Ph.D., author of Radical Acceptance and True Refuge

“Gary Kaplan is the Sherlock Holmes of chronic pain. In Total Recovery, he describes how to uncover the underlying causes of chronic pain and, how by correcting them, seemingly hopeless patients can move toward health. It is a ‘must read’ at every pain center, by every pain physician and for every patient with chronic pain.”—Wayne B. Jonas, M.D., President and CEO, Samueli Institute, Former Director (1995-1999), Office of Alternative Medicine, National Institutes of HealthGary Kaplan, D.O. is a clinical associate professor at Georgetown University, director of the Kaplan Center for Integrative Medicine, and author of Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression (Rodale, 2014). Founder of the Foundation for Total Recovery, his work has been featured in TIME magazine, the Wall Street Journal, Fox News 5, ABC's Good Morning America, CNN News, and NPR's Diane Rehm Show. He writes a regular column for MindBodyGreen and US News and World Report, and can also be found on Facebook and Twitter.CHAPTER 1

THE ONE-TWO PUNCH

WHAT IF ASSAULTS ARE CUMULATIVE?

Study the art of science. Learn how to see. Realize that everything connects to everything else. —Leonardo da Vinci

This was the moment he lived for. Perched on a single snowy peak surrounded by a formidable range of peaks yet to be conquered, Billy surrendered to gravity. Leaning forward, he slid quickly down the slope, faster and faster, casting plumes of powder in his wake.

With so little effort—less than a thought—Billy was back where he belonged, carving up the mountain with carefree pirouettes, deep into the powerful compulsion that he and his snowboarding tribe called shreddin' the gnar.

Like most 14-year-old snowboarders, he was still considered a "grommet," but Billy Kass could hold his own. His parents had given him his first Never Summer board when he was 5 and his brother, Travis, was 8. Like some kind of rite of initiation, Travis introduced Billy to the secrets of the mountain. Nodding for Billy to follow, Travis had shown him how to ride a slow S-curve to the bottom. He'd been following Travis ever since.

The 3-year lead Travis had over Billy gave him a distinct advantage. At 16, Travis was all flash and fury. Billy was more wry and understated—not that he couldn't have been the one making noise, but that riff was already taken. So Billy played counterpoint.

Gliding down the slopes together, they wove in and out like a perfectly syncopated song. Travis would line up a 180 "fakie," a 360, a 180, and Billy would intuitively echo the moves.

Gillian, the boys' mom, had almost gone pro back in the day, and their dad, David, had managed to build a meaningful career in environmental science that kept him on the mountain and made skiing a constant part of his life. Travis and Billy dreamed of one day making their fortune together with an environmental tech start-up.

At 14, Billy was more of an idea guy than Travis. As he swooped down the mountain, Billy realized that, of the two of them, he would probably be the one to come up with the brilliant tech idea they needed. He decided to mention that to Travis when they reached the lodge. The idea might not come to him for years, but there was no reason he couldn't start lording it over Travis now.

First, he wanted to "jib" the 20-foot rail up ahead with an enticing 10- foot drop to flat. Leaping on the rail, he rode it all the way down, planning a smooth 180 at the end, but he didn't quite make the full revolution. His hand slammed into the rail on the way down and he landed hard, twisting his back and almost wrenching his knee from its socket.

INEXPLICABLE PAIN

The emergency medical team at the ski resort stabilized Billy's broken wrist and sent him to the hospital. Doctors there confirmed that he did not have a concussion and set his wrist. His left knee was very swollen and tender to the touch. If he tried to stand, his knee wobbled so badly he nearly fell.

When the orthopedic surgeon ran an MRI, it showed an anterior cruciate ligament (ACL) tear. The ACL is one of the four major ligaments in the knee. It emerges from inside the femur itself. An ACL tear is a common injury in athletes, and the ligament is so vital to the stability of the joint that it has to be repaired as soon as possible.

The surgeon scheduled surgery for a month later. In the meantime, Billy would have to keep his knee immobilized in a brace. He couldn't even use crutches. When the doctor rolled out the wheelchair, Billy's heart sank.

Travis reminded him that sports injuries were a drag but only temporary. Still, Billy counted the days till he could take off the brace and get back on the slopes. By spring, he would be back to normal again. Or so they said.

After surgery, Billy had to wear the knee brace for another month. On top of physical therapy, he spent an hour every day locked into a continuous passive motion device to keep the knee moving in a controlled way and help it regain its full range of motion.

The physical therapist explained that his knee would gradually become more flexible as it healed, but that isn't what happened at all. As the weeks went by, the swelling in Billy's knee continued. The slightest pressure caused an unusually painful reaction.

Eight months after surgery, Billy was only one wrong move away from full-body pain at any time. Horsing around with his friends in the living room one day, he bumped into the doorjamb with his shoulder. A jolt of pain shot through his arm with startling intensity. After that, Billy had what his doctors described as generalized pain—his whole body ached all the time.

In almost imperceptible increments, he gradually started to move like his elderly grandmother, feeling fragile, afraid of being hurt. Travis tried to tease him out of it, but Billy's discouragement was too deep. He lost all interest in hanging out with friends.

Despite his family's concern, he was sliding down a precipitous slope into depression. Travis couldn't even interest him in daydreaming about their future in environmental tech. If snowboarding wasn't going to be a part of that life, Billy wasn't interested. Under the assault of the constant pain, Billy reeled and couldn't catch his balance, just as he couldn't save himself in the fall. Increasingly, he was in danger of letting that fall become a metaphor for his life. Looking on, David and Gillian were heartbroken to realize that if something didn't change, their son's life was going to be defined by perpetual pain.

During the next 6 months, he would be rushed from one hospital to another. Again and again, the x-rays, CT scans, and other testing would show no pathology. A spinal tap failed to provide answers.

Neurologists, pediatricians, physical therapists, pain specialists, knee specialists—any specialists they could find—were consulted, to no avail. Not knowing what else to do, the doctors would hospitalize Billy on intravenous morphine until the crisis gradually subsided; then a few months later, the pain would flare up again.

When no physical explanation could be found, the psychiatrists were called in. It was easy to assume that if the doctor couldn't find the problem, the patient must be imagining things.

Accusing any patient of exaggerating pain to get attention would have been humiliating. When the patient was a happy, dedicated teenage athlete with a tight-knit social circle, it bordered on malpractice. After a 5-minute interview, one psychiatrist jumped to the conclusion that Billy was "malingering" to get attention and all but told him to snap out of it and "man up!"

From Gillian's point of view, it should have been obvious to anyone—especially a professional—that Billy simply didn't have the temperament of a malingerer desperately feigning an illness to get attention. He had plenty of attention. What he needed was to get back on his board.

Travis was 18 now, heading for the slopes with their friends every weekend, which didn't make it any easier. Even in the off-season, he finagled a coveted job at Oregon's Timberline Lodge, the only ski resort in the country with lift-accessible snow all summer long.

In near constant communication on Twitter and IM, Travis tried to lure Billy back into the game, raving about 20-foot elbow rails, big wall rides, pole jams, jibs, and jumps. He never really came out and said he didn't believe that Billy was in pain, but his relentless enthusiasm was laden with expectation. Whether he meant it or not, it sounded like he felt that if Billy really wanted to, he could shake off the pain.

"Remember that crash of mine where I plowed into that mogul 2 years ago and broke my wrist in three places?" Gillian overheard him saying one day. "Hurt like hell . . ."

"But you went back out with a cast on. Yeah, I know," Billy muttered. The implication did not slip past him; it slid right through, like a sliver in his heart. "It's different for me, Trav." What else could he say?

As the pain became chronic, the growing list of emergency hospitalizations with normal test results started to work against Billy. Rather than wondering if something had been missed, doctors would assume the pain was psychological before they even met him. On top of Billy's chronic pain, the doctors—and an increasing number of his friends—were adding a new barrier for him to contend with: disbelief.

Months went by without any sign of hope. Then one night, David and Gillian attended a dinner party with David's colleagues in the environmental sciences. The keynote speaker was a medical doctor and avid skier. After dinner, the conversation turned easily to their mutual passion. When Gillian mentioned Billy's unusual symptoms, the doctor asked a few questions, then frowned thoughtfully.

"We haven't heard anything that remotely explains what he's going through," David said.

"Have you heard about reflex sympathetic dystrophy?" the doctor asked.

When David and Gillian got home and looked up the condition late that night, they were startled by how well the diagnosis fit.