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Selective Cox-2

gotgame

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I see posts every day about people complaining about all types of pain from a variety of causes such as joint pain, tendons, strains etc. I am not the type to immediately suggest meds..they should mostly be a last resort but ive seen some xrays for guys on here with severe joint issues and its either pain control or joint replacement so sometimes meds should be discussed.

Many guys take nsaids for the pain and they are certainly a decent option for many however id suggest looking into etoricoxib. Its not FDA approved but then again neither is tren and you guys dont have a problem with that lol. Its used overseas because of the whole vioxx issues from like 2004.

If you recall there was a bunch of nonsense about vioxx in the early 2000's and Merck took it off the market and wouldnt bring it back even after the FDA panel had voted to bring it back with a warning. This is not a thread to get into the full discussion on cox-2 inhibitors and cardiac risk but i personally think that you will find that with any cox-2 inhibition that doesnt have anti platelet activity its just more apparent when you have like 300:1 selectivity like vioxx did. Theere have been numerous studies looking into this and basically it comes down to primarily decrease cox2 induced prostaglandin production in the vessels. Some earlier studies thought it might be due to the 1-2 ratio but i believe its due to decreased cox2 in the vessels which would mean ANYTHING that decreases cox-2 would potentially have a similiar effect ( except ASA due to platelet). So before someone starts saying well what about this that reduced inflammation...well look at the MOA..does it work on cox 2 or upstream from it...then it probably has the potential for similar effects in the vessels although less pronounced if its inhibiting it less. But if its inhibiting it less then its also having less effects on inflammation which is your desired effect.

I see a lot of guys taking nsaids but it may be worth looking into a selective cox-2 inhibitor like etoricoxib as this is a bodybuilding forum. I was in the camp of believing that most of the nsaid negative effects on protein synthesis was due to cox-2 inhibition but ive read quite a few papers over the last few years showing thats its actually cox-1 and not cox-2 that is expressed in muscle building process.

So benefits of selective cox-2 inhib would be GI mucosa protection and less inhibition of protein synthesis in skeletal muscle. Ive seen some studies showing 50% decrease in protein synthesis if taking high dose nsaidsbut then studies looking at just cox2 didnt really show any decrease. You will see get decreased renal blood flow so i dont believe its much different then taking nsaids with respect to kidney function.

For many guys with somewhat chronic pain 30-60mg daily would be like taking 2000mg of advil a day with respect to pain relief ( depending on the studies it varies).

For more acute pain 90-120mg would be like taking 2400+ mg of advil a day but ofcourse without the cox1 inhibition negative effects.

Those above comparisons vary from study to study so just look up etoricoxib efficacy and ibuprofen etc

As with anything that reduces cox2 you get renal mac densa and loop effects and can get some Na retention/edema in a small percent of people like 4% but this is true or any nsaid as well.

I personally use it for a herniated disc in my neck. Works within a few hours and lasts 24 hours. I have had labs while taking it and nothing has changed at a 60mg dose taken for a week and i dont get any sides but everyone is different.

I made this post as i get the question often about antinflammatory meds and what people should use. Ill leave all the natural stuff to other people. My go to meds are for mild issues ( but signfiicant enough to take something) is naproxen, moderate etoricoxib 60mg, severe ( but i know what is causing it so im not just masking something) either toradol 10mg q4-6 hour or etoricoxib 90-120mg. I dont like taking prednisone for joint/musculoskeletal issues.

Please look into the meds before taking them. Please only consider taking them for known issues or for an issue ur 99% sure is inflammatory in etiology but knee pain from arthritis, bursitis, nerve root inflammation, tenosynovitis etc. Dont have like severe abdominal pain and take this.

Celebrex doesnt really seem to work that well in bodybuilders its just not strong enough for our pain in many situations. I was dissapointed that vioxx never came back to the market but most of the world has access to etoricoxib so its worth looking into.
 

Matsuo Munefusa

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thank you for the post, semi off-topic but care to share quick thought about BPC-157? I searched the site to see if you had anything to say about it but couldn't pull anything up. Interested what you think about it for daily administration to reduce chronic inflammation.
 

gotgame

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thank you for the post, semi off-topic but care to share quick thought about BPC-157? I searched the site to see if you had anything to say about it but couldn't pull anything up. Interested what you think about it for daily administration to reduce chronic inflammation.


I think its an interesting compound and I occasionally look on pubmed to see what else has been published. It appears to have many different actions making it complex to study. Some of its properties appear promising.

I would not personally take or recommend to anyone taking a compound that has not been fully studied. All too many times we see promising drugs but on large scale trials we learn a lot more about its effects and side effects. I dont like to experiment with health.

I would suggest you find out why you have chronic inflammation of a particular area and see if you can treat the underlying issue. If you cannot easily treat the underlying issue id address the inflammation and the effects of prolonged inflammation via other means.

Maybe in 10 years ill be all for bpc 157 but not now. The small studies on IBS and some GI issues is not enough for me to sleep well at night. Benchtop/ invitro type publications are not enough
 

thethinker48

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I think its an interesting compound and I occasionally look on pubmed to see what else has been published. It appears to have many different actions making it complex to study. Some of its properties appear promising.

I would not personally take or recommend to anyone taking a compound that has not been fully studied. All too many times we see promising drugs but on large scale trials we learn a lot more about its effects and side effects. I dont like to experiment with health.

I would suggest you find out why you have chronic inflammation of a particular area and see if you can treat the underlying issue. If you cannot easily treat the underlying issue id address the inflammation and the effects of prolonged inflammation via other means.

Maybe in 10 years ill be all for bpc 157 but not now. The small studies on IBS and some GI issues is not enough for me to sleep well at night. Benchtop/ invitro type publications are not enough

For what it's worth:

I tore my ACL (grade-3), MCL (g-2), LCL (g-2) and Meniscus (lateral, complex) in a bad BJJ injury about 5 months ago. Leg was stuck at an angle for a while, and developed two baker's cyst behind the knee from the fluid accum (I was going to get surgery, but Covid happened). 4 weeks post injury I started using BPC, and within 10 days, the swelling was half gone, and the cysts started receding. 2 weeks since started I was squatting the bar, and doing light leg work. I ran it for about 6 weeks I believe.

5 months later, I'm up to doing almost my regular leg poundages for training. I still need an ACL in the knee, the meniscus is 80% good, and the LCL and MCL injuries healed. I prob wouldn't outright recommend anyone try unapproved peptides, but I think it played a massive role in bringing me back faster.

If I was smarter, and a bit more patient; I prob would've just let it heal on it's own. But alas, that's impatience is a condition a lot of us suffer from, and half the reason we post here 🙂
 

lookslikesausage

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For what it's worth:

I tore my ACL (grade-3), MCL (g-2), LCL (g-2) and Meniscus (lateral, complex) in a bad BJJ injury about 5 months ago. Leg was stuck at an angle for a while, and developed two baker's cyst behind the knee from the fluid accum (I was going to get surgery, but Covid happened). 4 weeks post injury I started using BPC, and within 10 days, the swelling was half gone, and the cysts started receding. 2 weeks since started I was squatting the bar, and doing light leg work. I ran it for about 6 weeks I believe.

how did you get hurt? heel hook?
 

gotgame

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For what it's worth:

I tore my ACL (grade-3), MCL (g-2), LCL (g-2) and Meniscus (lateral, complex) in a bad BJJ injury about 5 months ago. Leg was stuck at an angle for a while, and developed two baker's cyst behind the knee from the fluid accum (I was going to get surgery, but Covid happened). 4 weeks post injury I started using BPC, and within 10 days, the swelling was half gone, and the cysts started receding. 2 weeks since started I was squatting the bar, and doing light leg work. I ran it for about 6 weeks I believe.

5 months later, I'm up to doing almost my regular leg poundages for training. I still need an ACL in the knee, the meniscus is 80% good, and the LCL and MCL injuries healed. I prob wouldn't outright recommend anyone try unapproved peptides, but I think it played a massive role in bringing me back faster.

If I was smarter, and a bit more patient; I prob would've just let it heal on it's own. But alas, that's impatience is a condition a lot of us suffer from, and half the reason we post here


I would LOVE to see your pre and post knee MRI. Some of that would be case report publish worthy.


The meniscus almost never heals unless its along the periphery due to the small vessels there but a complex tear would be more then that. Changes in meniscal signal to not always mean healing thats why arthrograms are done. I am not suprised you need the ACL repaired. Too many people let those go as functionally they recover but then degen happens so much more quickly due to functional instability.

Pop cysts rarely get smaller in a short period of time unless they have popped as its a one way valve. If the defect heals it can stay the same size but rarely do they get smaller in 4 weeks. Would be interesting to see if it had popped.

Just so you are aware they will likely consent you for a partial meniscal "repair" when they go in for the ACL. Its usually a debridement. You will likely develop OA a lot more quickly in life after but functionally you will be better in the short term so dont do things which will regret by placing too much stress on that cartilage otherwise OA will hit you hard and fast in life
 

thethinker48

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how did you get hurt? heel hook?

Wrestling trip, knee twisted the other way

Funny thing is I've gotten heel hooked dozens of times, and never any injury. Basically wrestling to prevent takedown, and bam! lol
 

thethinker48

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I would LOVE to see your pre and post knee MRI. Some of that would be case report publish worthy.


The meniscus almost never heals unless its along the periphery due to the small vessels there but a complex tear would be more then that. Changes in meniscal signal to not always mean healing thats why arthrograms are done. I am not suprised you need the ACL repaired. Too many people let those go as functionally they recover but then degen happens so much more quickly due to functional instability.

Pop cysts rarely get smaller in a short period of time unless they have popped as its a one way valve. If the defect heals it can stay the same size but rarely do they get smaller in 4 weeks. Would be interesting to see if it had popped.

Just so you are aware they will likely consent you for a partial meniscal "repair" when they go in for the ACL. Its usually a debridement. You will likely develop OA a lot more quickly in life after but functionally you will be better in the short term so dont do things which will regret by placing too much stress on that cartilage otherwise OA will hit you hard and fast in life

Yeah my surgeon recommended a meniscus repair with the acl reconstruc. He was also pretty upfront, saying that given my lifestyle, I might retear it, so he could also just clip it, and deal with the OA risk. There's some popping with full knee flexion during a2g squats or leg presses, haven't even bothered trying to pivot fast or run laterally due to the acl. But thankfully, overall it's so much better than I thought it would be. Being young (24) might also play a role with recovery.

Here's some scans from pre bpc usage, 2 weeks post injury. Sorry to flood your thread with this, but given your background, you could probably tell better from the images than I'd ever be able to describe to you. Maybe one day we'll be able to go full Mel Gibson and start blasting our joints with stem cells

334f448e-0b68-4a90-80e4-c85868d82136 (1).jpg 4c10ff38-533c-439e-a339-2846d9174b39 (1).jpg


e399d596-c26d-4cd0-a200-47b77fc60613 (1).jpg
 

gotgame

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you are catching an oblique part of a lat meniscal tear but dont see the complex portion. Would probably be seen better on the sag. LCL is a bit jacked up but appears intact where visualized. Not catching the ACL well not sure if due to the tear or other, also likely seen better on the sag.

MCL also has some abnormal morphology slightly thickened likely from low grade chronic sprain with some edema superficial consistent with low grade acute.

knee effusion. Some low grade cartilage stuff both mediallly and laterally
 

lookslikesausage

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Wrestling trip, knee twisted the other way

Funny thing is I've gotten heel hooked dozens of times, and never any injury. Basically wrestling to prevent takedown, and bam! lol
I'm always a little cautious with like say, an inside trip as i don't want to hurt my opponent especially if he tries to plant his foot hard. Same with scrambles. In wrestling, when you start rolling around and hooking around ankles, and it's different than in bjj cause guys are not worried about subs, i feel like things can sideways real quick. Can't wait to get back on the mat. have you been able to roll?
 

thethinker48

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I'm always a little cautious with like say, an inside trip as i don't want to hurt my opponent especially if he tries to plant his foot hard. Same with scrambles. In wrestling, when you start rolling around and hooking around ankles, and it's different than in bjj cause guys are not worried about subs, i feel like things can sideways real quick. Can't wait to get back on the mat. have you been able to roll?

That's what I did essentially, and my foot faced one way and knee turned counter-clockwise. Been drilling and rolling with a small group after hours. Haven't gone back to a full class due to covid. Stuff's going back up in my state, and I can't risk giving it to my grandma whom I see very often.
 

thethinker48

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you are catching an oblique part of a lat meniscal tear but dont see the complex portion. Would probably be seen better on the sag. LCL is a bit jacked up but appears intact where visualized. Not catching the ACL well not sure if due to the tear or other, also likely seen better on the sag.

MCL also has some abnormal morphology slightly thickened likely from low grade chronic sprain with some edema superficial consistent with low grade acute.

knee effusion. Some low grade cartilage stuff both mediallly and laterally

The Lachman test from the doc was a full rupture for the ACL; before I started guarding it right away and he stopped.

Radiology report:

- Rupture of the mid-substance of the anterior cruciate ligament.
- Attenuation, increased signal involving femoral attachment of medial collateral ligament, compatible with grade 2 sprain/partial tear.
- LCL complex shows attenuated fibular collateral ligament compatible with grade 2 sprain/partial tear; Grade 1, mild injury of the remainder of the complex.
- Lateral meniscus shows complex tearing, mild lateral extrusion. PD sagittal fat sat image 7-12 multifocal tearing is seen. This includes undersurface tearing/defect at junction of anterior horn and anterior body. Radial tearing of the body. Vertical longitudinal femoral space tearing of posterior horn.
- Patchy moderate chondromalacia of anterior weight bearing lateral femoral condyle, overlying the bone contusion.

As I understand; Radiologists kind of exaggerate sometimes 🙂

Doc said that a pre-op MRI would be useless, he'd rather just go in and see it arthroscopically. In case I do get it, I'll share it. I doubt any change for the ACL, and some healing for the meniscus probably. Lack of symptoms =/ fixed pathology; as much as I want to it to be
 

gotgame

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The Lachman test from the doc was a full rupture for the ACL; before I started guarding it right away and he stopped.

Radiology report:

- Rupture of the mid-substance of the anterior cruciate ligament.
- Attenuation, increased signal involving femoral attachment of medial collateral ligament, compatible with grade 2 sprain/partial tear.
- LCL complex shows attenuated fibular collateral ligament compatible with grade 2 sprain/partial tear; Grade 1, mild injury of the remainder of the complex.
- Lateral meniscus shows complex tearing, mild lateral extrusion. PD sagittal fat sat image 7-12 multifocal tearing is seen. This includes undersurface tearing/defect at junction of anterior horn and anterior body. Radial tearing of the body. Vertical longitudinal femoral space tearing of posterior horn.
- Patchy moderate chondromalacia of anterior weight bearing lateral femoral condyle, overlying the bone contusion.

As I understand; Radiologists kind of exaggerate sometimes

Doc said that a pre-op MRI would be useless, he'd rather just go in and see it arthroscopically. In case I do get it, I'll share it. I doubt any change for the ACL, and some healing for the meniscus probably. Lack of symptoms =/ fixed pathology; as much as I want to it to be


haha yes sometimes radiologists overcall some signal but im sure the major finding are all real. Yea the meniscal tear is probably best seen on the sagital not the coronal.

Definitely get the ACL repaired. Dont let them go too crazy with the meniscus..just enough to help it heal.

After this do your best to limit any heavy axial weight loading activities. Im not so concerned about the acl reconstruction but i dont want the cartilage to have issues sooner.
 

thethinker48

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haha yes sometimes radiologists overcall some signal but im sure the major finding are all real. Yea the meniscal tear is probably best seen on the sagital not the coronal.

Definitely get the ACL repaired. Dont let them go too crazy with the meniscus..just enough to help it heal.

After this do your best to limit any heavy axial weight loading activities. Im not so concerned about the acl reconstruction but i dont want the cartilage to have issues sooner.

Even with a "healed" or repaired meniscus; the risk of OA with heavy lifting is present?

I thought it was only when it was taken out that people had that risk?
 

gotgame

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Even with a "healed" or repaired meniscus; the risk of OA with heavy lifting is present?

I thought it was only when it was taken out that people had that risk?

They are going to debride it. You dont heal a part of a meniscus that doesnt have blood flow . You debride it at a minimum to smooth out the tear. Its a complex tear per the MRI report..they cant just tac it together... a decent part of the tear area is gonna be removed. even if they tell you its gonna be "repaired" they are gonna debride and then try to do a small repair. If its too bad they may consent for a partial menisectomy though there has been a trend away from that due to the issues down the line unless its a bad complex tear or a large full thickness radial tear.

The risk of OA is going to be present especialy in combination with an ACL reconstruction which gets mucoid degen overtime and gets some laxity in many patients.

Case in point. Today i read an MRI on a 35 year old guy. ACL recon and meniscus "repair" when he was 21. Now he has severe OA. ACL is intact and meniscus doesnt look retorn.

If i was in your shoes id still work legs and do all sorts of active liftestyle things but id limit axial loading. Gotta live your life but no need to cause more issues if you dont have to.
 

gotgame

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I have seen meniscus heal but those are peripheral tears like 1-2 mm often horizontal tears. i have not seen a complex multidirectional tear involving the substances of the mensicus heal
 

gotgame

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FYI: for other people reading this thread. I personally have a horz oblique tear of my medial meniscus. Its definitely real and ive been following it for 5 years. it hasnt gotten worse and no signficant cartilage loss in the adjacent central weightbearing cartilage. I follow it once a year. Not all tears need to be repaired but complex ones often do. Depends a bit on what you want in life.
 

thethinker48

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They are going to debride it. You dont heal a part of a meniscus that doesnt have blood flow . You debride it at a minimum to smooth out the tear. Its a complex tear per the MRI report..they cant just tac it together... a decent part of the tear area is gonna be removed. even if they tell you its gonna be "repaired" they are gonna debride and then try to do a small repair. If its too bad they may consent for a partial menisectomy though there has been a trend away from that due to the issues down the line unless its a bad complex tear or a large full thickness radial tear.

The risk of OA is going to be present especialy in combination with an ACL reconstruction which gets mucoid degen overtime and gets some laxity in many patients.

Case in point. Today i read an MRI on a 35 year old guy. ACL recon and meniscus "repair" when he was 21. Now he has severe OA. ACL is intact and meniscus doesnt look retorn.

If i was in your shoes id still work legs and do all sorts of active liftestyle things but id limit axial loading. Gotta live your life but no need to cause more issues if you dont have to.

:(

Damn ok, message received. Thank you for all the info and your thoughts on this!
 

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