8 ms·

Ice to treat soft-tissue injuries contraindicated by creator of protocol

62 points by stank345 2y ago

iwontberude 2y ago
And here I thought the ice was intended to be a pain reliever, not a way to induce healing.
- deleted 2y ago
  [deleted]
- blastro 2y ago
  Mostly a way to reduce inflammation, ice bath isn't exactly a "painless" experience
alistairSH 2y ago
It's amazing how much medical knowledge we have to unlearn (and sometimes relearn) as time passes. Some of it from experts; much of it folk wisdom. And how much of that knowledge was based on overzealous extrapolation (as appears to be the case here). Heat vs Ice for injuries Fats vs Sugars vs Proteins (and everything else diet-related) Leeches went out of favor, but now see limited use again (for very specific things, not blanket "release the bad humours!" quackery.
- radlad 2y ago
  What exactly do we need to unlearn about Fats vs Sugars vs Proteins?
  - alistairSH 2y ago
    In my life, eggs have been both bad and good. Butter vs margarine. Atkins vs paleo vs whatever else. Calorie restriction vs more exercise. Lots of junk science. Lots of marketing fluff. But, also lots of recommendations that were assumed correct but didn't stand up to deeper scrutiny. Note, I'm not saying any of this is bad, or that scientists are stupid and wrong all the time. Just always amazed about how much our understanding of the human body has changed in the last ~50 years.
    - radlad 2y ago
      Thanks. All of those examples aren't about macronutrients though, which I thought were fairly well understood. (Though I'm sure various myths about them have been spread: such as another commenter suggesting "you can't get fat if you don't eat fat.") Nutrition is definitely a minefield, I'm with you there!
  - mb7733 2y ago
    https://pubmed.ncbi.nlm.nih.gov/18296750 https://pubmed.ncbi.nlm.nih.gov/18296750: > This article examines how faith in science led physicians and patients to embrace the low-fat diet for heart disease prevention and weight loss. Scientific studies dating from the late 1940s showed a correlation between high-fat diets and high-cholesterol levels, suggesting that a low-fat diet might prevent heart disease in high-risk patients. By the 1960s, the low-fat diet began to be touted not just for high-risk heart patients, but as good for the whole nation. After 1980, the low-fat approach became an overarching ideology, promoted by physicians, the federal government, the food industry, and the popular health media. Many Americans subscribed to the ideology of low fat, even though there was no clear evidence that it prevented heart disease or promoted weight loss. Ironically, in the same decades that the low-fat approach assumed ideological status, Americans in the aggregate were getting fatter, leading to what many called an obesity epidemic. Nevertheless, the low-fat ideology had such a hold on Americans that skeptics were dismissed. Only recently has evidence of a paradigm shift begun to surface, first with the challenge of the low-carbohydrate diet and then, with a more moderate approach, reflecting recent scientific knowledge about fats.
    - radlad 2y ago
      Thanks for the link. My understanding is that fats are more energy dense than simple carbs, and therefore eating high-fat diets is more likely to cause weight gain. The article is interesting, but it seems to take for granted that this isn't true. Are there any evidence-based studies you can link?
      - mb7733 2y ago
        The reason I posted that article is because it summarizes how there has been a huge shift in thinking since the low-fat craze. I don't think it takes anything for granted, and I wasn't looking to argue for a particular point of view. I'm sure you can find studies about a specific topic as easily as I can. Re caloric density: it's true that fat has more cal/g than carbs or protein. But, people do not eat a fixed mass of food per day -- the satiety of the food they consume influences this. Insulin response also affects weight gain and satiety.
    - 2y ago
  - harimau777 2y ago
    When I was growing up there was a big emphasis on eating lots of grains which basically equates to lots of carbs. It was also widely believed that fats were bad and contributed to weight gain. Both of those ideas may not necessarily have been 100% abandoned but are at the very least now viewed with a lot more nuance.
  - jghn 2y ago
    I'm assuming you never saw folks like Susan Powter making claims of how you can't get fat if you don't eat fat.
  - SkyPuncher 2y ago
    Ancedotally. Growing up, there was a huge push towards "fat-free" and "low fat" foods that is extremely ingrained in my parents generation. I can only summarize it as an ingrained feeling of "Fat is what fat people have". It meant they avoided it like the plague while completely overdoing it on other bad stuff.
    - throwaway5752 2y ago
      Then, just like now, unscrupulous product marketing and media mistates medical consensus or ascribes consensus where there there is none. Just look at Snackwells. The product marketing term "Doctor recommended" does not mean all doctors, or even specialists in the relevant area. Unless you are talking to a physician or reading a medical journal, anyone should assume that someone claiming to talk about what the medical community believes is probably wrong and possibly lying. In the context of the current conversation, reducing saturated fats and bad cholesteral was a reactions to this epidemic https://pubmed.ncbi.nlm.nih.gov/24811552/ https://pubmed.ncbi.nlm.nih.gov/24811552/ After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels
- imzadi 2y ago
  [flagged]
nickburns 2y ago
one wonders how it ever even seemed like common sense to disrupt the body's evolved immune response to acute, traumatic soft-tissue injury, never mind good conventional medical advice. ice to preserve a detached structure? sure. quelling the inflammation of organs or the brain? yeah, those types of inflammation can turn into a cascading collection of responses, often (but not always) having distinct non-traumatic root causes. but disrupting increased (life)blood flow to the site of acute, traumatic soft-tissue injury? seems like some otherwise logical lines crossed there, not to mention just a bad idea on its face.
- lrasinen 2y ago
  That's because the body's initial response is often way out of proportion. I get the flu and my body decides to turn up the heat. There's pollen in the air and my nose goes into lockdown for weeks. I've dislocated my kneecap a few times and the near-immediate swelling was much worse than the actual injury. Recovery took a few weeks anyway so easing my discomfort for a couple of hours made no difference.
  - nickburns 2y ago
    my comment is limited to "acute, traumatic soft-tissue injury", the scope of which excludes viral infection, allergic reaction, and strict joint injury.
    - naasking 2y ago
      > my comment is limited to "acute, traumatic soft-tissue injury", the scope of which excludes viral infection, allergic reaction, and strict joint injury. The point is that evolved responses don't always properly account for nuance or proportion. If inflammation evolved for large traumatic injury, it may still be triggered for limited soft tissue injuries but then the response could be disproportionate.
    - lrasinen 2y ago
      Those examples were more about the body's tendency to overdo its response. (But aren't joint injuries usually soft-tissue as well? It's the ligaments that get the short shaft.)
tpoacher 2y ago
This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to apply warmth, not heat, to encourage increased perfusion to the area and promote healing. So, apples/oranges. There's nothing in the statement above to say that RICE is contraindicated as an initial management, and the implication that RICE was meant to be applied past initial management simply isn't true in the first place (afaik). I could be wrong as to how others used it, however. I wouldn't put it past a hospital to mindlessly make it a protocol that would then be followed blindly, I guess...
- harimau777 2y ago
  Does that mean that alternating hot and cold is no longer recommended for long term healing?
  - davidmurdoch 2y ago
    He's saying it never was
    - h0h0h0h0111 2y ago
      It's not mentioned here, but at some point there were studies suggesting that alternating heat and cold gave improved recovery over cold (ofc now we know that cold is debunked, the question is whether heat and cold improves recovery over doing nothing or adding heat)
- QuadrupleA 2y ago
  How is the initial swelling dangerous / compromising?
  - deleted 2y ago
    [deleted]
lambdaba 2y ago
I suppose it's related, that for athletes, ice baths after exercising are to be avoided because they hinder hypertrophy.
- zacharycohn 2y ago
  Hypertrophy is often not the goal.
  - deleted 2y ago
    [deleted]
  - blastro 2y ago
    Surprising that this fact is being often overlooked in this thread. If you're in a multi-day golf tournament for example, an ice bath for immediate recovery and lack of hypertrophy is exactly what you want.
    - awestroke 2y ago
      And why do golfers not want hypertrophy exactly?
      - blastro 2y ago
        They do sometimes - like when they're trying to gain strength. At other times, recovery is more important than growing stronger (like during a tournament).
    - lambdaba 2y ago
      I think it hinders recovery too though, inflammation has a function, which is why we don't just systematically administer high dose anti-inflammatories for every infection, only when it's too risky to leave the natural process handle it, or when the inflammatory response is pathological (e.g. COVID cytokine storm).
  - eternauta3k 2y ago
    Are there any athletes who want hypertrophy? Bodybuilders aside.
rob74 2y ago
> Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice Of course, for detached limbs, ice is really good to conserve them until they can be reattached. But that's not the majority of injuries fortunately. Also, compression is really good for wounds that are bleeding profusely. For soft tissue injuries, maybe not so much?
rawling 2y ago
(2014)?
jschveibinz 2y ago
Some additional reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/ https://pubmed.ncbi.nlm.nih.gov/11510876/ https://pubmed.ncbi.nlm.nih.gov/11510876/
kazinator 2y ago
It is contraindicated from the parameter of speed of recovery/healing. While that's important in order for someone to get back to work or a sport, the most important parameter should be quality of recovery, in my opinion.
- bunderbunder 2y ago
  I'm not prepared to provide citations, but my understanding is that the evidence indicates that attempting to inhibit inflammation also reduces that. For example, the use of NSAIDs to treat sports injuries is associated with an increased risk of things like chronic pain and lasting reductions in strength and mobility. This part of why the A in PEACE & LOVE stands for "avoid anti-inflammatories".
  - kazinator 2y ago
    The usual recommendation regarding ice is that it's only supposed to be used for a short while, immediately after the injury. Like minutes to hours. If used on the second day at all, the protocol is to alternate it heat. Pills may end up used for days. Some of them have long half-lives; e.g. 17 hours for naproxen.
mtalantikite 2y ago
Tangentially related, the article mentioned the first re-attachment of a limb from a 12-year old boy whose limb was preserved with ice prior to surgery at MGH. That jogged my memory, as my AP Chemistry teacher told us that story one day in class. Turns out he grew up in Somerville and knew the kid from the neighborhood, and all the kids used to hop the freight trains to catch a lift to various places around Somerville and the surrounding areas. He may have even said that he was there when it happened. He said that the kid was fairly new to hopping the trains like that, as you learn to pull yourself in between cars or very close to the train so that you don't hit a wall and, well, lose an arm. [1] [1] https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successful_Replantation_of_a_Severed_Limb_(Everett_Knowles) https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successfu...
throwaway5752 2y ago
Since people here are arguing about things that the article doesn't state, or mistating things it does state, here is the actual relevant text The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction.[7] Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury.[16] Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.[7] and Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid anti-inflammatories, compression, and education. It guides the treatment of acute soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries.
deleted 2y ago
[deleted]
Jerqfase 2y ago
Funny that anyone would point to icing a detached limb as a solution for the ones still attached.
readthenotes1 2y ago
Declared unsuitable in 2014 after 30+ years, and I'm just now finding out. I feel a bit like Woody Allen in Sleeper...

62 points by stank345 2y ago

iwontberude 2y ago

And here I thought the ice was intended to be a pain reliever, not a way to induce healing.

deleted 2y ago
[deleted]
blastro 2y ago
Mostly a way to reduce inflammation, ice bath isn't exactly a "painless" experience

alistairSH 2y ago

It's amazing how much medical knowledge we have to unlearn (and sometimes relearn) as time passes. Some of it from experts; much of it folk wisdom. And how much of that knowledge was based on overzealous extrapolation (as appears to be the case here). Heat vs Ice for injuries Fats vs Sugars vs Proteins (and everything else diet-related) Leeches went out of favor, but now see limited use again (for very specific things, not blanket "release the bad humours!" quackery.

radlad 2y ago
What exactly do we need to unlearn about Fats vs Sugars vs Proteins?
- alistairSH 2y ago
  In my life, eggs have been both bad and good. Butter vs margarine. Atkins vs paleo vs whatever else. Calorie restriction vs more exercise. Lots of junk science. Lots of marketing fluff. But, also lots of recommendations that were assumed correct but didn't stand up to deeper scrutiny. Note, I'm not saying any of this is bad, or that scientists are stupid and wrong all the time. Just always amazed about how much our understanding of the human body has changed in the last ~50 years.
  - radlad 2y ago
    Thanks. All of those examples aren't about macronutrients though, which I thought were fairly well understood. (Though I'm sure various myths about them have been spread: such as another commenter suggesting "you can't get fat if you don't eat fat.") Nutrition is definitely a minefield, I'm with you there!
- mb7733 2y ago
  https://pubmed.ncbi.nlm.nih.gov/18296750 https://pubmed.ncbi.nlm.nih.gov/18296750: > This article examines how faith in science led physicians and patients to embrace the low-fat diet for heart disease prevention and weight loss. Scientific studies dating from the late 1940s showed a correlation between high-fat diets and high-cholesterol levels, suggesting that a low-fat diet might prevent heart disease in high-risk patients. By the 1960s, the low-fat diet began to be touted not just for high-risk heart patients, but as good for the whole nation. After 1980, the low-fat approach became an overarching ideology, promoted by physicians, the federal government, the food industry, and the popular health media. Many Americans subscribed to the ideology of low fat, even though there was no clear evidence that it prevented heart disease or promoted weight loss. Ironically, in the same decades that the low-fat approach assumed ideological status, Americans in the aggregate were getting fatter, leading to what many called an obesity epidemic. Nevertheless, the low-fat ideology had such a hold on Americans that skeptics were dismissed. Only recently has evidence of a paradigm shift begun to surface, first with the challenge of the low-carbohydrate diet and then, with a more moderate approach, reflecting recent scientific knowledge about fats.
  - radlad 2y ago
    Thanks for the link. My understanding is that fats are more energy dense than simple carbs, and therefore eating high-fat diets is more likely to cause weight gain. The article is interesting, but it seems to take for granted that this isn't true. Are there any evidence-based studies you can link?
    - mb7733 2y ago
      The reason I posted that article is because it summarizes how there has been a huge shift in thinking since the low-fat craze. I don't think it takes anything for granted, and I wasn't looking to argue for a particular point of view. I'm sure you can find studies about a specific topic as easily as I can. Re caloric density: it's true that fat has more cal/g than carbs or protein. But, people do not eat a fixed mass of food per day -- the satiety of the food they consume influences this. Insulin response also affects weight gain and satiety.
  - 2y ago
- harimau777 2y ago
  When I was growing up there was a big emphasis on eating lots of grains which basically equates to lots of carbs. It was also widely believed that fats were bad and contributed to weight gain. Both of those ideas may not necessarily have been 100% abandoned but are at the very least now viewed with a lot more nuance.
- jghn 2y ago
  I'm assuming you never saw folks like Susan Powter making claims of how you can't get fat if you don't eat fat.
- SkyPuncher 2y ago
  Ancedotally. Growing up, there was a huge push towards "fat-free" and "low fat" foods that is extremely ingrained in my parents generation. I can only summarize it as an ingrained feeling of "Fat is what fat people have". It meant they avoided it like the plague while completely overdoing it on other bad stuff.
  - throwaway5752 2y ago
    Then, just like now, unscrupulous product marketing and media mistates medical consensus or ascribes consensus where there there is none. Just look at Snackwells. The product marketing term "Doctor recommended" does not mean all doctors, or even specialists in the relevant area. Unless you are talking to a physician or reading a medical journal, anyone should assume that someone claiming to talk about what the medical community believes is probably wrong and possibly lying. In the context of the current conversation, reducing saturated fats and bad cholesteral was a reactions to this epidemic https://pubmed.ncbi.nlm.nih.gov/24811552/ https://pubmed.ncbi.nlm.nih.gov/24811552/ After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels
imzadi 2y ago
[flagged]

nickburns 2y ago

one wonders how it ever even seemed like common sense to disrupt the body's evolved immune response to acute, traumatic soft-tissue injury, never mind good conventional medical advice. ice to preserve a detached structure? sure. quelling the inflammation of organs or the brain? yeah, those types of inflammation can turn into a cascading collection of responses, often (but not always) having distinct non-traumatic root causes. but disrupting increased (life)blood flow to the site of acute, traumatic soft-tissue injury? seems like some otherwise logical lines crossed there, not to mention just a bad idea on its face.

lrasinen 2y ago
That's because the body's initial response is often way out of proportion. I get the flu and my body decides to turn up the heat. There's pollen in the air and my nose goes into lockdown for weeks. I've dislocated my kneecap a few times and the near-immediate swelling was much worse than the actual injury. Recovery took a few weeks anyway so easing my discomfort for a couple of hours made no difference.
- nickburns 2y ago
  my comment is limited to "acute, traumatic soft-tissue injury", the scope of which excludes viral infection, allergic reaction, and strict joint injury.
  - naasking 2y ago
    > my comment is limited to "acute, traumatic soft-tissue injury", the scope of which excludes viral infection, allergic reaction, and strict joint injury. The point is that evolved responses don't always properly account for nuance or proportion. If inflammation evolved for large traumatic injury, it may still be triggered for limited soft tissue injuries but then the response could be disproportionate.
  - lrasinen 2y ago
    Those examples were more about the body's tendency to overdo its response. (But aren't joint injuries usually soft-tissue as well? It's the ligaments that get the short shaft.)

tpoacher 2y ago

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to apply warmth, not heat, to encourage increased perfusion to the area and promote healing. So, apples/oranges. There's nothing in the statement above to say that RICE is contraindicated as an initial management, and the implication that RICE was meant to be applied past initial management simply isn't true in the first place (afaik). I could be wrong as to how others used it, however. I wouldn't put it past a hospital to mindlessly make it a protocol that would then be followed blindly, I guess...

harimau777 2y ago
Does that mean that alternating hot and cold is no longer recommended for long term healing?
- davidmurdoch 2y ago
  He's saying it never was
  - h0h0h0h0111 2y ago
    It's not mentioned here, but at some point there were studies suggesting that alternating heat and cold gave improved recovery over cold (ofc now we know that cold is debunked, the question is whether heat and cold improves recovery over doing nothing or adding heat)
QuadrupleA 2y ago
How is the initial swelling dangerous / compromising?
- deleted 2y ago
  [deleted]

lambdaba 2y ago

I suppose it's related, that for athletes, ice baths after exercising are to be avoided because they hinder hypertrophy.

zacharycohn 2y ago
Hypertrophy is often not the goal.
- deleted 2y ago
  [deleted]
- blastro 2y ago
  Surprising that this fact is being often overlooked in this thread. If you're in a multi-day golf tournament for example, an ice bath for immediate recovery and lack of hypertrophy is exactly what you want.
  - awestroke 2y ago
    And why do golfers not want hypertrophy exactly?
    - blastro 2y ago
      They do sometimes - like when they're trying to gain strength. At other times, recovery is more important than growing stronger (like during a tournament).
  - lambdaba 2y ago
    I think it hinders recovery too though, inflammation has a function, which is why we don't just systematically administer high dose anti-inflammatories for every infection, only when it's too risky to leave the natural process handle it, or when the inflammatory response is pathological (e.g. COVID cytokine storm).
- eternauta3k 2y ago
  Are there any athletes who want hypertrophy? Bodybuilders aside.

rob74 2y ago

> Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice Of course, for detached limbs, ice is really good to conserve them until they can be reattached. But that's not the majority of injuries fortunately. Also, compression is really good for wounds that are bleeding profusely. For soft tissue injuries, maybe not so much?

rawling 2y ago

(2014)?

jschveibinz 2y ago

Some additional reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/ https://pubmed.ncbi.nlm.nih.gov/11510876/ https://pubmed.ncbi.nlm.nih.gov/11510876/

kazinator 2y ago

It is contraindicated from the parameter of speed of recovery/healing. While that's important in order for someone to get back to work or a sport, the most important parameter should be quality of recovery, in my opinion.

bunderbunder 2y ago
I'm not prepared to provide citations, but my understanding is that the evidence indicates that attempting to inhibit inflammation also reduces that. For example, the use of NSAIDs to treat sports injuries is associated with an increased risk of things like chronic pain and lasting reductions in strength and mobility. This part of why the A in PEACE & LOVE stands for "avoid anti-inflammatories".
- kazinator 2y ago
  The usual recommendation regarding ice is that it's only supposed to be used for a short while, immediately after the injury. Like minutes to hours. If used on the second day at all, the protocol is to alternate it heat. Pills may end up used for days. Some of them have long half-lives; e.g. 17 hours for naproxen.

mtalantikite 2y ago

Tangentially related, the article mentioned the first re-attachment of a limb from a 12-year old boy whose limb was preserved with ice prior to surgery at MGH. That jogged my memory, as my AP Chemistry teacher told us that story one day in class. Turns out he grew up in Somerville and knew the kid from the neighborhood, and all the kids used to hop the freight trains to catch a lift to various places around Somerville and the surrounding areas. He may have even said that he was there when it happened. He said that the kid was fairly new to hopping the trains like that, as you learn to pull yourself in between cars or very close to the train so that you don't hit a wall and, well, lose an arm. [1] [1] https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successful_Replantation_of_a_Severed_Limb_(Everett_Knowles) https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successfu...

throwaway5752 2y ago

Since people here are arguing about things that the article doesn't state, or mistating things it does state, here is the actual relevant text The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction.[7] Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury.[16] Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.[7] and Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid anti-inflammatories, compression, and education. It guides the treatment of acute soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries.

deleted 2y ago

[deleted]

Jerqfase 2y ago

Funny that anyone would point to icing a detached limb as a solution for the ones still attached.

readthenotes1 2y ago

Declared unsuitable in 2014 after 30+ years, and I'm just now finding out. I feel a bit like Woody Allen in Sleeper...