Trans-Care

About the Author:

Jacoby Ballard is a white working class transman living in Brooklyn. He
is a yoga teacher and herbalist practicing out of Third Root Community
Health Center, which he helped to found in 2008. Third Root is a
worker-owned cooperative offering acupuncture, energy work,

Surgery Zine
massage, herbal medicine, yoga, and health education at sliding scale
prices. See www.thirdroot.org for more information.

Written February 2006, revised Spring 2011
By Jacoby Ballard
Jacoby came out as trans when he entered herb school at the Northeast
School of Botanical Medicine, so his herbal work has always been
connected to his community and identity. Jacoby is also an Advanced
Yoga Teacher, having received his 200-hour training at Kashi Ashram in
Atlanta and his 500-hour training at Kripalu in Massachusetts and
teaches 3 weekly Queer and Trans Yoga classes. Jacoby has been part of
social justice work for the past 12 years, as is particularly grateful for
the work of CISPES in training him as an organizer and fundraiser.
Jacoby is on the Trans Community Advisory Board of Callen-Lorde
Community Health Center, is a provider in the Rock Dove Collective’s
Network, and a contributor to the Brown Boi Project’s Health
Curriculum to be released in August of 2011. Jacoby was part of the
Healing Practice Space at the 2010 US Social Forum, and continues to
participate in and grow the network of health justice in the U.S. Jacoby
teaches about holistic transhealth at conferences and herb schools
around the country.

Jacoby originally wrote this zine in 2006, when his dear friend was
getting surgery, and he used the protocol in his own surgery prep and
recovery. He hopes this work can help in the wellness and vitality of all
the beautiful and brave genderqueer, gender non-conforming, two-
spirit, transgender, transsexual, and intersex people.
Thank you to: Dori Midnight, a co-founder of the Transnatural listserv
for choosing to work together on transhealth and being a terrific ally;
Larken Bunce at the Vermont Center for Integrated Herbalism for your
wisdom and support; 7song for the ways in which you push and
support your many students; Lauren Giambrone of Rock Dove for your
continued interest and solidarity; Karen Rose of Sacred Vibes
Apothecary for all of the ways you support my work and how we grow
the herbal community that we want through our Herbal Education
Program at Third Root; Angela Ueckerman at Third Root for your
wisdom at essential oils that informs the reprinting of this zine; B.Cole
of Brown Boi Project for your amazing work in putting together the
Brown Boi Health Curriculum; and all of my dear clients, for your trust
and commitment. And much gratitude to my beloved Lezlie Frye, for
growing together a vision of love and trust within relationship and
justice, for all of your work, your inspiration, and your incredible
presence.
Preparing your body well before surgery, following with a good post-op
program makes an enormous difference in accelerating your recovery.
Your body has the power to heal itself, but its vital recuperative forces
need extra nutritive help after surgery to do it; a speedy recovery calls
for more concentrated nutrients than a normal diet provides. You are
your own healer. You need the discipline, the commitment, the
intention to heal and be well.
Depending on what kind of surgery you have, your body’s health pre-
surgery, your body’s healing process, and how you care for your body
before and after, your body will heal on its own unique, fabulous
timeline.
How to use and respect Herbs:
Please know that these herbs are a gift from the earth and the people
who have worked with them, harvested them, and researched them for
countless generations. These herbs benefit your body, and must be
taken seriously. If you are not going to use them, don’t purchase them-
this is a waste of the earth’s offer to heal you and a waste of your
resources. Herbs have profound effects and you must follow the dosage
guidelines outlined with each herb. Each herb is a different plant with
different properties and potencies. Some herbs do better as teas, others
as tinctures. Please follow the recommendations offered in these pages
or the herbs may give you a talking to.
Do NOT use herbs outlined for sleep or pain WITH medications
prescribed for the same reason. They do the same thing and can
make the side effects more drastic (and painful).
Telling your doctors about using herbs
As you may know, there is a profound disconnect between holistic and
allopathic (Western medicine) treatments, and medical providers
receive little to no training on herbs and supplements. As herbalists
who work without licenses, it is our job and necessity to know herb-
drug interactions and educate our clients about it. Our profession
depends on our knowledge of medical practices, given our limited
legitimacy within the power structure of US healthcare, while nurses,
doctors, and surgeons generally have no desire to know about our work
as herbalists. It would greatly benefit these providers to know about
holistic health, since 80% of the world depends on herbs as their
primary form of medicine, but the chasm between medicine and holistic
healing has been growing vastly for the last 150 years.
food and herbs could help soothe my stomach. Some people have a
lower tolerance of pain and so the pain meds can be really helpful. Use
them if you need to, no shame! But also know that once your pain has
lessened, but is still present and burdensome, there are herbs that can
help you.

If you choose to tell your surgeon about the herbs and supplements and Furthermore, as you will be on pharmaceuticals, it is useful to nourish
diet that you are using to prepare for surgery, they may advise against and flush your liver, which is the organ that processes the drugs. That is
the use of all herbs without any knowledge of them and their properties included in the post-op protocol.
and how they interact with the pharmaceuticals. I had one client tell his
doctors about the herbs he was taking, and the doctors proclaimed that
all herbs are blood-thinners and that he must cease taking them
immediately or he would need a revision for his surgery. This is
baloney, an uninformed scare tactic to cover their own asses. Please
assess whether you will be able to weather this from your doctors AND
take care of your body in your pre-op protocol, or whether you want to
not tell your doctor about the herbs and consult those who have herbal
knowledge.

It is my job to have researched the interactions between drugs, surgery,

and the herbs that I give you, and this entire zine is a thorough
explanation of my careful research over the past 7 years.

If you have questions, please ask a local herbalist or get in touch with
me, rather than researching on the internet, as clinical herbalists and
naturopaths have more information and considerations to offer than
the internet and can tailor our recommendations to your particular
needs and body.

The Drugs the Surgeon Gives You

Generally, the surgeon will prescribe that you take an antibiotic, pain
medication, medication for nausea, and sleep medication. The
prescriptions won’t necessarily say what they are for, so be sure to ask.
They can be very expensive, and truth be told, you may not need all of
them.

In my own surgery, I didn’t use the sleeping pill at all, and this varies on
the individual. If you generally have troubles sleeping, you may want
the medication, or you can try a tincture or tea for sleep, listed in the
following pages. I also didn’t need the nausea medication prescribed
after surgery (I was required to take one before surgery) and knew that

Pre-Op Protocol:
Holistic medicine approach emphasizes strengthening your body’s ability
to heal. A lot of the following herbs and supplements are generally
making your body stronger, giving it more vitamins and nutrients so that
when you go under the stress of surgery, your body has a solid and
healthy foundation from which to recover. For this reason, immune
system-enhancing herbs and supplements are helpful, so that most of
what is within your body is nutrient-rich.
You can find most of these supplements and herbs in natural food stores.
As many people are not familiar with these supplements, I explain dosage
and how to take them. The list of what you COULD take is long, and you
do not need to take everything. These are all just helpers for your body,
and your body will be grateful for however many or however few you
provide.
The herbs and supplements mentioned will help in wound closure, in
improving immunity, reducing inflammation, preventing infections and in
many other processes that play a vital role in the recovering process.
Supplies for the process that aren’t herbs, supplements, or food
.button down shirts. Because you won’t really have the range of
motion to lift your arms and slide into/out of tshirts
.bendable straws. For drinking water or juices during limited motion
and healing.
.wet naps. Helpful in the bathroom since the range of motion is limited
and because you can’t bathe/shower until your drains come out.
.movies and dvds. For entertainment during many hours at home
during healing. Stock up ahead of time!
.loofah with a long handle. Reaching your shoulders, upper arms, and
back is painful for a while after surgery and also it can stretch or rip
your stitches. This can make your bathing easier.
.slip-on shoes. Makes the first couple of days after surgery easier.
Loafers, flip-flops, something you don’t have to bend over for. Don’t
bend over for several days after surgery as it puts pressure on your new
parts and can cause hemorrhaging, breaking of stitches, tears, etc. Stoop
by bending your knees, and keeping your back straight.
.sweat pants. Immediately after surgery you might be too swollen to fit
into the jeans that you wore that morning! Have something loose
around to wear at first.
.More helpful Hints.
~avoid high-reching stretching, or movements that can pull/rip your
stitches. Before you go for surgery, get everything down that is up hight
that you might need for the next two months: cereal bowls, plates, toilet
paper, towels, clothes, etc. Two weeks before your surgery, start
considering everything you use and bring it down to below shoulder-
height.
~for surgeries in warmer weather: ask your surgeon to order you two
vests/binders for after surgery (yes, sad truth, you have to wear a
binder for another 3 weeks after surgery with most surgeons) so that as
one gets dirty you have a clean one to swap in.
~if you have a skin reaction to the vest/binder, wear an undershirt
beneath the vest.
For friends to keep in mind while supporting you:
-lots of love and affirmation!
-let the healing one talk about their fears freely
-be available for post-surgery fashion planning
-help do something meaningful to mark the end of one way of being in a
body and the beginning of another
-send a good luck kit with things for the healing one to do-crosswords,
Sudoku, snacks, weird toys, magazines
-offer to go over the paperwork from the surgeon so that Team Healing
can ask the right questions when you get to the surgeon’s office
-have ALL the details worked out before getting to the surgery city
(transportation, food, lodging, etc)
-offer big hugs (cuz it may be a while before you can get tight, close
hugs again!)
-offer to go to the consultation with the surgeon or the surgery itself
Pre-Surgery Protocol .Quercitin.
For the 2 weeks leading up to surgery Dose: 250 mg/day
Supplements: What is it: plant-derived flavonoid found in fruits, vegetables, leaves,
.bromelain. and grains with anti-oxidant and anti-inflammatory properties
Dose: 750 mg per day on an empty stomach What for: to reduce inflammation
What is it: an anti-inflammatory
What for: to reduce inflammation, helping your body not to puff up Herbs:
during and after surgery
.Arnica Montana.
Dose: homeopathic tablets, 200ck dosage-5 tablets the day before; 30c
.chlorella.
dosage the week leading up to and 2 weeks following surgery
Dose: 15 tablets per day
What is it: an herb from the Rockies that dispels the distress of
What is it: a green algae that provides high-grade protein, B-complex
accidents and injury and helps to speed recovery.
vitamins, and oxygen.
What for: reduces swelling after surgery
What for: B vitamins allow your body to handle stress a little easier.
Protein is important because anaesthesia can reduce your body’s ability
.Gotu kola.
to absorb protein, so your body simply needs more.
Dose: as a tea, 1 tsp per cup of hot water
What is it: herb known for benefitting the nervous system
.coenzyme Q10 (CoQ10):
What for: to accelerate the repair of nerve tissue damage and help
Dose: 120 mg daily
develop collagen
What is it: a huge antioxidant, destroying ‘free radicals’ in your body.
What for: CoQ10 is a substance necessary for the production of ATP, the
.Anti Oxidant Tea: elder, juniper, goji berries and rosehips.
main molecule that powers our cells, and enhances immune system
Dose: grind berries in coffee grinder, then simmer 2 tsp in 2 cups water
function.
for 20-40 minutes
What is it: all these berries are known for their vitamin C and anti
.Vitamin K. :
oxidant properties
Dose: daily food sources of leafy greens, alfalfa sprouts, molasses, or
What for: to create the most healthy environment within your pre-
probiotics
surgery body as possible!
What is it: a vitamin that aids in blood clotting
What for: so that the incision site can heal
.Meadowsweet tincture.
Dose: one dropperful once a day in the week leading up to surgery
.Probiotics.
What is it: an herb that was used to develop Aspirin; it has profound
Dose: 2 capsules/morning, 20 minutes before you eat. When you start
anti-inflammatory properties and is often used for pain relief.
your antibiotics, still continue the probiotics, just take 3 hours apart.
What for: to reduce the inflammation that is bound to happen as a
What is it: naturally-occuring bacteria in your digestive tract that
result of your surgery
benefits your immunity
What for: to ensure that your digestive and immune system are in tip-
top shape!
.Vitamin Tea. Nettles, Alfalfa, Peppermint, Red Clover, Calendula
Dose: 2 tsp per 2 cups hot water, let steep 20-40 minutes
What is it: Nettles, red clover, and alfalfa have tons of vitamins and
minerals. Calendula is great for nourishing and replenishing the skin
What for: to strengthen the body before and after surgery
Foods:
.Bioflavanoid foods.
Why: as part of the Vitamin C complex, bioflavonoids are particularly
helpful in preparing for surgery. They prevent arteries from hardening
and enhance the strength of blood vessels, capillaries, and vein
strength. They protect connective tissue integrity, control bruising, and
internal bleeding. Bioflavanoids are anti-microbial agains infections and
inflammation.
What foods have them?: strawberries, blueberries, cherries, turmeric,
ginger, alfalfa sprouts, the white part of citrus fruits
.fermented foods.
Why: all fermented foods are fermented by the same positive bacteria
that is helpful to your body-acidophilus and bifidus. Make sure when
you purchase the fermented foods listed that they are not pasteurized-if
they are, they would be on a shelf-unpasteurized you would find in the
refrigerators.
What foods have them: yogurt, miso, tempeh, kefir, sauerkraut,
kombucha, kim chi
**Do not consume blood thinners like garlic or gingko for 3 days
before surgery! You want your blood to clot!**
Post-Op Protocol
For friends to keep in mind supporting you post-
surgery:
-be reassuring that body functions are human and ok and that its ok to
be in pain and whine a bunch
-make sure you do a lot of things for the healing one: tie their shoes,
open doors, feed them, get them water, help them up and down from
the toilet, wash their hair, place pillow supportively, etc.
-movies! Movies! Movies!
-be really diligent about writing down when the healing one took their
pills and supplements, when their drains were changed, and what levels
of drainage they were at
-be extra loving!
-go to the doctor with the healing one-they need support!
Rest
Don’t jump back into life as normal. Life will never be the same for you
after this experience, and its important that you sit back and absorb this
huge shift. Recognize the stress you have been through and avoid other
stress-producing events. Eat with attention and care. Take time to
breathe, to notice things. Feel textures, smell aromas, enjoy colors. Go
SLOWLY. Keep your priorities very clear, the first of which is your total
healing. Wellness is a choice and a process.
Allow friends and loved ones to take care of you, to reach for things that
are tough to get to, to run to the store, do your laundry, cook your food,
wash your hair.
Food
Generally, make sure that your diet supports your immune system: low in
sugars and caffeine and rich in beta carotene. Make sure you have a lot of
food that is easy to access and will fill up your stomach.
.mixed vegi broth. For potassium.
.green salad. Daily for all of their many accessible nutrients.
.protein drink. Daily protein helps the body rebuild. Use hemp or whey
protein, found in a healthfood store and mix it into juice or smoothies.
.sushi and sea vegetables. Eat daily for their Vitamin B12 and to
enhance new cell growth
.yogurt, nuts, bananas. Easy to eat and provides lots of energy!
.fermented foods. (see pre-surgery section) for probiotics
.water. make sure to drink TONS of water: 64-96 ounces. It will help
flush the anesthesia out of your system and will speed up your post-
surgery recovery.
Supplements
.bromelain. 1500 mg (higher than pre-surgery)
.quercitin. 500 mg (also higher)
.evening primrose oil or flax seed oil.
Dose: 1-2 tsp
What is it: cold-pressed volatile oils that are rich in Omega Fatty acids
What for: To rebuild and nourish delicate post-op skin.
Herbs
For this section, I offer formulas for those less familiar with herbs. You can
put together these mixtures at a natural food store, or contact an
herbalist near you for their assistance.
Preventing Infection:
.Yarrow and Goldenseal tincture.
Dose and preparation: this is to be used only for one week after surgery.
Get one oz. of goldenseal and one oz. of yarrow tincture, mix together in
larger bottle. Take 1 dropperful 2x/day. You may also use this tincture
directly on the wound to clean it and prevent infection.
What do these herbs do? Yarrow is wound-cleaning and antibiotic, and
goldenseal is a strong antibiotic and anti-inflammatory.
For Wounds and Bruises:
.arnica tablets.
Dose: Homeopathic tablets at 30c dosage. 5 tablets/day.
What do these herbs do? arnica will reduce swelling and bruising,
provide pain relief, and rapid healing.
.arnica, comfrey and cypress oil.
Dose and application: rub on site of wounds 2x/day after scabs have
formed.
What do these herbs do? Cypress has anti-fungal, anti-septic (cleans
wounds), and antibiotic actions. Arnica reduces swelling and bruising.
Comfrey is used for healing bones, tendons, ligaments, and cartilage,
and can help in surgery recovery for healing deep bruises on the bones.
*arnica and cypress oil can be found in most health food stores, but
cypress is more rare. You can add 5-10 drops of cypress essential oil to
the bottle of arnica if a cypress in olive oil is more difficult to find.
Sleep Tea
.california poppy, passion flower, oatstraw, and chamomile. Equal
parts in mixture.
Dose: 1 tsp mixed tea steeped in 1 cup hot water for 20 minutes before
bed.
What do these herbs do? California Poppy helps to relieve pain as well
as help you sleep; Oatstraw nourishes your nervous system to do what
it does well; Passion Flower is a sedative and nervine; chamomile helps
you rest and also calms an anxious stomach.
*Do not use at same time as sleep medications like Ambien*
Pain Tincture
.white willow, Jamaican dogwood, and meadowsweet.
Dose: 1 dropperful hourly if needed up to 3 times per day, less often if
not, not to exceed 6 days in use.
What do these herbs do? White willow and meadowsweet both have
salicylic acid, which is what Aspirin is made of, and that reduces pain
and inflammation. Meadowsweet soothes the stomach and can relieve
nausea, making it especially appealing for tender post-surgery bellies.
Jamaican dogwood is pain-relieving, anti-spasmodic, and nourishes the
nervous system.
Nausea Tea
.Peppermint Leaf and Ginger.
Dose and preparation: use fresh or powdered ginger. ¼ tsp ginger to ¾
tsp peppermint. Pour hot water over top tea and let sit 20 minutes.
Strain and drink.
What do these herbs do? A surgery can be discombobulating, and What for: comfrey helps the bones and cartilage of your ribs heal from
nausea can result. Both herbs are great for digestion and soothing a the constriction of binding. Arnica helps with pain, bruising, and
nervous stomach. swelling. Cayenne helps with pain, and Eucalyptus helps open up the
longs and create more expansiveness in the chest.
Scarring and Nerve Damage Oil
.Gotu Kola, St. John’s Wort, Copaiba.
Dose and Preparation: St. Johns Wort oil is easy to find. Add 5-10 drops
Copaiba essential oil. Gotu Kola oil can be prepared by an herbalist or
by steeping the herb in oil in the sun for 1 month prior to surgery. Rub
oil site daily after scabs have healed and fallen off.
What do these herbs do? Gotu kola and Copaiba help reduce scarring
and break down scar tissue. St. Johns Wort oil helps nerves ‘find
themselves’ again-bringing back sensation.

Cleansing the liver after anesthesia and pharmaceuticals

.burdock, yellowdock, dandelion, reishi, turmeric and milk thistle
tincture.
Dose and preparation: Use as a tincture, made up of equal parts of each
herb and take 2 droppersful daily. You can take a tincture in tea or
water.
What do these herbs do? Burdock, yellowdock, and dandelion cleanse
the liver; reishi and milk thistle are both liver protective and help
restore a damaged liver; turmeric acts on the liver and works to reduce
inflammation.

Recovery from Binding

Binding can have significant effects on the ribs, the intercostal muscles,
and the lungs. If you had surgery after years of binding, it could be
important to support your body in healing from binding, as well as from
the trauma of surgery.

Supporting the Lungs Tea: coltsfoot, mullein, lobelia (1/10 of formula-

use a small dose or it will make you vomit)
Dose: 1 Tbsp each of Mullein and Coltsfoot, and ½ tsp of Lobelia; pour 2
cups water over herbs, let sit 20-40 minutes, strain and drink.
What for: coltsfoot and mullein nourish the lungs; lobelia opens up the
bronchioles.

Supporting the ribs and muscles salve: comfrey, arnica, and cayenne
oils, eucalyptus essential oils.
Recommendations from clients:
“I'm a little under 4 weeks out, and things have been going really easily.
I've had almost no pain at all, things seem to be healing well, and even
in the first week I felt really with it and healthy. I absolutely credit so
much of that to your zine + surgery kit: so thank you for putting those
resources out into the world!!” –Lex Horan, client, Minneapolis, MN
Third Root’s Treasure Chest Surgery Kit available for purchase!
The kit was borne out of the zine, and uses most of the herbs discussed
in the zine, all compounded into ready-to-use formulas with easy-to-
follow directions.

“Using the oils from the surgery kit, six months out, continues to remind $40-50 plus shipping if you’re not local in Brooklyn
me that my body deserves care. In the hazy painful days after the
passive (though longed for!) experience of surgery using the teas and from jacoby@thirdroot.org or by calling 718-940-9343.
tinctures gave me ways to actively take hold of my own healing. My
partner and I used your phrase "the healing one" quite a bit - it felt like
a spiritual title and helped me remember to slow down and rest. The
pointers for friends and partners were extremely helpful!”
--client, Brooklyn, NY

“We read the zine over and over again. It was a lifeline of information
and gentle advice. I was grateful for the section included for caretakers,
as I have come to believe that the better supported caretakers are, the
better supported the healing ones will be.”
--client’s partner, Brooklyn, NY

“Jacoby Ballard has put together a really wonderful and much needed
resource for people undergoing top surgery. The zine especially is good
at providing useful information, creating a sense of community and
shared experience, and showcasing the talent of trans artists and
writers. As a therapist who works within trans communities, I've
started to recommend this kit to my clients.”
--Sand Chang, PhD, Licensed Psychologist, San Francisco and Berkeley,
CA