Things Your Surgeon Should Tell You

Cameron’s approach is to treat surgery like an athletic event. He plans his own weekly schedule around surgery days, timing workouts and fasts. He wants patients to enter the OR in a state of ketosis because it provides a clear, crisp mental state for him as surgeon and protects the patient’s brain from oxidative stress. The 48‑hour fast clears glycogen and ramps up ketogenesis; then he refeeds with ketogenic foods (sardines in olive oil, a Dominic D’Agostino tip) to maintain ketosis without hunger. Creatine saturates tissues, providing a phosphate buffer for ATP and supporting the high metabolic demands of healing skin and neural tissue. Vitamin D is the most basic and overlooked pre‑surgical supplement; he notes that even rural general surgeons know it, but he’s seen his patients’ levels improve over the years. The peptide cocktail is added for its anti‑inflammatory and regenerative signaling, with KPV especially added post‑op for its neural anti‑inflammatory properties (leaky gut‑leaky brain axis).

Cameron contrasts two standard ends of the anesthesia spectrum: light sedation with fentanyl/versed (which cause POCD and respiratory suppression) and deep general anesthesia with volatile gases (which cause microemboli and inflammation). He lives in the middle. By using precedex, he provides a sleep‑like state that downregulates brain inflammation instead of fueling it. Low‑dose ketamine adds analgesia and dissociation without respiratory suppression, and propofol at low doses reduces the brain’s need for oxygen, making tissues more tolerant of any temporary hypoperfusion. The key, though, is starting with excellent local anesthesia: if no pain signal ever reaches the CNS, the post‑op pain pathways never become primed, significantly reducing post‑operative discomfort and analgesic requirements. This also means patients wake up without the grogginess of opioids.

Cameron learned this from Laird Hamilton and Gabby Reese. The pool was purpose‑built with descending depths and a special grip surface. The workout forces you to time your breaths to the exercise, because you cannot breathe whenever you want—you must exhale on the way up and inhale only when your mouth breaks the surface. This builds CO₂ tolerance, not oxygen depletion. He contrasts it with Wim Hof‑style hyperventilation, which lowers CO₂ and can cause blackouts; his method keeps CO₂ high, which signals the body to take a breath and thus is safer and more applicable to real life (like being tangled underwater as a surfer). He ties the CO₂ tolerance directly to stress resilience, referencing Anders Olson’s work: high CO₂ tolerance correlates with lower stress reactivity. The underwater environment also creates a hypoxic and hypercapnic stimulus that enhances fat oxidation and ketone utilization, further aligning with his pre‑surgical metabolic goals.

Cameron emphasizes that sleep is a massive lever for surgical recovery that is completely undertalked about. Even with his neuroprotective anesthetic cocktail, sleep is still disrupted to some degree. Melatonin helps quickly restore normal sleep cycles. The antioxidant effect is a bonus, particularly in the brain where surgery‑induced free radicals can accumulate. He also schedules surgeries to protect circadian rhythms, but melatonin bridges the gap.

Cameron explains that if a pain signal never reaches the central nervous system, the pathways don’t become hyperexcitable. This means when the local wears off, the pain experience is significantly less. He contrasts this with general anesthesia alone, where the brain is unconscious but the periphery is still sending pain signals that sensitize the CNS. This principle is also why he tells patients to ask for a regional nerve block instead of general anesthesia whenever possible, even for non‑facial surgeries.

Cameron ties this directly to his pool workouts and the concept of hypercapnic tolerance. He explains that simply breathing through the nose during light exercise builds up CO₂ tolerance without needing extreme breath‑holds. He also recommends mouth taping and nasal strips to his patients and uses them himself. He has found that adding a nasal strip makes him feel more oxygenated upon waking. He mentions the Hale intranasal stents for those who need more internal support, especially useful during sleep. These habits make the brain less reactive to any respiratory changes under anesthesia and speed up cognitive recovery.

Because Cameron’s patients stay for days and undergo a multi‑hour recovery protocol each day, he tries to have their day start at their biological morning. For example, if a patient arrives from Europe, 8 a.m. Pacific might be 4 p.m. their time; he will schedule accordingly so they aren’t forced to wake at 2 a.m. body time. This small logistical step has a disproportionate impact on sleep and recovery, especially since melatonin and other sleep aids only partially offset jet lag plus surgical stress.

The workout begins with rhythmic breathing where the athlete exhales underwater and inhales only at the surface, re‑learning not to hyperventilate. Different depths (10 ft down to 4 ft) serve as stations for varying weight loads—lighter weights in deeper water, heavier (e.g., 50 lb dumbbells) in shallow. Key component is ‘going to your dark place’ while holding a loaded movement, forcing adaptation to high CO₂ levels. Cameron cites Laird’s origin: being tangled underwater with a surfboard and needing to stay calm without pre‑breathing. He ties the CO₂ tolerance directly to stress resilience (a problematic email doesn’t trigger panic) and to his operating‑room flow state, where he must remain sharp for 8–10 hours. The pool bottom has a sandy, grippy finish for safety, and he always has a partner present. He also references Anders Olson’s research linking CO₂ tolerance to psychological resilience and Olson’s desk‑based CO₂ breathing machine.

Cameron traces the shift: initially only 10% of his (mostly female) patients were on creatine; now over 80% arrive already taking it. He links this to Rhonda Patrick and Huberman. But he goes further, noting creatine’s presence in neural tissue and its importance for fibroblasts—the cells that create and heal skin. After a procedure like laser resurfacing, the metabolic demand on skin is enormous. By feeding cells with creatine, he gets better structural results. He mentions unpublished studies showing creatine improves skin structure even without a stimulus. The higher 15 g dose is needed because the cognitive and skin benefits require greater saturation than muscle alone. He has his patients spread the powder throughout the day.

Cameron uses one product, Keto Start (BHB salts), pre‑operatively and also recommends it for patients in the days leading up to surgery. He acknowledges that his patient population is already metabolically flexible, but he insists the ketones work regardless. The rationale ties directly to Dominic D’Agostino’s research showing ketones stabilize neurons. He wants the patient’s brain to have an alternative fuel that reduces oxidative stress and neuroinflammation. He still encourages metabolic flexibility beforehand (e.g., adding an egg to the Cheerios) so the body can use ketones efficiently. The post‑operative benefit is faster return of cognitive clarity and less ‘fog’.

Dexmedetomidine is a central alpha‑2 agonist (not alpha‑1) that tells the brain to ‘chill’, inducing a state similar to non‑REM delta‑wave sleep. It does not depress respiration or peripheral blood pressure, avoiding the respiratory suppression of opioids. Crucially, it downregulates key inflammosomes in the brain, directly countering the inflammatory cascade that causes POCD. Cameron uses it as the base, then layers in low‑dose ketamine (which is NMDA‑receptor mediated, neuroprotective at low doses, dissociative and analgesic) and a tiny amount of propofol to lower the brain’s oxygen demand. He warns of the dose paradox: high‑dose ketamine becomes pro‑inflammatory, and high‑dose propofol acts like a general anesthetic with all its drawbacks. He also emphasizes that this protocol requires more skill and time, which is why it is not adopted in insurance‑based settings where reimbursement is low.

Cameron describes digging into the materials of every item in his OR: IV bags, tubing, syringes, etc. He discovered that some plasticizers used in the U.S. are illegal in Europe. Even though acute exposure from a single surgery might be dismissed as trivial, he reasons that microplastics inhibit cellular efficiency and healing, and for his elective patients even a 1% worse outcome is unacceptable. His staff, who share his mindset, helped him source alternative materials. He admits it was massively expensive and logistically difficult, but his private, non‑insurance‑based practice allowed it. He hopes this will eventually become a broader movement, but acknowledges it is far from mainstream surgical practice. The conversation touches on future microbial remediation strategies (engineered gut bacteria that degrade plastics) but notes that immediate post‑op detox is limited because sauna or other hormetic stresses are contraindicated right after surgery.

He describes the anatomy: external nasal valve (where air enters) and internal valve (higher up). Most external nasal strips address the internal valve; these stents open the external valve from the inside. He puts them in just before surgery as the last step, essentially hiding them under his mask. He also keeps them by his bed for sleep, though he notes his mouth‑taping habit has already partially retrained his breathing. He mentions Chris Froome of Tour de France fame used similar internal nasal dilators. The product is called Hale (he spells it out) and comes in three sizes. He is completely unaffiliated.