Degenerative disc disease, facet arthritis, labral tears and hip and spine arthritis

[JB]

@Eclectic_Horseman

He is a skier and did all of his ordinary activities in 10 days and was downhill skiing after 3 months (would have been sooner, but it was not the season.)

that’s still REALLY fast, and on one side of the bell curve in terms of recovery. I’m at 3 months now and could probably ski, because that type of motion doesn’t require the type that still gives me trouble. But a month ago, no way.

As well, it simply takes a lot longer for the bone to grow around the new cup, and there are activities that should be done with extreme caution, or not at all, in the first 6 months or so, even if the rest of the body feels great.

@Alterration

That’s kind of what I was worried about but I suppose I’m running out of avoidance choices. The recovery from the other surgeries was tough, and sounds very similar. It wasn’t the pain that got me so much as the restriction. I’ve got sh*t to do, dammit!

There are very few restrictions if the surgery is anterior. It’s the posterior approach that has some restrictions for 6 weeks, like not allowing a 90* bend in the hip, and not allowing the surgical leg to cross the midline. That’s all because the muscles in your rear need time to heal in order to properly keep the implant from dislocating. I think there’s a specialized posterior approach that doesn’t have that, but I don’t think many surgeons use it yet.

But anterior, the only restrictions in terms of movement is for the many hours of elevation and icing you should be doing to reduce inflammation and help prevent clots, so yes, a lot of downtime the first 2 weeks. Everything else is about your personal comfort.

[Alterration]

@JB

There are very few restrictions if the surgery is anterior. It’s the posterior approach that has some restrictions for 6 weeks, like not allowing a 90* bend in the hip, and not allowing the surgical leg to cross the midline. That’s all because the muscles in your rear need time to heal in order to properly keep the implant from dislocating. I think there’s a specialized posterior approach that doesn’t have that, but I don’t think many surgeons use it yet.

Do you have any good links for when they choose the anterior vs posterior approach? I can google, but if you have things handy that would be helpful.

@JB

It’s the posterior approach that has some restrictions for 6 weeks, like not allowing a 90* bend in the hip, and not allowing the surgical leg to cross the midline.

I can’t even imagine being functional with these restrictions. I run a small digital business and I’m a leg crossing side sleeper. I had a heck of a time with the first surgeries when they didn’t want me to sleep on my side and made me sleep in a brace. Crikey.

[McGurk]

Your back diagnoses sound daunting, especially for someone your age, but it would be hard to find a serious equestrian that doesn’t have some of the same back diagnoses. Mine are degenerative disc disease, facet arthritis, spinal stenosis and ankylosing spondylitis. And bulging discs at L4 and L5. I have found all of this manageable with losing weight and getting fitter, NSAIDs and epidural injections when the pain was acute. I also work out in a heated salt water pool a couple - three times a week. I also do things like ride in the jointed stirrups, dismount onto the mounting block or lower myself to the ground holding on to the offside stirrup leather. But I still sling hay bales, do farm chores and live my life.

Short version: I think you can manage the back issues for now and still ride.

The hips? Go as far as you can with conservative treatment, then go ahead and get the hip replacements. They’re easier than you think they are. Yes, it’s a major surgery, but the direct anterior approach is pretty straightforward and leads to a quicker recovery.

If you talk to 10 people who have had joint replacement surgery, 9 out of the 10 will tell you they wish they had had it done sooner. If you talk to 10 equestrians who have had the surgery, I’m pretty sure all 10 will tell you they wish they had it sooner.

Just because you’re tough and CAN tolerate the pain, doesn’t mean you should.

[JB]

@Alterration

Do you have any good links for when they choose the anterior vs posterior approach? I can google, but if you have things handy that would be helpful

I don’t offhand, but I know that posterior seems more common the more overweight someone is. I’m sure there are other details that would make a difference but I don’t know them offhand. Every surgeon has their personal preference and they don’t deviate from that unless there’s a very good reason to. There are quite a lot of approaches now, some are robot-assisted (MAKO robot for example).

@Alterration

I can’t even imagine being functional with these restrictions. I run a small digital business and I’m a leg crossing side sleeper. I had a heck of a time with the first surgeries when they didn’t want me to sleep on my side and made me sleep in a brace. Crikey.

yeah, it’s limiting for sure! An acquaintance had posterior just a couple days after I had anterior, hers was posterior due to her weight, and it was hard watching her try to get a lot of things done without breaking those rules. I can’t say that ALL posterior approaches have those restrictions, but I don’t think the 1(s) that doesn’t is very commonly done, yet.

[anonevent]

The doctor who finally helped me kept insisting on this theory that back pain becomes chronic because people self-limit their activity -basically, that back pain is primarily muscle based because muscles try to compensate for the back’s structural instability. He made me read this book: https://www.amazon.com/Back-Sense-Revolutionary-Approach-Halting/dp/0767905814

That was until he grasped the type things I was doing routinely as a horse owner. It’s more like a roller coaster, and a bad cycle to get into.

Maybe, as an experiment, you can pretend that you’ve had surgery for a couple weeks and not lift anything over 20lbs just to see if it brings you any relief. Break everything up into smaller loads to carry. I know it is tedious.

[Simkie]

@Alterration

I didn’t mean to sound so fatalistic - I just don’t know what to expect.

@Alterration

I’ll keep persisting in trying to get the issues fixed if living without restriction is truly possible!

I totally get it, and have been there. (With similar imaging–hip issues + lumbar spine stuff.) I’m just a few years younger than you are, and have been with pain med for gosh probably ten years now. I have several of them actually–the local one who manages my meds, the slightly less local one who does my regenerative medicine injections and occasionally others, and the one at the fancy hospital in the city who I’m working with on a puzzling issue. It’s okay if it takes a team! You just have to find yours.

Fwiw, as you look through and try out different pain med people, I far prefer physiatrists over anesthesiologists. Physiatrists (a lot of people read that word as psychiatrist, physiatrists are not that) are less focused on injections being the only answer ime. The good ones are really thoughtful, creative, and often out of the box thinkers, and view their job as getting you able to live the life you want.

There may be a point where lifestyle modification is the answer. But you have soooooooooo many things to try before that.

When you get interested in considering surgery (and there are a lot of conservative options to work through prior to that, if you want) see several surgeons for an opinion. Be up front with what you want life to look like after. Something that’s really surprised me on my journey is how varied opinions & approach can be. Doctors will take the same info, and come up with wildly different answers. See enough of them that you know you like the answer they’re providing, and back that up with a few other opinions in agreement.

[Alterration]

@JB

I don’t offhand, but I know that posterior seems more common the more overweight someone is. I’m sure there are other details that would make a difference but I don’t know them offhand. Every surgeon has their personal preference and they don’t deviate from that unless there’s a very good reason to. There are quite a lot of approaches now, some are robot-assisted (MAKO robot for example).

Going back on my diet today LOL I’m overweight but not by much. I’d like to make sure I’m fighting fit to the degree I can be pre-surgery anyway. It does make recovery easier.

@JB

yeah, it’s limiting for sure! An acquaintance had posterior just a couple days after I had anterior, hers was posterior due to her weight, and it was hard watching her try to get a lot of things done without breaking those rules. I can’t say that ALL posterior approaches have those restrictions, but I don’t think the 1(s) that doesn’t is very commonly done, yet.

Good to know - sounds like something to avoid if at all possible!!!

[Alterration]

@anonevent

Maybe, as an experiment, you can pretend that you’ve had surgery for a couple weeks and not lift anything over 20lbs just to see if it brings you any relief. Break everything up into smaller loads to carry. I know it is tedious.

I’ll take a gander at the book. I’ve been trying to think about how I could modify but there are certain activities (like dropping hay or carrying feed/bedding over) that I think are going to be a real challenge to sort. I guess the answer is to just make sure I am not the one to do it.

Equestrians I think are subtly strong. I had not weight lifted in awhile and picked up some rows again and was surprised that I was too strong for the limited dumbbells we had in the basement. Probably something I should avoid doing right now - but it was a curious experience. Farm work makes you tough!

[Alterration]

@Simkie

I totally get it, and have been there. (With similar imaging–hip issues + lumbar spine stuff.) I’m just a few years younger than you are, and have been with pain med for gosh probably ten years now. I have several of them actually–the local one who manages my meds, the slightly less local one who does my regenerative medicine injections and occasionally others, and the one at the fancy hospital in the city who I’m working with on a puzzling issue. It’s okay if it takes a team! You just have to find yours.

Fwiw, as you look through and try out different pain med people, I far prefer physiatrists over anesthesiologists. Physiatrists (a lot of people read that word as psych iatrist, physiatrists are not that) are less focused on injections being the only answer ime. The good ones are really thoughtful, creative, and often out of the box thinkers, and view their job as getting you able to live the life you want.

There may be a point where lifestyle modification is the answer. But you have soooooooooo many things to try before that.

When you get interested in considering surgery (and there are a lot of conservative options to work through prior to that, if you want) see several surgeons for an opinion. Be up front with what you want life to look like after. Something that’s really surprised me on my journey is how varied opinions & approach can be. Doctors will take the same info, and come up with wildly different answers. See enough of them that you know you like the answer they’re providing, and back that up with a few other opinions in agreement.

That’s awesome, thank you so much.

I used to live in a place where the specialist you got was the only one that you could really see just as far as location. I’m in a much bigger city now with a LOT of choices and still I find it hard to kind of break out of the mentality that “this is what the doc says and I’m being stubborn/difficult if I want to get another opinion”.

Always a good reminder that it is a team that I’m looking for, not necessarily a fixer who has all the knowledge.

[JB]

@Alterration

Equestrians I think are subtly strong. I had not weight lifted in awhile and picked up some rows again and was surprised that I was too strong for the limited dumbbells we had in the basement. Probably something I should avoid doing right now - but it was a curious experience. Farm work makes you tough!

it does make you tough! But it also makes us less and less aware of developing asymmetries and compensations, because the more work we do, the more often we do it the easiest way, using our dominant muscles more and more, while the others do less and less. And, we aren’t always (sometimes never) thinking about doing things in good form, we just get it done . All those things add up to using our bodies incorrectly, and transferring all that to bone and ligaments and tendons that aren’t supposed to do what we ask, for long.

[Alterration]

@JB

it does make you tough! But it also makes us less and less aware of developing asymmetries and compensations, because the more work we do, the more often we do it the easiest way, using our dominant muscles more and more, while the others do less and less. And, we aren’t always (sometimes never) thinking about doing things in good form, we just get it done . All those things add up to using our bodies incorrectly, and transferring all that to bone and ligaments and tendons that aren’t supposed to do what we ask, for long.

So true. I find it fascinating that we’re so focused on that for our horses, but for ourselves we’re like “meh, we’ll be fine”.

I’d have the vet out in a hot minute the moment one of my guys looks slightly off or abnormal

[Simkie]

@Alterration

I find it hard to kind of break out of the mentality that “this is what the doc says and I’m being stubborn/difficult if I want to get another opinion”.

Totally understand, and I think everyone struggles with that, but perhaps especially women. What I always remember when I’m feeling a little eeek about saying “thanks so much for your time and insight, I’m going to go discuss with a few others and let you know where I wind up” is that the person who is MOST vested in my outcome is ME. Not a single other person out there cares as much as I do where I wind up on the other side of things. And I’m going to really aggressively protect that outcome.

Surgeons (or any other doctor, but I think the stakes might be higher in general with surgeons?) who really believe in what they’re doing are SO compelling and it’s really easy to get swept up in their passion, but–as I have learned the hard way!–it’s so important to step back and see what the landscape really looks like. Talk to others, see what they recommend, and ask about treatment recommendations others have suggested. See people who vary on the spectrum from conservative to cowboy. Most doctors are willing to have that sort of discussion. The ones that are not are perhaps not your doctor. IMO, ego really has very little place in medicine, even though it’s so engrained in the culture. It should absolutely be a team sport, because doctors are people, and people are fallible, and no one knows everything.

Don’t ever be afraid to advocate for yourself! I hope you get some good traction from your referrals and are on a solid path to feeling more comfortable soon. (But if those doctors are all dicks, find others! You don’t have to deal with dick doctors.)

[Alterration]

@Simkie

Most doctors are willing to have that sort of discussion. The ones that are not are perhaps not your doctor. IMO, ego really has very little place in medicine, even though it’s so engrained in the culture.

I’m not a huge fan of doctor shows, but I there was a clip from Gray’s Anatomy where Derek and Meredith were talking and he was talking about how god-like operating made him feel. And tbh, you do need a fair amount of personal confidence to be cutting people open on a regular basis. I’m not sure I want my surgeon to be collaborative or unsure when he/she goes in to slice and dice.

BUT, it does seem like there would be room for some sort of medically trained advocate to kind of stand in the middle who could be more collaborative and manhandle the surgeons when necessary

[Simkie]

There’s a difference between confidence & ego, or confidence & arrogance. Confidence doesn’t get bruised when a patient wants additional opinions, or chooses another path.

Ego and arrogance get in the way of good medicine.

A medical advocate to aid patients in their conversations with surgeons would be very helpful for many! Hospitals do offer advocates, but their role is generally to step in only after things are not going well, I think

[Alterration]

@Simkie

There’s a difference between confidence & ego, or confidence & arrogance. Confidence doesn’t get bruised when a patient wants additional opinions, or chooses another path.

Ego and arrogance get in the way of good medicine.

Oh I agree - they just so frequently go together. Perhaps not arrogance, that always communicates a lack of confidence, but ego certainly.

As well as having a singular lens through which to look at things which is uniquely western medicine. If you’re a surgeon the answer frequently is cut, a nutritionist food, and so on.

Wonder if anyone has started a consulting business like such - seems like a great place for someone burnt out on traditional nursing.

[SpicyPRE]

I saw the title of thread and wondered if I had posted something and didnt remember. I haven’t read all of the posts, so its possible I am repeating something that has been already said. You need a great sports medicine orthopedic physician who can help you tackle the issues one by one. And what makes a great sports medicine MD is one who understands equestrian sports and understands your desire to continue riding plus doesnt jump to surgery as the only solution.

For me, I had nerve root ablations in 3 sites on both sides of my spine that addressed the DDD, facet and spine arthritis. For the hip pain, I have had joint injections. And lots of PT to get my core and back strong. It was a long process. Typically the ablations have to be repeated yearly, however, I am now 3 years post ablation and relatively pain free. I think I have had so much success as I didnt realize how my compensation patterns were contributing to the issue. The ablations took care of the pain and the PT corrected the compensation. The joint injection into my hip is just buying me time but I am OK with that.

[Simkie]

@Alterration

Wonder if anyone has started a consulting business like such - seems like a great place for someone burnt out on traditional nursing.

I haven’t seen one, but it would be a neat option! The closest I’ve run across has been a second opinion service. The patient liaises with a physician who collects info and then that person contacts a specialist to provide a written second opinion on the case. It seems to be a side gig for the doctors involved–the woman I worked with had a primary care practice. I found it of relatively limited value, because there’s no exam, but it’s better than nothing. That sort of thing is often part of the benefit/health insurance package.

An advocate to help navigate the entire process would be great. Patients don’t know what they don’t know. Even just navigating collecting records and imaging to get to the next opinion can be tough for many, nevermind identifying surgeons that are the best fit, and knowing what questions to ask. I’ve found FB groups specific to that surgery very useful but it’s kind of wild how that info is somehow best crowd sourced from other patients? Why don’t we have better resources?

Anyway, not meaning to take your thread so off topic! If you ever need some support on advocating for yourself, I’d be happy to chat via pm

[Leather]

@SpicyPRE

For me, I had nerve root ablations in 3 sites on both sides of my spine that addressed the DDD, facet and spine arthritis. For the hip pain, I have had joint injections. And lots of PT to get my core and back strong. It was a long process.

Thanks for posting about your success! I have facet arthritis and spondylolisthesis (L5/S1) and recently went to a new doctor (physiatrist who specializes in the back/neck). The treatment plan with my new doctor is to get a CT (already had an MRI but in my situation the CT is better for assessing bone/mechanical issues), then do some diagnostic nerve blocks. If those provide relief I’ll get the nerve ablation.

I’ve had facet joint injections but had held off on exploring ablation because my former doctor said they often aren’t effective any longer than injections. However my new doctor (who actually performs the ablations) has had a lot more longer term success like you mentioned. I know it’s a very individual thing in how quickly the nerves regenerate, but I’m keeping my fingers crossed it’s more typical to have longer success.

[SpicyPRE]

The ablations changed my life. I put it off as I had heard mixed opinion. Finding a great doctor who understood my lifestyle made a huge difference.

[Alterration]

@SpicyPRE

I saw the title of thread and wondered if I had posted something and didnt remember. I haven’t read all of the posts, so its possible I am repeating something that has been already said. You need a great sports medicine orthopedic physician who can help you tackle the issues one by one. And what makes a great sports medicine MD is one who understands equestrian sports and understands your desire to continue riding plus doesnt jump to surgery as the only solution.

First, I am so sorry that you have had this issue as well, but hello hip/back buddy!

I will look up the nerve ablations. That won’t heal any damage though, just make it pain free am I correct?