THR Merrimay's on the other side now THR

[Charlie33]

@Merrimay going to post this for all to see (or maybe someone can benefit down the road from this comment). Topic: Hip/Spine/Pelvis: all connected!

For those considering THR / Hip Replacement: see a orthopedic physiatrist or ortho practice where you have both your back and hip evaluated. It can be as simple as a full lumbar xray with your hip xray to start. More and more orthos are connecting dots with the hip/spine/pelvis connection versus 'you have a bad hip that needs to go'.

I did NOT do this.... had the hip surgery and then looked at spine post op.... and got lucky in that there wasn't a diagnosis that would have helped as most issues related to basics like range strength of hip pelvis..

Another friend of mine had both hip and spine evaluated and did staged surgeries. Biggest lesson he learned: post hip OP PT was MODIFIED given his spine issues and certain exercises REMOVED as they were not appropriate for someone with his spinal condition. I can't stress enough how finding the right PT or even exercises are crucial to recovery. I've been learning as I go and think I've found the right mix but took a lot of abuse and pain from the first two PTs....

Finally....big fan of @Merrimay and her efforts here to both support and inform the community!!! Thank you for giving back so much to the group!

 

[Merrimay]

Thanks for your research and kind words, @Charlie33 . May your words help others!

The more I read about this, the more I'm thinking that everyone planning to undergo a THR may want to ask their orthopedic for a spine check as part of the preop medical clearance. As I sadly learned, not all spine vulnerabilities are symptomatic pre-op.

Indeed, orthos ARE now connecting the dots between THR and potential damage to vulnerable spines. They're collecting stats and doing studies. Sadly, spine issues are common among those over 50.
Knowing about any problems with the spine before THR may reduce the likelihood of catastrophic errors made by PTs who don't know the hip is connected to the spine.

I look back at the PT I endured and cringe. If they'd been actively trying to injure my spine, they couldn't have done a better job.

As you can imagine, I've broadcast my story to everyone I know. And it didn't take long for others to tell me, oh, their cousin or colleague or someone at church also developed excruciating back snd knee pain post THR.

The good news is that most found help from spine orthopedists who know the phenomenon well. Treatment varies according to severity, but my new spine man
mentioned epidurals and a custom-made brace in my case. Two people recently told me that strategy has helped them, so I've perked up!

And thus now I'm envisioning The Death Tube, a.k.a. MRI, as my friend without whom my doctor can't know where to aim the injections.

You all have been so good to me during this latest "stop" along my road to recovery!!

 

[FionaW]

Hello @Merrimay , I’ve just read the last few pages of your thread with interest, and have some experience of scoliosis, which you might be interested in, so I thought I’d introduce myself. Apologies in advance for a long post. It’s hard to know what might be useful and what might not. Obviously, just skim over or ignore anything that doesn’t seem relevant.

I joined Bonesmart back in 2014 when I had a hip replacement, and have just come back because I have had a knee replacement, and I’m due to have my other knee replaced in May.

I also have scoliosis. This was diagnosed in 2020, mid pandemic, and I had no idea I had it. I found out when I was living in Greece; I had back pain, and a friend recommended an acupuncturist/dry needling therapist, who was also a conventionally qualified orthopaedic doctor. She agreed to treat me, but only if I had a spine x-ray first, so off I went to get one. When I brought the film back to her I knew immediately there was something wrong, from her sharp intake of breath! “You knew about this, yes?” she half-asked, half-stated. “What?” I asked. So she showed me the x-ray. Even I knew that spines aren’t supposed to be S-shaped!

Now, the interesting thing is that after my hip replacement, I was diagnosed with psoriatic arthritis, which is an autoimmune disease like rheumatoid arthritis. I also possibly have an aggressive, autoimmune form of osteoarthritis. I don’t think this is well understood yet, but I am under ongoing rheumatology care at a specialist hospital. And because of this, I have had periodic spine x-rays, and one MRI, as part of my disease monitoring. In 2016, I did not have scoliosis. In 2017, I did not have scoliosis, although I did have some disc degeneration. Then, by 2020, I did have. So scoliosis can develop.

My knees have been bad for years. Unlike my R hip and my spine, which seem to have collapsed fairly suddenly, my knees and feet have been gradually getting worse for decades. I actually suspect that my spine may have collapsed because I didn’t get my knees treated when I should’ve done.

Anyway, back to the scoliosis… I wore a back brace for six months after it was diagnosed. I then stopped wearing it, partly because it was 40-45°C in Greece, and I felt like I might faint in my ‘corset’, and partly because I was worried about losing my own muscle tone and building up trouble for the future. I had weekly acupuncture /dry needling treatments for about a year. I swam a lot and exercised a lot in water. I taught myself front crawl (you might call this swim stroke something different in the US?) so that I could swim without creating extra pressure on my spine. My back got stronger and I haven’t needed to wear the brace since, even when my knees got so bad (six months ago) that I needed to start using a Zimmer frame to walk around my house.

I thought you might like to hear that. : ) There’s lots of self-care you can do, and it seems to keep scoliosis well-managed, at least in some cases.

The doctors tell me that they don’t tend to do surgery with my sort of spine damage (mostly at L3-5) because the risks outweigh the benefits. I’m looking forward to seeing how much having new knees and straight legs will help my spine (severe valgus, both legs - well, not the right one anymore - that’s fixed!). I suspect, quite a lot. Ironically, it’s my Rheumatology team, not my orthopaedic team, who seem to pick things up.

I agree with you that orthopaedic doctors should look at us more holistically - hips, knees, feet and spines together, IMO. They’re all connected after all!

I seem to have written you almost a full novel! Sorry! I hope at least some of it is useful and reassuring. Best wishes.

 

[Merrimay]

Wow, @FionaW ! I loved loved loved your post. So grateful you took the time to reach and offer me (and everyone else here) the benefit of your experience.

I'm pleased that swimming helps you. Looking back, one of my 2 red flags over the years was the back pain I encountered doing the Butterfly. After I saw the x-ray of my spine, I asked my ortho if swimming would be out of the question. He said only the strokes that cause me pain. So I'm hopeful swimming will be in my future.

Last night, I read an article saying that swimming was best avoided by those with degenerative scoliosis. But then I wasn't quite sure how much credence to give it when they also suggested we give up the trapeze.

Hey, bonesmarters, we're a varied and colorful lot! Any of you former or current trapeze artists???? Surely I can't be the only one who wants to hear YOUR postop stories.

@FionaW

 

[Merrimay]

@FionaW , we in the States also call that swim stroke the Front Crawl.

 

[Elf1]

@Merrimay I don't have scoliosis but I do have degenerative disc disease in my spine. I do have curvature and also have spondylolithesis. Had a fusion at L5/S1 to stop the disc from sliding back and forth and pinching nerves. The Neurosurgeon told me there was no guarantee that it would stop any pain but would keep from causing any more damage to the nerves. Luckily it did help with some of the pain but not all, but I'll take it.

Luckily I had found Bone Smart before having my THR so knew to ask a few things. I did ask the OS about possible dislocation due to spine surgery as I had read that can be a problem. He took extra xrays checking my spine, the location of the hardware and the curvature so he knew what he was dealing with. If I hadn't brought it up he probably would have never taken the additional xrays.

I know that going to a pool was awesome after my THR. I'm not a good swimmer so used a pool noodle to get around, did a lot of water walking. So good, takes a lot of stress off the hips, knees and spine. You just have to be careful not to overdo because you can't really tell until after you get out. Unfortunately I no longer have a pool available but have recently started doing gentle yoga and tai chi. Neither require me to get up and down off the floor and some exercises are done sitting in a chair. Its really helping me get my flexibility back. I've been doing both of these online, there's tons of different options out there. Maybe that could be helpful.

 

[LaKarune]

@FionaW , we in the States also call that swim stroke the Front Crawl.

And the racers call it Freestyle!

Looking forward to being able to get in the water in another few weeks (hopefully).

@Elf1 How long do you recommend doing water walking and gentle swimming to avoid the “too much”? (And how many x per week did you find helpful?)

 

[FionaW]

I’m so glad you found my post useful, @Merrimay . I’ve always thought that one of the best things about Bonesmart is hearing if/when other people have similar experiences. When I’m suffering, it’s somehow reassuring to find out other people have similar experiences, and I’m not going mad or just being a total wuss!

@LaKarune , there are many other movements you can do in water, especially if you can move easily in and out of your depth. When I’m not ‘swimming’ - ie doing official swimming strokes - I often do kind of underwater cycling, imagining I’m on an upright bike. Sometimes I do breaststroke arms with my peddling legs, and if I want an extra challenge, I’ll pretend I’m holding handlebars and make my legs do all the work. I also do:
- Knee raises, alternate and together, keeping myself upright in the water;
- Scissor legs, using my thigh muscles, rather than my calves, and again staying as upright as possible;
- Kind of squats, but these involve me bringing my knees up rather than my body down (helpful to avoid drowning! );
- Super slow star jumps - you fling your arms and legs out together and then bring them back, but you don’t get any of the impact landing on a hard floor!
- Leg raises, one leg at a time or both together (that takes more core strength, than I currently have!).

Sometimes I just have a little bit of a boogie too! It’s like they say: “ dance like no one is watching” - only no one IS watching, because most of you is invisible below the water!

I used to do other exercises too, like swinging my legs around and pivoting from my waist (various things that felt quite like being a trapeze artist, now I come to think of it !!) but I haven’t done those since the scoliosis has been diagnosed, because I’ve never had any specialist physio advice, I don’t want to take any unnecessary risks.

The more weak and vulnerable my spine is feeling, the more upright I stay in the water. Even just hanging there, maybe trying to stretch downwards, feels really good. I love love LOVE that I am able to do all sorts of movement in the water, freely and easily because the water offer support as well as resistance, while on land I am currently really quite disabled.

 

[CricketHip]

@CricketHip, you know, he didn't use the terms S or C. He lay the x-ray on the table and said, "You have a bad back. Scoliosis," then waited for me to respond.

I'm not sure when I've been as appalled by anything as I was by that image. It bulges out to the left (my operative side) not far above the pelvis. The discs have very little space between them. Above the bulge the spine looks pretty straight. I suppose that makes it a C?

I feel such sorrow for my spine. I've run on mountain trails for 30 years, hiked all over creation, kayaked, and shot archery. And in all that time, my spine didn't make a peep. Or if it did, I called it knee or hip or shoulder pain, sciatica, piraformis syndrome, bursitis, blah, blah, blah.

This resonates so deeply with me. I have felt that sorrow and it's a tough pill to swallow. But you have a good sense of humor and you are resilient and will weather this new storm. (if we can get you through the tube of death)
I tend to keep my eyes closed when inside, also. I've had so many of those darn things that I doze off occasionally. the only issue with that is when I do a falling asleep jolt. But that didn't seem to skew any of the results.
I cringed when hearing how your doctor told you about your spine. Some of these doctors really need to take some lessons on their presentations!

 

[Merrimay]

@FionaW , I couldn't be more grateful and thrilled to get your detailed swimming (and water biking/dancing) protocol. A friend here has a pool with a spectacular view of the mountains. Once I have some pain reduction and the ok of my spine man, I'll jump (or climb down steps into her pool. (I suppose diving will be out of the question.)

In late fall and winter, I'll go to the pool at the college. This is my great dream now! Thank you for your inspiration!

It's wonderful you've made such progress.

 

[Merrimay]

Hi @Elf1 ! You've certainly done a good job pursuing relief and rehab for your spine.

My spine man mentioned Tai Chi and yoga designed for those with spinal issues, and I've been trying to find some local classes with no luck. My aim was to have a teacher at hand who could show me what I was doing right and wrong.

Which means I'll drive about an hour to a class a few times a week until I'm sure I'm adhering to proper form, then do YouTube classes from there.

Right now I'm so beat-up and battered that I'm waiting for the MRI, epidural, and brace. Once I grow stronger from those protocols, I hope tobbegin the swimming, Tai Chi, and yoga.

I've also been inspired by @CricketHip to find myself a massage therapist who "gets the spine." In the best of all worlds, I'd drive straight to her to do it! But...given my limitations,, I'll just try to find the second best massage therapist in the US!

 

[FionaW]

@Merrimay , I had at least as much fun writing it as you did reading it! I haven’t been able to swim like that since last September, and I’m kind of just fantasising until I can get back in the sea or the pool after my second new replacement in May. Now I think of it, I haven’t been able to swim in a pool for more than a year, because I had such severe valgus in the knee they’ve just fixed that I couldn’t swim in straight lines… people in the lanes next to me got a bit annoyed ! I really love water - I can’t wait to get back to swimming and floating and splashing

I’ve lived with chronic pain for such a long time, but I hurt much less, or not at all, when I’m in water. <3

P.S. I have dived with scoliosis, but I didn’t know I had it when I did it, and I think I’d be too scared now!

 

[Elf1]

@LaKarune everyone's body is different so you just have to kind of learn when its overdoing it for you. You could start out with 20 minutes say 3 times a week and go from there.

@FionaW has a fantastic list of exercises to do. I did quite a bit of those myself.

@Merrimay I didn't have any luck finding classes locally either. Luckily I was able to get the video classes through the VA (Veteran's Administration) and there is a live instructor that can give you pointers. There are some ones online through public access that offer the same, you just have to look. I wish you the best of luck on your journey and we're here to help if we can.

 

[Merrimay]

Hello, all bonesmarters! Thought I'd let you know I sailed through the MRI. For those of you who are severely claustrophobic, here's what worked for me:

1) Ask you ortho if an open or Wide-bore mri would get clear enough scans for him or her to properly diagnose your problem. In my case, an open MRI would not provide clear enough images, but he did allow me to use a wide-bore MRI. The tube is higher, wider, and shorter. In some cases your head may not even have to enter The Tube of Death.

2) Call the facility and ask how long your scan will take. I was told 40 to 60 minutes. Turned out it took 15!!!!

3) Begin to practice Exposure therapy on your own. I listened to YouTube videos of MRI clangs, bangs, sirens, alarm bells, and horns each day for 30 minutes. After awhile they became familiar and unintimidating.

4) Practice lying flat on your back (assuming your type of scan allows you to do that) with a wash cloth over your eyes. Don't move. Practice deep breathing and concentrate on calming words and images.

5) Adrenaline surges can be triggered unexpectedly. I read they can last 3 minutes. So I prepared for them and decided when or if I felt a surge of panic, I'd name the feeling then imagine myself floating out of the machine, then up and through the ceiling where a hot air balloon would lift me above the building. In a burlap bag, I'd placed my fears. As the balloon floated along, I'd release the panic and let the breeze carry it off.

6) Do not be afraid to ask for a sedative if you are claustrophobic or have PTSD. An old friend of mine was a tunnel rat in Viet Nam. Spent the war in narrow tunnels occupied by enemy troops. As you can imagine an MRI brings back devastating memories, and he won't do them. I said, "Respect your experiences. Ask for some help. You're not weak." In my case, I was given two .5mg tabs of Xanax, one 45 minutes before the scan and the other 5 minutes before the scan. I was not doped up by any means, but the fear was gone. I felt stronger and more in control.

7) Do NOT look into the tube. Lie down, arms at your side, blanket over you, 100% cotton wash cloth over your eyes.

8) They will most likely require you to wear ear plugs or a headset and ask you if you'd like to listen to music. My MRI was done in Knoxville, TN. I said, "What are my options?" and they said, "Country and Country." I said, "I can't listen to song-stories about losing your wife, your job, your dog and your truck and stay calm!" That got a laugh, so if you can, head into the Tube of Death laughing.

9) Ask your radiology tech to reassure you along the way, by saying things like, "You're doing great!" I asked mine to reassure me that I was the bravest and most inspiring scan-victim she ever had. We had some good laughs every 5 minutes or so.

Anyway, as I say, just some feedback for those of you who like me, would rather be dragged over hot coals than have an MRI. It's doable!!!

 

[CricketHip]

Good for you! You were able to overcome your fears and got the thing done. Hopefully you hear something from the MRI shortly!!
That is a great list of suggestions to help others with a closed tube phobia. So nice of you to put it into print for your fellow BoneSmarties.

 

[spaniel]

@Merrimay- Way to go- glad the MRI was done. All this is incredibly important information. And I do agree that its high time for the orthos to look at the body more holistically. Mine refused to order an MRI of the back. it was my neuro who then ordered the MRI. And I'd like to add that @Charlie33 's post highlighting the importance of the dual xrays is outstanding. Quite seriously, if the orthos refuse due to Medicare issues, tell them you will go elsewhere. They will then likely do it, but we should not have to manipulate ourselves into better care! And about the swimming- I find the side stoke the best in terms of not putting too much pressure on the spine.

 

[Merrimay]

Thank you, @spaniel . I agree that the side stroke seems the most gentle stroke. As soon as I'm able to get the okay on swimming from my spine guy, I'll be suiting up. I see him for my scan results and recommendations on the 17th.

 

[Charlie33]

Nice job! Glad everything went well and that you had a few laughs during the process.

 

[Merrimay]

@FionaW , I'm not sure what day your knee replacement surgery is this month, but best of luck!

 

[Elf1]

@Merrimay that is an awesome list of things to help you prep for and get you through an MRI! I'm going to bookmark that, with your permission, so that I can share with others that dread the "Tube of Death"! So love that name! You did a fantastic job!