As someone with herniated discs, spinal stenosis, degenerative disc disease and scoliosis for decades, who's already had surgery but still got worse... what else even is there besides more surgery?
I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.
This missing bit is that many people are pain free with the same scans as you have. Surgery does help people, but it’s clear that the signals we use to say surgery is needed are very noisy and not as accurate as the surgeons would have you think.
IIRC, besides being pain caused by physical problems, it can also be pain caused by nerve issues (slightly different), and pain caused by your brain (very different, could be multiple causes there).
If surgery doesn't help, and/or like the other commenter mentioned, people with similar physical characteristics don't have pain, then it's time to explore the other two.
I'm sorry you're suffering. There are several regenerative approaches getting ever closer which will be able to help your body re-grow cartilage. Hopefully they'll be FDA approved sooner than later.
This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
To be fair to your latter point, Massachusetts is arguably the biomedical research capital of the world, those MRI machines are being put to research purposes.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.
I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.
Any anecdotes or other experiences/thoughts are appreciated.
Go see a specialist sports doctor. They deal with lots of these types of injuries. My physio sent me to one when I did my shoulder in a motorcycle accident and for my case, the data showed that it was better not to operate.
Anecdote:
My dad has had two shoulder surgeries, one to repair his rotator cuff +15 years ago on his right arm, one back in March of this year on his other shoulder. I couldn’t tell you what specifically was wrong with it this time.
He was a regular golfer until last year when the pain got too bad to play through. He just started playing golf again at the beginning of September. He told me after three or so rounds he can’t even tell he had surgery or any previous pain in that shoulder.
He’s had one doctor do his knee surgery and the aforementioned shoulder surgery and he’s really happy with all of their work.
I hope you have as good of an experience as my dad has had.
One thing that bodybuilding taught me is to never underestimate how significantly you can change how your body works through weight training, mobility work and physical therapy.
I used to suffer from chronic low back pain. It hurt to get out of bed every day for years. 1-2 years after getting into bodybuilding the pain disappeared and didn’t come back. Not only that, but I’m not physically limited by my back whatsoever.
I’m not suggesting you start bodybuilding. But the things I think that helped was 1) weight training, 2) mobility work / stretching, 3) physical therapy. That combo can be really powerful.
My mother-in-law has spinal surgery last christmas, the pain for her, prior to the surgery, was unbearable so it's hard to justify not running from that into the arms of a surgeon. The surgeon showed exactly what was to repair though so it was simple enough to understand and clear in the way it was going to help her.
About 9 months out from that surgery and she doesn't have anymore pain.
Obviously, don't take medical advice on HN too seriously, but my uncle had shoulder surgery and was happy with the results. I have heard many more complaints about back surgeries making things worse than shoulders.
However, if available I would try to find a good Pilates/dance/sports instructor that has a Gyrotonic machine, which is built for repairing and strengthening shoulder muscles. I had debilitating back issues from sitting in a chair all day and a good instructor fixed it over a year through low impact Pilates. YMMV and group classes tend to be ineffective because so much of it is doing the exercises precisely correct - they were built for injury recovery
Well, sample size of 1 but a family member was in debilitating pain all the time until they had a couple vertebrae fused. They can walk and life is mostly normal for them now.
I am one of those people. Obviously the example says nothing about the norm. The article was behind a pay wall so I didn't read it. But the title is about an insanely broad set of surgeries. Bet there is a lot of nuance within.
(Below has nothing to do with people who need surgery due to catastrophic injury or congenital defect.)
Most surgeries are followed by more surgeries.
And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.
Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.
Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.
In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.
But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.
So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.
The same could be said about economist articles behind paywalls; worse than useless as it prevents linking to an article covering it at a different source. Perhaps https://www.unsw.edu.au/newsroom/news/2022/03/three-orthopae... or https://www.thetimes.com/life-style/health-fitness/article/h... instead
The latter link is also paywalled for me.
As someone with herniated discs, spinal stenosis, degenerative disc disease and scoliosis for decades, who's already had surgery but still got worse... what else even is there besides more surgery?
I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.
This missing bit is that many people are pain free with the same scans as you have. Surgery does help people, but it’s clear that the signals we use to say surgery is needed are very noisy and not as accurate as the surgeons would have you think.
IIRC, besides being pain caused by physical problems, it can also be pain caused by nerve issues (slightly different), and pain caused by your brain (very different, could be multiple causes there).
If surgery doesn't help, and/or like the other commenter mentioned, people with similar physical characteristics don't have pain, then it's time to explore the other two.
I'm sorry you're suffering. There are several regenerative approaches getting ever closer which will be able to help your body re-grow cartilage. Hopefully they'll be FDA approved sooner than later.
Physical therapy helps. Check this out https://youtu.be/n9CDhcVTAdc and https://youtu.be/k1luKAS_Xcg (I only started paying attention after my emergency back surgery)
This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
To be fair to your latter point, Massachusetts is arguably the biomedical research capital of the world, those MRI machines are being put to research purposes.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
At least most medications and interventions have to go through RCTs and tend to be quite standardized.
Don't even get me started with mental health therapy...
As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.
I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.
Any anecdotes or other experiences/thoughts are appreciated.
Go see a specialist sports doctor. They deal with lots of these types of injuries. My physio sent me to one when I did my shoulder in a motorcycle accident and for my case, the data showed that it was better not to operate.
Anecdote: My dad has had two shoulder surgeries, one to repair his rotator cuff +15 years ago on his right arm, one back in March of this year on his other shoulder. I couldn’t tell you what specifically was wrong with it this time.
He was a regular golfer until last year when the pain got too bad to play through. He just started playing golf again at the beginning of September. He told me after three or so rounds he can’t even tell he had surgery or any previous pain in that shoulder.
He’s had one doctor do his knee surgery and the aforementioned shoulder surgery and he’s really happy with all of their work.
I hope you have as good of an experience as my dad has had.
One thing that bodybuilding taught me is to never underestimate how significantly you can change how your body works through weight training, mobility work and physical therapy.
I used to suffer from chronic low back pain. It hurt to get out of bed every day for years. 1-2 years after getting into bodybuilding the pain disappeared and didn’t come back. Not only that, but I’m not physically limited by my back whatsoever.
I’m not suggesting you start bodybuilding. But the things I think that helped was 1) weight training, 2) mobility work / stretching, 3) physical therapy. That combo can be really powerful.
Single anecdata here.
My mother-in-law has spinal surgery last christmas, the pain for her, prior to the surgery, was unbearable so it's hard to justify not running from that into the arms of a surgeon. The surgeon showed exactly what was to repair though so it was simple enough to understand and clear in the way it was going to help her.
About 9 months out from that surgery and she doesn't have anymore pain.
Obviously, don't take medical advice on HN too seriously, but my uncle had shoulder surgery and was happy with the results. I have heard many more complaints about back surgeries making things worse than shoulders.
However, if available I would try to find a good Pilates/dance/sports instructor that has a Gyrotonic machine, which is built for repairing and strengthening shoulder muscles. I had debilitating back issues from sitting in a chair all day and a good instructor fixed it over a year through low impact Pilates. YMMV and group classes tend to be ineffective because so much of it is doing the exercises precisely correct - they were built for injury recovery
Well, sample size of 1 but a family member was in debilitating pain all the time until they had a couple vertebrae fused. They can walk and life is mostly normal for them now.
I am one of those people. Obviously the example says nothing about the norm. The article was behind a pay wall so I didn't read it. But the title is about an insanely broad set of surgeries. Bet there is a lot of nuance within.
(Below has nothing to do with people who need surgery due to catastrophic injury or congenital defect.)
Most surgeries are followed by more surgeries.
And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.
Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.
Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.
In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.
But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.
So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.
https://archive.is/j6oeD