update on my recovery (bit of bad news)

the readership has changed somewhat, so here's a brief "what happened", I
had severe SPD in my 2nd pregnancy (milder in my first), and at the end, I
developed all over body pain that basically left me unable to move, I spent
the last week in hospital being pumped full of pain meds, my daughter was
then delivered in the OP (back to back) position in a very painful (on the
joints) 2nd stage that took 8-10 times as long as my previous 2nd stage. It
was evident soon after the birth that there was more damage than just SPD
that didn't heal spontaneously as there was swelling and pain in places
there hadn't been before.

Fast forward 19mths, I'm a heck of a lot better than I was, but still with
some pretty significant problems. I've been working with a physical
therapist who is also a pilates instructor, which means she is hands on,
feeling how my muscles are working in the various exercises, for much more
time than in a regular physical therapy appointment, so that has allowed her
to really get to know how things are working and unfortunately what she
thinks, is that my muscles are doing a good job, they are responding at the
correct time and doing all the work they can to stabilise things, without
going in to spasm and permentantly switched on and causing pain in that way,
which means we have to look at the next level down, the ligaments that hold
the symphysis pubis together are just not doing their job and physical
therapy can't fix that.

Reflecting on how they got in that state, my understanding is pregnancy
makes the ligaments looser, it doesn't stretch them beyond the point they
can spring back to, it must be birth that did that (I'd always blamed the
birth, but I hadn't had such concrete evidence).

So where next, the surgery for SPD is not ligament focused, like say a knee
reconstruction, it's a bone operation, they fuse the two sides of the
pelvis, it's major surgery, long recovery and only about 50% sucess rate, I
don't feel that my current condition is bad enough to take that kind of
risk. The other option is a ligament treatment called prolotherapy, it's not
covered on insurance as it's way out there as an alternative therapy, there
is only one practioner in reachable distance and absolutely no information
that I can find on it's success rates, I've never come across anyone in all
my perusing of online boards and groups, someone who has even tried this, so
whilst it seems it's an idea that I must visit, I'm not desparately keen
either! I think I need to just pluck up the courage to go and have a
consult, not accept any treatment first visit and try and get more
information. My physical therapist has someone who went to this guy for a
different problem, but I think vaguely related as I seem to recall it was SI
trouble with good results and she is trying to put us in touch.

I've also been musing over what effect this might have on pregnancy and
birth, part of me is wondering if the damage is already done and whilst
pregnancy would be hard, delivery wouldn't be an issue, but a bigger part of
me is saying that this ligament has definitely recovered some since and then
putting a baby through it might be ok if the baby is well positioned, but
not so good if it isn't and that maybe even putting a baby through it in the
right position would be a bad idea, a bit like stretching a spring, if it's
in good condition it goes back, if it isn't, it doesn't and the amount it
has to stretch may well not make much difference, it may just be best it
doesn't stretch at all. I feel more relaxed about the idea of a c-section
than I did, so that's not really an issue, I'm not even desparately
concerned about pregnancy, whilst SPD makes pregnancy difficult and even
hellish for the last few weeks, it is still only 9mths (and there are other
discomforts that are equally troubling, I get stupid food and smell
aversions and last time I was sick right through, though not extremely so
and not accompanied by nausea) and with the right support in place, I can
hack that and it would be likely that one or both kids would be in school
and we could get a nanny or other help if needed, what I'm rather more
concerned about is the recovery afterwards, there is no way of knowing
whether it will be worse, the same, or better, the hope would be that
avoiding vaginal delivery would avoid further damage, but being heavily
pregnant does at least some percentage of the damage too and c-section means
in the short term the abdominal muscles are worse.

I needed to put this in words today, so I can put it to one side and get on
with life, the earliest I can even imagine getting pregnant is summer 2009,
regardless of all these troubles! Hopefully some people are interested to
hear how things have gone ;-)!

Anne

Anne Rogers wrote:
The other option is a ligament treatment called prolotherapy, it's not
covered on insurance as it's way out there as an alternative therapy

Actually, it isn't at all "out there", except perhaps for using
dextrose
(per www.prolotherapy.com) instead of the old standby agents heat
or acid or something (anything) else. It is basically what horsemen
know by the name "pin firing" and the idea is to fight inflamation
with
inflamation. Does it work? My personal experience has been that
counter inflamation does not work. Good luck with your research.

The other option is a ligament treatment called prolotherapy, it's not
covered on insurance as it's way out there as an alternative therapy

Actually, it isn't at all "out there", except perhaps for using
dextrose
(per www.prolotherapy.com) instead of the old standby agents heat
or acid or something (anything) else. It is basically what horsemen
know by the name "pin firing" and the idea is to fight inflamation
with
inflamation. Does it work? My personal experience has been that
counter inflamation does not work. Good luck with your research.

it depends what you mean by "out there", in terms of the logic behind it
that makes it work, it's exceedingly logical, though my understanding was
that whilst it causes localised inflamation in the area being treated which
then stimulates tissue repair, the area doesn't have to be inflamed to start
off with, so it's not so much treating inflamation as treating damaged
tissues, so it's not "out there" in that sense. The sense in which it is
"out there" is that most states seem to have under 5 practioners, so it's a
rarely used therapy, hence very little research basis purely due to lack of
numbers, it's rarely covered by insurance (though that doesn't necessarily
imply out there, acupuncture has great research support yet is rarely
covered). It's even more out there for my case because via prolotherapy
sites and SPD sites, I can't find any related case histories, so chances
that the doctor I go to will have seen anything like my case before is
almost zilch, which all add up to me as it being "out there". The good news
is that it doesn't seem to hurt during treatment, other than the discomfort
of the actual injections and there doesn't seem to be anything other than
minor risks, which makes it fall into the "worth a try" category rather than
the "approach with caution" category.

I'm not sure what you mean by "my personal experience...", have you had
prolotherapy? or some kind of related therapy?

Cheers

Anne

"Anne Rogers" wrote:
[...] whilst it causes localised inflamation in the area being treated which
then stimulates tissue repair

Repair? Most proponents claim it strengthens. That is not
necessarily repair. There is some evidence that the treatment
actually damages the vascular and nerve supply in the vicinity of the
injection sites. No living nerves confers less pain. But in no sense
is this tissue repair.

There is a Cochrane review.

On Jan 31, 10:27 pm, "Anne Rogers" wrote:
the readership has changed somewhat, so here's a brief "what happened", I
had severe SPD in my 2nd pregnancy (milder in my first), and at the end, I
developed all over body pain that basically left me unable to move, I spent
the last week in hospital being pumped full of pain meds, my daughter was
then delivered in the OP (back to back) position in a very painful (on the
joints) 2nd stage that took 8-10 times as long as my previous 2nd stage. It
was evident soon after the birth that there was more damage than just SPD
that didn't heal spontaneously as there was swelling and pain in places
there hadn't been before.

Fast forward 19mths, I'm a heck of a lot better than I was, but still with
some pretty significant problems. I've been working with a physical
therapist who is also a pilates instructor, which means she is hands on,
feeling how my muscles are working in the various exercises, for much more
time than in a regular physical therapy appointment, so that has allowed her
to really get to know how things are working and unfortunately what she
thinks, is that my muscles are doing a good job, they are responding at the
correct time and doing all the work they can to stabilise things, without
going in to spasm and permentantly switched on and causing pain in that way,
which means we have to look at the next level down, the ligaments that hold
the symphysis pubis together are just not doing their job and physical
therapy can't fix that.

Reflecting on how they got in that state, my understanding is pregnancy
makes the ligaments looser, it doesn't stretch them beyond the point they
can spring back to, it must be birth that did that (I'd always blamed the
birth, but I hadn't had such concrete evidence).

So where next, the surgery for SPD is not ligament focused, like say a knee
reconstruction, it's a bone operation, they fuse the two sides of the
pelvis, it's major surgery, long recovery and only about 50% sucess rate, I
don't feel that my current condition is bad enough to take that kind of
risk. The other option is a ligament treatment called prolotherapy, it's not
covered on insurance as it's way out there as an alternative therapy, there
is only one practioner in reachable distance and absolutely no information
that I can find on it's success rates, I've never come across anyone in all
my perusing of online boards and groups, someone who has even tried this, so
whilst it seems it's an idea that I must visit, I'm not desparately keen
either! I think I need to just pluck up the courage to go and have a
consult, not accept any treatment first visit and try and get more
information. My physical therapist has someone who went to this guy for a
different problem, but I think vaguely related as I seem to recall it was SI
trouble with good results and she is trying to put us in touch.

I've also been musing over what effect this might have on pregnancy and
birth, part of me is wondering if the damage is already done and whilst
pregnancy would be hard, delivery wouldn't be an issue, but a bigger part of
me is saying that this ligament has definitely recovered some since and then
putting a baby through it might be ok if the baby is well positioned, but
not so good if it isn't and that maybe even putting a baby through it in the
right position would be a bad idea, a bit like stretching a spring, if it's
in good condition it goes back, if it isn't, it doesn't and the amount it
has to stretch may well not make much difference, it may just be best it
doesn't stretch at all. I feel more relaxed about the idea of a c-section
than I did, so that's not really an issue, I'm not even desparately
concerned about pregnancy, whilst SPD makes pregnancy difficult and even
hellish for the last few weeks, it is still only 9mths (and there are other
discomforts that are equally troubling, I get stupid food and smell
aversions and last time I was sick right through, though not extremely so
and not accompanied by nausea) and with the right support in place, I can
hack that and it would be likely that one or both kids would be in school
and we could get a nanny or other help if needed, what I'm rather more
concerned about is the recovery afterwards, there is no way of knowing
whether it will be worse, the same, or better, the hope would be that
avoiding vaginal delivery would avoid further damage, but being heavily
pregnant does at least some percentage of the damage too and c-section means
in the short term the abdominal muscles are worse.

I needed to put this in words today, so I can put it to one side and get on
with life, the earliest I can even imagine getting pregnant is summer 2009,
regardless of all these troubles! Hopefully some people are interested to
hear how things have gone ;-)!

Anne

Anne, Just wanted to say I'm sorry for the difficulties. I don't quite
understand it all, but I'm sorry you have to deal with it. I hope
something can be sorted out before you decide to TTC again.