Diagnosis: Your Health Problems

What happens to your life with horses when you're facing major health issues? Juli S. Thorson has some understanding answers.
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What happens to your life with horses when you're facing major health issues? Juli S. Thorson has some understanding answers.

You've just come home from your doctor's office, and it's safe to say you've had better news. He's given you a diagnosis--maybe acutely serious, maybe something more chronic--that's going to alter most aspects of your life, at least for the foreseeable future. And it's dawning on you that your life with horses won't be spared.

Can you continue to ride? Should you? Once you've undergone the more immediate treatments, are there any modifications you could make in order to stay in the ranks of riders?

And what about the daily chores that go along with keeping horses? Will some or all of them be harmful to you, even if you still feel you can keep doing them?

So many questions, so many things to think about...

Allow us to be one of the many roadmaps you'll need as you travel your road to recovery. Using information gleaned from other horse folks--some of them medical professionals, some of them lay persons who've already been where you're about to go--we'll cover several areas of illness often suffered by your fellow Horse & Rider readers. We'll tell you what to expect, what the effects might be on your riding and horse-chores abilities, and what others have found to be helpful as ways to get back to the barn and the saddle.

Facing the Big C

Health problem: Cancer. It's the diagnosis everyone dreads, and not just because of the mortality rates. Chemotherapy and radiation treatment, plus cancer type-specific drugs and recovery from surgery (if needed), are known to task even the most determined of cancer sufferers.

What to expect: Disruption to your daily routine, as you take treatments at a hospital or cancer center; fatigue; nausea, vomiting, mouth sores, bone thinning, and hair loss, in reaction to chemo drugs; skin burns at radiation sites; possible surgery and recovery downtime; depression, which is common for cancer sufferers.

"Radiation therapy involves treatment every day, five days a week, for six to eight weeks," explains Karen Schrum, a Redmond, Ore., horse lover and retired emergency room nurse who underwent the treatment after being diagnosed with breast cancer. "After about two weeks of this, I began to feel very tired--radiation not only treats the cancer cells, but also takes out normal cells. It's taxing on the body as it tries to repair the damage done to the normal cells. The feeling of tiredness continued all the way through my treatment, and for many months afterward.

"Chemo patients don't have to schedule daily treatments, but in some ways have it worse because of the other side effects," Karen adds.

Can/should you ride? Possibly not, at least during the acute phase of treatment. Even if you're able to combat fatigue well enough to stay safely on top of your riding game, chemo weakens your bones and increases your fracture risk from falls or horse-handling mishaps. Other cancer-fighting drugs may numb your hands and feet, or affect your sense of balance.

Much may rest on your level of riding experience, and on your horse's temperament and degree of training. If you were a timid, green, or poorly balanced rider before your cancer diagnosis, or if your horse isn't high on the training/reliability scale, it might be wisest to forgo riding for a while. Your riding options may improve as time goes on.

What about daily horse care? Your reaction to treatment will tell you how little or how much you can do. "Most days, I was just too tired," Karen confides.

Others, like former Horse & Rider editor Kathy Swan, a breast-cancer survivor residing in Scottsdale, Ariz., report a different experience.

"I was able to continue caring for, and even riding my horses during treatment," she says. Kathy also confirms something stated by the American Cancer Society--that physical activity can improve the strength and endurance of those undergoing radiation and chemo, while contributing to mental health by renewing a sense of empowerment.

"I actually feel that working with the horses in the barn, and trying very hard to continue with them, made the whole experience tolerable for me," she says. "The horses gave me a reason to get out to the barn every day and keep active. I credit them for making me feel 'normal' and giving me a reason to not feel sorry for myself."

Tips to try: Take acidophilus capsules to combat nausea; use aloe vera toothpaste to soothe mouth sores; go on a bone-building regimen, such as taking Fosamax; apply creams to sooth skin burns; focus your horse contact and riding efforts on your gentlest, best-trained horse; farm your horses out to trusted friends for a while, in response to their "what can I do to help?" questions.

Oh, Your Aching Back

Health problem: Back pain. Whether acute (lasting six weeks or less), sub-acute (six to 12 weeks), or chronic, it's one of the most frequently diagnosed health problems. Fifty to 80 percent of adults deal with back pain at some point in their lives. Causes vary widely, from trauma or congenital issues, to degenerative processes such as arthritis.

What to expect: Pain that scores anywhere on a scale from mild discomfort to excruciating; inability to perform basic physical tasks; work and recreational downtime; side effects from pain medication, including stomach upset and/or mental dullness; irritability; possible surgery; the need for lifestyle changes (weight loss is a big one); depression (one study found depression to be four times as prevalent in back-pain sufferers as in the rest of the population).

"My back-pain problem traces to an incident where I fell off my horse, going down the fence in a working cow horse run," remembers California's Paula Zdenek. "I kept on saying 'it wasn't that big a fall,' and didn't feel much back pain at first, so I just kept working, riding, moving hay bales--which all added up to disaster. Like excess sun exposure, back pain can be cumulative. Mine's now under control (mostly), but I got to a point where my back pain was so intense that I'd have days when I wanted to scream, cry, and go mad, all at once."

Shannon Robinson, a 28-year-old show enthusiast from Chrisman, Ill., deals with chronic back pain caused by two bulging discs in her lower back. While she's found ways to mediate it, she's also had to make adjustments to her horse life.

"Overall, I'm always in pain to some degree. Ibuprofen and Tylenol with codeine get me through most horse shows, but if we've been to a long show or if I've ridden a lot at one, I won't be able to ride for several days to a couple of weeks afterward. At those times, I just practice for showmanship classes, or focus on helping my niece and nephew with their horses. I don't ride in hunt-seat classes any more, because right-leg numbness affects my balance, and I don't trail ride now, either, for the same reason."

Can/should you ride? It's certain that after injury or surgery, your body will need time to heal before you can resume riding. Beyond that, no case is typical, so a return to riding is something that you and your primary care provider need to discuss after laying out all the variables.

What about daily horse care? Many patients find that this aspect of horse ownership, which tends to include much in the way of bending, lifting, reaching, and twisting, requires more modification and adjustment than riding does.

You may discover, for instance, that you have no choice but to turn the biggest manual-labor chores, like moving hay or cleaning stalls, over to someone else. You may need to invest in certain kinds of labor-easing devices an easy-to-roll manure cart balanced over bicycle tires, in place of your trusty wheelbarrow. You may learn that some tasks, like body grooming, remain doable, while others, like bending down to groom or clip lower legs, are not.

"I had to experiment to see what I could and couldn't keep doing," Paula notes. "I also had to learn to ask for and accept help, and to accept that some things just had to go undone for a while."

Tips to try: Use a step-up block for mounting your horse; trade your heavy Western saddle for a lighter one; take anti-inflammatory meds before you ride; use a gel pad over your saddle's seat; switch from a horse that trots to a gaited, smoother-riding breed; employ labor-easing devices around the barn; try acupuncture, chiropractic care with a sports-medicine focus, and/or massage; improve core strength with exercises that'll help reduce the work your back must do. (For more information,
see "Healthy Back Resource" at the end of this article.)

The Bionic Rider

Health problem: Joint replacement. As a medical procedure designed to improve quality of life, joint replacement is one of the big success stories of the last 15 years. It offers pain relief, increased mobility, and often, a return to enjoyable pursuits--including riding--that had to be set aside before surgery and recovery took place.

What to expect: Pre- and post-op education and physical therapy; for hip or knee replacement, weeks with a walker, followed by more weeks with a cane or crutches; a long list of recovery-period do's and don'ts, including precautions against falls; three to six months of gradually increasing activity, until you reach full recovery; with hip replacement, the possibility of having one leg end up shorter than the other.

"The first weeks after joint surgery were no picnic," confides West Virginia horsewoman Ann Casto. Ann, who underwent full knee replacement in 2004 at age 54, experienced considerable post-op pain (variable from person to person), and also had to obey doctor's orders to stay away from the barn and not drive for six weeks. "But by that point, I had considerable improvement, and my range of motion has improved even more since then."

Jane Doskal, a retiree from Missouri, had a hip joint replaced last year and is happy that she did. She's back riding her favorite horse, and doing many of the other things she couldn't do before she had her surgery.

Can/should you ride? Hip and knee replacements usually spell an end to such high-impact activities as running and downhill skiing, but the prognosis is different for horseback riding. It's something many people can and do resume once their recovery is complete. The key lies in being diligent with your post-op physical therapy, and not attempting to ride until your doctor pronounces your recovery complete.

What about daily horse care? Due to the importance of avoiding falls, expect to be ordered to stay away from the barn for a minimum of six to eight weeks. Once the ban's lifted, you'll still have to be careful about the kinds of chores you do, and how you go about doing them. For instance, to avoid staggering under a heavy load, which could cause post-op injury, you should use a cart, dolly, or handtruck to move heavy objects such as hay bales.

Tips to try: Practice using a cane around the barn before your surgery, so you and the horses can get used to it; use orthotic inserts in barn shoes and boots, to provide support and keep joints aligned after surgery; ride with lengthened stirrups, to reduce knee strain; compensate for a shortened leg by using an extra padded stirrup, or shortened stirrup, on that side; trade your standard stirrups for ones that turn easily; install handholds in barn areas where you may need extra security against falls.

"A" is for Arthritis

Health problem: Arthritis. The word itself means "inflammation of the joint," and 40 million U.S. adults suffer from some form of it. Osteoarthritis (OA) and rheumatoid arthritis (RA) are most common. OA usually results from trauma or wear and tear, and often affects weight bearing joints. A quarter of those in the 45 to 64 age group have it. RA is a degenerative autoimmune disorder that affects the whole body. RA is three times more likely to affect women as men.

What to expect: Pain (often debilitating); loss of joint motion; reduced ability to work (and play); reliance on anti-inflammatories, painkillers, or other meds; need for lifestyle changes, including weight loss; considerable experimentation with ways to find relief; possible surgery (such as joint replacement); depression, as a result of living with chronic pain.

Nikki Owen, a 33-year-old from Butler, Ky., includes spinal arthritis in the constellation of painful issues that have kept her doctoring for several years. She's typical of people who find that arthritis can demand modifications, both of activities and of mindset.

"I still ride, but not every day, like I used to," she explains. "I seem to do best with light riding, every other day. Instead of pushing myself to do more, or feeling bad because I can't, I just take it one ride at a time."

"I've had to adjust to the idea of planning my life around whatever level of pain I have on any particular day," says Mark Morgan, an RA sufferer.

Can/should you ride? Yes, in many cases, provided that your pain level, form of arthritis, and types of medication make it safe and reasonably comfortable for you to do so. You may need to modify your style of riding--no posting the trot, for example, if you have arthritic knees--and may need to consider other modifications as well. But the independence and empowerment engendered by riding, not to mention the exercise value and chance to get outdoors, can go a long way toward helping with the depressive aspect of arthritis.

One caveat: Some of the medications used to treat RA lead to bone loss, or osteoporosis. Riding with osteoporosis can result in spinal fracture, or in easy breakage of other bones if you come off your horse. Osteoporosis often has no symptoms, so confer with your physician about the need for regular bone density scans.

What about daily horse care? For the most part, your body and response to treatments will tell you what you can and can't do. Some people find that the manual-labor aspect of horse care is just too pain-generating to deal with for their type, location, and degree of arthritis. Others note the therapeutic benefits of keeping their bodies in motion, strategizing compromises where they must (with occasional part-time help, for example, or by switching to a lower-maintenance style of horsekeeping).

Tips to try: See the suggestions for back pain and joint-replacement patients; reduce RA hand pain with warm-paraffin therapy (call a drugstore or manicurist for supply sources); use analgesic rubs at pain sites; reduce hip pain by trading your wide-seat saddle for a saddle with a narrower seat.

Thanks to the readers with health problems who shared their stories and tips with us for this article. For more on the subject, see Riding With Health Problems. And, visit the H&R Forum to pass along your own experiences on riding with health problems.

Healthy Back Resource

The Rider's Pain-Free Back: Overcome Soreness, Injury and Aging and Stay in the Saddle for Years to Come

By James Warson, MD, with Ami Hendrickson

Published by Trafalgar Square

Available at HorseBooksEtc.com

Hardcover, 170 pages

If you've had back pain, and tried to explain to your doctor why you can't stop riding, you may have been regarded skeptically. But when riders with back pain showed up at James Warson's Fort Collins, Colo., practice, he knew just what they were saying, and why they didn't want to stop riding.

A neurosurgeon and horseman, Warson tried to find ways to get riders back in the saddle--with a healthy back. But he found very little knowledge among colleagues when it came to equestrian specific treatments.

With a rider's eye--and a rider's understanding of how your back moves while you're riding--he began to analyze the anatomy and physics of riding. He attended shows and events, spent time in the saddle, and studied how posture, riding style, and the type of horse could impact a rider's spinal health.

Then he began working with patients to regain--and retain--back health based on his observations and medical knowledge. This book gathers his observations, treatment, and understanding of how riders use their spines, in an effort to keep those with back problems able to ride as much as possible.

He starts with basic information about the spine, illustrated with diagrams and photos, then covers the different types of problems riders can have. Throughout the book he's included case studies that riders can relate to. Then he explains the physics of riding--combining the motion of the rider, with the horse's movement--to explain how riding affects the spine.

He also addresses the importance of saddle fit and the use of saddle pads, and points out something that might seem counterintuitive: a preference for thin saddle pads versus thick pads.

"Prolonged riding using thick saddle pads leads to stiffness, soreness, tension, and muscular strain in both the horse and the rider," Warson says.

From there, he delves into the specifics of how various disciplines affect the spine, and the most common types of back injuries seen in those disciplines.

The second part of the book is devoted to achieving, improving, and maintaining back health, and offers specific stretching and strengthening exercises (see excerpted "Spider Crawl," below, for a good lateral stretch), then covers traditional and alternative treatments and pain management.

In his final chapter, Warson gives tips for preventing injuries around the barn--from barn chores and saddling to stirrupposition and fear--related body use.

He points out that many riders with back pain may need to make a stirrup adjustment. "In their desire to maintain, perhaps, a more vertical riding position, they tend to overdo it and move the stirrups too far back."

"These equestrians almost always have poor abdominal strength," he adds. "A combination of moving the stirrups a bit forward and strengthening the abdominal muscles allows them to have a more anatomically sustainable position when riding."

Warson moves on to address how changing riding styles, disciplines, or breeds can help keep you in the saddle longer.

"If a rider has an injury, or complains of chronic pain, he needs to ride a horse whose natural movements, rhythm, and activity complement, rather than contradict, his own," Warson says.

He suggests that a rider with a long torso may not be suited to a horse with a rapid gait. "A rider with a relatively short torso may be able to ride (the horse) comfortably, while the same animal may cause a rider with a longer torso to experience more of a whip--like motion that produces pain."

What if you're a very tall rider? Warson suggests a horse with a sweeping, horizontal gait.

If you have chronic or acute back pain and are trying to return to the saddle, Warson offers information that'll keep riding a part of your life for a long time.
--Debbie Moors

Spider Crawl (Excerpted from The Rider's Pain-Free Back.)

This exercise is especially recommended for riders who participate in team penning, cutting, or reining, persons with scoliosis, or for anyone who wishes to improve his or her lateral flexibility. Remember to keep your shoulders relaxed and breathe deeply.

  1. Stand vertically, with your feet together. Let your hands and arms hang loosely at your sides.
  2. Bend laterally (sideways) to the right, very slowly. (Don't twist your shoulders or your back.) Slowly "walk" the fingers of your right hand down the lateral or outside portion of your right leg. Stretch to the right as far as possible.
  3. Slowly stand up straight again.
  4. Bend laterally to the left, very slowly. Slowly walk the fingers of your left hand down the lateral (outside portion) of your left leg. Stretch to the left as far as possible.
  5. Repeat four or five times on each side.

(Editor's note: This stretch is done from side to side. Picture yourself sandwiched between two panes of glass, so the stretch is felt along the side of the body.)

This article originally appeared in the March 2008 issue of Horse & Rider magazine.