On September 25th, Jarmo Kekalainen admitted to the media that Nathan Horton was going to remain out of the lineup indefinitely.
When the words "degenerative back condition" were uttered, I winced, and immediately looked over at my wife, who shook her head.
You see, she has something in common with Horton - degenerative disc disease, that has slowly eroded away the discs in her spine in much the same way. (Horton's problems have been described as primarily in his lumbar discs. She has issues with both lumbar and cervical discs.)
Much like Horton, she was told that if she performed physical therapy and strengthened her core, it would reduce the pain. (In her case, she was also told that losing some weight would help - neither of us is a professional athlete, so I'm guessing that was less of an issue in Horton's case.)
That was almost two years ago.
In that time, I've watched my wife push her way through therapy sessions, and pay for it the next day. She performs the "take home" stretches, leg lifts, and balancing on inflatable balls. She wears a TENS unit at least once a week to help provide acute relief - sometimes she doesn't take it off until she's going to sleep.
She's had MRIs and X-rays. She's consulted with two neurosurgeons, a pain management doctor, and more nurses and medical assistants than I can count. She has a therapy "team" who work with her at least twice a week. One of them is a Jackets' fan. They talk about the games some times. Sometimes he asks me what I think about a player, or what the team's been doing in the front office. He's a nice guy, and he knows when he should push my wife to work harder, or when the pain and stress on her face means it's time to back off a bit.
Most days, it's two hours from the time that she wakes up to when she feels up to actually leaving the bedroom for anything more than using the bathroom. That's how long it takes for her pain medication to make an impact, usually. Until then, she has trouble standing up. Walking is a slow, painful process, and often requires a cane. Sometimes just sitting up makes her cry out in pain.
If she sleeps on her back the wrong way, it usually means taking a double dose of pain medication before it subsides, or taking a muscle relaxer that leaves her feeling "mushy", and barely able to stay awake.
On "good" days, once things kick in, she usually will ask if we can go out to a park, or maybe drive over to the zoo, or Easton. She'll probably still need her walking stick, but she can enjoy it without too much discomfort. Just leaving the house is a victory. On bad days, sometimes it's an achievement to make it downstairs to the couch. If the bad day happens to be a therapy day, she'll try to push through it and will go do as much as she can...but sometimes she curses with frustration as she tells me to call the medical center and reschedule her session, because it just isn't going to happen that day.
I don't know what the state of Horton's back is, but if his life is anything like my wife's, he has my deepest sympathy. I'd imagine he's probably doing a lot of the same exercises - it wouldn't shock me if he's got a TENS unit, too, and while I wouldn't speculate about what medications he's taking, I'm sure he's going through the same rotations of pain management specialists, surgeons, and therapists.
They tend to ask the same things, offer the same advice, propose the same solutions. It all becomes a blur after a while.
After six months of therapy, my wife wasn't showing much improvement - she had some additional mobility, but the overall pain levels were still the same. At the follow up visit with her pain management doctor, he told us that the next step would be to try some steroid injections directly into her spine.
This is exactly as fun as you think it is - and technically is considered an outpatient surgery. We went to the hospital. She was taken back to the surgery prep while I got old magazines and as much stale coffee as I could stomach.
She changed into a patient gown, was hooked up with an IV, and laid out on a special X-ray table. Her surgeon used real time x-rays to guide him as he placed a needle into her back, between the bad discs, and into the epidural space inside her spine. She received an injection of steroids and a little bit of anesthetic. Once the injection was finished, she had to wait 30 minutes while they kept an eye on her vital signs before letting her get dressed.
In most patients, after the anesthetic wears off, the pain generally reduces as the steroids reduce some of the pressure on the nerves.
Most, but not all. My wife wasn't one of the lucky ones. (And learned the hard way that she's allergic to the particular steroid that was used. THAT was a fun weekend.)
The next time she met with her surgeon, my wife was in tears - as much from the frustration as the pain. After almost a full year of therapy, the failed injections, and her pain management doc gradually increasing the dosage of her medication to remain effective, she was still looking at the same problems.
Laying down hurts.
Sitting up hurts.
Standing for more than a few minutes hurts.
Twisting her head hurts.
Turning around hurts.
There were two options - more therapy, or a fusion surgery.
Our insurance won't approve surgery (yet). She's only in her mid-30s. That's young for this kind of procedure. They want her to complete more therapy. To rule out every other possible alternative.
If this sounds incredibly frustrating, you're not wrong. There are times when she's furious at anyone and everyone. There are times when she is so depressed at how difficult everything is that she doesn't see the point of getting out of bed.
This is torture for a normal adult. I cannot imagine what it's like for someone who is used to being a world class athlete.
Two years ago he was skating the Stanley Cup around the ice. Now he's probably dealing with days where he has to put a chair in his shower because he doesn't think he'll be able to stand up for that long.
It's October 21st. Not quite a month after the initial news about Horton's back broke, if you excuse the pun, and it's starting to look like his career could be over.
Depending how severe the damage is, they may very well have skipped the steroid injections and gone straight to recommending the fusion. It's a difficult choice - do you keep trying to push past the constant pain and keep going with therapy, and see if it makes an impact? Or do you agree to a surgery that is very likely to relieve that pain, but will mean you can never play the game you've devoted so much of your life to again?
Do you endure another year (or more) of torture, in hopes that you might hold that cup over your head again? Is it worth the risk that would come every time you take a check, or get crunched along the boards? The fear that one bad landing on the ice might leave you right back at square one?
I don't doubt that he's frustrated and disappointed about not getting the opportunity to really be a part of the team here. He's made no secret of the fact that he saw Columbus as an opportunity to win the Cup again - and that he wanted to be a part of the team that made that journey. He was excited about guys like Johansen, Jenner, and Bob. He shared the vision that John Davidson offered about what this city and this team could be. Instead, he's almost certainly spent more minutes in waiting rooms and on top of exam tables than he's been on the ice.
If Horton does make the decision that the fusion is his best option, he's still looking at major surgery, particularly if they decide to harvest material from his hips to create the bone grafts. (Synthetic options work, but may not be ideal depending on the situation.) He'll have weeks, if not months, of rehab ahead of him. If they decide to fuse one level, he probably won't see much restriction on his mobility. If they have to fuse two, that may not be the case. There's the risk of infection, of a spinal fluid leak, of the grafted bone failing to heal properly. There's no guarantees about how much the pain will be relieved, or how long he'll be recovering - this is surgery, not someone waving a magic wand.
He's lucky, if that's quite the right word, that some of the best neurosurgeons in the world practice in Columbus and Cleveland. There are world class rehab facilities here, and I have no doubt that his teammates and the Jackets organization would be united in their support for him and his family through the entire process (and offer some ideas for life after hockey, for that matter.)
I'm not Nathan Horton. I have no idea what is going on in his head, but I have a pretty good idea of what he's dealing with, and what he and his family are considering. I know that if you asked my wife if she'd trade relieving her pain, permanently, in exchange for something she loved, she'd be asking where she has to sign.
Don't be surprised at all if, when all is said and done, he comes to the same conclusion.