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Next steps after diffuse idiopathic skeletal hyperostosis diagnosis?

Posted by kevenk2 @kevenk2, Jun 10, 2024

I had a chest x-ray 10/28/2022 as a compontent of a physical clearance for a left knee replacement. I had the knee replacement. The Doctor noted DISH in his closing sentence. There was a concern about my lungs and then open heart surgery so it has taken 2 years to get a DISH diagnosis. So far PT has been painful. I am very active gardener and Fly Fisher. In fact, I moved 544 bricks just yesterday. Yes, I am in pain and can hardly move my head side to side. I am not dietetic, having problems keeping my cholestrol levels out of the dangerously low levels when I am on cholestorl lowering medications, and on only blood thinners 9 months after open heart surgery. I walk all the time for gardening on an acre. All the reports I have been reading cover other underlining health problems. I have a doctor appointment this week to discuss the MRI results which do not sound good after the Tech asked why I did not inform him about the concrete that was injected into my back to stablize it. Should I just go back tomy normal workouts and try to include more yoga and stretching along with my active life style? So far I am really not getting answers from the doctor that provided the DISH diagnosis. Perhaps that will change with the MRI and talking to an altnerative medicine MD. Any recommendations would be helpful.

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Mentor
Jennifer, Volunteer Mentor | @jenniferhunter | Jun 14, 2024

@kevenk2 Hello and welcome to Connect. You might be interested in these discussions with members talking about DISH.

"Does anyone have DISH and/or OPLL?"
https://connect.mayoclinic.org/discussion/does-anyone-have-dish-and-or-opll/
"DISH (diffuse idiopathic skeletal hyperostosis) or Forestier's"
https://connect.mayoclinic.org/discussion/dish-disese-diffuse-ideopathic-skeletal-hypertrophy-or-foresters/
"I am reaching out to those with DISH "
https://connect.mayoclinic.org/discussion/i-am-reaching-out-to-those-with-dishd/
I can see why your MRI tech was questioning you. Are you referring to bone cement in a procedure to stabilize your spine? That kind of information is important to share with your providers who may not have your full history and records. I think exercise recommendations need to come from your provider after you get your imaging results in order to know what is safe for you to do.

REPLY
Profile picture for fl0rence
fl0rence | @fl0rence | 2 days ago

My orthopedic doctor told me more about my DISH from X-rays he took in the office, one with my mouth open. I got more information about it by googling it.
Diffuse = spread out, not confined to a single location
Idiopathic = with a cause that is not known
Skeletal = having to do with the skeleton
Hyperostosis = too much growth of bony tissue
Diffuse idiopathic skeletal hyperostosis (DISH) is a form of non-inflammatory arthritis that involves the tendons and ligaments around the spine. Also known as Forestier's disease, this condition occurs when these tendons and ligaments become hardened, a process known as calcification. Once the tendons and ligaments harden, parts of these tissues can turn into bone. This usually occurs where the tissue connects with the bone. As a result, bone spurs develop, which is an outgrowth of bone that develop along the edges of a bone.
Key Complications of DISH
Dysphagia (Difficulty Swallowing): The most common serious complication, caused by cervical osteophytes (bone spurs) pressing on the esophagus.
Spinal Fractures: The hardened, inflexible spine is brittle. Minor injuries can lead to unstable fractures, which have high mortality rates (up to 38%) and high rates of neurological deterioration.
Respiratory Issues: Large bone spurs in the neck can compress the trachea, leading to sleep apnea and, rarely, severe airway obstruction.
Neurological Complications: Spinal cord compression (myelopathy) or nerve root compression can occur, resulting in numbness, tingling, or paralysis.
Reduced Mobility: Extensive bridging osteophytes often lead to severe, chronic back pain and restricted range of motion, particularly in the thoracic and cervical spine.
Voice Changes: Hoarseness or dysphonia can result from pressure on the larynx.
Treatment Complications: The fixed nature of the spine can make medical procedures difficult, including intubation for surgery or gastroscopy.

Treatment is exercise and pain relief as needed. Sometimes, people need surgery to remove a bone spur.

DISH commonly affects the upper part of the back and neck, known as the thoracic and cervical spine.
However, DISH can also affect the shoulders, elbows, hands, knees, hips, heels, and/or ankles.
Causes:
No one is quite sure what causes DISH. As with most diseases, it's probably a combination of genetic, environmental, metabolic and possibly mechanical factors.
You're more likely to get DISH if you:
• Are male.
• Are over age 50.
• Have diabetes or another condition that raises your insulin levels, such as pre-diabetes or obesity.
• Have taken the acne medication, isotretinoin (Amnesteem, Claravis and others). Isotretinoin is a synthetic derivative of vitamin A. It's not clear if natural vitamin A from food or supplements might also be a factor.
• Are a member of the Pima tribe.
• Have unusual spine anatomy.
• Repeatedly move or lift heavy objects, though this connection is controversial.

• None of these factors alone causes DISH. For example, simply taking isotretinoin won't lead to bone spurs. But it you're also a man who has diabetes and does heavy physical work, your odds of getting DISH are higher.
Key Details on DISH and Genetics:
• Genetic Factors: Research indicates that certain gene variants (such as COL6A1 or FGF2) may contribute to the bone-forming, or osteogenic, process involved in DISH.
• Family Risk: Studies have noted that familial and population clustering exists, meaning it can occur in families, hinting at a hereditary link.
• Major Contributing Factors: DISH is strongly linked to non-genetic factors, such as age (over 50), metabolic syndrome (diabetes, obesity), and high blood sugar.
The best exercises for
Diffuse Idiopathic Skeletal
Hyperostosis (DISH) focus on gentle mobility, stretching, and low-impact aerobic activity to reduce stiffness and maintain range of motion. Key exercises include walking, swimming, pelvic tilts, and gentle spinal rotations. Consistent, gentle movement helps manage pain, while strengthening the core supports the spine.
Crucial Tips
• Avoid Pain: Do not push into pain; exercises should be gentle and comfortable.
• Use Heat: Applying a heating pad on a low setting before exercises can reduce stiffness.
• Consistency: Daily, moderate activity is more effective for maintaining flexibility than sporadic, intense sessions.
• Weight Management: Maintaining a healthy weight is essential.
I had bad neck pain and loss of motion in my neck. I purchased a Seally Dreamlife Contour Memory Foam
Pillow from Bealls of Florida(Kohls too) and Life Is Good Sticker Print Travel Neck Pillow from Bealls of Florida. I use only the Seally Dreamlife pillow when I lay down. I use the travel neck pillow to give my neck support when sitting and needed. I started both Physical Therapy and Swedish massage about the same time. This was before I was referred to the orthopedic neck surgeon specialist. The physical therapy caused me greater pain. My first massage my neck did not hurt for three days. I continue having a weekly massage, physical therapy is complete. I am incorporating on gentle mobility, stretching, and low-impact aerobic activity. Mine is not impacting my nerves that go done my spine. Usually, there is no surgery for DISH, unless Bone Spurs are causing you issues. I hope sharing my experience and stuff I googled has been helpful to you. Good luck.

REPLY
1 reply
Profile picture for Lisa Lucier, Moderator
Moderator
Lisa Lucier, Moderator | @lisalucier | 2 days ago
In reply to @fl0rence "My orthopedic doctor told me more about my DISH from X-rays he took in the office,..." + (show)
Profile picture for fl0rence @fl0rence

My orthopedic doctor told me more about my DISH from X-rays he took in the office, one with my mouth open. I got more information about it by googling it.
Diffuse = spread out, not confined to a single location
Idiopathic = with a cause that is not known
Skeletal = having to do with the skeleton
Hyperostosis = too much growth of bony tissue
Diffuse idiopathic skeletal hyperostosis (DISH) is a form of non-inflammatory arthritis that involves the tendons and ligaments around the spine. Also known as Forestier's disease, this condition occurs when these tendons and ligaments become hardened, a process known as calcification. Once the tendons and ligaments harden, parts of these tissues can turn into bone. This usually occurs where the tissue connects with the bone. As a result, bone spurs develop, which is an outgrowth of bone that develop along the edges of a bone.
Key Complications of DISH
Dysphagia (Difficulty Swallowing): The most common serious complication, caused by cervical osteophytes (bone spurs) pressing on the esophagus.
Spinal Fractures: The hardened, inflexible spine is brittle. Minor injuries can lead to unstable fractures, which have high mortality rates (up to 38%) and high rates of neurological deterioration.
Respiratory Issues: Large bone spurs in the neck can compress the trachea, leading to sleep apnea and, rarely, severe airway obstruction.
Neurological Complications: Spinal cord compression (myelopathy) or nerve root compression can occur, resulting in numbness, tingling, or paralysis.
Reduced Mobility: Extensive bridging osteophytes often lead to severe, chronic back pain and restricted range of motion, particularly in the thoracic and cervical spine.
Voice Changes: Hoarseness or dysphonia can result from pressure on the larynx.
Treatment Complications: The fixed nature of the spine can make medical procedures difficult, including intubation for surgery or gastroscopy.

Treatment is exercise and pain relief as needed. Sometimes, people need surgery to remove a bone spur.

DISH commonly affects the upper part of the back and neck, known as the thoracic and cervical spine.
However, DISH can also affect the shoulders, elbows, hands, knees, hips, heels, and/or ankles.
Causes:
No one is quite sure what causes DISH. As with most diseases, it's probably a combination of genetic, environmental, metabolic and possibly mechanical factors.
You're more likely to get DISH if you:
• Are male.
• Are over age 50.
• Have diabetes or another condition that raises your insulin levels, such as pre-diabetes or obesity.
• Have taken the acne medication, isotretinoin (Amnesteem, Claravis and others). Isotretinoin is a synthetic derivative of vitamin A. It's not clear if natural vitamin A from food or supplements might also be a factor.
• Are a member of the Pima tribe.
• Have unusual spine anatomy.
• Repeatedly move or lift heavy objects, though this connection is controversial.

• None of these factors alone causes DISH. For example, simply taking isotretinoin won't lead to bone spurs. But it you're also a man who has diabetes and does heavy physical work, your odds of getting DISH are higher.
Key Details on DISH and Genetics:
• Genetic Factors: Research indicates that certain gene variants (such as COL6A1 or FGF2) may contribute to the bone-forming, or osteogenic, process involved in DISH.
• Family Risk: Studies have noted that familial and population clustering exists, meaning it can occur in families, hinting at a hereditary link.
• Major Contributing Factors: DISH is strongly linked to non-genetic factors, such as age (over 50), metabolic syndrome (diabetes, obesity), and high blood sugar.
The best exercises for
Diffuse Idiopathic Skeletal
Hyperostosis (DISH) focus on gentle mobility, stretching, and low-impact aerobic activity to reduce stiffness and maintain range of motion. Key exercises include walking, swimming, pelvic tilts, and gentle spinal rotations. Consistent, gentle movement helps manage pain, while strengthening the core supports the spine.
Crucial Tips
• Avoid Pain: Do not push into pain; exercises should be gentle and comfortable.
• Use Heat: Applying a heating pad on a low setting before exercises can reduce stiffness.
• Consistency: Daily, moderate activity is more effective for maintaining flexibility than sporadic, intense sessions.
• Weight Management: Maintaining a healthy weight is essential.
I had bad neck pain and loss of motion in my neck. I purchased a Seally Dreamlife Contour Memory Foam
Pillow from Bealls of Florida(Kohls too) and Life Is Good Sticker Print Travel Neck Pillow from Bealls of Florida. I use only the Seally Dreamlife pillow when I lay down. I use the travel neck pillow to give my neck support when sitting and needed. I started both Physical Therapy and Swedish massage about the same time. This was before I was referred to the orthopedic neck surgeon specialist. The physical therapy caused me greater pain. My first massage my neck did not hurt for three days. I continue having a weekly massage, physical therapy is complete. I am incorporating on gentle mobility, stretching, and low-impact aerobic activity. Mine is not impacting my nerves that go done my spine. Usually, there is no surgery for DISH, unless Bone Spurs are causing you issues. I hope sharing my experience and stuff I googled has been helpful to you. Good luck.

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Hi, @fl0rence - thanks for the information and for what has helped you in your personal experience.

When you searched and got this information, was it from Gemini (AI, which appears at the top of the page in your search results), or from a certain website that appeared in your search results?

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