Terri Gardner

Terri Gardner grew up adoring animals and bringing home every creature great and small. But her true love was horses.

"It's the freedom. It's being one with your horse," Gardner says. "It's something inside that you just connect with, and it's part of you."

But her passion for riding and breaking horses cost her dearly. After many riding accidents and 15 subsequent surgeries, Gardner developed urinary and fecal incontinence. For a while, she couldn't even leave her beloved Ozark Mountain home, let alone ride a horse through the Missouri countryside. Gardner suffered silently for a year, telling no one, not even her closest friends or family.

Incontinence was holding her back during a busy time in her life. Gardner was caring for her best friend, who was dying from a brain tumor. She thought she'd take care of herself as soon as her friend no longer needed her. Gardner found ways to cope and became an expert at using products to stay dry and clean. When she finally saw a doctor, one test showed Gardner had no feeling in her pelvis. Her gynecologist was alarmed.

"I knew I was leaking, but I didn't realize how numb I was becoming," she says. "It was worse than I even imagined."

Her doctor told her the problem was out of his league. For almost a year, she went to specialist after specialist.

Between medical appointments, Gardner became housebound. Any activity that involved movement caused more leaking, so she stayed home.

"I was getting depressed going through this type of shame and feeling dirty," she says. "It was hard. I couldn't go anywhere or do anything."

After a visit to yet another doctor, she met a close friend and poured her heart out. Bolstered by her friend's prayers and encouragement, Gardner resolved to find someone, somewhere, who could do something for her. After the drive home, she went straight to her computer and looked up Mayo Clinic on the Internet.

"All I could think of was that Mayo could help me," Gardner recalls. "I was in a real predicament, and I'd seen all the doctors in our state, and I had urinary and fecal incontinence, and it was all I could do to say it, and I actually didn't tell my husband or my best friend until after I'd gone to all these doctors, and I didn't know what kind of doctor I needed to see, but I needed help."

The Mayo Clinic employee she spoke with told Gardner there was a physician at the Jacksonville clinic who was performing an incontinence procedure that had great results. She called immediately and was given an appointment that week, thanks to a cancellation.

She and her husband, Tim, bought one-way tickets to Florida. When she arrived at Mayo Clinic, Gardner said, she felt a huge weight lift from her shoulders. She sensed hope for the first time in a year.

"For the first time, everyone knew the questions to ask me," she says. "They knew what they were talking about, and I started feeling more comfortable with it, like I wasn't an alien. Everywhere else it was, 'You're hopeless.'"

A number of tests determined that Gardner was a candidate for a procedure to control urinary urge incontinence and urgency and frequency symptoms. The procedure uses a device called InterStim, which works by electrically stimulating the sacral nerve. The nerve, in the lower back just above the tailbone, governs reflexes that control bladder and sphincter muscles.

Mayo Clinic urogynecologist Dr. Paul Pettit, who specializes in incontinence and pelvic reconstructive surgery, says it's common for urinary and fecal incontinence to occur together since both involve damage to the same nerves and muscles. The Food and Drug Administration approved InterStim therapy in 1997 for treating urinary urge incontinence. Pettit is involved in U.S. clinical trials for its use in treating fecal incontinence.

The InterStim device is permanently implanted below the hip.

"With both you try conservative measures with physical therapy and medications," Pettit says. "But when these didn't work for patients, there really wasn't a good option short of a colostomy or taking the bladder out. Now we're able to do a minimally invasive surgery under local anesthesia and sedation and give patients back their quality of life."

In August 2004, Pettit performed the InterStim procedure on Gardner. The procedure involved surgically placing a thin lead wire with a small electrode tip near the correct sacral nerve. The lead is passed under the skin to a stimulator device, about the size of a stopwatch, which is permanently implanted in a pocket of fatty tissue below the hip. (In Gardner's case, a lead and stimulator on both sides of her spine were required to give her the best symptom control.) The stimulator is programmed for maximum benefit by the physician over a few post-operative visits.

The patient can also adjust stimulation within predetermined parameters by using a hand-held device. "I tell patients this cannot make their symptoms worse," says Pettit. "This has nothing to do with the spine. This is placed in the nerves below the spinal cord."

Gardner was surprised how well the surgery went. "It was an easy surgery for me. I was out the same day, and I was immediately free from symptoms."

Indeed, she was riding again by Christmas. But with renewed sensation in her pelvis, Gardner again became aware of low back pain.

"I've always had some back pain and understand I'll live with a certain amount of it," she says. "But it seems like after my InterStim when everything else came alive, I started feeling the pain more intensely."

So she came back to Jacksonville, where she sought the expertise of Mayo neurosurgeon Dr. Gordon Deen.

"Her previous surgeries made her case more complicated," he says. "One of the strengths of Mayo is that we work as a team, and it certainly worked out to the best in this case. She had a difficult situation with confounding variables in other medical issues. We were able to kind of unravel that in a multidisciplinary way to get an effective treatment for her."

The treatment she received was IntraDiscal ElectroThermal Therapy, or IDET, an outpatient procedure done as an alternative to spinal fusion. Deen, along with interventional radiologists Drs. Leo Czervionke and Douglas Fenton, performed the procedure to relieve lower back pain caused by degenerative disc disease.

Gardner's physicians inserted an X-ray-guided needle through her back and into a damaged disc. Then they threaded a special catheter through the needle into the disc, heating the catheter to destroy nerve fibers that had grown into the outer portion of the disc. The process also changed the outer structure by thickening it, essentially closing the tiny fissures. They repeated the process on a second damaged disc. A few days after the procedure, Gardner went home, looking forward to a summer visit from her granddaughter, who shares her passion for horses.

On Aug. 6, Gardner got back in the saddle. She no longer needed a cane to lean on and she felt good. A few short, easy rides on her horse was just what she needed.

"I couldn't stop smiling," she says. "It felt like one of the happiest times of my life."

But exhilaration aside, she won't be galloping down any trails just yet.

"I'm not taking any chances; I'm going slow and easy, " says Gardner. "I love my life and I want it back."

(This story first appeared in the September 2005 issue of The Mayo Clinic Checkup, a complimentary newsletter available to anyone interested in the latest news from Mayo Clinic in Jacksonville, Fla.)