Originally Posted by xanthippe

Hi everyone. I've had TOS since halfway through laws cool, and am about to finally start working full time as an attorney in a demanding environment (probably 100-hour weeks of nonstop computer usage, which I'm mentally very excited for but will physically destroy me within the first week).

I've been in physical therapy and also see an acupressurist and chiropractor several times a week. However, the time I have to invest in these things to maintain any sort of basic functionality is certain to create a conflict with my work obligations, as it already exhausts me to keep up with it given my ordinary levels of pain and fatigue. I barely graduated from law school and am struggling to manage basic things like laundry and housekeeping, and not being able to pursue any sort of social life has been an additional difficulty (loneliness, depression, no support network etc.). I'm not sure how much longer I can continue fighting just to keep my head above the water, and although I'm extremely capable in every way other than physically, I'm very reasonably concerned I won't last more than a few months and will be devastated if my career is over before it even starts because I can't do something as simple as sit in a chair clicking a mouse for a few hours.

Here is what I've tried so far, medically:

1) inconclusive nerve conduction and electromyography tests from a neurologist who ended up saying he couldn't find anything concrete to treat me for despite major long-term symptoms on both sides - a couple fingers on either hand are numb or have burning/tingling/itching nerve sensations with the slightest movement at any given time, and often get "stuck" for months on end (e.g. my right thumb and left index finger have both been about 75% numb for most of 2013 so far)

2) diagnosed with neurogenic TOS by an ortho-muscular specialist and a separate sports-medicine surgeon; vascular TOS specialist at NYU disagreed, but X-rays show disc issues in my cervical spine that seem to corroborate the neurogenic diagnosis

3) several inconclusive MRIs and CT-scans

4) escalating pain management with:

- NSAIDs (oral every day for the past 2 years, and intravenous on several occasions where pain has gotten so bad I've gone to the ER) - aleve or meloxicam daily in the morning, and I switch to ketorolac/cataflam/voltaren on days when pain is worse or I feel like I need a second dose in the evening

- daily muscle relaxers (tizanidine, flexeril, and now klonopin; xanax seems to help, too)

- oral prednisone occasionally (short 5-day intensive courses seem to buy me a little time when things are getting out of control and lying in bed motionless covered in ice packs for 2 weeks isn't an option)

- epidural injections of cortisol on both sides of my cervical spine - haven't really noticed any significant long-term pain relief on either of 2 occasions

- Botox injections into my scalenes and armpits - felt great for 2 weeks and was desperately hoping it would last for 6 months as my doctor told me to expect, but I'm now barely 2 months out and already feel just the same as before

- constant ice packs, kinesiotape on both forearms, and as many hardcore massages/PT sessions as I can manage physically and financially

- pretty much every ergonomic gadget on the market (Kinesis keyboard, vertical mouse, etc.)

- tried and rejected a few other medications like Neurontin (made me stupid!), tricyclic antidepressants with off-label chronic pain uses (worked for a while for blanket pain reduction, which didn't last, and eventually the side effects - increased lethargy, weight gain, lack of motivation - made me decide they were no longer worth it) and weaker muscle relaxers (seem to be mostly placebo effect)

What next? My neurologist has dropped me, and my other doctors keep saying "let's keep up with what we're doing now, you seem fine" but I am desperate for some actual improvement, and feel like despite their good intentions, they don't fully appreciate how bad the status quo has been for me. I also simply can't get away with the status quo once I have to start showing up for work every day and billing hours for clients - I learned how to get away with the bare minimum in school by spending all but a few hours a day in bed/on the floor stretching and icing myself, only washing my hair once a week, leaving the house only for treatment/tear-and-bruise inducing "massages," etc. but this just won't be acceptable back in the real world.

I am willng to try absolutely anything but hope to avoid surgery, and there are no extra cervical ribs or other clear targets for surgery in any case. I just want to be able to work and take care of myself again, at any cost. Apologies for the long venting and thanks very much for any constructive advice. I am in NYC, if that's relevant.