The second day of my 2 day trip to Denver was to see Dr. Sanders.

I was hurting by the time I got there. I usually try to show up less medicated for Dr appts so my symtoms are not masked by the pain meds. But I was pretty flared up from being maneuvered and poked the day before. r Sanders was late gettign out of surgery, so late to our appt, but Cathy was supre nice and let me know so I could get out of those waiting room chairs and walk around. Eventually I came back and threw my self on the floor of the exam room to stretch bc I couldn't take it. The were really very nice about it.

My first impression of Dr Sanders was that he had very bad posture...looked like TOS waiting to happen. Totally hunched over...like a little old lady (except that he is actually quite tall). And, I couldn't tell if it was on purpose or a result of the OR gear, but he also had a little faux hawk thing going on with his hair

Dr Sanders also took a comprehensive history from me. I don't think he had time to read my records because he had been late coming from surgery, but I was able to point things out as I talked through my history of treatment.

HE went thorugh a series of maneuvers, and explained how he and Dr Brantigan had different approaches to TOS...Sanders is more of a soft sturctures guy and Brantigan was a bony structures guy. Dr Sanders showed me pictures of the muscle fibers of TOS sufferers vs non tos sufferers and how there was significantly more scar and connective tissue in TOS sufferers than normal folks.

I have to say Dr Sanders seems to be one of those intuitive hands on type of people. he did a scalene block right in his office. He just made me look forward, picked his landmarks and stuck the medecine in there. Now I had someone ask me if it wasn't dangerous to do a block that way, and, I *think* the answer is no, it isn't dangerous, so much as possibly inaccurate. Generally doctors now use some type of guidance (emg, fluoroscopic, whatever) to ensure that the block gets to the right place. As I just mentioned, I think Dr Sanders is the kind of doc who is very good without the guidance...

In any case, the block was remarkably successful in my mind, I felt things go away that i didn't know were even in my arm (2 numb spots) and the pain in my rhomboid went away almost completely.

so, like dr brantigan, he wasn't terribly impressed with my clinical exam, but since i was "significantly debilitated" said he would probably be willng to operate but wanted to see the results of my MAC (medial anti brachial cutaneous) nerve conduction study.

That MAC study was really really awful. needles in the back of the neck, jolts thatcould be felt all the way to my toes, and the monologue of the doctor who kept saying things like "are you sure this has only been going on for a year?" adn "I know this test isn't fun, but if you are enjoying it I have a great psychiatrist for you to see..."

Dr Sanders told me that generally they find from 1-4 abnormal things in that test if you do, in fact, have TOS. I got the detailed report of the test and I know one thing was very abnormal but I am not sure how many of the 4 i got. It was worse on the right than left, but abnormal on both sides.

After having two doctors tell me they weren't sure if I really had TOS (which was the one thing i WAS sure of when I went to denver) it was reassuring to have sustained this torture but to at least have a test that said definitively "yes" you have TOS, and quanitify how bad.

SO, I discussed in detail with Dr Sanders what operation he would want to do. He said my pec minor as OK and he didn't need to touch it (this made me happy as I didn't want it cut, and confirmed that he was picking surgeries based on ME not HIM) HE talked about how he does a very complete scalenectomy, removing all the anterior and most of the medial scalene, wraps the nerves in his favorite medical saran wrap (don't remember the name) and that IF the nerve was restng on the rib he would take the rib during the operation. He does everything supraclavicularly.

we had a long discussion about scar tissue and about why he likes to do scalenectomy alone and how he thinks failures are more common when you take ribs and scalenes at the same time. He stated that he thought it was related to bleeding after the operation. HE says he can control the bleeding very well on scalene muscles alone, but not so much on the rib removal because he needs to cut so many deeper muscles. That's why he thinks there are slightly more failures for him when you do both at the same time.

It wasn't till I was on the plane home that I read the part (mentioned above) in Dr Brantigan's paper about upper plexus symptoms and how scalenectomy was required for those. Once I read it I was pretty convinced that I would have a scalenectomy with Dr Sanders because it would be the right procedure for me.

I was so convinced that I set a date, bought plane tix, and made hotel reservations.