On Tuesday I finally managed to meet Dr Ahn in person. I was supposed to have the left scalene block that Dr Reil was absolutely convinced I needed. Not being in the mood for more needles, I showed up with my report of the left scalene block from Dr Sanders and hoped I could use it as my "get out of being poked" free card.

I was going to skip the appt altogether, seeing as how I had plans to go have surgery with Dr Sanders, BUT on monday afternoon (sorry for the break in time sequence here) Dr Brantigan had called with my completely normal CT results and we had talked about doing the rib removal and scalenectomy at the same time. It hadn't occurred to me until monday nght that perhaps I could run that option by Dr Ahn and see what he had to say. I should probably also point out here that I have always been pretty certain I am having a rib resection on the right side and have pretty much always intended to have that at home with Dr Ahn...it was the left side that confused me with the weird extra symptoms.

When I told Dr Ahn I was hoping to talk him out of the scalene block, he gave me a pretty good explanation of why his block was different than other docs blocks (see above in one of my earlier posts, his procedure is the same as Dr. Jordan's). I think he and Dr Jordan have given this a LOT of thought. I think that, done their way, the block is a very accurate diagnostic tool. However, given that I had had an excellent (if short term) response to Botox, and all these other diagnostic tests in the past few weeks, i didn't really need it, and he was happy to pass. So we were off to a good start...

Next, I continued on with him explaining how I had read Dr Brantigans paper and with my funny symptoms on the left i was wondering if he would consider doing the scalenectomy at the same time as the rib resection. I made it clear to him that I had done a fair bit of research but that i was asking his opinion of my conclusions (which were that I should have both procedures done).

His answer, I thought, was very impressive. Not only did he complement me for very thorough research, he explained to me how he used to follow exactly the same thought process. He gave me statistics for various combinations of procedures- 45-55% of those who got scalenectomies first came back for rib resection. 25% of those with rib resection first came back for scalenectomy second, and for 10 years he followed the same train of thought that I was using (and Dr Brantigan suggested) only to find that no matter what, he could not really predict which symptoms suggested the need for the extra scalenectomy.

He also drew me a great big picture right on the exam table paper and we had a chat about geometry. Drew it up and we looked at the pictures- if you do a scalenectomy alone, you relieve one side of a 3 sided triangle. If you remove the rib, you relieve 2 sides of a three sided triangle. For that reason, the rib resection is alomost always going to relieve more compression.


still more to tell....but I have to stop and get the little kids, but maybe I'll finish this up tonight yet.