I'm a 39 year old male. I gave my self Paget-Schroetter Syndrome from weight lifting. Last summer (6/26/2014) I threw a clot down my subclavian vein. After months of testing, research, and waiting, I found specialists who could diagnosis the problem.

I had a first rib resection last week (5/5/2015) with Dr. Donahue. It went very well, far, far better than I expected. I went off prescription pain meds in less than a week (5/11/2015) and stopped taking Tylenol yesterday (5/13/2015). I am virtually pain free and have full range of motion. I'm now waiting for a venogram and angioplasty.

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Here's a timeline with some resources that I found helpful.

Spring 2014
I increased the frequency of overhead movements. I started doing overhead presses twice a week. I was also doing pull ups, chin ups, downward dog, handstands, and supermans frequently.

6/26/14
My right arm started swelling mid day. It felt like I had just done some high rep curls. It turned a little purple, so I went to an urgent care clinic. I thought it might be a bee sting, though I've never been allergic to bees. I guess I put the bee sting idea into the doctor's head. She gave me Prednisone. This certainly didn't help.

6/27/14
In the morning the swelling had gone down, so I went for a run. At 3 miles my arm was huge. The 3 miles home were very uncomfortable. The swelling got worse. I went back to the urgent care clinic mid afternoon. They immediately referred me to the ER. They said that I had compartment syndrome and might loose the arm!

At the ER they didn't know what to make of things. At first they thought I had a biceps tendon tear. I thought it might be due to an injury I incurred that week doing dips. . . .

Eventually they did an ultrasound and found the clot. They put me on blood thinners and told me to see my PCP. The resident said that this was the kind of thing they see in volleyball players, but he didn't seem to know about Paget-Schroetter.

(I know now that they should have performed Thrombolysis and done a venogram. Thrombolysis is the current recommend standard of care for cases like this, **

6/28/14
I saw my PCP. He emphatically said that this couldn't be due to an injury and that I would have to stay on blood thinners for the rest of my life if it happened again. He referred me to a hematologist for further testing. (I fired this PCP as soon as I could get another.)

7/?/2014
I started doing some research. I thought that this had to be related to weight lifting in some way. I found a helpful thread** A doctor participating on the forum mentioned decompression surgery in the thread. That got me looking into things.

Initially, the most helpful article I found was "Upper-Extremity Deep Vein Thrombosis" by Goldhaber: **

7/10/2014
I saw the hematologist. She ran a battery of tests and detected a lump in my testicle. I brought the Goldhaber article and some other stuff. She listened and ordered a vanilla chest and neck CT scan to see if there were any obvious problems.

7/?/2014
I had an ultrasound to see if the lump was a tumor. It turned out to just be a cyst.

The ultrasound revealed nothing unusual. Since it was arms down, this isn't surprising. The radiologist didn't think that they could see compression with the clot in place. (It turns out that he was wrong.)

7/?/2014
I saw an orthopedic surgeon. I thought he'd know something about Thoracic Outlet Syndrome. I even brought the blog post and the Goldhaber article just in case. The orthopedist dismissed the idea since I was pain free. I guess he didn't know that there are vascular forms of TOS. Good grief.

7/?/2014
After having read through a bunch of the literature, I saw that the effectiveness of thrombolysis diminishes greatly after two weeks and that the long term outcomes for conservative therapy (anti-coagulation and elevation) were bad, I made a hasty appointment with an interventional radiologist.

The IR thought that I had Paget-Schroetter. He did the Adson test and a few others. My pulse is obliterated when my arms are raised.

He recommended against thrombolysis though. He said that it was too risky and that everyone he knows has seen things go very wrong during the procedure. (At this point, I really don't know what to make of this.) I think he was excessively conservative, though nice. He didn't even think that I should be running until I was off the Warfarin. ???

He recommended that I simply wait and see if I would have another clot.

At this point, I knew that I would need to find a specialist. So I tried to make an appointment with someone in Goldhaber's group. I made an appointment about a month out to see Dr. Piazza at B&W.

8/1/2014
I finally got in to see Dr. Piazza. He ran a huge battery of tests an ordered an MRI with my arms in a provocative position. Finally!

The MRI took about 45 minutes. My hands went numb. They did imagining with my arms up and down.

Piazza called me on Saturday with the results: Thoracic Outlet Syndrome on both side. He immediately referred me to Dr. Donahue at MGH for decompression surgery. Piazza said that he had seen excellent results in his referred patients.

8/3/2014
I started working out again, avoiding any overhead movements.

11/5ish/2014
I had a CT scan in preparation for my appointment with Dr. Donahue.

11/17/2014
I finally got in to see DR. Donahue. I was worried about the delay at first, but I'm so happy I waited. He went over the options and recommended a first rib resection to avoid damaging the vein further and to head off possible nerve damage. He was booked until late February, but that wouldn't fit my schedule. So I had to wait until May.

11/17/2014 - 5/5/2015
This was a long wait. I became obsessed with the surgery. Some of the horror stories on this forum scared me more than anything. That's the main reason I'm posting now.

To prepare, I tried to gain weight and increase my strength. I went from a body weight of 191 lbs. in July after the clot to 220 by March. At the time of surgery I weighed 217. I was stronger than I've been in my entire life. As part of my routine, I did a ton of inverted rows, 3 times every two weeks. Otherwise, I did a Starting Strength linear progression.

5/5/2015
I had a first-rib resection at MGH. It went great. Dr Donahue's team is fantastic. They even called my wife mid surgery to let her know that things were going well. MGH was excellent and the Thoracic unit is great.

The surgery took about 3 hours. I was out of recovery in less than two hours. I woke up pain free. They gave me toradol, an excellent anti-inflammatory that lasts for about 6 hours. It tastes like nail polish remover when you breath it out.

I was hooked up to a morphine drip that I could control with a button. It did nothing but make me nauseous. So I stopped pressing the button. The next day, I started on a low dose of Oxycodone and Tylenol. I only took 5mgs of Oxycodone every three hours.

The pain on the second and third days was worse, but mild. I've had far worse pain from post exercise muscle soreness.

5/7/2015
On Thursday, the drain had stopped filling and I was discharged from the hospital with a prescription for Oxycodone and a set of simple exercise to perform three times a day.

5/11/2015
I stopped taking the Oxycode.

5/13/2015
I stopped taking Tylenol regularly.

I'm now waiting to schedule a venogram and angioplasty.

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I wish I could have found Dr. Donahue sooner. If I had known who to talk to, I would have been able to get in earlier and have had the surgery during the winter break.

In any case, I'm very happy with the results so far. We'll see what the venogram shows in a few weeks. They expect the vein to be very damaged.

I'll chalk my speedy recovery up to the skill of Dr. Donahue and his team. I'm not sure how much my strength training contributed.

It's been a week and two days and I'm now down from 217 to 209. I expect to drop another 10 pounds in muscle, as I can't workout for some time. . . .