So Gelabert keeps track separately of his neurogenic surgical TOS cases from his vascular surgical TOS cases (venous and arterial); am I understanding you correctly, Michael? Because he does plenty of both kinds of cases, and in a lot of cases - especially re ops I would imagine - his cases have become neurovascular (if they weren't before); that is certainly true in my case.

One of the biggest reasons people end up needing a re op is that the body has built up scar matter, and likely rather than simply atrophying up the cervical spine as is hoped, one (or both) of the resectioned scalene muscles has reattached itself via scar tissue to other soft structures within the outlet, such as the neurovascular bundle, the phrenic nerve, the LTN or the pleura....and this is what may be causing the recurrent TOS symptoms. If you're blessed with a body that tends to form a lot of scar tissue, that's what you may be looking at (join the club), some people get off light....some of us, not so much.

So a re op consists of not only a complete scalenectomy, but removal of all that scar matter....which can involve lysis of the blood vessels as well as neurolysis of the nerves involved. Dr. Gelabert does not like to 'scrape' too closely, either during the initial rib removal/partial scalenectomy or any subsequent re op, in order to avoid the risk of damaging these vital structures. Because Dr. Gelabert orders scalene blocks performed with ultrasound plus EMG, both visual and aural guidance might help to determine what soft structures are being compromised in your case....for that matter, someone like Gelabert can also read a great deal just from your symptoms themselves. But as a scientist he'll want the diagnostics if you ever do decide to explore things further.


If you decide to explore a TOS re op at some point, Michael, it's naturally a good idea to get as many second opinions as you need to feel comfortable with whatever decision you reach. Dr. Donahue at MGH in Boston, Dr. Pearl at Baylor in Dallas, Dr. Thompson at Washington U in St. Louis, etc. are all nationally recognized, very experienced TOS surgeons who've performed hundreds of re ops. And of naturally, Dr. Sam Ahn in Westwood right down the street from Gelabert would be a good source for a second opinion, as well (he and Gelabert are likely to echo one another, of course <only Ahn will order an angioplasty instead of a scalene block....which could give you some new info>).

Re ops are challenging....the only surgical approach that makes sense is supraclavicular. If scar matter is indeed the culprit, the surgical field can become very cloudy; it can also cause the nerves (for example) to drift towards the spine, so that things aren't anatomically where you would normally expect them to be located. Why you need a top doc to perform the re op if you do decide to go forward at some point. You can also ask for the contact info for a couple of surgical patients who've been through the same procedure, so that they can share their experience with you, Michael. As long as the patients are willing, there's no HIPPA violation in the TOS surgeon facilitating that for you. S/he's not bloody likely to give you anything but favorable outcomes, mind you, but still....could give you a different perspective on things and some valuable info.

In the meantime, please tell me you're not still lifting weights....or at least, that you've backed way off from what you were lifting before. I know it sucks. But unfortunately and as I'm sure Dr. Gelabert told you, weightlifting can contribute to if not cause the aggravation of your symptoms.

Wishing you the best.