sorry about the panic attack, have you been talking to my kid? []

i'm on the left coast so i can't really help you out with local referrals. wish i could. that's why i suggest you PM finz or dolfinz, or go to one of the support meetings at that RSI group on the harvard campus - you'll get lots of ideas that way, i'm sure.

my best suggestion would be to find a PM doc with a background in neurology to run the show (order diagnostic tests, refer you to surgeons and other specialists, prescribe meds, etc.) definitely look for one who knows TOS and other peripheral nerve entrapment and injury disorders. specializes in that area. that, my friend, would be golden! and i think your internist's idea about an SSRI is not a bad one; actually you may be interested to know that PM docs have found that some of the meds in this class are helpful in treating chronic pain and are prescribed off-label for that purpose and not just, per se, for depression as such. my PM doc actually gives me Namenda (which targets the NMDA receptors in the brain), which is an alzheimer's med. he was hoping it would help the nerve pain... but i find it actually addresses my depression much better than any SSRI i have ever been given (unfortunately, it didn't do squat for my nerve pain and i still take topomax for that - but everybody reacts differently to each med and you just have to keep trying various ones until you find the right chemical soup).

i know dr. kline is in LA; he's a good old boy! renowned the world over - he's the guy who saved al gore's kid. dr. charles brantigan, one of the 3 top TOS surgeons operating out of denver, CO, studied under dr. kline. i believe he can be reached at: 504.568.6120 / 504.568.6127 (fax) / dkline@lsuhsc.edu. hopefully, that contact information is current. there are several mailing addresses for him and if you punch his name in the search bar on this forum a bunch of stuff will pop up. and we actually had one of his patients on here not too far back; perhaps you could PM her if all else fails...

question for you: what kind of a surgeon is it that you are consulting with at NEBH? because with all due respect, if it is another orthopedist, i would not really pursue this avenue any further right now. you don't appear to have an orthopedic problem, so you need either a neurosurgeon or a vascular surgeon. top docs. take it from someone who wasted decades getting misdiagnosed by orthopedic surgeons when what they really had was a severe neurovascular entrapment disorder (i have a rare form of TOS)... these guys, for all their knowledge and experience, can unwittingly lead you down the garden path. the bald-faced arrogance can get in the way - shall we say, BIGTIME!%$!%$%!#%!#! not to mention the ignorance and controversy in the medical profession about this area of the human anatomy. it is truly frightening.

this is very tricky stuff. what feels to the patient like muscle pain is really nerve pain. and vice versa. and don't forget the vascular components - they are in there, too, and can be deadly serious. (breathe, man, breathe!) i'm not trying to scare ya and i'm only here to help. trying to cut through the BS and save you a whole lot of heartache. i made myself a promise a long time ago, that if i can help anybody else to avoid going through what i had to go through to get to some real answers and the right tx, then i would do it. so that's what i'm about.

the EMG, and i assume they will run an NCV along with it, that you're going to have on friday, could reveal some information about what is going on, but only if the right TECHNOLOGY is being used. and it also depends on the person running the test and reading the results. dr. scott fried's site will give you a lot of info about evoked potential, SSEP, etc.: www.nervepain.com; he is down in PA (a very good TOS doc, by the way - well worth the trip if you can swing it). dimarie knows a lot about this subject and posts frequently about it. you could post to her or shoot her a PM; she is very responsive and has a heart as big as the world.

a plain old MRI of the BP won't show much, unless you have pancoast's tumor, i'm afraid, or something like that. my understanding, anyway, is that a more useful test would be a 3-D MRI/MRA of the BP, but again, you would need that to be done and read by someone who knows what the heck they are doing. i'm at a disadvantage here because i don't know the boston area. see www.tosmri.com, it will show you what i'm referring to here i think.

physiatrists are good to have on your tx team (and it does take a team, with an injury like this), provided they know their stuff. but what would be GREAT would be if you could hook up with a TOS-savvy PT to start going to 2 - 3x a week. if what you are dealing with really is only nerve entrapment (which we hope it is! maybe your muscles are just clamping down to protect irritated or compressed nerves in the middle trunk and you won't have to have a BP release after all - that would be AWESOME!!!), then a PT - maybe in conjunction with an excellent bodyworker (feldenkrais, alexander, muscle activation technique practitioner - hellerworker, bowenworker - there are lots of similar postural programs out there...) might be able to design and develop the right program for you to calm those sx down and get you back on the road to recovery without an invasive procedure like surgery.

another pretty standard test to see if you are a good candidate for a BP release surgery or not would be a scalene block. or perhaps in your case a pec minor block would be indicated (for a different type of surgery involving that neuromuscular group); i really cannot say. but those are definitely ones i would let the surgeon order up for you at the facility of his or her choice (some surgeons prefer to do the procedures themselves).

trigger point injections, botox injections, stuff like that are other options you could certainly discuss with your PM doc before making a big decision like surgery. your body wants to heal. that is the good news. so anything you can do to give it the right signals and to put it back on the proper path, would be grand. just grand. we'll have you back on the water in no time. either that, or we're all wet.

but this is all going to hinge on what those diagnostic tests say and what the surgical consult reveals. because if some of the nerve roots HAVE been pulled out and are in need of surgical repair, or some other obstruction is there which cries out for surgical remedy, well, then... you'll deal with that with the very best woman or man for the job that you can find. i know you will. and in that case, it would be surgery, then recovery, then rehab, PT/bodywork, etc., etc. and we will be right here for ya through all of it.

miles to go before you sleep!

sorry i'm so long-winded. it's a character defect. just read every other word. or ignore me entirely! lotz of people do; just ask my daughter, she'll be HAPPY to explain it to ya...

hahaha

alison
"Be Brave"