No problem re: the rant. We all need to let off a little steam every now and then.

Keep in mind that after the scalenectomy, conservative approaches like chiro and PT might work better than before due to various reasons like more space, less muscle tension (the muscle is gone, hehe) and I would think that pushing/adjusting the first rib down would be easier. So if you still have symptoms after the surgery, I would restart the conservative approach first before getting the big rib operation.

Just my two cents. Hmm, what's that in the UK? Pence?