Hi JD, welcome to the forum! I'm sorry that you're suffering from such relentless TOS pain - I hope you'll find answers, help, and comfort here.

Guess what - I live in Austin, too. I have bilateral neurogenic TOS (without the cervical ribs) developed from repetitive stress of computer/engineering work, and have been to what seems like every doc and PT in Austin over the past 4-5 years searching for relief. (Though amazingly never saw Dr. Stewart, the vascular doc you saw yesterday - how did that go, was it helpful?) Not having cervical ribs, and having mostly neurological involvement with no vascular symptoms, the vascular doc I saw years ago couldn't help me but you may hopefully have better luck. What symptoms do you have? Sounds only one side is affected right now?

I tried just about everything for the first two years - doctor after doctor, chiropractor, three different types of physical therapy, Feldenkrais - for me, nothing helped. I ended up flying to Denver to see Dr. Sanders and eventually had surgery on both sides with him. The surgery help the numbness but not the pain. Post surgery it's been a continual journey searching for pain relief or any thing that will help - I think I've tried as many docs and treatments after surgery as before! I did find a neurologist I liked and saw for over a year - he at least believed in TOS and was helpful in trying different medications that might work. However, I recently realized I needed better pain control then my neuro could offer, and I started seeing a Pain Management Doc instead. So far I'm really happy with him - Dr. Wesley Foreman at the Pain Evaluation and Treatment Center at 360 and Lakewood.

The only other thing that helps me personally is trigger point massage. I just found a new massage therapist at Massage Envy I think I like - he's TOS aware and has a clinical background. Unfortunately insurance doesn't cover massage so the cost can add up, but for me it's worth it. As for chiropractors, I tried one a long time ago and it didn't help me but others swear by them. As Jo says, your extra ribs may complicate things so not sure if it's a good idea for you are not, but two chiropractors have come highly recommended to me (I've never seen either of them, though) - let me know if you'd like their names as an option.

Ditto Jo's excellent responses to your other questions, especially the part about avoiding activities that trigger your pain. That's the hardest one! For me, that meant giving up my career and severely limiting many my favorite hobbies. I think many of us TOSers consider teaching as a potential career; however, I think even teaching could have many aspects that are not TOS-friendly. For instance, if it requires a moderate amount of writing, paperwork, using computer to prepare materials, even driving to class - these would be just too much for many of us, especially on the repetitive basis. But that's not to say it's impossible - in fact I myself hope to teach some sort of wine classes part time! I think the key is to be honest about your symptoms and limitations and the requirements of any alternate career. Then again you have an advantage - if you should ever choose to go the surgery route, the success rate for patients with cervical ribs is way higher than for others like me - so, there is the chance that you may someday find relief and all of this will be irrelevant to you!

Please let me know how you are doing and if you have any other questions, especially about care in Austin - I'd be overjoyed if I could help in any way. Hope this rain is not making your pain worse!

Take care,
Nolina