OK, as promised...
I saw Dr. Weaver this AM.
I am on the computer without Dragon today, so I'll work at this slowly and see if I can't get it all out.
As many of you know I am a bit of a different case than Allison. I have had syptoms for about a year, a very timely diagnosis, good PT, well at least since Dec, However, Allison and I do have the esteemed Dr. Jordan in common, so our surgical referrals were from the same source...she just beat me to the first available appt
I was up front with Weaver about that fact that I was visiting several surgeons, and that I was conflicted about the fact that Ahn and Filler do it "their" way and no other way, and that I was looking for an opbjective opinion about which was right for me. (side note: yes, Filler will send people for rib resection with compelling MRN results, but it doesn't make good business sense for him to always do that....so I don't think his opinion is completely objective)
I am giving you my impressions from the best of my recollection...and it was only this AM, but my brain is wacky and my fingers are wackier...so please forgive anythign that later turns out to be glaringly wrong and know that I am not intentionally saying anything other than what it was, or trying to make anyoen look good or bad, just my layperson impressions.
1. I liked him...nice guy very conservative, as Allison mentioned.
2. No TOS welcome mat...I found his history questionaire to be totally useless for describing my symptoms, (for instance, under nerve symptoms, no box for numbness and tingling?, no body maps to describer pain or anythign else) so I added some of my own as I went along...
3. Had a really really hard time getting my story out in a way that made sense to him or his NP. she sort of asked me questions and made me start at the very beginning and we never really go to the important stuff..then at the end when she got to the box where I listed medications she was like, oh, this is something you take pain meds for? (duh?) Needed an extra hour for that I guess
3. He is
definitelycirculation centric. He was very unimpressed with an inability to make my pulse go away (thanks to SuperJoyce and RobertTheWonderWorker for that, I guess
) * and then said that if I didn't have vascular compression he had a hard time beliving there was significant nerve compression unless he saw wasting of the muscle or some other extreme sounding symptom. I didn't get exactly what he thought about numbess and tingling...?
4. Surgical approach:
well...for clarity I'll point out that
Filler does not take the rib (sends you to Ahn or someone else for that) cuts a portion of the middle scalene out and does neuroplasty (read: cuts way any crap connected to the nerve and surrounds it in seprafilm) to all the local major nerves. He goes in supraclavicular for almost everyone to do this part, and if you have pain in the front of the shoulder he'll also come in axillary to clear anything connected to the nerves down there.
Ahn on the other hand always takes the first rib and all but the last 4 inches of the middle and anterior scalenes with an axillary approach. in 25% of their patients they come back a year-ish later and remve the top portion of the scalenes with a supraclavicular approach bc those pesky leftovers have managed to reattach somewhere else
Weaver says he likes to go supraclavicular in the first place, says he gets a better view. He has done anterior scalene removal only and is willing but says he has gotten burned a lot doing that, and he really really hates redo's bc the scar tissue makes it much harder. So his preferred approach is to always take the rib, and to take the complete middle and anterior (i think, might have only been anterior) scalenes. Thereby going a bit further than Ahn/Reil, but taking away the 25% chance of second surgery. He also then disconnects anything attached to the nerves both at the scalenes and more distally in front of the shoulder.
4. Though Filler and Reil (Ahn's associate) were both ready to throw me down in the OR and have their way with me, Weaver suggested 3 more monthes of PT because I was experienceing some progress.
I thought this was due in some part to me not communicating correctly that I can't work anymore and I am on pain killers 80% of the time and it seemed to me like that was BAD...but when I pushed him he admitted that he almost never offers to do surgery on the first visit unless there is VERY compelling evidence that you need it and certainly if he couldn't even make my pulse go away I wasn't all that compelling. He went on to say that he knew he was very conservative, but that is just the way he is, kind of take it or leave it.
However, I kind of like his surgical approach, so I asked him another question- which was- If I go to Denver and get another opinion and it was reccommended that this surgery was right for me, would he (Dr Weaver) be willing to do it earlier than three months so that I didn't have to travel to Denver to have it done? He seemed pretty open to doing it sooner in that circumstance. He did have a checklist of caveats like making sure I understood what my real chances were, and had reasonable goals and continued with PT, etc etc.
5. Aftercare support: Unfortunately (Sorry, Alison) I didn't even have a chance to get to things like pain control, support before or after surgery, etc etc. I have to guess that surgery at a teaching hospital will be less comfy than at a private hospital, but I guess I'll be worrying about that later. I definitely didn't get the impression he was a "whole TOS" specialist, since he wasn't thoroughly on board with the neurogenic stuff... but as a surgical specialist I liked him.
He did not have any more tests that he wanted to send me for, since TOS was a "ruled out all the other stuff" diagnosis...just wanted me to go back to PT.
For me that means I'll be off to Denver now, having made the LA rounds.
talk at you all soon,
Johanna
* (Joyce and Robert are my PT and Hellerworker for those unfamiliar)