JKL'S TOS Journey or How I am seeing all the doctors in L.A.
 

I decided to start my own thread since my comments are all over the place. I will be pasting some of the older ones to save my arm and trying not to write to much at one time. Hopefully I can help others by documenting my journery like NoSpam has done. I also have a huge library of research,unfortunaltely i cannot post alot of the pdf's but will do what I can.

I have always been a persistent person and refuse to give in to the inevitability of pain. So it is no surprise that I have/am seeing all the dr's in L.A. and soon to possibly go out of town. I am an designer, I draw for a living and I havent been albe to work for almos a year. I was used to working 10 hour days at the drafting table and I'm sure this contributed to my TOS.

As of this week, I am starting to look at Surgeons as I dont think i will be able to go back to work without it.I may be able to try to do a slightly different thing within my field but it will not be easy. My health Insurance, Family stability,Pension etc are all tied up in my job, I am willing to try anything to get better.Th good thing about what I do is I can freelance, and dont have to work all year long, but the hours are usually long.

About a year and 1/2 ago I started feeling pain in my right arm while working. I did acupuncture and it helped for awhile. Then I started getting sharp scalpular pain and was having trouble working . Last April I finally went to my Primary Care Dr. who sent me to PT. It wasnt helping and I could hardley finish the job I was on. II went back to the GP and insisted on an x-ray and a specialist . She sent me to an Orthpedidt who sent me for an MRI. The dignosis was C-5-6 Spinal Stenosis,moderate bulge Osteophytes,and Degenrative disc disease.He gave me Trigger pt injections, Medrol Dose pack and PT perscription and a nerve test.

Around September my Orthopedist mentioned possible TOS because of the numbness in my pinkie. I had never heard of it and immediatley googled it and said to myself thats me! I went to 3 different Neurosurgeons who recommended disc surgery but said I didnt have TOS.

Finally I decided in the New Year, after nothing was working, traction and exercises were making it worse. I was ready to have a spinal epidural or go for the surgery when I saw an ad in the newspaper that Kerlan Jobe was having. Something caught my eye. Dr. Williams and Dr. Dillon (spinal surgery) were talking about how common it is to misdiagnose disc problems
and something hit a nerve(no pun intended)

March- December 2011

1 GP
1 Orthopedist/Pain doctor
2 Acupunturists
2 Physical Therapists
2 Chiropractors-Both supposedly the best. (I spent about 4,000 on one who is a spine specialist)
1 Pilates
3 Neurosurgeons who recommended disc surgery and said I didnt have TOS.

What is Pilates doing for you? I would think it would be very aggravating to TOS. I've had to give it up since surgery, but then again, I no longer have pain or symptoms, so I accept the tradeoff, no problem.

2012 and my search for a TOS DOC
 

Jan 2012
I made an appt with Dr. Williams at kerlan Jobe. He took one look at my shoulders and my disc mri and said he was guessing I have TOS.He sent me to Pasadena to have a Brachial Plexus MRI. The MRI showed some neural Edema , a large suprclavicular vein and possible TOS. Dr. W prescribed physical therapy and a posture shirt. By the way Dr. W has a financial stake in Alignmed which make the postureshirts. I told him I wanted a scalene block thinking at that time it would be the cure I needed. He said okay and gave me info on their surgery center with no other info . He also has a financial stake in the surgery center at Kerlan Jobe. Even though they took my insurance I did not feel comfortable with the amount of info I was getting. He didnt like too many questions and I am miss question answer. When i found out I would have to be sedated I decided that wasnt my first choice of treatment and went on my quest for a good TOS doc.

Went to Dr. Filler based on their website. He spent alot of time with me and confirmed the TOS diagnosis. He said my middle scalene was the culprit and my long thoracic nerve was involved. Told me about his fancy MR Neurography machine and if that didnt work he does scalenectomy at Cedars. Cost -MR Neurography $15,000 out of network so I would have been lucky if my insurance would pay any of it. They have a sales pitch and showed me the machine downstairs in the basement. When I got home I went online and most of the reviews are bad. There is also a fight going on btween dr. F and a former patient that you can read. After a couple of people warned me about him I decided this wasnt the one.

Started seeing Joyce Wilkinsin PT. I like her alot seems to know what she is doing. I am still seeing her but my visist are almost running out.

Went to see Dr. Carden a pain doc at the D.I.S.C. center, He is a well renownd RSD doc and has worked with alot of athletic teams .This was the most Bizarre experience. He told me I was doing to much research, didnt know what I was talking about,disbelieved the TOS diagnosis, gave me a sympathetic nerve block right there in the office and said I should get a spinal epidural,went ahead and ordered it from my insurance without asking me,got hostile when I asked for my records. Very aggressive and Condescending.

Finally,got into see Dr. Jordan and knew he was the one,even though he is cash only. He spends an hour asnwering my questions. His scalene block that he does in the office was 3500 as compared with Dr. F's 15000. Plus Dr. J explained that MR neurogrphy is outdated and what he does with ultrasound is much better because it is live. I am still waiting to see how much my insurance will cover.

With Dr. Jordan since Feb- I did

Scalene Block Injection-
It came back Positive ,but i'm not convinced since I wasnt in alot of pain to begin with.
Botox injections-
Bad reaction for 2 weeks then about a month of some releif,now symptoms are returning
Trigger Pt. Injections_
heped in a few muscles not much releif

Now Dr. J is recommending Brachial Plexus Nerve Block Injections or Facet injections in case some of the pain is coming from the facet joints.
Am still trying to decide if I want to do either of these. Bringing back the disk problem I've been ignoring is making me question all my decisions so far. I wish someone could just tell me where the pain is coming from!!!I decided I need more info so I go back to see Dr. J on May 17 and will bring my Disc MRI since I dindt have it last time. Every visit is $200.

Also in Feb, found out that a dr at Orthohealing ,Dr. Aufiero is covered under my insurance. Orthohealing is the famous place in Santa Monica with Dr. Sampson .Dr. A is Sampsons associate Dr. I like her alot and she is easier to make appts with a little more alternative than Dr. J.

She also spent alot of time with me and she and dr. J know eachother and respect eachother.

Dr. A gave me:
Amino Acids and Anti-inflammatory diet for Inflammation
The Spinal Q Brace which I finally just got and is great.
Neuropathy Cream from a homeopathic pharmacy
Recommended Trying Neural Prolotherapy if the botox or TRPS dont work.

Jan-April 2012

Dr. Williams/Kerlan Jobe
Dr. Filler
Dr. Carden at D.I.S.C.-
Dr. Jordon-Jackpot!
Dr. Aufiero -Orthohealing Jackpot #2
Joyce Wilkinson P.T. Jackpot #3
Dr. Raj-Trigger pt Massage.-Tried twice jury is still out


Okay enough Typing. Next : Surgeons and second opinions on injections

I had to give it up too. .I was doing the mat one. I love it because it was with friends and outside but It was making things worse. My PT recommends trying the machine one when I am ready to stregtnhen my core. She said you can do gentle stretches with it. Some of the PT's have them so at some pt I want try it again.

Will you be able to do it eventually? I am happy to hear you are pain free.

Neural Prolotherapy
 

I decided to try the Neural Prolotherapy with Dr. A since it is less invasive than the other injections. It is a diagnostic and she said I will know in 20 min if it works. If not she may give me more TRP injections. The Botox is wearing off. The nerve pain is coming back and my arm muscles are jumping around.

I go today at 3 pm Wish me luck! And I am a person who has always hated needles. At least this writing has been keeping me occupied today so I dont get too nervous.

Good luck today. I'm sorry to hear you've been going from specialist to specialist. Unfortunately, many of us have had the same experience. Trust your gut.

I had surgery 7 years ago which made me worse. But even before the surgery, my surgeon made it clear that I probably couldn't return to the work (attorney) that caused the problems in the first place. Think realistically about whether you can return to the same kind of work. Re-injury is too easy and too common.

Take care,
Kelly

I certainly hope so, but I'm under strict orders from Dr. Donahue to take it easy. It took 30-something years to build up the scar tissue and adhesions, I need to lie low for the next year.

Good luck to you, I'll be watching to see how you're doing! Nothing makes me feel stronger than Pilates, but I just don't want to risk the improvements I've made. No pain is hard to argue with! (I draw, though indirectly for a living, also!)

Thanks,It just took me awhile to find the right dr's . Once I did I am stick with them. I am sure I will do the same with Surgeons and once my pt is done I will be looking for a chiro or osteopath to continue with the rehab. I'm sorry you werent able to return to your work, and I might not be able to either, I may have to adjust,but not gonna give up hope.


We decided not to go ahead with the NP Injections today because I was not in enough pain! I did everything I could to bring on the burning pain I had last night and yesterday but go figure. Even after all that typing. You have to have enough pain to see if you feel releif right away oterwise its a waste of time So Dr. A said to call on a day I'm in alot of pain and she will squeeze me in. She is the Greatest!

I do feel lucky that I have good insurance and have a few of dr's to choose from here in L.A. Unfortunately this year UCLA decided not to contract with Blue Shield so that eliminates the docs there.

L.A. Surgeon visits
 

I saw Dr. Gelabart at UCLA today and he is by far my favorite Surgeon out of the 3 that are in L.A. A really caring and nice man. Fairly thorough although did not look at my mri's,just saw reports.Asked alot of questions.Kept saying "Interesting" when he was examining me He said that Dr. Jordan usually only refers patients to him that have failed his injections .etc, He saw no arterial and venous symptoms. Suggested I try Facet Block injections or Cervical Epidural just to rule out the disc bulge and stenosis being the cause of my pain before doing Surgery. He does Trasaxilary Rib Resection and partial scalenctomy.He thinks this is the superior way to go. says he has a 90% success rate. Once in a while a patient comes back to get a full scalenectomy. He says the scalpular pain only has about a 50% chance of getting resolved but arm pain is usually better. he didnt know statistics on the shoulder pain (Traps,pec minor) etc because not everyone has that pain so they dont keep track of that. He relys mostly on the scalene block test( They all do) so I would want to repeat that if I decide to proceed with surgery since I think it was questionable weather it worked or not. He didnt think Ahn's Angiogram or angioplasty test was a good idea,or that the MRA was necessary. he was so-so on a Mac or SSEP test.(Has anyone had either of these? Were they helpful in the Diagnosis? Where did you have them done?I'm particulary interested in the Mac,because my pec Minor is really tight.)
He gave me a 3 page doc on TOS which describes all the tests etc. I decided to pay cash because he is out of network on my insurance and he only charged $200 for the visit. it would have been $700 if they billed insurance. If I decided to do surgery, I would have to wait until August anyway when my insurance changes to Blue Cross(keeping fingers crossed this happens)

Dr. Ahn said I had Arterial and Venous symptoms because my veins stuck out of my neck and my pulse on right side was lower. No else has said this,so dont really beleive him. He wants everyone to do an Angiogram/Angioplasty so he can see where the impingement is and decide then which operation to do.He will either do Rib-Resection/Scalenectomy or Pec Minor Tenotomy, so he is the most versatile.I just didnt get a great feeling about him. in a way his approach makes sense,but just seems very invasive especially because I dont have any arterial symptoms. I beleive he is writing a paper on this and like nospam,I dont want to be a guniea pig.

I also saw Dr. Mckenna at Cedars Sinai. He hardly examined me at all. thought my left side pulse was worse than right,but said that test is unreliable.He was the most conservative,said to try more injections,pt etc He takes the whole rib out,no scalenectomy.Didnt feel particularly confident with him. He has some kind of tic that makes him look like he is going to sleep when he is talking to you. also I heard a horror story about a botched surgery from another Dr. Probabl would not go with him.. He is not on my insurance yet either. His visit was $600 through insurance. I will probably end up paying 400 of it.



If I had to choose today I would go with Dr. Gellabart,but luckily I dont. i have been doing PT with Dr Ando(No-spams PT) and I am feeling better overall but have had a couple of flare-ups lately. i am going to give it a few more months and if I still cant go back to work by August or September I will
consider it again. Of course I go back and forth depending on how bad the pain gets.This summer i may check into the Denver Dr's or at least call Dr. Sanders on the phone.

I see Dr. Jordan next week and will discuss the surgeons with him and injections again and see who he recommends for the facet block or epidural. and also make him take a look at my cervical MRI as I didnt have it last time and we want to revisit that.

i still will probably try the neural prolotherapy at Orthohealing if I continue to have flare-ups,before I go with the facet block or epidural. I hate how I have to do these invasive injections just to rule something out. I was also told they could make things worse for the nerves and muscles by Dr. Gart(Pain Dr. at Cedars)

Dr. Sanders
 

FYI Dr. Sanders in Denver no longer performs surgery. I was doing some research and found this out last week.

yes but he will consult with you over the phone and he supervises Dr. Annest. ther is also Dr. Brantigan there.

I agree that you should try the facet and epidural injections to know what pain is coming from where (I got relief from my cervical symptoms from the facet blocks). Gelabert wanted me to do SSEP only because I had a negative scalene block previously. He also wanted to repeat the scalene block as well. He said the MAC wasn't necessary as I had a recent EMG. He referred me to David Fish at UCLA for this testing. It took weeks for Dr. Fish's office to receive the official referral from Gelabert's assistant and offer to schedule me for testing. By that time I had found Dr. Angle and was already scheduled for surgery. Dr. Fish's office seemed very nice though.

Dr. Ahn and Angle were unimpressed that my scalene block was negative as they felt it was not a reliable indicator for surgery. My problems turned out to be my ribs and not my scalenes. I wish I would have learned more back in 2010 when I failed the scalene block and I thought I didn't have TOS.

Both Dr. Angle and Dr. Fujitani (UCI) had nothing but great things to say about Gelabert, he is well respected. Just be clear with him that you don't want residents performing any of the surgery if you go that route. Angle said his surgical method is basically identical to Gelabert's. He trained under Gelabert and Ahn.

I would have gone to Denver if scalenectomy only would have been an option for me. I'm just thankful that I found Dr. Ando to find my rib issues and found Dr. Angle for his expertise local to me without me be delayed by the slow moving University systems.

Too bad Ahn's bedside manner and patient focus is not what it could be. The engineer in me really identifies with his methods but I can't be his guinea pig or subject my family to dealing with him if I have a surgical complication. On the plus side, he did give me his cell phone number (after Misty and I cancelled our angiogram procedures and criticized his bedside manor). :p
Ahn could very well be the most skilled TOS surgeon in SoCal, but no one is really willing to take a chance with him when there are other viable options.

Dr. McKenna is not covered by my insurance so I never saw him.

I wasn't aware of this. I was always told that these injections were low risk, high reward.

Another reason why TOS is still not solved, a consensus on diagnostic testing still can't be reached.

I'm a NoCal patient and I can't even find anyone here to give a scalene block. I've heard of someone near SF, who potentially gives them, but they're unrelated to any TOS expert in the area.

I've been told by multiple Doctors what JKL heard at Cedars. Sticking any needle or substance in the BP area and scalene triangle is not a good idea and they will not perform an injection. My scalenes showed as mildly hypertrophied on an MRi/A/N, so don't know if a block would have any effect on me....then again, another whole group of Doctors would throw my MRI away as hogwash. :rolleyes:

I was referring to cervical epidural and facet block injections. I don't think there is much to fear with these routine cervical procedures.

What about Dr. ellis?

Marc, how did you get finally diagnosed if your scalene block was negative? Mine may not have been successful either thats why I will probably repeat it. I will of course do the facet and or epidural before I commit to surgery. Just not there yet,keep hoping Dr. Ando can help me.

[QUOTE=nospam;884679
Dr. Ahn and Angle were unimpressed that my scalene block was negative as they felt it was not a reliable indicator for surgery. My problems turned out to be my ribs and not my scalenes. I wish I would have learned more back in 2010 when I failed the scalene block and I thought I didn't have TOS.[/QUOTE]

Dr. Ellis doesn't do scalene blocks. When I saw him, he offered heparin injections in key trigger areas. They were not areas which needed to be done under guidance.

Marc: Since your scalene block was unimpressive, did Ahn or any other surgeon suggest the Collins MRI and if not, why?

JKL: Has anyone wanted you to have this MRI as well? I'm mostly curious as his Northern CA counterpart's study is viewed as solid info. The geographical differences in diagnostic testing makes TOS all that more frustrating. Good luck to you with Ando. I hope you find relief and answers.

I was told the same. I've had a cervical epidural as well as a cervical facet block. For me, it was because I had a bulging disc. However, the epidural did not help at all, the facet block helped for 1 day and because it helped I had a nerve ablation (burning of the nerves although they grow back in a year or so). The ablation did not help that's why I don't believe blocks are always reliable.

When my scalene block with Dr. Vernon Williams was unsuccessful (2010) I was never able to get back in to see him. I was suffering and his office only offered me an appointment 6 weeks away. My wife and I assumed that I did not have TOS. I sought out a new neurologist and neurosurgeon. There was evidence of cervical radiculopathy and I went through with cervical fusion surgery which was successful in eliminating many of my symptoms.

In the year following the fusion, some of my symptoms did not disappear and started getting worse. My doctors were overly thorough in verifying the fusion was successful. I also had another EMG which eliminated carpal and cubital tunnel as well, but had some suspicious C8-T1 readings which could point to TOS.

When I started seeing the vascular guys, they all said that failing the scalene block doesn't mean you don't have TOS. Gelabert wanted me to repeat the scalene block as it is his main indicator for selecting surgical candidates. Dr. Ahn and Angle both felt the scalene block was unreliable and didn't think I needed to repeat it.

I also had the MRI of the Brachial Plexus from Dr. Tsuruda in Pasadena that Dr. Williams had ordered in 2010. It showed neural edema and increased neural signal. Dr. Gelabert said Tsuruda does good studies and there was no need for Collins' study. Gelabert also wanted me to have the SSEP test since it was likely I would fail the scalene block again.

Dr. Ahn completely ignored all of my prior tests and said I had clinical signs of vascular and neurogenic TOS but would not discuss surgical options until I underwent his angiogram/angioplasty. Dr. Fujitani wanted to repeat everything, including my cervical fusion workup so I didn't want to reinvent the wheel with him.

Dr. Angle looked at all of my previous studies but said he mainly relies on clinical evidence as the imaging never tells the full story of what he finds in surgery. Clinically he found evidence of both vascular and neurogenic TOS. At my request (he didn't find it necessary), Angle ordered MRI/MRA which showed evidence of venous TOS with my arms overhead. None of the testing showed exactly what Dr. Angle found in surgery. The costoclavicular space was extremely tight on both sides. My left brachial plexus was fused to the rib. My right rib was in an odd position and was attached to the lung pleura.

Dr. Ando was key to me choosing to go through with rib resection surgery. Originally, I wanted to just do therapy or get scalenectomy only. My previous therapists were never able to get my 1st ribs to lower. In two weeks of trying, Ando was not able to get my 1st ribs to budge. However, he did reveal to me why. The ribs below were pushing up on the first rib (subluxations and torsions). This convinced me that my problem was rib related and not scalene related. My ribs have been easier for Ando to align on the left side since I had the resection. I will start therapy on the right side next week.

[QUOTE=jkl626;884561] he was so-so on a Mac or SSEP test.(Has anyone had either of these? Were they helpful in the Diagnosis? Where did you have them done?I'm particulary interested in the Mac,because my pec Minor is really tight.)

I had a MAC test done in Denver. Before my unsuccessful pec minor surgery with Doc Sanders, he had me get one with Dr. Machanic. Apparently it shows some nerve issues that everyone else misses. Mine was positive.

I had an MRA with Doc Collins and he said that if I ever decided to get surgery, I should go with Doc Gelabert and not Ahn. I told Dr. Angle that and he laughed. He knows all three of the Doctors and said Dr. Collins is an excellent radiologist and knows his stuff. Dr. Angle looked at the report for Collin's MRA and said it was accurate based on his exam with me (I have subclavian vein probs and neuro).

Anne:I had a brachial plexus MRI at Oak Tree in PAsadena It shows Neural Edema and helped my first Dr. Williams confirm a TOS Diagnosis. .I dont know if it differs from Collins or Dr. Werden's I think collins does MRA and other tests as well.Dr. Jordan doesnt think much of the MRI or the EMG/NCV. He relies on physical exam and scalene block to diagnose me. Dr. Gelabart didnt think either the Mac or SSEP was necessary but he did mention that the neural Edema points to the diagnosis. I would just rather do the MAC or SSEP before I do an Epidural or Facet Block when I know I have TOS. But I may have "double crush" symptoms whcih means the disc bulge could be causing some of my symptoms. I am going to make Dr. J look at my cervical MRI again since he is also a neurologist and decide what would be next.I also would rather have all the tests before I undrgo surgery if I can get them covered by my insurance. Dr. fish is not on my insurance right now and I dont know if anyone else in L.A. does them

[QUOTE=TOStrojan;884908]Thanks this is all good info. Did he say why to go with Gelabart and not Ahn? That is my gut feeling too. Where is dr. Mechanic? I dont have arterial or venous symptoms so I dont see why I would need an Angiogram or MRA.

So you had Pec Minor surgery based on the Mac test and it didnt work?
Do you think the test is unreliable then?

Did you like Dr. Angle? I cant remember have you had the surgery yet?

Dr. Ando has mention that to me too about the ribs below being a problem. I havent gotten him to let me know if he is able to lower my first rib. I will press him on this. My scalenes were very sore before the botox so I think the injections helped. And my scalene block was positve but I do want to retake it at some pt.as I am the only one not convinced! My worst pain has always been muscle pain Traps,Rhomboids , Scalpular and I'm not sure what causes this. The nerve pain is usually from overuse or overstreching.

Very Interesting. Where is your disc bulge? Mine is C5-6. I keep feeling that there is a connection between bulging discs and TOS. Dr. Jordan wanted to do a Brachial Plexus Nerve Block with Pulsed Radiofrequency to help with the nerve pain in my arm also, but after I saw him last that pain has not been too bad. I didnt go through with it,because I was not convinced and it scared me a little. Also there is not that much research on it.

The Facet block he recommended is for my disc also to see if some of the pain is coming from there. He thinks Cervical epidurals should be the last thing because they are more risky.Did you do the epidural and facet block together? Who did them for you? Did it make your TOS symptoms worse?

This is where mine was done as well, Jay S. Tsuruda was the radiologist and Gelabert knew him and said it was a good study with very clear images.

My neck MRI from August 2011 showed a disc bulge also at C5/C6. But a redid the MRI recently (April 2012) and there was no indication of the bulge. According to my doctors, discs regenerate over time so I guess that's what happened. I had the epidural done first in December 2011. After that didn't help, I did an EMG which came back negative. My doctor said that medial branch nerve damage does not usually show on the EMG so he convinced me to get the facet block (in January 2012) to see if it helps and to confirm his diagnosis for Cervical Facet Syndrome. Because it gave me some relief I did the ablation in February.

The doctor who did these in NJ (as I am from NY). After I went back to him for follow-up to tell him it didn't help, he told me to go to physical therapy (for the second time). I went for 10 weeks and I got worse. So I am not sure if the epidural or block particularly made me worse, or the physical therapy or the combination of all this. But I am much more worse now. But on my follow up after 4 weeks of physical therapy, the same doctor told me I was faking my pain (in better words) and that he had no idea what to do next. The entire time he was also only focused on my neck and told me he did not know where my right shoulder, arm and hand pain or the pain in my occipital lobes was coming from.

The epidural is basically a lot of steroids injected into your cervical spine. The block is usually either a numbing medication, steroid, or a combination from what I was told. Even if you are able to confirm that the bulge may be causing some of your symptoms, I don't believe these procedures can make you entirely sure.

My current doctor is also having me do a block to my brachial plexus (lower trunk). I am going ahead with it next week to see if my cervical ribs are compressing my lower trunk since that is what he believes (and I need some answers).

Let me know if you have any other questions.

hmm, thats interesting too. I had my MRI in June 2011. I have not repeated it, but maybe I'll check into that before doing any more injections. I dont know how many my insurance will cover.
Good Luck-Let me know how the block works for you

I believe a diagnostic block is just Marcaine and short acting. A therapeutic block adds steroid and is longer lasting. Often Drs want to do the diagnostic block before therapeutic or ablation/rhizotomy.

My scalene block was marcaine and a little bit of steroid. It didnt last long at all.

Saw Dr. Jordan today
 

I saw Dr. Jordan today and we looked at my c-spine mri again which shows bone spurs and the disc bulge pushing into a nerve and narrowing the foramina.

He is now recommending a transforaminal nerve block with steroids and stimulate the nerve as a diagnostic to see if it reproduces the pain. This will help decide if the disc is causing any of my shoulder and scalpular pain. If it does reproduce the symptoms then he will do pulsed radiofrequency to help with the pain for 6 months. Even though we dont think the pain is coming from the disc,I guess its worth doing if it will help rule it out.

I feel better about doing this one then I did about doing the BP nerve block as my shoulder pain is worse than my arm pain. I may feel better about doing the BP one later if this one isnt so bad. Hopefully it will tell me once and for all if the disc is responsible for any of the pain. All the surgeons want to rule this out first too. He didnt mention the facet block this time,but I think he was responding more to what he saw on the MRI.

I went ahead and asked them for a pre auth since this will take a few weeks to get anyway and it will give me some time to think about when /if I want to do it. Dr. J says he does them all the time and I have to trust that he is one of the best at doing these.

I told him I was going to try the neural prolotherapy that Dr.Aufiero recommends but he doesnt think it will do anything since i didnt respond to the trigger pt's but it is so much less invasive than any of these other injections and insurance will pay for the first one so I dont really see the downside.

He also gave me the name of an innovative pt that he recommends closer to me: Li-der Chan and a Chiro- Joe Horrigan. Anybody heard of these? I havent reseached either of them yet but that is next on my list.
He respects dr. Ando and says he is go to guy in Orange County. Its too bad he didnt give me those names earlier, because I am going to stick with Ando for awhile but for long term I will need to find treatment closer to me.Plus my pt visits have run out. I am in the midst of trying to ask for more but my insurance almost never approves it.

Everytime I see him there is so much to talk about and even though he spends almost an hour with me I always have more questions. ITs $200 everytime I go.

I have had the transforaminal lumbar block and it was effective. It is also easier (fewer needles) than the medial branch (facet) block. I hope it brings you some relief. Spinal issues are much easier to deal with than TOS in my experience. Is Aufiero or Jordan going to do the injections?

This is thru Dr. Jordan. Dr. Aufiero just does the neural prolotherapy which I will probably try first. I like the idea because it is diagnostic and it will be good to know once and for all if the pain is just the TOS or not. I hate being experimenting but I guess every procedure is.

I am still feeling better since starting to see Dr. Ando, so maybe I wont even need to do these,but my goal is to start working part time in July and then hopefully go back to my regular work in the fall and that will certainly be a challenge. The chin-tuck exercise is really difficult for me and gave me bad shoulder pain, I have to talk to him about it when I see him tomorrow.

Think this is the chiro guy?? Interesting :)

[Joseph M. Horrigan, DC, DACBSP, CSCS
Dr. Horrigan is the President of Horrigan Sports Chiropractic and Soft Tissue Center. Dr. Horrigan served on the American Chiropractic Board of Sports Physicians for seven years, of which four years were as Vice-President. He served as the Chair of the Written Examination Committee for nine years. Dr. Horrigan was awarded the 2001 Sports Chiropractor of the Year. Dr. Horrigan also served as the Head Speed-Strength and Conditioning for the Los Angeles Kings for three years. He served as the Team Chiropractor for the Long Beach Ice Dogs hockey team for several years and as their Director of Speed-Strength and Conditioning for seven years. Dr. Horrigan serves on the Medical Committee for USA Weightlifting. He served as the Chief Medical Officer for Team USA for the 1999 Junior World Championships and 2003 World Championships in Weightlifting. ]
http://softtissuecenter.com/about/st...r-Joseph-49575

Thanks, I looked him up too. It sounds like a big place, ofte you dont get to see the main dr. in these places They are right by my house so I'll give them a call. They are out of network with my insurance so will see how much it costs,but its worth in my search for a non-traditional chiropracter. Dr. J says he knows about TOS.

I got the BP block to the lower trunk yesterday. Today I am still in pain after being completely numb until this morning. However, I felt 10-20% relief in my arm and hand. My anesthesiologist wants me to wait until tomorrow to see how I feel after the pain from the injection site wears off (I am having a lot of pain in my collar bone, side of my neck and shoulder). Clearly there is more than just something in my BP going on, so I have to figure out the next step. But I think it's good that you are trying to rule out your disc first and holding off on the BP block for now since your shoulder pain is worse. When you did the scalene block, where did you feel relief? I am so confused about what could be the source of my shoulder and neck pain since I don't have any disc issues.

Hi Parbie,Thats good you feel relief,give it some time. It took me 2 weeks to feel better after the botox. I have bad shoulder and neck pain too and I really dont think its from the disc,and alot of my dr's dont either but theres no way to know for sure without some of these diagnostic tests. In your case it probably is the BP compression, alot of TOS sufferers have this type of pain. The muscles and nerves get inflamed from the BP compression so it could be the source of your pain.My PT is really helping with this with Rib Mobilization. I may get the disc injection just to rule it out,also he stimulates the nerve to see if it recreates the pain.but not sure when.

When I got the scalene block, I really didnt get much releif. If I did it was just for a few minutes.I remeber my scalpula pain coming back in the car on the way home. When he did the 90 degree hand test my pain was better after than before,but the problem is I wasn't in that much pain when I took it, The Dr. thinks it was positive, but I'm not so sure. I may have to repeat it if I decide to go for surgery.

Did you get Radiofrequency or just the block?