New here, seeking advice re: Rib Resection this Friday 12/23
 

Hello all... I am thankful to have found this board, as it seems to be filled with knowledgeable and active members... I wish I had found this months ago...

I have been dealing with shoulder/arm pain and numbness in my left hand for about 10 months now. My pain most of the summer was a 2-3, but since August it has been up to 6-7-8 range, and the last few weeks it has continued to get worse. In the last two weeks is when my multitude of doctors have finally landed on Thoracic Outlet Syndrome as the probable cause of my pain. (Diagnosis by exclusion)

My reason for seeking out some insight, I am scheduled to have rib resection surgery on Friday on my first rib on the left side. The doctor has told me that I will stay over night, and be released on Saturday (Christmas Eve).

I am looking for coaching from others who have had this surgery. My family lives three hours from the hospital, and I really want to be home with my kids for Xmas... My current plan is to have my wife drive me back home on Saturday so I can be with my family for the holiday, but I have no idea if I will be 'up' for that kind of travel the day after the surgery.

We have an SUV, so I could lay down in the back, if needed... I just don't know what to expect, so any thoughts would be great...

Thanks in advance....

Steve in Minneapolis...
(S.i.M.)

Get good drugs for the ride home, and dont use your hands. Just plan on needing lots of rest. A button up shirt, and away you go. Good luck, I had mine last week.

Good luck, Steve. I hope all goes to plan. I have not had surgery yet, and hoping to avoid it, but I wish you all the best.

Take care of yourself! :)

Steve -

I definitely can not imagine a 3 hr drive the day after surgery. I had my 1st rib removed 8 years ago and spent 2 days in the hospital. I'd recommend a pillow (or two) to rest the arm on for the trip back. Definitely keep up with the pain meds but maybe ask for something for nausea. Between the anesthesia, pain meds and the long drive, you might not feel that good.

Good luck!

To be totally honest , very few people go home the next day after a rib resection.
Most stay at least 3 days, and still feel like a truck hit them for a week or two longer.

I don't know if you've ever heard this , but holiday weeks/weekends are generally the worst time to have a major surgery done.
All the best nurses & interns are usually off. :( FYI

I feel I must mention a few more things.

Is the surgeon an expert at this surgery??

Has there been many tests and imaging to show this is the best course- like a clear cut cause - large or abnormal bony structures?

Please don't accept a less than expert surgeon for this surgery.
There are too many sensitive areas involved - and the chance of scar tissue later on, that can cause just as much pain as you have now.

Please explore the other messages & the sticky threads a surgery is not always a fix as the drs may lead you to believe.
our search tool link -
http://neurotalk.psychcentral.com/search.php

I just want to be sure you have as many facts as possible to decide for yourself if this is really the best thing to do now.

I haven't read your other posts yet so I may have jumped the gun , but a busy time of year and I wanted to be sure to get this reply to you.

ditto about after home post surgery - pillows, recliner, easy meals, easy on/off clothes, ice packs/heat packs.. on and on

Hmmmm....
 

That is quite a bit to chew on... I really hadn't thought about your point about the staff being off on the Holiday... Something to think about next time.

I have read quite a few of the stories about the surgerys, and peoples recoverys. I haven't read many about the diagnoses of TOS.

For me, It started this Spring, where I suddenly had a pain/numbness in my left shoulder, scapula, and sometimes in front around my rib cage, with occassional numbness in my left hand around my pinky/ring finger.

I spent the summer with many different doctors, three different PTs, took 5 MRIs, a half dozen XRays, an EMG, three different surgeons, a chiro, and none of them were able to diagnose the issue, or alleviate the pain.

Finally after the EMG, I was referred to a vascular surgeon (Dr. HL Saylor) who 'has been doing this surgery for 20 years'. Not sure if that makes him any good. I did see his name elsewhere on this board....

since I have excluded all of these other potential causes for my pain, and had tried PT with several different doctors and clinics, they felt that this surgury was the best option...

What other potential non-surgical remedies are there for this pain?

I don't know how advanced, or what kind of training / experience the PTs & DC had, or what kinds of therapies they used...
The wrong kind of PT can make you worse.:eek:

Also what may have brought on your TOS?
job/desk work/weightlifting/sports injury/previous whiplash- or any other injuries like that?

Even if mostly a posture/repetitive/soft tissue cause it can take years of rehab to turn it around.
And if you are still working while trying to rehab that will take even longer.

Therapies & tips -

Trigger point work

posture, posture , posture = the bad forward head/forward shoulders needs to be addresses if that might be an issue

diaphragmatic breathing - "belly" breathing

explore relaxation methods if you are stressed - stress = less oxygen to cells that need it & subconsciously tightened muscles

fluids = keeps the tissues lubricated so they don't get sticky - "sticky" fascia tissue can adhere to muscles, vascular & nerves and cause all sorts of problems

general nutrition for overall health


I could list more but it would be helpful to see all your sx listed for a better idea of what to suggest.

Here are a couple of posts from the Useful sticky thread that might be helpful -

http://neurotalk.psychcentral.com/post85992-17.html
http://neurotalk.psychcentral.com/post87845-18.html

Why not try intense progressive shoulders shrugs before your surgery ?

I don't have a specific traumatic injury or work that I think has triggered it. I originally tweaked one of my shoulder muscles while coaching my 5 year old daughters hockey team. I was dragging four or five of them around on the their bellies on the ice and 'whipping them' by pulling my hockey stick across my body and them pulling back, effectively sending them spinning like a top across the ice. I only did that a couple of times and ended up with a sore shoulder. after a couple of PT sessions, I ended up having totally different pain, and now numbness.

My pain started at that point in the 2-3 range and stayed there for most of the summer. By late august it jumped again... by this time I had begun doing some chiropractic work... I ended that immediately... but now my pain is in the 7-8-9 range...

Beyond the fluky hockey practice thing that I don't think would have caused this, I work at an office and do spend a fair amount of time on my computer... but I am not sure that is the issue... I do know that I like to sleep with my left arm straight above my head, with my head resting right on top of my left shoulder. I have done this for years, and I wonder if that is what is causing this issue...

Many of us have had to learn to sleep other ways, my elbows were super sensitive when my TOS began. Had to wrap padding on them so the mattress pressure wouldn't irritate them.
Others use extra pillows to prop the body or arms for comfort.

I can usually sleep in any position now after 8 yrs.( sleep has been normal for 5yrs, only messed up for the first 3) -after many sessions of PT and chiro, plus all the home care stuff I did for myself.

One of my early dx's was a chronic strained neck/shoulder w/arm pain.

My PT & DC sessions were focused on pain relief first, not strengthening or anything else.
ultrasound, massage, heat/ice, then gentle stretching & ROM work, some biofeedback to check for full muscle relaxation, chiro also added IF stimulation, low level laser, upper cervical adjustment, manual trigger point work and some deep tissue work.

Personally if it was me I'd pospone the op to at least after the New Year. Like Jomar has already mentioned, less staff at hospital and possibly less help available at home over the Christmas period????
Unfortunately in my experience the post op stay was alot longer than suggested. Be prepared for the unexpected..... I had to stay for a total of 5 nights including 3 nights due to EXTREME nausea from the anesthetic and a bad reaction to diclofenac pain relief med ( TERRIBLE stomach cramps )! I don't want to freak you out but BE AWARE of the unsaid possibilities.
Best wishes to you.

Although I have not had TOS surgery, I agree with postponing until after the holidays. I had wrist surgery (fixing some ligaments) last year which was outpatient and I was advised not to do it right before Xmas or between Xmas and new years. However I chose to do it a few days before Xmas which allowed enough time between the surgery and Xmas had there been any complications with pain, meds, etc. From what I hear about TOS surgery, you need to take it easy afterwards which may be difficult to do around the holidays esp with children. Whatever decision you make, I wish you a speedy recovery and successful results.

Yes, I totally forgot to say , whatever you decide is best for you, we'll support you fully and hope for excellent results.

:grouphug::):grouphug:

Thinking of you s.i.m.........If you went ahead with op BEST WISHES for your recovery!!!!!!!!!!!!!!!!!!!:hug:

S.I.M. praying things have gone well.
Cheers,
Jay

Hope things went well, Steve.

Good advice
 

Thank you for this advice... I definitely had not thought of this, but your post (and the similar sentiments echoed by others) allowed me to ask some questions I would not have asked during my stay and I avoided some 'junior/new' staff members thanks to those questions...

I still had some bumps in the road which may or may not have been due to the holiday, but the mistakes were certainly not ones I would expect from this hospital based on previous extremely positive experiences...

Some examples: It took the nurse three times to get my IV in.. and she eventually needed the help of her superior. Not the best start to my check-in procedure. The over night assitants were not good- at 3am one of them helped me out of bed, unplugged my IV tower and walked me to my bathroom, and then she just disappeared. She forgot that she needed to make sure I was able to get back INTO bed, and more importantly, that she needed to plug my IV back into the wall... The head nurse was more than a little flustered when she saw me tottering down to the nurses station (unattended) with my IV tower and my bright yellow "fall risk wristband".

After sharing my concerns about my level of care and wondering whether I needed to be concerned for my safety, things went very well....

Thank you all again

Post Surgery Update
 

I am floored by the support, thank you. I am wide awake in the middle of the night, so I thought I would share a little about how things have gone so far.

As some background, I think I found these boards less than a week before my surgery, and I spent quite a bit of time in that week scouring the net to learn anything I could about TOS and rib resection surgery... There is very little out there, as you all probably know, and I was thankful to find a resource that not only had inf, but was a message board of active members.

I had my rib resection surgery on Friday at 11am. The doctor said things did go well, and that there were no surprises. I did have some extra muscles in my shoulder area that aren't normal and may have contributed to TOS, but he doesn't expect them to be an issue going forward.

I didn't get much sleep, about 3-4 hours total in 45-60 minute increments, but over the course of the evening/night my pain did drop from 7-8-9 down to five-ish the next morning. I was fortunate to avoid any of the side affects from the anesthesia. By that night, I had progressed from jello to graham crackers but still hadn't had any real food and was hungry. My wife had brought some Chinese back to the hospital, and over the course of an hour or two I was able to eat that which did wonders.

Despite the night-time adventures I listed above, and just a few hours of sleep, I woke up feeling pretty good. My pain was continuing to get better, I was up and about on my own (I moved the IV tower to a different outlet so I didn't need their "help" to get to and from the bathroom). By 8am my doctor came by to check on me, and I asked about some things that I wanted to do, and by 10am I was leaving the hospital.

I took it easy for a few hours, and by 2:00 I was feeling good enough that we were able to drive with my wife/kids for the 2.5 hours to my parents for Christmas. The drive was a little rough, but I just plugged in a movie in my laptop and zoned in/out of sleep for most of the trip.

I got a little wiped out at the end of the day,but otherwise was no worse off. It sounds like my experience is atypical, and I am feeling pretty fortunate so far.

I have been tring to get a sense as to howmuch of the pain I am having is due to the surgery vs. consistent with what I had before, and I really can't tell... I am cautiously optimistic...

Thanks again to you all for the insight, coaching, support and for sharing your experiences here. I am hopeful that I willbe able to continue to "pay it forward"...

Merry Christmas...
Steve in Minneapolis

Pleased to hear you are doing well, Steve. I hope the recovery period goes smoothly!

Good to hear things are going so well for you.

Please just don't overdo or risk with any quick or heavy movements too soon.

:grouphug:

I fully agree..... take it easy, the pain killing meds can mask so much!
Best wishes for the recovery!!!!! :winky: NICE & GENTLE does it now. xx

Glad it has gone well S.I.M. I was one stubborn bastard lol. I had my iv/pain pump on one side of my bed, and drain tube with suction attatched on the other. I would get up at night, unplug my suction, then unplug my iv, and wheel both to the bathroom, come back and hook them back up. I was awake most of the nights anyways, and the hospital was more than busy.
I would give it some time to notice the pain difference. The big one at this point to notice is the numbness and tingeling...if it is gone or not. The pain (including nerve) will continue for some time. The surgeon told me 6weeks is the mark that we can start to gauge that, and see whats going on, as the inflamation goes down. Though we both know the road to healing is much longer than that.
all the best in healing,
Cheers,
Jay

Thanks to you both... SD38, I appreciate the support and thanks for your thread. I am sorry to read about your relapse, and I hope things improve for you.

Jay -

Thanks for this response, it was incredibly timely... I have a call into my doctor this morning to answer some of these exact questions.

I am still feeling pain in the shoulder/collarbone areas and I still have some occasional numbness in my fingers...but that is triggered by specific positions like reading a book... I couldn't remember what (if anything) my doctor said about when things should begin to feel better if the surgery worked...

Trying to sort out what to expect and when...so I greatly appreciated your comments.

Thank you...

I don't know what position you're reading your books in, but I got a nice tip from the "The TMJ Healing Plan" (I have that too. Yay.). The tip is to stack two pillows in the lap and rest the book and forearms on that. This keeps your arms and shoulders fairly relaxed and requires less head tilting.

It's been working well for me, though not so much for the cat.

HTH.

No problem, floating in the same boat. I have had more pain the last couple days than since leaving the hospital. I did speak with my surgeon yesterday about all of my different concerns, including a reaction I had to an anti inflamitory I was on.
He has diagnosed me with CRPS (rsd) in my arms, and it spread as well. So now its a matter of seeing how much things improve with the constant compression being gone. Hoping to deal with just one pain rather than two. I did notice some improvements right after surgery. Just going to be a long road I know...
How is your sleep going at nights? can you lie flat? I am sleeping on a wedge so that I can breath better at night, but so wish I could sleep on my side. lol.
I hope your surgeon is good at post op care, and answering your concerns. Mine gave me his cell number and told me to call anytime.
Cheers,
Jay

4 months post and sleeping on my side can still cause probs for me but I have to say that around the 6-8 week point it got easier to do so, if only for alittle while...... laying on your back or propped up ALL night is the pits!!!!
Hope this passes soon for you, I truly feel for you.... Sleep deprivation is the worse.
Rest well.:winky:

Sleep has been okay... I used to sleep on my left side (where I had my surgery), so that has been a challenge, but not causing me to miss too much sleep...it just takes longer to happen...

My post Op appointment is this week, hoping to get some answers to a few questions.

Beyond the basics about pain/ surgery recovery, are there any questions any of you wish you had asked or would recommend I ask?

Steve,

How are you feeling? You seemed to be doing better than most immediately following surgery. I hope that's continuing.

Kelly

No, I would just say make sure you can keep up on your muscle relaxers, and nerve pain meds, as things take time to heal. Sorry, I cant remember if the surgeon told you exactly what he found was the issue? not just the vague "we removed the compression" so many hear. Good Luck with your appointment.
I had an issue post op that landed me back in the hospital related to the medication I was on. I spent 4 days after christmas in a hospital where tos is an "unknown" condition. Why would you have your ribs out? is the question I was asked the most. I highly do not recomend a ride in a ambulance if you have not yet tried it, or ending up in the ER, unless you want to be called a drug seeker.

The trick is to Heal correctly. I have had this "beast" 35+ years. 2 rib resections, Ulner transposition, Left Scalenectomy, Middle and a SCS. Out about 3 to12 mo you will form scar tissue. This is the threat of TOS surgeries.

Just getting going this AM not doing to hot. I'll try and start posting again.
Remember, the first 100 years are the hardest

Mark J

Yes, ask about scar tissue formation, which can cause additional issues and the offer of physiotherapy.
Apparently pain can reoccur around the 4-6 months post op mark, bc of scar tissue and tightening around the incision point and muscles etc. Unfortunately I think that this is what I'm encountering.

This has been quite the adventure. My pain has not gone away and I have tingling every few days. I had the surgery in Sept 2011 and continue to struggle. After the surgery the doctor said I had a lot of scar tissue and over developed scalene muscles. I see the doctor again next week. Just found out that I also have a torn labrum and cysts in left shoulder which I am sure is not helping my cause.

It sounds as though we are at the same sort of recovery stage at the moment. How are you coping with the cold weather...... OUCH!!!! It makes the scar tissue near to my incisions so tight and brings on a sharp pain in the side of my breast!:( Good news is that I now have been referred for physio.... hopefully this will help me to gently stretch and strengthen the area????
Take it easy :winky:

cold weather does not help at all. I started active release technique which really hurt for a couple days then had some relief. I have another surgery on the 27th to repair torn labrum and remove cysts in shoulder. The doc said that should relieve some pain as well. I have been off work since April and if I can not return and take disability I will move south to warmer climate