1st Rib resection - post-op & returning to work
 

Hi Everyone,

I'm going to be booked in for a 1st rib resection for "TOS, Vein compression" due to a car accident May 2012. the JUST found out 2 weeks ago, scar tissue is severely compressing the nerves, and subclavian vein.

I haven't been able to find any information regarding returning to work post-op???? being a work-a-holic i'm just curious on people's recovery period and being able to return to work. I do a desk job, Stats Analyst.

Aswell I have concerns hearing AVOID public transportation, and needing help post-op. i'm just worried, because I live in Toronto, and that's my only mode of transportation (mainly the subway), and I'm also worried because I won't have anyone to help me out post-op. and of course I HATE not being independent, and what's worse is i'm right handed and that is the side i'm having resected.

Any suggestions????


Thank you :)

You'll be able to do MUCH more than you think you'll be able to post op. Your arms will be virtually unaffected in terms of basic manipulations (no lifting though and your ROM will be limited). By the time you leave the hospital you will be able to care for yourself. I had both sides done at the same time so they sliced my sternum in half and I was still functional.
You're going to need to stay home for about 3 weeks to get through the pain/sleepiness of being post-op. For the first week and a half you're going to do nothing but sleep, eat, and stare mindlessly at a television. After 3 weeks, you can probably return to work if you feel up to it and you have proper arm support at work (bring a few pillows and you can probably make it work) but know that healing from this surgery is a ***** and your body is going to crave rest so it's not about "toughing it out." If you're not ready to go back you just physically won't be able to go back.
That being said, my TOS surgery apparently triggered fibromyalgia and I have additional problems that I thought were caused by the TOS but, instead, were caused by Ehlers-Danlos syndrome. So I have not returned to work and will not be able to.

Recovery is different for everyone. I was in a great deal of pain for two months following surgery. I also couldn't drive for 2 months. I could bath and dress my self. But I couldn't do food shopping and meal preparation. If I'd needed to do that I would have eaten a great deal of oatmeal.

I was an attorney before TOS. I also have never been able to return to work. It's been 10 years now since I stopped working.

Generally speaking, patients with vascular TOS have much better surgical outcomes. You may recover very quickly. I hope so. But you should build in as much support as possible -- make sure your house is stocked with food. Have all your laundry done. Clean your house. Do everything in advance that you can because you may be out of commission for several weeks.

Sometimes people wear slings following surgery as a way to alert others to take care. This may help ease your mind if you're riding public transport.

Take care,
Kelly

Find someone...family, friend, or even co-worker to help you get home and at least check on you periodically post surgery. You don't want to try this alone. Depending on the nerve damage/scarring you may not have much use of your arm/hand initially (or you may be just fine). Start practicing using your left hand primarily now so you'll be ready to do everything with the left for a while.

The only way I could imagine you doing this alone is if they keep you hospitalized for several days until you can fully get around and care for yourself.

I second kelleysf's advice regarding a sling. You might not "need" it, but if you are dependent on public transport its a very good way of making people aware that casually bumping into you is not OK. I hate wearing mine and do anything to avoid it whenever I can, but sometimes I get paranoid that someone is going to walk into me, and when I feel like that the sling really really helps.

My personal experience leads me to suggest that you err on the side of caution when trying to plan a return from surgery. I wouldn't have been able to take care of myself when I left the hospital after my 1st/2nd rib re-sectioning. I'm 2 months out and only now am I at the point where I *might* consider returning to work (if other more recent developments weren't preventing me from doing so). My body still constantly craves rest. If I don't set an alarm, I sleep 12 hours. Every single night. I hope I don't sound like a downer. But be prepared if you can, just in case.

Follow-up appointment with my surgeon today, turns out they are doing 2 procedures, not just 1. thankfully they are keeping me admitted for at least 5 days, probably more because of my past medical history, due to allergies, pain control and swelling.

I asked how long I would be off work for. He was blunt and said 2-3 weeks and I should be back at work (I'm kind of hesitant knowing the type of surgery this is going to be).

Now the waiting game... for a date of surgery...

Thank you everyone for the suggestions!!

I saw my thoracic surgeon this morning, for the pre-surgical consult. Turns out they are doing 2 surgeries at once.

Thankfully, I will be admitted for a minimum of 5 days, due to my medical history (allergies to: NSAID, Fentanyl (most common pain med given in surgery). and the fact i'm immune to most pain meds other than hydromorphone (and that barely works).

When I asked about length of time off work. He said 2-3 weeks I should be good enough to return to work (hmmmm I wonder if that is accurate).

I am DEFINITELY taking 'kellysf' & 'BDBomg' advice on using a sling!! today alone i got bumped into 4 times!! (hurt like a *****, had a few tears drop - blamed it on the rain haha).

nowwww it's the waiting game.... for the date of surgery....


Thank you again!!! if anyone has any other info/suggestions re: TOS surgery please let me know!!!

Great news. I hope they have internet access, the food is good and the nurses pleasant so you don't get cabin fever.

2-3 weeks to return to work if optimistic IMO, 5-6 realistic...if all goes well.

Good luck to you!!!

In addition to WHEN you return to work, also give some thought to WHAT you'll be doing when you return. I think you mentioned that you have a desk job. If by that you mean that you do a lot of computer work (who doesn't?), then you are going to have to be exceedingly careful during your recovery.

My surgeon told me point blank that even if my surgery was a success, I should not expect to return to my old job (as an attorney) because my work was what caused the problem in the first place. Most people -- even if they have great surgical results -- cannot just go back to doing things exactly the same way in exactly the same amounts. Most of us are forever changed.

I don't know what caused your TOS. Regardless of how it began, you will want to be careful about overdoing and potentially causing scar tissue. Best advice -- if it hurts, don't do it. This is no situation where you want to try to power through.

Good luck,
Kelly

Thanks Kelly,

Yes, my job is computer based (statistics analyst). That is exactly what I was thinking swell when he said 2-3 weeks and I should be good? I get a majority of my symptoms WHILE at work, my co-workers are the ones who often inform me "oh your hands purple again" or "did u not realize you dropped that?". But your right that makes complete sense, I don't want to screw anything up after dealing with what I have heard a VERY tough and painful recovery.

I will definitely take that advice. i'm just dreading having to deal with our "occupational health" *****! (if my surgeon and/or specialists mandate I take that time off.

I hope i'm able to return to work... at some point....


Thank you again!!

HAHA! I can tell you now... there is no internet access (unless you want to pay a $15 fee per hour or something stupid like that ) but THANK GOD! for smartphones! (can't live without mine)

I'll try and post some pictures of Toronto hospital food, I will tell you now, it will NOT be eaten (you might end up seeing "ensure/boost, Starbucks, or our famous Tim Hortons! in the pictures).

Thanks again for the heads up on the 5-6 realistic time period. It makes a hell of alot more sense.

Oh man, hospital food! My one single complaint about my experience at MGH. The lady who serves meals in the thoracic surgery recovery area is the nicest and most helpful woman alive. But that food is terrrrible. I'm not Canadian, but I sincerely wish there was a Timmy's in the MGH area. I cant afford to lose any more weight.

DO NOT FORGET YOUR PHONE CHARGER!! :cool:

If you can, get an ergonomic evaluation of your workstation before surgery so you're ready to go when you're ready to return to work.

There are ways to better manage how you do your work, but if work makes you worse, that's a huge red flag. You are going to have to be incredibly mindful of how you're feeling and how your body is responding (turning blue).

Even now, if I'm in a meeting with my son's teachers or something really engaging, the pain recedes to the back on my mind only to come roaring back as soon as I leave. Being really engaged with work can be a great thing but it can also be really bad if you're not paying attention to posture, taking breaks, stretching, etc.

sooo... I have my surgery booked. May 9th it is. I was NOT expecting it to be so soon. Here it's more like 2-3 MONTH wait for surgeries (unless it's very urgent). especially the hospital mine is being performed at.

now.. i'm just freaking out about the fact if there are no private rooms available the day of admission. If I get a semi-private and have to share. OMG! i'm sort of a clean freak, and the fact I will not be the most pleasant person to deal with after surgery, if anyone gets on my nerves (I am NOT nice).

what is going through my head is "how clean is the bed", "how clean is the washroom", "seriously I have to share a room"?, "NOONE better use the freaking patient washroom other than PATIENTS!", "There better not be many visitors if there is another person", and "they better NOT be screaming when the so call talk", "no one better bring in food that are strong" OR PREPARE IT (yes a friend of mine, she had just given birth, and her room-mate's husband brought in a portable cooker, and was cooking some sort of Chinese/Korean food).

I swear I am brining Lysol cleansing wipes with me (no joke).

and being aware than I won't be able to/ or can't clean is getting me anxious (even though I know i'll be cleaning the crap out of my place before hand).

Sorry for the rant. just a lot going through my head right now.... AHHH!.

You might share some of those concerns with your surgeon, maybe they can do something to help alleviate some of the stress about it.

I am 3 weeks post-op from a first rib resection and now doing pretty well, but still on oxycodone, although significantly lower dosages then the first couple weeks. The first 2 weeks were a bit tough for me in terms of post-operative pain and to be honest with you I had to be re-admitted once for another few days for IV pain control. I am a registered nurse in a busy Boston ER so I probably will not be able to go back to work for another month or so, which is right on target per my surgeon. If I had a less physical job, I could foresee going back sooner.

Best, Lisa :)

Thanks for the feedback. previous extensive surgeries (non-rib related), we found out, narcotics don't work for me. the strongest meds they could prescribe is hydromorphone, and being allergic to NSAIDS is the other issue (in terms of inflammation). I will just have to find out, tomorrow's my 5 HOUR (pre-op assessment - not looking forward to having to take the day off work). i'm just hoping something can sorted out. Thank you again for the feedback. It's very helpful to know what I should somewhat expect.

Good luck. I took hydromorphone for the post surgical pain. Unfortunately, I still take it 8 years later, but that's another story.

I'll be sending positive thoughts your way.

How are you doing?
 

I'm 18 days post-op first rib resection and doing pretty well. Curious about others' recovery. Started PT yesterday and am definitely sore, but not horrible pain or anything.

Also very curious on how you are doing after your surgery so far? Also, who was your surgeon? I am originally from TO and if I knew of a good surgeon there, I would consider him/her since my immediate family lives there.

Hi parbie,

Dr. de Perrot (thoracic surgeon) at TGH. he's AMAZING!! I definitely recommend him .

Unfortunately, they couldn't do the full resection due to the extensive damage they found when they opened me up. They ended up removing "ALOT" (docs words) of scar tissue which was attached to the bone, and nerves (which was causing the numbness in the entire right arm), and that was causing severe compression on the subclavian vein (making my hand go purple/ blue). So pretty much he said they scrapped the crap out of inner part of the 1st rib, and removed as much scar tissue as possible without causing too much damage.

Surgery was 1.5 weeks ago. still in ALOT of pain (still needing pain meds every 3 hours) - severe lack of sleep (3:29 am right now - have only slept about 3 hours in the past 48). i have limitations with the movement of my right arm (which is to be expected) - THANK GOD! for the advice from kellysf & BDBomg about using a sling - this has been a life saver!!

My battle scar is located at the base of my neck on the right side (lovely 3.5 inches) plus a nice ugly hole below that where they had to put a drain in.

Unfortunately, i'm still having all the same symptoms I had previous to the surgery (discolouration, numbness) - i'm hoping this is only due to the swelling. only time will tell.

follow-up with the surgeon is in another 2.5 weeks. They said they only wanted to see me in the office once the pathology reports are in (which is kind of strange, if it's only scar tissue what's the concern?).

I will write another update within the next few weeks on the recovery progress.


Katie

My nerves were really aggravated after surgery. It took almost 2 months for it to calm down so don't get too discouraged. As my surgeon said, "Nerves can't take a joke." Just be REALLY gentle with yourself.

Take care,
Kelly

Hi Katie,

I hope your recovery goes as smoothly as possible! Thanks for the response, really appreciate it. Would you happen to know how much experience Dr. de Perrot has specifically with treating TOS? I did not think there were ANY experienced surgeons in Toronto and having one there even just to consult with would be so great. Also, how long did you have to wait to be seen by him?

Help post op
 

I believe from your post that you live in Canada and I am unaware of their policies for help. I told my Dr. that I will have NO help which concerned me to no end. I called my insurance company (Medicare and AARP supplement) and asked what the circumstance would be for me to either go to a re-had after the hospital or have someone from the VNA (Visiting Nurses). The told me that you must be in the hospital 4 days, not come out on the 4th day, be in the hospital a full 4 days in order to qualify for the re-hab and your doctor must request it in writing. I will be in 2 days. The qualifications for the VNA are the the doctor request it. When I told the doctor I would have no help he said, don't worry at all about it. When you are in the hospital the VNA will come to you and make the arrangements. My insurance co said you are allowed to have the VNA 1-8 hrs a day depending upon need. I surely hope this can help you because I know the fear and insecurity of feeling alone without help. Let me know what you find out about getting help because now I'm worried about you. Maybe you were unaware there may be help. Don't be afraid to ASK for HELP, please.

Irisheyesmilin

Hi Parbie,

I'm not 100% sure as to how many TOS patients he has seen. my referring Dr. (from Mt. Sinai) has referred 2 prior patients (dx with TOS) and he stated 1 of the 2 had surgery - and it was a success (the other pt refused, and sent for vascular physio ?). I think you're right i'm not sure if there is a specialist surgeon who treats patients with TOS specifically. Although i'm sooo glad he's my doctor, I completely recommend him. in terms of wait times (I was shocked! when i got a phone call within 2 weeks - usually it's 2-4 MONTH wait), and my appointment was made for early the following week. His assistant (sue) is fabulous! i'm not sure if I was having good luck or what! within a month I had 2 appointments a CT Scan, and was booked for surgery - and 3 weeks after I had my surgery (surgical wait times here are like a minimum of 4-6months if your lucky). Although waiting in the clinic is different beware you might have to wait up to 2 hours.

If you have anymore questions, please don't hesitate to ask.


Toronto, Canada

Unfortunately here in Canada is sort of the same. I have "sunlife" (private insurance) and I am only able to use $400.00 worth of physiotherapy/homecare nurses a year (Plus I need a request from my dr). which is like 5 physio treatments, and the closest one to me is a 30min walk. I was given a booklet of physio exercises I'm to do, my biggest issue is the nerves that are healing still (keep dropping things) - embarrassed to say yesterday alone i broke a pint glass, coffee mug, small plate, and a magic bullet cup with banana smoothie all over my floor. So far this morning it's been good nothing broken.

I see my surgeon on tuesday, i'll talk to him about physio (or if it is just the healing process thats taken it's toll on me) and not realizing my limitations due to surgery.

thank you for your suggestions

Toronto, Canada

Thanks for the response! Yes I am very aware of the wait time hence why I like the US healthcare system, as expensive as it may be, way better than Canadian. I am Canadian but have been living in the US for 5+ years and coming back for a year maybe more after my redo surgery and left side surgery with Dr. Donahue. I just wanted to make sure I wasn't missing anything about there being a specialist even closer to home that I wasn't aware of. Good luck with your surgery!

Sooo, I saw my surgeon for a follow-up today. conflicting details, my parents (who were with me the day of surgery) said the surgeon told them he didn't remove the 1st rib but only "alot of scar tissue". well today during my follow-up I wanted confirm what was actually done, and he said infact, yes he did remove the rib, alot of scar tissue, and a bit of muscle (to relieve pressure on my nerves/vein). So far all the symptoms I had before the surgery I still have, although I was reassured it's still in the healing process so it's nothing to worry about just yet, it's probably just inflammation (which makes sense). I've been told i'll be off work for at least another 1.5 weeks, and need to see my referring dr before I can go back full-time or starting back as part-time (mid-june), which is going to be a challenge - his secretary is a b---- hope an email to the dr himself might help?, plus I'm going to try and get both consults/OR report for my own records.

My biggest issue right now is trying to relax, letting my body heal! I can't seem to sit still (I feel like if i keep myself occupied i'll get back into things) which is defiantly not working in my favour right now. Going out for a walk (trying to at least once a day) but my deep breathing issue is getting in my way, plus (has anyone had severe pain when out walking - ie. in the upper chest area?) - i usually end up in tears on my way home (not sure if it's just part of the healing process?) I'm still trying not to lift more than 5lbs which is harder said than done.

PRAYING! I the feeling in my arm comes back soon - frustrating as hell when i'm breaking dishes every other day (thank god for cheap dish sets) - guess I should invest in some plastic dishes...

I'll keep my progress updated!


Katie

I'm really concerned you're doing too much. Returning from a walk in tears is not conducive to healing. Take stock of how you're actually feeling -- as opposed to how you want to be feeling -- and act accordingly.

Take care,
Kelly

The vascular surgeon who wants to do surgery on me said I won't be able to return to work for at least 3 months. This would be after removal of a cervical rib, scalenectomy, and removal of scar tissue.

3 weeks sounds way too soon from what I have read of others experiences, but what do I know?

Hi, twelveleaves


oh wow 3 months? Cervical rib is a little different from my case, Cervical is an extra rib (so your surgery might be more complicated due to the anatomy in which the rib grew and what structures it has effected). Thankfully I didn't have the cervical rib, I just 1st rib (the regular rib) removal, scalenectomy, aswell as scar tissue removal . Do you happen to know the approach (the way) they are doing your surgery? (under the armpit?).

I was caught off guard when I woke up after surgery, I thought my incision was going to be under the collarbone, but it was on the side on my neck (roughly 3 inches vertical and above and along the collarbone). I'm curious if anyone has had this approach?

I'm seeing my referring physician on June 10th, to fill out my "return to work" documents. My surgery was on May 16th. so just over the 3 week mark. I'll find out then if i'll be on modified work duties (my surgeon stated I might have to work part-time at first), or if i'm still going to be off work longer. I'm hoping he'll state when I do go back to work, I have to work from home (due to the weight limitations) - I never knew how hard it was going to be not lifting more than 5lbs (being a women my purse/bag comes very close to that 5lbs mark).

I guess it's just to see how the progress is in the recovery process, yesterday and today's been a rough day - a bed ridden day. Pain is still the biggest concern as my pain meds are almost gone, which i'll have to switch back to my old prescription - praying it helps, even a little. Aswell as my breathing is a huge issue still (it's hard to breathe deeply - and painful) - having mild asthma is also a concern i'm just hoping a attack doesn't happen . the last 3 days here in Toronto have been Heat Advisories - therefore housebound - which sucks.


Anyways good luck on your surgery!! let me know how everything turned out!


Katie

sooooo..... my recovery is going to be a bit more complicated than I thought. came down with a case of shingles on my face - totally obvious (on the right side of my nose, and a patch just below my eye) and because pain is very common with singles... my jaw is killing me and having severe chronic right TMJ pain (jaw joint) is obviously NOT helping, also the pain has spread to my neck, shoulder and close to where the rib was removed, and headaches are another story... the Dr is pretty sure because the surgery was so recent, and I haven't been eating much, being in pain, lack of sleep, and just in general run down, it might have triggered an outbreak.

Seriously... of all times...

follow-up surgical appointment is in 8 days, I will post an update.


Hope everyone else is feeling good!


Katie

Katie,

My understanding is that surgeries involving cervical ribs are actually more straight forward. They also have better outcomes that do surgeries that stem from gradual, repetitive "injuries."

I did not have cervical ribs. I was told recovery would be 6-12 months. The surgeon also told me that I should not go back to the job that caused the problem in the first place (attorney) because the likelihood of re-injury was too great. In my case, I never went back to work (that was 8.5 years ago).

The recovery time provided by the surgeon is less important simply taking an honest appraisal of how you are feeling. I'm really sorry you now have shingles in addition to the surgical recovery to contend with.

Take care,
Kelly

So sorry to hear about the shingles and all the complications Katie! I had the same experience as kellysf regarding realistic recovery time even with cervical ribs. Having them doesn't mean recovery is any shorter, it can mean better recovery based on research and since mine isn't out, and my TOS has gone on longer than should of because of my surgeon basically not doing what he said he was going to do, my case is different from the"norm". But I think you really need to take it easy and please look into a home health care nurse as suggested by someone else. I am originally from Canada and came back to recover following my first surgery for 2 months. I got private health ins fairly cheap and home health care would be provided if in your situation, having no one to care for you. And PLEASE do not carry a purse. DO everything you can to watch your limits and listen to your body. At the end of the day, everyone is different so one dr cannot even say 3 weeks or 3 months, it all depends on the surgery and the person's overall health, job, support system....basically a variety of different factors. Take all of these things into account. I made the mistake of trying to go back to work by job hunting/interviewing for a new one to accommodate me and I could not even handle that. But again, everyone's situation is different. I hope you feel better soon!

Thanks guys,

Update. my return to work date as been postponed now until July 1st (I was scheduled to go back June 12th). I have been taking it easy I think I've defiantly learned my lesson - I'm glad it's been postponed will be relaxing as much as possible. Now my biggest hassle now is dealing with my work. you have no idea how clueless people can be when you state "cannot lift/pull or push anything more than 5 lbs" seriously they ALL said "can't you use a laptop bag you can pull" like DUHHHH.. do people not know what stairs are (you must use to lift up curbs, on and off buses, dealing with the subway is another issue and WALKING up stairs to street level (they don't have escalators) and doing all of this during rush hour and in Toronto??? No thanks!!! Dr's orders are until at least August 2nd not to lift weight (Which I'm listening to). Now, it's time to deal with the BS with work, and all the documents that have to be done with both work and the government for unpaid medical leave. Fingers crossed there won't be anymore issues....


I hope everyone is doing well!!

Katie

Hey guys,

I've got a question, Did anyone have any issues with shortness of breathe after surgery? it's been almost a month post-op, and it's definitely bothersome, I had Xray last week, when the shingles started the dr noticed i was struggling to breathe in the office (I was trying not to make it that obvious), I don't know if others have had it, it feels like i sort of panic if I cant' breathe for like 5-10 seconds. Dr. was concerned enough to personally drive to the closest clinic to do an emergency Xrays, Thankfully no pneuothorax (which he thought I had). I'm just curious if anyone has had this? how long did it last for? I saw my dr 2 days ago and he just said "It was a potential side effect, which a few patients have, it should resolve over time"... what is the definition of "time". I'd really like to know from actual patients who have had this.

please let me know!

Thanks,
Katie

yes it is a side affect.....in My case though, I had complications that reqiured 2 extra surgeries due to "Chyle Lymph Leaks" ( now 29 months post op) which caused damage to the Phrenic Nerve and my diaphragm was elevated into my lung and unfortunately continued to about 20 months post surgeries.......early on had bouts of bronchitis, chest tightness and terrible cough.....I still have shortness of breath when I do too much.....it is a very scary thing and doing "diaphragmatic breathing" is helpful but I still have great fatigue and other complications due to those extra surgeries.

chloecasey

Oh My.... i'm so sorry to hear about all the complications.... thank you for answering, I wasn't sure how common it is or how long it might last. I will try to do diaphragmatic breathing, i'm hoping it will help.

I hope your recovering well!

Thank you again!

Katie

Hi Katie,

Your shortness of breath would be a touch of pleurisy which should not take too long to get over. The rib cage generally assists with all things breathing and a full rib resection can have an impact on some peoples ability to breath as easily as they used to be able to. If your surgeon happened to touch the Pleura (the lining surrounding the lungs) during surgery, you will get a bit of irritation and inflammation until it settles also.

Did you have shortness of breath in hospital as well? I couldn't walk five yards without needing a rest. I couldn't talk and walk at the same time, which some thought was a good thing...

Shortness of breath is not mentioned often in these forums but you can be confident that you should get over it after a while. Remember to keep warm when it gets colder again.