Denver - Dr. Sanders and Dr. Annest
 

So I am in Denver now. I have the pec minor scheduled for Thursday.

I met Dr. Sanders first, he did a block (lidocane) on the left side for the pec minor first, overall I had about 20% symptom relief from this. Then he did the left side for the scalene muscle, this gave me a 50-70% relief in symptoms. Based on this, I will be doing the scalenectomy and first rib resection as soon as the schedule permits - February or March.

Anyway, for those who were wondering, Dr. Sanders is real, alive, and still working. However, he only does diagnostics and is also present for the surgery - Dr. Annest is the surgeon. For those deciding what kind of surgery to have, he look at page 182 of his book - then flip roughly two pages, for success rates of the surgeries.

I have had TOS for ten years, so what i have experienced as pain, I describe as "achy" or "painful stretching" not generally a sharp pain. With the blocks having the pain be gone was weird, it was as if I was missing a body part or something, I am so used to the pain, it has become a part of me.

Next I went to Dr. Annest, he had a very thick file on me, I had my doctors send basically everything about me for the past 10 years. Based on my file, and my language it was apparently pretty evident to Dr. Annest, that I knew what I was there for and what I wanted. He gave me a thorough exam and agreed to do the pec minor surgery as scheduled. He also went over the risks and possible complications and let me know that it was possible that the surgery would do anything for me.

Anyway, I am feeling pretty confident in their abilities, hopefully all goes well. If at the end of it, I only have 50% improvement in my symptoms, it will be worth it.

Lots of luck and keep us posted on your recovery-jkl

Dr.Annest is amazing, frank and surgically talented. Thank goodness he gives no false hopes, but his hands are the best to address needs. If he feels a surgery may help, that is a great start. We don't talk cures, but minimize symptoms, remission and free up of problem areas.

After surgery caring for yourself not to flare by old activities is best. I have not had surgery. Two family members have, but not pec minor.
Best of luck,
Di

Yes Dr. Annest cleaned out the scarr tissue from my brachial plexus. I didn't know he word be doing that. Some of my fingertips can feel things. It is pretty cool, you hands that feel. Lol.

Eight -- thank you so much for this post!

I just read a very interesting book chapter by Sanders and was wondering if he was still practicing.

The chapter mentioned that they (assuming Sanders/Annest) perform scalenectomy with "selective" first rib resection through supraclavicular approach for NTOS. The decision for rib resection is based on the relationship between first rib and lower trunk of plexus. Using this method they have removed ribs in only about 15% of the last 150 patients that they operated on during the previous 2 years. (the book was copyrighted 2007).

Do you know if this is still their approach? Do they only remove the rib based on what they see?

I am very interested in learning more about scalenectomy-only approaches and who is doing them.

In the chapter, Sanders also noted:
"We continue to note no difference in results between those with rib resections and those without rib resections."

Since you have seen them recently -- any additional info would be *most* appreciated!

I thought I remembered a post abut Dr Sanders retiring.. 2009 - here -
http://neurotalk.psychcentral.com/sh...ght=dr+Sanders

From Eight's post...it sounds like Sanders is still involved in patient exams and diagnostics but is not performing surgeries. Perhaps Eight can provide more clarification on their arrangment and surgical approach ??

Dr Sanders is retiring but has trained Dr. Annest who I believe does all the surgeries. Dr. Sanders still does consults(as of 2 years ago) and he will talk to you over the phone. I had an e-mail exchange with him. i was interested in scalenectomy only and researche this as well. After I did extensive PT with dr. Ando my ribs seemed to be more of a problem then my scalenes. I hardly have any scalene pain anymore, mostly trapezius so I stopped. Dr. Johansen in Seattle and Dr. Brown in San Diego also use this approach.

Alot of people seem to have good experiences with Sanders/Annest but Parbie on this Forum had a bad surgery with Dr. Annest. You should read these threads too Also there was a forum member who wrote about her experiences with Dr. Brown, she ended up having a rib resection after they opened her up so she didint get to choose the vascular surgeon.

I have learned that it sometimes seems so great when you read some of these Dr's studies, but it doesnt always translate into great care or surgery.Sorry to be negative, but I recently had this experience with Dr. Fish here at UCLA. He wrote 3 articles about TOS and Shoulder and neck pain and long thoracic nerve injury.I thought maybe I could get some clarification on whether my pain is caused by my bulging disc or TOS or a LTN injury. I finally went to see him recently and was SOOO DISAPPOINTED.He saw me for 5 min, looked at my mri, said I needed an epidural but I would have to be in pain to do it even tho you have to schedule it a month in advance and told me the only thing to do for the TOS was to get the surgery and he recommended Dr. Ahn who I have seen and would not choose.

Dr. Sanders saw me and did a lidocaine block in my pec minor and anterior scalene to diagnose me on December 3, 2013. He assisted Dr. Annest with my pec minor surgery on December 5, 2013.

Dr. Sanders is in his late 70's or early 80's.

Dr. Annest is a good surgeon. I would have had surgery with him, I still would. Dr. Annest won't operate on me again because I didn't recover well from the pec minor, and because I had a brachial plexus injury at birth too. He and Dr. Sanders decided I was not a good candidate for surgery.

Oh, and regarding the trap pain, my trap pain went away, like completely, totally all gone now after both the anterior and median scalene blocks **BOTOX, not blocks** (it is good to have a pec minor block with this too, but I already had the pec minor release).

mine didit go away from the scalene blocks or botox, thats why I am going to try the epidural. Why do you think a pec minor relea
se would help with Trap pain?

I had surgery with Annest/Sanders in 2012. They performed scalenectomy and rib resection. Based on my situation the doctors felt like that was the best option. I felt like all options were considered and they did the surgery that fit my circumstances. The outcome so far couldn't be better. Good luck!

Oops, sorry, botox, not blocks. Did you just have the anterior scalene Botoxed? My trap pain didn't go away completely until I had both the anterior AND then I flew back to Boston six weeks later and got the median scalenes Botoxed too. If pec minor is an issue too, it can be Botoxed as well.

I noticed the pec minor was an issue for me after reading forums on here. :D

Thanks for all the info on Sanders/Annest.

JKL - thanks for pointing out those additional threads. I'll definitely take a look. Regarding scalenectomy-only, perhaps we can exchange notes on this. I am currently trying to learn everything I can about this option. I'll send you a PM. Although, I do have my first appointment with Art Ando tomorrow...maybe my neck pain will go away too!!

About trapezius pain, I recently read this:

"Often patients with TOS have muscle guarding
in the upper trapezius as a protective mechanism
because of the thoracic outlet pain and muscle
imbalance. Deep fascial and trigger point massage
release especially of the trapezius and rhomboid
muscles therefore may be helpful [28]."

TosDad - I'm *thrilled* to hear of your positive outcome, especially 2 years post-op. Just awesome! Did you, by any chance, have neurogenic TOS? Would you mind sharing some of your symptoms pre-op? I am really hoping to find some positive NTOS outcomes...somewhere...

many thanks -

I had it all done-in about 5 places. I had abad reaction and couldnt move my shoulder ofr arm for a week. Dr Jordan did it and hes an expert.

Cyclist, I did have neurogenic tos. On and off for 10+ years, the last two were a nightmare. Symptoms started around my shoulder blade but progress to extreme pain throughout my shoulder and arm. With constant tingling and numbness of my hand and fingers. I am a cyclist, and would lose complete feeling on my affected side. Good luck on getting better!

Wow. Your symptoms were quite severe...making your successful outcome even more encouraging. Thank you so much for taking the time to post. I really appreciate it. Wishing you continued success and many pain-free miles ahead...