I saw Dr. Donahue at Mass General in late March, now waiting for insurance company to give in. He's unbelievably NICE, patient, thorough. For TOS, he views surgery as the last choice, not the first, he said, explores everything else before deciding on surgery, as he wants to make sure it's the right thing to do, since it's so major. Considering all the idiots I've been sent round and round to, and how I feel about the entire medical "profession" at this point, that I would recommend anyone is kind of incredible.

I'll be calling both Dr Donahue and Messina today. Both are listed in MA on the ATOS website. Donahue appears to be one of the lead Drs. here.

What's scary is that if it weren't for my neurologic symptoms, I probably wouldn't have even uncovered this arterial issue since I don't display any of the arterial TOS symptoms.

Really feel like I need to get a measure of the severity of this "thrill" or bruit. I also wonder if some of us are walking around with these things and just don't know it.

KY

Hi ky, I just read your post and wanted to mention that I have a bruit on my right side despite a scalenectomy I had on that side 20 years ago. I'm not sure if that's the same thing as a thrill or not, but this was seven years ago that a Dr. pointed this out to me. So my point is, even after surgery, the bruit is still there. No one ever told me it was dangerous or anything to worry about.

Coop,

It's my understanding that a thrill is the same thing as a bruit.

That's interesting. And that's exactly what I'm trying to figure out...does the presence of a bruit mean that the only avenue is surgery? Or can you "live with it" as long as your symptoms remain stable? In your case, it looks like you're certainly living with it fine.

Question: Can you feel the bruit? That is, feel the blood flowing when you put your finger over it? It's a strange feeling. Usually, you should just feel a pulse, but in this case, it's almost like you can feel the blood moving through the space and "rubbing" against your finger.

Just got an appt. with Dr Messina. Not until July 18th. Working on Dr Donahue but can't make one until the secretary is back from vacation in 10 days (and how ridiculous is that).

KY

No, I can't really feel anything from the bruit. My hand swells a little sometimes but I don't feel anything weird like you're talking about. When I feel my pulse it seems normal.

From the links I read it seemed like the thrill is the vibration being felt with your fingers on the skin??

I used to have the bruit sounds - inside my head.. a whooshing pulse like sound. when I had the severe spasms.

http://www.google.com/search?q=bruit...ient=firefox-a


hmmm ...
[A bruit is an audible vascular sound associated with turbulent blood flow. Although usually heard with the stethoscope, such sounds may occasionally also be palpated as a thrill. In the head and neck, these auscultatory sounds may originate in the heart (cardiac valvular murmurs radiating to the neck), the cervical arteries (carotid artery bruits), the cervical veins (cervical venous hum), or arteriovenous (AV) connections (intracranial AV malformations). These sounds may be normal, innocent findings (i.e., a venous hum in a child) or may point to underlying pathology (i.e., a carotid artery bruit caused by atherosclerotic stenosis in an adult). Head and neck bruits loom especially important today because physicians encounter arterial occlusive disease more frequently as a greater proportion of our population lives longer.]
http://www.ncbi.nlm.nih.gov/books/NBK289/

Well clearly the Dr here is putting the MRA finding of a compressed subclavian artery together with the thrill and bam...not an innocent finding.

I've read that determining the severity of the situation by pressing on the thrill is art more than science. It's easy to misinterpret. Thus, the additional tests.

If anyone else had / has a bruit I'd be interested to here how this finding was linked to other TOS symptoms.

KY

Hopefully you'll find a surgeon who will be able to tell you the risks of embolism are small. One wonders what the significance of the thrill is if the MRA was ok in normal postures (Unless of course the thrill has only just appeared and wasn't present when the MRA was done)

Did your surgeon not say why he wanted to perform surgery (besides the obvious cash incentive)? Has he started you on aspirin or similar?

Yeah, that certainly would be ideal.

To be honest, I can't remember what the doctor's said when they were assessing the bruit while moving my arm around in different positions. I was so blown away with where the conversation was going (i.e. surgery) that it was hard to stay focused. The MRA clearly showed compression with hands above head, but not with hands below...I know that much.

Couple questions that I think need to be answered. Now, assuming that maybe I've eliminated some of the compression with all the stretching I'm doing:

1. Is it possible that the subclavian artery can heal on it's own?
2. Aren't there blood thinning drugs or other that could be taken to help the blood flow? Or even aspirin?

From my reading, once you get over the 60-70% blockage territory that's bad news. The question is, what do you do if you are under that mark? Other considerations: I don't smoke, my diet is solid, I'm in great cardiovascular shape -- in other words, I'd say that I don't have as many other risk factors as others.

Ultrasound and other tests today. Yippee.

KY

I have a bruit with my arm extended into some ridiculous position. It was visible in a MRA, and on manual feeling and listening. I believe much of the population has one when you contort your arm, so it is NOT isolated to TOS and isn't a diagnostic tool.

Go through the additional tests to explore it more, but I wouldn't base a surgical decision to have something removed from it, especially with no vascular symptoms.