Ok, had two additional appts. yesterday. The first, a follow-up with vascular surgeon Adam Vernadakis at Lahey Clinic and then second, a 2nd opinion with Dr. Dean M. Donahue at Mass General.

The good news: Surgery is not in the cards...at least not immediately.

I first met with Dr. Vernadakis. He had previously felt the "bruit" over my subclavian artery and had me rushing off to surgery "sooner rather than later" 2-3 weeks ago. He informed me that the test results showed everything fine with hands held down, but there was definitely a kink in the subclavian artery with hands held up. That said, blood flow was excellent and it didn't appear that there was any damage to the artery. This alone had him backtracking on the surgical option. Additionally, he felt my bruit and indicated that it didn't sound as bad this time around. All this in combination with my diminishing symptoms had him put me in a "wait and see" type mode.

Dr. Vernadakis also indicated that there was no cervical rib or boney abnormality causing the problem. In his mind, the anterior scalene muscle was acting like a "rubber band" over the subclavian artery. If we had to go surgery, he indicated I'd need one month of rest and after two months I'd be good to go. Didn't sound so bad. He also indicated that he had done this procedure "30-40 times." Not sure if this is a lot or not. One interesting tidbit: I asked him about CT guided botox to shrink the scalene muscles. Nope. Will not do it. Too dangerous he said. I thought this was odd.

A couple other things on Dr. Vernadakis. He has a little bit of a "nutty professor" type personality. It didn't make me very comfortable. A little young as well. This, combined with his quick rush to surgical judgement and now a backpeddaling, has me a little uncomfortable with him as a potential surgeon. Something I would keep in mind when talking to Dr. Donahue later.

So anyway, I left feeling a bit relieved. Still, I had Dr. Donahue to come and I felt, based on opinions here and research elsewhere, that this was THE guy to talk to so I wasn't holding my breathe.

Later in the afternoon, I met up with Dr. Donahue at Mass General. When I met him he had just come out of an 8 hour TOS surgery for a minor league baseball player. Immediately I felt "I'm in the right place." My first reaction:

* Of all the multitude of doctors I have seen over the last two years this was without a doubt the nicest, most understanding of the bunch.

What a great guy. Unlike so many, he really understands TOS and LISTENS to you. Dr. Donahue just has a great way about him and he makes you feel very comfortable. This was entirely different than Dr. Vernadakis.

A full battery of physical exams were then executed along with a discussion of my history. Dr. Donahue then went on to explain that he is NOT quick to diagnose TOS and refused to do so with me. He indicated that he had looked at the MRA that showed the subaclavian artery tightness along with all the ultrasound tests, but he wasn't sold. He doesn't think MRAs are 100% correct and wanted to pursue more exploratory tests that were unique to Mass General. I thought his attitude towards TOS was great and clearly, Dr. Donahue was going to go the "extra mile" here. Even more, it's clear that Mass General has the testing firepower to do so.

Dr. Donahue does have a hypothesis of what is going on with me. He thinks that I do have an abnormality in my scalene muscle. Apparently, it's possible that my insertion makes me predisposed to scalene muscle tightness. This is consistent with Dr. Vernadakis, BUT Dr. Donahue's explanation dug much deeper.

So, next step: A unique CT Scan that was developed by Mass General that really takes a more detailed look at the anatomy around the thoracic outlet. If his hypothesis proves correct, the next step would indeed be a botox injection into the scalene muscle. Dr. Donahue indicated that he's used this teqhnique hundreds of times and apprx. 2/3s of his patients have symptoms clear up. This approach would also allow me to use a more aggressive physical therapy approach.

And lastly, Dr. Donahue DID NOT think I needed surgery. I thought this was shocking.

So, I'm somewhat relieved with the outcomes yesterday. First, I don't feel like I'm at risk of dropping dead. 2nd, it sounds like there could be a non-surgical path here. And lastly, even if I did need to go the surgical route, I am super comfortable with Dr. Donahue. I can't stress enough how impressed I was with him.

Hope this is helpful to others.

Thanks.

KY