I saw Dr. Gelabart at UCLA today and he is by far my favorite Surgeon out of the 3 that are in L.A. A really caring and nice man. Fairly thorough although did not look at my mri's,just saw reports.Asked alot of questions.Kept saying "Interesting" when he was examining me He said that Dr. Jordan usually only refers patients to him that have failed his injections .etc, He saw no arterial and venous symptoms. Suggested I try Facet Block injections or Cervical Epidural just to rule out the disc bulge and stenosis being the cause of my pain before doing Surgery. He does Trasaxilary Rib Resection and partial scalenctomy.He thinks this is the superior way to go. says he has a 90% success rate. Once in a while a patient comes back to get a full scalenectomy. He says the scalpular pain only has about a 50% chance of getting resolved but arm pain is usually better. he didnt know statistics on the shoulder pain (Traps,pec minor) etc because not everyone has that pain so they dont keep track of that. He relys mostly on the scalene block test( They all do) so I would want to repeat that if I decide to proceed with surgery since I think it was questionable weather it worked or not. He didnt think Ahn's Angiogram or angioplasty test was a good idea,or that the MRA was necessary. he was so-so on a Mac or SSEP test.(Has anyone had either of these? Were they helpful in the Diagnosis? Where did you have them done?I'm particulary interested in the Mac,because my pec Minor is really tight.)
He gave me a 3 page doc on TOS which describes all the tests etc. I decided to pay cash because he is out of network on my insurance and he only charged $200 for the visit. it would have been $700 if they billed insurance. If I decided to do surgery, I would have to wait until August anyway when my insurance changes to Blue Cross(keeping fingers crossed this happens)

Dr. Ahn said I had Arterial and Venous symptoms because my veins stuck out of my neck and my pulse on right side was lower. No else has said this,so dont really beleive him. He wants everyone to do an Angiogram/Angioplasty so he can see where the impingement is and decide then which operation to do.He will either do Rib-Resection/Scalenectomy or Pec Minor Tenotomy, so he is the most versatile.I just didnt get a great feeling about him. in a way his approach makes sense,but just seems very invasive especially because I dont have any arterial symptoms. I beleive he is writing a paper on this and like nospam,I dont want to be a guniea pig.

I also saw Dr. Mckenna at Cedars Sinai. He hardly examined me at all. thought my left side pulse was worse than right,but said that test is unreliable.He was the most conservative,said to try more injections,pt etc He takes the whole rib out,no scalenectomy.Didnt feel particularly confident with him. He has some kind of tic that makes him look like he is going to sleep when he is talking to you. also I heard a horror story about a botched surgery from another Dr. Probabl would not go with him.. He is not on my insurance yet either. His visit was $600 through insurance. I will probably end up paying 400 of it.



If I had to choose today I would go with Dr. Gellabart,but luckily I dont. i have been doing PT with Dr Ando(No-spams PT) and I am feeling better overall but have had a couple of flare-ups lately. i am going to give it a few more months and if I still cant go back to work by August or September I will
consider it again. Of course I go back and forth depending on how bad the pain gets.This summer i may check into the Denver Dr's or at least call Dr. Sanders on the phone.

I see Dr. Jordan next week and will discuss the surgeons with him and injections again and see who he recommends for the facet block or epidural. and also make him take a look at my cervical MRI as I didnt have it last time and we want to revisit that.

i still will probably try the neural prolotherapy at Orthohealing if I continue to have flare-ups,before I go with the facet block or epidural. I hate how I have to do these invasive injections just to rule something out. I was also told they could make things worse for the nerves and muscles by Dr. Gart(Pain Dr. at Cedars)

FYI Dr. Sanders in Denver no longer performs surgery. I was doing some research and found this out last week.

yes but he will consult with you over the phone and he supervises Dr. Annest. ther is also Dr. Brantigan there.

This is an ages old situation. I flew to Denver and saw both Brantigan and Annest. I chose Annest and the Presbyterian Hospital for my brachial plexy and scalenctomy, as they do many, many each week, and I liked Annest's professional attitude by saying "I may only save you 10% of your pain, this is risky, do you still want it?" As my RSD was growing wildly with the TOS right behind it, I said, "yes."

It is my OPINION that many moons ago Brantigan and Annest studied under Sanders, then the two tried a partnership, but were so different in mind-set that they split. Annest is one walkway away from his hospital. Brantigan suggested (rightly so) that I had more than just TOS going on, but I have had every test possible, and he said there are more neurological diseases than we can ever know.

I do feel that the computer is to blame.

I agree that you should try the facet and epidural injections to know what pain is coming from where (I got relief from my cervical symptoms from the facet blocks). Gelabert wanted me to do SSEP only because I had a negative scalene block previously. He also wanted to repeat the scalene block as well. He said the MAC wasn't necessary as I had a recent EMG. He referred me to David Fish at UCLA for this testing. It took weeks for Dr. Fish's office to receive the official referral from Gelabert's assistant and offer to schedule me for testing. By that time I had found Dr. Angle and was already scheduled for surgery. Dr. Fish's office seemed very nice though.

Dr. Ahn and Angle were unimpressed that my scalene block was negative as they felt it was not a reliable indicator for surgery. My problems turned out to be my ribs and not my scalenes. I wish I would have learned more back in 2010 when I failed the scalene block and I thought I didn't have TOS.

[QUOTE=nospam;884679
Dr. Ahn and Angle were unimpressed that my scalene block was negative as they felt it was not a reliable indicator for surgery. My problems turned out to be my ribs and not my scalenes. I wish I would have learned more back in 2010 when I failed the scalene block and I thought I didn't have TOS.[/QUOTE]

Dr. Ellis doesn't do scalene blocks. When I saw him, he offered heparin injections in key trigger areas. They were not areas which needed to be done under guidance.

Marc: Since your scalene block was unimpressive, did Ahn or any other surgeon suggest the Collins MRI and if not, why?

JKL: Has anyone wanted you to have this MRI as well? I'm mostly curious as his Northern CA counterpart's study is viewed as solid info. The geographical differences in diagnostic testing makes TOS all that more frustrating. Good luck to you with Ando. I hope you find relief and answers.

When my scalene block with Dr. Vernon Williams was unsuccessful (2010) I was never able to get back in to see him. I was suffering and his office only offered me an appointment 6 weeks away. My wife and I assumed that I did not have TOS. I sought out a new neurologist and neurosurgeon. There was evidence of cervical radiculopathy and I went through with cervical fusion surgery which was successful in eliminating many of my symptoms.

In the year following the fusion, some of my symptoms did not disappear and started getting worse. My doctors were overly thorough in verifying the fusion was successful. I also had another EMG which eliminated carpal and cubital tunnel as well, but had some suspicious C8-T1 readings which could point to TOS.

When I started seeing the vascular guys, they all said that failing the scalene block doesn't mean you don't have TOS. Gelabert wanted me to repeat the scalene block as it is his main indicator for selecting surgical candidates. Dr. Ahn and Angle both felt the scalene block was unreliable and didn't think I needed to repeat it.

I also had the MRI of the Brachial Plexus from Dr. Tsuruda in Pasadena that Dr. Williams had ordered in 2010. It showed neural edema and increased neural signal. Dr. Gelabert said Tsuruda does good studies and there was no need for Collins' study. Gelabert also wanted me to have the SSEP test since it was likely I would fail the scalene block again.

Dr. Ahn completely ignored all of my prior tests and said I had clinical signs of vascular and neurogenic TOS but would not discuss surgical options until I underwent his angiogram/angioplasty. Dr. Fujitani wanted to repeat everything, including my cervical fusion workup so I didn't want to reinvent the wheel with him.

Dr. Angle looked at all of my previous studies but said he mainly relies on clinical evidence as the imaging never tells the full story of what he finds in surgery. Clinically he found evidence of both vascular and neurogenic TOS. At my request (he didn't find it necessary), Angle ordered MRI/MRA which showed evidence of venous TOS with my arms overhead. None of the testing showed exactly what Dr. Angle found in surgery. The costoclavicular space was extremely tight on both sides. My left brachial plexus was fused to the rib. My right rib was in an odd position and was attached to the lung pleura.

Dr. Ando was key to me choosing to go through with rib resection surgery. Originally, I wanted to just do therapy or get scalenectomy only. My previous therapists were never able to get my 1st ribs to lower. In two weeks of trying, Ando was not able to get my 1st ribs to budge. However, he did reveal to me why. The ribs below were pushing up on the first rib (subluxations and torsions). This convinced me that my problem was rib related and not scalene related. My ribs have been easier for Ando to align on the left side since I had the resection. I will start therapy on the right side next week.

Dr. Ando has mention that to me too about the ribs below being a problem. I havent gotten him to let me know if he is able to lower my first rib. I will press him on this. My scalenes were very sore before the botox so I think the injections helped. And my scalene block was positve but I do want to retake it at some pt.as I am the only one not convinced! My worst pain has always been muscle pain Traps,Rhomboids , Scalpular and I'm not sure what causes this. The nerve pain is usually from overuse or overstreching.

Anne:I had a brachial plexus MRI at Oak Tree in PAsadena It shows Neural Edema and helped my first Dr. Williams confirm a TOS Diagnosis. .I dont know if it differs from Collins or Dr. Werden's I think collins does MRA and other tests as well.Dr. Jordan doesnt think much of the MRI or the EMG/NCV. He relies on physical exam and scalene block to diagnose me. Dr. Gelabart didnt think either the Mac or SSEP was necessary but he did mention that the neural Edema points to the diagnosis. I would just rather do the MAC or SSEP before I do an Epidural or Facet Block when I know I have TOS. But I may have "double crush" symptoms whcih means the disc bulge could be causing some of my symptoms. I am going to make Dr. J look at my cervical MRI again since he is also a neurologist and decide what would be next.I also would rather have all the tests before I undrgo surgery if I can get them covered by my insurance. Dr. fish is not on my insurance right now and I dont know if anyone else in L.A. does them

This is where mine was done as well, Jay S. Tsuruda was the radiologist and Gelabert knew him and said it was a good study with very clear images.