Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 06-02-2012, 12:27 PM #11
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Originally Posted by Jlorainne View Post
"It seems that Dr. Thompson wants to throw the kitchen sink at you by decompressing all three potential areas of TOS compression:
  1. Scalene triangle (scalenectomy)
  2. Costoclavicular space (rib resection)
  3. Subcoracoid space (pec minor tenotomy)

What is the evidence that you have all three areas of compression and why are all three procedures necessary? "


I definately have all three areas of compression. Confirmed by others; not just Dr. T. Maybe he does do a one size fits all but from his success rate maybe one size fits most. Im not loving the idea of a surgical option. However several of my family members have had major surgeries to fix areas that cause massive pain. They have all said that it is 100% worth it.


I want to let everyone know that I appreciate all the feedback on here. I need these questions. Thanks

Jess
Hi Jess,
Did he say he wanted to do all three on you or is it that he just does all of those depending on the diagnosis.Thats what Dr. Ahn does after his Angiogram he can tell where the compression is.

How do you know you have all three areas of compression? I still dont know where my compression is and my scalene block was positive. Have you spoken with him since your scalene block and your visit with the pt? did you have the MAC test or how can you tell your pec minor is involved?

Sorry for so many questions , but it is important to understand everything before you commit to the surgery, also I am curious for myself.
Does he do all of these surgerys together? If he does then he is one of the only ones that does this.

ps sorry I just scrolled down and saw marc was asking some of the same questions.

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Old 06-02-2012, 02:47 PM #12
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Doing all 3 complete procedures require both transaxillary and supraclavicular incisions. I think the surgeons who remove the rib supraclavicularly do all 3 at once. I think the transaxillary rib guys prefer just doing partial scalenectomy (I've seen this called scalenotomy) and coming back later supraclavicularly for full scalenectomy only if necessary.

My surgeon said he has never had a need to perform the pec minor procedure.
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Old 06-02-2012, 06:45 PM #13
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It sounds like you've done your due diligence.

Good luck with surgery and congrats on the nuptials!

Please promise not to forget about us. Come back and update us on your progress.
You bet I will. All thru surgery and recovery.
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Old 06-04-2012, 04:00 PM #14
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I saw Dr. Thompson on Wednesday. He and his staff are wonderful. If you are in the midwest he is the guy to go see.
When you walk into his tiny new patient office you are bombarded with success stories. There are pictures, articles, athletic jerseys and thank yous covering his walls. All successful surgeries. Its overwhelming. It gave me hope that I could get my life back. He has a small staff. I met a few of them. He has surrounded himself with wonderful people. His secretary Della is an amazing kind woman she helped me with everything I needed. I had to call her several times and she was nothing but kind and patient.

Dr. Thompson's RN Valerie is also amazing. She was very patient in my exam and did not want me to push myself, because she understood the pain it would cause me. We talked for a while about my pain, symptoms, and my lifestyle. She asked about what makes pain worse or better. Then we did an East test. (hold your arms out to your sides like a touchdown sign. Arms bent at the elbow. So your arms and head look like a sideways E. Then make fists and then release, fists and release, the test is for three minutes.) It basically makes all your symptoms flair up all at once. I barely made it to 2 minutes. I was in excruciating pain and both hands were numb. She kept telling me to breethe. She also tested my range of motion and grip. Pretty standard stuff. She was patient and let me take breaks. She listened, it was amazing to talk to someone who understands this syndrome. Then we met with Dr. Thompson.

Dr. Thompson was not what I expected. He walked into the room introduced himself and sat down in a desk chair. He slouched and just looked like a friend getting comfy before a long chat. He was ready to listen and answer any questions. Which was good cause I had a lot. He checked my grip, range of motion, and pulse over my head. Then told me that I had scored very high on their tests. I asked if that ment I could go home. Or if that I was really bad. He laughed and said that I have definitely have neurogenic tos very bad. No arterial or venious. He said he wants to do surgery on both sides to remove the anterior and middle scalenes, my first rib. And split my pectoralis on both sides. Surgeries would be 6 weeks apart. In the hospital for 3-4 days and have to stay in St. Loius and extra 4-6 days just to make sure I'm close should any complications arise. He wanted me to do a scalene block and meet with a physical therapist before I made any decisions. He talked with me and my mother for over an hour. Answering all of my questions fully. He was wonderful. He said that he recommends surgery a lot, but that is because it works. He does at least 6 week and that 95% of his patients get to go back to their lives. They do a lot of surgeries and they do them very well.

Then I had the scalene block. One of the worst experieces of my life. It did not help my pain. All the nurses and Drs were wonderful. It is just not a fun procedure, and I do not tolerate needles well. I almost passed out from pain. It's a dull needle and they really had to push hard to get it into my muscle.


Last was the physical therapy appointment. Yes this was all on wednesday. A very long and painful day. The Physical therapist was amazing. Jeane was also very knowledgeable. It was so wonderful to have all these people who know and understand tos. She had some suggestions like sleeping with pillows and using pillows to lift my arms and shoulders to take pressure off my scalenes. It is amazing how much further in can move my neck in the elevated position. She thinks pt can help, but I cannot continue working for Starbucks. I have to change careers.

Dr. Thompson and his team are wonderful. Go see them. Yes, he is surgery happy, but if it works then I fail to see how that is bad. I told him that I would be writing about him on here. He said that was great. He would love to help more people. He is also doing research to help more people with tos and to help others understand it. That is very important to me. I am going to be part of a new study that keeps track of patients long after surgery to see the outcomes of tos surgery. He said that he thinks the surgeries will help me, and that after I can go back to my life. I will always have tos and some pain from time to time. However my pain will be at a one or two, not a nine or ten. I can stay at a job that I love. While the physical therapist said that I have to find a new career.

The thing that he said that stuck with me was that we, all tos sufferers, need to keep in mind that after surgery we are not just recovering from surgery but also from TOS. It's a long recovery. It will take time for nerves to mend and muscles to readjust. I haven't made up my mind yet, but I'm clearly leaning toward surgery. I want my life back and Dr. Thompson thinks he can give it to me. And judging by all the thank your and photos covering his office walls I believe that he can.

Jess
Thanks for posting all the info. My appt with Dr. Thompson is for June 20th. However I just started PT with a new therapist and it seems to be helping and making a little difference to my symptoms. I might move my appointment with him to July and give PT a chance.
I was just thinking is it possible for you to ask to talk to some of Dr. Thompson's patients who have had a somewhat similar case as yours and had to have all three procedures done and how are they feeling post surgery, possibly one who has had surgery not so long back and one who may have had one say more than 8-10 months back. I am specially concerned about the pect minor tenotomy.
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Old 06-04-2012, 10:43 PM #15
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Hi Jess,
Did he say he wanted to do all three on you or is it that he just does all of those depending on the diagnosis.Thats what Dr. Ahn does after his Angiogram he can tell where the compression is.

How do you know you have all three areas of compression? I still dont know where my compression is and my scalene block was positive. Have you spoken with him since your scalene block and your visit with the pt? did you have the MAC test or how can you tell your pec minor is involved?

Sorry for so many questions , but it is important to understand everything before you commit to the surgery, also I am curious for myself.
Does he do all of these surgerys together? If he does then he is one of the only ones that does this.
Julia

ps sorry I just scrolled down and saw marc was asking some of the same questions.
Dr. Donahue in ma noted the compression in all three places. Confirmed by my chiro. I'm going to call him in the morning. I have lots of questions as we have decided on surgery. Not sure what the mac test is. I have lots of pain in my pecs and they are very tight.

The questions are fine they help us all figure out what is going on. I still don't know everything. As far as surgery. He does one side of the neck taking out scalenesnand first rib. Will cut both pecs. Then 6 weeks later do the other side of my neck.

Jess
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Old 06-04-2012, 11:24 PM #16
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MAC test, a bit of info -
[Diagnostic tests, such as EMG's or NCV's, may show non-specific abnormalities, but usually are normal in people with TOS. However, recently a new nerve test was found which has been abnormal in the large majority of patients with neurogenic TOS and pectoralis minor syndrome. This test can be considered a variation of EMG/NCV measurements. It is a determination of the medial antebrachial cutaneous nerve (abbreviated MAC). It is one of the few objective tests that can support the diagnosis.(Reported recently by Machanic, BI and Sanders, RJ in the Annals of Vascular Surgery,March,2008.)]
www.ecentral.com/members/rsanders/

http://www.researchgate.net/publicat...utlet_syndrome
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Old 06-05-2012, 06:37 PM #17
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(Reported recently by Machanic, BI and Sanders, RJ in the Annals of Vascular Surgery,March,2008.)]
www.ecentral.com/members/rsanders/

http://www.researchgate.net/publicat...utlet_syndrome
This is the guy who did mine. Note that he works with Sanders. Bottom line is that it shows some irregularity, but doesn't let the Dr. know where the prob is. Sanders only ordered the MAC test at my insistance. Sanders knew I had TOS based on his physical exam, he didn't need a MAC test to tell him that. If you and a TOS specialist are sure you have TOS, then more tests aren't neccessary. One then just needs to decide to have the exploratory surgery (TOS surgery) or not. Some tests to see if neck is involved might help. But once you know you have TOS, extra tests like the MAC test don't help ---- at least they didn't in my case. My MAC test was positive and Sanders went ahead with the pec minor surgery. That was a mistake because my problems are with my brachial plexus, subclavian vein, first rib, subclavius muscle, etc.
Sanders would have known this if he looked at my MRA. He did not because he didn't believe in the test. Angle looked at the MRA and said it gave him a good indication of what was going on inside. He feels they are useful. At this point, I'm not interested in any more tests (scalene block, etc.). I know I have TOS and so do the Doctors. The only thing left to do is to have surgery or live with pain management.


** The above is only my opinion based on my journey **
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Old 06-05-2012, 10:39 PM #18
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At this point, I'm not interested in any more tests (scalene block, etc.). I know I have TOS and so do the Doctors. The only thing left to do is to have surgery or live with pain management.


** The above is only my opinion based on my journey **
Sounds like you've reached the same conclusion I did. I'm so glad Dr. Angle felt more testing was unnecessary when the other doctors wanted to keep repeating the same old tests or try experimental new ones on me. I had been through enough!
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Old 06-06-2012, 10:30 AM #19
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I am glad no more testing for you too. Sometimes doctors do things that don't need to be done. Some of the more painful tests, I turn down at every opportunity. Let them get some of the same tests, and they may find it a tad painful too. humph.... Hope all turns out good for you, and that you get the relief you really need. ginnie
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Old 06-15-2012, 08:39 AM #20
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Dr. Thompson made me go on disability leave. So no more working for me. Im starting pt on Thursday. We will see how that goes. Dr T's pt has very specific instructions that my pt is to follow, so hopefully that will keep from hurting too much. I am going to try the pt, but I don't think it can get me where I need to be. Thoughts?

I have been off work a week now and I feel a lot better; the change is amazing. But I have to get back to work eventually. I'm facing the fact that I may have to give up a job I love. I don't know what I'll do if I can't work for Starbucks. I love my job and the insurance and benefits are unbeatable. One day at a time.

My primary care Dr started me on gabapentin. That made me so tired I couldn't function. Does the tiredness get better with time? Or is it time to try so something else?

Thanks,
Jess
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