First Rib Resection - understanding side effects after surgery

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In October 2015, I underwent a first rib resection after being diagnosed with Venous Thoracic Outlet Syndrome (Subclavian Compression v. Nueral Compression). My case was fairly urgent as the blood flow was limited to roughly 10% thru my subclavian vein. I was very lucky as I did not experience any typical symptoms such as a swollen arm due to clotting. I originally went to the doctors because I had a pain in my lower abdomin, which I thought was pneumonia coming on. I tested positive for D-Dimer (results around 2.0+), therefore my doctor immediately sent to get a CT Scan to rule out a blood clot. I did not have a blood clot, but this is when they did discover the unusually narrow vein. The doctor advised I see a Thoracic specialist. 

The surgery went well. I was in the hospital for 2 nights. Recovery took about 4-6 weeks before I could go back to work full-time. I underwent PT for about 2 months, starting 1 month after surgery. 

However, since October I have experienced a number of side effects including:

1. Horner's Syndrome. My right pupil (side of surgery) is still noticably constricted. 

2. Numb arm due to damage of the long thoracic nerve, a constant roller coaster of sharp, acute pain and soreness near my right breast bone (I had my right first rib taken out). I want to understand if the pains I am feeling 6 months later are a normal part of nerve regeneration and if anyone has a similar experience, how long they last? The pain seems to come on and off all day. Some pains (acute/shooting) mainly in the mid-section of my right arm. The under side of my arm is still numb to touch.

3. Another pain I experience is near my second rib, where it attachs to the breastbone. A lower position then where my first rib was taken out, so I find this strange, the irriation would be lasting this long.

4. About 2 months ago, I started getting sharp pains in my upper lung (is the best way to describe it). When I drink cold water or other beverages it sends a sharp pain to the area. It is very strange.

5. Stuffy nose at night. Since surgery I can not breathe through my nose fully. It feels stuffy and not clear. 

I have been to a few typical follow up appointments but my surgeon has not been able to identify a detailed reason for these pains besides a side effect of surgery. I understand my body underwent an intrusive surgery and needs time to heal, but I often get worried now something else is wrong, since the pains come on so suddenly and sharp, six months later. 

We do not know the reason for the development of the VTOS. One of my surgeons suggested it happened when I was young, as the network of blood vessels around the vein were enlarged and carried much of the blood not flowing through my subclavian vein. The main surgeon thinks it may have happened within in the last 5 years. Typically trauma or excessive overhead movement causes VTOS, however neither of these applied to my case. 

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  • Posted

    Hey,

    Just like you I underwent a first rib resection after being diagnosed with Venous Thoracic Outlet Syndrome in October 2015 and I had angioplasty due to a blood clot in my subclavian which didn't fully heal 6 months on Xarelto. The surgery went well considering I had a collapsed lung but 6 months I'm randomly (about once a week) feeling shooting pain from my chest area to my elbow (where they went in - angioplasty), sometimes it’s just localized to my chest area, and I've felt it twice from my abdomen to my left shoulder so I too was wondering if these symptoms will gradually subside. I had no idea what Horner's Syndrome was until I just googled it and I too have my left pupil a bit constricted which I've only noticed last month and had no idea that it actually had to do with the surgery sad Hopefully our symptoms get better with time and I wonder if anyone else would be able to chime in regarding our concerns.

    Best,

    ​Eddie

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    • Posted

      Eddie,

      Thank you for the reply! I just read the entire thread below. I too have been avoiding heavy arm exercises since surgery which seems to help. Prior to surgery I was very active and lifted regularly, but now it's just going to take patience to rebuild strength and not injure my arm further. My PT did say it's very easy to aggravate the healing nerves so until your body has little Pain in that area not to over stress it. Good luck with your healing! I have yet to try acupuncture but I heard from multiple people it helps a lot!

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  • Posted

    HI! 

    I had a first ribb resection about a month ago and am also experiencing these the shooting pains in my arm and chest. I am also suffering from a lot of panic attacks sad I don't have much to offer besides comraderie and am interested in the same things as you are, to be honest, of all the threads I have read about this we seem to be (thank goodness) having easier recoveries than many others. Hope you all are feeling well today smile

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    • Posted

      Hey Leah,

      I haven't done any planks or burpees in years but I noticed that I stopped having the shooting pains ever since I stopped working out my chest and triceps although I do continue to work out my back. Im taking it super easy at the gym as well so it kind of sucks not being able to put in 100% but in due time I think I'll be able to do all the exercises that I've done in the past! Good luck to you🤗

      -Eddie

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    • Posted

      Leah, thank for this comment and all the below ones in thread. I am in the same boat with panic attacks. When you start as a healthy woman, I am in my late 20's and have never had a previous health issue, it's hard to swallow a long recovery and has led to panic attacks thinking I will never be back to 100%. Advice from a few friends who have gone through far worst surgeries say it has often made them stronger as their diets and exercise are more targeted. I am working out more, started burpees again a few weeks ago, light cleans and dead lifts around 90 lbs, and all other sorts of exercises regularly. I still can't mentally get myself to do a pull up but attempted a resistAnce band pull up two weeks ago smile good luck with your healing !!!
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    • Posted

      It is so great to hear you are lifting and doing burpees! That makes me so hopeful!! I've been seeing a therapist for my panic attacks and it has really helped so far, she's given me some advice on how to ground myself before I spin out of control and it doesn't work every time but it has definitely helped. Please let me know if you are interested as I'd be happy to share what I've learned 😊
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  • Posted

    I was just diagnosed with Bilateral VTOS this past Thursday after nearly 2.5 YEARS of suffering debilitating symptoms. I'm scheduled for my first surgery starting with my left side next month. The right side will be scheduled following recovery from the left side. Obviously, I am praying for full recovery, but am aware of possible complications and ongoing symptoms. I am sorry to hear that you continue to experience symptoms...some old and some being new...post surgery.

    I am curious to know what method your surgeon used ....open surgery or VATS? ...and the location(s) of the incision (s).

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    • Posted

      My surgeon did open surgey and the incision is under my arm. I feel like my recovery was really aided by my being as active as I could be and not being reliant on pain medicine past my hospital stay. Obviously, all of that depends on how you are feeling from the get go post surgery. I also think that doing as much walking or running (or any other exercise you can without using your arms) prior to surgery is really strongly to your benefit. My doctors and myself are convinced my recovery was made far easier by having been an avid exerciser prior to the surgery. 
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    • Posted

      Good luck! I had an open surgery through my armpit. The scar healed quickly and was the least painful area. The surgeons did not know which way they would go in until the incision as its all dependent on the state of the vein being compressed..they told me they may have to go through my chest too if it's not possible to take riv out safely, luckily they could however I did have a lot of muscle around it so it was more complicated to remove than expected. The vein also went back to nearly normal once they released rib so I did not have to get an angioplasty. How long did they tell you should wait until next one has to be removed? Did you clot?
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  • Posted

    I had 1st rib resection and cervical rib resection on Feb 2 2016, had above collarbone incision, complications from surgery was pneumothorax in which was an accident due to type of surgery 10% chance and scalinectomy also to clear the way for the subclavian artery and nerves. Dr told me it would be about 2-3 week recovery time then back to work. Well that didn't happen as I am still in therapy, I lost the use of my right arm after surgery and only about 50% use now with very limited use that is. I was just diagnosed with cervical vertigo where I have problems when turning my head to the right of loosing loss of vision. Pain has been a big issue and has had a great impact on my daily life. Pain as you described shooting stabbing from center of chest to feeling like my arm is being ripped from the socket. Surgeon pretty much told me that surgery was not always a success and dumped me off on my primary care physician. Between therapy and pcp they both think that some sort of nerve damage occurred during surgery. The surgeon actually told me after surgery due to being in good physical condition and the amount of muscle tone that he had to do more dissection then most patients. With all that said and done I am scheduled next week for another scan to make sure if anything can be done. I have lost 26 lbs since surgery and can't even do the things I did prior to surgery anymore. I guess have to take in to consideration I do have RA, fibromyalgia so any major operations can trigger flair of underlying conditions. Not to scare anyone away from the surgery but have to think that the trade off of a long recovery verses a blot clot that would cause a stroke or death I guess I will just have to adapt and over come. How ever these are some of the complications that can happen. I was just one of the unlucky statistics I guess and at 44 years young As of this Friday I have hope that I will get my life back soon. I think the surgeon's grossly underestimate the recovery times of the surgery. Good luck in all of you guys in recovery!!
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    • Posted

      OH Roger!! I am so incredibly sorry you are going through this and in so much pain. I wish you a speedy and full recovery and that all of this pain you are going through is quickly alleviated. I was very lucky to happen to live in the same town as a surgeon that athletes around the US are sent to, one of the benefits of being in a college town with a well known medical program. Is there any recourse in regard to your surgeon? I hope you feel better soon 💜
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    • Posted

      Not as of right now, having the cervical rib, in which if not familiar is basically an extra rib that attaches at c7 and comes under the collarbone there are extra ribs. Also was done at a major university hospital here on the east coast. As of the surgeon all he does is thoracic surgery and not neuro, so that being said I don't blame him the nerve problem was there to start and the surgery it's self did have some positive effects that was unexpected. Such as my blood pressure is prefect and has never been, lol. Blood flow is open now and not worried about a clot. I'm sure we will find the culprit and get it fixed over time just have to find the right dr for that, lol..
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    • Posted

      Hey Roger,

      I hope all your symptoms subside with time man, I haven't experienced any more shooting pain/chest pain since I stopped working out my chest and triceps. I guess I'll just take it slow for now and give my body some extra time to heal. Im on the east coast as well and had my first rib resection and angioplasty done at weill cornell in Manhattan. I see an acupuncturist in Darien, CT from time to time and I feel that it's helping me heal a lot quicker.

      -Eddie

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    • Posted

      I'm so glad blood flow isn't an issue. I still have concerns about that one myself but it's most likely paranoia. In about a day I went from being the healthiest person I know to having a blue swollen left arm caused by a blood clot. My therapist thinks I've got some ptsd from the whole thing. Good on you for being so open and rational regarding your surgeon, I'm not sure I'd be as even tempered😉
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    • Posted

      Haha I am in the same boat as you! I eat well, exercise, take care of my body, and have no stress in my life but ended up with a blood clot (with help from my underlying condition of vtos) which I caused because of the stretching exercises I was doing. I was basically pinching the vein at 7/8 minutes at time while holding one of those stretches. I definitely had ptsd and I believe it's due to the blood clot scar tissue (or whatever it's called) still being there but the surgeon says my body should heal in time so when I take another ultra sound in two years it should look like I never had a blood clot there.

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    • Posted

      I am so sorry To hear about complications! Yes they seem to grossly underestimate no matter which age. I lost 18 lbs after surgery mainly due to loss of appetite from meds. I would suggest getting active ( non arms) as soon as possible. Long walks and light exercises to keep your physicality and mentality up! I went back to work after 1 month and was back to 75% within 2 months and practically back to normal now minus the random side effects and pain. It no longer impedes on my active lifestyle. I just always worry the same thing will happen on the other side! You will have a series of follow ups and I would ask as many questions as possible, it helped relieve my anxiety. Best of luck!
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