First Rib Resection - understanding side effects after surgery

The anasetescia is different from having the wisdom teeth removed so don't worry about being awake. In fact I was quite p*ssed when they woke me up was having a good dream, lol.. I did have this incision done on mine but unfortunately the surgeon didn't know what he was doing and caused permanent nerve damage to my shoulder. Do you have the cervical ribs? You also said you have had a prior clot so surgery is going to be a must due to Rick of getting one again. As of the structure around the incision they are very careful with what's underneath if the surgeon is experienced with the surgery. Only advise if can give is to make sure they do and have done the procedure a lot. Feel free to ask anymore questions. I can tell ya every thing that can go wrong because it happened to me but I was that unlucky one out of the group that has had a really bad experience.

Thanks for the reply roger.  Sorry you had a bad experience and are experiencing side effects.  I guess I am fortunate enough not to have any cerivcal ribs in my body, so they wil just be taking out some scalene muscles and part of the first rib I imagine. So is it like you literally are brought into the operating room and then your laying on your back while nurses and asisstants are prepping you for the procedure then you just slowly pass out when they give you the drugs? do you wake up in the operating room with the whole team of surgeon/assistants or do you wake up in a recovery room with just nurses? sorry if my questions don't make any sense or are silly haha just want to know what i'm getting into I have never done anything like this before.

Sorry forgot to add, did your lung collapse during your surgery? I already asked my surgeon about this and she told me it does happen once in a while but it is not that bad.  What does having the drainage tube in your chest feel like? Did you have a lot of blood loss? Thanks again!!

Hi Rdizzle, where are you having your surgery done? I am also in Ontario, Canada. My surgery is scheduled for January 11, 2017 in London. I am extremely nervous as well. I am a 30 year active female who suffered from a subclavian DVT in April 2015. I have only been under G/A once as well for my wisdom teeth so I feel your fear

What blood thinner are you on? I have been on Xarelto since ( they took me off after 4 mths but I ended up with small clots while travelling again so they put me back on it ). Basically the discussion of surgery has been ongoing and I decided to have it done.

The pain I experience is bearable, but it does affect my daily life as I want to be very active and feel that it holds me back. Also, I am an optometrist and am doing alot of overhead motion through the day. I have only been practicing 4 years, and want to have a long career, so the doctors felt this was the best option.  I have lots of collaterals present and the blood flow is okay, but my arm basically remains swollen most of the time, and is always darker in colour compared to my other arm. The surgeon feels I will be able to get off the blood thinner 6 weeks post surgery, but my internist feels differently, and I am scared to ever to ever got off of it and end up with another DVT. What were you told? Thanks! Victoria 

Hi Victoria,

I had very similiar experience as you.  One day i woke up and my left arm was very swollen, tight and darker but no pain.  After a few days i went to ER and they did a d-dimer blood test.  It came back positive it was 4 times the normal range, so ER doctor sent me to ultrasound.  Ultrasound found a big clot in my subclavian and axillery vein.  I was admitted, they performed thrombolysis where they put a catheter in my vein and infused tpa and heprain.  After about 3 days most of the clot was gone and they did some tests to check for TOS like raising my arm above my head and doing venogram to check blood flow.  I was diagnosed with Venous TOS, after i was discharged the hematologist kept me on xarelto just like you (15mg twice daily for first 3 weeks than 20mg once daily) they reffered me to a thoracic surgeon at the same hospital where they treated my clot.  had a few meetings with the sugeon and did a CT which showed that the blood flow was being reduced where my vein passes through clavicle and first rib.  She recommened surgery.  It seems like they followed the standard of care for this problem by the book. I don't think we should be that worried if your in london i know there is a really well educated surgeon there who went to MIT and mayo clinic who does these i think your in very good hands...but yeah i have way more collateral veins now on my left side and its still a little bit swollen and darker.  I try to avoid raising it above my head.  In regards to the discussion about the surgery.. she just advised me there is possibility for nerve damage but its best to do the surgery since im young and healthy and wont need to stay on the blood thinners.  from what i've researched most patients have good outcomes from this surgery it is pretty rare to have nerve damage or any more thrombosis going forward.  Even the recovery times seem reasonably good patients leaving hospital next day and being on painkillers for a few weeks and doing phisio.  I am supposed to do the surgery in march, I had the clot in May 2016 so It will be almost a year to do the surgery.  If you have any more questions please let me know

Good luck and take care!

Yes it sounds like a very similar experience to mine. I swam growing up, and got into triathlon in 2014 wehn I purchased my first road bike, so I do think that aggravated the already present issue.

I was actually supposed to undergo the tpa procedure as well, but they ended up just doing an angioplasty because they thought that was helping the blood flow enough and the clot was out of the way at the time I guess. But then my arm remained swollen/darker for basically another year, so they tried to do another angioplasty last summer but it didn't help much, and so they referred on for surgery. Do you know why they are choosing to the supraclavicular approach? She plans to use a transaxillary approach but said there is a possibility that they may end up having to go through my clavicle area.

The surgeon said that I should be able to get off xarelto around 6 weeks post surgery depending how things go which makes me nervous lol. I am going to London for my pre-op stuff in a couple days and my surgery is next Wednesday, so I will keep you posted 

Yes let me know how it goes! Best of luck.  I think she's doing it above the collarbone because it is easier to remove the scar tissue on the vein, better view of the sclaene muscles to excise any muscles that's compressing the vein, good for re do. I got my clot from riding my road bike too.. i remember feeling a lot of discomfort in my arms/hands being in that stance with my arms locked out i would go on 2-3 hour rides.  Before that i was a competitive swimmer for many years and weight lifter..  I never see anywhere that cycling can aggreatve TOS it should really be added lol 

Hi rdizzle92, victoria93724, roger45144, 

I hope you don't mind answering some question I have. My daughter had rib resection surgery in March 2018, had her rib and scalene muscle removed. Her healing and physical therapy went well and she worked her strength back up to her normal, but when the doctor went back in for a follow up to check on the vein and found that the scar tissue was ecluding (blocking) the flow of the vein. Have any of you experienced any of that? Did you have to have a procedure done to correct it? Did it work? Is there any therapies that can be done to scar tissue? Any help much appreciated, Thank you

Hi Jennifer 30214, no problem answering your question,

I had surgery in November 2017, the surgeon used the under the armpit method, no complications. Recovery, as expected, took a few months to gain the full use of my arm back and for the pain in my chest,neck, and shoulders to lessen. I did do a follow up test to see how the vein is doing a few months after the surgery, and the vein (subclavian vein in my case) like your daughters was found to be still occluded, but since my body developed so many collateral veins around the blocked segment of the vein I had no symptoms like I did when I initially developed the clot (swelling, numbness, etc.) So the plan was to do another angioplasty to see if we can open the vein. However, in my case, when they tried this, it was unsuccessful as so many collateral veins have developed it was too risky for the doctor to try to get the balloon to the occluded segment so they decided to just leave it alone. Even if they were able to balloon the vein there was a good chance it would occlude again as the vein was damaged from the clot.. i followed up this news with my vascular surgeon team who told me in some cases the vein never reopens but since you have good collateral it should not be an issue. I am no longer on any medication like blood thinners, aspirin, pain killers. etc.

please let me know if you have any other questions.

Hello rdizzle92, 

Thank you so much for the detailed response, it has given us great insight and understanding into my daughters ongoing progress. I really appreciate you sharing your story, it sounds very similar to her's. My daughter is 16 years old, from Wisconsin, tall and very strong, has played alot of softball (pitcher), volleyball (middle hitter), lifted weights, and did alot of crossfit, so put alot of work and stress on her right arm which she has a DVT in her subclavian in January 2018. I also had her put on a birth control to help control her acne break outs, wish I would have known what I know now but this puts you at a higher risk of clots. She was put on Eliquis & baby asprin, but her arm stayed swollen but never had any pain from the clot. We saw a vascular surgeon and he recommended TPA to blast the clot, we had it blasted and got word that the vein was open. When the cath was in the vein, he tested the compression and noticed the rib and scalene muscles were contribution to the clot also. In March she had right rib resection with incisions above and below her clavicle. Went though PT and restored her strength and full movements of head, arm and neck. I thought everything was going well but I thought she looked blue yet with her collateral veins, on her shoulder, not quieting down and went back in for an ultrasound and found the vein had occluded. One vascular surgeon said it was the scar tissue compressing the vein, and the next one that we were further referred to, said it was the old clot, it was extremely frustrating. Then even more frustrated, the vascular specialist we were referred to see said he doesn't think there is anything further that he can do because he thinks it is just going to close up again. 

So now as we stand, she is still swollen and has blueness on her right should and chest/clavicle area from her collateral veins, her right side bicep measures 14" and her left measures 13". She has no pain and has great strength in her arm and hand. She is still on Eliquis, but we don't go back to see the vascular specialist til December (not sure if he is going to do anything any way). My daughter goes to high school where they do performance training and she tries really hard to do all the work outs like bear crawls, sit ups and push ups, but her arm starts to swell up more and her fingers throb a little bit. She has to stop activity and raise her arm and take a break. The vascular specialist recommended her to get a compression sleeve to help with circulation, which she is trying to work with to wear. 

Sorry to be long winded here but I have had a hard time getting explanations and comforting answers to understand her ongoing care and prognosis from the doctors.

Also have some questions for you, do you know if your arm measured more than the other for a while? Wondering if it will slowly get less swollen or is this her new normal. What blood thinner were you on? Did you use a compression sleeve? Do your arms measure the same now? Can you still see your blue collaterals? Have you returned to your fully active lifestyle and returned to cycling? 

Robert, you have been such a blessing to us , I am so glad we found you and are praying for your continued health! Hope all is well in Canada! Hope to talk with you again, Jennifer30214 

 

Just checking up on you to see if any of your pain went away?

Hi Eddie, the tension that was there before hand has reduced from surgery. I still have an ongoing weird crampy tightness in my neck area that I think has worsened since op. I think I have other issues going on though. I'm still waiting on tests to be done. They now think it may be all down to a trapped nerve in my spinal cord and perhaps I could have dodged this surgery! Are you awaiting surgery?