Nuss Bar Removal

In 2013, three years after my Nuss surgery, I consulted with my doctor and we decided that it was time to go ahead and have the bar removed. Now, with this procedure, the reason they keep the bar in your chest for so long is because there is no way for them to physically tell whether or not the cartilage connecting your ribs to your sternum has grown back completely and able to support your chest wall. X-rays can show you that there is cartilage there again, but it can't show you if it is sturdy enough to support your rib cage on its own without the bar. For this reason, the keep the bar inside adults for 3-5 years, just to make sure. In children I believe they only keep it in for 1-2 years because of how fast their bodies are growing.

I decided to have mine taken out at three years instead of five for two reasons. The first reason was that my husband and I really wanted to have a baby and the doctor suggested that I not get pregnant while the bar was in my chest; since then, I have done further research and there have been several women who have gotten pregnant with the bar still in them and everything was just fine. My second reason was that on my left side I felt a constant pinching and tearing right where the bar was that made it uncomfortable for me to work out our do things that required me to stretch my left arm up. Since I am a very active person this made it very annoying for me every time I wanted to work out, to feel like I had to limit my left side on all things. So I talked with my doctor about each of these things, and he said that he believed I was fine to have it taken out at three years, especially since my bones seemed to be very pliable and flexible. I was SO EXCITED!!  In fact, excited is an understatement, I was over the moon that this thing was going to be out of me once and for all and I would be able to finally look normal.

 This was the bar that was removed from my rib cage 

The doctors told me that it was a simple same day procedure and I should be fine in 2-3 days, but I didn't really trust that since my recovery time was WAY off at the beginning of all of this. So I scheduled an entire week off of work just to be sure. My husband took me in early in the morning and they hooked me up to the IVs and everything, which luckily they got right on the first try this time, nurses like that are the best! Then they wheeled me back, knocked me out, and took that bar out of my chest. I woke up about and hour and a half later in my room. I was so tired I could barely open my eyes, but my husband kept trying to wake me up and talk to me. They told me that they needed me to drink some juice before and wait about 10 minutes for it to settle before they could let me go home. It was at that time that I realized I wasn't in any pain, not even a little bit. I wasn't sore, my left side wasn't pinching any more and I felt great! I was so tired though I couldn't really jump up and celebrate. They told us we could leave, and I walked out of there just fine. I got home and passed out for a few hours, which felt great. I felt so good that the next day I called up my boss and said that I would be going back to work the next day and wouldn't need the rest of the week off. I was so relieved that this process was quick and easy, especially with how long and painful the first surgery was.

This is my husbands hand comparing the size of the bar

Going back a little bit to my left side pinching and tearing. I had mentioned this to my doctor a few times before I had the bar removed, and he had told me that it wasn't anything, and it was probably just because I was babying that side and if I just worked through the pain it would get better. As nice of a doctor as he is, he was wrong ha ha. I tried working through it and it just made it more uncomfortable. Luckily, I was able to prove the doctor wrong when he went in to remove the bar. After the bar removal, the doctor told me that the bar had somehow adhered/attached to my rib, so that each time I moved too much on that side, the bar was tearing the cartilage and pinching me on the inside. When he removed the bar, he actually had to saw away a small part of my one rib that it was attached to in order to get it out. So, moral of the story is that YOU know your body best, not the doctors :) I don't blame Dr. Mitchell though, he is still one of the best doctors I have ever had, but they can't feel what you are feeling so they have to go off of what they know and have had experience with.

The next 3 yrs...

The next three years weren't that bad once I got past the first few months of pain and soreness. It took me probably 5 months to feel 100 percent back to my normal self. Which, if you read my previous posts you will realize that I had my wedding and honeymoon during those few months of discomfort. being on my honeymoon was not fun with the Nuss bar.

Wedding Day Photo

My husband and I went to Cabo San Lucas, Mexico for our honeymoon. With both of us being adventurous people, it was hard for us to find activities that we could do together that were okay for me to do with the bar. For example, we really wanted to do an ocean floor walk where they put those helmets on your head and you walk across the bottom of the ocean. However, that would have been too much pressure on my rib cage and it would have collapsed, so instead we had to do snorkeling up top, which was still fun. We ended up being the only people on the tour that morning so we had our own private guide who got in the water and swam with us, grabbing fish out of coral reefs and handing them to us, it was pretty sweet!

Snorkeling in Cabo

We also had to be careful when doing that thing everyone loves to do on their honeymoon, have sex. I was able to sit myself up if I was propped up with some pillows, but if I was flat on my back someone had to help me sit up.You can't hold yourself up on your arms for very long and also, there wasn't a lot of rolling around, because that too takes muscles that you don't quite have yet after such an intense surgery. Just make sure that you know what you can and can't do while you have the bar in your chest. Sorry if that was too much information, I just want to make sure you know what you are getting yourself into before you go through with it. I probably would have waited till after my wedding or done it several months prior if I would have known exactly what to expect.

This is the only picture I could find where if you look close you notice that there are really no scars from the procedure

For the most part, once I felt good enough to do everything I used to, everything was normal. I did have to be careful on certain activities like playing sports, and definitely had to work up to doing push-ups again, but the bar never hinder me from doing the majority of the things I wanted to do. I was able to feel the bar and each of my sides where they inserted it, but I don't think that is with everyone, it was a fun party trick to show people though. If you do decide to do this procedure, just know that the older you get the harder and longer it is for your body to recover, so the younger you are the better. If you are older, just know that the first few months are miserable, but after that it is pretty much smooth sailing and hopefully you will be glad you did it.

After the Surgery

Sorry it has taken me so long to write my next post.  Life always gets in the way of everything, I need to make sure and schedule time to write.  Thank you so much for those who commented on my last post.  I always love to hear about others going through the same thing, support in numbers right!

     One of the things that I forgot to mention on my last post is returning to work after the surgery.  The doctor told me to plan on 2 weeks of recovery and then he assured me I could go back to work.  I was working in a pediatricians office at the time as the receptionist so I thought even if I was still in a little pain I would be sitting down all day and it wouldn't be that bad.  Well after 2 weeks I went back to work and ended up throwing up everywhere within the first 30 minutes.  I think just the constant moving of getting patients files and walking back and forth to the copier was too much too soon.  That happened each day the first 3 days back at work and then I think my body started getting used to the movement all day and I started feeling better.

     A few weeks after the surgery, once I started feeling well enough, I started my wedding planning.  I had my surgery March 17th and was told I would be just fine for my wedding day on June 11th.  Well let's just say that wasn't completely wrong, but it wasn't exactly right either.  For the first 2 months after surgery I wasn't able to lift my arms above my head, it was too painful because I would be stretching the muscles that I just barely ripped apart and shoved a bar into (sorry to be so graphic).  Each time you move those muscles your body realizes that there is a foreign object in you and it doesn't like it one bit.  When you shower it is really hard to shave your armpits because you can only lift your hands out to the sides instead of straight up, attempting to reach places like your back to scrub wasn't exactly easy, trying to put a shirt on in the morning was a nightmare, but I was determined and figured out pretty quickly strange ways to put a shirt on without lifting my arms to high.  On that note though you can only imagine how wedding dress shopping went ha ha.  I had to have someone help me into each one and they had to start at my feet and pull it up instead of going over my head.  Also they couldn't do the dress up all the way because it would be too tight on my chest and I wouldn't be able to breath.

(This is me trying on dresses, as you can see my arms are completely at my side and stayed there the whole time.)

     After the surgery the hospital gives you a breathing tube device that is supposed to help your lungs learn to expand to their full capacity, since they have been smooshed by your rib cage your whole life (depending on how bad your indent is)  Mine was pretty bad so I used the device several times a day to try and train my lungs, although I never got as good a number as my husband the show off :)  How it works is you put the end of the tube in your mouth and inhale slowly as far as you can and then hold it there.  While you inhale you can watch the dial go up and measures your lung intake which will show you if you are improving or not each time.

     Here is the device, an average lung can make it to the top line of 2500ml, when I first started I could barely make it to 1500ml and that was struggling.  Since then I am able to make it to 2000ml on average and have gone just barely past it a few time.

     This is the other device that you are sent home with.  This one is supposed to help remove the mucus from your airways, since coughing is out of the question.  You blow into the end as hard as you can and it vibrates the lungs and breaks up the mucus.  I found this helpful especially since coughing and sneezing were so painful the first few months.  When you cough the doctor tells you to hold a pillow and brace yourself the best you can because you move everything in your chest when you cough and it's painful.  I was able to control my sneezing for the most part though and just stared at the light or did anything to keep the sneeze from coming out.  Probably not the best thing to do but for me it was better than the hurt that came with the sneeze.
   
     They said that everything would begin to get better with time, the only problem was that I was the oldest patient they had ever done it on, so they weren't sure how much time, and usually their calculations were off.  I don't blame them but they did always seem a little frustrated, almost to the point that it felt like they didn't really believe me, when I would tell them I was still in pain or still couldn't do certain activities like putting my arms above my head.  So the older you are just be prepared for a longer recovery than normal.  We aren't as limber as we used to be :)

Day of the surgery

     The morning of the surgery I went in at 4:45 a.m., they told me to wear loose close and no bra (I wouldn't be able to wear a bra for the next few weeks).  They do a pregnancy test, just routine, and then stick a bunch of IV's in you.  The nurse I had could not get the needle in my hand into the vein and poked me about 5 times before I told her that if she didn't get it the next time I wasn't having it, luckily 6th time was the charm!  They wheeled me into the Pre-Op room where they hold you until it's your time, at that point I said goodbye to my boyfriend and waited in the room till the doctor came to see me.  Dr. Mitchell then came in and measured my ribs so that he could shape the bar correctly for the size of my chest wall.  Then the Anesthesiologist came in and gave  me an epidural to numb my chest, surprisingly that hurt a lot less than the IV pokes in my hand.  They then took me to the surgery room and all I remember is counting backwards from 100 and only getting to 98.......

     As soon as I woke up I was in intense pain, it shocked me so much that I took a deep breath which was a bad idea.  I felt like something was just crushing my chest from all sides, nobody had noticed that I woke up yet, and then I started crying, which again was a very bad idea, I couldn't catch my breath from the crying and every time I breathed in it was a new wave of pain going through me.  The nurses had to quickly call the doctor back in to check on me and that is when he realized that my epidural had been turned down.  I guess while in the surgery my blood pressure started to get REALLY low so they turned the epidural down, when they wheeled me into Post-Op they forgot to turn it back up, so I woke up feeling A LOT!  Once they got that under control, which took 2 hours in Post-Op,  they were able to take me to my room.  A few hours later when the doctor came into my room he told me that he wanted me up and walking around in a few hours, I looked at him like he was CRAZY, I was in so much pain I couldn't even sit up in bed by myself and he wanted me to take a stroll around the hospital!  Even though I had drugs and an epidural I was still in shock with how much pain I was in, I didn't feel like eating anything so I just drank water, I tried to sleep through the pain but I couldn't get my muscles to relax so I would have 5 min cat naps throughout the day and that was it.  They told me I would be in the hospital for 2-3 days, I actually ended up being in there for 5 days!  On the 5th day they finally told me that they HAD to take the epidural out of my back or else I could get a serious infection and they made me go home.

     Being home was not any easier!  The doctor gave me some pain killers and nausea medicine but I was still in so much pain.  I had to sleep sitting up, laying down flat was too much pressure on my chest, and I would have to have someone sit me up cause I couldn't do it alone.  It was at this moment that I realized just how much I use my chest in everything that I do each day.  The doctor told me to get a lot of rest, but I wasn't able to sleep through the night for the first month, I would wake up every few hours in pain.  It wasn't until my Grandma came into town and saw how much pain I was in and called and got mad at my doctor that I got the pain meds I needed ha ha, go Grandma.  She figured out that I wasn't sleeping because my muscles were constantly contracting from the pain and without them relaxing they couldn't heal as fast.  So I was given muscle relaxers that day and that was the first time I slept through the entire night!! So if you have this surgery be sure to ask for muscle relaxers!!!!  My Aunt was also really nice and gave me a hot stone massage sitting up which actually helped relax me a lot.

                                                         
Just rubbing the hot stones on your back can feel really good, just a suggestion.  Once my muscles were able to relax I felt better and better each day.  With this surgery recovery is especially difficult because your chest is constantly moving, we have to breath we don't have a choice.  Normally when you break something the doctor will re-set it, cast it, and tell you to try your best not to move it until it heals right?  Well this is the same thing, your ribs have all been broken and detached from your sternum, they have reset it in the correct spot, but it can't hold still.  So your healing time takes 3 times as long as any other broken bone because it can't just hold still and heal itself.  (I hope that made sense).

Before the Surgery

     After I decided that I wanted to have the Nuss Procedure done to correct my Pectus Excavatum, I searched the area for a Doctor who has done this surgery, surprisingly there were a lot less choices than I thought.  I did find one that was in Provo which wasn't far from me at all.  His name is Dr. Mitchell and he is a Thoracic Surgeon at Intermountain Healthcare, on my first visit with him he told me that he had done the surgery a handful of times, but that I would be the oldest patient so far that he has done it on.  This didn't make me nervous at all because in my research I had found out that the majority of people with this condition are encouraged to get it fixed when they are young because your bones are still growing and the re-growth process would be much quicker and more effective.  Dr. Mitchell told me that the surgery itself has been done on much older patients than me with success so he was very confident in his ability to do the procedure on me.  He said that my bones were still very pliable (I guess meaning that they are flexible and not stiff) that I have a lot of elasticity from being very active which would make it easier for my body to heal. In my head I was thinking "Yes, working out everyday has finally paid off ha ha."  Before we could go forward though there were several tests that I had to do in order to determine if I was a good candidate.

     Before starting all of my testing, my Doctor told me that most of the time insurance companies considers this procedure as cosmetic and not medical therefore they won't cover any of it.  The only way to get them to cover the surgery is to prove that it is detrimental to your health and will cause problems if it isn't fixed.  They prove this by doing all of the tests Dr. Mitchell had me do.  One of the most important tests was called the 'Haller Index' test, this is basically where they measure the distance of the inside of your rib cage and divide it by the distance between your sternum and vertebrae.  A normal Haller index should be about 2.5, insurances will only cover this if yours is a 3.0 or higher.  Mine ended up being a 7!!!!  Can you believe it!!!  I sure couldn't, later I came to find out that my sternum was just over an inch away from my vertebrae which is insane!!

                                                         
                                     This is just an example of someone with a 3.58 (as soon as I find my picture I will post it).

     So after I completed all of my tests, I found out that my sternum was actually squishing my heart to one side and preventing my lungs from expanding all the way, which explained why I was always short of breathe even from just walking up the stairs.  Once they submitted these test, my insurance approved it and I set the date to have the procedure done.

    

A Little About Me!

     This Blog is for all the WOMEN out there who have Pectus Excavatum.  P.E (meaning hollowed chest) is the most common congenital deformity of the anterior wall of the chest, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest.  It can either be present at birth or not develop until puberty. I hope to answer questions, give advice from my own personal experience and help all the women with this deformity feel beautiful and LOVE your body for how it is.

                                                            

     My name is Tara Fox, I am 26 years old and I have Pectus Excavatum.  I started noticing my chest indenting when i was in Junior High and it has progressively gotten worse since.  I always thought that it was just something that I was born with, I was the only one who had it, and that there wasn't anything that could be done about it.  When i was 23, I was working out in my basement, and after one of the exercises I just couldn't catch my breath, it was like I couldn't take a deep enough breath to get the oxygen I needed, I tried to sit down and that is when I passed out.  I knew this could not be good and so that is when I really started to do my research on P.E. and realized that what I had was a condition called Pectus Excavatum and that other people had it and it could possibly be fixed.

     In doing my research I have found that this condition is mostly in males and very few women.  In fact I was only able to find 3 women on youtube.com that had it.  This was hard because I needed advice from people with experience and I didn't have it.  Having P.E. as a women takes a toll on your self esteem, bras don't fit correctly, even if you have a decent cup size nobody can tell because it is sunken in.  Wearing swim suits for me was just a nightmare, especially when you come out of the water and your suit sticks to you and shows off your indent.  I never wanted to wear low cut shirts or anything that would show off my dent.  At the time that I was researching P.E. I was dating my soon to be husband Scott :) and I was so embarrassed just thinking about him seeing my chest that I really wanted to do whatever I could to fix it.  I know it sounds silly but like I said this condition really hit my self esteem hard.  So i started looking for ways to get this fixed so that  I could feel comfortable and beautiful for myself and my future husband.  I found that there are 2 surgical procedures, the Ravitch and the Nuss, or you can try physical therapy which didn't have a very high success rate.  The Ravitch procedure seemed a little too intense for me, they have to open your chest up and physically remove all of the cartilage connecting your ribs and sternum and then put a metal plate in there until it grows back.  Then you had to deal with the gnarly scar that it left across your whole chest.  In my head I thought that there were just too many things that would fix one problem but then cause another.  As I researched the Nuss procedure it seemed like this one was a surgery that I could handle better.

     The Nuss procedure is a minimally-invasive surgery (that does not mean it isn't painful!) through which two small incisions are made in the side of the chest, then a concave stainless steel bar is slipped under the sternum through the incisions in the side of the chest (it is kind of like a long steel nail file) The bar is then flipped, and the sternum pops out.  After speaking to my doctor and doing a lot of tests I decided to have this procedure done.  I will write more about my procedure in my next post.