ISufferFromFlankPain.com

I just got off the telephone with the collegiate swimmer from the case report linked to the right: Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report. She had a lot of insight and advice to offer me, and I shall use it. If there’s one thing I’ve learned during all this, and trust me, I’ve learned ALOT, it’s that in situations like this, it’s important to reach out to others, to network and build a framework for support. I’ve met several people now, whose insight, advice and words of kindness and encouragement have helped me more than just about any doctor has so far.

That said, I had a very emotional weekend, as I didn’t realize how much frustration and anger I had bottled up, until I spoke with a friend whose recovering from SRS Surgery. I can’t begin to tell you how helpful she’s been to me…She deserves a fast, painless recovery.

So anyway, I had to stand for about 3 hours today and my flank is almost throbbing. I have therapy scheduled tomorrow, so hopefully I can get some relief. I also plan on sitting down with my Chiropractor soon, to formulate a “Plan B,” should I need it.

As of today, I’ve been seeing my Chiropractor since October 6, three times a week. Each time I go, he puts muscle/nerve stimulators on my upper and lower back, then ultrasounds the tender spot on my rib, to break up scar tissue and calcium deposits that may have formed there. Then, he manually puts my rib back in place and re-aligns all my other ribs and spine. My overall feeling is that I am getting better, but, as he put it: “You’re suffering from an ailment that did not happen over night. It’s gone untreated for a very long time and has caused a lot of collateral damage. It’s going to take quite some time before you begin to feel better.”

Now, normally I wouldn’t trust this guy’s words, just because he’s a doctor and all the doctors I’ve been to seem to have had an agenda (and by agenda I mean a way to “cash-in;” I’m not stereotyping or generalizing doctors-I’m just saying the doctors I’ve seen haven’t had my best interest in mind). However, I went to grade-school and high-school with this doctor and have known him pretty much all my life; he’s been practicing long enough to remain driven and determined without becoming jaded and cynical. We also talked about the “witch-doctor” stigma Chiropractors seem to be labeled with, i.e. they’re not “real” doctors (kind of like foot doctors; I mean really, how many things can go wrong with a foot)? We had a long talk about the nature of Chiropractic and what they do, specifically, and I have a new-found respect for them.

So, I’m pretty much in a wait-and-see pattern. I’ll just have to wait and see. If I had to say whether I thought the therapy was working or not, I would say that it is, albeit slowly.

I’ve also been in contact with others who have been and are in the same boat as me, and I can’t tell you how helpful and uplifting it is to have them as a support-network. You know who you are, K, and you are invaluable to me!

I’m trying to post as often as possible, but I just can’t seem to find enough hours in each day. I just wanted to write a quick update to let anyone reading this know that I’ll write a full update this weekend (it’s Thursday night). I’ve been receiving a few comments from people with questions and I’m more than happy to reach out to any/everybody to help them! Until the weekend, here’s a link for fans of Rock, Paper, Scissors…This guy took this game to a whole new, ridiculous level!

I made an appointment with a new Chiropractor and, on Friday, October 6, I went to see him. I remember sitting in the waiting room, scared and anxious; if this doesn’t work, what do I do? When he called for me, I gave the same synopsis/story to him as all the other doctors, only he reacted differently — much differently. I asked him if he’d ever heard of Slipping Rib Syndrome and he said that he had. He then physically examined me and, when I directed him to the tender spot on my rib, confirmed that I have costovertebral syndrome, which is basically the same thing as Slipping Rib Syndrome (also called Floating Rib Syndrome, Tietze’s Syndrome and Rib Dysfunction Syndrome). He said that my 12th (last) rib had popped out of it’s facet joint, where it meets the spine and was causing referred pain to my left flank and upper abdomen.

He then took an X-Ray and, I’ll be damned, he showed me on the x-ray, how my 12th rib appeared higher and slightly behind the facet joint, as opposed to the others…How had all these other “doctors” missed this? He then said that because I’ve had this ailment for so long, I was developing additional complications, e.g. scoliosis, scar tissue, etc.

So, he put muscle stimulators on my upper and lower back (along with heat) and then ultrasound (to break up the scar tissue and the calcium deposits that have formed) on the tender spot. He then had me lay down on my stomach and proceeded to manually put my rib back in it’s spot. It didn’t hurt, put when he put it back, I felt an immediate sense of relief — in more ways than I can explain. It seemed my nightmarish journey was coming to an end, all thanks to my Chiropractor. He explained the condition, therapy and what we were looking at time-wise, and said he had his work cut out for him, as the Chiropractor I had been seeing (ironically) only made my condition worse.
So, I’m currently going to my new DC three times a week, and I feel better and better after each session. I know when my rib slips back out, as the pain comes back, and this happens often, but my DC said it will take some time before the rib stays where it’s supposed to. As the days go on, I can feel my rib slowly healing…This is by no means a quick process, but the faster you get started, the faster you can heal.

I urge everyone who has any questions about my ordeal, or theirs, to email me! I want to educate the masses on this issue, so no one has to spend the time and money I did before I was properly diagnosed!

On July 3, 2006, I went to my PMS and advised him, also, of SRS and everything I’d been through until now. He also said he’d never heard of SRS and ordered a Thoracic MRI. I was called by his office a few days later and advised the results were normal (as expected).

On July 18, 2006 I saw the Thoracic Surgeon. He physically examined me and was able to make my rib slip, i.e. he had me sit straight up and, from my left side, manipulated my lower, left ribs, making them move. He also pushed on them from the side and was able to reproduce the flank/abdominal pain. He also, surprise, surprise, conceded that he has never seen this before and has never heard of SRS. He advised the only thing he could do, and would be more than willing, is refer me to his mentor at Ocschner. He did, however, assume that my PMS did a nerve block on me prior to now. I advised him that one had not been done and that, I would have one then get back with him for the Ochsner appointment.

On July 25, 2006 my PMS conducted the Intercostal Nerve Block procedure. As expected, the block did not relieve my symptoms. I contacted the Thoracic Surgeon and his staff made an appointment at Ochsner for me, to see a Thoracic Surgeon there.

So, I continue to see my PMS (who has me on Vicodin and Ultram ER, because the Vicodin alone is not enough to resolve my pain). I also tried to reach out to the authors of the Case Report and actually was successfull in contacting Dr. Brian Udermann, via email:

I wrote:

Mr. Udermann:
I’ve had rib pain for almost one year now and came across Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report while researching online. I was stunned when I read the report, as I have been through almost the exact same thing as the swimmer. My problem, and why I write you for your help, is that every doctor I’ve been to has not heard of Slipping Rib Syndrome. I had an appointment with a thoracic surgeon today and, although he agreed that my symptoms are the same as the swimmer in your case report, he has never seen or heard of my situation or Slipping Rib Syndrome.
Can you please direct me to any resources or anything that would help me get a diagnosis to my problem? I live in Louisiana.

He responded:
Sorry to hear about your rib pain. I’m afraid I don’t know any surgeons in your part of the country. Dr. Daniel G. Cavanaugh (one of the authors on the paper) was the surgeon who performed the surgery on our patient. At the time the paper was written he was practicing at the Marshfield Clinic – Eau Claire Center in Eau Claire, WI. I haven’t spoken with Dr. Cavanaugh in a year or so but I think he is still practicing at the Marshfield Clinic. Not sure if you would be able to travel to see him . . . but he might know of a thoracic surgeon in the south a bit closer to you if you are not. The believe the phone # for the Clinic is 1-800-924-8515. I just received an e-mail from a young lady earlier this week from New Hampshire who has been dealing with rib pain for nearly two years and who just made an appointment to see Dr. Cavanaugh.

I wish I could have been of more help . . . and best of luck in having your pain resolved.

Have a good day.
Dr. Udermann

What a nice man…I then followed up with:
Dr. Udermann:
Thank you for your prompt response. Can you tell me why this syndrome is such a mystery to other doctors and why they have never heard of it?

To which he responded:
Not sure I have a good answer for your question. I have been working in athletic training and sports medicine for the past 15 years or so and had never heard of slipping rib syndrome until our athlete saw Dr. Cavanaugh. It is not a condition that is currently discussed in our (i.e., athletic training) literature or textbooks. Maybe it is covered in medical school curricula and textbooks . . . but I don’t think it gets a lot of attention there either.
Have a good day.

On September 28, 2006 at 9:00 AM, I went to Ochsner and saw four different Thoracic Surgeons. They all huddled around me like I was an alien and poked and prodded me, etc. They concurred that I do have SRS, but used a synonymous term, Floating Rib Syndrome. They advised me that, as far as resolving my pain, they wanted to start conservative, as surgery is not exactly the desired option here. They suggested I see a good Chiropractor; one familiar with SRS, etc. and, if that doesn’t work, try Physical Therapy. In the event the first two options don’t work (and they should), then we’ll consider surgery.

So, there I was. I had already been to several doctors and had several procedures; all which showed the same thing: I am perfectly healthy. That’s weird, because I sure don’t feel healthy.

On June 15, 2006 my wife was rubbing the area on my left flank (it should be noted that she is a Registered Nurse currently in school to become a Certified Registered Nurse Anesthetist), so her knowledge of various physiological aspects of human anatomy are above-average [as compared with mine]), when she pushed on my bottom/last rib and the area/cartilage between my last two ribs. I felt a jolt of pain/tenderness and we discovered pain localized on/almost under my last rib. She continued to poke and prod until the spot became very tender. At that point, I took Aleve and shortly after, the tenderness went away, and the flank pain was all but gone!

My wife began researching on the internet and came across an article/case history entitled “Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report.” We were both stunned at the similarities between the swimmer’s case and mine. After reading it and several other articles on Slipping Rib Syndrome, she tried to perform the “Hooking Maneuver” mentioned in the Case Study. When she did so, it produced left flank pain and left, upper-quadrant pain in my abdominal wall. The rib also became very tender after pushing on it for a short time. When I push on my left, lowest rib, the dull ache seems to intensify…If it’s already there, it gets worse.

So, we figured out that the flank pain (and the abdominal pain) is actually referred pain and the source is my rib! Holy Shit! Why didn’t any of these doctors figure this out?

After reading the above case report, I immediately recalled an instance in 2000 where I was jumping on a trampoline at a friend’s house and, upon landing on the canvass, felt like something dislocated/dislodged in my lower-abdominal/back. The pain was initially intense, but seemed to go away after awhile, so I didn’t seek medical attention. It was after this incident that these flank pain “flare-ups” began occurring.

So, I was very excited at this point and scheduled another appointment with Asshole, OS. When he came into my room, I explained what I had been through until now and he went off on my ass. He berated me (at least, he tried to; I know I’m not worthless) and even suggested I was making things up. His problem was that I didn’t follow up with my family physician, as he instructed me to when I first saw him. Well, what the hell do I know? I didn’t purposely disregard his instructions; I’m doing what all these doctors are telling me. Lucky for him I’m disciplined enough to refrain from hurting him; I wanted to shatter his jaw, but instead sat there and ate crow…

On June 22, 2006, I followed up with my family physician, and guess what he said? He said there was nothing more he could do for me, as all the tests he would order have already been done. Wow, take that Asshole, OC. After looking at the research I conducted on Slipping Rib Syndrome (hereinafter referred to as SRS), he diagnosed me with SRS and referred me to a Thoracic Surgeon.

So, then I was referred to a Pain Management Specialist (Anesthesiologist). I explained to him what I had been through up until now, and what the OS’ opinion was, and he completely disagreed with him. He said that my flank pain could be caused by my bulging discs.

So, in January of 2006, the PMS (again) gave me Celebrex for one month; after that didn’t work, he gave me a series of three epidural injections into my lumbar spine. These injections did not resolve my pain, either, although it should be noted that the local anesthetic he gave me worked to relieve me of the pain. After it wore off, however, usually that night or the following morning, the pain returned.

In April of 2006, the PMS gave me a shot of Toradol for my pain and scheduled a bone scan. I had the bone scan done and the following day began experiencing severe pain in my lower back/upper lumbar, sides/flank and stomach, nausea, sour stomach, chills and sweating. It felt as though my entire abdominal area was shutting down. I withstood the pain that day, but the following day I went to the ER. The ER Staff/Doctor conducted X-Rays and a CT scan and again, everything came back normal, including the bone scan. The attending physician advised me whatever my ailment was, it was not life-threatening, and to follow-up with my family physician the following day.

The following day I scheduled an appointment with a Gastroenterologist. He ordered blood work, etc. which all came back normal, with the exception of finding I am lactose intolerant. I also told him about the pain/burning spot on my upper (left) abdomen and he felt for an ulcer/tear, etc. and found none. He did, however, find blood in my stool and ordered a colonoscopy. He found one benign polyp and removed it without incident. So, once again, I was back at square one, but not without being medically molested…My hopes were dashed.