Aliens, intercostal neuralgia, rib surgery: a chest wall story

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A few months after my 2009 bike accident, I started to notice some swelling on my side below my 11th rib. Time passed and nobody could determine the cause of this painful protrusion. I dubbed it The Alien. I was certain that at some point a hand would push its way through my skin and some kind of strange creature would pop out. Since my life is not a Sci-fi movie, nothing so interesting happened. Which is a shame; because that would’ve made for a most excellent blog post and a nifty pet.

Rib Cage with each rib numbered
You can see that the 11th and 12th ribs don’t attach in the front which is why they are called the floating ribs.

After scouring the US and Canada for many years, I found a surgeon willing and able to investigate the source of The Alien. In August, 2012, nearly three years after the accident, I underwent exploratory surgery.

The Alien turned out to be an intercostal neuroma, a benign nerve tumor. Such is the rarity of such a thing on an intercostal nerve, the surgeon had previously encountered only one other one in his storied career. And, if there was a contest for neuroma size, I surely would have won a prize, as my neuroma measured in at 2 inches, which is apparently quite large in the world of neuromas.

Neuroma’s generally occur from trauma, either from an accident or surgery. Since The Alien predated any of my chest wall surgeries, and it occurred after my accident, and the 11th rib was found to have fractured cartilage, using the transitive theory it can be concluded that the neuroma formed due to the accident.

Here’s the problem. Surgically removing a neuroma greatly increases the chance it will grow back. Having tried non-surgical methods to rid my body of The Alien, there was no choice but to cut it out. During that same surgery, the fractured portion of my 11th rib was excised.

Flash forward three years to 2015. Sometime around May, I noticed a similar pain in that area. I knew the Alien had returned.

On May 22, I had surgery to remove hardware that was placed in my ribs in October 2014. Luckily, the hardware did its job and permitted an unhealed fracture on my 8th to heal. The day after surgery, however, I knew my troubles were not over, as I was still experiencing an enormous amount of nerve pain unaddressed by the surgery.

Throughout the summer, I tried conservative treatments to alleviate the pain to no avail. Part of the problem was that my 12th rib was very hypermobile; I could feel it moving and jarring much like a broken rib. This hypermobility was recognized shortly after the accident, but until now was left unaddressed.

There were no easy answers to my situation. I recognized, unequivocally, that something was wrong with my 12th rib and that the Alien returned. It was my belief, based on reading every study published about 12th rib syndrome, that surgical intervention was only the possible resolution, since the other treatments did not work. An MRI did not reveal any abnormalities, though, making it challenging to find a surgeon to agree to do yet another exploratory surgery.

Fortunately, I found Dr. Cross, a thoracic surgeon at Centura hospital in Lakewood. I had an initial appointment with him on Monday, September 14. His likable personality and attention to detail endeared me to him immediately. His thorough physical exam revealed some abnormalities that did indeed require surgical intervention.

The information he provided paralleled what I gleaned from the papers I read throughout the summer. Once he decided he would perform the surgery, I wanted it done immediately. I am not a patient person, and I just wanted to put an end to endless pain and begin the healing process. I did not go into this surgery lightly or without trepidation, but I knew, didactically, that it needed to be done. Certainly, it was not my preference to have a 3rd surgery in 11 months, but once it became medically necessary, there was no point in waiting.

Much to my surprise, he fit me in two days later. The plan was to remove part or all of the 11th and 12th ribs and look for a neuroma. Since the MRI did reveal any abnormalities, the final decision on what would be done would be made during the surgery.

The plan was to remove part or all of the 11th and 12th ribs and look for a neuroma.

He found a hot mess. My 12th rib was clicking, probably due to an unhealed fracture (I had so many unhealed fractures because they all occurred in the cartilage part of the rib and cartilage does not heal on its own). He removed three inches off of that rib. He found a small neuroma, so he excised it. There was a ton of scar tissue around my 11th rib with some nerves caught up in it. He took out the scar tissue and freed up the nerves and buried them under muscle to prevent further damage to the nerves. Finally, he removed about 3 inches off my 11th rib and smoothed out the end of it.

By now, my 11th rib is probably a nub! Most importantly, he did not need to remove the entire ribs, preserving the attachment to the spine and sparing muscle damage in my back. My lung got nicked during the surgery, so I ended up with a chest tube.

surgery site explainedAt this point, I will never be a torso model. I have so many scars on my abdomen it looks like medical students used me as their cadaver.

This surgery they did something very cool. A catheter was inserted into my abdomen near the incision. The catheter was attached to a “balloon” filled with a lidocaine-like local anesthetic. The balloon was encased in a plastic bag which I carried around in a very unfashionable black fanny pack. The anesthetic was pumped into my abdomen at a regulated rate until the balloon was empty, about three days. The anesthetic drip eased the discomfort and greatly diminished the need for post-operative narcotics. Carrying around the fanny pack made me feel like I was toting a colostomy bag.

I’ve had troubles coming out of anesthesia, but nothing, and I mean nothing, compared to the aftermath of this surgery. I only remember about 5% of the recovery room and the night in the hospital. One thing I do remember is spying the black fanny pack next to me on the bed. I recall saying to the nurse “Look, I have a present! Who left me a present?”

The nurses couldn’t have been nicer and helped me through the rough patch. Although, I am not sure they were psyched about me pressing the call button every 20 minutes in the middle of the night to help me to the bathroom.

The recovery thus far has been difficult. Because of where the incision is, and due to the pain in my back, I am unable to lie down. I’ve been sleeping in a recliner chair, which sucks big time. I’ve been taking my regular post-surgery walks. Slow and steady, but better than sitting around all day. The anesthesia has finally worn off and my brain and body feel less groggy. All in all, the pain I am experiencing now is different from what I felt before. Rather than the stabbing pain and the nerve pain, I feel the discomfort that comes from having muscle cut and two ribs lopped off.

Is the fourth time a charm? I honestly don’t know. All I can do, and all I have ever done, is hope for the best.

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