Modern Understanding & Therapy for Thoracic Outlet Syndrome with Farid Gharagozloo, MD
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- Опубликовано: 29 сен 2024
- Our goal is simple.
Provide a platform for physicians that have extensive and successful experience assisting patients with Thoracic Outlet Syndrome (TOS) to:
Help patients understand the disease more fully
Share their clinical approach with physician colleagues
We encourage you to join us…
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don't guess with tos
the tos guy
do I have thoracic outlet syndrome
do I have TOS
the tos guy and today we have a really special guest we have dr fareed gary gaslow who is an excellent surgeon in florida in orlando florida not only does he have experience doing standard tos surgery but he has developed a whole new field of tus surgery using robotics he's on the cutting edge of this and i'd like to welcome everybody to dr farid gargassel well thank you dr dan um and uh it's a privilege to join everyone in this uh presentation and discussion about tos i will try to take everybody through a journey of discovery that really started about maybe 20 some years ago and hope that it will slowly clarify some of our new thinking about this disease the important thing is that for many many years since the really the 50s especially we have thought that this disease is because something is compressing a structure in the in the neck and the thoracic outlet area and uh the the compression has been thought to be a physical compression like of a nerve most commonly we are now understanding that many times the patients who have these symptoms and i'll go through it actually have uh trouble with blood flow and uh and the reason that they're having a lot of the nerve symptoms probably is because of a change in blood flow to the extremity as opposed to a compression of a nerve that is the sort of the overall kind of approach to this that we're taking and i'll kind of take our audience through this slowly to understand how we have come to this conclusion the important thing is that unfortunately medical practitioners underestimate this disease this is a common disease it is highly under diagnosed i call it the three-headed chameleon because it really is a disease that can present with nerve symptoms most commonly about 95 of the time but unfortunately 98 of that 95 percent have no specific objective finding and we call them disputed neurogenic pos we're going to talk about that i think we're also going to talk about how we need to change some of our terminology because neurogenic means that it is caused by nerves and probably nerve symptoms is a more uh accurate way of talking about symptoms in those patients there are a very few patients who have trouble with the artery in the thoracic outlet area and then another group of three to five percent of the patients who have trouble with compression of the vein that actually is the most the easiest one to understand and diagnose as you'll see we started with that in our journey the key is this is a disease of young people and young females and this is really important because unfortunately in our culture we when someone comes and talks about pain and they're talking about pain in a way that physicians cannot understand from physical diagnosis standpoint then we start talking about histrionic personality we start labeling people we start giving them pain medicines on and on and on and really we do a disservice just because we are not understanding what's really going on so this is a fascinating disease and let's go on this journey together everyone pretty much knows that this chameleon presents with pain numbness tingling weakness fatigue people can have headaches and they can be swelling of the extremity many different ways of presentation and for centuries now people have tried to understand what in the world is going on when these patients have so many different and complex symptoms
unfortunately sometimes in medicine when we try to sort of outsmart ourselves we really do end up outsmarting ourselves in a very negative way and this goes back to 1956 when a
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Please watch: "NeoVista® MRI for Thoracic Outlet Syndrome: What makes it different?"
• NeoVista® MRI for Thor...
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Where is Dr. Gharagozloo practicing now? I've been trying to track him down for months.
This was great. Bless you both!
I wish we had specialists like yourselves in Australia!!
You can go to a dr and suggest they watch the video and hopefully the TOS advances will be passed along. And don't think that just because these drs are in US, that everyone in US has access. If one is lucky enough to have one of TOS knowledgeable drs in your state, it's likely they would not be in the same health insurance group as the one you have. Thus insurance would not pay for costs. Hospital costs in US cause ppl tp go bankrupt. So we can only hope that drs in every country, state, territory, etc get continuing education to be able to help all of us who have been the mysterious cases where nobody knows what is causing anything and everyone just says, sorry I can't help you.
Have the drs considered that patients might have connective tissue disease like Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder? Also possibly POTS patients? Dr. pradeep Chopra has discussed pain management in EDS...but I wonder if there is any connection. They could look at patient populations and/or start 'bending' patients to see if they have hypermobility in joints. My pain sounds very similar to what he discusses....and I have HSD. Drs have postulated that I too have TOS. We have not gone done that road yet....as my pain is in many limbs so not sure if surgery would work...especially since connective tissue disorders don't heal well.
Hi, and thanks for the thoughts. Many TOS specialists feel that there is a higher incidence of patients with EDS than in the general population. However, there is no literature to support this. On an individual basis, a TOS specialist who does a thorough exam typically would find evidence of HSD. As to surgery, yes, this would be an additional factor to consider when making the decision to go to surgery.
@@tosmri thank you for your response. My dr suggested that my symptoms were related to TOS but I was to research it. Question: is there a named condition for a blood vessel somewhere in spine being compressed such that feet become numb? (For example when attempting to squat or kneel or stand in one place (such as in a ine in a store) or conversely when sitting and driving for more than 30 min. ) All nerve tests were normal (and they were done twice. People with EDS/HSD seem to have a lot of pain that everyone attributes to fatigue in the joints, muscles to keep the joints in position But I wonder if they have ever looked at assessing the blood flow to see if the pain could actually be caused by the veins being compressed. I mean if TOS was just figured out within last 20 yrs, could it be that nobody in the EDS community thought to check this out? It is hard enough to get a diagnosis of EDS/HSD. I saw there is a cervical outlet syndrome so would that be lumbar or SI outlet syndromes. (It's like sciatica but completely positional. Also I now understand what is probably going on when I sit with legs crossed in the formerly known sitting position, indian style. Some call it lotus style. My feet will go numb but if I stretch my legs put straight in front of me, everything is normal. It is very difficult to do gardening work sitting on ground without crossing my legs. (Having a marfoidus habitus...sometimes the arms aren't long enough. Imagine trying to pick strawberries if you can't squat or kneel. However with TOS no pressure can be put on arms as if to hold yourself up while lying down or on all fours...while trying to pick.) This has been a challenge that is steadily getting worse over time. I'm in Wisconsin in an HMO...could you advise as to which type of dr to see for TOS? Also instead of cutting out bone, has anyone tried something like inserting a balloon in the areas where the veins are being compressed? (I've heard about balloons being used in other areas of the body but much of which I do not understand.) I just worry that perhaps the blood vessels are stretchy (connective tissue disorders present in many ways....so have you seen anyone still have trouble after a surgery)? (Age wise, I'm in my 50s and getting a diagnosis for me took many dr eyeball rolls and it literally took 10 yrs. Another question: how does compression socks or sleeves with TOS. For me despite trying to wear knee-hi compression socks in very warm temperatures, I can last about 20 min more than without wearing them. The TOS videos were huge learning opps for me today and now I'm trying to put the pieces together. If there is another resource you can point me to...I would appreciate it.
@@maryr7593 Thanks for all the good questions. Most of these are out of our wheelhouse. I hope you have a good primary care doc who can be your quarterback-they can coordinate the specialists you see and put together all the information to make decisions on next steps. Unfortunately, these comments aren't designed or intended to discuss individual people and their health care issues. I hope that's helpful.
@@tosmri thank you, I apologize for asking personal questions, I thought they were general enough that they could apply to other people. So you are saying start with PCP and see if they can identify TOS? I had gone through the entire process ten yrs prior as the PCP didnt recognize it and suggested it was in my head. So for everyone else who has been on the merry-go-round before...if the insurance does not require a referral, who is next best person to try to see? Patients are trying to put puzzle pieces together except they dont know what picture looks like, the pieces are scattered all the ground, etc. Most of us just need a direction to try to go to see someone who knows about TOS. Just like EDS/HSD...there is no medical specialty area. If there is, there is 1 person in the entire city who has waiting lists, 2 yrs long.
@@maryr7593 Here is a Facebook group with lots of patients. Its a source for certain TOS specialists and opinions about them. facebook.com/groups/TosSupport
No wonder I've been struggling for so long.
This is debilitating.
Appreciate the help, these videos are extremely helpful.