mystery of pain after a year resolved-Costochondritis

[Shine_on_Syd]

Around Christmas time 03, 8 months post op, I was experiencing chest pains. I knew it wasn't coronary related as my pre op cardiac cath was clear so I was worried that something had gone wrong post op from my AVR or it was just the stress from the holidays. I don't really have a relationship with a cardiologist because I can't find one that seems to take any ultra inquisitive interest in my problems nor do they really answer my detailed, well researched questions, nor don't know much about conditioned athletes post AVR. Plus they all seem to think I am nuts that I believe in the Ross Procedure. My February echo seemed normal, then months went by without getting any answer to the cause of the pain. Finally I picked up the phone and called my surgeon and we pinpointed the problem to " Costochondritis... an inflammation of any of the costochondral junctions (also called costal cartilages) that join the ribs to the sternum, or breastbone, on either side of the ribcage' http://www.charleston.net/stories/032403/sci_24medical.shtml
.......resulting from the trauma of separating the rib cage during open heart surgery. Its fairly innocuous but the surgeon said it can be painful for some. For me, the fact that my heart is healthy I can stand the pain.
I sit in the hot tub at the gym for relief. As an aside, the surgeon said that my heart function for a 55 year old man with a non Ross Operation is astonishing. I do 45 minutes to an hour of workouts pushing anaerobic limits daily.
Wanted to share this will you all and wanted to know if anyone else has had similar problems rib cage pain.
Also, I don't know about you all, but when patients reach the level of treatment that we do on this board, it is my conclusion that the surgeon who has been inside our hearts are the ones that can only really answer our questions. And I am so lucky to have a surgeon that returns my calls. That's my exprience at least.

 

[Ross]

Man it's been awhile since I've heard this term. So long in fact, I forgot all about it. I'm glad to see someone found the root cause and was able to answer.

 

[Sherry]

Good morning, Shine On,
In answer to your question, yes, yes, and more yes. I have suffered from relentless back and chest pains for the last four years. I've gone through the gamut of tests to see what's wrong, and my general practitioner (who is a wonderful guy) couldn't find anything serious and also called it chostochondritis. One thing, though, I did have some moderate disk damage also which could involve a pinched nerve as well. Just last night on my way to prom (teacher chaperone), I ached so badly, I almost turned around and went home. (Since I teach seniors, I toughed it out and went anyway.) I've tried Celebrex to no avail. I've had injections, massages, used pain pads that adhere to your skin, and even saw a chiropractor. Unfortunately, it's something I've just learned to live with. I can't help but think, as you mentioned, that being splayed open during surgery doesn't factor into this condition. Let me know if yours ever goes away or anything that helps.

 

[tobagotwo]

Good link.

This sounds like the long-term version of the intercostal pull that many experience during recovery. Apparently, your cartilege also got involved, and stayed mad. Pain in the ribcage is very painful, and can be at least momentarily crippling. I only had it for a couple of days, and I really didn't like it at all.

There is another term for a similar problem (or possibly the same problem), called intercostal neuralgia.

As all of these are inflammamations, Celebrex or some other arthritis-type drug does sound approprite. Vioxx might be, too. Or Orudis for over-the-counter. All are NSAIDs, so there is an implied warning about aspirin sensitivity and possible stomach bleeding if you are on Coumadin.

Of course, the Celebrex didn't work for you. Orudis worked for me, but mine was short-term, and probably more muscle related.

While it makes sense that this would be related to being propped open like a cracked crab for surgery, there have been postings about some of the statins (taken for cholesterol) and muscle pain. It's a long shot, but it might be something to look into, if you take those.

Here are links to some more exotic approaches:

Cryoanalgesia: http://www.crsti.org/protocols/intercostal.html

Accupuncture: http://pointinjection.com/ht/intercostal.neuralgia.shtml

As these are web finds, I do not know their validity, and you would certainly want to run anything from these sites by a trusted professional.

Best wishes,

 

[Shine_on_Syd]

Costochondritis

Costochondritis

Sherry and Bob your replies are great. Sherry funny you should mention about the Prom, my 17 year old had his last Saturday and I was so grateful to be alive and see the grand parade of couples that I didn't even think about the pain. I think I will just take the Spartan approach like you and live through it. I was popping NSAIDs like crazy on top of my daily 83 mg Ecotrin and my primary care doctor said "stop that." I limit myself to less than 325 mg of any pain reliever a day; except when I get a migraine aura and then I find Tylenol helpful. Like I said I am happy that it is not heart related.
I am a big guy with a barrel chest, my surgeon showed me pictures of the operation and saw that they had to use an extra amount of wire to put my sternum back together. I joke with him that I can go back to playing hockey with my steel reinforced sternum.
What seems to be working in the last few weeks is the hot tub at the gym.
Bob your links are great thanks for the info. Bob, can I ask about the Mosaic
valve? Is that the brand name? I have a pig medtronic stentless Freestyle and wondering what is different about yours. I used to live in Rocky Hill, NJ not too far from you.
Thanks,
James

 

[tobagotwo]

Mosaic is a model name for a new porcine tissue valve made by Medtronics. It's a new set of preserving processes for a proven line of valves (FreeStyle). The link for medtronics is: http://www.medtronics.com
You can look at the Mosaic information by going to physicians, then product.

Rocky Hill's not that far. I was born in Summit, NJ, but spent my growing years away from NJ. I came back following jobs during the second oil crisis. Since I've been back, I've lived in Denville, Mt. Freedom, Boonton, East Brunswick, Dunellen, Middlesex, Bound Brook, and two addresses in Bridgewater. It's very likely we'll leave here when we retire, though, assuming we get to retirement.

We went on a driving trip along the Maine coast last year, so we slipped through a small section of New Hampshire. Since we're planning to do southern Vermont this year, maybe we'll slip into NH for a bit on this trip as well.

Best wishes,

 

[Shine_on_Syd]

mosaic

mosaic

Thanks Bob,
I checked the medtronic site.I have the medtronic freetsyle stentless.
New Hampshire has 17 miles of coastline between Maine and Mass. It is just a beautiful place. We are close to Boston, near the ocean and 1 1/2 hours from the White Mountains. Moved here from NJ. Feel free to stop in if you are in New England. We have crossed paths geographically too. I grew up in Maplewood and used to make Bootonware in college.
James

 

[tobagotwo]

My father, John Hendricks, was a Research & Development manager at the Boontonware plant years ago. Hope you never had a run-in with him. I remember him bringing home Melmac and other obscure plastic dinnerware from samples, and even a barrel of off-spec, urea-based crumbles that would have been melted into melamine base. It was a while ago, as avocado was still apopular color then.

I worked for a while as production planning asst. mgr. at Pacific Vegetable Oil in Boonton, which was right next to the old Drew Chemical plant, which you might remember from its many noxious odors.

Many escape Taxachusetts by living over the line in NH. When I saw Dover, I figure there's a 50/50 shot you worked in MA. Live Free Or Die is a common license plate in Boston parking lots.

Best wishes,

 

[Bryan B]

I'm wondering if this is what I have. The docs have been chaulking it up to a wire rub near the upper left side of my incision that "should" subside as the muscle around it develops a callous. Before that I was diagnoised with a cartiledge tear on my right side. I'm eight weeks out and still waiting. I get it worst after exercising. I take Vioxx for it which seems to do a good job, but it tears my stomach up (I've tried everything to prevent it). When I take narcotics for it it does a good job but my docs don't want to keep going down that road. Has anyone here had a wire removed and was it worth it (i.e. did you get permanent relief)?

 

[Shine_on_Syd]

Bryan,
If it helps I can tell you that my pain is on the left hand side of my sternum, right above the heart and is a brief shooting pain. If I touch the rib at the cartilage joint it is tender. I have extra wire in me and no one has ever mentioned taking it out.
I am not sure how strong Vioxx is but Ecotrin is coated aspirin and is easier on the stomach.
To be honest it will take you a lot more than 8 weeks to get your chest back to normal.
Glad to see you had an RP, I am definitely a Ross Procdeure proponent.

 

[Gisele]

I am now six month post op and still have a tough time with my sternum. I didn't have these problems the first time around, but this time I just can't seem to get rid of this pain. To make matters worse, I was sewn back crooked which is visible only if I am wearing my bathing suit or my birthday suit.... I think my whole rib cage is off on the right side and you can see this by looking at my back. I see my cardio next week, so I will ask him what I should expect in terms of how long I will stay in pain. Can't wait to feel 100% normal again.............not sure if that will happen though, but I am hopeful!

 

[Bryan B]

Syd,

To be honest with you, I didn't read the link until today. The description sounds exactly like what I have. It's tolerable most of the time, but the pain gets intense after my walks and rehab sessions. I love my exercise, so I got this cycle going of feeling good and then paying the price afterwards. It's a vicious cycle.

 

[Blake777]

I have a horrible pain and when it comes I have to just scream because it is so bad. I can't bend I have to keep my body straight. It is at the bottom of my left rib cage. Could it be my spleen? The pain is unbearable when it comes. I'm also having pain from my incision and the doctors keep telling me I shoud'nt be having any pain at 23 days post op. So I wonder why I'm in pain everyday. They gave me mobic, said it was something like celebrex but it just helps for a little while and I don't want to go back to narcotics but I may have to take one before bedtime just to get some sleep. The oxycodone I was taking had me vomiting for two days and I just got back to myself, except for the pain. I was diagnosed with chostochondritis before surgery.
Ronda

 

[tobagotwo]

Blake777, I'm sure you're checking with the doctors about that pain, but it does sound like intercostal issues on the face of it. When those little muscles (or that cartiledge) starts to complain or spasm, it puts you in a vice of agonizing pain, and you can't even take a full breath.

I've had it on both sides, at one point or another.

Bryan, I had good luck with Orudis (ketoprofen), which is over the counter. You may have to go to a drugstore to find it, as it's not as popular as ibuprofen, aspirin, or Tylenol. It's an NSAID, so I don't know how it might affect your stomach, or if it would be contraindicated by anything else you might be taking.

 

[Blake777]

Thank you tobagotwo, I will try anything to get rid of this pain. I'm even trying muscle relaxants right now.

Thanks Again
Ronda

 

[Duds]

Hello All,

I'm 3 months post-op and was able to get a diagnosis of costochondral inflammation from my surgeon after 6 weeks...he suggested I take NSAIDS to help 5 days on / 5 days off. It's still pretty tender and flares up after exercise and of course as I take on more and more trying to resume a 'semi-normal' life after OHS surgery. The surgeon told me that small people don't tolerate the whole cracking of the sternum as well as others. I take it day by day and definitely don't let it stop me from my rehab walking/biking. I was also told it can take 6 months to a year to fully go away!

 

[Mentu]

I am somewhat relieved to read all your comments. Since my sternum was closed with a set of clamps, it caused me no pain after the AVR last year. For the past three weeks, however, I've been wondering what might be going wrong because I've developed a painful area just at the right edge of the sternum not in the center. It aches after exercise and is sharply painful when I sneeze or cough. There is also some swelling around the spot so it is on my list of things to discuss with my Cardio in a few days. It is helpful to know that others have similar issues. Thanks.

Larry

 

[Bina]

this is an older thread, but it makes for very interesting reading.
My ribcage was a total mess for a VERY long time. (I am also small), and suffered alot with it. Sternum was fine.

 

[LisaD]

I am a year and a half out and still get some aches and pains after doing a lot and during cold wet weather, but the pain is much better since having my sternal wires removed. I had them removed almost exactly a year after my surgery. I had gotten to the point of not being able to carry groceries or lift my arms up over my head. The wires were not only causing me great pain in my sternum, but inflammation in my pectoral muscles. I also found that once I had the wires removed that my back pain improved as well, I think it was a combination of some nerve inflammation a posture problems that lead to the back pain. I am very glad I had the removal procedure. I had mitral valve repair surgery at 35 years old and had previously been very active, so the crippling pain was just devastating. I am have now resumed many of my previous activities like dancing and snowboarding, but I take ibuprofen before and after activities to help.

 

[Kathy McCain]

I had minimally invasive AVR. My incision is about 3 to 3 1/2". I have been taking prednisone 5mg since pericarditis set in appox one month after my surgery. It definitely was diagonosed as such, and I had all the symptoms. I recently tried to completely come off the pred. and I experience a very similar symptom to pericarditis, only pain just under my left breast, around the rib. The pain is worse when I take a deep breath. I just assumed that was the problem. As long as I take the prednisone, I'm okay. Could it possibly be the same problem you were diagnosed with, even with a minimally invasive procedure ? As far as a pinched nerve in the back, I am having my last spinal injection next week. It can come on suddenly. I lock up and can't do much of anything. It was so bad this time (it has happened twice before) I had no other choice, but to have the injections. They have helped. Evidently I have a mild arthritis in the lower back, which is causing the problem.

Good luck everyone!