Sternum won?t heal.

[soundman]

Hi folks,
I had a bypass operation (CABG) in more then a yar ago, in December 2001.
The heart seems to be OK now, but I am having problems with the healing of the sternum.
First thing that I noticed is that after a week I needed stronger painkillers and also I still needed them at a time the others had already stopped using them. Also after 6 weeks I did not feel confident using my arms to stand up, picking up things etc.
Of course I mentioned my problems in rehabilitation. The physicist and the cardiologist tried if they could feel if the parts of the sternum could move towards one another. But they felt the situation was OK.
As my complaints persisted, I went to the surgeon that operated me. She decided to take out the steel wires. This was done 12 weeks after the heart operation. It gave me relief of some pains, but not all.
After 6 months a CT scan was made. This showed non-union of the sternum. Some connective tissue was formed, but no bone. In fact the two halves had formed a sort of joint (pseudo artrosis). This situation explained the persisting pains. Although the pains had got less, I still could not carry (light) loads, or get back to work.
I am a TV soundman and so I must be able to carry a suitcase and hold up a microphone boom for about 20 mins. at a time.
So 10 months after heart surgery I was operated again to refix the sternum. The formed joint was taken out and fresh bone was tied together again. This should have done the trick, but it hasn?t.
It has been almost 5 months now, and the situation is better then last year, but still not good enough. Again I am still on painkillers and do not feel confident in doing things with my arms.
A new CT scan was made and it shows some growth of bone structure, but much less then might be expected. What can I do? Will I be able to pick up my work again or must I try to find an other job to do? The doctor wants me to wait for another two months before I make a decision. Am I special or are there more like me out there?

Soundman (54), Netherlands

 

[Ross]

Hello Soundman and welcome to VR

It's slow on the weekends around here, so give it some time for everyone to take a look at your post. I don't have anything to add to this myself, but with 680 members, I'd think someone would have had a similiar problem. I wish I could be more informative on this, but for now, you'll have to settle for my welcoming you to the forums.

 

[hensylee]

Hey Soundman - welcome to VR - there are lots of folks in here to answer your questions and lend support. But this one is a stumper - I think you are special - we haven't had this particular situation come up in the 3 yrs I have been a member, although there have been quite a few sternum related issues - mostly with the wires. It would be a shame for you to give up your job. I think 5 months is still to early to make a final decision. We are told that it takes up to a full year for the sternum to heal, but I will always know that something happened with my sternum. Like you, I had bypass.

Just hang on, tho and many others will follow me with information. I am just the first one out of bed after you posted. Go bless

 

[Nancy]

Hi Soundman-

Welcome to this wonderful site. I'm sorry to hear that you are having these problems.

I know there are folks on the site who have mentioned sternal movement for quite a long time after surgery. I hope they can give you some insight as to what their doctors have had to say about the situation. You mentioned that it has been 5 months since the reop of the sternum.

Just wondering--I have no knowledge whether this could help in any way, but has anyone mentioned fitting you with some kind of brace or harness that would keep your sternum a little more stable while it heals? They do it for people with broken ribs, kind of strap them around the chest area, and there are braces used for scoliosis and other back problems. Why not for your situation?

Just brainstorming on your issue.

I wish you the best, and hope we can have the pleasure of your company at our little site.

 

[weekycat]

Welcome Soundman!

Welcome Soundman!

I had my heart surgery over 9 months ago, and still feel some movement in my sternum occasionally.

It seemed to take a very long time at first, and then it seemed pretty well healed maybe 3 months ago. (6 months post-op).

Sometime after that, I think I sneezed very violently, and it hurt like the dickens! Ever since then I still feel some movement again when I change positions in bed, or just make certain arm movements etc. The other day I was sitting in a chair with a table to the left of me. I reached across my body with my right arm to grab something off the table, which of course put pressure on my sternum. I couldn't believe the pain that was caused from such a simple movement!

When I saw the cardio for my 3 month check-up, I had told him that I still had some popping and clicking in my sternum, and all he said was, that if I felt there was still some movement there, I should contact the surgeon that did the surgery.

At that point, I figured I'd just give it a little more time, but now I'm not sure what to do.

I'm sorry, I don't have any answers for you, I'm actually hoping someone else will respond to this thread that might have answers for both of us! I realize it hasn't yet been a year for me, but I don't like the fact that mine seemed to get worse after it got better.

 

[Guest]

Soundman,
I usually only watch the Coumadin forum but I was checking out something else and noticed the name of this thread. I run the website www.warfarinfo.com. Through this, I have had thousands of e-mails concerning warfarin. I had one about 2 years ago concerning a boy who had to be on warfarin that suffered a broken arm. After nearly a year, his arm had not healed. The mother wanted to know if warfarin might be implicated. I have no idea whether it was or not. Such occurrences do happen even when people do not take warfarin.

However, this might possibly be related to warfarin. Since you are in The Netherlands, you have a possibility that we do not have in the US. There is an alternative drug, acenocoumarol, that is approved in your country. On the long-shot chance that this might be related to warfarin, discuss with your doctor the possibility of using this alternative anticoagulant. Since you have had such a long and unsatisfying response it seems worth trying.

Please keep us posted on what you do and any response (good or bad) that you have.

 

[Soundman54.nl]

Warm welcome

Warm welcome

Dear VR-people,

Thank you very much fore the quick response and warm welcome. It is a good thing to be able to discuss these matters with people that know about it. But of course you know.
Even if it turns out that my case is special, it is good to know that. Although I very much would like to know what can be the cause of the trouble of course.
I?ll try to give some answers to your questions.

Nancy, after the refix operation, I did wear a elastic brace for 2,5 months, 24 hours a day, and I slept on my back. At first the idea was that I should wear it for about two weeks, but I didn?t feel confident enough to take it off earlier. One feels so vulnerable, and the brace really helped to give some confidence. It also helped when sneezing and coughing. Of course I had my pillow, but one doesn?t always have it in place at the right time.

About the warfarin: I didn?t use that. I was on acenocoumarol right away, and I?m on Ascal now for a long time. So I can?t confirm your idea about the drugs. Nevertheless, thank you for bringing it up.

As for the sneezing: I think we all can confirm that. Also my fellow patients that heal nicely and quickly tell me that it keeps on hurting. When you sneeze an enormous pressure is build up in the chest. In the beginning it feels as if you get ripped apart. In fact here might be a point as referring to my case: I sneeze a lot! Every day, and more then once. It is normal to me. So maybe, this is a cause of the problems. I take a medicin now, to prevent me from sneezing. It got less, but it can?t stop it completely.

 

[Christina]

Soundman...

Soundman...

Hallo en welkom Soundman,

I want to welcome you to this wonderful site. I was born and raised in The Netherlands but have been living in the states for more than 25 years. I still speak the Dutch language fluently and vacationed in The Netherlands this past X-mas season.
I am sorry to hear about your sternum healing problem. I had two AVR's in August 2000, but have not heard of your particular sternum related issues here on the forum. Maybe someone will come along shortly and give you the answers you are looking for.

Hou je haaks en laat van je horen.

Christina
__________________________________
AVR's 8/7/00 & 8/18/00
Tucson, AZ.

 

[Nancy]

Hi again Soundman-

How about getting a consultation with an orthopedic specialist. Maybe they would have some "magic" for your ailing sternum.

 

[sylviayasgur]

hi soundman!
welcome to this site! everyone here is so supportive and kind, it's a great place, as you can see.
i am so sorry to hear that you have to go through this.

i have a brother who lives in wassenaar with his girlfriend. we grew up in aruba (dutch island) and moved to n.y. when we were in our teens.
unfortunately, my dutch is very rusty since i only speak it with my parents.

i hope you resolve this problem with your sternum soon.
please keep us posted and let us know how you are doing.
be well, sylvia

 

[Soundman54.nl]

Name has changed

Name has changed

Somebody changed my name from "soundman" to "soundman54.nl". Not that is not correct, but I wonder who does these things! Turns me into a number! If necessery, I would prefer Soundman1948.nl. Would last longer too...

 

[Soundman54.nl]

Dutch connection

Dutch connection

I was very much surprised by getting replys from Dutch speaking persons! I write to them in Dutch:

Dit had ik natuurlijk niet verwacht, maar het is wel een heel leuke verrassing. Het heeft best lang geduurd voordat ik ertoe gekomen ben om mijn probleem in het engels te verwoorden, en nu dit!
Het is fantastisch dat deze mogelijkheid bestaat, en ik heb ook al het initiatief genomen om een nederlandstalig forum op te zetten, want dat was er tot nu toe nog niet. Het zal misschien niet iets zijn voor jullie zelf, want jullie wonen al zo lang in de States dat je je vast heel goed weet uit te drukken in het engels, maar misschien kennen jullie nog andere mensen die er wel iets aan zouden kunnen hebben. Ik geef je het adres: Club Home: http://clubs.freeserve.com/groups/Hartcontact. Het stelt nog niet veel voor want het is nog "under construction", maar alle beetjes helpen!

Groeten uit Holland,

 

[Soundman54.nl]

AVR?

AVR?

Christina,

What means AVR?
Can you translate that into Dutch?

Groeten,

 

[Soundman54.nl]

magic

magic

Hi Nancy,

No, unfortunately, no magic. No plates, hormones, bone particles or other things of the kind either.
If one waits long enough, connective tissue is formed and the pain gets less or can be killed permanently. But then one still will not be able to carry normal loads as f.e. 20 kgs. For me that means I cannot go back to my job.
As I understand it, when normal bonestucture is not formed in time, the body will start to make cartilage (? I had to look that word up in a dictionary, never seen before!) in two layers between the parts of the sternum, forming a kind of non-functional joint. This was what happenned last year, and it had to be taken out because it itself prevents a normal bone stucture to grow. This happens at ca. 6 months. As I am 5 months after last operation, this is an important period. Next CT scan will show if I'm on the right track, or not. But I do feel better then last year already; the last operation might not bring what it should have done, but it was not completely in vain!
I am on a rehablitation program now, and they are watching me very closely!

Greetings,

 

[Christina]

Soundman...

Soundman...

Hallo Soundman,

Dank je voor de hartelijke groet, en fijn om je zo van dienst te kunnen zijn. Als je nog meer vragen hebt, vraag dan gerust verder, want er is er altijd wel iemand die je raad kan geven of die meer informatie heeft over jouw probleem.
AVR betekent: Aortic Valve Replacement. In het Nederlands vertaald is dat: Aortic klep Vervangen door een kunstmatige Klep, ook wel een kunstklep genoemd.
Ik had twee operaties binnen de 11 dagen in Augustus 2000. Lees mijn verhaal met detailles op de main valvereplacement.com site.
Ik vind dat jouw Engels bijzonder goed is, dus ga zo door. De mensen hier zijn ontzettend gastvrij en al kun je geen perfect Engels, dat hindert toch niks. Iedereen begrijpt dat en houd daar rekening mee.
Ook nog bedankt voor het geven van de Nederlandse hart website. Ik zal er eens een kijkje gaan nemen. De webmaster van deze site is ook zo begonnen een aantal jaren geleden en kijk eens hoeveel leden we nu al hebben.
We hebben ook jaarlijkse reunies, en dat is ontzettend gezellig.
Wil je prive e-mailen, mijn adres is:[email protected]

Groetjes,
Christina
_________________________________
AVR's 8/7/00 & 8/18/00
Tucson, AZ. USA

 

[Kincaidm38]

My daughter broke my sternum 6 1/2 years ago and to this day we can't get it to heal. I have had surgical plates inserted to stabalize it in hope of promoting healing but those plates broke in half as well. I had my second surgery last may and had new stronger plates inserted. Those plates are now coming loose. I am on a 5 lb weight restriction and to do NOTHING in hope of healing it as there is nothing to secure anything to anymore. If these plates break, they may have to take my sternum out entirely...but then I run the risk of my Collar Bone caving into my Ribs. :O( It is fractured in two places and dislocated. I live in constant pain. Any arm movements, scrubbing, etc. make the pain worse. And to sleep...HEH..not easy. I have two body pillows and I have to position just so to make sure that my back and spine are straight and in line to prevent excessive sternum pain while sleeping. My doc is great though and I have vicoden for the really bad nights. During the day I just suffer. Some days are worse then others. The hard part is that I have 3 kids and the youngest is only 1 1/2 and I am not even suppsed to pick him up as he weighs over 30 lbs. I am using a bone stimulator twice a day and have a TLSO brace but those don't seem to be helpling either. My bone density test came back normal..so it's all very frustrating. I have been on the stimulator and the brace for over 6 months now and it is just as broken as it ever was. Sooo frustrated. Anyone have any ideas? I am seeing an Internal Medicine Specialist and a Cardiothoracic Specialist Surgeon. But they are stumped when it comes to me! UGH! Sooo frustrating.

 

[Greg a]

My daughter broke my sternum 6 1/2 years ago and to this day we can't get it to heal. I have had surgical plates inserted to stabalize it in hope of promoting healing but those plates broke in half as well. I had my second surgery last may and had new stronger plates inserted. Those plates are now coming loose. I am on a 5 lb weight restriction and to do NOTHING in hope of healing it as there is nothing to secure anything to anymore. If these plates break, they may have to take my sternum out entirely...but then I run the risk of my Collar Bone caving into my Ribs. :O( It is fractured in two places and dislocated. I live in constant pain. Any arm movements, scrubbing, etc. make the pain worse. And to sleep...HEH..not easy. I have two body pillows and I have to position just so to make sure that my back and spine are straight and in line to prevent excessive sternum pain while sleeping. My doc is great though and I have vicoden for the really bad nights. During the day I just suffer. Some days are worse then others. The hard part is that I have 3 kids and the youngest is only 1 1/2 and I am not even suppsed to pick him up as he weighs over 30 lbs. I am using a bone stimulator twice a day and have a TLSO brace but those don't seem to be helpling either. My bone density test came back normal..so it's all very frustrating. I have been on the stimulator and the brace for over 6 months now and it is just as broken as it ever was. Sooo frustrated. Anyone have any ideas? I am seeing an Internal Medicine Specialist and a Cardiothoracic Specialist Surgeon. But they are stumped when it comes to me! UGH! Sooo frustrating.

i am going to PM you with my personal conatct info that you can use if you wish but read my info here fiirst http://www.valvereplacement.org/forums/showthread.php?35064-Radical-Sternectomy&p=453639#post453639

Also http://sternectomysupport.webs.com/

 

[Greg a]

And a big welcome to the board

 

[Lynlw]

Did they try to do any muscle flaps, and wrap the muscle around your sternum to help stabilize it and help it heal? MY son didn't have a problem with his sternum not healing, but 10 days after his heart surgery he had a massive infection in and under his sternum. They had to cut out a a bit (all of the infected areas) of his sternum, the bottom third was pretty much "mush" to quote the surgeon. They used his right pec muscle to wrap around the sternum and in any holes. The fact the muscles has so much blood and oxygen is supposed to help with the healing and the muscle holds the sternum together since they couldn't use any wires. He never had any plates. Do you have a Plastic surgeon on your team? They seem to have the most experience with muscle flaps used for sternums. Here is a short article about them http://emedicine.medscape.com/article/1278627-overview FWIW, Justin's sternum ended up healing well, he hasn't had any weight restrictions after the first couple months, when he finally got most of the strength back in his right arm (thats the side they took the pect muscle from) He had the surgery 3 years ago, we did have 1 scare this winter when the infection came back, but it was caught earliy enough it cleared up with antibiotics, but he came very close to surgery again (was even in preop a couple hours waiting to go to the OR) He just had his cardiolgy appt this morning and his card said his sternum feels nice and strong, no clicking.
Are you a diabetic by any chance?

 

[Mentu]

I have a different form of sternal fixation that has worked quite well for me. I understand from my Surgeon that these "Sternal Talons" were developed initially for people such as yourself. You can read about them here:

http://www.rapidsternalclosure.com/medical/talon.php

I've attached a drawing of a set of Talons. View attachment 8691

Talons do not depend upon penetrating the bone for their anchor like plates do. Instead, they are clamps that pull the two halves of the sternum together and hold it secure. For adults, they are used in a set of 3.

Talons are also being used after surgery for people such as my self with large chests where the sternum may have a problem healing properly. The added benefit for me was that after surgery last year, I had no chest pain. I could breath, cough, sneeze and all with little discomfort. Certainly, I was stiff and sore but the only thing that really hurt was a spot under my left shoulder blade.

Let me know if you any additional questions.

Larry
Tulsa, OK