Hey Gang,
Here’s the TL:DR—
54M got 3 bars with Dr J today. This post is about how I decided to get my pectus fixed at a later age than most (I had CHF symptoms that I believed were from sternal compression of my heart) and how I got my appointment with her. Most of it was written while I was waiting in preop. Here goes:
I’m having a 3 bar repair with Dr. J today!
I’m 54 and have always had poor exercise tolerance with any endurance activities. I knew about pectus from an early age (teens) and had seen a plastic surgeon in the 1980s who offered to put in a silicone implant. Nuss was very new and repairs were pretty radical surgeries in those days.
About 4 years ago I was feeling more dyspnea with exertion and wondered if I could have some coronary artery disease. (I had a couple of colleagues that had had heart attacks at an early age, so that’s what prompted that concern.) I asked my primary care doctor to order a stress test.
I had a stress echocardiogram which was difficult for the cardiologist to interpret, likely because of poor windows (the echo probe needs to see all of the chambers and valves by peeking through the spaces between the ribs) which I attributed to my pectus. The big takeaway though, was that my inferior vena cava was severely dilated (>4cm). The IVC is the big blood vessel that returns venous blood to the heart to get moved into the lungs.
Since my stress echo didn’t have good enough images to be diagnostic, I had a CT scan of my coronary arteries (CTCA), which showed normal coronary vessels, but my IVC was noted to be dilated.
A severely dilated IVC is usually a sign of congestive heart failure, which I really didn’t think I had, so my PCP had me talk to a cardiologist. He also thought it was CHF and ordered a blood test (BNP) which is a marker that can indicate CHF. My BNP was undetectable, and cardiology said that I don’t have CHF and nothing else was needed from a cardiology perspective.
When I reviewed the images from my CTCA I could see the cardiac compression from my sternum. I put 2 and 2 together and realized that if my sternum is compressing my right ventricle (on the side of the heart where venous blood is pumped to the lungs) and my IVC is dilated, then my heart isn’t able to move through all of the blood that is returning to it. Physiologically it’s like CHF, only it manifests most when I’m exerting myself, like when I had the stress echo.
I calculated a Haller index which was a significant number. A subsequent CT (for another thing I won’t waste time on) showed an HI of 4.1.
I started reading about pectus excavatum correction surgeries after this. I found out about Dr J from internet research and from a patient (I’m a physician) that I saw who had had a Nuss with Dr J in her 30s. She told me that Dr J had operated on patients in their 60s. This surprised and encouraged me.
I tried to get an appointment with her, however this was not straightforward as she is no longer taking self-referrals for patients over 50. The office staff said that this was due to increased risk of coronary artery disease in that patient population.
One of the perks of being a physician in a fairly big health system is that doctors tend to squeeze you in for appointments when you reach out to them personally. They still bill insurance and we still pay the copays etc, but often we can get pretty expeditious scheduling of appointments.
I got an appointment in a week or two with one of the pediatric surgeons in our system who has done a lot of pectus surgeries, but typically only on teenagers and patients in their 20s. We talked for an hour and a half and because I was outside of his patient age range, he wrote me a referral to Dr J. He also sent her an email. It also helped that she knew of him professionally, so I think his letter/email carried more weight than a letter from a physician that she wasn’t familiar with would be.
Eventually (maybe after 2-3 weeks, I don’t recall) I got a call from Dr J’s office and got scheduled for a consultation.
I saw her in January and was very impressed. She reviewed my testing with me and told me about risks and benefits. At my age there is a 10% chance of rib fractures. The bars need to stay in for 5 years to lessen the chance of regression.
We planned on October for the operation. Commitments at home and work were why we scheduled so much later.
We flew in to town on Sunday. Yesterday I had preop labs, a chest X-ray, and an EKG. I also had a preop visit with Dr J’s PA.
This morning we arrived at 8:30 am. Met the anesthesia team, and Dr J’s assistant Jesse. Dr J answered all other questions. Everyone was extremely professional and answered all questions thoroughly. Five stars. Would recommend.
I’m pretty tired now and will add an update tomorrow.
Have a great night! Zzz
