I've stumbled across this site a few times now but finally decided to participate.
I was officially "diagnosed" with moderate to severe asymmetric pectus carinatum back when I was 16 in 2009. My entire left side of my sternum was higher and had excess cartilage growth on most of my ribs. I also had the issue where the bottom of my sternum stuck out. I was fitted for a brace by Dr. Robert Acton from the University of Minnesota Hospital and wore it for around 16 hours a day for about 7 months. The brace helped some but due to the excess cartilage it was never going to be fully corrected. Dr. Acton moved my severity to mild to moderate and we decided on a modified ravitch (during the summer of 2010) to try and further correct it by removing some of the excess cartilage. Once I was healed I was not satisfied with the results as Dr. Acton was unable to reach one of the rib's cartilage so I was left with it sticking out (I had the horizontal incision) .
Fast forward to 2018 where I was starting to look for other options. I easily found Dr. J and started going through the basic calls to the appointment office to try and get things moving. I was instructed to send over my surgery recap notes and after they were reviewed I was told that Dr. J does not do any surgeries on patients who have had previous ravitches. Now from Dr Actons explanation to me (And from reading the surgery notes) is that I had a mild modified ravitch in which no bone/rib/sternum separation occurred, he simply shaved 3 rib's cartilages and opted not to put a bar in me.
Is this a recent thing for Dr J not accepting previous ravitched patients? Online forums from only 2 years ago or less were all still talking about how she does tons of redos. I know she is more known for her nuss on Excavatum patients though.
I guess I just dont know where to go from here anymore... I had my hopes on Dr J as shes one of the best in the US and my insurance was in network. I tried working out and after 11 months of lifting 4-5 days a week I was a little happier with how i looked but adding mass to my pecs actually made the asymmetry look worse from any angle but straight on.
This message has attachments images. Please log in or register to see it.
Yeah the appointment office at Mayo actually said Dr J refers a lot of people to Dr. Daniel Miller but they were unable to give me much information other than a name. I haven't really read a lot about him though on the different pectus sites.
I don’t know why there is not more about him on this site. He does the 3rd most adults in US. I only found out about him through a. High school classmate that does surgery alongside Dr. J (Dr. David Notrica.) . i am. 5 weeks post ravitch and he was an amazing surgeon. I am trying to get the word out about him for those that dont want to wait so long for Dr. J.
Has the swelling gone down enough to tell if you're satisfied with the outcome? (Hope the recovery is going well btw).
I still feel uneasy about a full ravitch. I've read too many horror stories about ribs and sternums not healing all the way together. Then again I guess I do not know what I'd be a candidate for...
Did he explain his background/experience at all to you when you went to him? Like is he mainly all for ravitch or does he do nuss and reverse nuss and such pretty frequently? What was the process like? Did you have pre tests done before heading down there or did you have them done there like the Mayo usually wants you to do?
After reviewing all the tests which he ordered (pulmonary function, echocardiogram and CT) he offered me either the Nuss or Ravitch. I was afraid of the long recovery time and 6 weeks on pain meds for Nuss, so I had the modified Ravitch. He does what's called the "Miller modification" which I guess he invented- he uses a dissolvable bar made of polylactic acid to secure the sternum to the ribs. I believe this prevents the old problems that used to cause failed procedures, and does away with the need for a second surgery because the bar dissolves over the course of a year. Also, he cut only about half the usual amount of cartilage on me. I could tell immediately when I woke up that I could breathe better than ever. I have been able to walk further than ever on a treadmill and my heart rate stays below 125! (It was 188 before surgery.) I still have some swelling and soreness below incision. Dr. Miller said that's because of the disruption of muscles and where they placed the drains. I am taking Advil and Tylenol, using heat and trying to walk. I can definitely say it was worth the surgery, although I am anxious to be completely pain free. I keep reading accounts of patients who have Nuss and their pain seems to go on longer and be much more severe than mine. I was able to sleep on my side two weeks after surgery.
As for the process, the tests took about two weeks, then we reconvened and he told me I could have either surgery and his wait time was only three weeks. I waited about 5 because I had to organize things at work before taking a month off. I was four nights in the hospital, received excellent care. He has an orthopedic company come measure and make you a shield to wear while driving during the first 6-8 weeks. I've had two follow up appts. I did have an infection in my incision which cleared up on antibiotics, but from what I understand that is unusual. He thought mine was caused by breast tissue weighing heavy and pulling on incision- so men won't have to worry about that.
I hope this answers all your questions - feel free to ask anything!
If you don´t find anybody else we redo PCs after any sort of previous surgery and we do a self developed way of endoscopic reversed Nuss , so far 365 cases since 2002
if you send me an E-mail you can inform me about more details of your case
apart from the PC repairs we did 1854 Nuss PE repairs including 179 redos we did mostly referred to us after failed repair in other centers ,
I would like to ask you directly for a few more details on your personal symptoms and signs
Prof. Dr. Dr.med. Klaus Schaarschmidt
Tel.: +49 30 9401-54400
Fax: +49 30 9401-54409
Well finally after almost 9 months I managed to get set up with a consultation next week March 13th. Flying out to Georgia to go to see Dr. Daniel Miller. Hope the consultation goes well. I took a peek at my CT scans I had done and am a little concerned that it doesn't, seem to appear that bad from the images though. I did do a self Haller Index calculation off the images though and if I did it right it looked like I might be at around a 1.9-1.96. ...