Sternal non-union

Hi everyone

I haven't posted for quite a while as we've been very busy at work.

I've had a clicking sternum ever since my 3xCABG in April 2008 and assumed that it would get no worse and that I would learn to live with it (see my earlier posts on the subject)

However, recently it has been getting worse in that it's become painful and intrusive into my life - people around me can hear it clicking when I exert myself and I am getting disturbed sleep because of it. Sometimes I swear my sternum has moved up in my chest and the collar-bone joints are quite 'knobbly' and pushing on my throat arteries.

Anyway last week I went back to the hospital for a review and they told me that ALL the clips have broken, the sternum is in at least four distinct pieces and that, yes, the tension from the collar bones is pulling the sternum open at the top and it IS moving upwards towards my throat.

To cut a long story short, they need to re-operate to expose the sternum from the front, remove the damaged wires if possible and then use plastic or steel plates and screws to anchor together the various parts of the bone.

It's not as serious an operation as the CABG, since they won't actually open the chest up, they'll try to do everything from the outside.

So, guys and gals, am feeling a bit low, waiting for a date for the op and trying not to do any more damage.

Advice to all - please don't overdo things early on in your recovery - give the sternum a chance to heal and become strong before you expose it to any lateral stresses

I know what I did wrong first time around and I'm pretty damn sure Iwon't be doing it again this time !!

Regards to all

John

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John,

It is quite disturbing that the sternal separation can occur. You mention that you know what you did wrong. Can you elaborate? Much thanks as I am 7 weeks out and my sternum is clicking and the feeling at the collar bone is there and a couple other places as well. I am told I can lift 25 lbs now as long as I'm careful to keep things close to my body in front....and I have been.

I'm not mowing the lawn yet or playing golf...or shoveling....or sweeping floors with a heavy brooms. But, I do play drums already. I'm not carrying the drums around without my helpers loading and unloading. I was assured that the downward motions in front of my "core" would not be harmful to the sternum. And I was warned not to extend my arms WIDE while playing. So no "heavy rock n' roll" with a strung out big set up. :)

~Gear

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John,

I am so sorry you will have to endure this additional operation. This is a warning I will be heeding as my CABG is forthcoming.

I am not a swimmer, but I have envisioned myself for 'sometime after' surgery not lifting my arms much above my chest. Did your 'overdoing' it have anything to do with your waiting 12 weeks to return to work?

I read with interest your 'what you can and cannot do' thread and have copied it to another doc so I can print and read again (a little slow I am...?)

John, I am sure you will do fine with your surgery and wish you all the best in your recovery. You and your team will be in my prayers.

Looking over this reply, I see a lot of 'I's" whereas there should be more 'you's', but this is all about you and my well wishes for you in your continued health.

Be brave John and enjoy the love of those around you.

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Hi Gear

I'm a big guy - broad-shouldered and strong, scuba diver and former rugger player, proud of my chest expansion, and I simply couldn't ask for help with small things which I felt well enough to do myself.

Mowing the lawn with a hover-mower, bit of gardening, reaching overhead to screw up a new curtain rail, swimming competively with my daughter , diving for stuff at the bottom of the pool, fitting a 90 horse outboard to the back of my boat - all these things put quite a stress on the sternum - it's a big plate of bone and I now know it's not only there to protect the organs behind it; it's also the attachment for all those muscles which give our manly shape and which support our shoulders via the collarbones.

What I was doing too soon was pulling the two halves of the plate apart before they had a strong bond again. Think of the activities which women would use to lift their bust and you've probably got the exercises you need to be very careful of !!

In the US I read they use a thicker stronger wire for guys over 100KGs (220 pounds) but I don't think that's the case in the UK, so the wires simply weren't strong enough to compete with my strength. Some snapped, others may have pulled through the bone - whatever the case X-rays last week showed that none remined in place doing their job !!!

BTW, I'm writing this very slowly as you say you're a drummer and I know that means you don't read very fast (lol) : )

Take care and keep your sticks light and your solos short !

John

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LOL John....and thanks for a very informative post. I'm 5' 10" and went in to surgery at 256 lbs. So I'm hoping they pulled out the big stuff when they wired me up. In fact I did ask how thick the stainless steel wire was. He said it was "number 7". But couldn't give me a gauge size. My thoracic surgeon probably didn't do the closing up anyhow. His specialty is the smaller bits. ;-)

Btw, you know the first thing a drummer says the day after his nightly gig? ............"you want fries with that?"

-Gear

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I believe the clips they'll be usinfg this time around are Nitinol clips shown in use at this website - don't look if you're at all squeamish !!!

http://www.ctsnet.org/multimedia/vidgal/2009/vg2009_NikolaidisN_NitinolClip s448.swf

Apparently the metal is soft at freezing temepratures, rigid at body temperature, so they chill it and stretch it before insertion, then as it warms up in the body, it returns to its original shape and pulls the two halves of the sternum together tightly.

Looks like a good solid piece of kit.

Re the wire gauge, I recall reading an article which said Gauge 4 for smaller people 6 for larger, so at gauge 7 I think you should be OK Gear

Thanks for the kind words UAE - i didn't have any choice in waiting 12 weeks to return to work - my surgeon would not allow it sooner, nor would my employers. Even then I had a phased return, doing first one or two mornings, then five, then a couple of full days, etc.

Keep us informed of your op and your progress, it's always good to chat with others who have gone through it, especially on those inevitable "low" days .

Rgds

John

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Geary I think you are home free. I am only half healed and I lift over 50 pound no problem but straining chest mussels near max caused angina. Want do that again. My problem was caused by sneezing in hospital. Once I got home I took only shallow breaths and medicine to stop sneezing and chest grew back at top but still moves in and out at bottom. After years pain stopped but is still a little painful and a lot scary when I sneeze.

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Hi Jabberwock.....Sorry to hear of your upcoming surgery. Hopefully, you'll be better than new with the outcome. I had CABG x 3 in March 2010. I had complications with sternal infection so I was on IV antibiodics for 5 months. I was doing pretty good until lately....now I have pain (increasing) in sternum again. Going for bone scan on the 24th to determine cause but I assume it is non union of sternum complications. I will be following your progress and I wish you the best of luck. Hang in there buddy....I am sure things will be better for you in no time !

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Hi John,

I am so sorry to hear that you have had these issues. My husband has been laced but also has Talons (http://www.rapidsternalclosure.com/medical/demo.php) I wonder if they might not be more secure than those that you foresee them using on you.

Hubby had CABGx5 on July 27 2010, he has only ever felt 2 "clicks" in the entirety of his recovery, and when checked by the surgeon for our follow up, he pressed good and hard on his chest very roughly. Hubby's sternum is now considered fully healed because there was almost no movement during the recovery period. (Not his movement of course, but sternum rubbing etc....).

From my understanding these are realatively new, however have proven invaluable for Brad. They give you a "boxy" feel at first, but as you mentioned this is a small price to pay, I also love that they lock into place..... kind of like that added bit of security.

I wish you a speedy recovery whatever the case my be and that things move forward for you!

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I have my surgery on Dec 7th for the same thing.. I have broken all but one wire and will be getting sternal Talons. My sternum is just free floating at this time and it is very annoying.. along with not being able to do much because of it..

What did they choose the clips instead of the talons?

just curious

I want the talons myself because they just seem sturdier..

Kel

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Hi John,

I had my sternum re-wire done on 9/10/2010. It's the same surgery as the cabg but without any heart work. My surgery went fine, but my recovery not so... Lungs filled with fluid causing a whole host to other problems. My otherwise out patient status on day one turned into 7-days in ICU. They even incubated me for 48-hours. But they never figured out what went wrong. Their best guess is/was I had an infection somewhere which reacted adversely to the anesthesia.

So...my best advice to you is spend the time (and money) to have yourself checked out thoroughly to make sure you don't have any infections going on anywhere with your body. No matter how minor postpone your surgery until you are 100% infection free.

I am 2 months out now from the redo and I'm doing fine. My chest is solid, and it does feel much better than that free-floating experience. So I'm at a point where I can now say I'm glad I did it. And glad the surgery part is behind me too.

I am going to give myself 12 months before I allow myself to get back to "normal." For me that means excluding swimming, racquetball, back packing, mountain biking and skiing. And any other activity that puts a lot of strain my breast bone. I was in too big a hurry last time -- swimming just 3 months out from my cabg4 may have lead to my own undoing (literally).

You know how it works...keep your spirits up; keep yourself healthy; take all precautions; give yourself plenty of time to heal; surround yourself with love from family and friends.

And keep us posted.

Good luck John!

Edwin

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I do hope I'm home free and doing fine because I am clicking like a metronome including my collar bone area. My doc said, "that's because you are a very active patient".....and it's normal...."you'll probably need more time than the average 3 months or so. I'm thinkin' he's right. ;) However, I have zero pain and no heat/infection and not dizzy, etc, etc. All intents and purposes considered I'm doing great. Guess I'll just keep pinching myself and carry on. ;P

~Gear

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Hello John,

Any update on your 'fix'? I hope you are not stressing out too much about it. You will be better than new soon I am sure. Have you looked into these 'talons' discussed here? They really look like quite the piece of machinery. I have to be honest, I just took a 'peek' at the link you provided on the clips, but as you indicated - not for the squeamish - as in me!!! Even the animated clip of the other was too much for me.

Do you think (feel) that you 'over exerted' yourself and that is what caused this problem with your sternum healing?

Must be nice to have a 'real' job not having to head back for awhile. Another gent here talked about half days at first too (he was also 3 months out) - I can only hope my employer will be as kind... I am not complaining, just hoping it all falls into place (it will......).

I sincerely hope all (almost) is going well for you.

Take care John.

Tim.

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John,

I just reread your post to Geary where you talk about over doing it. I guess you already answered the question I had (almost a week ago) - it's like I didn't want to interfere in your discussion with others.... I am 'stubborn' too, but 'baby' enough to relax quite a bit after this upcoming event (I think.....hope).

Your post(s) has and will help me not do the wrong things after mine - and for that I thank you.

Take care my friend. Tim.

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John,

Im sorry to hear about that man. Ive gotten a lot of positive feedback from you on the site and its made me know that everything will be okay. Everything will work out for you, you just have to chill for at least 3 months, so let your type A personality take a break. Let people help you. You dont wear a cape!! LOL

Greg

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Recived my talons on Dec 7th.. feel LOADS better. No more clicking popping or grating.. I can breath deeper and I Can sleep on either side without ANY pain or crepitus.... Healing well, Scar even looks better this time around! Still have a drain which I hope comes out Friday! I was in the hospital only 2 nights..

Talons are the way to go!

Kelly

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