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Pectus excavatum – it looks like the chest is sinking inward

Have you ever noticed someone whose chest sinks inward in the front, kind of like a funnel? The first time I ever noticed this bony malformation was when I was in high school, and a friend of mine on the soccer team had one. It was called “pectus excavatum,” he told me.

In my thoracic surgery training, I was often called upon to evaluate patients with this chest wall abnormality. As a result, I began to delve deeper into some of the issues that may affect people with this type of defect.

Pectus excavatum is the most common chest wall deformity and results from abnormal development of the sternum and its attachments. Most patients are self conscious about the defect and usually focus on its appearance but because this is usually present for much of a person’s life, symptoms associated with it may not be totally obvious. Individuals affected generally get used to how they feel and try to overcome any limitations to the best of their abilities without even knowing that’s what they are doing. Most patients describe some chest discomfort, shortness of breath when exerting themselves, lack of endurance, or feeling embarrassed in social situations when their shirt is off. It is not uncommon to hear patients say that they have trouble keeping up with their friends during activities, or that they avoid any activities that would require them to take off their shirt in public-such as going to a pool.

Most physicians aren’t even aware that there is an effective treatment for pectus excavatum...

Swedish and Minor & James at the Northwest Women's Show

Come to the Northwest Women’s Show held this Friday, March 2 through Sunday, March 4 and visit the various Swedish and Minor & James booths. Come learn about Weight Loss Services, try your hand on the daVinci robot at the Robotics Surgery Program booth, visit Minor & James and ask skin-care questions or learn about the women’s health services available. Or, take a look inside the Swedish Mobile Mammography van and learn about mammograms and breast care.

(Make sure you take advantage of a $2 off coupon for admission to the show!)

We'll also have the hands-on daVinci robot device so you can test your hand skills on the robot and get an idea of what it would be like to be a robotic surgeon at Swedish - you can also meet our gynecological surgeons and ask any questions you have.

Traditional and New Technology in Treating Vascular Disease

On a daily basis, we see patients who are seeking treatment for hardening of the arteries, typically in the legs or neck (PAD-peripheral arterial disease); weakening of the main artery in the abdomen (AAA-abdominal aortic aneurysm); and varicose veins. In each case, there are traditional ways of being treated (what we call “Open” Vascular Surgery) as well as innovative alternatives (what we call “Endovascular” Surgery).

How do we arrive at our recommendations and how do you decide what’s best for you?

It helps if your Vascular Surgeon performs both types of procedures rather than just one since s/he can draw on personal experience as well as the results of research, to tailor treatment to your specific needs.

You have to consider the trade-offs between short and long term risks and benefits.

  • For AAA and varicose veins, endovascular techniques have virtually replaced traditional treatment given their low risk of complications and excellent outcomes, and both are well supported by the literature.
  • In PAD – from the carotid arteries in the neck to various arteries in the legs – results of newer technologies are a “mixed bag.”

If you are referred to and seen by a Vascular Surgeon, be sure and discuss traditional and endovascular treatment options before you make your final decision.

Diagnosing Peripheral Artery Disease (PAD)

(Ed. note - As it is heart month, we asked Dr. Rocco Ciocca, Chief of Vascular Surgery, to explain a little more about heart attacks and peripheral artery disease.)

In the last blog we defined a condition known as PAD, which is a constellation of problems related to narrowing of the arteries outside the heart.

PAD, If left untreated, can lead to having a stroke, worsening high blood pressure, difficulty walking, non-healing sores on the legs and feet and in extreme cases gangrene necessitating amputation of the involved body part.

I briefly mentioned how it can be diagnosed and would like to describe that in more detail here.

The great news is that doctors do not need order a bunch of painful or expensive tests to diagnosis PAD. The best and most cost-effective test is a thorough history and physical exam. During that, the health care provider will listen to your symptoms and ask questions about your medical history and your risk factors.

The major risk factors for PAD are:

  • smoking
  • diabetes
  • hypertension (high blood pressure)
  • high cholesterol levels

Heart Attack and Peripheral Artery Disease (PAD)

(Ed. note - As it is heart month, we asked Dr. Rocco Ciocca, Chief of Vascular Surgery, to explain a little more about heart attacks and peripheral artery disease.)

Most people are familiar with the phrase “heart attack” and know that it can be a life threatening condition.

The most common case of a “heart attack” or myocardial infarction is the sudden closure or clotting of a vessel or vessels that supply blood and thus oxygen and other nutrients to the heart. The heart is a muscle and without adequate blood flow the muscle dies. The most common case of a heart attack is “hardening of the arteries” or atherosclerotic disease of the arteries. The disease, which is most commonly related to various risk factors such as age, smoking, high blood pressure, high cholesterol and high suger levels in the blood (diabetes), causes abnormal blockages to develop in critical blood vessels in the body limiting flow. The blood vessels of the heart are not the only vessels affected.

In fact, hardening of the arteries is a systemic (total body) process that involves many other blood vessels of the body. When it involves the other peripheral arteries of the body it is know as PAD, peripheral artery disease. The diagnosis, prevention, and treatment of PAD are managed by vascular specialists such as vascular surgeons.

Palmar hyperhidrosis

Everyone sweats – but what if you had a condition that caused uncontrollable sweating in your hands?

Palmar hyperhidrosis is a benign condition where individuals experience uncontrollable sweating of their hands, way beyond their physiological needs. Hand sweating in such a scenario is often described as being present 24/7, may be worsened in situations of stress but also occurs out of nowhere in times of total rest and serenity. From the constant dampness the hands are exposed to, ulcerations and other skin related changes may develop. Many patients with this condition adopt a line of work and a life style that minimizes public encounters and avoid hand contact such as having to shake hands.

It has been known since the 1920s that by dividing the sympathetic chain (nerve) high up inside the chest, a procedure called thoracic sympathectomy, we can make the hands stop sweating. To achieve this surgically was quite an undertaking back then. The surgical trauma was such that historically very few individuals with hyperhidrosis opted to have corrective surgery. With the development of videoscopic surgery, however, it has become possible to perform the sympathectomy with minimal trauma to the patients. In addition, the magnification provided by the optics of videoscopic surgery has made the surgery safer.

What is involved in an ETS (Endoscopic Thoracic Sympathectomy)?

Nowadays, we offer surgery under general anesthesia as a day surgical procedure (meaning most patients are expected to go home the day of surgery). Two small incisions are needed, and we preferentially place those on your sides. At Swedish, our preferred approach is to clamp the nerve by placing titanium clips on the nerve at appropriate levels. The advantage of clipping the nerve instead of removing a segment of the nerve (as we did prior to 2005) is for possible reversal of the sympathectomy in the rare instance where a patient may be unhappy with the side effects of the surgery (see below).

What results should I expect?

In our hands, ETS will render the hands dry in 99 to100% of cases ...

Let it snow

Have you been outside enjoying this weekend's snow fall?. Whether or not you were able to play outside, we thought we'd share some new videos in our robotic surgery series that don't require going out in the cold..and might give you inspiration of a craft project to do with your kids.

In Seattle, we can make a snowman:

And not only can our robots (driven by our robotic surgeons)
fold paper airplanes, but they can also make a snowflake:

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