Nearly destroyed: a compounded ToS story                                                              Audra Bravard 2022

All tales have a beginning I suppose. Mine started in 2006 long before I’d meandered into Dr. Hagan’s office. I was young and working as a nursing assistant while pursuing my nursing career. My purpose in this world was caring for people that needed me. I’d spent years in direct patient care and my body reminded me of that frequently. As a young adult I was determined, proud, independent, and stupid. I’d had myself convinced that I could conquer anything and I had no need for assistance of any kind. The tomes of life have a way of bringing you humility when you need it most. My journey is no different. My life was about to be ravaged and I was too naïve to notice. This journey taught me so much. Most importantly is that I didn’t have to stay at rock bottom. I was going to have to ask for help. I was going to have to fight, but I did not have to do it alone.

At twenty-two years old I became plagued with progressive numbness and tingling in my right hand. I was severely underinsured, scrapping to pay my bills, and I could still bring in a paycheck if I adapted. Which I did, I’d not had a diagnosis at this point, but it was clear that I was exhibiting classic signs of carpal tunnel syndrome. I didn’t have time to invest in my health, I was too busy working my way through college.  It became something that I’d just adapted to live with. I’d completed my courses and received my nursing license; I continued to work and live life by making adaptations to avoid the pain as much as possible. By 2012 I had no feeling in my right hand with the exception of heat and pressure. Numbness and pain were creeping up my arm and into my shoulder. I dropped things constantly which embarrassed me in front of my patients on a daily basis. I had adapted to living this way. I mentioned it to my doctor who prescribed a short round of anti-inflammatory medication and a brace to wear at night time. I was told me that it should get better. It did not. I slept in that brace for five more years. It frustrated me to be hindered by the pain in my arm which continued to worsen. The pain kept me awake most nights with or without the brace.

In 2013 I had my first experience with occipital neuralgia. Splitting migraines that started at the back of my skull and shot over my head and cut into the back of my eyes. I’d initially attributed these headaches to the stresses of my new job, until months had passed without relief. My provider gave me ten days of migraine medicine and muscle relaxers in response to my complaints. Which barely scratched the surface of the pain and stopped immediately after the course ended. I lived in pain, rating my migraines at an 8-10 without relief. It was turning me into a person that I did not want to be. I was grasping at straws. My hair hurt; the back of my head hurt even to touch. It felt like toothpicks being jabbed into the back of my eyes, removing environmental triggers did not help. I could not adapt to this. With a little bit of research, I took it upon myself to get chiropractic treatment. The identification of cervical disc deterioration and misalignment; this could potentially help with the pain, and it did help a bit. Little did I know that this seemingly benign decision would open the gateway to my freedom from the ever-consuming pain and weakness.

When the non-invasive options were exhausted without improvement my primary sent me to a local neurologist for an EMG. This neurologist was held in very high regard in the local medical community. I’d worked with him for years and valued his opinion. I hoped that he would at least be able to get me some answers. When my results came back as “inconclusive”, I melted into tears, drove directly to my doctor’s office, and demanded answers. The MRIs that were scheduled afterwards were also inconclusive. It was beginning to look like the doctors were right. Maybe it was all in my head.

I continued chiropractic care, massage therapy, acupressure, acupuncture, daith piercing, float pods, reiki healer, heat, ice. You name it, I tried it. The nerve pain and numbness in my right arm had become so unbearable that I couldn’t brush my hair. It hurt to pull my hair up, sometimes it hurt just to touch. The headaches became all consuming, I became someone that I didn’t know. My employees were afraid to talk to me, my husband and I fought constantly, my friends kept their distance. I’d almost accepted that this was my new normal, I’d began to believe that the pain identified me and I’d have it in my company forever. My children had never known me any other way.

My massage therapist of all people managed to piece together my symptoms and complaints after I’d expressed my frustration with inconclusive diagnostic testing. She was the one that flipped the switch and turned the lightbulb on for my providers. She’d made the suggestion to my chiropractor, he did the clinical assessment, hung his head and said, “why didn’t I catch this sooner?” He began the search for a specialist and a surgeon that had the best outcomes and patient experiences. He’d made it his mission to get me to the right physician. He said that it was his mission to get me to the right physician. He’d seen the decline in my mental health as this disease progressed and ravaged my life. Another visit to my primary and he did an assessment as well. He hung his head and apologized to me. We were colleagues long before he was my physician, I could hear the regret in his voice when he said, “that didn’t even cross my mind. Your symptoms are textbook.” I had thoracic outlet syndrome.

My chiropractor’s hard work prevailed when he my first appointment with Dr. Hagan in late 2016 for me. I humored him and said that I would go to this specialist too, though I had my doubts. I was convinced that I would continue to live in misery. I was shocked when I’d entered Dr. Hagan’s office for the first time. I’m sure that they were familiar with the gaze of apprehension that I’d brought with me. It was a miracle. The people here actually believed me. They assured me that it was not all in my head; they were the first. Dr. Hagan did his assessment, spent time with me to explain the disease process, answer my questions, and established a care plan with me. At this point the headaches were my primary complaint, but I was losing function of my right arm as well. I’m a nurse, losing my dominate arm was not an option. The specialists that he sent me to confirmed his diagnosis and are most definitely experts in their fields. In fact, the neurologist discovered that my previous EMG was read incorrectly and I did have carpal tunnel in my right wrist. The MRI and MRA were inconclusive again, but this time I was assured that was the expectation as thoracic outlet syndrome is a “rule out” diagnosis.

I had my first thoracic outlet decompression surgery in early 2017 and my carpal tunnel release followed six weeks after. My surgery experience was seamless and comforting. Dr. Hagan and Terry explained everything to me and my husband. I trusted Dr. Hagan; he was the person who promised me the possibility of end to the life of misery I was currently living. The recovery was incredibly painful. After my incisions had healed into scars, I was still unable to do so much. The nerve pain was fierce, physical therapy was intense and drawn out, but it’s what helped me the most in my recovery. Being at home and not being able to go to work and do what I did best tore at me emotionally. I’d became anxious and scared that I’d never recover. The headaches had not gone away. I did heal from my first surgery and regained approximately 80% of the nerve function and feeling in my right arm and full range of motion. Had it not taken so long to get a diagnosis I’d likely have had better results. The carpal tunnel resolved entirely over time. I continued on with life. Again, accepting that my migraines would just be a part of my life and continued to work and take care of people which is where my heart truly is.

I was caught off guard one day when I hung a bag of IV fluids on an IV pole above my head and I was met with that all too familiar “zing” of nerve pain. I remember taking a deep breath. I wasn’t going to wait this time. I knew this pain. This was that familiar monster that I’d thought quelled. Quickly, other symptoms began to compile. I was dropping things, fatigue plagued my shoulders, the inability to raise my arm was making it difficult to do my job. This time would be different though. This time I had the right number to call; I knew that I had a whole team in my corner. I was rather anxious, defeated, and scared to be facing the most painful surgery that I’d ever had for a second time when I called Dr. Hagan’s office. Kristen remembered me from five years prior and was able to get me in for an appointment within the week. It’s not common for thoracic outlet syndrome to occur bilaterally, I knew this from before. Dr. Hagan met with me and again took the time needed to diagnose and establish a care plan. We were not going to let this go this time. I was going to have a better outcome. He also asked me about my headaches. I’d had them for so long I’d forgotten to mention them, but when I did, he had options. (Which if I’d continued to follow up would have been resolved years prior.)

Another uncommon phenomenon, I had occipital neuralgia bilaterally. My primaries and specialists told me that it was impossible to have both sides affected. If only they’d have listened to me. Dr. Hagan performed an Occipital nerve block on both sides. Unfortunately, this procedure was not covered by my insurance as it was ‘experimental’. Anything was worth it at this point. Within the week there were less headaches. Within the month, there were none at all. Now, six months later, the migraines are 80% better and I call that a tremendous success! My only regret, not following up with Dr. Hagan sooner.

I had my second thoracic outlet decompression in early 2022. Again, six weeks later a carpal tunnel release as well. I’d no idea that I had carpal tunnel on the left, I was only feeling the pain in my head and my arm. My first follow up I remember asking Dr. Hagan, “is this over? I’m not going to have to do this again right?” His response of “there’s only two of them and I fixed them both. You don’t need to worry about it.” But I was, I was panic-stricken, depressed, and defeated, I was very worried about it. He took the time to ease my mind and assure me that I was healing and progressing as expected. He reminded me of the journey that I’d taken so far and the strength that had required of me to come this far.

I trust Dr. Hagan. That says so much. Chronic pain had me anxious, fearful, and depressed. This surgery had me doubting if I would return to the job that I love. I was fearful that I’d not be able to take care of others. I’d felt that I’d lost my purpose. Again, physical therapy was intense and continued after I’d returned to work. I had to have a peer with me while I was not strong enough to complete my job duties. This tore into my heart as I take so much pride in the level of care that I provide, but I couldn’t. Fatigue, weakness, and lack of precision taunted me. Autonomy in my job didn’t happen again for three months, but I was eventually able to return to all job duties and I felt on top of the world.

Everything that Dr. Hagan told me was true. I did heal. I did get stronger. The nerve pain did subside. I now have nearly 100% function of my left arm and hand. This, I attribute to both my quick action when symptoms began, and the expertise of Dr. Hagan and his team. I am a much better version of myself. I am free from the pain that took me from the people and the things that I love for years. I’m the wife and mother that my family deserves. What’s best, his team looked at my whole self. They took into account my mental health, but did not make my existing diagnosis a defining attribute. Their kindness in knowing that this was a very difficult journey for me spoke immensely to the compassion and empathy of every member of his team. They kept me informed and alleviated my fears throughout the recovery process, the office was easily accessible. Even allowing telehealth visits when they were able to eliminate my ninety-minute drive to the office.

My case was compounded. There was nothing normal in my journey. I was indeed and ‘interesting case’. I cannot express enough gratitude to the diligent kindness and immense knowledge that Dr. Hagan showed me. It’s been sixteen years since I’d known a life without pain. It has truly been the greatest gift. The gift of rediscovering who I am without pain, the mother that I’ve always wanted to be, and the wife that I once was. I’ve reclaimed the writer in me that had been torn from the keyboard so many years ago. This syndrome has the power to take all that you love away from you. Dr. Hagan has the power and the will to help you get it back.