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21st March 2022 

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I really wanted this blog to focus on hope and positivity where possible, but it also needs to be a real reflection of what's happening and how I feel. I imagine people don't really want to read about to know how much pain I'm in on a given day or how much I'm struggling, or how many times I woke up in pain because I turned over in my sleep. You know all that is going on and it would probably be quite a boring read, but today is one of those, hopefully rare occasions where I feel particularly crappy. 

 

I overshot my limits and ended up writhing on the living room floor for almost an hour, followed by some sobbing at the kitchen table and hours of residual pain. All I did was wipe a litter tray, lift a binbag out of the bin and carry it for a few metres. 

Really, I know my limits now, and I know where pushing myself gets me, but I still did it because it needed to be done. I think there is a part of me that still believes sometimes that because I feel like I should be able to do something, that is reason enough to go ahead and do it. 

I can't, and I know I need to accept that, but at the same time, it just brings home for me that I'm someone who used to work 50 hours a week, walk 8 miles a day, cycle, garden, rush around cleaning, and now I can't lift a light binbag without turning into a sobbing mess. It's hard to come to terms with. 

I spend most of my days alternating between sitting still on the sofa wrapped in a maternity pillow, and lying flat on my back on the floor, and in doing so, it keeps the pain levels from going from "just about manageable" to what I experienced today. 
 

I told myself "The bin bag isn't heavy. It won't take long. You only have to walk a few metres, and you can change the litter on the floor. It's just a few minutes, then you can sit down. You'll be fine." 

Big mistake. 

It took the pain to a level that I haven't had for weeks and I'll likely be paying for it for a few days. 

I'm beating myself up because in my head I feel like I should be able to do these things. These are really simple tasks, but my body just can't take it. It's still really hard for me to accept that I want to do these things but physically can't. It's also the first day of spring. I should (there's that word again) be out in the garden clearing leaves, pruning dead plants ready for new growth, planting seeds for summer... but mother nature is on her own this year, and it's back to the sofa for me. 

 

 

30th March 2022 
 

As I begin to write this, it's 5.15am. I had around 2 hours sleep and was woken by intense nerve pain wrapping around my right side into my back.  

Today is Wednesday and I spent the entirety of Monday and Tuesday in bed with a pain level reminiscent of the intensity I had when things seemed at their worst in late November.  

Usually, at the moment, It's 'groundhog day'. I get up, have coffee, take meds (vitamin D and propranolol for chronic migraines), shower, and then sit on the sofa tightly wrapped in my maternity pillow for the rest of the day until it's time to go to bed, occasionally digging my fingers into my ribcage to pull 'my 10's' away from whatever they're hitting, or lying flat on the floor for a few minutes in the hope that everything will sit where it should be for a little while and me a bit of temporary relief.  It's the same every day and it can be pretty soul destroying, but restricting my movement is the only way to keep the pain at a level where I can think. I'm still trying to stay positive and on most days I manage, mentally, to get through the day. 

 

We have a small group of friends who meet up around once a month, usually for a chat, some food, and some card games. We planned a few weeks ago to have them come to our house on 27th, which was this Sunday just gone, and as it also turned out to be Mothers day, in the daytime we went to my partner's parents for lunch (they picked us up). I only had to walk from the sofa to the car, from the car to their chair, and visa-versa. It's difficult getting in and out of a car, and turning, or going over bumps is very uncomfortable but otherwise, I didn't really do anything differently. I was just sat. It was nice to get out of the house and, with being cooped up at home months at a time, naturally, it lifted my spirits.  

 

In the evening, our friends came over. It was so good to have some company and some normality. We had some food, some wine, and I was sat for the whole duration, so it came as a bit of a surprise when I started to get really intense nerve pain in my back. At first I put it down to perhaps the fact that I was sat on a different chair, and told myself that it would lessen by morning. I was in bed on Monday until around 10pm, unable to move, and had to text my partner downstairs to bring my stick up and help me to get out of bed so I could eat. I was in bed all day yesterday too, just lying there because the pain was so intense. Usually lying on my back would give me some relief, but no matter how I lay, it was relentless.  

The only way I can describe it is that It felt like my spine had been replaced with a red hot iron poker, that was also being crushed from top to bottom, whilst someone was also squeezing their fist inside my back, and was giving me taser shocks in the intercostal spaces between my ribs every few seconds with their other hand. 

I tried everything. I tried every position imaginable, I tried lying on the floor, I tried more pillows, less pillows, I had ibuprofen, topical ibuprofen, knowing full well that they wouldn't touch the pain, but out of sheer desperation just in case.  

I was able to get to sleep, eventually, and the pain is still there now but although it's not as intense, it's creeping up. At the moment I'm able to focus on writing this and I'm managing to sit at the kitchen table, but I feel like I'm going to have to lie on the floor soon. I just hope that it stays at this level or gets a little better today, as if it gets much worse it looks like I'll be spending another day in bed.  

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Although Sunday was different to 'groundhog day' in that I got out of the house and saw people, I didn't push myself, I stuck to my limits and I was sat all day. The only things that I can think of that could have caused this 'spike' are either sitting in several different chairs, something moving inside me and irritating something as a result of being in the car, or having wine.  

I'm not a big drinker, and when all of this started last year I stopped drinking altogether, because I didn't know what this was at the time and decided it was best until I did, even before all this when things were normal, I might have had 1 or 2 beers once a month or a glass of wine with a meal. Since I found out it was Slipping Rib Syndrome et al I've treated myself to an odd little 25ml of whiskey before bed on occasion, and not had any increase in pain levels as a direct result. I had a few gins on Christmas day and wasn't it noticeably different then either. On Sunday I had 3 glasses of red wine over a period of about 5 hours.  
 

I researched whether certain types of alcohol can make nerve pain worse or cause inflammation, and even asked the SRS support group for their opinions and experiences. Google says that red wine contains anti-inflammatories and is good for reducing inflammation in small quantities. I found some medical studies relating to intestinal, liver, and gut inflammation in relation to chronic heavy alcohol consumption, which is irrelevant, so, i'm none the wiser. I'd love to know how a small infrequent amount of alcohol could have such a huge, quick and lasting difference to nerves and general inflammation. Some people in the groups swear that alcohol makes their nerve pain and inflammation worse, and others say it helps, or makes no difference, so, again, I'm none the wiser.  

I could be wrong, it could be nothing at all to do with the wine and have been the change in chairs or not having the pillow for support, or vibrations from being in the car, but whatever it is, it's increased the pain 10 fold.  For now at least, no more wine, but in terms of sitting and limiting my physical activity, I couldn't be more careful than I already am. I just hope that this settles back down a to a level where I can sit or lie down with a manageable level of pain. I'm not tired, I'm wide awake, but even now just after sitting and typing this I need to lie down again because the pain and tightness are creeping up. It's 4 weeks and 6 days until I meet Joel Dunning, and I am counting.  

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27th April 2022.  
 

I've not had much to say recently. I've been spending at least 2 days a week in bed. I was woken by intense nerve pain between ribs 11 and 12 this this morning which I think was a result of turning over in bed, and since my last blog post I've had 2 short car journeys, which definitely makes things worse, especially the next day. I imagine with the 'up and down' and 'side to side' from the car, if something's loose inside me, it's going to move and irritate things. I've been in a lot of pain and feeling quite down. 
 

I had a visit to hospital a few weeks ago with chest pain. It felt very tight in the middle of my sternum and to the left just over my heart. I tried to ignore it in the hope that it would go away but when it got worse I called my GP and the receptionist told me to go straight to hospital. I'll be honest. It was pretty scary. It was nothing to do with my heart, but due to the type of pain and where it was, it felt like it could have been. I had an ECG which came back normal and some blood tests. The doctor asked if I had any medical conditions so I told him "I have slipping rib syndrome." (Pause and blank stare). "You've probably never heard of it". He hadn't, so I explained what it is and about the Hansen procedure. At first he said it could be indigestion or heartburn (It didn't feel anything like indigestion or heartburn) and asked what I had had to eat (Yogurt and Granola), then he said that it was likely something to do with my ribs and to discuss it with my surgeon, and that it might go away on its own. I didn't expect much from the hospital visit, and no pain relief was offered other than "take paracetamol", but at least I had the reassurance that my heart was ok. 

 

I did feel a little patronised. If I thought that taking paracetamol would have helped, I wouldn't have been at A&E. I'm not a fan of hospitals and previous experiences haven't been great, but I felt that I needed to go because of the nature and location of the pain. 

I'd had a similar feeling twice before, in around November when I was still a little mobile and things were at their worst. Costochondritis? Who knows. It was in the chest quite far above the usual places, and was a different sort of pain. Tight, heavy, and tender.  

I went to bed when I got home, and the pain lasted a week. I've had a few bouts of tenderness there since, but that particular pain is not as bad as it was. 

I'm 6 days away from my appointment with Mr. Dunning. I'm getting increasingly anxious. I keep telling myself that I have no reason to be and I'm trying to keep myself distracted, but the 'what ifs' are there. I'm really afraid of having to live "groundhog day" for the rest of my life, so limited, and in so much pain.  
 

I hope to have a positive update, and a plan by this time next week. 

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5th May 2022. Meeting my surgeon. 
 

Dad and I drove to Middlesbrough on Monday and stayed over before the appointment on Tuesday morning. It took around 4 hours from the West to East coast of England, and It was a rough ride, especially over speedbumps and turning corners but I managed with the help of some lidocaine patches.  

Tuesday morning I met my consultant, Joel Dunning, his registrar, and a 3rd year medical student. I was very nervous prior to the appointment, which is unlike me, but this meant so much to me and it had to go well.  
 

It couldn't have been better. The whole team were lovely, compassionate, and really listened. He already had my dynamic ultrasound report, and my e-mails but it was a chance for him to feel my wobbly 11 and 12 on my right side. I was asked some questions, and we agreed on a plan to to suture my 10th rib to my 9th using the Hansen technique, on both sides as well as stabilizing rib 11. I can't remember the exact details of what the procedure for 11 will involve but I'll update this once I have confirmation. Originally I thought the plan was going to be to resect rib 12 but as 11 seems to be the main culprit, it makes sense to try to stabilize my 11th rib to stop it from moving so much so that 12 can't get underneath it, as it's less invasive than resecting, and only involves one incision at the front and can be done at the same time as the suturing of 10 above. I'll be having 2 operations. right side first, and then the left. I know some people in the US have bilateral surgery and I've heard really good things. I've thought about this a lot and there was a time when I thought I'd have preferred to be in more pain for less time as opposed to going through it twice, but with my surgeons guidance, it makes sense for me to have 2 separate procedures, which seems to be preferred here in the UK. I'm hoping the second time will be a little easier since I'll know what to expect and it will only involve suturing 9 and 10, so in theory it should be a less painful recovery, but I don't know.  
 

I'm delighted that I'll be having the surgery, and after what has been a very tough journey, I feel that mentally and emotionally, the world has been lifted off my shoulders and the end is in sight. I know it won't be a walk in the park. it's a long recovery period, as it takes time for the body to get used to the ribs new positions, for the muscles to heal, and for scar tissue to develop (which helps to create a 'bridge' between the ribs to further aid the sutures in securing them long term), but I am looking forward to having some of my life back! 
 

I'm hoping to get a date for my first surgery soon, which will be sometime in summer this year.  

 

After the chat with Joel and his team, I had my pre-op assessment done by some nurses. My blood pressure was taken, ECG, height, weight, and BMI, blood tests, allergy test for the yellow antiseptic they use during surgery, and some questions about my medications and lifestyle. The nurses were equally as lovely, and I could tell that everyone in the department loved what they do. 

I then met Robin, who is an acupuncturist at the hospital and works closely with the cardiothoracic team, and had some acupuncture between my intercostal spaces to release some of the tension in my muscles. It was very relaxing, and I really think it helped me to manage with the journey home.  

I'm so happy with the outcome and so grateful to have this chance.  
 

I don't imagine I'll be posting for a while, as I'll just be waiting for and preparing for surgery, but I'm so pleased to be able to have such positive news!  

 

 

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19th May 2022. Preparing for surgery. 
 

I got my date for surgery on the right side last week. 30th May! Much quicker than I expected, and only 11 days from now. 

We'll be going on Friday 27th, as I'll be having a Covid swab on the Saturday and won't get a time until a few days before, then I'll be self isolating and will be admitted to the ward on the Sunday afternoon, and Surgery will be on the Monday. 

 

I'll likely be in hospital 3-4 days as they like to wait for the local anaesthetic to wear off in the UK and make sure pain is under control before discharging, and I'll either be in the thoracic ward or the high dependency unit afterwards depending on how things go. I'm hoping Dad will be able to visit for an hour a day too. Someone local to the area kindly sent me some ideas of places for dad to visit whilst he's there too, which was really thoughtful. 

The original plan was to stay at the same hotel we stayed at before the consultation, onsite for a few days after until I'm well enough to get into the car and endure the 4hr journey home, but it's half term and the Queen's Jubilee week, so the hotel is fully booked and the others locally are very expensive, so we'll be winging it. if I'm well enough to drive home when I'm discharged we will, or we may break it up and stay somewhere in between for a day or 2. It all depends on the pain. My abdominal muscles will have been cut through so I'll need a lot of help for the first week, and If I do come home Dad will be staying until I can be a little more independent. I'll also be on strong painkillers for a while so I'm expecting to be a little woozy too. 

 

I've bought some straws so I can drink lying down (sitting up will be difficult for a while), some extra pillows so I can be propped up, and some wearable ice packs. I'll also be getting some laxatives as the pain meds will cause constipation, and stocking up on OTC pain meds so I have those if needed when I'm off the meds the hospital give me. I won't be able to do much so I've been saving 'The last Kingdom' on Netflix to watch after surgery to keep me entertained and hopefully take my mind off the pain. It's quite gory so I'll have the added benefit of being able to say 'At least I'm not that guy' when some poor Saxon gets his head chopped off. Going by what others have said, recovery is going to be quite nasty for a few weeks and it'll likely be a few months before I get any benefit, but I need to go through it. "Pain with a purpose".  

 

As well as 'Hansen 2.0' on 10, The plan for rib 11 is to loosely tether it to rib 10 to, hopefully, reduce the hypermobility and stop it flaring out as much. I'm a little nervous about 11, as it needs to have some freedom for us to be able to bend and twist, but at the same time it can't be left to wiggle around as it is either. I'm giving my surgeon free reign to do whatever he thinks necessary once he gets in there. My 11 is very long so it might need the end chopping off, and I have a feeling might need 12 shortening too to stop it contacting my hip, as that's also hypermobile, but we'll see. I have total faith in him. I managed to get in contact with a lady in Australia that had 11 tethered to 10 and is better than she was before surgery, but still has some pain. That was reassuring as I've not come across many people who've had this exact issue, though I have heard of people having 11 sutured to 10 and ended up having to have the suture removed at a later date and the rib resected instead.  

 

I've been researching this condition in one way or another every day for the past 5 months, and it's become clear to me that people vary so much in terms of recovery. It takes time, it gets worse before it gets better, and I'm not expecting to ever be 100%, ("Prepare for the worst and hope for the best" is a great motto.) I expect that I'll always have some pain and some limits based on the experiences of others who have had surgery, but If we can reduce the pain substantially and increase my mobility, and if I can get to even 70% of 'Old Matt' I'll be able to adjust and live with that. Any improvement is better than none. 

 

I am a little nervous, which is suppose is natural. The 2 surgeries I had previously (not rib related) were both emergency operations so I didn't have any time to prepare for or worry about them, but I'm keeping myself distracted and remembering that although it will be tough, it's going to be worth it long term and will give me some quality of life back. The pain from Slipping Rib Syndrome has been the only pain I've had in my adult life that has reduced me to tears. Not even appendicitis or kidney stones did that, so on that basis, maybe the post surgery pain won't be so bad. 

One of the gents from the Group is having surgery on the same day as me, and 3 ladies 2 days later, so it'll be good that we'll all be going through it at the same time and will be able to support one another.  

 

I imagine the next post will be after surgery and although the journey won't be over yet, Hopefully it's all going to get easier from here. 

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30th May 2022, 18:48. Surgery. 

 

Dad and I drove to Yarm (where we were staying) about 20 minutes out of Middlesbrough on Friday afternoon and arrived in the evening. We stuck to the motorways this time which was much easier for my body to handle than the speedbumps, twists and turns of the last route we took when we listened to the satnav! I had my covid test on Saturday afternoon and was admitted to ward 32 at James Cook Hospital on Sunday afternoon. 

I had a visit from my anaesthetist at 9pm, and was given some electrolytes to drink before bed and again at 6am, then I went down for surgery at 8am. I was quite nervous about the anaesthetic, I'm not really sure why, as I've had it twice before, but the theatre staff were wonderful and explained everything they were doing to put me at ease. I remember the anaesthetic being delivered through my cannula and panicking a little, thinking "I'm sure this worked more quickly last time", and that's the last thing I remember. 

 

I don't really remember waking up afterwards, or coming back to the ward. I was in the High dependency unit for a while so they could keep an eye on me, and I was quite sleepy but I started to feel more conscious by about 2pm. Dad came to visit at 3pm, and I had some biscuits, then dinner at 5. I didn't expect to have much of an appetite but managed to eat with no problems. 

I've not had any pain at all so far. None. which I'm surprised about. This is the first time since October 2021 I've felt no pain. It will come though and I know to expect it. I was given lots of local anaesthetic in my intercostal spaces and when that starts to wear off overnight I'm expecting it to be really tough for a few days. Day 4 is supposed to be particularly nasty, or for some people it's day 3, but I'm ready for it, and then it'll be a case of listening to my body and taking one day at a time. 

 

I'm expecting that I'll probably feel tightness in the front and back, inflammation, muscle soreness, possibly some increased nerve pain and some pain at the incision site until things settle and the ribs get used to their new positions. 

Although I've had no real pain yet, I've needed a lot of help to move, to sit up and stand up from the nurses, which is understandable until the muscles that were separated heal. We use our abdominal and oblique muscles so much more than we realise and I'm hoping those 4 months of planking will pay off. 

As planned, from what I remember, my surgeon sutured my right 10th rib to my 9th and tethered my 11th to my 10th. He also found once he was in there and had a clear view of everything that there was a big space between ribs 9 and 8 so he has sutured those too to bring them closer together. I noticed straight away how much easier it feels to breathe! It feels less laboured and more natural, and I had a very light feel at the side with my hands (away from my incision) and I can no longer feel 11 sticking out or get my fingers under it. There are no bumps or ridges so this is really promising! I'm going to leave it all alone now and not poke the bear, but this is reassuring. I was really worried about my 11th rib in particular. 

Although It all still feels very numb I'm taking particular care not to rest my arm near my incision as I write this (I am sat up on an incline on the bed typing on my phone). 
 

I've just been moved to the main ward and have my own room, which is great! 

I'm pretty tired so I'm probably going to have a tactical sleep soon (tactical because I think it'd be a good idea to get some good quality sleep before the anaesthetic wears off). 

From what I've read from other people who've been through this, it's going to get worse before it gets better, there are going to be some stumbling blocks and some bad days whilst things slowly heal, and it's going to take time, but I'm feeling positive and I'm ready for the rest of the journey. I have tons of support from an amazing group of people from all over the world, who have been absolutely invaluable to me so far. 

One thing I have realised is that, with these operations, there are so many variables, and because of that no two recovery journeys are the same. 

Some people have one side operated on, others have 2. 

Some have unilateral slipping rib syndrome, others have bilateral. 

Some have excisions or resections, others have the Hansen procedure. Of those, some have Hansen 1.0, some have Hansen 2.0, others have reconstructions with plates and cartilage grafts. Some people have 1 slipped rib, others have 2, 3, 4, 5, or 6. 

Some people have hEDS or another underlying condition, others have had a fall or accident. For some the symptoms come on gradually, others got their symptoms suddenly. 

We also vary in symptoms, where and how we feel the pain, age, pain tolerance, responses to pain relief etc... 

So it's important for me to remember not to compare my recovery to anyone else's, and important for you, if you're having or have just had surgery and are reading this, not to compare your recovery to mine, but to use it as a guide and take from it whatever you find helpful.  

Nevertheless, I'll be continuing to document my experience through the highs and lows of recovery. 
 

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2nd June 2022. Post-op days 2 - 4. 

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I've not felt able to write anything over the past few days as I've struggled to concentrate. I'm on a total of 13 medications and some of them are very strong. 

I was discharged on day 2 and came straight home. I wanted to get the car journey over with before the local anaesthetic wore off and I'm really glad I did. Getting into the car was difficult, and the journey was quite tough but I managed. I Couldn't use my oblique muscles to twist or get out of the car so I pulled myself to the side in a sat position using the car door, lifted my legs out, dropped onto the floor on my knees, and then eased myself up on my legs. It probably looked ridiculous, but it worked! 

 

The past few days have sort of rolled into one and I'm very dazed and "away with the fairies" because of the medication but I'm doing well so far. I've not taken morphine in 2 days as I've not felt the need to but it's there if I need it and if things get unmanageable. 

I needed help getting into bed the first night at home, and couldn't lie flat, so I used 3 normal pillows and a "v pillow" to elevate (Pre surgery I just used 2 pillows) and slept on my back. I've been at home for 2 nights now and slept right through on both nights which is good as I didn't think I'd sleep well on my back. 

 

I didn't feel like I could shower yesterday and it took me about 10 minutes to get out of bed, and quite awkwardly, but today I managed to get out of bed independently (I rolled to my non op side, dropped my legs off the side of the bed, and then shuffled/pushed my body up with my left hand and arm). 

I was using the stick yesterday to get up and down the stairs as well as the rail, I used the stick to stand up from the chair, and to get around the house slowly. Today I am able to get up the stairs just using the rail and I can stand up on my own, which I think is really good progress! 

I showered this morning (though doing my legs was hard and I couldn't dry my legs or feet). 

I needed help to put my socks on and to put my t-shirt on as I can't bend down or stretch my arm out yet. 

Brushing my teeth is difficult (I'm 6ft2 so it's a long way to bend over the sink, and I struggled to get up from a bent position pre surgery) but I did it on my knees and used my legs to get up so I didn't have to bend at all). 

I took the dressing off my wound and had a look at my scar this morning. It's still fresh and very bruised (normal) but it's healing well. It's clean and there are no signs of infection. 

 

I can't sit for very long on a normal chair without elevated pain and I've spent the past 2 days in the recliner, with an ice pack on my wound at the front and a hot water bottle at the back. I have been lightly hugging a cushion, which I've been using to 'brace' by hugging tightly if I need to cough as that causes a massive pain spike, and although it's not nice and I'm still apprehensive and dread it every time, it's over quite quickly. 

I've had some pain, sometimes quite nasty, especially at the back in the rib heads near the spine as the ribs and muscles get used to their new positions. I know that will take a while to get used to, and I think I still have the inflammation to come, but the painkillers are working very well so far and I get some relief as opposed to the pain being constant.  I take meds at 8am, 12pm, 5pm, and 11pm, and I'm finding so far that between 9.30pm and 11pm is the toughest part of the day when the pain is at its most intense, but I can honestly say that none of the pain I have had on my right side has been as bad as the pre surgical pain, so far, and that is a huge relief. 

 

It's day 4 now and too early to tell how much things are going to improve as I am still very limited physically  and still have a long way to go in terms of recovery, but overall I'm incredibly pleased with my progress in such a short amount of time since surgery. 

I have been sleeping a lot and haven't been able to read or watch anything as concentrating has been difficult but I think after this first week when I'm off the strong meds that should get easier. 

It's also too early to tell how rib 11 is and how much my mobility is going to improve, but it feels secure inside compared to before and it no longer sticks out all the way around so I'm hopeful. I'd really like to get to a point where I can walk like I used to, without nerve pain, the 'bone on bone' feeling, and feeling it 'wiggling around inside me'. 

 

I know it will get harder once the inflammation sets in and I am off the medication, and it will take a long time, and there's still the left side to contend with, but so far, I'm really, really pleased with how things are going and I feel incredibly hopeful for the future. 

 

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5th June 2022. Post-op days 5 - 6 

 

I need to remind myself to be patient. 

Waking up I'm feeling the pain, especially with having been in the same position all night but the meds are helping with that. The site feels very sore and burny but it's surgical pain and the meds and ice are helping to relieve it hugely, so it's not constant and at the moment it's manageable. Before surgery there was barely any relief at all. The wound is itching a lot but that's a really good sign as it means it's healing. 

Dad went home yesterday and I ran out of paracetamol (Tylenol) so I walked about 40 metres (with the stick just in case) to the garage (gas station) and it didn't go as well as I hoped. I had to sit down for a rest on the way back, as I was getting that familiar pain between the shoulder blade and spine on my surgery side. It worried me a little but I need to remember that I'm only 5 days out. I turned to the group for some reassurance and read some post surgery stories that I've been collecting since January. 

 

It takes 3-6 months for the scar tissue to form internally to really hold things together, the inflammation is likely pressing on the nerves, and these nerves have been irritated for years so it's going to take time for them to calm down. 

Overall I still feel very positive and I'm pleased with my progress, I just need to remember that this will take time, and to be gentle with myself. 

Most people start to see their biggest improvements at 4-6 months post op, and it's going to be up and down until then, so I need to be patient. 

I definitely feel much taller and more stable, and I'm not hunched forward when I'm sat, as I was for many years. Previously I had no stability as my 10th ribs were buried right behind and under 9 on both sides, and I had to use my arms or elbows to hold myself up and stop myself from flopping forwards. As I'm writing this I'm sat on the chair at the kitchen table with a straight spine and my stomach muscles are holding me upright as they should. I can tell how much taller I am standing by looking at the mirror in the kitchen. Before, I could see my whole head, but yesterday I noticed that now it chops it off at my eyes! My right shoulder is visibly higher and straighter than my left (which will be fixed at a later date) but even having one side fixed has made a huge huge difference structurally. 

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7th June 2022. 1 week post-op 
 

I started feeling the inflammation yesterday, in the evening of day 7. I'll admit I was feeling like recovery was "too easy" up until then in terms of the pain and part of me wondered if somehow I'd escaped it and another part of knew it was coming because I'd been warned. I would describe it as a Hot, raw, intense, localised "inner bruising" that spreads through the right side, with the incision at its epicentre. 

 

It's not nice, and it's certainly not easy, but it's nothing to be afraid of either. I took the advice of people who'd previously had surgery for slipping ribs, and bought a re-freezable wearable ice pack before surgery in preparation, and I'm very glad I did. I'll link the one I bought here in case anybody reading this would find it helpful to go with a recommendation. It has 2 re-freezable packs so I can alternate. They freeze pretty quickly and last about 2 hours before needing to go back into the freezer, but I bought another one so that I have 4, so each time I use one I can be assured that it's at its coldest. 

I came off anti-inflammatories 2 days ago as directed by my surgeon. Taking anti-inflammatories too long can inhibit growth of new cells, so it can actually prolong healing, so if you're wondering why we don't take them until the inflammation has gone down, this is one of the many reasons why. I won't bore you with the ins and outs of anti-inflammatories, and the pro's and con's of what they do and what inflammation is or why we experience it after surgery, but there's plenty of information available online. If you've been following my story you've probably gotten to know me a little and realised that I'm an avid researcher, and I love knowing the "what's" and "why's" of absolutely everything. I spent some time researching today, and I find it really helpful to know what's happening in my body and why. 

 

I'm expecting this to last at least a few weeks, perhaps a little longer. A lot of people who've had surgery for slipped ribs experience "Inflammation phase 2" between the 6-8 week mark as they get a little more used to moving around, and sometimes beyond, but I'm assured that does get easier in time. 

Again, for me, although it's not pleasant, and can be very intense, it's easier to deal with than the pre surgery pain. Partly because it's a different sort of pain, and partly because although it's intense, painkillers and ice help massively to relieve it, and there are points in the day where It's at a totally manageable level, so long as I continue to find the balance between resting, and doing some light walking around the house for a few minutes. 

I've found that for me so far it's at its worst as soon as I wake up, and last thing at night. Being in one position all night and getting in and out of bed probably aggravates things. From today, I'm putting on an ice pack as soon as I wake up, and moving around a bit helps too, even though that might seem counter-intuitive at the time. 

 

I have had some of that dreadful "spine pain" if I stand too long, but I'm not worried that the surgery hasn't worked or that I'll be like this forever. It briefly crossed my mind, but if I think logically, it makes perfect sense that if the intercostal spaces are swollen and inflamed, there's going to be some added pressure on the nerves, which are probably still quite angry about having been messed with, but once the inflammation settles, in time, I think this will too. I knew it wasn't going to be a quick fix. The rib head (the part at the back that connects to the spine) of rib 11 is very sore and tender and is making it known that it's not happy. There's been some sharp nerve pain around there too but I expect that this is partly because the rib has been moved and is getting used to its new position, and also due to the inflammation and swelling, and once that decreases, that will settle too in time. 

Yesterday I walked around my garden for a few minutes, and even something as small as that felt wonderful. Although parts of it are pretty wild with me not having been able to do anything with it for a year, it's the first time I've been able to go out there in a long time as opposed to just looking from a sat position through the window. My garden was my pride and joy and I'm confident that in time, it will be again. I also completely stopped playing piano about 3 years ago because sitting on a stool without back support was too painful and I'd hunch forward due to no stability with my 10s being buried under and behind 9, and as I was using my hands to play as opposed to being able to prop myself up with them, as I so often used to have to do when sat, the pain was just too intense. I didn't know it was due to slipping ribs at the time, but one day, when everything has settled and healed, and after my second surgery, I imagine I'll be able to sit completely upright unaided and without pain, and I'll be able to play again. 

 

SRS and "wobbly" (my hypermobile 11th rib) have taken so much away from me, I didn't know what was wrong with me for so long, and there was a long period of time before I'd even heard of slipping rib syndrome when I honestly didn't think I'd be able to do the things I love again. 6 months ago the thought crossed my mind that I might not even leave the house again! But now, there is so much hope, and that in itself overshadows any pain or inflammation I am feeling.  

 

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17th June 2022. 2.5 weeks post op. 
 

I wanted to wait until I was off the codeine until I gave another update, especially on my gastrointestinal symptoms, as codeine causes constipation and can cause abdominal discomfort as a result and I wanted to get a clear picture of how things were naturally. I've also been carefully trying some things I couldn't do before surgery or immediately after to see how I am with them before giving an update. 

Let's start with the good news!: 

 

I'm happy to report that since surgery and since I ceased taking codeine 5 days ago, I've had no sharp abdominal pain, no abdominal discomfort, excess gas, gurgling, diarrhoea or "stuck" feeling under rib 10. All of my gastro symptoms were on the right side throughout this. I found a really interesting case study from the Chest Wall Injury Society that might shed some light on why some of us get gastrointestinal symptoms, which I will try to find again so that I can link it. 

I have been off all pain medication apart from lidocaine patches for 5 days now, although I am using ice packs on rotation daily throughout the day, alternating between the front and back, and that is helping a lot. 

I still have some nerve pain on the right side at the back between the shoulder blade and spine in the intercostal space between ribs 9 and 10 but it is more occasional and manageable than before and will likely continue to settle over time. Previously I couldn't stand for more than 2-3 minutes before it started to reach an unmanageable level very quickly and I had to sit or lie down. Now I can stand for 10-15 minutes without pain. I still have issues with the left side, but I am sure that that slipped a few years after the right and doesn't involve the floating ribs, so I'm going to leave that out of the equation for now for the purpose of writing this and focus on the right side which was the worst of the 2 and started 4 years ago. I am still using lidocaine patches near the shoulder blade in the intercostal space between 10 and 11 but not every day (I cut each patch into 6 smaller patches and apply it over the epicentre if the pain so that they last). 

 

The surgery site itself is doing great! The scar is very healthy and still feels numb on the surface, the redness and bruising has settled, my skin has returned to its normal colour and I can feel the thick scar tissue forming underneath which will take time to develop but is what will hold things securely in place long term. Rib 10 feels very secure and I'm still having no movement at the front or in the flank from rib 11 when I walk, which is wonderful! 

I did have a setback 2 nights ago after sneezing three times in a row without having enough time to grab a cushion to use to brace it, but it settled after a day. 

I am still getting discomfort and tightness at the front if I sit in a normal straight backed chair for more than about 15 minutes and I'm still finding that the recliner is the most comfortable place to be, but that's quite normal at this stage. 

I couldn't lie flat, but I can as of today (although getting up from a flat position I need help). 

I can't bend or twist yet, but that's not an issue as I can squat and use just my legs whilst keeping my spine straight, and I am still unable to sleep on my side (despite really wanting to) and am sleeping on my back, but that's pretty common at this stage too. 

I had my first car journey today 20 minutes each way as we went to visit the in-laws. I could get in by sitting down facing backwards and then twisting my legs in one at a time. Car journeys were incredibly difficult pre-surgery and really elevated my pain to a point where I'd usually have to spend the following day in bed. I had movement of rib 11 at the back (I will get on to that...) but had a cushion which helped to brace and I was wearing a lidocaine patch. 

All in all, really good progress! 

 

Mood wise, I've noticed a big difference. I've tried to remain positive and hopeful throughout all of this, despite some huge challenges and I think I've done a pretty good job considering the circumstances, but this week for the first time in a long time I've noticed myself smiling, joking, and generally just starting to feel like my old self again. I've been able to have full conversations with my partner and family members without having to stop or losing focus because of the level of pain. 

What I have been referring to as the "spine pain" around an inch to the right of T11 is still quite nasty but I'll explain that now. You'll remember my "wobbly" 11th rib was flared out all the way around and moving a huge amount at the front whenever I moved. I suspected a while ago but now I'm sure: It's either subluxed or completely dislocated from the spine at the costotransverse joint. It feels more like that latter. It has a few different names, including rib head syndrome, rib subluxation (if still semi attached) and rib dislocation (if completely detached) I can even tell you exactly when and how it happened. The issues with 11 started in November, the day before I started my symptom diary. My partner and I had travelled to Edinburgh by train for a holiday, and I'd carried a heavy backpack on my back and a smaller rucksack on my front through a narrow passage through several train carriages. It caused a lot of pain. When we got to the hotel I immediately unpacked my back stretcher, I elevated it to its highest position, lay on it, and then stretched back putting my hands above my head for extra pressure. My whole body shook and a loud crack was produced, but that in itself didn't hurt so didn't think much of it. The next day was when I started feeling the new flank pain, and the walking problems began. 

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Rib head syndrome/rib subluxation/dislocation is another condition that is apparently easy to miss in imaging. The best example of an explanation of this with an x-ray image can be found here. It's clear as day in the image as you will see, but her doctor missed it. She had hEDS, which is notoriously common among us slipping ribbers, and, interestingly, hers is also rib 11 on the right side. 

I can actually feel it moving in the back now that it has been secured at the front, but not all the time, not when I'm sat, or walking, but in the car and, especially, in bed, and if I take a deep breath, it hurts. I assume that's the inflating pressing it out and into muscle. It's not the worst pain in the world compared to before and, honestly, if I had to choose between the 2 I'd have it over the movement at the front that I did have because that was SO painful and SO debilitating. Ideally though, I'd rather not have either. 

 

I've thought about it at length and I'm going to email my surgeon ahead of my follow-up, but also copy in my GP in case imaging would be beneficial. Although I believe it's an orthopaedic issue, not a thoracic issue, I trust my surgeon implicitly, and I don't particularly want to have to have another discussion with my GP about yet another issue that's hard to diagnose, and they may never have heard of, but at the same time I don't particularly want to have to live with another chronic pain condition that could get worse, and make me miserable, so my usual go-to "deal with it, hide it, avoid the doctor, and try to ignore it" method isn't an option and I need to at least pursue confirmed diagnosis so that if things do get worse, it's all there and documented and I'm not starting another difficult journey from scratch. 

From the research I've done (You know me and research by now!) The general consensus is that there isn't anything surgical than can be done with a high chance of success, but I did find one single case, which was a novel procedure: 

This patients subluxations were in multiple true ribs (connected at the spine and sternum) , whereas mine is in 1 floating rib (connected only at the spine), however in both cases the joints at the spine are the same. 

 

The Surgeon examined the ribs that were suspected of being unstable in pre-op and compared them to the ribs below and above. He palpated ribs 3-6 and saw there was a clear visible difference in T3 vs the unstable 3 ribs (T4-6). The costotransverse joint should not move, but he touched both the rib and transverse process and both the rib and CT joint were globally unstable. When he pushed it, it would slide and the abnormal motion was in every direction. 

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A CT scan was obtained prior to the operation in order to aid in the surgical planning from which they made a 3D reconstruction and got a 3D printed model. The model showed the patient had the propensity for encircled material to slide off due to the slope of the rib into the transverse process so they overcame this by creating some notches in the rib and transverse process. The patient had 2 attending orthopaedic surgeons. One performed the suturing and another shielded the organs in the area (lung, aorta etc). They wrapped nylon polyester bands around the patients rib head and costotransverse process using as many ties as were possible, knotted them and wrapped Ethibond (non-absorbable fibre tape) on top of it to discourage untying. 

The patient is now a little more than 9 months post op and has report that it seems to have been a success. It does take at least 2 years of follow-up to publish and consider an orthopaedic surgery successful so it is still early, however, the patient did report that as a result, her body started to compensate for the stability and her ribs on the contralateral side (Left side) started to subluxate and dislocate. It was hoped that early intervention with injections before the joint capsule got too stretched out would prevent the ribs from dislocating however they could not prophylactically stabilize all of the ribs because it was hypothesises that it would lead to restrictive lung disease. 
 

Following a few dextrose injections with just 1 week of relief, the patient questioned if dextrose was the right agent to use. She started to do more research and found a publication pertaining to the use of tetradecyl sulphate, which was injected it into the CTP and around all the rib head ligaments. The patient received 7 days of relief. The patient managed to contact the author of the publication for advice and a meeting was held with the author, the patient and her GP. The author made the following points: 

1. Everything needs to be in alignment prior to the injection to heal properly. This is done through osteopathic manipulation. 

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2. If the thoracic spine is not stabilised, it will put torsional stress on the ribs. Ribs need to be injected not only at the CTP but also at the interspinous ligaments. If these are too lax, the torsional stresses on the ribs will cause them to dislocate. 

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3. If the patient has a joint dysfunction in the thoracic spine, they will mimic and cause rib pain. The facet joints allow the spine to move back and forth but if they go too far forward, you can tear the supraspinous and interspinous ligaments that run between them. In the case of a hyperflexion injury, you tear the ligaments between the spinous processes which may put you in a flexed and rotated position. Through osteopathic manipulation, you bring that into a more normal alignment and then inject the tips of the spinous processes and between the spinous processes. The manipulation seems to be key to releasing the stuck joints and then the 0.5% tetradecyl sulphate (higher concentrations induce necrosis) strengthens the interspinous ligaments. 

It is hard to apply force to a set of structures and The patient, who herself works in a research hospital, reported scepticism initially and stated: "Interspinous ligaments causing this much instability didn’t make a ton of sense to me. In the rib head-spine articulation, there is less bone contact and it is largely dependent upon ligaments, the potential for that moving around in multiple dimensions is much larger than the possibility of the thoracic spine shifting much due to the interspinous ligament laxity. There is a lot of inherent bony stability to this area whereas the rib-spine articular are purely ligamentous. Ribs generally move a very small amount but maybe small amounts may make a big difference especially in those of us with EDS" 

The patient reported a decrease in the frequency of the subluxations after the third round and 5 weeks of complete stability with a huge decrease in subluxations. She states that she had 40+ relocations a day prior to the injections and 2-3 at this point. The popping felt more superficial and less deep in the joints. 

 

My thinking is that if I did have surgery to secure my 11th rib at the spine, with it also now being secured at the front, it would either cause excessive tightness and restrict the lungs due to it not being able to expand with respiration as it should, or there would be a risk of more movement at the front following securing the rib at the back, which would be catastrophic and land me back at square one but I'm no expert in this which is why I need to bite the bullet and discuss it with a doctor. 

I don't think nerve blocks would work because I do consider myself to be an expert in what nerve pain feels like, having experienced it at such an intensity for such a long time, and It doesn't feel like nerve pain, it feels mechanical. Like bone stabbing, trapping, and rubbing soft tissue. It's not muscle spasms either.  

I am going to suggest that, once I have recovered from this surgery, a referral to physiotherapy might be a starting point based on the theory that if I strengthened the muscles surrounding the joints and ligaments at T11 with intensive targeted exercises, the muscles around it might hold the rib a bit more firmly in place. I wonder if perhaps cortisone injections above and below would work in conjunction to work on the pain, but I'll take advice on this. In the meantime I'm going to try lidocaine patches down there too to try anaesthetise the area when it gets particularly bad, and once things have healed enough for me to consider wearing a back brace (which will take a while) I will try that based on the theory that a bit of pressure from the outside might restrict movement inside and give some temporary relief. Although wearing a back brace won't be practical in bed, it would be practical and might help a bit day to day. The most important thing for me at this stage is to get the ball rolling on pursuing confirmation of the diagnosis whilst I try to manage it conservatively as best I can. 

 

Despite this, I am still feeling almightily positive, because overall I feel SO much better now than I did 3 weeks ago and although there is some quite intense pain near the spine and there is the fear of it getting worse over time, I am in so much less pain overall, in less places, with no gastrointestinal issues or pain after eating and I can walk around the house and short distances without having to use a stick. 

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10th July 2022. 6 weeks post op. 

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Things are continuing to go well in terms of the slipping ribs. I've not had any nerve pain at all around ribs 9 and 10 which is wonderful, and it feels very stable. I did have a marked increase in pain after overdoing it (bending) about 2 weeks ago and I did worry that I'd broken the sutures, but they're still firmly in place. I'm still in the process of working out what I can and can't do, but 6 weeks is still quite early.  

 As I mentioned in my last post rib 11 is still a problem, although not as much as it was. I didn't go into surgery thinking I'd be back to 100%, but that it would help somewhat, and it has. The reduction in nerve pain and the absence of clicking has made a big difference to my quality of life as (depending on what I do and making some adjustments/avoiding certain things) I can have pain free periods, or have a manageable level of pain. Pre surgery I'd have 1 or 2 days in bed. I've not had to spend a day in bed since surgery (with the exception of day 1 and 2) which is a huge positive.  
 

What's somewhat ironic is that bed was the most comfortable place for me pre-surgery, now it's the opposite. I'm still having to be very careful getting into bed as 12 still goes under rib 11 and causes sharp pain if I'm not careful, and I have to try to avoid sleeping in the foetal position for the same reason. I can't sleep on my stomach, or on my surgery side, and if I sleep on my back all night (Which I was never really a fan of to begin with) I wake up with more severe pain near the spine, so it's taking a while to get comfortable but I'm trying to sleep on my left side, with my legs completely straight so 12 stays away from 11, and that's working well in terms of getting to sleep, but I find I'm subconsciously moving in my sleep and then waking up very sore around 11. Mornings are not too nice, but once I've had a hot shower and then put my ice pack on, it reduces, and as long as I don't bend at the waist, or do anything too strenuous I'm ok. I'm still wearing the ice pack all day and I can see myself doing this long term. Even when the ice has melted I've noticed that the slight pressure from the elastic is helping to prevent too much movement and although wearing an elastic band all day isn't too comfortable, it's much more comfortable than not wearing it.  

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Walking is still causing pain at the spine (though not in the flank or at the rib tip as it did pre-surgery) and I can only walk for so long before I need to stop or, ideally lie down on the floor. I relax my body, inhale slowly, exhale slowly, and if I'm lucky, on the exhale I can feel a 'click' followed by immediate relief as the head of rib 11 moves to, or at least closer to, where it should be. It's looking like mobility's going to continue to be an issue, but I'm grateful that It's more manageable than it was 6 weeks ago.  

On that note, I had a telephone appointment to review my medication a few days ago with my new GP, Dr. Burns. As you know, my relationship with my previous GP wasn't great, and neither was my opinion of his manner or level of professionalism, but he has since left the practice. I was so nervous about this appointment with a new Dr. I had the worry of not being listened to, being dismissed or not being taken seriously, and anxiety around having to explain what SRS is and the issue with 11 and how it's affecting me. Dr. Burns was absolutely lovely. She was very professional, she listened, and was patient as I explained what SRS is and about the surgery.  

My surgeon agrees that physiotherapy is a good idea to strengthen the muscles around the surgery site, the left side, and my back muscles around rib 11. There is an Osteopath in Harley Street who has put together an isometric (exercises without moving the muscles or joints themselves)  physio program.  
 

Dr. Edward Lakowski explains Isometric exercises very well:  

"During isometric exercises, the muscle doesn't noticeably change length. The affected joint also doesn't move. Isometric exercises help maintain strength. They can also build strength, but not effectively. And they can be performed anywhere. Examples include a leg lift or plank. 

Because isometric exercises are done in one position without movement, they'll improve strength in only one specific position. You'd have to do many isometric exercises through your limb's whole range of motion to improve muscle strength across the range. 

Since isometric exercises are done in a still (static) position, they won't help improve speed or athletic performance. Isometric exercises can be useful, however, in enhancing stabilization — keeping the affected area's position. These exercises can help because muscles often tighten without movement to help stabilize joints and your core." 
 

I haven't had any specific post op instructions but Dr. Hansen advises his patients not to lift anything over 10lbs for 3 months, and to take care not to bend or twisting , so I'll be waiting another 6 weeks before starting a physio program, and will take it gently, and listen to my body throughout. I'll take Ciaran's (The osteopath) program and go through the exercises with the physiotherapist (If you're American and wondering what physiotherapy is, it's the British English word for what you call 'Physical therapy' in American English) so I know I'm doing them correctly, and then hopefully they'll be able to work with me to formulate an isometric program to target the muscles around rib 11. I'm also going to look further into prolotherapy injections around 11, as these can help in terms of pain reduction, but they are not available on the NHS, and there is nowhere local to me that does them, so that will have to wait. 

 

I'll be having another dynamic ultrasound (In London or Surrey) on the left side (and the rib head and costovertebral joint of 11 on the right if they can do that) as soon as finances and circumstances allow, with the hope of having surgery on the left side later this year. I imagine that will be much easier as it's only rib 10 and the floating ribs on that side are (thankfully) secure, which will reduce pain further, as, although it's not as bad (yet) as the right side was, the 10th rib on the left is constantly buried behind 9 above, as was its right sided counterpart pre surgery).  

 

I had an interview last week with a lovely journalist called Lucy about my condition and my experience with surgery. That'll be going in an NHS magazine, and will hopefully spark the curiosity of, or help to educate, more doctors and medical staff within the NHS, which is great. 

I'm not sure when I'll be providing another update, as things are quite consistent at the moment, and I'm focusing on healing.