Patient Story – Max Blair, Oboist for the Pittsburgh Symphony
Surgery date: July 31st, 2019
I was first made aware of the Nuss Procedure when I was thirteen years old. I was playing competitive hockey at the time and the surgery’s long recovery time would have meant taking a season off. Since my doctors at the time told my family and me that my Pectus Excavatum didn’t pose a medical risk, I decided not to have the procedure done. My chest deformity continued to leave me uncomfortable with my body but it wasn’t until the beginning of 2019, when I started to work out regularly and get in better shape, that I realized I would never feel at peace with how I look unless or until I addressed my Pectus.
I began looking into the Nuss Procedure and, after much research, decided I would reach out to Dr Losasso to see if the surgery would be a possibility for me. As an adult, I wasn’t sure if it would still be an option for me. I met with Dr. LoSasso in person after a conversation on the phone and he assured me that he had a lot of experience performing the procedure on adults. He did make it clear that the operation is more difficult in adults and that it requires a surgeon with a lot of Nuss experience to achieve good results in older patients. After hearing this, I became increasingly surprised at how many hospitals offer the procedure to adults, despite their surgeons having little experience with the procedure in general, let alone experience with adult patients. During my Nuss research, I came across many horror stories of adults who had a very difficult time with the procedure; I came to realize this was likely due to surgeons performing the procedure with insufficient experience.
Although my initial reason for wanting the procedure was aesthetic, Dr. Losasso made me aware of the medical reasons that made it prudent as well. With a case of my severity, he told me that, although I didn’t consciously experience symptoms at the time, it is often the case that symptoms resulting from Pectus can begin to present as a patient enters middle age. I’m 29 now and lead a very active lifestyle; I do CrossFit, play ice hockey, and walk my dog about five miles a day. I didn’t like the idea that I may begin to be incumbered by my condition and no longer be able to do the things I love. Furthermore, Dr. Losasso told me that it’s possible that I was in fact slowed down by my Pectus, I just wasn’t aware of it because it’s all I’d ever known.
My biggest concern in considering the procedure stems from the fact that I am a professional musician; I play oboe in the Pittsburgh Symphony. I was concerned that such a major change to my torso could adversely affect my ability to play my instrument. I brought my oboe to my in-office consultation and played for Dr. Losasso as he examined me. He reassured me that he didn’t believe the Nuss Procedure would adversely affect my technique. In fact, he told me he had previously operated on an adult flutist and she reported that her playing was actually improved by the procedure.
After reading about many people’s experience of the recovery process, I didn’t have a good idea of what to expect; there were such a wide range of experiences. I was a bit concerned because I had only six weeks off before the orchestra season started again and the PSO had a European tour scheduled for exactly three months after my surgery date. While I of course made management aware that there was a possibility I may need additional time off, I didn’t want to be a burden to my colleagues by taking extra sick leave and missing the Europe tour was really not an option. Dr. Losasso assured me that he thought I could meet this timeline and, indeed, as it happened, my recovery was easier than I could possibly have imagined. My pain level never exceeded a 3, I had little discomfort, and was able to start practicing oboe again after three weeks. We leave for Europe at the end of this month and I already feel a hundred percent back to my normal self.
I stayed in the hospital for a total of five days but felt like I was more than ready to leave on day four. The biggest annoyance in the hospital was in fact the extensive ICU monitoring equipment, rather than any pain I was experiencing. Dr. LoSasso made use of an intraoperative nerve block which numbs the chest and generally lasts between seven and ten days. He said it significantly reduces pain and therefore the need for strong pain pills. Although I had a PCA (patient-controlled analgesia pump) on the first day of my recovery in the hospital, the nurses ended up taking it away early on. The number of times you push the button which triggers the pain medication is monitored, and I was using it so little (about three pushes in the time period when 150 were allowed) it made sense to remove it. I was worried about my pain management after leaving the hospital due to the nerve block wearing off and less pain medication, but in fact no pain spike ever occurred.
I was back to driving a car, carrying daily items and walking my dog, and practicing oboe within just one month after the surgery. I started physical therapy one month after the operation as well and will continue that twice a week for the next two months. Although my physical therapist is in Pittsburgh, we are following Dr. LoSasso’s prescribed PT protocol remotely. I expect to be able to go back to the gym and my normal exercise routine by the time my PT sessions have concluded, which will be three months post-op.
My biggest piece of advice for people with pectus excavatum who are considering the surgery is to find a specialist. I originally thought, ‘A doctor is a doctor’, but came to realize there is a huge difference in competency level between surgeons. It was and remains truly shocking to me how much variance there is in patient outcomes, simply because of the experience level of the surgeon. It is an especially important consideration for adult patients! For me, the procedure, while time consuming, was not at all sufficiently painful or difficult so as to be prohibitive. I wholeheartedly recommend Dr. LoSasso, whom I believe should be any Pectus patient’s first choice of surgeon. After my surgery, Dr. LoSasso informed me it was a difficult correction due to my age and the severity of my deformity; the whole procedure took seven hours. Despite the complexity of my case, my recovery has gone unbelievably smoothly and I am truly thankful for such an ideal outcome.
Because Dr. LoSasso did not treat the flared ribs that accompany my pectus, in retrospect I might have tried a bracing regimen before surgery. There are various Pectus braces available, the best of which seems to be called the T-Joe. It is custom fitted to each patient and, according to their materials, best to be worn before undergoing the Nuss Procedure. Although I have already had the surgery, I hope to still try bracing to treat my flared ribs in the future. When I brought this up with Dr. LoSasso (the brace requires a prescription), he said he usually waits to consider bracing until one-year post-op, as the ribs may rearrange themselves on their own during that time.
The Nuss Procedure with Dr. LoSasso was so much easier than I could possibly have imagined. There is so much information online that says this surgery is not possible or is very painful for adult patients. I no longer believe this to be true. Because of my experience, I fully trust Dr. Losasso to treat Pectus in adults with the Nuss Procedure and recommend him without reservation.