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Ribs lost, careers saved: WUSM surgeon gets athletes back on the field

(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Science & Technology section on Tuesday, July 15, 2008)

By Blythe Bernhard St. Louis Post-Dispatch

Colorado Rockies pitcher Aaron Cook always has a spare rib for good luck.

It's not part of his pregame meal. The rib came out of his own body and sits in his locker.

Cook suffered from Thoracic Outlet Syndrome, a condition in which the space between the collarbone and the uppermost rib gets cramped, pinching nerves, veins or arteries. The serious condition causes pain, swelling, scar tissue and blood clots.

During a game in 2004, Cook grew dizzy and had to leave the mound. Doctors discovered life-threatening blood clots had traveled to his lungs. Suddenly, a promising major league career dangled by a bone.

In the past, athletes with Thoracic Outlet Syndrome faced the end of their careers and a lifetime on blood thinners to prevent further clotting. Cook turned to Washington University vascular surgeon Robert W. Thompson, one of the few doctors in the country using a surgical procedure that gets athletes back on the field.

Tonight, four years after the procedure, Cook is expected to pitch in the All-Star Game in New York.

"His story has given a lot of confidence to many other people that they, too, could come through their own ordeal and end up doing well," Thompson said.

Anyone can develop the rare syndrome, but pitchers and other athletes are more susceptible because of their repetitive overhand movements and thickened shoulder muscles. More than 60 professional, college and high school athletes Thompson has operated on have returned to competition after physical therapy.

In the delicate operation, Thompson removes the top rib and the two muscles attached to it. He repairs the damaged vein, removes scar tissue and sometimes follows with a bypass procedure, restoring normal blood flow to the heart. The complex surgery can take up to 12 hours.

"You can function normally without the first rib," Thompson said. "I tell patients they have 11 more on that side, and that's plenty."

Thompson first learned about the operation during his fellowship at the University of California, San Francisco. When he came to Washington University 17 years ago, the procedure was virtually unknown here. Last year, he performed 130 of the surgeries.

Thompson speaks at athletic trainers' conferences and Major League Baseball's winter meetings, and has gained a reputation as a go-to vascular surgeon.

He has operated on 10 professional baseball players, including former Cardinals pitcher Kip Wells. Most of the athletes were back in action within four months of surgery.

One of Thompson's first patients asked to keep the rib. Thompson has been giving patients back their 4-inch bones ever since. Some put them on a shelf. Others fashion them into a necklace.

"It's a nice little souvenir of their stay in St. Louis," Thompson said. "They worked hard for it."

Colin Bates, a 20-year-old pitcher at the University of North Carolina, keeps his rib in his back pocket during games. In North Carolina's appearances at the College World Series last month, television announcers mentioned Bates' surgery and the rib in his pocket.

At least two young athletes heard the story and soon came to St. Louis for the same surgery.

Michael Griffin, a 19-year-old pitcher from San Diego, hopes to regain his 90-plus mph fastball and pitch for the University of Hawaii. He sat out his freshman year because of the injury that caused a 6-inch blood clot in his shoulder and swelling down his torso. Two doctors told him he wouldn't throw another fastball.

After surgery last week Griffin said, "I have dreams of seeing myself pitch again."

Houston ballerina Kathleen McClure, 16, looked up Bates on the social networking website Facebook and booked her own trip to St. Louis. McClure danced up to four hours a day before the syndrome and blood clots sidelined her.

"I can't even put my hair in a bun at this point," McClure said in her room at Barnes-Jewish Hospital after the surgery last week. Soon, she hopes to send Dr. Thompson a pair of her pointe shoes to display in his office.

When Thompson gives patients their ribs, he asks for a game-worn memento in return.

Aaron Cook's Rockies jersey hangs behind Thompson's desk, along with a note thanking the doctor for the "spare rib."

Since the procedure, Cook has continued pitching for the Rockies. He recovered from an unrelated injury in time to pitch in Game 4 of the World Series last fall. In the offseason, he signed a four-year $34 million contract with the Rockies.

Tonight, Thompson plans to watch his patient in the All Star Game.

"This season has been his best yet," Thompson said. "To think that we helped a little is nice to know."

bbernhard@post-dispatch.com | 314-340-8129

Copyright 2008 St. Louis Post-Dispatch, Inc.

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