Median Arcuate Ligament Syndrome (MALS)

I have had 3 procedures for my MALS The first was a major open surgery. A little over a year later, they wanted to do a bypass but I was not healthy or strong enough so they put stents in celiac and SMA artery. I was rare since my sma was involved. Then I had a balloon in my celiac. It is now narrowing again. For me, this is going to be a life long thing. For many though, I have seen people have even laparoscopic surgery and eventually they are fine. These people usually have the compression and nerves taken care of . Every person is different. It is definitely possible to have one and done. It all depends on your situation. Honestly more often there are more than one surgery, but there are people with one and are fine.

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Hi. These symptoms exactly match mine. I have had 8 years undiagnosed except for Small Intestinal Bacterial Overgrowth (SIBO). Can MALS cause SIBO does anyone know or have? I am going to the Scottsdale MAYO clinic next week. Is there anything I should ask them or tell them to help them diagnose this if it is the condition I'm struggling with? Haven't been able to eat for 2 months so living on elemental diet which can even cause pain. Lost a lot of weight. I usually have exacerbations like this that put me in bed with epigastric pain and what feels like overwhelming autonomic nervous system symptoms but usually they come right in days to maybe 2 weeks but never this long so know I'm getting worse and I need a diagnosis. SIBO is not a diagnosis - there is always an underlying cause and I have had most others, except for SMAS, excluded. Diet modification does nothing. Medication, other than pain killers taking the edge off it and lorazepam calming me down, otherwise do nothing. It is very waxing and waning in symptoms, night or day. Exercise, stress and eating anything are the triggers. Sounds just like MALS to me. Should I also ask the specialists there to test me for vascular and connective tissue disorders? Thanks so much, this is all new but hopeful finally

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I went to the doctors for pain I have been having for years. I have constant pain in my abdominal area. I have several scans done and they believe I have MALS (arcuate ligament syndrome). It’s my understanding they could determine it through scans. The Dr. wants me to get a nerve block if it works he said I have MALS if it doesn’t work I have something else. My question is are there some cases where a nerve block is required to determine MALS?

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Welcome to Connect, @patrice207. You'll notice that I moved your message from the Chronic Pain group to this existing discussion about MALS in the Digestive Health group. I did this so you can meet others who are talking about abdominal pain and MALS. I encourage you to read back through the past messages where you'll meet @kariulrich @jmmb @annief and others, and find useful resources and tips that they've shared. Perhaps they can answer your question about how a nerve block may be used to help diagnose MALS.

Feel free to ask questions to help you prepare for your next appointment with your doctor. Have you seen a GI specialist?

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I went to the doctors for pain I have been having for years. I have constant pain in my abdominal area. I have several scans done and they believe I have MALS (arcuate ligament syndrome). It’s my understanding they could determine it through scans. The Dr. wants me to get a nerve block if it works he said I have MALS if it doesn’t work I have something else. My question is are there some cases where a nerve block is required to determine MALS?

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Hello @annief . Sorry to hear you are not feeling well. MALS is a really tricky and complicated disease/diagnosis. I don't think any two people are the same. Usually all have general similar symptoms like you have described. My MALS was found by accident. I have always had stomach issues since I was little. Told IBS and had ulcers. About 4 years ago, the pain was so bad I decided to go to the er just for pain meds or something. They insisted on ct scan. The dr. came out and asked if I knew that my arteries were narrowed. I was like I don't know. He said I should see a vascular surgeon. I told my pcp an he got me into a University teaching hospital and with the chief of vascular surgery. I had no idea what was going on. They did the doppler and said my velocities in the celiac and SMA were literally off the charts and I needed surgery right away. I was a teacher and asked to wait for spring break he said no. I thought ok, I took a month off. Wow was I wrong. Now of course mine was different. I had two arteries and they were severely compressed and it was a mess and about 8 hr surgery. I did feel better after. Long difficult recovery, plus a lot of personal stresses, family deaths, which didn't not help. But my arteries were good. However, 5 months later they were narrowing again. My surgery was Feb. 2014, In Sept. 2015 I got stents put into each artery. It would have been best to do a bypass, but I physically could not handle that. I did feel relief again. Then it came back. I also had SIBO, which is a big issue to watch for. I was getting confused of what was what. If that is caught and taken care of, I think it would be fine. Mine wasn't. Oct. 2017 I had a balloon in the celiac. For me this will be a life long thing. That doesn't mean for you. I have heard people have open surgery and in a month feel a lot better and continue on that path. There are many that have had laparoscopic an out of the hospital in like 3 days and done great. It depends on the situation. If you are unsure I would definitely get a second opinion. I think, personally, it should be a vascular surgeon. I have not had luck with GI drs even acknowledging that MALS is causing damage to the stomach. I have heard though some GI drs were great in diagnosis of it.
Sorry not much help. As for eating, I used to try to stay away from certain foods. Honestly it didn't matter. Just depended on the day and how bad my symptoms were. Water is really hard for me. Weird I know, but if I am really thirsty and drink more than a couple of sips, it hurts so bad, even now. I would definitely eat SMALL MEALS and more often throughout the day. If you have a problem with eating, and one day something sounds good and is working, eat it all day, who cares as long as you get something in you.

Well good luck to you. Oh and I was 47 when I was diagnosed and my surgeon said I was young, but I don't think he realized it was truly MALS until he went in and saw the diaphragm compression. I don't think age matters so much as the shape and health you are in. Feel free to ask any questions. Don't know if this helped any....

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Kari, you are awesome.
I'm still hanging in there. Still 109 pounds at 6 foot,1inch. I can't gain any weight unless I can stop the pain and exhaustion.
My doctor has me taking a trial course of oxycodone, 5 mlg., 1/2 hour before I eat. I think it's working but I'm not comfortable about taking opioids. I keep a very close record of when and what I take in a daily notebook. I'm curious if anyone has ever taken opioids before eating and how successful they found it? The MALS surgery did not relieve the pain and exhaustion when I eat. Of course I eat small meals and avoid hard to digest foods.

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Hello: My husband was on Opioids for three weeks and lost weight, lost appetite, and had difficulty staying awake. When we transferred to Mayo Clinic (for 3 months opioids were not used. Thank goodness.It was a challenge to find food he liked. He slowly began to gain weight.
I encouraged him to listen to Dr Amit Sood's Mindfulness tape that I listen to regularly. Although both of our medical issues are much different from yours...the lessons learned about how to really relax eased each of our very different pain. Dr Sood has written several
books that are a interest read on the Body, Brain & Mind connection which has helped me heal and deal with breathing.

Our body often need time to heal and if we can learn to incorporate mindfulness and tell our brain to ease the pain and relax
our nervous system we can heal better. I wish you all the best. Oh, Dr Amit Sood has done some entertaining yet helpful talks
that can be found on You Tube. I hope this helps.

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