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Aug 28, 2017 · Median Arcuate Ligament Syndrome (MALS) in Digestive Health

Wow jmmb, I have not heard of compression from the diaphragm. I was only aware of compression by the ligament. That must have been a very rough surgery. How long ago did you have it done and who was your surgeon(s)? No wonder you feel it is hard to take in a deep breath at times. I do not know but you may have developed some scar tissue that causes issues. Do you think you had SIBO before your surgery? Did you have any symptoms of SIBO like malabsorption, weight loss, bloating?

Aug 28, 2017 · Median Arcuate Ligament Syndrome (MALS) in Digestive Health

Jmmb, you will have to remind me what surgery you have had. I have not had surgery for MALS release but 13 years ago I had a hysterectomy and my gall bladder removed at the same time and I have had GI problems ever since. I feel the SIBO may partly be a result of scar tissue from those surgeries. For me, the compressed arteries were an incidental finding after many of the tests I had came out normal (gastric emptying, abdominal CT, liver MRI, endoscopy, colonoscopy, blood tests) except for the fat malabsorption test, breath tests for SIBO and fructose intolerance, B12 and D. The compressions are significant so when I went to Cleveland the GI doctor could hear the bruit through his stethoscope. I struggle most with the GI symptoms. I do feel a tightness and pressure in my sternum but I can live with it if it does not get worse. It does not make it hard to take a deep breath. If it does, at least I don’t have to go through all the testing and various doctors again. I know what the problem is now. I agree with you about the GI’s advice to go ahead with the surgery. I won’t do it unless a vascular surgeon says it is time.

Aug 27, 2017 · Median Arcuate Ligament Syndrome (MALS) in Digestive Health

Jmmb, I totally agree with you. Knowing I have two arteries that are as compressed as mine is very nerve wracking to me. However, in meeting with both vascular surgeons and the general surgeon, all three said I have developed collateral blood flow. It is their opinion this is what is giving me enough blood flow, but not optimal. I understand this collateral blood flow to be alternate circulation around the blocked arteries by nearby small blood vessels. I can feel the tightness and pull of the median arcuate ligament if I take in a really deep breath and try to expand my ribcage as far as possible. I also can feel it when I do the back stroke in the pool. It feels so tight and hurts when I have stretched it. When I first went to Cleveland Clinic, I had an appointment with a well known GI doctor. He first sent me to an interventional cardiologist. When I went to see him, he did not feel I should have a stent placed because he said the ligament could crush it, move it, or tear the artery. He called in a second interventional cardiologist who said the very same thing. They referred me to the vascular surgeon, Dr. Parks. He is (was) the only vascular surgeon at CC doing the MALS surgery. I just received a letter informing me he has taken a position in another country so I will have to wait and see who will replace him.

As for the SIBO, I researched it until I was blue in the face. I am very familiar with Allison Siebecker’s work and her website. I listened to many of her youtube videos when I was desperate for help and to keep my hopes up. For me, the antibiotics were critical. I was so low in B12 that I was put on a prescription for them along with vitamin D. I will have my levels checked again next week when I see my PCP. My B12 was so low (under 200) that my doctor wanted to do shots, but I wanted to see if the tablets would work. I don’t think they have because I am so exhausted there are no words to describe it. I have felt this way for over a year now. It has to be the MALS and SIBO. I dread SIBO being a chronic problem for me but I suspect it already is. My GI doctor where I live wants me to do one week of antibiotics every month. I may give it a try. The GI doctor in Cleveland totally disagrees. He wants me to have the surgery right away. I asked him what my percentage was that it would help the GI symptoms that I deal with and he said 10%. I said would you do that huge surgery for a 10% chance of it helping and he said yes. I am not so brave.

Aug 27, 2017 · Median Arcuate Ligament Syndrome (MALS) in Digestive Health

Dear jmmb, I suffer from median arcuate ligament compression with high grade stenosis of the celiac and sma arteries. I found this out after a year of treating my symptoms through a GI doctor. In the course of a year (2016) I had most of the tests everyone else has had, in addition, my GI did a hydrogen breath test for SIBO and one for fructose intolerance. I came back with a very high score for both. I have taken a total of five rounds of Xifaxin, two rounds of Flagyl (metronidazole) and one 14-day course of Diflucan (100 mg) to address the SIBO. My weight had dropped 20 pounds in a four month period with no end in sight so I stayed the course for months taking the antibiotics and anti-fungal. And I did get a bit better. For me, the SIBO treatment seemed to reduce the nausea and stopped the weight loss. I was not able to gain weight, but it helped me to feel a bit better. I have malabsorption issues, which my GI doctor could not figure out. I had a repeat breath test last December (2016) after a full year of treatment and it showed my SIBO numbers for both methane and hydrogen had gone way down. So the GI doctor was able to address the SIBO but I did not feel much better and was not able to absorb food very well. He felt I needed to see a psychologist. I am 60 years old and I know my own body pretty well. I knew this was a physical issue and not a mental one. However, I did go see the psychologist he referred me to and she said during our visit that I needed a second opinion immediately and she got me an appointment to see a GI doctor at the Cleveland Clinic. One month later, the GI doctor at Cleveland looked over all my tests and said, “have and of your doctors ever considered this may be a blood flow issue?” Within a day, I had the Doppler ultrasound and CTA which confirmed 99% stenosis of the celiac artery and over 70% stenosis of the SMA. I was in shock and scared to death. I was referred to a vascular surgeon and a general surgeon at Cleveland who both felt I should not have the surgery (yet) because I do not have the intense pain that goes with MALS. Instead I have a constant, colicky pain, lots of gas, bloating and indigestion, but not the nerve pain most patients report. They said my blood flow seems to be adequate, but not optimal, so that is most likely the cause of the SIBO and malabsorption. I then saw a vascular surgeon back in my city and he felt the same. He said there is enough blood flow to be adequate right now. He said that malabsorption is highly associated with MALS but is not correlated. I share my story in the hopes it may help you. In my situation, it seems to be a condition that I will have to manage daily, and may or may not need to have surgery. I follow a low residue diet and avoid all fruit and many vegetables. I don’t like it, but managing the SIBO has enabled me to put back on the 20 pounds I lost. I watch my symptoms very carefully and if I start to drop weight again, I will try a round of the antibiotic and if that does not work, I will know it is time to consider more aggressive treatment. I feel like the other shoe could fall at any time but I try to stay hopeful. Some days it is not possible because I feel so lousy. Other days can be pretty good. I wish you well.

May 10, 2017 · Median Arcuate Ligament Syndrome (MALS) in Digestive Health

Hi Kari. I am 59 years old and was just diagnosed with MALS on Monday (two days ago) after having many tests run over the past year by my PCP and my GI doctor. After a year and no diagnosis, I went to Ohio to get second opinion at the Cleveland Clinic where it was confirmed with a Doppler Ultrasound and a CT Angiography after the doctor heard a bruit in my abdomen. I have severe stenosis of the celiac artery (368). However, the surprising thing is, I do not have the type of pain the vascular surgeon typically sees with MALS patients. I have had some pain, on and off, for the past four years under my right rib, but it is mild. For me, the symptoms that make me miserable are: gas pain, bloating and slight nausea. I also have malabsorption and have lost about 10 pounds due to getting full so quickly. I was wondering if you or anyone else on this board have gas or indigestion as a symptom of MALS? I am so scared to do the surgery, it is all very overwhelming right now. Thanks