Cardinal athlete dives back in, thanks to Stanford surgeon

Media Contact: Ashley Georgian, (650) 725-6625, ageorgian@stanfordmed.org
Todd Holland

Thoracic outlet syndrome would make Taylor Sishc's left arm feel numb and weak. He underwent surgery at Stanford to treat the condition.

STANFORD, CA (September 23, 2013) Taylor Sishc is honest about the mystery condition that turned his left arm so numb and weak he could not even pick up a shoe. "I struggled," he said. "I'm not a crier, but I broke down multiple times. It just seemed like it would never end."

Sishc, an All-American high school diver recruited to Stanford University's elite team, had received prompt attention from the team's trainers and sports medicine doctors, but until he was referred to Stanford Hospital & Clinics' vascular surgeon Jason Lee, MD, he didn't really know what was going on with his arm.

Lee, an associate professor of surgery at the School of Medicine, had his suspicions about what the problem was: Sishc might have thoracic outlet syndrome, a condition often seen in athletes but also found in people who use their arms in a repetitive motion, which can lead to the compression of nerves or blood vessels, or both, in the thoracic outlet — an area bounded by the base of the neck and the first rib.

Diagnosis of thoracic outlet syndrome, also known as TOS, is not straightforward. "There's no one blood test or radiographic test or physical exam finding that gives you that 'aha' moment," Lee said. "It's a combination of positive and negative tests."

Sishc had been a gymnast since childhood and a serious competitive diver since he was 13. By the time he reached Stanford, he had been lifting his arms over his head in a similar motion for years — exactly the kind of long-term overuse that creates thoracic outlet syndrome. Sishc's TOS, Lee determined, was caused by compressed nerves. The growing numbness and weakness in his arm threatened a premature end to his college diving career.

Todd Holland description of photo

Sishc had been a gymnast since childhood and a serious competitive diver since he was 13. By the time he reached Stanford, he had been lifting his arms over his head in a similar motion for years.

The tricky part about TOS, Lee said, is not just making the diagnosis. Trainers, therapists and surgeons have worked on TOS treatment for decades with results that were not always consistent. In a 2010 paper published in the Journal of Vascular Surgery, Lee and his colleagues presented a review of nine years of Stanford TOS patients that showed that a specific set of steps for work-up and surgical intervention increased successful outcomes for TOS operations from 50 percent to nearly 90 percent.

Lee asked Sishc to begin a six- to eight-week course of physical therapy of what's called the Edgelow protocol. It's a series of movements and breathing and posture adjustments designed to alter the compressed space of muscles and bones that causes TOS. It mimics what surgery might do, Lee said.

What his research had shown was that patients who improved completely with the therapy obviously wouldn't need the surgery and that those who didn't respond at all probably wouldn't be helped by further anatomical reconfiguration. Those who were helped initially and then plateaued would be the best candidates for what Lee calls "the ultimate decompression of the nerve, the ultimate space clearing."

Lee wanted to determine, before making a decision about surgery, to what extent such exercises would help Sishc. Surgery would mean the permanent removal of his first rib to reduce pressure on the compressed nerves. Sishc had never heard of TOS before his diagnosis; he was surprised at the possible surgical solution. "I didn't expect that," he said. "But he seemed pretty confident that he could get me back in the water."

Jason Lee

Sishc began diligently doing the Edgelow exercises. "Some days I'd wake up and I'd feel fine," he said. "Others, I literally couldn't lift my wrist to put on my clothing. I remember thinking, 'Am I ever going to be normal again? Am I going to be able to dive?' And I though about my future — I want to be a dentist — and I knew if this didn't get better, that would end that pathway in my life."

"When I met him, I felt he was a set-up for TOS because of his years of diving and cross training with swimming and weights," Lee said. "I was also struck by his perseverance. I could tell he was somebody who would follow our instructions."

The therapy did help — until it didn't. That was exactly what Lee was expecting in the high-performing athlete. Lee went in and removed Sishc's first rib. The surgery was followed by months of rest for Sishc's arm, physical therapy and a gradual return to his sport. "It was a lot easier than I expected it to be," Sishc said. By the time he was given the go-ahead to dive again, he'd been out of the water for six months. "Diving is not a sport where being out for six months, you're going to get back in right away. I felt like a new diver again." He had shown up for all the team practices in that six months, however, supported by his coaches who wanted him to still feel part of the team. "It was torture," Sishc said, "because all I wanted to do was get in and dive."

Finally, he was allowed to train again. "We took it very slow," Sishc said, "and my first meets were a little rough. For a year, I struggled with getting strong and getting everything back to where it was. I didn't expect to make the NCAA championships."

But his old form came back. In January 2012, as a Stanford senior, he helped his team win the annual Stanford Diving Invitational — taking the top spot in five of six dives he made from the competition's highest platform, the 10-meter.

Last March, as a Stanford graduate student in psychology, Sishc qualified for the NCAA national diving championships, winning a chance to compete against the nation's very best divers. "I remember standing up on the platform for my last dive, thinking not only was this the last dive of my career but also what it took for me to get to this point. I honestly did not think I was going to get back up there. So it was a great feeling to say that I did it," Sishc said. "I also knew that it wouldn't have been possible without the medical team here at Stanford, especially Dr. Lee."

And, as Sishc modestly put it, "it ended well." He made the top group of finishers in the 3-meter springboard, as well as in the 10-meter platform he once thought he'd never see again, to become a collegiate Division 1 All-American in two events. This fall, he's applying to dental school.



About Stanford Hospital & Clinics
Stanford Hospital & Clinics, located in Palo Alto, California with multiple facilities throughout the region, is internationally renowned for leading edge and coordinated care in cancer, neurosciences, cardiovascular medicine, surgery, organ transplant, medicine specialties and primary care. Stanford Hospital & Clinics is part of Stanford Medicine, which includes Lucile Packard Children's Hospital and the Stanford University School of Medicine. Throughout its history, Stanford has been at the forefront of discovery and innovation, as researchers and clinicians work together to improve health, alleviate suffering, and translate medical breakthroughs into better ways to deliver patient care. Stanford Hospital & Clinics: Healing humanity through science and compassion, one patient at a time. For more information, visit: StanfordHospital.org.

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