Friday, May 24, 2013

The Month of the Pneumothorax

I mentioned that I was going to do a recap of my collapsed lung experience. Well, yesterday was my LAST pneumothorax-related appointment, so I feel like I'm finally in the position to actually recap the whole thing. If you missed my previous posts, you can read my first post after it happened and an explaination of exactly what it was that happened.

This post is intended to be more informational for anyone else that has this happen to them! As I mentioned previously, this is kind of a rare occurance and I felt like there wasn't a ton of information out there to help me know what I could expect.

Day 1: I'm walking home from work when I feel pain behind my left shoulder blade- it feels like a cramp so I try to stretch it out and take deep breaths, but everything I do makes it worse and I start to feel light headed. Brian meets me at a nearby Urgent Care. They check my vitals and run an EKG, but everything is fine so they send me home. The walk home (only a few blocks) is super slow because taking anything more than a tiny breath is incredibly painful.

Day 2: Brian and I head to my primary care physician and when I describe the pain he's concerned that I might have a blood clot and sends me to the ER for a chest x-ray and some other tests. At the ER they set me up with an IV, do another EKG, and some blood work. The doctor at the ER mentions that she hears some decreased breath in my left side.

Within minutes after my chest x-ray, they tell me that my left lung is 40% collapsed and that they'll need to insert a chest tube. The doctors decided to send me to Interventional Radiology to have the chest tube inserted. They inserted a small needle just below my left collarbone, with guidance from an ultrasound image. The doctor gave me a shot first to numb the pain and I really couldn't feel anything until they started to suction out the air that had leaked from my lung and into the chest cavity- that part is painful. They  set me up with a portable pneumostat so that I could go home. It has a valve that allows air to continue to exit my chest so that it doesn't build up inside me again.

I head back up to the ER and they give me some morphine and a muscle relaxer. At this point, the pain was the worst of the whole experience, so I was pretty grateful for those meds. They were ready to admit me for the night, but said if I felt up to it, we could go home. After an hour or so, the pain meds did their thing and we called a cab.

I spent the night on the couch so that my body had a lot of support to stay upright, but it was pretty uncomfortable and I didn't sleep great.

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portable pneumostat device
Day 3: More pain today and I stayed on the couch as much as possible, taking Vicodin every 5 hours. Sleeping wasn't so great again- I had to sleep on my back and keep my chest elevated, plus I was still just so uncomfortable.

Day 6: We headed back to the hospital to see if the chest tube was ready to come out. They put a few drops of saline on the valve that let air escape, and then had me cough. The saline totally flew off of the valve, which meant that air was coming out of my lung. I had not been expecting that at all. They did an x-ray and saw the pneumothroax was still at about 20%, which was an improvement, but obviously still a problem. The good news was that Monday morning was the last time I took any pain medication and I really was feeling better.

Day 7: Saw the pulmonologist and she ran the droplet test again, and again I failed miserably. She sent me for another x-ray, and then showed me how to tell from the image where the oxygen was not getting into my lung.

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Day 10: For the first time, some fluid started to collect in my pneumostat. It was kind of gross- the color of urine- and there was about 10 mL of it, which I had to drain out using a syringe. About 10 mL/ day continued to collect until it came out.  My doctor said this was fine as long as it wasn't cloudy or bloody. I noticed that the fluid in the tube stopped moving when I was breathing. Before, if I inhaled, the fluid would move in the tube in the direction of my body and vice versa if I exhaled.

Went into the thoracic surgeon… and this time I actually did a little better on the droplet test! The surgeon decided he wanted to be conservative with my treatment and give me the weekend to continue to heal before deciding on surgery.

The nurse practitioner helped me figure out why I had so much pain in my left arm- the chest tube was bumping against some of the nerves in my chest cavity, so when I moved that arm or lifted anything, it was painful, but normal and nothing to worry about.

Day 13: Back to the thoracic surgeon with my fingers crossed and… I passed!

The surgeon removed all of the bandaging around the site where the chest tube had been inserted (which ripped off a few layers of skin) and had me take a deep breath and hold it while he pulled out the tube. It was like when you swallow a strand of spaghetti down the wrong tube and pull it out, except also really painful. The pain didn't last though- as bad as it was, it went away pretty quickly. The pain in my left arm was also gone immediately.

I had a waterproof bandage put on, which meant that I could shower and wear normal clothes (I had been living in a tank top and baggy zip-up hoodie)!! Brian was probably extremely relieved about the whole being able to bathe again thing.

Day 14: Back to work!

Day 15: The surgeon told me to remove the bandage after 48 hours, so I did that after my shower. There was basically just a tiny little hole. I put a lose cloth bandaid on it while I was at work just so that nothing was rubbing against it.

Day 17: Saw my primary care physician and he had me go for an x-ray. It was good!

So there you have it, there was also a follow up with my surgeon and then another with my pulmonologist. Right now, I'm feeling about 85%- that last 15% is just a little bit of discomfort when I take a deep breath and a little tiredness. As far as the rest of my life goes? Here's what I can expect:
  • No flying for one month
  • No exercise for 3 weeks from when they took the tube out
  • No scuba diving (ever)
  • I have about a 50/50 chance of recurrence 
Hopefully, it won't happen again, but if it does I will at least know what I'm in for! If it does happen a second time, both my pulmonologist and surgeon have told me that I would need to have the surgery that time around.

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