If you are a complete stranger reading this, then I have to assume a search engine sent you here. Hopefully this can help you if you are going through this.
| 3/18/02 | 3/19/02 | 3/20/02 | 3/23/02 |
| 4/3/02 | 4/4/02 | 4/5/02 | 4/6/02 |
| 4/20/02 |
| Things to Look Forward to After Surgery |
| Bibliography |
After about 6 weeks I went and saw a doctor, and there were a couple of suggestions.
The xray revealed there was some sort of 'mass' in the lower left lobe of my lungs. In a frontal view it is obscured by the heart, but is clearly visible in a lateral view. Figuring it to be some sort of infection I went on high powered antibiotics (Tequin).
Two weeks later I went back and we did another chest xray, and it hadn't really changed. So, another round of high powered antibiotics ( Zithromax), but we also did a CAT (CT) scan.
Then I went out of town and got really sick. In the mean time my CAT scan came back with the radiologist's report, and my Dr. didn't know what it meant. The Radiologist described the mass as a pulmonary sequestration (intralobar)
So, my Primary Care Physician (PCP) called the radiologist and got more detail. The summary is:
It is a piece of tissue that developed into lung tissue as I developed, but is not normal lung tissue because it gets it's blood supply from the thoracic aorta instead of the pulmonary blood supply and because it does not communicate with the other lung tissue. This communication is a fancy pulmonologists way of saying that it is not connected to the standard bronchial airways and that it performs no function in respiration.
From here I went to see my first pulmonologist, Dr. Amy Silverthorn. She concurred with the radiologist that it was a pulmonary sequestration and said it had to come out. She said that this would involve removing the entire lower lobe of my left lung (~18% of my total lung tissue). This was, as you can understand, disturbing. She also put me on my third high powered antibiotic, Levaquin
The good news is that when I saw the first thoracic surgeon he said it had to come out, but just the affected tissue, and the second thoracic surgeon has agreed with that.
So far I have seen my PCP, 2 pulmonologists and 2 thoracic surgeons, and they all agree it has to come out. This is done via a procedure called a thoracotomy. I am scheduled to have this done on Monday, April 1st, 2002. (Really, I'm not fooling here :) The surgery will be performed by Dr. Ravi Koopot as things stand now. It will happen at Good Samaritan Hospital in Phoenix.
(On a side note, is there any hospital that is called Bad Samaritan?)
Here are some links that have good information on what I'm dealing with.
Dr.s that I have seen (in order):
Here are some images of what the x-ray, CT scan and surgery look like. Please note, a lot of these images are not for the faint of heart. If you aren't a Dr./Vet student/Really interested I wouldn't look. Pulmonary Sequestration Images
Ok, here are 4 images, 2 x-ray and 2 CT scans of a IPS. Now all of these are of a IPS in the right lobe. Mine is left, which is more common. X-rays are mirror image because the film is on the opposite side of the patient from the camera. Now, I am not a radiologist, and although I'm pretty good at looking at my films now, these aren't my films, so take my explanation with a grain of salt. :) These are also images of a child, so it's a little harder to read.
You can see the spinal column descending, and then a mass of tissue defined by the parabola of the diaphram. The large mass on the right side is the heart, and the fuzz you see on the left side just above the diaphram, and appearing to merge into it is the IPS. In my films you don't really see the IPS because it's hidden behind the heart. If you know what you're looking for you'll notice that the aorta gets obscured and as a result you can see where the IPS is.
I can't really make out much in this view, as I can't tell what is heart and what is IPS. In my films it's pretty clear what looks anamolous. Actually, in my films, this was the first place we really noticed it.
This is where things get really clear. All of the dark space is normal lung tissue (as it's mostly air). The large object front and to the right is the heart. The mass to the left and towards the back is the IPS. I don't know if they used a contrast solution here or not, but I would guess they didn't as all the fluid looks similar (the pulmonary arteries and the plenum don't look significantly different to me). With contrasting solution my IPS shows what is described as the classic 'scimitar' of the thoracic aorta blood supply.
A similar view to the last, but now we see some dark area (normal lung tissue) in with the IPS. I'm sure this tells someone who knows what they are doing something, but that isn't me.
A thoracotomy with its associated pathophysiological abnormalities produces one of the most damaging surgical insults which it is possible to inflict upon patients.And yes, I'm going to ask the anesthetologist about using lidocaine.
So, why does this have to come out? There are a few reasons.
Also, one of the articles [5] indicated that it is a good idea to be on antibiotics before it is done to reduce infection and as a result the amount of inflamed lung tissue they would have to remove. I sent a fax to Dr. Silverthorn and she called in a prescription for Levaquin for me.
Three hours later I woke up in the Post Anethesia Care Unit (PACU) as they were taking the oxygen mask off and replacing it with the oxygen feed. I was woozy, but conscious from that point on. I have to tell you, I was concerned about my PACU time, because the sheet from the hospital said I would be in there 1 to 2 hours and relatives could not visit. I'll tell you now, don't worry about it. I may have been concious, but I have no memory of my time in there until the end, and once my memory returned I was moved immediately and was able to see my family.
I have a chest tube in my left side, the IV line in my right arm, an A line in my left wrist and a catheter. Thankfully the cath, A-line and chest tube were done when I was out.
For medication they put a local into the chest opening, but other than that I'm on a morphine PCA (Patient Controlled Anagelsic). This runs at 1 mg/hour with the ability for me to push the button to get 2 mg no more often than every 6 minutes. They also give me Toradol (Tordol) every 6 hours (I don't know the dosage). I actually like the Tordol dosage because it allows me to limit the use of the morphine which makes me loopy, tired and hot.
Dr. Koopot said the surgery went well and there as actually a good amount of connection with the pulmonary veins, which means I probably had a cardiac shunt going on.
I was in ICU on Monday and Tuesday. I could have been out on Tuesday morning, but they didn't have any beds available to transfer me, so I stayed until Wednesday morning. Then I moved to the Surgical Telemetry floor. At this point they pulled my Foley catheter (oh, isn't that fun) and my A-line (which I think is a arterial catheter, but I'm not sure). You also lose the Oxygen sensor, the suction tube to chest tube box was pulled by now and all the EKG leads now go to a small radio transmitter that sends the EKG stuff to a remote sensing facility in the hospital. The unit is about the size of a deck of cards, so if your hospital has this I'd recommend bringing a tshirt with a front pocket, and then you can get rid of the hospital gown all together!
This makes me much more mobile and that is nice. I would have liked to have been more mobile earlier, but every time you move it's a major production because of all of your connections. There are probably 15 connections that have to be moved when you move. Here is the list as I remember it.
The plan is for me to have the chest tube removed tomorrow (4/4/02) and then go home on Friday.
After that they removed my IV drip and PCA, but left the IV stub in my arm in case of emergency. (This is actually also called a catheter I think, but it's not a Foley catheter). From there I took a nap after seeing Mom off and then about noon I took a shower.
Oh, shower, glorious shower. It felt so good to be able to scrub and shampoo. I had to have something covering the IV stub, but other than that I cleaned everything. I felt like I needed a brillo pad to scrub and keep scrubbing.
After the shower I took another long nap, and then went for a walk. It's amazing how quickly I tire. I'm sure some is the medication and probably some is fluid loss. Overall, though I feel fantastic, especially considering what I had been anticipating.
Last night the pain was a little worse, probably because I'm down to just Vicodin and not the continuos morphine drip. Another side effect of no morphine is that I got colder during the night. The morphine tended to make me warm, so after 3 nights I had to add a blanket last night. However, it means the pain runs in the 3 to 4 range as opposed to the 0 to 2 range. (0 = no pain, 10 = worst pain in your life)
The thing that hurts the most is coughing. I have to force a cough and use the incentive spirometer. The spirometer isn't that bad as you can take it slowly and work up to get the benefits without causing excrutiating pain. The coughing though, just plain hurts. The goal is to work any fluid out of the cavity, and maybe force it through the wound. That sounds pretty fun, eh?
Speaking of wounds, I have to tell you that the incision is pretty damn impressive. It's about 8 inches long and starts about 2 inches behind and 4 inches down from my the back of my armpit and ends about 6 inches down and about 3 inches in front of the front of my armpit. There is also a circular wound about 8 inches lower than my armpit from the chest tube. I'm going to tell people I was attacked, stabbed and shot. :)
Another note while I'm thinking about it. You can't choose your nurses, but make sure you appreciate the good ones, because you'll dread the bad ones. For instance, I had 5 nurses in ICU, and 3 of them were good and 2 weren't. There is a world of difference there. (Good: Suzanne, Will, Tosh). In the surgery ward I had 3 nurses, and all 3 were good (Jill, Sarah, Rosie). The bad ones didn't really check on you, didn't check to see if you were doing your therapy and seemed to believe that you were really in their way. If you needed something you had to hunt them down, ask them and if you were lucky, wait. If you weren't lucky, you had to hunt them down again. The good ones would check on you periodically, make sure you were doing therapy and if you asked them for something they would either try to get it done right then or tell you they had something going on with another patient but they would be there in a few minutes, and then they would show up. They would even (*gasp*) volunteer to do things that were helpful, like call your doctor.
The pain is much worse. I'm taking the Vicodin as well as Aleve (2 pills, twice a day), but it seems to be hard pressed to keep up with the pain. It is mostly in my 'lat', probably from where it was cut for the surgery. It has a consistent ache. The second problem is the bloating in my upper abdomen. I think this is caused by excess air and my diaphram pushing against my lungs. The spirometer really seems to help, so I use it more often than the Dr. suggested. You can get much the same effect simply by inhaling all the way and really pushing it and then hold it for a few seconds. This is good for at night when you're laying in bed, and don't want to get up, get the spirometer, and do your exercises right then. (Especially around 4:00 a.m.). You can do the breath hold just lying in bed.
First thing, Vicodin is damn near useless. The only affect it had as a painkiller for me was that it made me sleepy, and you don't feel much pain when you're asleep. Now, Vidocin is really hydrocodone, and the generic prescription will read something like Hydrocodone/APAP 5mg/500mg. This means it's Vicodin with Tylenol. I called my Dr. and said that Vicodin wasn't cutting it and he wrote me a prescription for Percocet (oxycodone). (Oxycodone is a derivative of opium, I belive, so you're almost doing 'hard' drugs :) The problem is that they can't call the prescription in, you have to have the paper. This is because it's a Schedule II drug as defined by the Federal Controlled Substances Act. Consider getting it before you leave the hospital just in case. Also, be aware that both of these medications are constipating and can be addictive. I realize this is an exciting and engaging conversation starter, but when it hurts to push, you might want to consider having a laxative. However, I get better pain relief from 4 Percocet a day than I did from 12 Vicodin a day!
Also, I experience a decent amount of back ache. This tends to be concentrated in the muscles just below my shoulder blade on the surgery side. I suspect it's related to have the lat cut. There is also abdominal muscle soreness, although that is supposedly transferred pain caused by the nerves being pulled out of place. Neither of this is debilitating. I've found however that it feels really good to lie on the floor, on my back. It really seems to help the back pain.
Now, I have to tell you, you need to take it a little easy. I'm an active, (reasonably) young guy, and I'm shocked at how little stamina I have. I decided I would wash and wax my car (a Toyota 4Runner) and I was exhausted for the rest of that day and part of the next! Walking doesn't seem to affect me, but that just wiped me out.
I've seen both my Pulmonogist and my sugreon, and they say I'm progressing well. The stitches for my chest tube hole were removed at my first visit, 2 weeks after surgery. Aside from the scars, the only other thing that is obvious is a large lump over the incision. The surgeon says this is a result of fluid buildup in the muscle that was cut, and as the muscle heals this will disappear, in 3-4 months.
Now, I know what you're thinking. You're saying to yourself, "Self, I'd like to know more about that Foley catheter". So, I'm going to help you out. Here is what you need to understand, it takes a few days to learn how to reuse the plumbing after you've had one. Now, maybe this is different for men and women, but for men, I'll tell you it's tough. (No, it's not hard, that is a different problem :). It will take you a few days to get back to normal, and it is very frustrating while it's happening.
Expect to have a lot of gas. For me this is primarily burping. The reason is that you have managed to get a bunch of air into your thoraic cavity and abdomen, and it takes a while to work out. It does this by causing you to burp. Initially you'll feel like you have to burp, you'll start to burp, and it just won't finish. That is frustrating. But shortly after that you'll be burping like a Vaudeville performer and feeling better as a result.
If it's not the drugs that don't make you hungry, or the the gas, or the fact that you're tired, it will be something else (like the fact that it's cafeteria food). Don't push it, eat what you feel like. You'll even hear an option that sounds good, order it, and then find it completely unappetizing when it gets to you. Unless you were aneroxic when you got in, losing a few pounds won't hurt you. It definitely won't hurt you as much other things are.
Expect to be numb across a large portion of your chest. There is some nerve damage, and in my case the Dr. sutured some of the nerve bundles out of the way, so I'll be numb until the sutures dissolve. I'm numb in a rough square from the centerline of my stomach to about 3 inches below my nipple to about 2 inches above my waist to the transition from my side to my back. It just feels a little weird.
You're not going to have a bloody nose, you're just going to notice dried blood. I suspect this is blood that you are exhaling out of your lungs, it's irritating, but should not alarm you.
Initially all three hurt a lot. After about 3 weeks coughing and sighing are not problems, but sneezing still hurts. I suspect it's because of abdominal muscle damage.
