A Spontaneous Tension Pneumothorax?
My first spontaneous pneumothorax (20% collapse) caused me to become very concerned about the possibility of future occurrences. The doctor had said that it could happen at anytime and that there wasn't anything I could do to prevent another episode. Within 24 hours of returning home to Michigan I received a follow-up x-ray, which revealed that my lung was slowly re-expanding. It was difficult to breathe and the pain was still enough to cause difficulty sleeping and moving in awkward positions. Two weeks passed and I was returning close to 100% health. The pain had become almost unnoticeable, and the follow up x-rays showed that the lung had completely healed. I was cautiously optimistic that everything was going to be okay.
A week passed, and as I was walking towards my car on my way to work, I felt a pain in my chest similar to my first pneumothorax. The pressure was significant, but not as severe as my first pneumothorax episode. In my own mind, I thought I was just feeling some minor side effects of the healing process. I continued to work, and the pain slowly worsened. Three hours later I decided to go to a medical diagnostic center to have a "stat" chest x-ray. I had to wait for over one hour before they finally took the x-ray. As I waited, I began wheezing and feeling short of breath. I also became very exhausted. When I walked, it felt as though someone was stabbing in my back with a knife. I knew this was not a minor incident.
After the x-ray was taken, I was called into the back room by the radiologist. He informed me that my lung had collapsed 100% and that it was a tension pneumothorax. I knew that this was serious. They immediately gave me oxygen as we awaited an ambulance. I mentally prepared myself, knowing that I would be getting a chest tube, and a multitude of other medical treatment. As we waited for the ambulance, I could feel myself becoming more and more exhausted, and it was becoming difficult to speak. The radiologist gave all of my recent x-rays to the medic to give to the emergency room physician.
Ironically, I was not rushed to the hospital. It was as though the medic didn't realize the severity of the pneumothorax. After being in the ambulance for fifteen minutes, we finally arrived at the emergency room. They immediately rushed me into the trauma unit. The chief emergency physician immediately asked the medic what my vitals were. The medic told the physician that he did not know. At this point, the physician became angry, questioning why he did not check my vitals. My chest x-rays clearly showed the tension pneumothorax and saved a lot of time. I felt comfortable knowing that the doctor who was going to treat me was diligent and understood exactly what to do.
The Emergency Room Experience
Within ten minutes of arriving at the emergency room, two doctors and nurses aided in inserting a chest tube, releasing the air from my chest cavity. They saved my life. The morphine they gave me significantly reduced the amount of pain I would have felt. Within minutes of receiving the chest tube, I began feeling much better and all of my vitals returned to normal. I continued receiving oxygen as I waited to be admitted to the hospital.
4 hours later I was finally admitted to the neurology floor at the hospital. The neurology floor? It was quite odd to be admitted in a floor that had nothing to do with the reason I was admitted in the first place. The nurses on the floor had apparently never had to deal with a chest tube before. It was very frustrating and scary to see nurses attempt to work a device that was connected to my chest. At one point, a nurse got out a manual to try and figure out how to use it! Ahh, is this what you call a hospital?
For the first 24 hours I waited to see a specialist. Finally, about 36 hours after being admitted I met with a pulmonologist. It turns out that my chest tube was supposed to be on suction, and it wasn't. Suction meant that the tube would be hooked up to the wall where it would use suction like a vacuum to keep the lung from collapsing. Finally, a doctor was able to properly set up the chest tube. Frequent x-rays were showing that the lung was not healing properly.
The next day I met with a thoracic surgeon. He immediately and without hesitation suggested surgery to repair the lung. He said that he didn't know whether this pneumothorax was related to my previous incident. He also confirmed that without surgery, the probability of recurrence would be very high. It took me a very short time to realize what needed to be done. Four days after being admitted, I would have surgery.
In the mean time, it became increasingly difficult to sleep and move in the hospital. The chest tube caused a great deal of discomfort, and made it almost impossible to sleep. Aside from the chest tube, the continuous visits from nurses throughout the night made relaxing very difficult. The only thing that gave me comfort was understanding and knowing exactly what the surgery entailed.
Preparing and Experiencing Lung Surgery
The surgery would be performed using a video-assisted scope (VATS). The surgeon explained that once he was able to get a visual of the lung, he would remove the blebs and then repair the lung. He also explained that he would "rough up the lung" also known as pleurodesis, to force the lung to heal to the chest wall. This would make it virtually impossible to have another pneumothorax on the same side of the chest. However, my doctor also mentioned that the scar tissue that would form would make it very difficult to have any future surgery on the same lung. As part of post-operative pain management I would be given an epidural (similar to what a woman receives during pregnancy). The most reassuring message from my doctor was that the probability of success was 99.9%!
The night before surgery, the entire cavalry of medical technicians, nurses, anesthesiologists, and even chaplains visited me. I signed a waiver that I understood what the surgery was and the risks that were being taken. It was all very strange. As the night wore on, I became more and more mentally prepared for my first surgical experience.
I was not allowed to eat or drink anything other than water 8 hours before surgery. I wasn't even allowed to have any painkillers. I really missed them that night! I woke up at 6am, 1 hour before I was to be taken to pre-op. It was a very scary and eye-opening hour. I had never been put under?and it wasn't something I was looking forward to.
I remember very little about the surgery. I do however remember needing to urinate very badly. It turns out they failed to mention to me that I would be given a foli catheter to circumvent my attempts to go to the bathroom. This wasn't something I was too thrilled about.
Returing to Normal
The days following surgery consisted of many trips to radiology for chest x-rays. I received so many x-rays during the course of the 8 days of being in the hospital, that I could practically read the x-rays myself. The subsequent x-rays showed that the lung had re-expanded and was beginning to heal properly. This obviously was great news!
The final few days of being in the hospital reminded me of the possibility of having a new pneumothorax in my other lung. I asked my surgeon what I could do in order to prevent future incidents. He explained to me that the only way to prevent future occurrences was by avoiding smoking. Being a non-smoker already, this was a very difficult answer to be satisfied with. One week after being discharged from the hospital, I returned to have stitches removed as well as to have another x-ray. This x-ray showed that the surgery was a success!
In the months following both pneumothoraces, I continued to feel minor discomfort and pain in my chest area. Fortunately, I have had no recurrences, although the pain I feel is a constant reminder that a spontaneous pneumothorax can occur at any time!
As a result of these experiences, pneumothorax.org was developed in hopes of creating a community of support and shared experiences with those individuals who are and have been affected by a pneumothorax.
If you have any questions about this experience feel free to email Karim at firstname.lastname@example.org