VATS-Days 1-5 1/2

[Guest guest]

VATS-Days 1-5 ½

Many, like myself, have debated the question of lung biopsies, now

performed as VATS. Therefore, like others have shared first hand

information, I am now also doing so and will update during the next

couple of weeks until recovery from the surgery is complete.

My surgery was scheduled for 7:30 AM, Wednesday Oct 17 with me

reporting at 5:30 AM for Blood Work and a Chest X-Ray and was done at

The Heart Hospital of Baylor Plano, which is a hospital next door to

Baylor Hospital at Plano performing only Cardiovascular Surgery. I

checked into a room on the 4th Floor which is where all pre-op work

and recovery is handled. In addition to being the latest and greatest

in equipment and surgical quality, this hospital (like its sister

next door) is designed to be so in terms of patient comfort and the

lobby has the appearance of a nice hotel. The rooms are huge so that

they can accommodate any equipment that needs to be brought in for

testing or monitoring or recovery. There is plenty of room to both

sides of the bed. There are only private rooms. The chair in the room

is a recliner in addition to a high back recovery chair, the sofa is

designed so the back cushions come down and fill in, creating a bed.

There is a 32 inch flat screen tv, and food (unless restricted) is

ordered from a menu and delivered in the same way as room service at

whatever times you want it. The Filet Mignon isn't bad, although is

health conscious menu and wish they had real bacon and not turkey

bacon for breakfast….lol

To get the only real bad part out of the way first, I believe I

experienced a strange situation that none of you are likely to

encounter. I suffer from sleeping disorders and often am in Level

One, where technically I am asleep, but I'm fully aware of all going

on and all around me, able to converse, tell time, pretty much what

normal people do when awake. I remember the period from 9 AM until 11

AM as worse than anything I could ever imagine. I remember severe

pain and inability to breathe and doctors all around and the clock in

front of me moving so slowly and not having the energy to speak, but

imagining the rest of my life in such a condition and wishing I had

died during the surgery. In retrospect, I believe I was in recovery

and for all apparent purposes still asleep and they thought still

under anesthesia. I do intend to discuss with my surgeon in a week

when I see him as the explanation didn't hit me until late.

However, around noon they moved me to the second floor. This hospital

has no ICU as basically all rooms are such and second floor is where

any ICU patients are housed. I sat up that afternoon and was feeling

ok. I also started respiratory therapy with both the nebulizer and

with the famous little machine with the blue hose that measures

inspiration.

Of course I did still have a tube to my lung for drainage. There was

concern about the amount of urine and thoughts I might have to be put

back on equipment but Wednessday night all hell broke loose. I recall

urinating about every 30-60 minutes and all the getting in and out of

bed led to some soreness. Thursday morning they disconnected my iv

which reduced liquids and eliminated that problem. From that point I

only a couple of times got quick iv's of medicines.

Thursday morning, Day 2, I was suppose to start walking and walk four

times that day. I started with my daily chest x-ray, breakfast,

respiratory. However, things turned a bit into a zoo as there were so

many heart by pass surgeries and serious cases. I was moved to the

less critical 3rd Floor midday (yes, I have now been on every floor

as no patient rooms on the first and only 4 floors). I began walking

and continued the other treatment.

Thursday night I was doing better but still very disappointed in my

inspired volume as I typically was only able to hit around 500ml and

occasionally 750. Anything below 1000 greatly increases the chance of

pneumonia. Thursday night from 11 pm until 2 am, my temperature rose

from 98.1 to 100.7. I was given Tylenol and an immediate nebulizer

treatment and at 4 am it was normal again.

There had been thought of removing the tube and me going home on

Friday, but after my Friday morning chest x-ray, the surgeon decided

no and added suction to the tank to which the tube was connected.

Also, one other change was made and this was the biggest move toward

improvement I believe. If you were ever to ask me (well, except from

9-11 am on Wed) if I needed pain killer, I will always say " no " as I

have such a high pain tolerance. I basically took none after a colon

resection two years ago. However, in this case the hidden effect is

that any amount of pain reduces the depth of your breathing. So, I

was put on hydrocodone and Tylenol from that point forward. My

breathing levels started to increase. By Friday afternoon I was able

to walk my laps with satisfactory oxygen levels and the oxygen set at

3, versus Thursday morning when 6 was barely enough.

The big moment of excitement for me was 1 am (Friday night/Saturday

morning) when respiratory used the nebulizer then had be breath

through the tube. Both (the RT) and I were shocked and stared

at each other when I hit 1500 on my first breath. I then hit 1250

regularly during the next nine and 1500 at least once more. They

combination of the hydrocodone and the continued respiratory therapy

(yes, I breathed into the blue tubed thing at least every hour) had

raised me out of what I would call the danger zone. At 4 am the

suction was stopped so it wouldn't impact the chest x-ray.

I had my regular chest x-ray Saturday morning and then the surgeon's

nurse practitioner removed my chest tube. I had heard about this

being painful but experienced zero pain from its removal. Now, it may

be because I was immune from pain after she ripped the tape from me

as they didn't shave my chest far enough down and the lower strip of

tape got chest and stomach hair. Saturday I walked more, doing two

laps of the floor at total of five times.

Sunday morning the started scampering early with my chest x-ray at 5

am so the doctor could review everything and release me when he came

in. I left and came home around noon.

I was a bit tired when I got home yesterday, but did manage to

briefly use the treadmill, 1 mph for 15 minutes with oxygen level of

4. I am permanently attached to my oximeter (not literally) as I

depend on it to measure my needs regularly.

Today I've shaved, showered, made a couple of phone calls, about to

eat, and have home health care this afternoon. I'm currently on an

oxygen setting of 2 while seated, 3 while moving about, 4 with

stronger exertion. I expect those to all gradually improve over the

next ten days or so. I am still on hydrocodone and Tylenol every 6

hours and will remain so at least a few days.

Verdict at this point. I'm glad I had the VATS. I think within two

weeks I'll be pretty much where I was before it but I'll have more

information. That's worth the two hours of hell I experienced that

none of you probably would. I should get the biopsy results early

this week. If they aren't read as definitive enough, then the

biopsies will be forwarded to one of four doctors or so nationwide

who specialize in reading Interstitial Lung Disease only. That could

take two to three weeks. Note that the ultimate accuracy of diagnosis

using VATS is believed around 97% which is far higher than the

statistics using other tools-60% on CT's, which I have had three sets

of.

I was in pretty good condition going in, using little oxygen, mainly

for exercise and sleep. That certainly put me at an advantage. I do

value knowing exactly what I've got as if it is IPF, then I avoid

taking unnecessary Prednisone with all its side effects, but if its

another of the possibilities then I take the appropriate medication.

They did intend to biopsy some lymph nodes in my chest as long as

they were in and near them, but couldn't as reaching them had too

many obstacles in the way. The oncologist hadn't recommended biopsies

of them on their own so will continue to monitor them with CT's for

now. What is found on the lung biopsy may also give a clue to the

cause of the swollen lymph nodes. (Initial Frozen biopsy says pretty

unlikely for any lung cancer.

Now, I just wait and read and chat with you here and order my LL Bean

pack and learn more and exercise and recuperate. Meanwhile I'll

continue planning to live my life to its fullest based on whatever

the diagnosis.