VATS pleurectomy: Day three post-op

Thursday 14th May 2015
Recovery from a pleurectomy and bullectomy to treat reoccurring spontaneous pneumothorax.

Another awful nights sleep. 

So last night I had struggled to sleep with the frightening anxiety and sickness that I seemed to get as a result of the morphine. Equally bad, but due instead to physical pain, was this nights sleep. I want to be clear that I don't think the pain was a result of coming off the morphine. I had been fine all evening and can put the pain down to a particular event. If anything I was glad not to also be suffering the anxiety I had as a result of the morphine the night before, so I definitely think coming off it was a good option for me personally. 

The particular event where the pain began to get worse was in the middle of the night, when I noticed a slight leak from my chest drain. It wasn't bad but I could feel a tickle under my dressing and it felt a little cold to the touch as though it was wet underneath. I called for a nurse and explained I needed a new dressing (this had happened before). I also decided to tell her that I think the drain had pulled slightly as I had caught it on the bottom of the chair a little earlier. As far as I was concerned the drain hadn't moved as a result but the nurse said I had to wait for the senior nurse to check the drain and make sure, before she could redress it. 

So I found myself waiting...and waiting....and waiting. I was anxious that without dressing to support the drain it would pull downwards, so I sat holding it carefully in an upright position that was making my back and chest ache like crazy. The first nurse returned every now and again and I made it clear that I was in a lot of pain which was making it hard to even breathe properly. Unfortunately I did not get much sympathy and even the woman sat opposite became concerned as to how long I was having to wait. All I wanted to do was lean back and relax my back, but I couldn't. 

I think it was about 20 minutes to half an hour later when the nurse came and she glanced at my wound and then checked my drain. I had stood up and let some of the fluid flow into the drain a little earlier so the tube was clean and this concerned her, apparently it should have fluid in it. I told her what I had done but she removed the lid of the drain and checked the inside of it. I am not sure why but after she put the lid back on I was in immense pain in my shoulder area. 

I don't know now what may have happened, perhaps the drain moved slightly in my chest, but I was so worried she had done something wrong. I had heard earlier in the day from someone who had knocked their drain over that it was bad if air got into it, so I panicked that this must have happened when the nurse removed the lid (she later informed she had clamped the tube so this couldn't have happened). Of course this made me worry that I would be back on suction again and all progress would be lost. I called for the nurse many times that night due mainly to the agony I was in. I could not breathe properly and every single position hurt. I got the impression after a while though that they were getting fed up of me and this made me feel even worse. I didn't want to be a burden, it just hurt like hell and I didn't know what else to do! 

I want to say here that I have nothing but gratitude for the nurses by the way. More often than not they did a wonderful job of making me feel better. I think it is hard on an evening though as they are understaffed which, when you are in the situation I was in, does make you feel a little like a nuisance. 

After some time the nurses called the doctor, who told me the pain was likely due to the lung healing well and expanding so much that it was hitting the chest drain and causing it to further aggravate the nerves running down the rib cage. He said the drain looked fine and told me not to worry. This helped a little with my panic, but not at all with my pain. He said he could order stronger painkillers but I was worried how I would react after the morphine so chose to wait a little longer and see. 
In the end I found myself sat on the cold floor, which was for some reason comforting, and leaning forward and sideways onto the chair beside my bed. With a couple of pillow piled onto the seat for support, I finally found some comfort. It seemed to allow my shoulder to open up a little which reduced the pain and the made the breathing a little easier. 
And so I fell asleep on the floor, until I woke up with dead legs and then worried I would be increasing my risk of clotting. I ended up trying to get the same position dragging one of the plastic visitors chairs across the room to my bedside, raising the bed and placing a mountain of cushions in front of me. The end result was pretty much the same but at least I wasn't squishing my legs. And once again I fell asleep. 

The morning

Well as I had had only around 2 hours of in and out sleep I was absolutely shattered this morning. So much so that it made me feel quite sick and I found myself once again with a cardboard bucket in front of me. Luckily at around 6 in the morning the nurse was kind enough to get me some toast as I felt the sickness was in part due to hunger. It helped quite a bit and I was able to try and dose off again, back on the floor this time though!

I think I gave the nurses a bit of a laugh to be honest, especially on the change over as it became my neighbours job to explain to the new nurses that I hadn't disappeared and was merely sprawled out on the floor. The day nurses seemed to sympathise a little better and were very helpful. So most of the morning was spent on the floor with a sick bucket, cup of water and toast all nicely within reach. Oh and not forgetting the drain filled with bodily fluid that sat next to me waiting to be knocked over! 

In the end at about 9 o'clock (the last four hours of the morning had felt like a whole day) I figured I wouldn't get much more sleep and was fed up of feeling extremely sick so I asked for some anti sickness meds. These took a while to arrive but when they did they soon kicked in and I was managing to get up and about a bit. 

The smelly stockings

Whilst struggling with nausea due to lack of sleep, I was also struggling to cope with the smell coming from my feet. My god it was awful! Since my first day in hospital the stockings I was given to prevent blood clots had not been changed, and as a result the smell was horrendous. I actually found myself opening the windows and sitting with my feet downwind in order to get it away from me. Please make sure they change your stockings, and if they don't...don't assume this is normal procedure as I did, ask them too. I wish I had, because now it was too late and I suffered all morning. 

Drain out!!

Well it all happened pretty quickly. The doctor came round whilst I was sat on the floor and asked me to do the usual. I got up as best as I could and gave a cough to satisfy them that there was no air leak. He seemed very happy and judging by the pain I was clearly in practically ordered the nurses to get my drain out ASAP. And they did, within half an hour the nurses were by my bedside with the sterilised cart and were ready to take the damn thing out. I couldn't wait! Although I was a little anxious about what to expect. They explained that happens very quickly, one person will remove the drain and the other will pull on the stitches which close around the hole like a purse string. 

Well it took two seconds and I didn't feel any pain whatsoever. Felt a brief hollow feeling that is hard to describe, but it was painless. AND NOW I WAS FREE!!!

It is hard to believe how quickly my mood and energy had turned around. An hour ago I had been laid on the floor feeling sick, in agony, unable to breathe well and exhausted, now I felt practically pain free, I could breathe again and with the help of the anti sickness meds I could actually get up and about. I was so happy and took to immediately walking around the ward as much as I possibly could, because now I was on a mission to get home!

False hope

Well all I had been told since yesterday was it would be drain out and then home. So I was over the moon when the drain came out and I thought I could prepare for home time. After all, I was walking about unaided and seemed much better in myself. One issue however was, and I hate to say it, I hadn't been for that all important poo. If you have ever had an op before you may know that they are obsessed with ensuring you have been to the toilet before you can go home. And I hadn't...for days. :( 

A nurse suggested I be sent to my own room where the privacy might just help me relax and get things moving, I was also given some lactulose to help things too. Please note that I refused anything which works the same as senokot. I have taken senokot in the past and it resulted in the most horrendous cramping which I definitely did not want to repeat at this time. If you know you react badly to this make sure you check what they give you as this is often the first option. 

The toilet incident

So off to another room I went, leaving my neighbours behind in the hopes that I would soon be home. Now this is where I wish my friends and family did not know about this blog, because it is embarrassing and not something I really want to share, but I said I would give an honest account so here goes. 

After a few hours of no movement I eventually asked what else could be done and was told that I could try a suppository. If you don't know what this is, it is a bullet shaped glycerin capsule that basically goes up your bum. It dissolves and makes you go...simple. 

Thankfully I was not made to lie on a bed and have this inserted and was allowed to do so myself in privacy, saving me at least some dignity! And I have to say that within minutes, it had worked. I was finally going for a number two! woop!

I was sat on the toilet, feeling unusually happy for the occasion as I would finally get to go home...until SHIT!! (not literally) blood had leaked from the chest drain wound and filled my dressing so that it felt like a water bed. The slightest strain had caused this to happen and I freaked out! I thought for sure that this meant there was a hole in my side and air will have got back into the chest cavity and that that would be it for a few more days. 

I hurried off the loo and called for a nurse in a panic. He listened to what had happened and had a look and told me not to worry, it was normal for the wound to leak and it doesn't mean I have broken anything. He removed the dressing and wiped away the blood and then asked me to cough. Stupidly I decided to look at the wound as I did so and I saw yet more blood leak out of me with every cough. Once again I was worried. The nurse again reassured me and decided that he would put some steri-strips over the stitches to help keep things in place. I had three steri-strips in total and except for a very small amount of leakage this seemed to do the trick.

Unfortunately though, as a result of the leak, they decided it best to keep me in over night in case it happened again. So I was no longer going home today. :(

On the plus side, I now had my own room which was nice and I could have the TV as loud as I liked. I had more visitors round which was great and I it was lovely being able to walk around the ward with them. I was even allowed a very short trip outside (I came back in as it was cold and made me shiver). Don't get me wrong walking was still a little hard, it was like a dull ache that I could feel on my wounds when I put my foot down, but the physiotherapist said it would be good for me so I did as much as I could. 

Still air on the lungs

Towards the end of the day the X-ray machine came round to my room once again and I was asked to grasp the large board and sit upright for the scan. I remember thinking please please please be OK as I heard the man say "take and deep breath and hold". I took the biggest breath I could and hoped for the best. It always happens so quickly and then you are just left sitting there wondering what is showed. I wish they could tell you straight away, the wait is painfully long and anxious. 

After an hour or two I was informed that there was still a small amount of air above the lung. My heart sank, my stomach flipped and I suddenly felt very anxious again, the thought of more surgery or another chest drain made me want to cry. Within a few seconds however these feelings resided as I realised the surgeon was telling me that it was only a small amount of air, and likely a result of the chest drain removal. He said they would look again the following day and if it had improved or stayed the same, I could go home. 

It wasn't as bad as I had thought, however I was still worried because what if they were wrong? What if it was a leaky lung again? I decided the best way to tackle this was through my exercises. So I used my spiro-ball just about every 15 minutes for the rest of the evening, and each time was reassured that my lung capacity hadn't suddenly reduced. 

I could also feel some bubbling or spasm however in my lower chest area which as freaking me out. It looked and felt like it could be muscle spasm, I could even see the skin bouncing where it was occurring, but I called for someone anyway. The physio came and looked and she said felt the skin for any trapped air. She couldn't feel any and said it was most likely true that it was just a spasm and to keep an eye on it. (It has now gone and in all honesty I now think it may have been coming from my bowels). So until it was time to sleep, I spent the rest of the evening trying to distract myself from the weird spasm and focus on my breathing. 

Last night in hospital

So it was my last night in hospital, and being in my own room I was able to watch TV until what I considered a normal time of around 10:30, before feeling tired enough to try and sleep. I had hoped that with the drain being out this would be way easier, but unfortunately it was not. This was due to prior problems I have of backache however. Ever since the late afternoon my back was beginning to ache as it has for years when I find myself doing little exercise, and it was proving very hard to cope with. I could not lay in a position that made my back comfy, as this involved bending forwards or lying quite flat, both of which made my chest feel tight and heavy. So I ended up once again struggling to find a comfortable sleeping position. Fortunately it wasn't as bad as the past two nights and my emotional state was at least a lot more positive. I finally found a comfy position having rearranged the pillows umpteen times, and settled myself down with everything I might need in reach of me on the bedside table. (This is very important as once you get comfy you really do not want to have to move!). 

This is when the slightest thing, like a nurse leaving the curtain open and light flooding into your room, annoys you. What do you do? Move to fix the issue and risk being uncomfortable again, or just lay there feeling annoyed until you fall back to sleep. I did the latter. I know it isn;t their fault, they have much more important things on their mind, but you can't help be frustrated all the same!

Anyway, sleep time came and once it did I think I slept solidly for the first time in a while!