Tuesday, March 25, 2008

My lungs, on air

I'm feeling like a bad storyteller here, the kind who says,
"And then... and then... and by the way...." So be it: The
idea is to write a narrative of the illness that will
eventually be up to date, so my reactions are fresher and
more detailed then they are when I'm trying to recall the
particulars of byegone tedious and narcotic-soaked days in the

So, anyway, after being bounced from chemo and admitted to
the hospital with another collapsed lung, this time on the
previously "good" side, Dr. Lump-not-Split was suspicious of
metastasis, despite repeated CT and MRI studies and testing
of some fluid evacuated from the pleura for malignant cells.
(This suspicion wasn't -- isn't -- wrong; while the studies
are possibly capable of picking up tiny pulmonary nodules of
about 5mm plus-or-minus a couple millimeters, such tiny
nodules are easy to miss.) Enter VATS. A surgeon makes about
1cm incision and inserts a video camera into the chest
cavity. In my case, the doctor completely deflated the
relevant lung, inspected it for abnormalities, took a biopsy
(which was normal!), and blew in some talc for
a pleurodesis. I found the immediate aftermath of the
procedure difficult: I felt as though I had been kicked in
theribs, and I also felt a milder version of the same
feeling of lung constriction I had after having pleurodesis
through a chest tube. I was discharged from the hospital
about two days after the procedure with a sore chest that
became intensely painful when I coughed, sneezed or laughed.
Humor was outlawed for a while. Fortunately, the pain
steadily decreased. I'd say it was more or less gone within
10 days; my reward for healing was getting to restart

I should point out here that while VATS is a great
technique for all sorts of lung maintenance (biopsies,
removing nodules, fixing pleural effusions and pneumothorax,
even lobectomies) and generally has similar results and
quicker recovery than old-school open lung surgery, the
video camera's resolution is such that it's hard for doctors
to see small lung nodules (one five-year old paper I saw
said 10mm and down, which surprised me) unless they know
what they are looking for. In the case of
early-stage sarcoma lung mets, in which there might be
dozens of unscannable miniscule nodules, the gold standard
for detection/resection is still opening a large incision,
spreading the ribs and allowing the surgeon to take every
bit of your lung in his or her hands and meticulously feel
for lumps and bumps. I'll pass on that one for now.

And then I had chemo, and it was routine, except for the
usual exhaustion, and the shortness of breath, and then
I... Sorry.

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