ONE YEAR ON

This article was written in February 2013, and published on the British Lung Foundation Blog.

ONE YEAR ON

12 months ago, I had 3 valves inserted into my right lung, in the upper lobe. This lobe had such severe damage from emphysema, that large cavities had formed where there should be alveoli, along with scar tissue. This lobe was not doing very much to help my breathing, in fact, it was hindering the process.
Let me explain. The lungs depend for a large part of their operation on the fact that good lung tissue (alveoli and minor airways, and the blood vessels) are elastic. When good tissue gets damaged, either it heals with a good repair, and all is well, or if the damage is not so easy then scar tissue will form. Think of a cut on your skin, if the edges can be kept nicely together and clean, then the chances are that the skin will repair with no sign of scarring, and soon there is nothing to show that there was any damage. But if the cut was a bit deeper, or on a part of the skin where it is hard to keep the edges together, or the cut becomes infected, then the chances are that the repair will involve scar tissue. Scar tissue in lungs is bad news. Firstly, it is not very elastic, and that interferes with the ability of the lung to expand and contract. This seriously affects airflow in and out of the lung. Scar tissue does not pass gas. So this affects the flow of oxygen into the blood, and carbon dioxide and water vapour out. Like I said, scar tissue is bad news. I sidetracked. Back to the beginning…..
12 months ago, I had 3 valves inserted into my right lung, in the upper lobe. These caused a substantial part of the upper lobe to collapse. Done on purpose. Crikey I hear some of you saying. Why would you do that? I’ll explain. Your lungs sit inside your chest cavity, right? Wrong. It’s more like they hang there stuck to the inside of your ribcage courtesy of a gooey, sticky, slippery fluid stuff that sticks the outer membrane of your lungs to the inside your chest wall, while allowing them to slide up ad down at the bottom while being fixed in place at the top. In fit healthy lungs, this allows the diaphragm (mostly, the other bit is chest expansion) to drive breathing, by pushing the lungs up and then pulling down. Operating the bellows. So what holds your lungs in their shape, while they are getting pushed and pulled? The internal structure, that’s what. In your lungs, the air enters via the major airways that divide and divide again and again until the tiniest branches end in little sacs called the alveoli, where gas exchange takes place. Also within your lung are blood vessels that also divide repeatedly until they are capillaries alongside the alveoli. Add into the mix nerves that sense what is going on, and muscles that control how open or restricted the airways are, and the nerves that control them. All of these various and different parts of the lung have one thing in common, they are elastic. Taken all in all, this tangle of strands has an integrity that gives it sufficient rigidity that without any outside influence, it will just hang there in the correct place. OK. That’s a good lung. In good shape. In good condition……. Now damage it. Give it a series of infections. Pollute the air going in with smoke, fumes from fires, fumes from chemical processes, fumes from traffic, dust from concrete, coal, asbestos, flour. Now add in maybe the odd parasite. That lot all conspires(?) over your lifetime to damage the internal structure of your lung. Good tissue gets replaced with scarring. Sometimes, bits of your lung, after being stretched, don’t go back. They have lost their elasticity. Also, a lot of your alveoli are so damaged, that they have merged to form cavities. Your lungs sag because of the loss of internal strength and structure. They now sit on your diaphragm like a pair of tired bags. Your breathing now becomes laboured. Every time you breathe out, your diaphragm doesn’t just have to squeeze your lungs to push air out, it has to lift a substantial part of the weight of your lungs. Add in the loss of tissue that can transfer gasses in and out of the blood, you have lost a lot of your breathing capacity. Congratulations!!! You’ve got Emphysema. COPD. Welcome to my world. Oops! Sidetracked again.
12 months ago, I had 3 valves inserted into my right lung, in the upper lobe. These caused a substantial part of the upper lobe to collapse. This caused a reduction in the volume of the lung. Knock on effect of this is that the depth (top to bottom) of the lung was reduced, allowing it once again to hang above the diaphragm. In its proper place. Once again, the bottom lobe was hanging free, instead of sitting on the diaphragm with maybe half of it squashed to the extent that it was useless in that it could not even expand or contract through lack of room. So I now have a lung that is in the right place. Add to that, I have had a chunk of my lung that wasn’t doing much, taken out of service, by being sucked shut. At the bottom of my lung, that bit that was sat squashed on my diaphragm is now working again. Not only that, but that bit is in far better condition than the bit that is now not working. The good part of this episode is that my FEV1 prior to having the valves put in was measured at 16% a few weeks before the op. Several weeks after the op, it was measured again at 31%. Figure out for yourself if that measures up to success or not.
So now, where am I? I’ve got three valves implanted in my right lung. That right lung is now hanging pretty much where it should, and generally working pretty good. I have had a fairly heavy-duty operation (the only other way to get this result would be to have a chunk of lung cut out), without the trauma of major surgery, which I have been told several times, I would not likely have survived. Score one major plus point for my consultants. I am still using oxygen most of the time, but probably actually less than even I think, my oxygen is fed to me via nose cannula, and I often find myself mouth breathing, so not taking all the extra oxygen after all. I notice this when I move after sitting for a while. I am far from optimum. My breathing is better, yes. Because my right lung now does NOT sit on my diaphragm, a lot of the sheer effort of breathing has been reduced. Since the operation, I’ve put on weight, mostly, I think because of that reduced effort. If I stay on my feet for a while, say 10 or 15 minutes, while cooking or making a sandwich, or doing something similar, I will end up huffing and puffing a bit, and have to sit and take a few minutes to recover. But that is not panic gasping like I would have been doing before the operation. If I would even have attempted something like that. Without my wife doing just about everything for me for those several years, where would I have ended up? OK, so I’m better, but not ‘well’. I have been dragged back from the brink of death, but, metaphorically, I’m still on my knees, close to the edge, but considerably safer. Drug use. Much reduced, and I feel better for it. I haven’t used my nebuliser since I can’t remember when. Do the mental adding up yourself. Was it worth it? You answer.
OK. I had an operation. My breathing is better, my quality of life is MUCH better, my wife is happier. But what has actually changed? I have still got all the same tissue in my body, no bad stuff taken away, no good stuff added. Just a change of emphasis really. Different bits of one lung working. With a big effect. But don’t get carried away. My left lung, don’t forget that, is still hyperinflated. Actually, it’s more hyperinflated than before. With the right lung now hanging right, trim and slim, it’s actually taking up less room, which means that having shoved the heart and some other bits out of the way, the left lung has expanded a bit more. That’s right, my heart and the parts of the digestive tract that pass through the chest have been pushed sideways by about 40mm and all the associated blood vessel etc. I now get funny questions when I have scans and x-rays. I am also just as susceptible to infections, they knock my capacity for doing anything right back, and I take so long to recover from doing so little when I’ve got one. So I do what most of you who know do, get on the antibiotics and up the steroids for a few days. As I said before, no bad tissue was taken away, so any extra damage from infection erodes what bit of good tissue I’ve got left. I have become wary of situations that I consider dangerous to me. Doctors’ surgeries and places where children collect.
So what have I really gained in all this? Several possible answers to this, but I think the most relevant one has to be —- TIME. Without having had the valves fitted, I might still be here, but much poorer in health, or I might not. 50/50 either way I reckon. This extra TIME is giving me more time to annoy my missus, see the girls (children), grand children, and great grand children (two or three, depending on the delivery system at two thirds the way though February). I also have enough spare energy to take up a hobby! Just a bit each week. Large scale modelling of narrow gauge railway stuff. In the garden.
The extra energy means I can do a bit of cooking, and occasionally baking. My wife is perhaps not too keen on this, I am a bit messy in the kitchen, and usually run out of energy beore clearing up, so someone else ends up doing that bit, guess who. Shopping is easier too. I still rely on my little scooter when we know we will be a long time in a shop (think full trolley), but for shorter periods (less than about twenty minutes) then I’ll push the trolley and lean on that. I’ve managed not to get into trouble yet. Life is pretty good for me at the moment, compared to where I’ve been, I’m gratefull.
This little essay is my way of explaining to those of you who may be offered the valve operation an in-depth look at what you might get. And also to put into context some of the effects that can happen after the operation. All of the above is truly what happened to me, except that I also had a big pneumothorax after the operation. But that was just a complication, it’s been described elsewhere. And once sorted out takes nothing away from the success of the procedure.
What about failure? If the fitting of valves does not provide benefit, or indeed if it causes a problem, which I believe is possible if the recipient has other major issues, what then? Well it is reversible. The surgeon can use the same equipment to remove the valves as to fit them. Then you just end up back where you started.
If you want to read more about the operation and its effects, read my earlier blogs. A good place to start is :-

blf.healthunlocked.com/blog…

As always, if you have any questions, just ask. I’ll do my best to answer them.

Breathe easy, all of you

John

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2 responses to “ONE YEAR ON

  1. Hello John. I’m impressed with your knowledge, articulation. Wondering, could you not get the left lung done now?

    • Thanks for a serious question.
      It was looked at last year. The right lung has an incomplete fissure, so valves are out, due to the likelihood for colateral ventilation. The damage is too far gone for other remedies. We are starting to look at transplant asan option. Still waiting for the initial assessment for that though.

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