Monday, June 8, 2015

The Frustrating Fifth

On April 24, I woke up with pressure behind my left shoulder blade. I rolled my eyes and got out of bed so I could get my kids off to school. An hour later as I was blow-drying my hair, I noticed the pain was increasing and my breathing was becoming labored. It was more intense than my previous three, but not nearly as painful as my first collapse. A nagging feeling told me I should call someone to come watch my toddler so I could go to the hospital, but I kept pushing it aside and went on with my day. That evening, I let my husband know that we may want to think about making another trip to the ER, but I never made time for it. The next morning I felt quite a bit better. Tyler still wanted to take me in, but I continued to drag my feet. I have a lovely friend who is a physician, and I finally decided I'd ask her opinion. If she told me to go the hospital, I would. This is the text I sent her:

"Need your advice.
Since my pneumothorax in September, I've had 3 other occasions where I've felt pain that presented itself identical to my first pneumo but with significantly less intensity and almost no compromise in my breathing aside from having some difficulty taking deep breaths. In each of those situations, a few days to a week's rest was enough to get me back to normal. Yesterday I woke up with chest pain. Didn't say anything to Tyler about it and hoped it would subside. It was pretty intense all morning--steady pressure on my left side, some SOB, dizziness, pain when I breathed deeply, pain radiating up my shoulder and neck, and the odd sensation that I could feel something bubbling or rubbing at a specific spot in my chest when I bent over (this happened the first time, too). I told myself the smart thing to do would be to go to the ER, but I'm stubborn and stupid and didn't. The pain eventually subsided, though the pressure remained, and I kept a low profile for the rest of the day. Had a hard time falling asleep, but when I woke up this morning, I felt markedly better. If I'm resting (and not laying down), I'm pretty much fine except for a dull ache in my back at the base of my left shoulder blade and some pressure in the front under my left breast. I don't feel like my breathing is all that compromised. Just a little resistance when I breathe deeply. I'm fatigued but not dizzy. I can still feel the strange bubbling when I bend over, but even that is not as pronounced as yesterday. I do not feel like my life is in jeopardy. (In fact, I just did the dishes and changed a diaper) I hate the thought of going to the ER when I'm not "that bad," but am I being irresponsible by not? I highly doubt my current condition warrants a chest tube, but I obviously am not a doctor, nor do I have the chest X-rays to prove that. If I feel like I have measurably improved since yesterday and am not getting worse, do you think I'm okay to wait it out, or should I bite the bullet and go? "
She called immediately. She let me know the "bubbling" I was feeling was subcutaneous air in my chest cavity. She was concerned about the frequency of the collapses and pointed out that I couldn't really know how severe the collapse was because my body could be learning to adapt to side-effects of the collapses. She acknowledged my desire to not overuse medical resources, but told me she was going to contact the on-call pulmonologist at our University Hospital to see what he said. When she called back, she told me she had explained my history to him and that he recommended I go to the ER for a chest x-ray. In their opinion, five pneumothoraces definitely warranted some follow-up care, most likely surgical, and I needed to have a paper history in order to receive that referral. My friend said she was calling the ER to let them know I was coming and then heading over to pick up my kids so Tyler could drive me to the hospital.
An hour later the ER physician came in and let us know that the x-ray showed another spontaneous pneumothorax. He said it likely had been larger the day before (and that I should never wait to seek medical care for something like that because it is potentially life threatening, etc., etc.). At the time of the x-ray, it was not large enough to require a tube, rather I'd be sent home with oxygen therapy and more rest. They paged the cardio-thoracic surgeon on-call, and I was instructed to make an appointment to see him that Wednesday to discuss options.
The oxygen machine arrived that night, and from then on, I was stuck at home with a 50-foot plastic leash.

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