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Forum Name: Miscellaneous Chest Diseases

Question: pneumothorax... what to do??


 robnmist - Thu Jan 26, 2006 3:36 pm

I am a 35 year old female who had an ulnar transposition on Nov. 28th of 2005. I had a nerve block that I guess ended up giving me an pneumothorax... at least that was the best educated guess. (I waited 2 1/2 weeks until I just couldn't stand the shortness of breath, pain, etc. any longer and by the time I had gone in the pneumothorax was at 15%. Therefore, the Dr.'s agreed to let it continue to heal on its own. However, I have still continued to feel weak, heart rate at rest 119 and just an over-all feeling of weakness. My Dr. sent me for a echocardiogram and we found out I have a trace regurgitation of my tricuspid valve and a moderate regurgiatation of my mitral valve. (The Dr. said it isn't anything to worry about and is minor.) The internist I saw said to me, "Some people tend to hyperventilate due to the lack of oxygen they were getting. This might just be a psychological thing." So, I felt like I was going INSANE and started to do light walking at home. Well, Tuesday I thought I would add pilates to the mix, because before this pneumothorax I WAS VERY ACTIVE and pilates is no impact and just basically stretching. Appx. 2 hours after the 10 minute workout I started to get a gurgling sensation (without pain) under my ribs on my left side. It started in the front and then went to the back. (This is the side I had my pneumothorax on.) Later on that night, I started to get a stabbing sensation, with intermitted gurgling. I decided to sleep at an incline, but thought that my body wasn't ready for the pilates and was just telling me so. Now, two days later... I am have pretty sharp pain right under my rib cage that increase when I walk. My Dr.'s have played the "Dr. shuffle" is what I like to call it. So, my question is... could this just be my muscles or should I be concerned???
I am currently taking 200mg. of Topamax and taking 7.5/500 mg Vicodin every 4 hours.
 CrohnieToo - Sat Feb 18, 2006 1:59 pm

I'm not a medical professional, just a patient. However, I encountered one spontaneous pneumothorax back in the early 80s and realize that I most likey had two prior to that that I chalked up to "pleurisy", both of which took some 3 months to clear up on their own w/limited activity and sleeping propped up the entire time.

I was at a dog show and after running around the ring three times collapsed and was taken to the nearest ER where the pneumothorax was Dx'd and a tube put in the help reinflate the lung.

Were I you I would go to my pulmonologist and insist on a good discussion w/complete information as he could provide including going over films and showing me what he is referring to. Then I would insist on a treatment plan that would speed up recovery and lessen the need for medication and pain killers. If that includes intubation to help w/re-inflation, so be it. Its not that uncomfortable a procedure at all.

Good luck and God bless.
 John Kenyon, CNA - Sat Jul 26, 2008 8:47 pm

User avatar Hello -

I just found your question here as I normally help moderate the cardiology topic.

It is entirely possible that an inept nerve block caused the intial pneumothorax, although you also could be one of those people born with a certain number of "blebs" on your lungs, which occasionally will break and sometimes cause a partial collapse of a lung. Since your first pneumothorax happened subsequent to a medical procedure involving a needle insertion, however, it is just as likely to have been a medical error. In either case what you've experienced since has very likely been related to it.

Your echo results actually yielded nothing of importance (a very high percentage of the healthy population has minor regurgitation in one or more heart valves). I don't think your problem is "all in your head." What it is isn't clear, especially at a distance, but given the pneumo history, I wouldn't blow off your current complaint. From your description of the pilates-related symptom, I think you were feeling crepitus related to a second, probably very minor breach in the lung where the first pneumothorax occurred. It apparently wasn't as significant, and probably resolved on its own. You may have been experiencing trapped air in the pleural space since the first event, and that could have accounted for the other symptoms. There is, after such an experience, a certain psychological component that enters into the equation ("waiting for the other shoe to drop"), but ths is reasonable when the symptoms have not altogether subsided, and I don't think it is causing your symptoms, although as increasing concern turns into anxiety it makes it more difficult to recognize concrete symptoms from the usual funny business the body pulls on a day-to-day basis. Had your doctors been more thorough to start with, you probably wouldn't be feeling this way now. Rather than acknowlege you could be having sequelae to the initial pneumothorax, they are trying to marginalized it. Unfortunately this leaves the patient feeling marginalized (and rightly so). The patient is actually who is being treated. The problem isn't just a symptom, not just a body part, but a person. Sometimes this fact is forgotten in the business.

Pllates actually is a great no-impact exercise, but because it involves stretching it definitely could have caused an aggravation of the original site. Hopefully it's no worse than it was, and small pnuemos are sometimes allowed to heal on their own, but if symptoms persist I would think someone would at least take a look to be certain there isn't some air trapped in there. Since air doesn't show up on x-ray (although a collapsed lung usually will), there can be pressure between the pleura and the lung just sufficient to make a person feel very uncomfortable (cause some symptoms) without being obvious on a cursory examination.

If you can't get a better answer from one of your doctors, perhaps you could get a referral to a pulmonologist or at least insist on a second opinion. Everyone's entitled to one of those.

I hope by now this has resolved on its own. If not, please do follow up with us. Good luck to you.

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