台灣漏斗胸(凹胸)病友協會

I’m writing this on the request of Dr. Chu, who was the surgeon who performed the Nuss Procedure surgery on me. Many of his patients have written down their experiences in Chinese, but none have been in English, so having a first-hand account in English would be useful for English speakers. Having spent the last few weeks with Dr. Chu, who I felt to be a caring, energetic doctor, I was happy to agree to the task.



CONTENTS



BACKGROUND 1

PRE-SURGERY 2

SURGERY 2

AFTER SURGERY 3

DAY 1 - ICU 3

DAY 2 – PAIN & PATIENCE 4

DAY 3 – SIT UP, STAND UP 4

DAY 4 – PRACTICE BREATHING 5

DAY 5 – PULLED OUT ALL TUBES 5

DAY 6 – WALKING 5

DAY 7 - LEFT THE HOSPITAL 5

DAY 8-14 – RECOVERY AT HOME 6

2 WEEKS – 6 WEEKS 6

6 WEEKS – 6 MONTHS 6

6+ MONTHS 7

CHINESE 7



BACKGROUND



Since I was born, I always had a “dent” in my chest. The dent was always about the size where my fist could fit into it without any difficulty. As a child, I remember making a game out of it. They would punch me in the chest, and we would pretend that they accidentally made a dent in my chest to the amazement of onlookers.



When I was around 12 years old, my parents asked me if I wanted to do an operation for my chest. At that time, the physician I was seeing said that it was mostly a cosmetic operation, and that I was physically more or less fine. Also the surgery seemed pretty major consisting of cutting open the chest. I thought about it, and being a bit more cautious and frugal, I decided against it. It seemed like not worth the risk or expense. I was quite healthy, athletic, and how often did I take off my shirt? Although I did feel a bit awkward taking off my shirt when swimming among strangers, especially when I was a teenager with the onset of hormones and peer pressure, I also felt that sufficiency was a virtue. I was quite content with what I had.



However, recently, at 29 years old, I began to have difficulty with physical activity and work. I felt like I could not keep up with those who were in their 50s.


PRE-SURGERY



I went through a series of tests at hospital: blood test, urine test, echocardiogram, CT scan of my chest area, electrocardiogram (EKG), breathing test, etc.



The tests showed that there were serious problems with my heart functions. The echocardiogram showed that there was a significant amount of pressure placed on the heart because of the dent in my chest. My pulmonary artery pressure was 38mmHg when my body was at rest, whereas the normal pressure should be around 10-20 rising to 30 if someone was running or exerting themselves heavily. At 38, my heart was working extra hard to pump blood throughout the body. The EKG test after I did about 5-10 minutes of light jogging showed that my heart had depleted oxygen, which is probably the reason for my fatigue doing physical activity. The results made it pretty clear to me that surgery was the best option.



The doctor also spoke to me a few times about the surgery itself, showing me pictures of others who had undergone the surgery, and played a video of the operation (which I must say looked really painful!). Video of operation from inside body: link, from the
outside: link.



He joked how the surgery was rather easy on the patient’s part because they just slept through it, and he was the one who had to do the work of the operation. It was said in good humor, and he said to trust him to do a good job. Given his broad, confident smile, and 400+ previous operations without failures (he actually was referred patients who had done other chest operations that had not worked out), I trusted I was in good hands. Still the night passed with a bit of anxiety. In my heart, I tried to call forth some courage and strength, “here we go...”



I was told not to eat past noon as the surgery was tomorrow morning, and I spent the night at the hospital.


SURGERY



The next morning, the nurse came and put in the intravenous line (IV). This was my first time getting surgery, so I must say I was pretty anxious. The anesthesia doctor came in and wheeled the bed to the operation room. It was actually kind of fun being pushed around in the hospital bed—a bit reminiscent of the childhood games in wagons or shopping carts.



Once I got to the operation room, there were around 5 people in the room. The anesthesia doctor put a needle in my back to apply the local anesthesia for my chest area. He touched different areas of my body asking if I felt any sensation, and I told him that I couldn’t feel anything in my chest area. Then, everything suddenly went black.



In what seemed like a few seconds, I woke up and was lying in the ICU (Intensive Care Unit) shaking. I was very cold, and I felt a strange pressure in my chest. The surgery was done, and there was a doctor there explaining to me what happened. There were three incisions on my body. Two were for inserting and “flipping” the metal rods that were going in behind my chest. And the other was for a camera to see what he was doing. There was also two marks around my sternum because he used a clamp to pull up my chest so that it would be easier to put in the metal rod without puncturing or damaging the heart as my heart was pressed quite tightly against my rib cage.



The doctor ended up putting 3 metal bars in my chest because of the depth and scope of my chest depression. He was initially just going to put in 2, but after putting in 2, my chest still had a bit of a depression. He then asked my father, who came into the surgery room, and decided that having another bar would be the best in terms of distributing the tension on my bones and for not having a depressed upper chest area. So, the doctor put in another metal bar. He secured them all on my rib cage and then sewed up the incisions.



Waking up after the surgery was a bit disconcerting. My shaking stopped after a few minutes, and although I felt a pressure in my chest, it was significantly less painful than I expected. I was far from comfortable, but the pain was manageable. I spent that night in ICU reciting a Buddhist mantra in my mind. It kept my mind focused on something so that it wouldn’t get pulled into doubts and negative thinking.


AFTER SURGERY

DAY 1 - ICU


In the morning, some of the hospital staff came in and took an X-ray of my chest and then wheeled me into the hospital room upstairs. The pain had slowly increased over the last 8 hours as the general anesthesia and pain killers used in the surgery were wearing off. It was still manageable though, but far from being pleasant. That day was probably one of the most difficult in terms of dealing with pain and immobility. I had never been hospitalized and bed-ridden before.



My dad ended up staying with me at the hospital taking care of me. I was pretty grateful for his support. He would use cotton swabs to allow me to drink some water, feed me through a straw when it was meal time, and help take off or put on blankets if I was cold or hot. I definitely felt a lot of gratitude for my father’s kindness. It was like being a little baby again. The kindness of parents is truly unfathomable!


DAY 2 – PAIN & PATIENCE


I was on a number of different painkillers including the epidural analgesia, a localized anesthesia, being administered at a slow regular rate into my chest area and a mix of morphine and other pain killers. However, often times the pain would be quite acute and I would find it a bit difficult to breathe and would ask the nurse to administer what they called “demo.” (It reminded me of “demolition”—either demolishing the body or the pain—probably both.)



The demo was injected directly into my shoulder and the effect could be felt after about 10 minutes where the pain diminished and my body relaxed. I didn’t feel too much change in my actual mental awareness as I was trying to stay mindful of what my mind was doing with all that was happening. Still, I was told that the demo was essentially morphine and highly addictive, so I should try to minimize its use if possible. They would only administer it in 4 hour intervals.



I had decided not to try to be heroic and bear the pain under all circumstances, but rather, stick with the middle. If I could keep my mind focused and be patient with the pain, I would do that, but if it felt that it began to get overwhelming, I would ask for a shot of demo.



I also had the experience of blood and “qi” flowing around my upper left area of my chest where my heart was. It felt like something got unstuck, like a hose getting unbent and everything was moving around. Although it was a bit uncomfortable, it felt like my body was returning to a more normal situation where my heart would have more space to pump. I also could feel my heart and lung trying to make sense of the new environment. It was a bit of a strange experience to have sensations from inside the body.


DAY 3 – SIT UP, STAND UP


The pain had become more manageable, but my back was beginning to feel very sore as I had been lying in bed for the last 60+ hours. I felt that my circulation was not very good and there was pain wherever the bones jutted out into the bed. It also was quite hot and humid underneath (partly due to the waterproof pad underneath my upper back), like I was being roasted on a hot plate. I asked my dad to help give me a massage on my back which helped a lot. Still after 30 minutes the pain would return and I would simply have to be patient with it.



Then, in the late afternoon, Dr. Chu came and took a look at my condition. He thought I was recovering quite well and helped me sit up without the support of the electric bed. That was quite an experience of trusting his strength and knowing what he was doing as I was told just to relax as he picked me up. I then sat on the edge of the bed and after getting acclimated to the new position (namely, my heart had to adjust to pumping blood to my head in a sitting posture against gravity whereas before it was used to pumping blood more easily while I was lying down), he helped me stand up. Again, that took a bit of trust. After that I was pretty exhausted, and I rested for the rest of the day.



Also, the painkiller was changed from morphine to Ketorola (“Keto” for short) as it did not have an addicting quality. The effect of Keto was not as fast, but it did help relax my muscles and reduce the pain when it became a bit too much.


DAY 4 – PRACTICE BREATHING


The pain decreased a bit and I was feeling a bit stronger. I was able to sit up occasionally throughout the day and was also given a breathing device with three balls in it to practice deep breathing. I practiced occasionally as the doctor recommended that I do not do it for too long periods of time until I was stronger.



My digestion improved and I was able to eat more solid food and had a better appetite. I also had my first experience using a bedpan. What goes in has to come out... so it seemed like my digestive tract was working all right.


DAY 5 – PULLED OUT ALL TUBES


On this day, Dr. Chu came and pulled out all the tubes in my body.



The catheter used for urination, the epidural used for localized anesthesia, and the IV that was going into my veins. He then helped me sit up, and then stand up, and was considering helping me walk, but I declined feeling quite a bit shaky still.


DAY 6 – WALKING


I felt a lot stronger and was able to get up and walk a tiny bit.

This was quite an experience given that I’ve been in bed for the last five days. The doctor said that I probably could go home tomorrow or the day after depending on how I felt.


DAY 7 - LEFT THE HOSPITAL


Feeling quite a bit stronger, Dad and I decided to return home from the hospital as I no longer needed to be hooked up to the machine and could walk around on my own. However, I still needed my dad to help me get out of the electric bed, put on clothing, use the bathroom, etc. But, I didn’t need any of the hospital services anymore.



As the room needed to be vacated before 12pm for cleaning, my dad and I left in the morning for home. The car ride was rather bumpy and painful. Upon arriving back home, I was quite exhausted and needed to lie down to recover. My dad had ordered an electric bed which was extremely helpful for being able to lay down in a gentle and smooth manner that did not twist and disturb my chest.


DAY 8-14 – RECOVERY AT HOME


Day 8 was significantly better than Day 7 (in fact, it probably would have been easier to have left the hospital on Day 8 as it was quite exhausting leaving the hospital on Day 7).



Day by day, I got stronger. And around the 10th day or so was able to get out of bed on my own after sitting up with the electric bed. I still needed my dad’s help for some basic functions, but I could be much more independent at this point. In general, I could get up, do some work on the computer for about an hour or so, and then I would need to rest again. The length of time I could stay up without needing to rest increased day by day.


2 WEEKS – 6 WEEKS


Day 15. I went back to see the doctor and he was quite happy with the results and my recovery. He had an x-ray done on my chest and the bars were in their proper locations. He told me to practice breathing by breathing in fully and then exhaling through parsed lips. This would help my lungs’ alveoli get stronger. At this point, I can walk around on my own pretty easily for short periods of time. I can also work for 2-3 hours at a stretch before needing to rest.



Day 21. I’m recovering quite well and am able to walk around on my own and take care of myself more or less. As an experiment, I tried getting out of bed without the help of the electric bed by using a bedsheet that was tucked in under the mattress. It was a bit uncomfortable, but I was able to get up. However, as my dad rented the electric bed for a month, I still think it is a lot easier with the bed.



Also, there is a sharp, needle-like pain on the left side of my upper torso where the scar is when I lie down. When walking and sitting upright, the sensation goes away. I asked Dr. Chu, and he said having some pain for the first two months after the operation is very normal. I should be concerned if there is inflammation or the contour of my chest changes. Another opportunity to practice patience.


6 WEEKS – 6 MONTHS

Day 30. I felt a lot stronger and went for a two-hour hike in the mountains. However, once I got back, I was quite tired and slept for quite awhile. In the early morning, I felt more pain in my chest than usual. Maybe overdid the exercise a little bit. I was a bit sensitive throughout the day, but by evening, it was not really a problem.



Day 50. Much better. I went on a relatively long road trip to visit a school and monastery without any difficulty. I am able to go on long walks without much problem, and I feel like my energy has returned. Using strength with my upper body is still difficult. Doctor says not to lift heavy objects. I can get out of the bed now on my own pretty easily if I hook my foot under the bed for leverage and then use my other hand to grab my foot and swing myself up to a sitting position.



6+ MONTHS


[I should be able to do most physical activities, but should still be careful about my chest and not dislodge the bars.]