pneumonectomy of left lung and healing concerns

[Moonbeam]

My husband had a pneumonectomy of his left lung on Dec. 10th. We have been home for about two weeks. Last night, my husband got up to use the bathroom. As he reached the toilet, he fainted and landed in a seated position where he then lost his bowels. He was only out for a few seconds. He feels a cold darkness and then he faints. This happened last weekend as well. It seems to be in response to pain. His ribs hurt so bad when he woke and continued until I gave him 600mg of Advil. He walked yesterday, had a good day. Went out to eat and was very mobile. He only had a bagel in the am and then dinner. He feels it may be because he hasn't eaten too much. His blood pressure last night was i believe, 98/74 and this morning, 123/66. This morning, he is a bit sore on the right side from the fall and his left is about a 4 on a 1-10 scale. Last night, the pain was about an 11 he said. Has anyone had this before? I have reached out to his surgeon and am awaiting a response. I have fed him breakfast and added a bit more salt to his eggs. Drinking gatorade. I am going to purchase a walker to help in the middle of the night.. Obviously I am concerned as I don't like the fainting part and am worried. When does the pain in the ribs go away? My heart breaks for him and he is so embarrassed that I had to help clean him up. I don't mind obviously..I'm just worried. 

[LexieCat]

It sounds like you're saying he felt the severe pain when he awoke after falling.  But his blood pressure seems quite low.  My dad (not a cancer patient) had "postural hypotension" that used to cause him to faint/fall if he sat up or stood quickly.  

Maybe a portable potty seat next to the bed would make it easier if he has to go to the bathroom in the middle of the night, at least for right now.  A walker won't help that much if he faints--he can still fall.

[BridgetO]

The postural hypotension mentioned by LexieCat is an interesting theory. Let us know what the surgeon says. If that's what it is, sitting up on the side of the bed for a  bit to let the body adjust before standing up can help. My blood pressure goes up when I'm in pain-- but everybody's different. Keep us posted.

[Moonbeam]

update: spoke with surgeon and his staff....The fainting is from low blood sugar from not eating more frequently and the pain is common as some days will be better than others. He is only taking Advil 3x per day 600mg. My husband wanted off the pain pills as he didn't like the way they made him feel. His surgeon says a lot of his symptoms in the last few days are normal after a thoracotomy and many of the sensations etc are  due to the inflammation of the intercostal nerves having performed a large incision and cutting one of the ribs. Was just a very scary night. And yes, he needs to take his time moving forward getting out of bed. Unfortunately, last night he was in pain so it lead to a series of events. 

[BridgetO]

Glad you heard back from the surgeon so quickly and got some reassurance. I agree that pain meds- opiate ones- are a big drag. I don't like the way they make me feel, either. Sometimes they're necessary, though. At one point I was taking them only at nightso I could sleep  without pain but didn't have to be feeling those opiate feelings while awake. Would your husband be willing to do that? On the other hand, if he did have to get up to go to the bathroom, his fall risk might be increased. No easy answer to pain, unfortunately.

[Tom Galli]

Moonbeam,

I'm sorry your husband is having a tough time. Unfortunately, a conventional surgical pneumonectomy with the complications your husband had presents a very painful recovery.  I had three thoracic procedures using the same incision site over the span of 4 months and the last involved rib removal. As I recall after each surgery the strain from moving my bowels, complicated by the constipation of narcotic pain medication, was very painful.  I also suffered (suffer) muscle cramps and when they occur in my stomach or chest area, my incision pain soars.  These cramps are due to low magnesium levels, a side effect from too much Taxol and Carboplatin chemotherapy.

Here is an idea.  When his sutures (staples) are removed, find a day spa or a YMCA that has a hot tub, and have him spend about 1/2 hour or more fully immersed in the tub.  The buoyancy of water eases the gravity pull on incision scars and that for me relieves my pain.  I have chronic incision pain but that results from three surgical procedures using the same incision area in the course of 4 months so I use our pool in the summer and benefit somewhat from easing gravity on my still painful incision scars. Unfortunately a home tub is not deep enough to provide the buoyancy effect but a hot bath may be soothing.

I didn't like narcotic pain medication either because it did make me feel very loopy.  I still use lidocaine patches after a muscle cramp that effects my incision scars.  They drop my chronic pain by 1 to 2 notches and are especially helpful allowing me to fall asleep.  I also experience incision scar pain when I fly in a commercial airliner.  The cabin pressure altitude is between 6,000 and 8,000 feet and this lower than ground pressure allows everyone's abdominal cavity to swell.  So long flights for me can be painful but I tolerate it because we love to vacation.  I sometimes take pain medication ahead of a long flight and that helps somewhat.

The best I can suggest is to encourage his walking around as much as possible.  If he can't walk, then have him sit vertically in a chair and encourage this as many times a day as possible, increasing the frequency and duration each day.  It was painful for me for my wife to drag me out of bed and walk me around the house but it did speed my healing.  My last surgical recovery was during football season so each Sunday my wife established a goal of how many quarters I could sit up and watch the games.  Moreover, she "encouraged" me to eat all my meals at the table.

Try and keep him away from school aged children.  Coughing can be very painful for me and the last thing he needs is a chest cold with attendant coughing.  Recovery takes time and hopefully he will feel a little better every day.

Stay the course.

Tom

[Moonbeam]

Tom - I believe that’s what happened last night. Muscle cramp and then all he’ll broke loose. Was very nerve wracking and felt terrible for him. You have given me great suggestions for him. How far should he be walking/day? He walks around our block 3/10ths of a mile most days if not every other. He’s hittong his incentive spirometer most days...today he’s just getting to about 1250/1350. Most days more than that. Last night and today has been a setback for him and hoping he gets some sleep tonight. He has vicryl stitches and dermabond?! Can he put the patch on those/that? I cannot thank you all enough for your help...feel so blessed to have found this site! 

XO

[Tom Galli]

Moonbeam,

He’s putting in a good walking effort. See if he can increase his distance a little more every day. He’s also putting in a good spirometer effort. Keep encouraging this effort. My wife tagged my competitive bent by betting me that I couldn’t hold the spirometer at a level for 15 seconds. I hate to lose!

Be careful about constipation. Use a gentle laxative to ensure he avoids abdominal strain. The objective is no straining whatsoever. 

I see no reason the patches can’t be used with stitches still in. There is no warning on the literature I can find. His wound should be healed by now. 

Sleep is very important. Use the patches to bring down the pain level before he goes to sleep.  To hold the patches flush to my scars, my wife used medical tape. She also shaved my back before applying patches and tape. 

Stay the course. 

Tom