Now here’s an Interesting Article. I just found this through a link to Vermont Public Radio on my Twitter feed. It’s a very interesting treatment concept. I wonder if it could be the next wave in treating lung collapses?
Of course, I take interest in this because in LAM (lymphangioleiomyomatosis) lung collapses are a personal hell that many of our community members face. It’s also one of the issues that lead healthcare professionals to the LAM diagnosis (especially if they seem to recur).
I’ve had 6 myself & 3 pleurodesis procedures. I even had my first collapse before the markings indicating I had LAM even showed up on an X-ray or CT scan (in 2001-early 2002 over New Year’s holiday. I wasn’t diagnosed until later in 2003). It was an astute resident who noticed I had Tuberous Sclerosis Complex in my medical history who gave me the heads-up. That advance notice from his “homework” probably saved me at least 2-3 years of misdiagnosis or walking around with something I may have never known I needed to look out for. I also knew prior to my diagnosis & for the first year I had letter perfect lung function. (I was lucky I had a good baseline to start from.)
For those who don’t know, a pleurodesis is a surgical procedure where they remove the space between the lung & the chest wall. They surgically adhere it to the chest wall with either a chemical (talc) or mechanically (or sometimes both) which makes it harder for the lung to collapse since it is glued to the chest. It’s possible to have recurrence of a pneumothorax (lung collapse) after having this procedure done, but when they happen most of the time they are smaller & require less invasive interventions. (The larger ones require chest tubes & sometimes multiple tubes – something I would not wish on my own worst enemy).
Tying this back to the transplant world, some centers refuse to do lung transplants on patients who have had pleurodesis procedures. Others say it’s not a contraindication (something that is a disqualifier). They will tell a patient that having had it done will make the surgery longer & more difficult. They also may lose more blood, but it is possible to have a successful surgery in spite of it.
I’ve only had the mechanical based pleurodesis (at least from what I was told by my thoracic surgeons) but I know that the talc method sometimes causes very severe reactions in patients & that it’s a chemical they use to give the pleurodesis extra sticking power.
I was very aggressive & opted for pleurodesis procedures right away because my collapses were quite large. Over 50% in at least half of the cases (in fact, I’ve had complete collapses on each). My left was done in 2004, & had to be repeated because they were too “light” the first time. I had a collapse a month or 2 after. The right was done in 2006, which ended up being a very dangerous tension pneumothorax where the pressure builds up & pushes against the collapsed lung itself. It is life-threatening. Fortunately I knew right away that something was amiss & sought medical attention immediately. I’ve never regretted being aggressive even when I knew in the early days it might affect my ability to be transplanted. Mine were so hard to deal with physically & emotionally that my quality of life improved significantly not having to worry constantly about my lungs “going down”. Many times the collapses were so large, it’s sad to say I could actually feel the physical sensation of the lung as it was collapsing & knew it was happening.
Since having my lungs “tacked”, I’ve had two very small collapses. One was treated with home oxygen for 2 weeks (in 2007). The other was only detected about 2 weeks after it happened (after one of my doctors rotated a CT scan to a certain angle & blew it up. An area where it was tacked was trying to pull away. This is what they call a “loculated pneumothorax” where it doesn’t really collapse because it physically can’t, but still tries to pull away & air gets trapped in that space. (It’s still considered a collapse, however). This was a few months ago. I actually mistook it for cysts popping when it happened; which I have also had occur spontaneously every so often. (I was already on oxygen & had felt off that day of the loculated pneumothorax & used it more, which was probably why it resolved relatively quickly & was not as painful as past collapses).
I think the prospect of a liquid bandage such as this is more feasible & might be more tolerable with less complications than the methods currently in use. I also think since it’s not a chemical abrading agent like talc, it might also result in less pain. It may also speed healing as the article suggests. It will be interesting to see where this research goes.