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Patient education, Reader Mail, Surgical procedures

Post operative pain after thoracic surgery

Like all posts here at Cirugia de Torax, this should serve as a guide for talking to your healthcare provider, and is not a substitute for medical advice.

Quite a few people have written in with questions about post-operative pain after thoracic surgery procedures so we will try to address those questions here.

1.  What is a normal amount of pain after these procedures?

While no two people will experience pain the same, there are some general guidelines to consider.  But to talk about this issue – we will need to refer to a basic pain scale which rates pain from 0 (no pain) to 10 – (excruciating, writhing pain, worst possible imaginable).

Unfortunately, for the majority of people who have thoracic surgery, there will be some pain and discomfort.

Pain depends on the procedure

In general, the intensity and duration of pain after thoracic procedures is related to the surgical approach – or the type of surgical incision used.

open thoracotomy,empyema, advanced with extensive purulence

This open incision (with rib spreading) will hurt more..
Photo: advanced empyema requiring open thoracotomy for decortication

Pain will be much less with a single incision VATS surgery (now with chest tube) and specimen removed (photo courtesy of Dr. Chen)

Pain will be much less with a single incision VATS surgery (now with chest tube) and specimen removed (photo courtesy of Dr. Chen)

Patients with larger incisions like a sternotomy, thoracotomy or clamshell incision will have more pain, for a longer period of time than patients that have minimally invasive procedures like VATS because there is more trauma to the surrounding tissues.  People with larger incisions (from ‘open surgeries’) are also more likely to develop neuralgia symptoms as they recover.

.  (I will post pictures of the various incisions once I return home to my collection of surgical images).

Many patients will require narcotics or strong analgesics for the first few days but most surgeons will try to transition patients to anti-inflammatories after surgery.

Post-operative surgical pain is often related to inflammation and surgical manipulation of the chest wall, particularly in procedures such as pleurodesis, decortication or pleurectomy.  For many patients this pain will diminish gradually over time – but lasts about 4 to 6 weeks.

Anti-inflammatories

This pain is often better managed with over the counter medications such as ibuprofen than with stronger narcotics.  That’s because the medication helps to relieve the inflammation in addition to relieving pain.  Anti-inflammatory medications also avoid the risks of oversedation, drowsiness and severe constipation that often comes with narcotics.

Use with caution

However, even though these medications are available without a prescription be sure to talk to your local pharmacist about dosing because these medications can damage the kidneys.  Also, be sure to keep hydrated while taking this medications.

People with high blood pressure should be particularly cautious when taking over the counter anti-inflammatories because many of these medications have drug interactions with blood pressure medications.

2.  “I had surgery three weeks ago, and I recently developed a burning sensation near the incision”

Neuralgias after surgery

For many patients, the development of a neuralgia is a temporary effect and is part of the healing process.  However, it can be quite disturbing if patients are unprepared.  Neuralgic pain is often described as a burning or stinging sensation that extends across the chest wall from the initial incision area.  Patients also describe it as a ‘pins and needles’ sensation or “like when your foot falls asleep”.  This usually develops a few weeks after surgery as the nerves heal from the surgery itself.

It the discomfort is unmanageable, or persists beyond a few weeks, a return visit to your surgeon is warranted.  He/She can prescribe medications like gabapentin which will soothe the irritated nerves and lessen the sensations.  However, these medications may take some time to reach full effect.

Range of motion and exercise after surgery

Exercise limitations are related to the type of incision.

Sternotomy incisions/ sternotomy precautions

If you have a sternotomy incision – (an incision through the breast bone at the center of your chest), this incision requires strict precautions to prevent re-injury to the area.  Since the sternal bone was cut, patients are usually restricted from lifting anything greater than 10 pounds for 6 to 12 weeks, and to avoid pushing, pulling or placing stress on the incision.  Patients are also restricted from driving until bone healing is well underway.  (Be sure to attend a rehab program or physical therapy program to learn the proper way to exercise during this time period).

Patients will also need to take care to prevent a surgical skin infection or something more serious like mediastinitis.  The includes prohibitions against tub bathing/ soaking, swimming or over- aggressive cleaning of the incision with harsh abrasives like hydrogen peroxide or anti-bacterial soaps.  These chemicals actually do more harm than good in most cases by destroying the newly healing tissue.  A good rule of thumb to remember (unless your doctor says otherwise): No creams or lotions to your incisions until the scabs fall off.

Post-thoracotomy incisions

With a large thoracotomy incision, most patients will be restricted from lifting any items greater than 10 pounds on the surgery side for around two weeks.  However, unlike sternotomy patients – we want you to use and exercise that arm daily – otherwise patients have a risk of developing a ‘disuse’ syndrome.  One of the common exercises after a thoracotomy is called the spider crawl. This exercise helps the muscles to heal and prevent long-term disability or problems.  The physiotherapist at your local hospital should have a list of several others that they can teach you to practice at home.

The spider crawl

In this example, the patient had a left thoracotomy:

1. Stand with your surgical side within arm’s length of the wall.

start with your hand at waist level

start with your hand at waist level

Now, use your hand to “walk” up the wall, similar to a spider crawling.

'walking' the hand up the wall

‘walking’ the hand up the wall

Continue to walk your hand up the wall until your arm is fully extended.

continue until arm fully extended

continue until arm fully extended

Perform this exercise (or similar ones) for several minutes 5-6 times a day.  As you can see – it is fast and easy to do.

VATS

For patients with minimally invasive procedures – there are very few exercise restrictions, except no heavy lifting for 2 to 3 weeks (this is not the time to help your neighbor move his television.)

General incision care guidelines are similar to that for sternotomy patients – no soaking or bathing (showering is usually okay), no creams or lotions and no anti-bacterial soaps/ hydrogen peroxide/ harsh cleaners.

Whats NOT normal – when it’s time to call your surgeon

– dramatic increase in pain not associated with activity (i.e. lifting or reaching).  If your pain has been a “4” for several days and suddenly increases to an “8”

– If the quality of the pain changes – ie. if it was a dull ache and becomes a stabbing pain.

– any breathlessness, shortness of breath or difficulty breathing

– Any increase in redness, or swelling around your incisions.  Incisions may be pink and swollen for the first 2-3 days, but any increase after that warrants a ‘wound check’ by your surgeon

– Any fresh bleeding – bright red blood.  A small amount of drainage (from chest tube sites) that is light pink, clear or yellow in nature may be normal for the first few days.

– Drainage from the other sites (not chest tube sites) such as your primary incision is not normal and may be a sign of a developing infection.

– Fever, particularly fever greater than 101.5 – may be a sign of an infection.

– If you are diabetic, and your blood sugars become elevated at home, this may also be a sign of infection. (Elevation in the first few days is normal, and is often treated with insulin – particularly if you are in the hospital.

– Pain that persists beyond 3 months may be a sign of nerve damage (and you will need additional medications / therapies).

About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

Discussion

88 thoughts on “Post operative pain after thoracic surgery

  1. I still have a burning pain under my arm right beside my chest. It’s about a 6 on the pain scale. Is it something to worry about? Is strange back in June of 2014 and got a clamshell thoracotomy incision

    Posted by Michael | January 25, 2015, 2:52 pm
    • Michael,

      As you know from personal experience – a clamshell incision is a fairly large incision. During surgery, nerves get stretched and injured. This is the most common cause of the burning type sensations – which can last for several months (or longer!) as these nerves heal. However, a “six” is a lot of pain/discomfort to be enduring on a continual basis – so this is definitely something you want to talk to your surgeon about. The newer generation of gabapentin type medications such as Lyrica can be helpful for many people. Tens units, additional physical therapies and other medications have proved successful for other patients. Other people may require more extensive treatments with a pain specialist.

      Posted by CartagenaSurgery | January 27, 2015, 6:27 pm
  2. I’m 15 months post left side thoracotomy for decortication of lung and am unable to move my left arm normally, which also affects my gait while walking and made running impossible. Any suggestions for treatment would be most appreciated as my surgeon and orthopedist & physical therapy not helpful. Thank you.

    Posted by ken | April 13, 2015, 9:42 pm
    • Ken –

      Continue with your current therapies for now, even if they don’t seem to be helping, so that you don’t develop any sort of atrophy or ‘disuse’ syndromes on that side.

      Have you talked to your doctor about additional options? Without knowing you, or your case, my only possible suggestion other than the ones you are currently pursuing would be a neurologist/ neurosurgeon since from your brief note, since it’s possible that some kind of nerve impingement/ injury could be affecting you. (Shoulder/arm nerve and muscle injury during surgery is not common, but does occur). That wouldn’t affect your walking – other than a stiff/ “funny” feeling arm might make you alter your stride/ gait to compensate but that sounds similar to what you are describing. Best of luck to you.

      Posted by Thoracic Surgery | April 18, 2015, 1:27 pm
    • I had a decortication of my right lung 2.5 years ago. I’m still in pain. I’m seeing a pain specialist, but so far, I haven’t had much relief. Recently I had a nerve stimulator trial. But to date I haven’t had much relief. If you figure out something that helps, please let us all know. Thanks.

      Posted by Dale Huss | June 3, 2016, 8:30 pm
      • Hi there…. I am in the same boat as you. I had half of my left lung removed 3 years ago and I’m still in awful pain. Not much seems to help. I’ve tried the whole gamet, acupuncture, physio, chiro, trigger point injections, IMS, prolotherapy and topical prescription creams. Still living every day in agony. My lung surgeon just throws up his hands. I’m exhausted trying to find help….

        Posted by Kim | June 14, 2016, 6:15 am
  3. I have pain 2 weeks post op in ribs under breast and on side nowhere near back and drain incisions from pluerodesus and biopsys. Why is tih?

    Posted by Donna Letham | May 4, 2015, 4:13 am
    • Donna,

      Pain is conducted through nerve tracts (sort of like a long cable) that travel along the chest – so surgery, injuries or procedures in one area can cause pain to be felt in other areas. Also, during VATS or other procedures to perform biopsies or pleurodesis, these nerve fibers are stretched/ stimulated/ affected.

      Posted by Thoracic Surgery | May 8, 2015, 12:15 am
      • Is it normal to feel pressure like a slab on your chest after pluerdocessurgery? my ribs are still sore and I have numbness under my ribs. I am meant to go back to work beginning of june, and am unsure if I can stll do physical work.

        Posted by Donna Letham | May 11, 2015, 11:28 am
      • Donna,

        I can’t speak to ‘normal’ because everyone is different. Is this pressure new from surgery? what makes it better/ what makes it worse? Has your pain worsened since discharge or just changed? (It may get better and then change to the numb sensation). Does it radiate? Do you have nausea/ headaches / cramps or any other symptoms that go with this sensation? Make a list – and call your surgeon’s office to discuss it. If it’s new onset chest pressure that has never occurred before, or your pain is more severe than before – call your doctor right away. He/She can also address any remaining physical limitations or restrictions you may have.

        Posted by Thoracic Surgery | May 13, 2015, 10:56 pm
  4. So here is a question and some backround info. About 5yrs ago I was shot in the chest in an attempted robbery, while the attackers didnt get ant of my things they did fire a .22 into my chest damaging both lungs and the pulmonary artery of my heart. I had to undergo a Clamshell Theracotomy with the insition spand fron armpit to armpit and another from the bottom of my Sternum to just above my belly button. Now the question, I am still experiencing phantom pain at the bullets entry site that I have felt is normal however just the slightest scratch over my nipple area and it can bring me to my knees at times, is it possible that the nerves were damaged or destroyed from either this emergency procedure or the bullet damage itself? One more question while im here, if the bullet could not be removed what are the risks involved with lead posioning? (sorry for any typos/spelling I missesd)

    Posted by Ryan | May 12, 2015, 2:03 pm
    • Ryan –

      First off – so sorry to hear you had such a traumatic experience, but glad that you have recovered. It is certainly possible that the bullet (even small calibers can do extensive damage due to heat/ velocity and trajectory) caused significant nerve damage. The clamshell incision could have certainly contributed to this as well. As you know – it’s a large incision, and with the injuries you mentioned – an emergent case, so it is certainly possible that nerves were stretched and damaged while they repaired the major vessels and your lungs.
      Lead/ Lead poisoning
      I am not a traumatologist or a toxicologist – (please keep that in mind), but in several past cases of people with similar type injuries, the consultants from toxicology either performed chelation therapy (chemicals that bind to the iron and remove it from the bloodstream) or the measured lead levels were too low to require treatment (since chelation is kind of like the lesser of two evils, and carries its own risks). It may have already been done – but you were probably in no condition at the time to understand/ remember due to the severity of your injuries. Sometimes, depending on the type of bullet (and the doctors experience treating gunshot wounds – they may be able to predict whether or not it’s an issue.) You can always ask on your next doctor’s visit. There is an interesting (free full text article) by some Colombian doctors on just this topic that may be interesting to you: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001953/ – basically it says with your neurological symptoms, it might be worth investigating. Specifically, read the case reports. Again, I am certainly not an expert in this area.

      Neuropathy
      Have you seen a pain management specialist or a neurologist? It is hard to tell from a short note how debilitating your pain is – and if it is affecting your every day life. If so – the addition of lyrica/ gabapentin or another similar medication might be helpful. If the pain is debilitating, some pain specialists can perform intermediate term blocks (lasting days to weeks) for some pain relief. If it’s not that frequent, it might just be something you have to live with – because there are trade offs and side effects with medications, etc. A neurologist can also tell you if your symptoms are indicative of other problems like heavy metal poisoning versus post-surgical trauma.

      Best of luck.

      Posted by Thoracic Surgery | May 13, 2015, 10:48 pm
      • P.S. Of course you know – this is just an informal discussion, not expert medical advice. It is impossible to diagnose or treat any medical condition without a full physical examination and medical history. But hopefully, this will aid you in your discussions with your medical providers/ and in finding the right provider for your symptoms.

        Posted by Thoracic Surgery | May 13, 2015, 10:51 pm
      • Thank you so much as this was very easy to understand and I really like that. Thanks also for the insight into that article as well. this was very helpful and i am greatful for your time.
        Warm wiishes,
        Ryan

        Posted by Ryan | May 14, 2015, 2:26 pm
    • Hi Ryan, I took interest in your story because I too was the victim of a crime in which I was shot 4 times. Mine was the right lung. After 30 years I still have a bullet lodged in the right lung, as well as the spine. My bullets have not caused any long term effects. Scar tissue builds up around them and from what I was told, they will NOT remove them unless they are life threatening. They were more concerned with saving the LIFE instead of removing bullets or nerve issues. I too have some tenderness in those areas, but MORE issues with the surgical site 2 months after the Vats procedure. I will let you know how THAT progresses, but if you are a smoker, STOP NOW! That is what caused the damage to my lung on TOP of the shooting.

      Posted by Kelly | July 1, 2015, 1:32 am
  5. I had a my left lung removed back in July I have been in pt for about 3 months I’m getting chest and back cramps that are pretty severe what is th cause

    Posted by Randy | May 17, 2015, 6:17 am
    • Randy,

      I apologize but there is no way to even venture an educated guess based on the limited information provided. In order to spare your privacy, and ensure that you receive the optimum care for your physical discomfort, I would advise you to return to see your surgeon. During your visit try to define your pain with descriptors to help your doctor determine both the cause and the best treatment. Do the cramps affect the lower back? Do they radiate from the chest to the back/ is it two separate areas? Is it accompanied by tingling/ burning/ stabbing/throbbing or aching? Any shortness of breath, nausea or vomiting with the cramps? What makes your pain worse? Does rest improve or worsen your symptoms? What about exercise? What makes it better? Does ice help? What about heat? Do any over the counter medications help? All of this information, combined with a physicial examination is necessary to treat this condition. Best of luck to you, Randy..

      Posted by Thoracic Surgery | May 17, 2015, 9:18 pm
  6. Hello,

    Before asking any questions, I will provide some background info – I had my first spontaneous pneumo in 2011. I received a chest tube the same day because it was a tension pneumo. After several days with a chest tube, my lung did not re-inflate, so I had mechanical pluerodesis. Two months after this surgery my lung started collapsing at least 3cm every month but docs said that it would never collapse to a dangerous level (tension pneumo) because of the pluerodesis. I was finally able to see a specialist eight months after my surgery (I was only 16 so the pediatric unit dealt with me instead of a specialist) and he referred me to a surgeon because my lung happened to be 70% collapsed. After this I has a plurectomy in combo with mechanical pleurodesis. Two weeks after I was discharged a had another tension pnuemo. Next, I had chemical pluerodesis. Since then, my lung has not collapsed, but I have been experiencing chest pain since then even though it has been almost four years since my last operation. This pain is not constant, but will sometimes occur and last up to two weeks before it disappears. It feels like my lung is collapsed, but every time I get an x ray when I have pain everything is normal. Do people experience long term pain after these procedures, and if so, how can it be managed without pain medication? I am a full time student and cannot afford to take pain meds every time I have this pain, but I cannot function normally without pain meds while experiencing pain. Please help!

    Posted by Liz | October 13, 2015, 1:18 pm
    • Chronic pain can and does occur in thoracic procedures/ injuries. As you mentioned, long-term narcotic medication regimens are less than optimal (for multiple reasons including overall quality of life). I am not sure about your financial situation but a short term anesthetic block from a pain management specialist might be an option. These blocks last from days to weeks, and eliminate many of the side effects and problems related to other pain medications.

      Posted by Kristin Eckland | October 14, 2015, 1:06 am
  7. My wife had vats surgery on 7th October 2015 and is suffering from really bad back and chest burning pain, is this normal

    Posted by mark | November 13, 2015, 5:22 pm
  8. I had a VATS and decortication surgery on a stage-4 empyema two years ago. Surgery and recovery went very well with no issues. I am a very healthy and active 41 year old male but notice when I get a chest cold, there is noticeably more pressure in the left lung where surgery took place. Is this common and is there a way to loosen up the lung to prevent the inflammation/congestion from making the lung feel tight and restrictive?

    Posted by Kris | November 16, 2015, 7:20 pm
    • This is not uncommon.. I recommend several things to help alleviate your symptoms
      – first, be sure to get your annual flu vaccine and pneumonia (if applicable.)
      – Secondly, continue the pulmonary exercises you were prescribed in the hospital (incentive spirometry, coughing and deep breathing), as well as regular physical exercise.
      -Quit smoking, if you smoke.
      If you get frequent chest colds – check in with your primary care physician – so that you do not develop another pneumonia/ empyema.
      If you develop these symptoms in the absence of a respiratory infection or chest cold, please seek medical attention immediately.
      Hope this helps.

      Posted by Kristin Eckland | November 16, 2015, 11:01 pm
      • Thank you for your response. One additional question – is there an one increased risk or concern in developing pneumonia in the years following a VATS procedure? I only ask as I have noticed it more difficult to have productive coughs when dealing with chest congestion, especially on the side the surgery was done.

        Posted by kris | November 19, 2015, 11:38 pm
      • There is no long term increased risk documented in the literature, however, since you have already had a pneumonia (cause of empyema) – it is important to be proactive and prevent further pneumonias. Vaccines are one of the most effective ways to prevent pneumonias.

        Other causes of pneumonias include aspiration (of food etc) including silent aspiration – generally right sided pneumonias
        as well as uncontrolled reflux / GERD (by a similar mechanism).

        Practice deep breathing (ie. ‘Yoga’ style breathing to promote the cough reflex and to open up the distal portions of your lungs. Thats a deep inhalation over 5 to 10 seconds – then hold for a count of ten – then exhale over several seconds. That should help. Also avoid cough suppressants and smoking, both which prevent effective cough and mucous clearance.

        Posted by Kristin Eckland | November 24, 2015, 5:00 am
  9. Hello,

    I would like to give you a little back ground information first if thats ok. Whilst at a wedding reception on a Sunday evening an ambulance was called and I was taken to A&E with sharp stabbing pains and severe pain when breathing in. The paramedic suspected I had Gaul bladder stones. At A&E i was x-rayed and put on a ward and treated with anti-biotics for Gaul bladder stones. On the Tuesday I had a Ultra-sound and the Dr said I didn’t have Gaul stones. When I went back to the ward, the ward Dr said I had Pneumonia. I asked how he had diagnosed this to which he replied he looked at my initial X-ray. I was told that they would be using the same anti-biotic as prescribed for Gaul stones. By Friday I was feeling better but the Dr said my CRP level wasn’t coming down quick enough and so arranged for me to have another X-ray. The results came back late Friday night and I was told by the “emergency’ weekend doctor that my Pneumonia had progressed. I later saw an image of my right lung and the whole lung was covered with fluid. I was left taking the same meds until the following Tuesday. I had an Ultrasound to see how much fluid was there and to place a drain if needed. The specialist Dr who saw me said he only saw a small amount of fluid and that it did not warrant a drain. I was feeling considerably well at this point and had very little to no pain ironically, I was quiet happy not to be needing a drain in my chest.

    Once again I returned to the ward, I was then sent to have a CT Scan to check what was going on. This confirmed that I did have fluid on my lung and they estimated it to be around 2500ml. I was sent on the Wednesday of the second week to have a chest drain inserted (under local anaesthetic) under the CT-Scanner. A sample of the fluid was sent to analysed but was rejected by the lab as it was not labelled correctly. The drain seemed to be work for a few hours and then stopped after 300ml. It was flushed twice but never drained more that the fluid used to flush it.

    I was then told that I had Empyema and needed surgery. I had a VATS procedure and had 2 drains inserted on a vacuum. The surgeon said it all went well and a few days later I had my chest drains from the side of my chest removed.

    I was discharged at the end of August and sent home on 2 x 20mg Morphine modified release, Morphine solutions as a break through pain relief & Paracetamol. I was told to do some breathing exercises as my right diaphragm was in my chest are and stuck to my side wall. My right breast area was very sore at first but started settling a few days later. I had my stitches removed after 7 days. A week or so after that, one of my wounds got infected and I was given anti-biotics. From then on I fell the pains have got worse. I had an X-ray in October, It showed a very small loculation on the right lung. I was also told that this will hopefully drain away by itself. I have a follow up appointment on the 2nd December. I have been having constant pains under my right hand side ribs, It fells like a stitch/cramp pain. I have a numb area from the centre of my chest that extends over my right nipple to my arm pit and about 5cm wide. I have a constant dull pain in the middle of the right hand side of my back. I am currently on 30mg Morphine modified release twice a day. 30mg Amitriptyline at night, Nanproxen and liquid morphine. I would describe the pain between 4-7. Some good days some bad. I struggle sleeping at nights but the Amitriptyline has started to let me sleep 3-4 hours. Once i wake up I just focus back on the pain. I’ve very sorry for this long winded message, I’ve found myself in a place where my GP doesn’t know what to suggest and my surgeon seems to be very relaxed about it all. I really need to return back to work, I work as a Mathematics teacher. I don’t I cope teaching with the way I am feeling. Please help.

    Is this normal? what has possible gone wrong? Should i seek a second opinion? What could I suggest to my GP?

    Thank you

    H

    Posted by H S Bart | November 24, 2015, 1:20 am
    • Thank you for your comment. I am glad you wrote in advance of your next appointment. I would like to suggest a few things –
      1. a definitive pain management plan: – pain between 4 and 7 is not really an acceptable or tolerable level. It is not a ‘functional’ level for most people. Also narcotics are not the best choice for this pain – and after 4 months, less than optimal for you. You need to talk to your doctor about your other pain management options – maybe a tens unit, lidocaine patches or an additional non-narcotic regimen. (You probably aren’t a candidate for a nerve block due to the presence of infection). Pain management is an essential point, because you need to be functional – and able to teach math. You need life to begin to return to normal – and that won’t happen if your pain is not managed better.

      2. If your X-ray on the 2nd shows any fluid – be prepared for another CT scan to check for loculations. If there are loculations, anticipate further attempts at drainage. (It is very hard for antibiotics to penetrate the pleural space, so drainage is really the only way to treat fluid collections). Only a very small amount can be absorbed by the body -and that won’t happen if it is loculated (or walled off). Since you have had this process for several months – a very small, needle like drainage tube probably won’t work – because the fluid has probably congealed (or become thick and purulent). I do not recommend t-Pa use, and the scientific evidence is mixed.

      3. Some of the pain you are feeling can be considered ‘normal’ but some of the continued pain may be related to an on-going infectious or inflammatory response. Until that is healed/ treated, you will continue to have pain.

      4. Unfortunately, empyemas can be very difficult to treat – mainly because they tend to be diagnosed late – after several rounds of antibiotics and such. In the meantime, the person continues to get sick. Streamlining the algorithm to get patients faster diagnosis and definitive treatment (VATS not just antibiotics) has been one of my goals. Empyemas carry a high morbidity and overall mortality – though that has improved due to minimally invasive surgical techniques like VATS

      5. If you develop fever, chills or a purulent /productive cough with foul- tasting, purulent appearing (pus-like) sputum, please call your surgeon immediately..

      6. I am not sure where you are located, but I would be happy to suggest another surgeon (if I know one) in a nearby area.

      Lastly, (if you haven’t already), please get both your pneumonia and annual flu vaccine to prevent a recurrence..

      Posted by Kristin Eckland | November 24, 2015, 4:53 am
  10. Hi Kristin Eckland,

    Thank you for taking the time and replying to me, I really appreciate it. I just have a couple more questions please.

    You say a nerve block may not be suitable due to infection, do you mean my loculation is the infection? I will ask to be referred to a pain management clinic and discuss the options you have mentioned.

    If indeed the CT scan shows loculations, how best should the attempt to drain it bearing in mind the 3 months or so since this started? Would surgery be the best option to remove the fluid? Is it safe to leave the fluid there or do you believe this may be one of the causes of my pains?

    I agree that it was difficult for the hospital to diagnose the empyema and there was a considerable delay, Would delay have an adverse effect on my healing?

    I do occasionally feel feverish but when i check my temperature it is within the normal range. Could this be signs of an infection but the paracetamol I take regularly is bringing the temperature to normal levels? I am currently on Amoxicillin as of yesterday as my GP has said to take it to be on the safe side until my appointment on the 2nd. I have developed a cough in the last day or so too with a yellow sputum, should i report this to my GP or Surgeon?

    I am based in the Midlands, Leicestershire (UK), I was invited for a flu jab by my GP’s surgery in October, when I arrived they suggested I not have the vaccine as I was still ‘recovering’. When would it be safe in your opinion to have the flu and pneumonia vaccination? I would also welcome any local surgeons you may recommend.

    Thank you again for your kind advise, this has been far better than what my GP (but I guess their not thoracic specialists) or my surgeon has given me. I at times feel that maybe my surgeon is hiding something as he gives very limited and small responses whenever I speak with him and ask questions. My surgery happened in Nottingham (this is where I was at the wedding reception when I fell ill) which is about 25 miles from where I am, this is where the surgeon is based too. I can ask to be referred to my local Thoracic ward at the Glenfield hospital which is supposedly renowned for their expertise. Would you suggest I try that? Would the be able to pick up from where the surgeon has left off so to speak? Do the pro’s outweigh the cons in my situation?

    Thank you again,

    Regards

    Harvey

    Posted by H S Bart | November 24, 2015, 11:58 am
    • Harvey,

      1. Please ask for a referral to the Thoracic ward.. I think that is an excellent idea and the most effective way of getting you back to full health and wellness. As long as they have your records, any surgeon can assume your care (because you are there to fill in the blanks beyond scans and reports).
      If for some reason you can’t get one (and I am not entirely clear how referrals and such work in the UK) then I would suggest Papworth Hospital in Cambridge with Dr. Marco Scarci. But that’s quite a distance for you – so lets try to get you in the local thoracic ward first.
      2. Regardless of your current clinical situation, I would recommend seeking care from another thoracic surgeon since you feel like your surgeon is not communicating well with you, or addressing your concerns. This is a valid consideration! Your health depends on these interactions.

      3. A loculation is a nice way of saying infected fluid. It is a product of pneumonias and other conditions. Once fluid gets into the area around the lung (the pleural space) [especially after pneumonia] bacteria grows and it becomes essentially pus. I won’t use my usual explanation as it is somewhat graphic, and I don’t wish to offend readers. But these ‘pus-pockets’ will not go away without treatment. Sometimes they can use a chest tube or large bore catheter to break up these pockets but sometimes a return to the OR is necessary. I can’t even begin to venture a guess at this point – it will depend on your symptomology and radiology results.
      A pain specialist might be very happy to do a block, and do a safe and effective one – but since I can’t see your wound sites (and you said your wound was previously infected) I wanted to be sure I mentioned it.

      4. I would defer vaccinations until you are seen by the surgeon – they aren’t a critical matter at this point, more preventative medicine for the future.

      5. The delays in diagnosing empyemas (which is very very common) means that the empyema is usually more advanced. However, in your case, it does not sound like you had ‘walking pneumonia’ with outpatient treatment for a month or two prior to going to the hospital. (That is when the delay becomes more critical, particularly in frail elderly patients). It is this delay that allows a pneumonia to progress to an empyema. This ‘delay’ isn’t the result of poor decision making, its a result of poor outcomes (difficult to predict which patients will respond to antibiotics and which ones will not.) Many thoracic surgeons are trying to develop a way to better anticipate who these people are – so that we can treat them before it becomes an empyema – but you also don’t want to operate on people who don’t need it either..

      6. The paracetamol (acetaminophen to my USA readers) could indeed be masking your fevers – try holding off on taking it for 24 hours (if you don’t have to) and see if you develop a temp greater than 100.5 F or (38.1 C). If so, I would be concerned, that this along with your continued productive cough are signs of on-going infection. I would be sure to contact your physician promptly with these findings.

      7. Lastly, we haven’t really talked about it here at thoracics.org but please make an extra effect to eat well. Try to ensure that you are eating a good diet rich in vitamins, vegetables and minerals. A long illness like yours depletes the body of the essential nutrients needed to heal. Often this kind of illness also diminishes the appetite. If you have diabetes, now is also a time to keep a very close watch on your glucose readings.

      Please keep me updated with your progress. I wish you the best of health and a speedy recovery. I hope this information has been helpful.

      Kristin

      Posted by Kristin Eckland | November 24, 2015, 1:55 pm
      • Thank you again Kristin for your time and very valued suggestions, I’ve understood my condition better in the last 24 hours by reading your webpage and comments than I have done in the last3 1/2 months under my consultant.

        The procedure here in the UK is for your GP to make referrals. I will visit my GP later this week after I have a X-Ray today. Hopefully the GP will have my results back in a few days and will see if there have been any changes since my last X-ray on the 12th October.

        My GP did write to my sergeon on 20th October and sent him this X-ray with the radiographers comment stating it was a small loculation. The surgeon replied on 11th November to my GP and said that it looked much similar to the X-ray taken after surgery and there was not much difference. The surgeon said he didn’t feel he needed to see me sooner than the previously scheduled appointment on 2nd December. Would this suggest that this loculation has been there since the VATS surgery? I do have photos of my X-ray when I left the hospital and of just prior to surgery if you wish to view these. I noticed I don’t have a ability to upload them directly here. I could also email you picture of my surgical wounds etc that were taken at the time.

        I think you are correct when you say I didn’t have walking pneumonia. I did not have any typical symptoms I.e. A cough or a cold until a day or so before having the severe pains. I am a diabetic (type 2) and was told this may be a contributing factor, this is being address currently.

        As per your suggestion, I will stop the acetaminophen for 24 hours and monitor my temperature.

        I currently take vitamin supplements and my recent bloods showed my vitamin d (this was low after leaving hospital) and other levels were all in order.

        I will happily keep you posted on here, I apologies for the long messages.

        Thank you and once again all your advise has been very helpful.

        Regards
        Harvey

        Posted by H S Bart | November 24, 2015, 5:12 pm
      • This is very similar to what happened to me at Nottingham hospital recently. I thought I had reaction to the flu jab and I was getting bad stabbing pains mostly around my neck and top of stomach for a couple of weeks but not realising my chest was a problem. I was in hospital a month and discharged end November – I am one month on from bronchoscope, left VATS to Open Decortation. My left lung was ‘white out’ on initial X ray.,I had a pleural tap. I was treated for a community acquired pneumonia with IV antibiotics. Later there was a problem with the antibiotics (i was hullicinating) and they were stopped. I had a chest drain and initially the thin fluid draine easily, a considerable amount. I was feeling good.the consultant came and it seems the drain had blocked for 3 dayys & couldn’t be unblocked. Attempts to get another doctor to put in a further drain was difficult as no-one seemed available and took some days. Two different doctors tried & said by now the pus was thick/viscose and would not drain. They eventually put another drain in but it did not work at all. It was in for about a week and very painful. I was not having further antibiotics in this time. They then told me I had Empyma and op was only option. Suddenly after 4 weeks post op the pain seems more severe and I’m getting burning/pins & needles in chest. I’m very concerned about this or is this a normal thing in the healing process? My questions is: Did the delays in having effective working drain cause the Empyma? I feel incredibly traumatised by it all and shocked to have such a major op (I even needed blood transfusion X 2). I can’t help feeling it should not have ended like this. It seems shocking. Now post VATS I have huge scar.. I feel weak & exhausted and now worried that pain has increased one month on. I stopped morphine some weeks ago. It killed my appetite and I did not eat at all for about 6 weeks. The surgeon was pleased with progress when I had 2 week check up. He suggested using those little live yoghurt drinks – they were marvellous and I’m back earring nutritional little bits which has helped recovery.i’m also type 2 diabetic and in good shape prior to this.(this site has given me the best info yet.thank you).

        Posted by Mumblygirl@btinternet.com | December 25, 2015, 12:03 pm
      • MumblyGirl,

        I am not surprised it is taking you a while to recuperate.. Empyemas are an under-appreciated infection. From what you described, it sounds more like the empyema was already there – (as loculations) when the drains were put in. The infection probably had pockets of liquid pus surrounded by thicker and more fibrous material The drains were able to drain the liquid portions, but the thicker material clogged the drains.

        This scenario is one of the reasons I am not a fan of the antibiotics + drainage route. While all of this is going on, the patients are sitting in the hospital (usually not eating well because they feel bad) and being exposed to all the other risks of being in hospital.

        Now, if you had VATS, you shouldn’t have a huge scar.. Are you sure you didn’t have a thoracotomy? It sure sounds like it from your descriptions. Wait… you had conversion to open decortication ie. a thoracotomy.. This is the surgical approach I hope to avoid in my patients. Thoracotomies are the reason that most doctors delay surgery until after they try antibiotics and drainage (and this is the current treatment recommendation/ guideline). They are very very painful and do take a long time to recover from. (2 to 3 months, with longer effects for 6+ months). Most experienced VATS surgeons have a very low rate of conversion to open surgery these days – but that is of no comfort to you, I am sure.

        The advent of VATS is one of the reasons I push for earlier operative intervention. Since it is a much lower morbidity (less pain / complications) than the older type of surgery, I think that when you compare the risks of VATS to the risk of having a patient become septic/ deconditioned or die waiting for surgery – that VATS clearly wins out.

        Most of the time, people with this infection are going to need an operation – so in my opinion (yes, just my opinion), it is better to do the operation straight away before the patient either becomes septic, or just the usual deconditioning and weakness that comes from being sick for several weeks. (Also it is easier to clean out the infection at earlier stages – once it becomes more advanced, the tendency for bleeding with decortication increases as the peel becomes firmer and more fibrous). Unfortunately, these are only my opinions, based on 10+ years of experience. The current recommendations are still based on a model comparing antibiotics to open thoracotomies. These recommendations advocate for antibiotics first, then drainage, then surgical referral.

        (On a related note: I was actually working on collecting and publishing data on this topic including a revised and updated surgical algorithm as part of doctorate study but I lost my financial support and could not continue my research).

        So short answer is: your doctors followed the guidelines exactly. I am just not convinced these guidelines aren’t completely outdated. Thus, what you and I consider to be a delay in receiving a definitive treatment (ie. surgical decortication) would actually just be the first and second line treatments failing to work (as they often do).

        Best of luck for your recovery. The pins and needles sensation is from having nerves stretched during the open portion of your operation. It is actually a sign of healing – and should lessen over time. There are also medications like gabapentin and lyrica which can help, but often take several weeks to be effective.

        Posted by Kristin Eckland | December 27, 2015, 3:01 pm
      • Hi Kristin,

        Hope you’re well. I thought I’d give you a brief update. My GP advised I go to my follow up appointment with the Surgeon to see what they thought is the problem and that we could move my care after this. My GP was concerned I wouldn’t be seen locally fast enough if there was an underlying problem.

        I went to the follow up appointment and had a chest X-ray prior to being seen. I was seen by a ‘Junior’ surgeon/doctor this time, this doctor was present when I was in hospital initially, he was very helpful at the time and spend time explaining what would happen during surgery etc.

        This doctor explained why didn’t believe I had ‘fluid or empyema’ again as the X-ray suggested. He explained that the X-ray they had taken straight after the surgery was similar to the one taken recently. He said that during surgery he had seen that my diaphragm was raised and that the X-ray showed the same.

        He has booked me for a CT scan (6th January) and I will see him again on the 13th January. He explained either a drain or surgery would be needed if it is a fluid or empyema. He felt it is the raised diaphragm that is showing and that if it continues to give me problem then they may consider surgery to ‘stitch it down’ as he put it. My GP advised that i should I plan to see it through to the appointment with this doctor, and if it is the diaphragm then I could ask for it do be dealt locally. My GP said it;s better as the Nottingham Doctors “know’ me and my condition.

        I am feeling a lot better and am managing to sleep fairly well now, I rarely take the liquid morphine now and only take the 30mg slow release morphine in the morning and then again at night. I stopped taking the acetaminophen for 24 hours and hadn’t noticed a raised temperature. I still have a constant dull heavy pain at the bottom of my lung, I also have a sharper pain at the top of my lung when I take a deep breath in. I am able to deal with these pains for now. The Thoracic doctor said he would refer me t a pain clinic after the scan result had come though, he said they may be able to deal with the pain dependant on what the CT scan shows.

        Thank you again for the time you have given me, you was extremely helpful and that brought me comfort at a time when i was desperate to understand what was going on with me and my condition. I’ll write back once I have met the consultant after the 13th January.

        Hope you’ve had a lovely start to the new year.

        Regards

        Harvey

        Posted by H S Bart | December 27, 2015, 4:07 pm
      • I am happy to hear that you are feeling better. I hope your scan goes well. Thank you for following up and letting me know.

        Posted by Kristin Eckland | January 12, 2016, 9:05 pm
  11. I had open chest surgery sternopromy to remove a tumour it has been almost 3 month since my surgery and I still have pain in my neck,collarbone,right shoulder blade and upper mid back is this normal and how long will it be like this

    Posted by Terry | December 11, 2015, 3:49 pm
  12. Hi. Ty for answering these questions as best you can with limited info. Mine is about my 12/4/15 vats resection of right middle love to remove lymphoma nodule. Inner chest or lung wall area is about an 8 when I breathe in or drive/after driving. This pain was either not felt much or medicated the first week or so after. My numbness seems to be bouncing back fairly well it’s just this internal burning

    Posted by Brandi Fitzpatrick | January 4, 2016, 10:20 pm
    • This burning, while uncomfortable, is fairly common and should ease off in a few weeks.
      If it doesn’t, your surgeon can start you on medications to help with the discomfort. (These medications can take several weeks to take full effect.) I am glad you are otherwise doing well.

      Posted by Kristin Eckland | January 12, 2016, 9:10 pm
  13. I just had surgery on my left lung to remove multiple Bullous and now I have a burning sensation under my underarm whenever I move it like I’m experiencing 3rd degree burn. Why is this?

    Posted by David Peeler | January 7, 2016, 3:38 am
    • Mr. Peeler,

      This sensation is usually caused by nerve irritation from stretched nerve fibers. It can also occur in cases when pleurodesis is performed. It should gradually lesson in the next several weeks. I apologize for the late reply.

      Posted by Kristin Eckland | January 12, 2016, 9:12 pm
  14. My Mother, 73, underwent surgery to remove top lobe of her right lung Dec. 10. She is a small lady, 78 lbs when she was admitted. She suffered from drug induced delirium which I now understand is pretty common with elderly patients. She was hospitalized 13 days due to air leak from chest and was discharged with it still in place, which we had to clean and drain daily. It was just removed this past Monday, chest tube was in there over three weeks. She is doing poorly, extreme fatigue, short of breath just to walk to the bathroom and back. She has oxygen and only wears when she’s short of breath. My concern and hers, is her pain in solely in her pelvic/abdomnal area. She feels as though she has a belt tightly around her. We have spoken with both her surgeon and Onocologist but feel like we are running in circles. Her PET scan, done prior to the surgery, shows a mid size mass in the pelvic region but does not light up like the lung cancer did. Her Onocologist just noticed the mass on her first post op visit and is requesting radiology to review PET with him. Meantime, each day, Mom tells me she feels worse than the day before. Her weight is now down to a shocking 71 lbs. She feels as if she is starving yet when she begins to eat, “doesn’t want” the food. I have told all the doctors how concerned I am about not only her lack of progress but the fact she is so weak and not eating. Your advise?
    Thank you so much for anything you can offer/advise!
    Lori

    Posted by Lori Jolly Savage | January 10, 2016, 1:22 am
  15. I had burning pain for 8 months and I went from Doctor to Doctor n no one could figure out where the pain was coming from. One day I decided to do some stretches n I found a lump under my rib I went and seen a chirothorsic surgeon he said my floating rib was displaced n he would remove it . Well surgery was about 2 weeks ago and my burning stinging icy hot numb pain is worse … It starts right next to the incision n travels to my back he made the incision under my rib . When he got in there he couldn’t find the rib n so he had to roll me on my side to find it then he laid me on my back and removed it . I’m having so much nerve pain I’m taking gabapentin and hydrocodone . Someone please give me some answers.

    Posted by Becky | March 4, 2016, 9:43 pm
    • Becky,

      I am sorry to hear about the pain you have been having for several months. Unfortunately, I won’t be able to provide the answers you seek, as your case sounds fairly unusual. I hope that as time passes, the pain from the incision and associated symptoms lessen.

      Posted by Kristin Eckland | March 7, 2016, 5:22 am
  16. I had empyema of the lung a build up of fluid causing me to struggle breathing the operation was successful and I had a chest drain after for a further 4 weeks this illness was due to my IV narcotics use and unfortunately I have relapsed agen and am getting chest pains and get short of breath really quickly.should I go get this checked out ?? I’d say the pain was 3 out of 10 so far

    Posted by Tasha richardson | April 19, 2016, 2:03 pm
  17. Hello 43 y/o male was just wondering I am post surgery due to right cervical rib, compression of subclavian artery and nerves. In surgery rib resection 1st rib with scalinectomy was preformed incision above collarbone , cervical rib not removed due to I was one of the exceptions where they got the top of my lung and caused a pneumothorax. Surgeon said due to having more musle tone then what he was use to more dissection had to be done. I am now 4 months post op and have lost about 50% use of my right arm, pain is bad after rest and by end of day unbearable at times. I have continued therapy with slight improvement but my PT guy is worried that something else is wrong and when I contacted the surgeon he just blew me off. Current symptoms include pain of course, musle waisting, I have stayed swollen in the chest and under arm, all muscles involved are always restricted, and I do get stabbing pain over where the 1st rib was cut back to. Also the muscle in the shoulder during therapy will spasm if direct pressure is not applied. I can reach out with my arm but no lifting up unless assisted or doing something as simple as putting on a belt can not reach behind my back. Shoulder is not frozen I guess I should mention but when doing daily task if I push it to hard it feels like my arm is ripped from the socket and pain is so intense that I could almost scream. I am now starting to have increased headaches and cervical pain with this also. I did go back to work a few weeks ago restricted per my pcp but can only stand up to a couple of hours due to driving and bending is a big part of my job. Pcp wants me to see a spine specialist but I don’t think that will fix what is going on at this point. I live in a rural country setting and had my original surgery 5 hours away from where I live. Just don’t know where to turn now feel like the surgery made me 10x worse then before and my pcp has never had to deal with this so I feel he is flying blind also but is an excellent MD and will take any suggestions at this point due to the surgeon just dropping me off on him. Thanks for any info that anyone can give me I am at a loss..

    Posted by Roger | April 30, 2016, 2:10 pm
    • As you have already surmised, your experience is not the typical post-operative course. I am very sorry to hear that you haven’t received support or assistance from your surgeon.
      However, your PCP’s suggestion is an excellent one. A spine surgeon actually sounds like the best option – since he’s a specialist in nerves and bone (orthopedics and neurosurgery) which is what immediately came to mind as I read your message. I know that it sounds like it will take a lot of effort to get into see one, especially since you are so far away – but given your current quality of life, it doesn’t sound like you can go on like this. Not only that, but if it is something that can be fixed surgically, or otherwise, it’s better to do it before you have any additional muscle atrophy/ nerve damage or scar tissue formation. Please let me know why you find out – and I hope you find some relief!

      Posted by Kristin Eckland | May 2, 2016, 1:56 am
  18. I had thoracic surgery to remove a large tumor in 2013. It’s been 3 years, I’m 33 and I still experience high levels of pain at the chest tube site, as well as the scar area. The pain is heavy and tight feeling and is always present. It is sometimes worse, but I am always aware of the pain. It’s like I have to go about my normal activities every day feeling like I’ve been kicked by a horse. I have not found any medications or topical creams to be of any help, aside from Gabapentin which I did take for a year but stopped because I did not want to be dependant on the drug. While it did help for the pain, it did not completely relieve it.

    Posted by Jamie | June 19, 2016, 4:35 pm
    • Jaime,

      You might be a good candidate for a tens unit or a temporary nerve block. The tens unit is an alternative to medication. A temporary nerve block is a treatment that can give relief for weeks to months.

      Posted by Kristin Eckland | June 19, 2016, 5:25 pm
      • Thanks Kristin. I will bring it up to the doc on my next visit. Last he told me, the pain may never go away and I will in time just deal with it. I’m now pregnant as well, and worry the stretching will make the pain even worse.

        Posted by Jamie | June 19, 2016, 6:08 pm
      • I wish you the best of luck and a safe and uneventful pregnancy. I will post any new developments on pain management strategies here..

        Posted by Kristin Eckland | June 19, 2016, 11:25 pm
  19. I had a pleural effusion in January of this year. I had 3 drain tubes on 3 different occasions. The first obe spontaneously came out after 3 days. After a couple days they inserted a 2nd tube because CT still showed fluid build up. While they were inserting the tube I had tremendous pain in my left shoulder and neck. Doc stopped and repositioned the tube. I had this tube for close to 7 days. Then after removal I still had pain and shortness of breath so they took me in and drained the remainder and didn’t keep a drain in.
    I was in hospital close to a month. Today I still have consistent pain in my left side. It’s about a 5 most of the time but if I do anything strenuous I have more severe pain and have to take pain meds. Doc days I may have nerve damage and had ordered a chest X-ray
    Does this sound normal! If I lay on my left side the pain is worse.

    Posted by Nettie | July 14, 2016, 5:56 am
    • Nettie,
      It sounds like you had some nerve injury at the time of tube insertion – and (while rare) this can happen.

      A CXR won’t show nerve injury but it will rule out some other causes of your pain – like a re-accumulation of fluid. (Shoulder and neck pain in these types of scenarios – are often called “referred pain” – as you’ve experienced, meaning pain occurs in the shoulder / neck because of something inside the chest instead of an actual injury to the shoulder.)

      Physical therapy, lyrica and pain management strategies like a tens unit may help while the nerve heals.

      Posted by Kristin Eckland | July 15, 2016, 9:55 am
    • I had the same pleural effusion in April. In hospital for a week while my lung was cleared. All turned out well until about first of September when I developed a sensitive skin/ burning pain from my waist line to my knee on the same side as the surgery. My GP believes it is nerve damage that should heal. Why did it take 4 months to show up and my pain is about 5-6 and I am on Norco only 2 tabs a day. Does this sound normal like Nettie. Will this go away??

      Posted by Greg C | October 25, 2016, 4:54 am
      • Greg,

        In some patients, the “burning” or pins and needles type of pain does occur as a delayed presentation. The common theory is that this occurs as part of the healing process (and that this is in itself a sign of healing).
        But norco is not a good medication for this type of pain – which usually responds better to drugs like the gabapentin family which are specifically designed to modulate and decrease nerve irritation. For most people, this is a temporary situation, and will resolve over time.

        Posted by K Eckland | October 26, 2016, 2:21 am
      • K Eckland,
        Thank you for your quick response. Any guess how long this takes to heal? I am hesitant to take that medication since it is a anti depressant with numerous side effects.
        But living with what I describe as a very bad sunburn feeling on my leg, I am about ready to try it maybe only at night. Any added thoughts?
        Thanks,
        Greg

        Posted by Greg | October 26, 2016, 3:10 am
      • Greg,
        For most people, the neuropathic symptoms you describe resolve over several months to a year.
        The medication takes several weeks to work. I would suggest starting at the lowest dose to see if you have any side effects (and if they are tolerable). Most people only need to take it for 3 to 6 months before their symptoms subside (and these symptoms should not return after discontinuation of the medication.) If you have a history of depression or mental illness, I would be more cautious/ concerned about having psychiatric side effects – which are sometimes attributed to the drug working (i.e. suicide is often actualized by patients once the medication helps them overcome the incapacitation that may accompany severe depression.)
        However, have you discussed your concerns with the prescribing physician? They would be in best position to monitor you and titrate dosing.
        Does anything else relieve your symptoms? Do you have sleep apnea or other conditions which may worsen this condition?

        Posted by K Eckland | November 5, 2016, 9:20 pm
  20. Hello my father had a port put in the right side of his neck today. For to start his chemo treatment. He’s in alot of pain and they didn’t give him anything for pain. I love him so much he’s all I have now. I lost my mom to cancer in 2014. So I have a prescription for gabapentin 100mg. I hate seeing him go through this again after battling prostate cancer now bone cancer. Am I wrong for giving him one of my 💊 for his pain. And would it harm him?

    Posted by Marilyn Akins | July 19, 2016, 11:01 pm
  21. I had a median sternotomy to remove my thymus who h had grown to the size of a salad plate and had attached to my aorta. 4 months later I still have significant pain at the bottom of the scar. Also I have a sharp/numb/burning pain on the left side of my chest. As well as terrible pain when coughing or sneezing. I can’t lie flat without burning pain at the incision site. Also I seem extremely sensitive to heat, which I’ve had since the surgery. I have a very physical job and haven’t been able to return to work. I am in constant pain and am going broke fast with no income.

    Any suggestions would surely be welcome.

    Posted by Jason Stancil | July 30, 2016, 9:31 am
    • Mr. Stancil,

      Have you spoken to your surgeon about your symptoms?

      Posted by Kristin Eckland | August 2, 2016, 11:54 pm
      • My surgeon wasn’t in so I aw one of his partners. He prescribed neurontin. He said he believed I was having neuropathic nerve pain and this drug should help. However, when I picked it up from the pharmacy the pharmacist was explaining the drug he said to be careful taking it if I have kidney disease or other kidney issues. Well I was born with only one kidney so bow I’m concerned as to whether or not I should take this. All I want is for this pain to end and to be able to get a decent night’s sleep in my bed but as of now this seems like a long shot.

        Posted by Jason | August 6, 2016, 10:18 am
      • How is your baseline kidney function?

        Posted by Kristin Eckland | August 9, 2016, 2:47 am
  22. Hi,

    Firstly would like to congratulate you on a really useful and resourceful website.

    I had a spontaneous around 11 weeks ago, and after aspiration, a small drain, a large drain and then a large drain under suction, I had a bullectomy and pleurectomy by VATS. 2 weeks after the operation I was x-rayed by the local hospital, and the consultant (not a thoracic specialist) asked if I had had some lung removed as it looked like my diaphragm had risen by a few inches. I then saw my surgeon a week later who advised it was a build up of basal fluid sitting in the bottom of the lung from the surgery which is natural and would dissipate. Since then, the pain in that area has got a lot more intense which I initially put down to the nerves waking up, but I am actually swollen under the last rib and concerned the fluid is not draining and actually increasing. The area is very tender and is particularly painful (an 8 if pressed or laid on by mistake at night). I was initially told that I would be recovered and back to work 6 weeks after the op, but now 9 weeks later I am in more pain than after recovering from the op and being discharged. I have tried weening myself off of the codeine which was very painful, and the doctor actually prescribed me more codeine and a bottle of morphine and told me not to suffer – which I can appreciate but plays on my mind a bit after being on opiates for so long. My GP has again signed me off from work and sent me for a further x ray, but results not back yet. In the mean time I have spoken to the thoracic nurses who have requested a copy of the x ray (which my hospital cannot find apparently) for their opinion. The hospital tell me the fluid isn’t a problem and it will resolve itself, but it’s so painful even with the relief I am taking so obviously concerned and need to be getting back to the real world! Have you experienced any patients with similar symptoms before and if so is there anything I should be asking the hospital for in terms of tests or procedures to resolve? Thanks in advance.

    Posted by Ross Bell | August 8, 2016, 8:22 pm
    • Dear Mr. Bell,
      I am concerned about the fact you said you have actual swelling that is visible under your rib. This, combiined with the level of pain you are having should be further investigated. Ask to have another X-ray for the thoracic surgeon and his staff to review.

      An elevated diaphragm or a small amount of fluid, are indeed somewhat normal findings after surgery – and do usually resolve without treatment.

      Hope this information helps.

      Posted by Kristin Eckland | August 9, 2016, 2:50 am
      • Thanks for the reply. I have spoken to the thoracic nurse team this morning and they have reviewed a copy of the x ray taken a week ago. Although the fluid amount has not decreased from beginning of June, they are not concerned at this stage and suggest the pain is due to nerve damage or disturbance caused by the operation. They have suggested requesting a prescription for Pregabalin from my GP which I have done. Fingers crossed that will bring the pain down to a manageable level so I can return to work and the fluid will disperse in it’s own time.

        Posted by Ross Bell | August 9, 2016, 11:11 am
      • Dear Mr. Bell,

        Thank you for the follow up email. Don’t get discouraged if it takes several weeks for the medications to take full effect. Make sure you continue to use your incentive spirometer, cough/deep breathing exercises and exercise your arm and shoulder on the affected side. I hope your symptoms improve..

        Posted by Kristin Eckland | August 13, 2016, 1:24 am
  23. Hi I am a 47 year old woman who had no previous health issues but 11 weeks ago I was admitted into hospital with severe pain in my right chest and difficulty breathing. I was initially treated for a PE but after a CT scan it showed a spontaneous extra pleural haematoma – apparently very rare and pleural effusion. I wa in hospital for a few days and then monitored me for a month as an outpatient to see of it would naturally breakdown. I was on liquid morphine for the pain. Unfortunately after feeling better I woke up and again couldn’t breathe and they performed a needle fluid drain without pain relief and then admitted me to hospital for a general anaesthetic vats chest drain and tube. I have been feeling better each week apart from sneezing which really hurts, but the last few days I have been experiencing pain when I lift, push with with my right arm and I am in agony in my chest if my partner cuddles me and I lie on my right side. If I take a deep breath the area feels tight. Is this normal healing? Just worrying a little……….

    Posted by Sharon | August 14, 2016, 9:18 am
    • Have you been doing any sort of rehab after your VATS? Is this pain reproducible? (Meaning it always or almost always hurts if you move your arm a certain way?) is the pain only in your chest? Does it affect your arm/ or shoulder?

      Posted by Kristin Eckland | August 16, 2016, 11:36 pm
  24. I had thoracic surgery on my right side in Jan to repair a diaphramic hernia , my liver had moved up through the hole and was attached to my lung . I have been experiencing tightness in my chest ( feel like I am being squeezed ) also pain in my back on the right side . If I extend my right arm a certain way I have difficultly moving it back , it almost feels like I slightly dislocate it as I have a strange sensation when a bring it back . Also were I had the chest tone incision feels sore still . I have had follow up rays and and CT scan and everything looks fine .. Will these symptoms eventually go away , I have read that I could see improvements up to 2 years after surgery is this reasonable to expect ?

    Posted by Heather | August 25, 2016, 6:26 pm
  25. I had a pluerectomy in April 2015 and for the last 6 weeks or so I have pain in my left arm and pins and needles in my hand a lot! Not sure if this is normal as they told me 18 months to recover

    Posted by Pat | January 5, 2017, 4:38 pm
  26. Hi Kristin,

    After reading all the questions here and the awful illness people have experienced, i almost feel like an imposter asking these questons. However, i am in awe of your knowledge and experience and hope that you dont mind me posting.i had a complete midsaft transverse break to my left humerus 6 years ago. After 3 unsuccessful operations, where the plates lifted completely and total non union, i was eventually referred to an upper limb specialist!! My new consultant pondered for a year regarding the best way to proceed with what would hopefully be an end to the non union . He brought an excellent plastic surgeon to the team and i had lateral thoracic on the left side with a 1 full rib removed with all the surrounding tissue, that was then transfered to my left humerus. This was done in order to provide a new blood supply to my arm. I had this op at the end of 2015, with follow up surgery 3 months ago, to improve the scar on the side of my body and take away excess tissue in the my arm. The rib and the plate remains. Thankfully my arm has healed, however i have been in extreme pain from where the rib was removed last year. I just assumed that this was normal, and it would go away.
    I spoke with both of my surgeons and before the last op a nerve blocker was put into my chest, it was amazing, i was pain free, but it only lasted 10 days.i am currently waiting on an appointment for a pain management team. I am super fustrateted now, i just want my life back. 6 years is a long time ! I am trying to do more, but the more i do, the more it hurts. I have been out of work for the last year. I am really good at coping with pain , but this is just not normal. It starts just under my left breast and travels all the way up my back on left side. It burns, feels like my skin is tearing. I honestly dont know how we all don’t have 6 packs, i never realised how much we use our core lol …….. currently i am using a combination of tramdol, 1 a day, i dont like it. Also 1 amatriptine 25ml per night …..but its doing nothing either. Will this ever go away or am i facing life long medications?
    Thanks in advance

    Posted by Michelle | January 12, 2017, 2:08 am
    • Michelle,

      As frustrating as it sounds – I have no easy answer for you. It sure sounds like you have experienced a lot – six years of pain is a lot of suffering!
      I am so sorry that you have had this experience.
      It sounds like you are already seeing the right specialists to get your pain under control – but it may be a long term problem. Medication-wise, you aren’t on a lot of medications (one tramadol and one other medication) – which is re-assuring. It’s also re-assuring that the block worked – even if it didn’t last very long. Stay patient and hopeful until you see the pain specialist – I wish you the best of luck, and I am sorry I can not offer you more concrete solutions.

      Posted by K Eckland | January 12, 2017, 8:46 pm
  27. Hi Kristin,
    Thank you so much for responding. You truly are a wonderful, sensitive and kind person. Oh I am so pleased to hear that it’s a good sign the injection worked, even if it was only temporary, it gives me hope it’s treatable. It’s been a tough few years, but I’m positive, just thrilled my arm is finally fixed. I have deliberately tried to manage the pain, by limiting excessive stress on my body, but continuing to move, and keep my head busy, I knit and bead. After my 3rd op, my radial nerve was damaged, so I lost the use of my hand for 7 weeks. That was terrifying. Honestly, keeping your mental health strong is so important, I find Doctor don’t factor that in. I miss the gym though 🙂 the human body is truly amazing. Medication frightens me! Just one more question, have you ever heard of a rib being used in an arm? I have found information on mandible reconstruction, but never used in this way. Thanks so much, have a great weekend

    Posted by Michelle | January 13, 2017, 9:00 am
    • Michelle,

      I am glad to hear that you can knit and bead – and that your fine motor control has been restored!!! I don’t know much about the procedure you had – since it’s primarily an orthopedic procedure (and outside of my specialty training). We generally did rib resections for different reasons (like tumors).
      But in theory, a rib would have major advantages over traditional hardware, particularly as it is less likely to get infected. (Infected hardware is a nightmare – and sometimes results in multiple repeated surgeries or even, in severe cases, sepsis or amputation.

      Keep your spirits up – keep beading and knitting. I will keep you in my thoughts and wish you the best of luck and a speed(ier) recovery in the future.

      Posted by K Eckland | January 15, 2017, 4:58 pm
  28. What’s causes severe swelling and hardness around the area where tube was inserted.

    Posted by Bonnie. Williams | February 15, 2017, 6:47 pm
    • In many cases, that is the normal inflammatory response (part of the body’s healing process). This can last from days to weeks. If you are concerned about an incision, please contact your surgeon.

      Posted by K Eckland | February 15, 2017, 8:32 pm
      • I had Thoracic surgery on February 2017 to remove a thymoma. 3 cuts around rt breast to remove the tumor, had to have a partial resection of th lung, and two chest tubes had to be place for drainage; the pain was excruciating, now after 10 weeks the pain gotten better, but still have pain. Have developed a air leak th lung that caused atelectasis,I don’t have an idea how long the lung is going to take to fully heal.

        Posted by Alma Munoz | April 28, 2017, 5:29 am
  29. Hi

    My husband underwent a chest wall resection last year to remove a tumour from his lung. He is still in the worst pain ever and is getting no relief at all. He went to see a pain specialist and he gave him nothing, said he just needs to cope with the pain. He’s taking over the counter pain relief such as Nurofen, Paracetamol and Solphadine but at different times and they really dont help much. Unfortunately my husband has had to have another round of treatment as they feel the disease has come back. He was diagnosed with Sarcoma that spread from his thyroid to his lungs as he was mis-diagnosed. I am desparate to find some alternative information as he isnt getting great medical support for the pain. He has a really bad cough, so everytime he coughs it hurts his back/shoulder and is stuck in a vicious circle. He’s been crying his eyes out tonight saying he cant cope anymore. Please if there is anyone that can offer any advice we’d be so grateful to hear it.

    Many thanks

    Posted by Alison | May 1, 2017, 10:08 pm
  30. I had thoracic surgery in December 2016 and still in chronic pain in my ribs on my right side where I had surgery. All I keep being told is it’s part of the side affects of my operation. Is there anyone else experiencing the same symptoms please.

    Posted by Mark wood | June 4, 2017, 9:23 am
  31. I had a large non symptomatic cyst attached to my esophogus and I had thoracic robotic surgery. They went in through my right rib area…the surgery was November 2016. I am still in agonizing pain..on oxycodone and gabapentin. I have nerve damage. I am 43 years old and I do not know what I should do…I am tired, scared and so madd this happened. Everyone is sick of hearing me say how much pain I am in so I just lie and say I’m fine. I have not made it a full week of work since the surgery, thank god I have a great employer. I have had injections, but they are costly and I have to pay down my bill first before I can get another one. I just needed to vent and if sombody may be in the same situation as me has another solution for pain relief they could let me know. thank you for listening!

    Posted by Tara Boyle | July 14, 2017, 8:05 pm
  32. i’ve been undergo to VATS surgery, the procedure is the removal of the bleb on my lungs. It is 2 month ago. I am suffering tightness of my neck which made me hard to breath, and i have this pain like stabbing my back and my chest. The wound of insertion of tube is already healed but it has pain sometimes, is it normal or do i need to have a check up?

    Posted by Julane mae | July 31, 2017, 9:53 am

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