Pneumothorax

How it started

I woke up on a Sunday of a 4-day weekend at around 8:30 am. Lied in bed for about an hour before getting up. Everything felt normal still. Shortly after realized my morning grogginess was gone but I had shortness of breath and pain in my right chest. I though I must’ve done something wrong in my sleep, as I recall twisting my back a bit awkwardly while sleeping on my right side.

I ignored it, making oatmeal for breakfast and browsing the internet. I googled “pain in right chest after sleeping”. Went through a couple sites, but couldn’t really figure out what it was.. The pain was moderate, maybe a 5 on a scale from 1-10. I could live with it for no issues for a couple hours, but it would be really worrisome if it lasted for more than an hour or so. Thus, after about an an hour, I went to bed to see if it would get better from lying down. It hurt so much more when lying on my back! It was like a 6, but across my entire right backside of my chest. I tried lying on my left side for a few minutes. This was alright, but there was pain on the most bottom right side of my lung/chest area. I got up and tried stretching a bit. I even tried hanging from my pull-up bar for a few seconds sometime this morning, which oddly didn’t increase or decrease my chest pain much.

I told my older sister over Facebook Messenger of my pain. She said it could be a heart attack! Well, it was on the other side of my heart..but who knows.. And it’s been going on for an hour..but..again.. who knows. The pain wasn’t going away at all, so I continued googling. Some site didn’t, but most sites said to get medical attention immediately since chest pain could be a symptom for urgent medical conditions. I decided to go to an urgent care since I had plans to volunteer at a park cleanup and go biking this weekend. If it was something minor, I would have peace of mind. If it was something major, then it’d turn out to be very good I went to get evaluated.

Urgent Care

There are 2 urgent cares within 1 mile from apartment. I called the slightly closer one, and they said they were open shortened hours since it was Easter Sunday. I drove over and was about to go in. I realized the other urgent care was only a 2 minute drive away, so I checked the reviews for them, which were relatively close, 4.0/5 for the one I was parked outside of, and 4.2/5 for the other. I gave them both a call to ask if they would be able to help me with chest pain. The one I was parked at told me I had to go to the ER for chest pain! The other one said they couldn’t do much but could have an EKG to check my heart. It made sense to just go to the urgent care that’d at least take a look.

There were 2 people in the lobby waiting, but I was brought to the back within a few minutes to have my vitals checked. All seemed good. The staff and doctor came and talked with me, and had me get an X-ray of my chest. After my X-ray, I swear I heard the doctor, who was probably around 60 years old, say, “Oh Sh*&”. Then, a minute later, she came into my room with a worried look and said something along the lines of “it’s not good”. Apparently she was suspicious that I might have a pneumothorax (collapsed lung), and confirmed it after looking at the X-ray. She said if I was less healthy and elderly like her, this severity of a pneumothorax would have me doubled over. I was pretty nervous now. The urgent care called the ambulance and took me to a nearby hospital. First time riding in an ambulance. Unfortunate since I drove my car to the urgent care, and now have to take an expensive ride to the ER. Oh well, I understand it’s a lot safer this way.

Emergency Room

The ER quickly took me in. The resident doctor showed me an ultrasound of my chest, while we waited for an X-ray to be done since both they or I didn’t have the X-ray from the urgent care. The gel used for the ultrasound was pretty smooth and cool on my skin. He tried to explain what we were seeing on the screen, but I didn’t really understand what I was seeing. After the X-ray, the doctor said that I had a really bad pneumothorax. I asked, “Like really bad?” He replied, “Yes, it’s really bad.” He explained to me that I needed it to be drained with a chest tube. I asked if I could get a copy of the X-ray, so he brought a monitor in and let me take a picture.

I was pretty nervous and scared since the doctor said it is really uncomfortable/painful to have the tube pushed into me. My shaking stopped as soon as they gave me some medication intravenously. I think they said it was Dilaudid, some form of Morphine. They pressed pretty hard into the side of my chest, but the pain only peaked around an 8 for very short periods. The tube was put on intermittent suction while I waited in the ER patient room before being moved to my hospital room.

Hospital Room

After being moved to my room, the nurse left the water seal with no active suction. I asked the nurse if I should be on suction, but she said the order on their system said that I just needed a water seal and no suction. I was hoping I could be discharged the next day, Monday. I was told after 24 hours, if I was good, they would clamp the tube for 6 hours. If everything was still good, then they would remove the tube, and I’d be discharged!

I had an X-ray done in the morning the next day. Aftewards, a PA came in and said my X-ray showed my lung collapsed a bit again. What?? Apparently, I was supposed to be on active suction the whole time. There had been 2 nurse changes already. Each nurse just listened to the previous nurse’s instructions as far the water seal and suction was concerned. The PA looked at the order on their system, and showed the nurse where it said I needed to be on suction. Wow. I even asked specifically the previous day!

The PA said I should be on suction for 24 hours, showing good progress, before they could move onto clamping the tube for 6 hours. I thought I could be discharged after just one night. Instead. I stayed from Sunday until Thursday. I stayed on suction for 2 nights since my lung wasn’t completely reinflated even with suction. Then, they clamped the tube at 3pm Wednesday. My X-ray wouldn’t be until 9pm, so I’d have to wait overnight before I could get the tube removed if the X-ray was good. I learned that hospitals can make mistakes, and they move slowly delaying many things.

Fun things included eating lots of food even though I wasn’t hungry, reasons including I wanted to heal faster, I got dizzy and nauseous once and my blood pressure dropped to 80/44 after not eating almost the entire first day, and it was ‘free’.

Because I was not active (sitting in bed most of the time), I was given blood thinners and wore a scd in bed. The sequential compression device (scd) was a nice message most of the time.

I got Norco for pain, which apparently can make you constipated. Along with the fact I wasn’t moving much, they gave me stool softeners. Unfortunately, on Wednesday, I pooped a lot and clogged the toilet. I thought my first flush had gone through enough and tried a second flush. However, I miscalculated and a tiny bit of water spilled over. It was quite embarrassing having to call the nurse and have someone clean it up. I know better now though to be more careful with toilets, haha.

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Healing

After the tube was removed, the PA put vaseline gauze on the wound. I was to keep it on for 2 days. After which, I can have it removed and shower. I was told there would be a hole and some fluid leakage such as blood or clear liquid. However, my wound was basically closed. Hopefully this isn’t an issue. The pain was basically completely gone once the tube as removed. I just need to be careful while it completely heals up in the following weeks!

Possible Causes

As far as prevention, all the doctors and nurses I talked with said it was just spontaneous. Nothing I could have done to prevent it or to reduce the chance of recurrence. However, the urgent care doctor said it could be my run the previous day. However, she misheard me and thought I ran the previous evening, when I actually ran the previous morning, and felt fine the whole day. I twas only for 15 minutes and I didn’t push myself very hard.

The attending physician at the hospital (or someone else I don’t remember who) said some people think it can be related to a growth spurt where the lung cant keep up with your chest. This actually strikes a chord with me. I used to only be able to do 0 pull-ups before college, and 1 pull-up during college. Starting about 3 months ago, I’ve been doing pull-ups consistently, and have gone from 2 to 5 pull-ups. My upper body is scrawny. Doing about 100 pull-ups in about 24 out of the last 80 days hopefully did help with my upper body. Though, it could have been another factor that led to my pneumothorax.

My uncle is also tall and skinny. Probably 3 inches shorter than me, but the same height to width ratio as me. He apparently had a pneumothorax when he was 16 after doing some chest exercises with bands. It must have been a partial collapse, as he was just put on oxygen for about 2 weeks to let it heal without other interventions. He said he stopped doing strenuous exercises, such as the bands he used, or swimming/basketball which requires heavy amounts of breathing. He hasn’t had another pneumothorax afterwards. This sounds like a safe strategy. However, too conservative for my current lifestyle. I can’t imagine giving up working out (pull-ups and push-ups), or biking and running. However, I will definitely hold off on these types of activities for at least a 2 months to ensure I am healed, even if I feel better.

Future Preventative Measures

Smoking: I don’t smoke or use any recreational drugs, so that’s not a path I can take to reduce my risk.

Diving: I don’t dive.

Plane flights: I can’t realistically avoid flights.

Holding a deep breath and bracing: I can try not to? Not sure when that happens. Maybe poor breathing technique in weight lifting.

Growth spurt: Some sources I’ve found say that growth spurts can increase the chance of having blebs, which can result in a pneumothorax when ruptured. Maybe avoiding sudden bouts of rapid upper body training in case this causes growth of some sort in my skeletal structure. Probably will try to stay on the safe side until I’m 25.

Not being a skinny and tall male in his 20s: Pneumothoraces are very common in men who are skinny, tall, and in their 20s. Not much I can do about these besides waiting to get older, and bulking up (slowly).

I will probably very gradually pick up my exercise intensity after 2 months. I also have a flight in 3 months during July 4th week to LA. I definitely want to be healed by then and hopefully not have a recurrence!

Hospital Bed Thoughts

While stuck in the hospital, I thought about how I try pretty hard to eat healthy, exercise, and be healthy in general. Yet I was stuck in the hospital!

First, I wish, and am quite sure, there will be advancements in medical care. Less nurse mistakes, quicker recovery, and less pain at hospitals. But this is mostly out of my control. I greatly admire everyone in the medical field and really appreciate all their hard work.

Accident rates can be decreased with technology as standard of living and safety increases worldwide. Diseases/illnesses can also be better understood to prevent them. Even so, I can still fall ill. Living in the present may be a good idea. Save a bit less, spend a bit more, since I may die any day. Has my youth invincibility faded? Well, I still want to try lots of interesting things in life, but maybe my perspective on life changed just a tiny bit.