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U.K. Pneumothorax Experience: 50 Year Old Male

I am a fifty-year-old male and my work involves organising and delivering training for public sector managers and supervisors. I was running a seminar with a small group of managers at a town-centre venue about 12 miles from my office. Shortly after the coffee break I became aware of a subtle change in my breathing and a mild discomfort in my windpipe. I noticed that I had an urge to cough but when I tried to there was "nothing there". Although these sensations were a little strange and mildly alarming they were not painful or debilitating enough to prevent me from continuing with the seminar which ended about an hour later.

On leaving the building I was alarmed to find that as I walked up the hill toward my car I was having some difficulty breathing in, and felt a growing tightness across the front of my chest. By the time I reached the car I knew that there was something fairly seriously wrong and when I attempted to get into the car I felt sharp pains in my sides just above my waist.

By now my main thought was that I might be having a heart attack or stroke or something, so I was reluctant to start driving anywhere. But resting beside the car for a few moments I rapidly felt better. I decided to walk toward the town centre where I remembered there was a pharmacy. This time the walk was downhill and although the breathlessness and other sensations returned, I found that the symptoms quickly eased as soon as I stopped walking. I spent some time alternately walking and resting - each time I rested feeling increasingly confident that I was not in fact having a heart attack but that there was something wrong with my breathing. I decided to abandon the idea of visiting the pharmacy and to risk driving home.

The twenty minute drive was uneventful, but my breathing still didn't feel right. On arriving home I bent down to pick up some mail from the doormat and again felt sharp stabbing pains in my sides. I sat on the sofa and immediately felt drowsy and I think I slept for a short time before I eventually phoned my doctor's surgery. As soon as I mentioned chest pains and difficulty breathing the doctor was paged. When he phoned me and I described the symptoms again he told me that because he was unable to get to me immediately himself he was obliged to call an ambulance to take me to the local A&E dept.
En route, the paramedics ran their standard checks, concentrating on my heart and cardiovascular system. But they seemed puzzled. Everything seemed OK. Having been a dedicated cigarette smoker for over thirty years I was terrified. I wasn't having a heart attack, but I knew something was seriously wrong with my breathing. What could it be?

Soon, my wife joined me at the hospital and we waited for the results of my chest x-ray. A cheerful man we hadn't seen before suddenly appeared. Grey hair and suit. A consultant, we assumed.
"Mr Boyle?"
"Have you had problems with your lungs in the past?"
"What, none at all?"
"Are you quite sure?"
"Yes" (and all the time I'm thinking "but doctor I have smoked hundreds of thousands of cigarettes so I realise I probably have got a problem with my lungs???.")
With a knowing look, the consultant turned to the junior doctor.
"His x-ray's just come back. Take a look!".
What the hell did that mean? Clearly something significant had been found.
I was scared. Soon the doctor was showing us the x-ray so we could see for ourselves.
"You see here on this side? - all those sort of white whispy shapes?"
"Well, that's the lung. Now look at the other side. It's all black, there's nothing there!"
It was true. On the right there was just a black space. No lung. So that's it? I've survived all these years with only one lung?
"No. Your lung has collapsed."
Later I learned more accurately that I had suffered a spontaneous pneumothorax on the right side. It would be necessary for me to be admitted for treatment to remove the trapped air in my chest cavity so as to allow the lung to re-inflate as spontaneously as it had collapsed.

The treatment involved having one end of a length of plastic tubing inserted into my chest cavity between the ribs about 8 inches below my right armpit. Even with morphine this was painful. The other end of the tube went into a clear plastic box containing water. This operated as a valve, allowing air to escape via the tube but not to return that way. With the benefit of this apparatus my lung would be able to gradually reflate and resume its rightful size and shape within the chest cavity.

At the ward round on day four, bubbles were still visible in the valve, indicating that full re-expansion of the lung had yet to be achieved. It was considered to be taking too long, and there was alarming talk of sending me to London for surgery if there wasn't a resolution soon. This prospect upset me a lot. However, as a last resort, it was decided to encourage things along a bit by applying suction to the tube. I was duly connected to what looked like a small central heating pump on the wall beside my bed.

Two things surprised me about this: (1) it didn't hurt, and (2) it worked! Within 24hrs I was gritting my teeth as the tube was pulled out. X-rays had shown that the lung was fully re-expanded, minus about 5% which I was assured would gradually be absorbed naturally over the next few days. This all seemed pretty satisfactory. I'd now been in hospital a little longer than originally expected and I looked forward to being discharged a.s.a.p.

But this wasn't to be. Unfortunately, the chest tube wound had, I was told, become infected. Enormous syringes full of antibiotic fluid were pumped into my arm at frequent intervals over the next three days with the aim of seeing the infection off pronto. It certainly seemed to be working, and each day I felt a little better, enjoying the freedom of movement the chest-tube had prevented for the best part of week.

Then, at about midday on day nine the charge nurse came to see me with unexpected news. Test results had shown that the hole in my back was infected with a methicillin resistant germ known in the trade as MRSA - a bacterium called stephylococcus aureus which, according to the Patient Information Leaflet I was given, is resistant to 'the more commonly used antibiotics'.

This discovery precipitated major changes to my care and treatment. I was moved immediately to a single room (for the protection of other patients, most of whom were, unlike me, quite seriously ill). The antibiotics - now known to be useless - were stopped. Surgeons were brought in to advise on the management of the infection; a microbiologist was consulted and the infection control nurse dropped by. I had a colostomy bag attached to my back to catch the pus now being produced in large quantities by the encounter between MRSA and my bloodstream. Fingers were crossed as everyone waited to see if I would survive the infection unaided.

Well, I did get steadily better, and on day thirteen I was pronounced fit to go home, the wound having healed sufficiently to be handed over to Sue to manage - with technical support and weekly visits from the district nursing service. Later that day I was discharged.

I spent the next six weeks gradually recovering from what was. I think, a pretty close encounter. Had my body's natural defences not been up to the task of defeating this invasion unaided my chest and/or lungs could have become infected with the 'superbug'. To prevent or treat such a spread of the infection would I was told, have involved the use of particularly potent specialist antibiotics with "very unpleasant side-effects". Sometimes people die as a consequence of MRSA infection. Fortunately perhaps, I didn't know this at the time I was dealing with mine.

Tomorrow I'm back to work having added a couple of weeks holiday to my official sick leave. I feel fully recovered now, nine weeks after the original blow-out.

I have found that people are often interested in understanding the collapsed lung phenomenon. I guess it sounds fairly serious and a bit scary, and I've noticed that people usually assume that it must therefore have been caused by trauma, illness or stress of some kind. So people often want to know "how did it happen?" or "what causes it?".

Using the internet, I have discovered a lot about spontaneous pneumothorax, it's treatment, and other people's experiences of it (many of them much worse than mine). It turns out that anyone can get a collapsed lung anytime. You don't have to be ill, or have some pre-existing causal defect or condition. Your lung, it seems, can just blow. However, some types of people are much more likely to experience a spontaneous pneumothorax than others.