Sunday, January 12, 2014

It's all getting a little bit technical . . . (A picture of my lungs).

So now for the scientific bit. I often write about thoughts, feelings and expectations of having a lung transplant, but not too often of the actual operation, what it involves and the difficulties I face during and post operation. There are some graphic pictures in this update, so I apologise for that - that's a warning! So here it goes, time to get slightly medical, slightly scientificy.
Firstly, lets take a look at my lungs. As you can see from the picture below, they aren't the best and a lung transplant probably isn't a bad idea. My right lung has completely collapsed. It collapsed last May. It wasn't a pneumothorax (a type of lung collapse), it just died due to being rubbish and filled with infected mucus. I was quite fortunate in the sense it wasn't a pneumothorax, as they can be quite sudden and scary. My lung did collapse over a weekend, but I just experienced a backache and slight shortness of breath, it had little affect on my ability to get about. In fact I think it had collapsed for at least two days before I decided to go to hospital. I like to think my lack of urgency to get to hospital demonstrated my strength and ability to handle pain and suffering, however, it may just display my stupidity and foolishness. Either way I had a lung collapse. My lung had been 'shrinking' for the previous year, the lower lobe on the right side had disappeared and so there was evidence that my lung was slipping in that direction. In fact it was the shrinkage, along with kidney failure and a few other factors that I believe made the Newcastle Transplant team speed up the lung transplant assessment process and see me, ultimately accepting onto the transplant list.
Anyway, back to my x-ray (the one on the right). As you can see the whole right side has gone, so there is no functioning lung there. Since the lung collapsed my heart has moved over, as has my windpipe. When this first occurred there was a little concern that it could affect transplant. However, the transplant team at Newcastle are known for transplanting difficult cases and so apparently they weren't too bothered. Not to say mine is difficult, but the degree of difficulty isn't beyond them and that's the important and exciting thing. However, the fact my lung has collapsed will probably make the operation a little longer, a little tougher. They guestimate the operation should take between 8-12 hours, so it's a long one. I'll be out of it, so tougher for those around me. Usually I ask for my music to be played while I'm in theatre (I think I had 'Admiral Fallow' last time, check them out), but then I'm usually awake and so no need this time. Without doubt my right lung is the ruined one, the good one isn't great, quite a bit of shadowing lower left, and mid left. For those of you learning here, I should inform you that your right lung has three lobes (sections), whereas your left lung has two lobes.
So the plan is to take out my two lungs and stick in some new ones from a very generous, kind and thoughtful person. I often get asked 'so when is your transplant?'. To those in the know that is the most stupid question in the world. A lung transplant can't be planned, you are waiting for the someone with the right match to die. There can be no knowing when that will be, who that person will be or if it will ever happen and therefore you can never know when your transplant will be. Obviously you need someone else's lungs and that other person can't survive without their lungs, so logically you are waiting for the sad and unexpected death of someone else. In recent times I actually had a Dr (Consultant) ask me when I was expecting my transplant. I was astounded! Not a respiratory Consultant, not that I think that's an excuse. 
Anyway, as I said, they are going to take my two lungs out, this is called a Double lung transplant/Single Sequential Lung Transplant. They are taking both lungs leaving in a an infected lung would only infect and kill the new lung.  I'm now going to quote from the wee booklet they give you to help those who are going through the transplant process,
'If you have infective lung disease and your heart is healthy, it is possible to transplant two lungs while keeping your own heart. The wound will stretch across your chest below both breasts. Although the nerve supply to both new lungs is cut, your windpipe will still be able to send messages to your brain to make you cough'.
So the good thing is I have a good heart and I get to keep it. It's better to transplant just the lungs, while potentially a slightly harder operation to perform than heart and lungs together, post-transplant you are in a better position because there are less organs to reject and therefore less risk afterwards.
So for that incision. In the past they would cut you down the middle, however now they cut you underneath both breasts and perform a 'clamshell incision'.  This will be what I'll be going through. The thought of this is scary, scary beyond belief. I'm quite good at dealing with all the medical procedures I've had, bronchoscopy, hernia, portacath insertion, chest embolisation, the list goes on , but this is beyond comprehension. This is something I don't even want to think about, something I can't think about, certainly something I prefer not to dwell on, as the picture below will one day be me. Now....this is a very graphic photo, so stop reading now if you are eating.
Well....if you're still reading, thank you for sticking with it. Did you notice the lack of lungs? I'm going to reward you with an even better picture, one that will blow your mind further. While still blowing your mind and being graphic, it won't be as graphic as the above photo and hopefully will just interest you rather than make you feel queasy. This is a wee video about ex-vivo lungs. I know what you're thinking, 'what are ex-vivo lungs?'. As I'm sure you know there is a shortage of organ donors, only 50% of those waiting for lungs are ever fortunate enough to receive them. Lungs are particularly low in terms of numbers transplanted. Often lungs can have slight damage or not be deemed fully up to the level required for transplant, but in very recent years (still in a trial basis) they have created a procedure whereby they can make some lungs previously deemed not suitable for transplant, suitable for transplant. What they do is they put the lungs in a box and then put a solution through the lungs that cleans them, freshens them up. I know, I've not described it in a particularly scientific manner, but ultimately that's what happens. It is a procedure that they expect will increase the number of lung transplants they perform and therefore save more lives. As I said, it's still in a trial basis in the UK, but the results are so far positive.
So I have explained why they have to take two lungs, why I keep my heart and how they'll open me up and what it will look like. You've also learned about 'ex-vivo' lungs. The ultimate aim is to have an x-ray like the one I showed earlier on the left hand side. Now for your final video. These could be my lungs before they go inside me. Oh . . before you look at it, I should point out that little of what I write is 'scientific', just my understanding of procedures. No doubt I've poorly explained things or assessed my x-rays poorly. Now look at this magic video.



Jac said...

excellent explanations :-) I enjoyed that! Dr MacG showed me my before and after lung CT once - very cool. Hopefully you will have boring normal lungs soon xx

Karen Gates said...

Thank you for that information.. I'm going to be going on the list next week after my review (no doubt about it!) your explanation of ex-vivo was enlightening.. the pic of the open torso not so nice, but I won't see that side of it so it's ok!!