Pleurodesis for Pleural Effusion

In mid January I was suffering from the worst case of bronchitis known to mankind and when the antibiotic prescribed just wasn't getting me better fast enough, my doctor ordered a chest x-ray showing a large amount of fluid had built up on my right lung. Was sent for a CT scan that very day and was told lung nodules were seen on the right lung as well. Referred to a pulmonary specialist who ordered the fluid drained and tested. The 1200 cc's of fluid drained was found to contain malignant cells and I was referred to an oncologist at our local Vince Lombardi Cancer Clinic affiliated with St. Lukes in Milwaukee for further evaluation. A PET scan confirmed lung cancer - largest nodule 2.5 cm. Was sent to a oncology gynecologist to confirm no breast or ovarian involvement. A med-a-port was installed and a second fluid drain done of 1500 cc's the day before chemo treatments of Taxotere and Carpboplatin were scheduled to begin. Three weeks later had second round and was scheduled for my third treatment on April 5 but unfortunately the pleural fluid has returned (verified by x-ray) and I can barely breath again. Chemo has been cancelled and I am now scheduled to have a pleurodesis done on the 5th instead.

Needless to say I am scared about this operation but my oncologist feels it is the best way to stop this fluid from coming back so I can breath and have some quality of life while dealing with the side effects of chemo and fighting for my life. Right now it's all I can do to walk up the steps to go to bed at night without huffing and puffing and no matter how this ends up, it would be nice to be able to work in my flower garden and take my dogs for a walk again. I can do that with my bald head and the other ugly things that you have to deal with on chemo but not if I can't breath.

Can anyone who had this done tell me about their experience? My thorasic surgeon explained the procedure very well and is highly regarded in his field so I trust the surgery will go well - God willing - but I'd like to know about the recovery from the time you woke up following the operation until you were out of the hospital and strong enough to return to your treatment programs. Discomfort level, length of discomfort, was it successful, any after effects, etc.

I will be grateful for any info you can share. Information is power and helps get me past the anxiety of the unknown.

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Carol, it sounds like your doctors are being very proactive and it sounds like you are in good hands.
It sounds so routine in your case but I had to force the issue for my wife's pleurodesis. Is it because you are with a clinic that has a Team that work together??
You and my wife's case sound similar. She went to Emergency with shortness of breath because she had fluid in the pleura space. It was tapped and dx with NSCLC. She was stg IV.
Some months went by before the fluid started rapidly coming back and she had 2 more taps.
The amounts were about the same as yours and it was the color or strong tea.
After a CT scan showed the fluid filling up the space again I got the pumonologist to do the Pleurodesis in a recovery room at the hospital.
The doctor used SiIver Nitrate as the irritation agent to cause the pleura space between lung and chest to close up. His report said he used Silver Nitrate because in her case would be less complications. It is the oldest of the agents. What will your doctor use? I would be interrested to hear what he has to say about Silver Nitrate.
My wife is very small 4' 8" and 90lbs and her rib spaces are probably smaller than yours.
You probably won't have anything to worry about.
They gave her a shot of something that made her aware of what was going on during the procedure but later she couldn't remember anything.
I'm sure they have given you all the details of how they roll you arround to spread out the injected agent. The discomfort is the 1/2 in hose stuck in your side. It's hard to get arround in the hospital room with all that drainage tubing and collection box but you can do it.
They stick the hose in and drain the fluid. They wait for your lung to open back up and the fluid to slow down. The time for that depends on how rigid you lung has become.They inject the agent and clamp the hose and you roll arround with the nurse assisting. They un clamp the hose. When the drainage has slowed to a certain amount they remove the hose and put a big bandage over the hole. The wound heals from the inside out which is pretty remarkable. My wife was in hospital for 10 day (normally 7 days). The extra time was because it took longer for her lung to expand. They take daily CXRs or CT scans to check the lung expansion.
In the end the pleurodesis was a success and it was the turning point in her recovery. Without the procedure she would not have survived. Her oncologist and Pumonologist are both amazed at her recovery. She didn't have any problems with the pleurodesis and she breathe much better. She still used O2 for a few weeks. I guess the lung was healing.
Take care of yourself - Chanwit

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Thank you for the info Chanwit. My surgeon explained the procedure a little differently than your wife's experience. I will be under general anesthetic in the operating room where he will insert a tube and drain the fluid. He will then insert a camera through the tube to visually inspect the pleural area for any remaining fluid or pockets of fluid that may have formed from the 2 fluid drains already done. Once satisfied that all the fluid is removed, he will "buff" the lung (not sure what that means - sounds horrible doesn't it?) and then spray a a mixture of talc (and something else I can't remember the name of) into the pleural cavity until all areas are covered checked again by his magic camera. I'm not sure what happens after that but he told me the whole procedure takes about 1 hour and involves only a 3 to 4 day hospital stay if everything goes the way it supposed to.

He quoted the statistical success rate at 85 to 90 percent. I asked him what his success rate was and he told me he has done 3 of these so far this year with 100% success. He added that he does many of these a year and feels his percentage of success is higher. I guess alot of that depends on the skill of the surgeon and the condition of the person. I'm very fortunate in that I don't have any other chronic conditions going on that I'm aware of like heart disease or asthma, etc. and my general healh is fine except for this surprise diagnosis of cancer from out of nowhere so I am expecting excellent results so I can get back to my chemo and my fight to beat this thing.

He didn't say anything about leaving in a drain tube or lung expansion but he did say that the "buffing" will aid in starting the irritation process very quickly. I would think a drain tube would need to be in for a while until they are sure nothing is draining and the areas are sealing well. I think I'll call his office on Monday and ask his nurse about the lung expansion part. He told me that I would need to be monitored for any possibile infection or allergic reactions and of course all of the other scarey stuff that they always tell you could happen whenever you have any king of anesthetic or surgery, but he made it sound like lung expansion happens in the operating room. I could be way off track. It's been a tough week and a lot of info to remember. I only hope and pray that I can hang in there until Thursday. This is one kind of fluid a person can't control and it's getting pretty uncomfortable. I would hope the surgeon would have scheduled this sooner if he was concerned that it would continue to build up until it runs out room and deflates the lung before Thursday. He's the pro and I've been told by people that I really respect that he is an excellent doctor and we are lucky to have him in our community.

Did your wife have a lot of pain and discomfort following the procedure? No doctor ever wants to talk about that - they just keep telling you pain medication will given to make sure you're comfortable.

Also, could you tell me more about her treatment plan - your reply sounds like she has battled the beast and won and I'd really like to know more if she doesn't mind. My oncologist hasn't put a stage on my cancer but it doesn't take a rocket scientist to know it's either a IIIB or IV because of the malignant pleural fluid.

Oh, and just one more positive piece of info - while reading up on this procedure on one of the various reliable cancer sites, it very clearly stated that a pleurodesis for malignant pleural effusion is recommended only if there is a good survival prognosis. Guess that means my doctor is in my corner and plans on keeping me around for awhile.

Again, thanks for responding with your reply - I really appreciate any info I can get and I think this site is going to become my new best friend. It's really great to be able to talk about this with others who have gone through it or gone through it with a loved one or friend.

CarolDe

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CarolDe,
You would think that all doctors should 'Be in your Corner' and fighting with you but some put a label on you and say 'This one shall Die and This one shall Live' and everything they touch and do echoes those beliefs.

That's why I had to fight to get her some relief with the Pleurodesis because she didn't have a promising survival prognosis. It was a terrible phase of her treatment. Her oncologist wrote 'worstening condition and recommend hospice' in the hospital log and then left town for the annual ASCO convention. The nurses kept bringing in Men of the Cloth and asking 'who do we turn to in this end of life situation'. We countered by inviting in our local monks and lay people since we are buddhist. We turn inward toward ourselves in any situation. The alternate oncologist was saying the pleurodesis wouldn't work and on and on and asked if we were going to seek further treatment. It was us against them. They almost got us believing them. The oncology floor of a hospital is a horrible place to be.

Well with that off my chest I will finish by saying that the pleurodesis was a success and my wife was given the choice of continue chemo, Tarceva, or hospice. Should have chosen Tarceva at that point but the doctor had already beaten us up with disbeliefs early on so we chose to continue Gemzar and Carbo.

I'm not going to say how that went because that would require another chapter but it ended and so the doctor said Tarceva or hospice. This time we took the Tarceva eventhough I didn't have a clue how I was going to pay for it.

The Tarceva worked and my wife then became a Miracle girl. 5 weeks later the tumor in her lung had dissolved, her chronic cough gone, and she was off oxygen. She has metastasis but they are shrinking as well. She will have her 3 mo. scans next week. Wish her luck. She celebrates her 1 year and 3 mos survival this month.

Oh, she didn't have much pain at all after the tube was removed. Hydrocodone pain meds kept her cough down and any breakthrough pain. Her lung inflated right away after the first few taps but it took longer during the pleurodesis because of all the previous radiation and chemo.

Take care of yourself - happily - and don't worry - you are in good hands - Chanwit

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When my mom was diagnosed a year ago she had the same procedure. The short term results were amazing.

Within 4 weeks after she left the hospital her breathing was back to normal. And most importantly, the fluid didn't return.

About 3 weeks after the procedure my mom started Tarceva and WBR as the mets spread upstairs.

The results were outstanding. Her cancer shrunk about 60% and her Brain Mets were gone.

I recall her doctor telling us that when the fluid drains, so do Billions of Cancer cells.

On a side note, the Tarceva did stop working after a year, and my mom is now undergoing her first cycles of Chemo and Avastin, yet I am happy that we got one year out of Tarceva.

Also, since she has started Chemo she is feeling better so we expect a good result there.

Every part of the disease is a battle. The Plerodesis is part I of your battle. There are many weapons you and your doctor will have at his/her disposal. This latest weapon, you will find to be very effective.

Good Luck and G-d Bless!

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Thank you so much for sharing another positive experience with this procedure. I have always thought of myself as a very organized and capable person able to make intelligent decisions. This whole experience began so quickly and unexpectedly and isn't following any kind of organized or predictable path. I feel like I'm in a foreign country and don't speak the language so of course I'm overwhelmed and have no idea if any of my decisions are intelligent or not anymore.

I am now convinced that agreeing to this procedure is a good decision and thanks to responses to my discussion post I am going into surgery this Thursday in a much better frame of mind and not as afraid now that I know there are others that found it to be a positive part of the success of their treatment and quality of life.

Thanks for your input and your kind thoughts. All my best to your mother and her success.

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i've been away from computers a few days and just saw your question I had a pleurodesis 2 months ago. I was diagnosed stage IV NSCLC Dec. 2005. There was always some fluid but chemo and avastin combo last spring seemed to clear it up. After radiation for one spot last fall my right lung half filled with fluid . The pleurodesis procedure was simple, but I was in the hospital 7 days because they didn't notice the tube wasn't draining properly - it was clogged . We wasted 2 days. According to my doctor it was very important they get as much of the fluid out as possible to increase chance of success.

Make sure you get painkillers before you leave the hospital - you'll be very sore for several weeks where they put the tube in. It took me about 3 weeks to go without taking them. Taking deep breaths was also hard as the lung will be irritated from whatever they inject (they used talc for mine). But it gets better after a few weeks. I also could only sleep on one side for a while because of soreness so was using sleeping pills to help with that. (without them I'd roll over in the middle of the night and wake up - many times!)

You might also notice months later that your lung sounds and feels different. Everybody is different - but my lung makes "creaky" noises sometimes when I breath - even my husband can hear it. My doctor said that is a result sometimes of this procedure and that there is also some scarring from my procedure but that it doesn't significantly impact my lung capacity or health.

My pleurodesis was successful and well worth the discomfort and time - no fluid has come back and I can do all the things I did before - no shortness of breath. I wish you good luck with the procedure - it does have a high success rate and you'll feel much better once it's healed up.
Make sure you have someone that can help you the first few days at home because you will be tired and sore.

By the way, I notice you mention "waking up following the operation" - the doctor did my procedure in the room with a nurse - gave me a mild sedative and some morphine but I was not completely under.

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