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Author: Subject: 35 yr male with PE in Oz
DentBoy
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[*] posted on 3-2-2014 at 06:10 AM
35 yr male with PE in Oz



Hello Family Pectus

I've already written a little bit about myself in a previous post but I'm back to post some pics and see what you all think.

But first, here's my quick journal summary:

Subject: DentBoy's Journal
Location: Port Hedland, Australia
Age: 35
Sex: Male
Condition: Pectus Excavatum
Development: Probably born with it, but definitely obvious in my teens
Intervention: None as yet
Images: Pics below taken just a few minutes ago by my lovely wife

Story: I've said a little bit about myself in the thread 'What Are Your Pectus Excavatum Symptoms' so I'll summarize quickly here. Since my early twenties I've felt like life is a bit more of an effort than it should be, simply because I found I become easily tired and rundown. As time went on I would find that I couldn't go out as much as I like and just didn't have the same stamina as my friends. As a teenager my PE effected me psychologically but this was much less a problem for me in adulthood. As the years went by it was my worsening health symptoms that concerned me the most. My stamina continued to decline and I would also be plagued by dizziness and balance issues from time to time, as well as a few other strange symptoms that seemed to come and go without much reason. My ability to do any sort of exercise declined more and more until earlier this year I found that I could no longer condition myself and any attempts to become fit would leave me with a very high pulse rate for hours and even days afterwards.
Of course, as seems typical with pectus deformities, over the years not a single doctor related any of my health concerns to the dent in my chest, not even cardiologists. Finally, and just in time I think, a GP who I went to for my annual skin check (it's a burning hot sun down here!) a few months ago just happened to say the words 'Ah, pectus excavatum' as he studied the moles on my chest. I was speechless, simply because I didn't even think my chest deformity had a name. A few weeks later I googled this name and one thing leading to another, here I find myself - in a place I should have been in many many years earlier....

So folks, here are my first pics. I'd love to hear any comments you may have, especially of my CT images (my Haller Index was measured as 4.0 on inspiration and 5.1 on expiration) and of my chances for a successful surgical correction.

Thanks :)
DentBoy



PE1.JPG - 30kB PE2.JPG - 26kB PE3.JPG - 26kB PE4.JPG - 26kB PE5.JPG - 25kB CT1.JPG - 37kB CT2.JPG - 36kB
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Sinister
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[*] posted on 3-2-2014 at 12:16 PM


Ya, I think you'd be a great surgical candidate with a high likelihood of a great result. For the most part, it's symmetrical (ever so asymmetrical to the right but barely). Also, it appears to be almost entirely lower PE, could be some upper PE but I can't appreciate it in the images. One or two bars in the right hands and you'll be rocking a nice chest and back surfing within a year.



" Whatever you have, you must make the most of it. Rest assured that you can
transform yourself, no matter where you started from. The most important body part is
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DentBoy
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[*] posted on 3-3-2014 at 05:33 AM



Thanks Sinister. I hope your prediction is a pretty good one.

In your experience, would you consider me a kind of 'easy' case then?



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[*] posted on 3-15-2014 at 04:46 AM



Hello folks, just bumping this up a bit hoping for a few more replies.

At the moment I am mostly considering either Dr Jaroszewski in Arizona or Dr Park in Korea....

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DentBoy
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[*] posted on 6-26-2014 at 06:19 AM




Hello again, its been a while but I'm back and I'm post surgery!

Just over 1 week ago I had my operation performed by Dr Hyung Joo Park at the Seoul St Mary's Catholic University Hospital here in South Korea. From an operational point of view everything went very well. Dr Park is very experienced with the nuss procedure (here they call it the MIRPE - minimally invasive repair of pectus excavatum). I found a few articles stating that he actually has the world record for the most nuss procedures - somewhere over 2000, over 500 of which are with adults. In fact his demand is so great that nowadays this is the only operation he performs.

Anyway, I'm going to summarise quite a bit but if any one has any questions just fire away and I'll elaborate. Basically, the first 2 or 3 days post op were a bit vague and there were at least two instances where I needed morphine and tramadol injections to dull the pain. Almost all of the pain was in my back (muscle spasms), but then suddenly, on day 3 or 4 I think (it was all a bit of a blur), my pain subsided and became highly manageable, and it is still like this today. In addition, soon after the operation, my range of movement improved considerably and now I can already rest on all sides, although I don't think I'm quite ready to sleep on my front (maybe another couple of weeks).

I am out of hospital for 2 and a half days now, just staying in a holiday apartment close by to the hospital with my kind caring father. Walking around is getting easier everyday. Walking one or more kilometers at a time is okay now and doesn't cause too much pain. Sometimes my breathing still feels a bit restricted by the bars though. But as far as I can tell I am very pleased with my recovery thus far. And best of all, no post operative complications thus far, and hopefully none to come!

Unfortunately, despite my heart and lungs having much more room now, I still seem to have all of my original symptoms - high heart rate, especially when standing, dizziness etc. This is a bit depressing since this is the reason I decided to have the operation in the first place. But perhaps I am being a little too impatient, maybe my heart needs time to strengthen and recover, I'm not sure, but I do hope things improve. I'm not actually sure how long necessarily I should expect these things to take....

Here are a few selfies I took in the hospital. Sorry, probably not the best quality but I think they show a good repair.

Anyhow, I would love to hear what you think. Thanks :)


PO1.JPG - 34kB PO3.JPG - 33kB PO2.JPG - 26kB PO4.JPG - 26kB PO5.JPG - 29kB
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GodsWill
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[*] posted on 6-26-2014 at 12:22 PM


Congrats being dent-free! Looks good from what I can see. Please keep us updated and post some more pics as the months progress.
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[*] posted on 6-26-2014 at 08:34 PM


Hey DB

I dont think your images show a good repair, IMO, the repair is beyond good, it's into the area of perfection. Wow, man, that is awesome!!!

No worries or thought of your continued symptoms today. For tomorrow and time will show the result of decompression.

The pain will remain the same for some time, Yes, some time. It will diminish yet the breathing restriction Im not so sure. It should or may improve but the fact is your chest is bolted down with the bars until removal. My restriction is still with me.

Just my quick thoughts.............

Oh Yah............ your are one fortunate man to have your father with you in these memorial days.

Randy
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[*] posted on 6-27-2014 at 11:07 AM


congratulation, your chest looks awesome. How many bars do you have inserted ?



Live long and prosper!
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DentBoy
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[*] posted on 6-29-2014 at 06:32 AM



Thanks guys for your positive comments.

Randy, you especially - your positive vibes are the arms that cradle this forum. You have a knack for knowing what to say and how to say it.

And I think you are probably right about my continuing symptoms, a fair bit more time needs to pass before I have a proper understanding of things.

Speaking of time though, I am amazed at the progress of my recovery. Two weeks haven't even passed and I am already only taking ibuprofen once or twice a day (although, after a lot of sitting on hard ground this evening I did take an oxy when I got home, just to ensure a good sleep!). Pain is barely a problem at the moment, even after one or two hour long walks. I chose an experienced surgeon based on the many contributions I have read on this site and I'm glad I did (and lucky that I could).

Getorix, I have two bars. They are so close together that they overlap slightly. Dr Park said that he put the first bar in but he couldn't avoid a persistent slight dip at the base of my sternum and so he put another bar in. He eventually put them so close together that they actually overlap slightly. This was how he managed to achieve the best result. I think he is a perfectionist because the whole operation took almost 3 hours.

I will post some x-ray images soon. I think you will see that he uses some unique fixation methods. He doesn't use the old fashioned stabilizers (or stab-ilizers as Randy once nick-named them) but uses 'hinge plates' and 'bridges'. He also uses 'claw fixators' (all of these things he has designed himself), but he didn't incorporate these in me. His goal is to achieve zero bar displacement and since he has used his 'bridges' nine months ago none of his patients have experienced any bar movement. So far so good....

Back soon with images. Ciao.

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[*] posted on 6-29-2014 at 03:55 PM


Congratulations Dentboy, your results look amazing. Hope the speedy recovery continues. How many bars did you end up getting?



42 yo, Male, considering correction in the UK.
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[*] posted on 6-30-2014 at 08:01 AM


Hi Dentboy, that looks like a great repair! I'm interested in seeing those xrays with the bars overlapping.
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[*] posted on 7-1-2014 at 01:51 AM



So here are my X-rays, from a few days after surgery.

You can see some of the unique 'metal work'. The hinge plates are the two long pieces of metal with the oval, or oval like, cut outs in them. I think these are designed to cradle the bars and prevent any intercostal stripping and any bar movement over time. I guess the other two lengths of metal near the ends of the bars must be the bridges which are to further prevent any bar movement, but I must admit I forgot to ask detailed questions about these.

You can also see the slight overlap of the bars. This was how Dr Park managed to achieve the optimal result. I had some concern that this overlap might rob my heart of some space but I had an echo today at the hospital and there does not appear to be any sign of this being the case - in fact my heart looks happy in its new found space, so much so in fact that I have been given the green light to fly home earlier than originally planned....



XR1.JPG - 37kB XR2.JPG - 29kB XR3.JPG - 30kB
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[*] posted on 7-7-2014 at 07:51 AM


That is quite interesting!
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[*] posted on 7-8-2014 at 06:04 AM


Quote: Originally posted by DaveM  
That is quite interesting!


I concur! Thanks for the updates and pics, DB!:)
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[*] posted on 7-11-2014 at 09:46 AM


Great fix DB. X-rays look amazing, some real craftsmanship there. Wishing you all the best, especially with the symptoms. I still suffer from the dizziness and palpitations and ready for a redo soon as 1st attempt failed dramatically. At least you are already past mid-point. Please keep us updated and best of luck.
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[*] posted on 7-11-2014 at 09:53 AM


I forgot to add, great new chest and great new torso. I was amazed how after the procedure my pot belly disappeared. Enjoy relaxing in the shade with no shirt on. With the exception of the scars, nobody would ever know.
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[*] posted on 7-29-2014 at 06:58 AM



6 week post op update:

So I'm six weeks post op and things are going quite well, but I did have a bit of a set back about 2 weeks ago when I had to go to hospital due to quite sudden severe and debilitating pain. Whatever pain meds they gave me in the ambulance didn't do a thing and then it took them 4 shots of morphine before I began to stabilise - it was pretty nasty.

The hospital took x-rays and compared them with my x-rays from Korea. There was no obvious change but the surgeons there suspected that the bars may have moved slightly downwards which Dr Park also suspected when I emailed him later.

Unfortunately the next day, once I returned home and emerged from my morphine haze, I noticed one or two of my ribs on my right side had depressed inward a little (presumably under the pressure of the bar/s), and this was the location of my most severe pain. Most frustratingly however is that I also noticed that my sternum had regressed inwards by about 1/2 to 1 cm (probably closer to 1/2). My nice new flat chest now has a small dent again but I am not too upset since I think it is certainly still within the limits of a normal chest. In any case Dr Park said he slightly over corrects most of his adult patients so I think it will all be okay so long as I do not have any further problems like this.

The only reason I can see for this slight movement of the bars is that the night before I had a bit of a laughing fit that hurt quite a lot but that I just couldn't contain, and that perhaps I had also been doing a bit too much (such a lifting things - nothing too heavy though) since my pain had been very low up until that point.

Anyhow, I am back to low pain again now, especially during the day, and my biggest challenge is to stop myself from doing things I shouldn't. I certainly don't want another incident!

I have one question though if anyone is able to answer it. At the moment I can often still feel the bars rubbing inside my chest cavity, especially when I make certain movements. Does anyone know how long it will take for the scar tissue to 'grab' onto the bars and stop this rubbing? I figure once this happens I can worry a lot less about any further regression.

Thanks.




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[*] posted on 7-30-2014 at 08:27 AM


Wow, great result DB... I think you're right, the surgeon is a perfectionist!

Recovery is a roller coaster ride. Remember, you're always a day or two from the big break through, where all your complications are behind you. Keep trudging forwards. I promise you, soon enough, you'll be at the one year mark thinking "where the hell did the last year go?". And you'll vaguely remember these long nights with the pain that sent you to the hospital but it will seem like such a long time ago, you'll have forgotten all the details :)

The scar tissue begins to adhere from about 8-12 weeks. I had such bad rubbing in my chest around 6-7 weeks post op, I went to go see a pulmonologist at the hospital I work in. He said it was one of the worst pleural friction rubs he'd ever heard. Basically, the pleural sacs around the lungs were irritated and rubbing against the lungs when I would breath, as opposed to gliding across them smoothly. Every breath would hurt, not badly, but enough to be annoying.

And then one day it was gone. And the sun came out and I was tired of being indoors. And I never looked back. Lifes been better (for the most part) ever since then.

You're day is coming

Also, I felt like there was a some slight regression after surgery. I'm not sure if it was the swelling going down or maybe there was actually some regression or just my trained PE mind playing tricks on me but somewhere around the 6-8 week mark, I noticed it. Then I started reading on here and realizing quite a few others did too. So whatever it is, regression or not, it's normal as I'd say more than 50% of those that get the nuss feel like at some point post-surgery they have some slight regression.




" Whatever you have, you must make the most of it. Rest assured that you can
transform yourself, no matter where you started from. The most important body part is
the mind.
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DentBoy
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[*] posted on 8-6-2014 at 07:49 AM



Thanks Sinister, a very insightful and honest reply. I certainly look forward to an end of the internal rubbing and I'm sure you're right, it is just a matter of a little more time. At least it is not painful.

Yes, I am definitely in that 50% thinking about regression. I have wondered whether it could just be swelling easing up or my keen eye for PE playing tricks on me, but in my case I feel certain that I have experienced a small regression of approximately 1 cm or so. A small dent has certainly returned (though it is relatively mild) and it's occurrence has coincided with an indenting of a rib on my right side, so I suspect the pressure of my sternum has pushed the bar downward and inward slightly, which I think would explain both occurrences.

From an aesthetic point of view I can't help but be a little upset by this (especially since I have now seen myself with about as perfect a chest as I could have imagined) but I am hopeful that from a physiological point of view this will not be a problem. My post surgical Haller Index was measured at 2.36 and so even a regression of 1 cm would still give me a score of around 2.6, or so I figure.

Sometimes I think half the trick is just learning how to let go of this whole thing and just get on with life again. I will get there. I think we can all get there, someday.... :)

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[*] posted on 8-12-2014 at 06:47 PM


Just remember...even those "perfect" chests we all admire have little dips and dents too...I know I will be extra observant of my chest after surgery, but I have to remind myself that I'd take a 1 cm dent over the cave I have now ANY day. I hate how critical of ourselves PE makes us! Just remember that you have come so far and to just about anyone else, your chest looks completely normal. I personally think it looks fantastic :D How are things going otherwise?



"Man never made any material as resilient as the human spirit."--Bernard Williams
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[*] posted on 12-17-2015 at 07:29 AM


Any chance you are lurking on here, DB...? I am 3 weeks away from following in your footsteps to Korea. I would really like an update on how you are going...
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[*] posted on 11-21-2016 at 03:47 AM


@DentBoy: I dropped you a private message.
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[*] posted on 1-16-2017 at 01:58 PM


Hows it going?
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