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Author: Subject: Tony's Nuss Journal 20/M 7-20-17 (Also for those considering)
Tony99
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thumbup.gif posted on 7-22-2017 at 11:41 PM
Tony's Nuss Journal 20/M 7-20-17 (Also for those considering)


Before I begin, this will be my personal, all inclusive journal. I hope I can answer questions for people who have questions about PE, my doctor, or anything surgery related. I know these forums have died down a bit these past years, but I will be here offering support.

Onward...

Since around my teen years, I have noticed probably what some of you may have experienced. I personally could not keep up with my peers during my physical education classes. Honestly, my initial thoughts were that I was out of shape as that is what others tell you. But, little do they know the underlying causes of what causes the shortness of breaths--what causes the exercise intolerance.

I am now 20 as it been about a decade since my initial problems. Like everyone, the symptoms have only gotten worse as I've aged. I finally took it upon myself to search the internet for whatever symptoms I was having. Looking up phrases such as "pushed in" with "chest." And that is when I came across pectus excavatum. It was definitely more of a self-diagnosis that anything. I never went to a doctor for those years. I just lived with it and I regret it every day.

Truly at first sight of the pictures of PE, I was afraid. More digging allowed me to find a network of people who have had this problem or are experiencing this problem--you guys and gals. I have read many success stories and wished that could be me. I have never made a journal, but I thought I should share my experience.

In April, I finally took it upon myself to schedule an appointment with Dr. Meguid, who is a cardiothoracic surgeon at the University of Colorado Hospital, Anschutz Center. To be honest, there are a few, few doctors out there who can correct PE, but I happened to come across this doctor from a search on the internet.

He was just a few hours drive from Wyoming. I know distance should never be a factor, but after my initial appointment, I felt confident, relieved, and ecstatic in his ability. His experience, he mentions, comes from being and working under the wing of the famous Dr. Jaroszewski.

Fast forward to the tests I took (irrelevant, but tell a tale of PE):

Pulmonary Function Tests:
- Diagnoses: Pectus excavatum, DOE (dyspnea on exertion)
- No airflow limitation by FEV1/FVC or FEV1
- Lung volumes show air-trapping likely secondary to the chest wall deformity
- Normal diffusion, Normal airway resistance, Flow-volume curve is normal

CT Scan:
- Haller index (inspiration): 2.7 - Haller index (expiration): 3.0 (I shoud add here, my doctor did not agree with the radiologist on my Haller index. Instead, he measured a 3.31 index)
- Compressed heart
- Thyroid: Normal.
- Thoracic inlet: Normal.
- Heart and great vessels: Normal.
- Mediastinum and hila: Small volume soft tissue density in the anterior mediastinum likely reflects residual thymic tissue.
- Lungs and pleura: Normal.
- Breast and axilla: Symmetric gynecomastia. No axillary lymphadenopathy.
- Bones and soft tissues: Pectus excavatum with measurements as above. Normal soft tissues.
- Upper abdomen: Normal.





Cardiopulmonary Testing

- Resting ECG: Sinus rhythm. rSr' pattern in V1-V2 with ST-T wave changes. Otherwise normal ST segments
- Stress ECG: Negative for ischemia
- Ectopy: One isolated PVC in recovery
- BP Response to Exercise: Initially appropriate response that became blunted at higher levels of exertion
- HR Response to Exercise: Exaggerated
- HR Recovery: Normal with a 16 bpm decrease, one minute walking recovery
- O2 Saturation: Maintained at 95% or greater during exam
- Reason for Ending Test: Shortness of breath, no dizziness during exam
- VO2 Peak: 38.9 ml/kg/min (80% of predicted 48.5 ml/kg/min) moderately reduced functional capacity
- RER: 1.09 VE/VCO2 Slope:34.634- mildly abnormal ventilatory efficiency

Metal Allergy Testing

- Positive to Amalgam :(
- Negative to others

Fast forward a few months, insurance (Anthem/BCBS) approved my procedure, praise the lord. I needed titanium bars made as I showed a reaction to amalgam, which I was totally okay with.

On July 20th, this past Thursday, I finally had my surgery. I went to the hospital. I remember getting my chest prepped, getting my epidural catheter put in (hurts like heck), and falling asleep as I was told to take a deep breath in.

It is a lot to take in so I apologize.

I will post my experiences subsequently below.

Before I forget, here are my before pictures.




I'm also happy to answer any questions/concerns/etc. :)
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Tony99
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[*] posted on 7-23-2017 at 09:34 AM
Day 4


Here is my chest x-ray:



I am now on day 4 as I write this. Last night was rough as I couldn't sleep due to burning sensations on my right incision site. I was given an extra dose of gabapentin to help my nerves heal faster and hopefully rid of the burn or at least tone it down. I have also been feverish these past days. I have had blood cultures done to determine if I had an infection. Thank god the results came back negative. I was told by a doc that it was normal and was given extra doses of Tylenol.

My first three days were exceptional. On my first day, I stayed in my bed nearly the whole day but was given the option to walk for the first time since surgery. I did not hesitate and agreed to do so. I took it slow at first and I must say, I felt much better.

The next day, I met with my physical therapist who instructed me on sternal precautions following the Nuss procedure. I know these will be tough to follow for 6 weeks. I was instructed on walking five times that day. I pushed myself to do more.

I also had my incentive spirometer where 2500 ml was the goal. I worked my way up, taking deep breaths in between each attempt. I am so happy to see that I could reach that mark. My x-ray results have shown huge improvements to lung capacity, saying "Lungs are adequately expanded and are clear."
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[*] posted on 7-24-2017 at 10:56 AM
Day 5


So... day 5. Phew. I am finally due for discharge as my orders were just put in. I am not sure what the average discharge is, but some people fare well or worse than others. The pain management team came and ensured I was doing well. It has been quite a ride. I have met some wonderful nurses here and I know for sure I will miss them. I am however ready to leave.

I got all the wires removed from my body, all my EKG stickers were ripped off. I finally was able to put on the clothes I came with. I was also given 7 prescriptions of painkillers and laxatives to get me through the recovery.

Personally, I feel better. I feel like I have more 'capacity' to walk, move, and just more generally, which is great.

Here are my post op photos:




I have my checkup in 2 weeks. Till then, Godspeed.


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Tony99
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[*] posted on 7-25-2017 at 03:57 PM
Day 6


I made the drive home for a total of four hours. When they say every bump in the road hurts, they mean it. I tried to react apporiately by hugging myself as that really limits the amount of pain received. Other than that, each bump, dip, and hole literally shook me to the core.

I got home and my dog was a fresh sight for sore eyes. I hopped in the shower for the first time in nearly a week. My first night in was definitely experiemental. I tried sleeping on one pillow, then stacked another on it, which worked great as sleeping high, for me at least, relieves some if not 99.99% of my pain. I did wake up multiple times due to pain. A quick swallow of ibuprofen, oxycodone, or extra strength tylenol definitely does the trick, however.

I did go on Amazon and order a wedge pillow with next day delivery as I think that might help. I also priority shipped a new charger as I forgot mine in the room! (doh)
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[*] posted on 7-26-2017 at 05:15 PM
Day 7


Today, I am resuming my daily walks around the block with the pup to prevent blood clots, but mainly to train my new and improved lungs obviously! I feel great. At the end of my walks, I was usually fatigued, even if it was rather short distances like a quarter mile. Now, I feel more energetic and willing to walk more farther and longer distances.

I am currently in school as well, enrolled at UWYO, for those who are wondering. I am in two summer courses that began 14 days before my surgery. It was crazy to even enroll in these as lots of people do tell you to take it easy. However, from my experience so far, I am keeping up very well with assignments. That probably has to do with completing lots of work before my surgery. However, I still have the same productivity and time as before to designate towards school work. Again, not all people are me and can devote time for that after surgery, so that is something to keep in mind.

I am also trying to lessen the times I use my painkillers. I still pop them in my mouth every few hours, but my end goal is to end my dependence on them. I still do get burning sensations from my incisions whenever I lay down a certain position. It definitely, definitely sucks and is the worse pain at the moment.

On a side note, the doorbell rang as I was typing this and my wedge pillow and charger came! I will update how it goes with that.
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[*] posted on 8-4-2017 at 08:58 PM


Tony, thanks so much for sharing your story. It is very helpful for those making the difficult decision whether to go through such a tough surgery/recovery. I am really surprised there aren't more people here that appreciate you taking the time to write all the details that you have provided.
I personally have and will shorten my story because I feel like no one is reading and it really does take time out of one's schedule, especially when on heavy drugs putting words and thoughts together for me is difficult.

Good luck with school and the recovery. Looks like you are doing great and already on your way to a speedy recovery!
By the way, your new chest looks great! Congratulations!
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Tony99
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[*] posted on 8-5-2017 at 01:46 AM


Thanks for your thoughts, Stan! I understand the difficulty of writing your story. I did my main post a few days after my surgery and was literally out of it from the meds! I came back and realized tons of grammar and spelling issues which I hope are fixed now, lol.
I appreciate you taking your time to write. It feels like the community has thinned out from a decade ago, but I do think that posting here will hopefully give people some hope or guidance in their decision to pursue surgery!

Thanks for your kind words!
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[*] posted on 8-9-2017 at 12:09 AM
2 Weeks 5 Days


Picking off from my last post, I can say that a wedge pillow helps and doesn't. I can honestly sleep well from a wedge pillow with two 'basic' pillows on top or just three pillows with one stack of one and one stack of two pillows behind it.

I went to my follow up appointment today in Denver. My chest xray's findings were: "The heart is normal in size. Lungs remain clear. No pneumothorax or pleural effusion. Subcutaneous emphysema has resolved in the left chest wall. Unchanged appearance of two transverse sternal bar is. No acute osseous abnormality."

- in short, I don't have traces of emphezema in my lungs anywhere so I have no shortness of breath anymore (and I can definitely feel it enlarged)! My bars have also remained stabalized which is always a good sign.

I am currently on ibuprofen and gabapentin and should be dropping oxycodone depending on my pain management. Doc says I was doing very well compared to other patients. Till the next check up in a couple months.

Do I also need to add that I feel great? Minus the pain, haha.
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[*] posted on 8-9-2017 at 07:52 AM


Hi Tony,

SO wonderful to hear that you are doing this well at 2.5 weeks!! Your repair is fantastic, you must be extremely happy :) Time will only be good to you. You will notice such an improvement in your stamina and ability to perform in endurance activities. Kick those pain meds if you can, but don't be a martyr. Treat the pain so you can keep moving around.

I agree with you and Stan, the activity on here has died down significantly. But don't let that stop you from sharing your experiences, for you never know who is reading and gaining courage from your words. :nw:




"Man never made any material as resilient as the human spirit."--Bernard Williams

My journal: http://www.pectusinfo.com/board/viewthread.php?tid=11088
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Tony99
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[*] posted on 9-20-2017 at 01:24 AM
8 Weeks 5 Days


^ Halcyon, thanks for your kind words.

I have received a message from a member about my doctor so I feel that I have made a difference and hope to continue to do so :).

As of week 6, I was off all my pain medicine altogether. Although, there is still the occasional 'tightness' feeling on a day to day basis that is rather uncomfortable, but manageable.

Today, I have begun physical therapy. The goal of my PT is to get into a program of lifting again with the nuss bars in my chest. I do have to loosen some scar tissue around my surgical site, but it should be no problem. I have advocated seeing my PT for two times a week and hope all goes well!

My next checkup will be next month. Till then...
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[*] posted on 9-20-2017 at 09:53 PM


A good repair. Congrats!

Like the journal too. Keep up the good work.




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[*] posted on 9-23-2017 at 08:05 AM


Looking great buddy. Congrats on the successful repair! Hope it's smooth sailing from here on out! :nw:
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