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Recovery from Thoracotomy?

happyHBmomhhappyHBmom Posts: 2,070
edited 06/11/2012 - 8:49 AM in Upper Back Pain, Thoracic
I had a complex surgery done on my L1-L3 and the anterior access was gained via thoracotomy (this is where a thoracic surgeon goes in through the side, between 2 ribs, and moves all of the vital organs. My surgeon did end up deflating my lung and I had the chest tube for 3 days.

I have read through a few posts about people's experience with this surgery, but I was wondering if you'd indulge me. I was wondering whether the intense pain at the incision site was normal? And how long was it before you could breathe pain-free?

Also, mt organs are causing me grief, especially my intestines.

I am told I'm healing quickly but it seems slow to me :(



  • I've obviously not had this surgery. Just wanted to let you know I'm thinking of you and supporting you! :)

    Love your new signature by the way! (G)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks! Not many people have had it- it's the reason more thoracic fusions are done! I am having a really odd and severe pain that none of my doctors have an answer for :(
  • You're Welcome!! I figure if it ever comes for me to have thoracic surgery, it will be levels T8/9/10 - and though I hurt from them now, kinda glad I am not even close to surgical for that area! (G)

    Is it an "internal" pain maybe from the organs being moved and messed with? Or more neuropathic from the nerves being upset? I know sometimes the nerves get all crazy when they've been disturbed.

    Another thing I can think of is your back moved into the Kyphosis mode for a while with the L2 failing. Is it maybe something where your back is trying to adjust to a more structured "normal" position? Dunno, just tossing ideas for thought.

    I hope you or they figure it out soon. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • It is internal, and could also have to do with cut muscle, or what you said.

    I just read the Wiki on thoracotamies, and they say "Postoperative pain is universal and intense." So yeah, I agree with that ;)
  • happyHBmom said:
    It is internal, and could also have to do with cut muscle, or what you said.

    I just read the Wiki on thoracotamies, and they say "Postoperative pain is universal and intense." So yeah, I agree with that ;)

    Nodding.. From what I've researched (like you I am a research fiend!) patients can get "deep internal" pain if they have to move everything. I know that when I had 2 tumors removed from my abdomen, the "internal" pain was fierce for like 2 months - no, make that more! I went back to work (light duty) around week 8, and I felt EVERY bump I hit! (G) They routed around my intestines and uterus, etc. to be sure there were no more tumors. So maybe that is what is going on with you.

    Oops, almost forgot, for me the abdominal muscles were all cut, and they screamed! My surgeon said to me, "This is odd, it is too bad you are in such good shape abdominal wise." I looked at him with a "huh?" He said "Since those muscles were strong, cutting across them was going to be much more painful than most for recovery"....He was right! (G)

    I hope it starts backing off. I have a feeling you might have this for 8-10 weeks if that is what is causing your deep pain? Gentle *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Still wish someone who had btdt could help. I definitely could not manage this for 8 weeks! Even 2mg IV dilaudid push only takes the edge off. Last night I bumped myself with a water cup and collapsed in a whimpering ball right in front of my kids :(

    I wonder if high dose muscle relaxants would be more effective than narcotics?? Right now I am on so many pain meds I can barely feel my back, but that thoracotomy is kicking my ass.
  • muscle relaxants may help that is about the only thing that helps be I take soma 350 I take two at night and I also take 4mg dilaudid
  • HB,

    I was given percocet back then. With me, percs make me sleepy, but didn't help that pain much. Have you tried PMing Angela Talley? She had complete works on her thoracic. Haven't seen her on here for a while though.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • great your being able to post from hospital, certtainly been a rough surgery, hope this internal pain resolves soon for you

    nice to have your husband who will take care of you when you get home

    didnt like to hear that your pain wasnt managed properly after the first surgery
    do hope you progress steadily, with your pain controlled well and the surgery helps with your mobility
    take care

  • I am feeling better being at home, I got out of the hospital yesterday.

    I'm posting in the thoracic section because I think only a few people have been through a thoracotomy, and my recovery story might have some benefit to someone.

    So for clarity- for full anterior access to L1, a thoracotomy is required. I needed that anterior access because my neurosurgeon had to basically pluck pieces of bone out of the spinal canal- not possible via posterior. Also, he could not properly align the spine without anterior access. This was all fully explained to me.

    The thoracotomy is where they have to spread your ribs, unattach your diaphragm, sometimes deflate a lung. Right now I have a numb swath about 4" wide from my left side to just above my belly button. This is because the process cuts through a huge bunch of nerves, which is what makes the process so painful, along with the rib spreading (right now, about a week post surgery, the ribs are my most overwhelming pain).

    Anyway, what I will say is that my spine is really not too painful ;) I gained half an inch and now feel like my bottom and top halves are attached properly. I expect this is going to be a very successful surgery.

    So does anyone considering thoracotomy for thoracic surgery have any questions? I'm happy to answer.
  • Brenda, right now I am taking Norco 3x/day, Oxycodone 15 mg 4x/day, and Fentanyl 50mcg/hour. So, I have a pretty broad coverage. The one thing I don't have is a muscle relaxant (I got valium in the hospital, and have xanax at home, but I think xanax isn't as good at muscle relaxing).

    I feel not terrible today. It seems like the ribs are going to feel better every day, yay!

    RFE, did you have a thoracotomy? I couldn't figure out whether you are post-surgery or not. I didn't find the dilaudid so helpful even IV, so not really motivated to suggest it oral. The oxy is doing well enough, and nothing is helping with the thoracotomy pain except just not doing the things that are painful.
  • No I have not had surgery but I have a bad T spine, no my whole back is a mess, I have a lot of rib pain and have found that dilaudid helped only if it is 4mg. nad with the soma
  • HB,

    Do you have a good relationship with your surgeon such that you can request muscle relaxers to see if that helps further control your pain? The rib pain should be helped with the present meds I would think? I've broken quite a few ribs over the years, and man is that painful (breath, cough, sneeze!!!). Even broken, I found they felt a lot better by the end of week 3 or so. I hope spreading them results in a short time of that pain. Very gentle *hugz* :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Oral dilaudid is a much different animal than IV dilaudid, because it does not absorb readily when taken by mouth. My husband and I were trying to translate what I was getting in the hospital with what I'd have when I got home, and I think the ratio is 5-1, so 2 mg IV dilaudid is equivalent to 10 mg oral.

    But you know, we all react differently to meds, and I found I reacted much differently to dilaudid this time than when I had my accident, before I had been on opiates for 3 years. I never got much relief, even when I was getting 2mg pushes on top of the drip and the patient-directed thing. I should have been completely knocked out, and I was pretty loopy, but not much pain relief :( I was better off when he switched me to the combo fentanyl + oxy + dilaudid, and I weaned off the dilaudid before leaving.

    I did bring home a prescription for 50 mcg/hour fentanyl patches, vs the 25s that I have at home. Other than that, my home meds were given to me by my regular PM doctor (and he was happy to OK the patches as well).

    The thoracotomy pain is a different animal altogether. I am not really sure how to cope with it. None of the meds really help much.

  • Sorry I didn't find you sooner but my facebook friends come and found me and told me that I may be able to help you.. I had my surgery on Feb. 17, 2010 and my lung is still very painful when I yawn or sneeze.. I have had it checked out and it is fine but has scarring which is expected and nothing can be done for it as I have had 3 Dr.'s tell me... I had my chest tube for 8 days... My scar pain was quicker to releive when I got home and was comfy in my own bed.. I am still dealing with nerve pain from my incision and the 4 layers of muscle that they have to cut to get to my spinal so I am still doing lots of spinal injections
    And I am still on a lot of pain meds.. If I am not any better by Feb. we are going to try a nerve stimulater... I am so ready for this to be over to be over with.. But I had a CT the other day and 6 of my remaining 11 thoracic disc are also pressing on my spinal coed.. Here we go again... If you would like to talk just PM me and we can email, facebook, or exchange numbers..

    Ps. Oh and the pain in the intestines pain is because they have to start working all over again after your surgery and you probably aren't eating much and pain meds make you constapatef so it is adjusting to alot right now.. I stayed on stool softeners for 2 months after my surgery just on my on because I knew all the morpheon I was on would really mess with me if I didn't..

    I hope you get to enjoy your Christmas.!.!.!
  • Angela, thank you so much! I have heard that continued nerve pain is common- but damn, that incision still REALLY hurts :( My intestines are back to working. I only had my chest tube for 3 days and the remaining fluid is supposed to reabsorb. I need another chest x-ray next week.

    I'm kind of lucky in that I have both the thoracotomy and the posterior scar, so I don't have much of a comfy surface to sleep on. Last night was a tough one, I am hoping for progressive improvement.

    Was there anything you did to make yourself more comfortable in terms of the ab muscles and incision? Or is time my only hope?

    And I should re-read your whole thread, but how slowly did you go back to activity? I don't know whether I'm expecting too much of myself- I didn't get out for a walk today, but I did walk around the house some.
  • Well, it's now 12 days post-surgery. I am now getting periodic pain at my incision, but was comfy enough last night. If I start to tense up I really pay for it.

    My lung feels pretty good, I only feel it with a very deep breath and can easily do the top on my spirometer.

    I'm off today to get lung x-ray and bloodwork to do post-op with my thoracic surgeon. Hopefully tomorrow I can get those staples out! (actually I had half of them out in the hospital and replaced with steri-strips, but I'll be happy to get the rest out!).

    I was reading a bit about anesthesia for post-thoracotomy pain control, and mine was just not done well. Anyone getting a thoracotomy might want to ask about this and research it a bit- as I suspected, "they" recommend ketamine in addition to opiates because the pain is severe and the level of opiates required to reduce it can depress breathing (which is an issue when you can hardly bear to breathe in the first place). I really wish I had thought to ask for it.

    Just a mention. I know at least one other person is looking at thoracotomy, so if my experience can help I would like it to!
  • one of my surgeons,say that he wants do discography to confirm that pain cames from my t6 t7 degenerative disc! I quote his words : " If discogram is positive i will do a surgery. and when i ask him about surgery he said realy normaly for this : " i will cut you from side,move part of the rib,remowhe whole disc and put piece of rib betwen vertebrea...last week i have operatet one woman on this type of surgery" So i dont know why his words were like he do this surgery every day...realy confusing.....or maybe he is the man for thoracic??? Every people here in Croatia say nr.1 for spinal surgery,yes for lumbar,but for thoracic im not so sure....hope you are getting better? :)
  • Well, I couldn't do minimilly invasive because my surgeon needed broad access. But I think the rib spreading and the muscle cutting is the painful part- so anyone who does that is going to have a recovery. Post-surgery, the days with the chest tube are really awful. No way around that.

    The thoracotomy goes through several layers of muscle in an area really rich with nerves, so even if the incision is made smaller or they can spare some muscles, it's a big surgery.

    Also, there's a risk of "post-thoracotomy pain syndrome."

    I don't know what the odds are that your doctors are offering for improvement. I will say this isn't something I'd go through unless I had 1) really limited function, and 2) a really high probability that it was going to improve my function. The Thoracotomy is about as painful as when I broke my clavicle, scapula, and ribs all at once. So I won't say don't, but ask yourself whether that's something you'd go through for whatever chance of improvement your doctors are giving you, especially given the risks of the surgery itself.

    But for me, my husband already feels like I'm more functional than I was before surgery- do you believe that? He says I look *more* comfortable now than I did pre-surgery just because I'm not constantly shifting and re-shifting position. So obviously for me this was a good thing.
  • With everything I went through with the surgery and ALL of the pain that went along with it, I would do it all over again if I had to choose.. The moment that I woke up from surgery the spinal pain was gone.. I knew all the new pain would heal and go away...

  • I had my follow-up with my thoracic surgeon today! He says my lungs look good, I still have some fluid but it is receding well, and was happy to see me walking well and getting around by myself.

    I did find out today that he *was* able to spare most of the large muscles and that once the bone pain is healed I should feel pretty good. That was good to hear! I was concerned about rehabbing all of those muscles! So I didn't have the full access thoracotomy, it just felt like he cut everything ;)

    My back feels good. I was able to tell him that already, less than 2 weeks post massive trauma, my spine feels better than it did before. That's a wow to me. He said "usually the surgeries that start off good like this have good results, so it's good to hear."

    Just an addendum that my thoracic surgeon was a total character. He basically does things his own way and nobody stands in his way because he's just that good. I was sharing some of my in-hospital experiences with his receptionist and we were laughing (like the nurse panicked that I hadn't been using my spirometer because he'd yell at her, or him raging through the halls yelling "how long does it take to get a patient on magnesium? Hours? That's ridiculous!") But seriously, if I had another surgery, I'd rather have the doctor that keeps staff on their toes! I have learned that it's impossible to be your own advocate in the hospital sometimes, and so you need a doctor who is going to stand up for you.

  • And here is the first glimpse at my new L2, as seen via chest x-ray ;)

  • he was able to spare cutting those large back muscles

    x-ray pic looks good, nice n straight now and stable,and you sound like your improving nicely, with a good report from your surgeon

    good news HB
    keep healing
  • I don't really understand what I'm seeing on the x-rays that well, I'll admit. I have one rod on the left side, but the screws enter at a slant. The plates in the back I don't really get either, as far as how they are attached or where. I will ask about it when I see him next week.

    But, it feels good! When I sit or stand, my spine feels like it is stable and supportive. So far there is NO nerve pain from the spine- only pain that feels as though it is due to the actual procedure (inflammation and such). I have been able to sit up to 30-40 minutes with discomfort only at the thoracotomy site!

    Unfortunately today was kind of a "two steps forward, one step back" day. I had family visiting and wasn't feeling great, and whether I'm not up and around enough or what I'm having some constipation issues (sorry if that's too graphic, but it's pretty normal with both the surgery and the meds). I was going to try going out to dinner, but just wasn't up to it.

  • Sorry, I've been away for a couple of weeks so I missed this! I'm glad your back is feeling better at last, happyHBmom. I hope the incision site and other pain eases up soon and you continue to have a smooth recovery. It sounds like you had a great surgeon!
  • I am so happy for you. You sound wonderful in your posts. It sounds like you are doing faboulously so soon out of your surgery! Keep up the good work!
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • HB- It looks like you are doing good. I am sure as the days go by you will start feeling a little better and eventually your life will have changed dramatically for the better.... Sure you may have some stiffness and occational bad days but you are through the worst of it >:D< I really appreciate your posts on the recovery. It gives me some sense of hope and relieves a little of the stress that I have started feeling since my NS suggested that I may be headed this direction.

    As far as having the VATS or full thorocotomy what I have come to understand (just from speaking to my NS at my last appointment). Is that it really depends on the location of the herniation/injury amd the best way to access it. Herniated right/left/center, posterior/anterior and the number of levels involved. Once he knows more about the problem then he designs the surgey plan.

    Happy New Year- <:P


  • In my case, it wasn't a herniation but the need to access the full vertebral body and into the spinal cord area so he could pick out bone fragments. Also, they need to place these clamp thingies to reduce the deformity (kyphosis) and realign the spine.

    But, since it was low I think that's why the major muscles of the shoulder were spared. I still have full use of my arm, for example. I know some thoracotomy incisions go through the muscles of the scapula.

    So some things worked for me and some things against me. I just hope my experience helps you develop more questions to ask :)

    I'm in the process of writing a letter to the hospital about my experience with pain control, which was not good. If I have to do this again some day I will be asking a LOT more questions in advance about post-surgical pain control and making more plans. My own assumption that large doses of dilaudid and PDA would be sufficient coupled with a pain control doctor who didn't think outside the box really did not serve me well (ooh and that one nurse still just chaps my hide!).
  • Well my cut is one of the one's is high that messes with my shoulder and arm... I have pictures in my original post... So how is your cut HB? How long is it.. My cut went through 4 layers of muscle and tons of nerves which is why almost a year out I am still having so many problems with nerve pain..

  • My cut starts about even with my left nipple and goes almost down to my belly button. Maybe 10"? It's definitely not a small one, but since he didn't have to access higher regions I guess I was spared the arm issues. I do have the nerve issues, though- I'm still numb across my entire left abdomen.

    I was actually able to go to a friends for a few hours for a NYE party last night. Not that I strayed from the couch much (where I stole every pillow in the house and camped myself) but at least I was out and about.

    Then I came home and crashed out until after noon today! Long sleeps are my new normal.
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