Lung Volume Reduction Surgery

Referred to as LVRS.  This is the surgery Dennis underwent in 2005 with such high hopes. The statements below are from my personal experience watching my husband's struggles.

First of all, I want everyone to understand that no one could have foreseen the problems Dennis had after the surgery.  His surgeon is one of the best thoracic surgeons in the USA and his pulmonoligist is, in our opinion, the best in the world.

I truly believe that the major obstacle for Dennis was his anxiety and the inability to control it. For the 30+ years we have been married I have watched as he worried about everything.  Not necessarily things that were critical to our survival but non-important things like if it was going to rain or not, the temperature during the winter or summer, and heaven forbid we should decide to take a trip.  Once we decided to go somewhere, it was a constant planning session until we actually left the driveway. If the trip was going to take place 6 months later, then we had to work on our plan for 6 months.  

When I got him a puppy to give him something to do in 2000, he kept the veterinarian in business with trips if she acted like she didn't feel good. He worried about her if she coughed or didn't eat as much as he thought she should and he considered it an emergency if she threw up (something puppies do quite often). I have raised horses for almost 20 years and even though he had nothing to do with them, they are a subject of constant worry.

He seemed to be handling everything pretty good when he awoke from surgery, but by the second day he began to show signs of anxiety because he was being asked to use a Bi-Pap machine. I believe that he was confused about the piece of equipment and thought he had been put on a respirator (something our doctor discussed prior to surgery). His anxiety made it a battle to keep him settled down and using the bi-pap as ordered. When he developed pneumonia, his anxiety was uncontrollable. During the month he was in ICU, the doctors tried every medication available to help with the anxiety problem.  Several attempts to remove him from the respirator resulted in a tracheotomy being performed to avoid the tube down the throat.

I hoped that getting him out of ICU and into a regular room would help but I was wrong.  He was still dependent on a respirator and would become agitated and over anxious when asked to exert himself in any way.  Dr. Millard contacted a psychiatrist and discussed possible medications to control the anxiety.  After a number of trial medications, he finally settled on Lexapro which seemed to be more beneficial with less side effects.  This anxiety was extremely detrimental to Dennis' progress.  Even with the medication there were days when nothing would convince Dennis that he needed to do his physical therapy so we could go home.

We fight this same battle every day at home.  To the average person who goes about their daily activity without a thought, it is inconceivable that something as simple as standing up and walking to the bathroom could cause a panic attack but I see Dennis fight his panic every time he moves.  It took a year to convince him that he could sleep just as well in bed with pillows propping him up as he could in a recliner.  

A year after surgery I was still struggling with him over getting a shower.  Even with his medication, he would have to also take a Xanax to be able to get through a shower.  Mind you, he was sitting on a bench the entire time - no standing up to tire him out but his heart rate would climb to 130+ and his oxygen saturation would drop to the low 80s or upper 70s before his shower was finished.  Even today, 3 years later, he will not begin his shower without me right beside the door in case he needs help and he still takes a Xanax 30 minutes before. The fear is just more than he can handle. 

He knows that when he becomes anxious and fearful his ability to breathe is diminished because his airways shut down but he still cannot control the fear.

I understand that the anxiety and fear are part of COPD but I believe that patients who have a successful LVRS are those that have the ability to control the stress, anxiety and fear that comes with shortness of breath and for those patients, this surgery is wonderful.

Here is a link to the American Lung Association discussing the surgery.

The link below covers every aspect of the surgery. 

NATIONAL EMPHYSEMA TREATMENT TRIAL (NETT):
EVALUATION OF LUNG VOLUME REDUCTION SURGERY FOR EMPHYSEMA