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Bronchial Thermoplasty - A Weekly Blog on What to Expect
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Cyberperro posted:
Hi, my name is Adrian McLain, I'm an Air Force veteran and I had this procedure done on me at the David Grant Medical Center, Travis Air Force Base, CA. I started this procedure on 19 March, 2013; had my second one on 2 April, 2013 and the last one on 3 May, 2013.

I'm starting this community discussion because when I was looking for information and a "what to expect" from someone whose undergone the procedure, I didn't get a warm fuzzy from the websites I went to. It's probably just my lack of trust for big corporations such hospitals and corporate sponsorship; as their videos of their patients looked commercially packaged for TV America, and the videos spent more time on the Doctor's point of view of the procedure, and then jump to the after affects with the patient months later. Trust me, that's not what you are thinking about when you are about to be put under for the first procedure; and after experiencing the adverse affects for two weeks after the procedure, you gotta get ready to ride the bull again for the next procedure and then the next. I cant tell if ignorance is bliss, because not knowing how I was going to be affected going into the first procedure definately was an anxiety attack waiting to happen; but then knowing what to expect (regarding recovery) for the next procedures was just as stressful because I already knew the toll it was going to take on my energy/lungs (nothing like labored breathing=wheezing to test your courage). So this blog is more to give those who are seriously considering this some insight on what to expect preop and postop from the patients point of view.

So I did a lot of research (youtube vids/website material) on this procedure before deciding to undergo BT; as it wasn't until my allergy specialist informed me I was a candidate, based on the severity of my asthma, did I even consider the pros/cons. In the end, optimism took hold of my heart and I figured what do I have to lose; for you chronic asthmatics out there like me, I think you'd agree that if there is a chance to increase your quality of life (aka better breathing/less meds), than bring on the radio frequencies (RF).

First, a brief description on my asthma/allergy symptoms prior to the procedure. If you can relate or are like "pssh I'm worse," after reading this part, than it is likely you too are a candidate. Obviously being a veteran, my procedure was free, so I'm grateful; as I know many asthmatics have to deal with their respective health insurance policies regarding whether BT is covered, and then of course there's the cost (your part of the deductible lets call it) for the procedure ( I read a study while back, where it varied from hospital to hospital, state to state, from $19,000 at one place to $80,000 in another).

My status prior to BT:

I take the following prescribed meds: Xolair shot once a month; Advair (two puffs twice a day-this being my long term acting mild corticosteroid drug); Spiriva (one pill inhaled per day--this is a COPD inhaler, when I was prescribed this last year to try and get my asthma better controlled, I knew my asthma was worsening--this one did have positive affects tho); Zyflo (4 pills a day); singular (1 pill per day); Zyrtec (1 pill per day); albuterol (once in the morning, and before or after gym).

My type of asthma attack:

I've never considered my asthma to be life-threatening because the shortness of breath I experience starts with labored breathing over a period of days where the wheezing ultimately gets so bad that I walk into an ER; and walk out hours later after having a chest X-ray, 2 breathing treatments, and a prescription for Prednisone (which I love because after a couple of days on this med, I actually feel like probably most non-asthmatics feel..if only they knew how lucky they are). But I hate it also, because it is a strong corticosteroid with significant adverse affects.

I've had asthma and allergies for 20 yrs. Next week, we'll discuss BT preop.

Adrian.
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sgbl88 responded:
Thanks,

This will be very helpful for the community.

Praying tat the procedure is a huge success for you.
Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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brochialgirl responded:
hola Adrian,
I am super interested in your experience with bronchial thermoplasty. I have an appointment on june 25 about it. would you please tell me more now? are you happy you had the procedure?
thanks, sandra
 
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Cyberperro responded:
Getting Referred:
So let's talk about how first. How this all began, and where I assume your starting point will be if you are considering this treatment. I've been going to an allergy specialist (I'll call him Potter, cuz he is wizardly and now magical, not to mention he's rocking Harry's look) for the last 5 years once I started getting the Xolair shot monthly. In November 2012, he told me that I was on a short list of people that were eligible for BT; this presumably was because o f the number of times I had to receive breathing treatments annually, occasional 5-day bursts of Prednisone to get me back to my baseline and ER visits for asthma related breathing problems.


Poke and Prod:

(Next Step) My allergist did a referral consult out to a pulmonologist, who I saw in December 2012. The surgeon (I'll call him Dr. Pi—cuz his Karma was good, and yes he was Indian too and resembled old boy from the movie) had his techs do various pulmonary function tests on me, and I was scheduled for a chest x-ray and blood work up in March 2013 prior to the surgery. 3-days prior to the surgery, I had to go see the preop folks, whose techs hooked leads up to me for the EKG machine, and checked my heart out for irregularities.


Anesthesia:

Lastly, the anesthesiologist (I'll call them Dr. Feel Good) reviewed my medical history with me, and then discussed how I would be anesthetized. For all three of the procedures, I received general anesthesia; good old sleep meds intravenously and I was hooked up to a breathing machine. I was super paranoid about this, as I figured the a breathing tube was going to be inserted in my windpipe; and that Dr. Pi would put the bronchioscope thru my nose to perform the BT. I'm not certain which avenue he took, as I had no nasal irritation, and my throat wasn't even sore after any of the procedures. Once of my lessons learned—ask more procedural questions (at least the ones that freak you out).

Though this is an outpatient treatment (unless complications arise), and other hospitals may also choose to use a light anesthesia, I was very happy that the hospital I chose used moderate sedation. (Note: I watched the BT video on Jove.com that gave me good insight on the entire BT procedure); nevertheless, seeing the scope going thru the nose was definitely not the entrance I was hoping—mouth please.

I would also presume it costs more money to undergo moderate sedation, as opposed to a local anesthetic due to the number of people involved, procedure, meds, recovery process. So this may also be a factor you may want to look into in case you are footing some of this BT bill.

The Scary:
1st Surgery.
Dr. Potter prescribed me a 5 day prescription of Prednisone three days prior to the procedure, where I'd be still on the meds for 2 days after the procedure (trust me, you need it). So I took all my normal meds, plus the Prednisone the morning of the surgery, had a pulmonary function test done on me while I was in the gurney waiting to be anesthetized; and then woke up about 4 hours later in the post op room. So of course, I can tell you that each time I awoke I was grateful to still be alive.

 
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Cyberperro replied to Cyberperro's response:
Prior to being transferred to the recovery room, I had to have a gag reflex and my breathing was closely monitored; as my pulse oximetry fluctuated for about an hour. ?The nurses had me periodically blow into a breathing exercise device to expand my lungs. ?Eventually my breathing stabilized and I was released to recovery room. ?I stayed at this place for about an hour and a half; as I had to perform another pulmonary function test and score well enough prior to release, and be able to urinate and eat. ?What I did notice about my breathing was while there in recovery, I began wheezing; my breathing wasn"019t labored, but I wasn"019t expecting this as I wasn"019t wheezing prior to the procedure. ?So of course, immediately I was worried and kind of depressed about it; just know its to be expected, as your lungs don"019t like to be messed with---but still, it was a little disheartening at first until I later made sense of it. ?It took a full week until my breathing was back to normal, where the wheeze had disappeared. ?So I was back in the gym and running about 7 days later, but still on my normal regimen of medications. ? 2nd Surgery: ? So of course, expect to have to go thru everything again regarding visiting the Pulmonologist, breathing test and preop exam"014blood work and the other things. ?Guess that makes sense from a liability standpoint to ensure nothing has changed with your health. ?But having to go thru the rigamortis of all this over again each time, yup, one of the downsides to the procedure. ? ? I Got on my 5-day supply of Prednisone again, and everything else was pretty much the same regarding waking up and being released from the hospital. ?This time during my recovery time, it took about 10 days to return to normal breathing; and I did notice my face (around the eyes and cheeks) were puffy and red, as if I had an allergic reaction to whatever meds they used during my surgery. ?I had different anesthesiologists during each procedure. ?When they explained to me what they were using to knock me out; each had their own cocktail and were using different amount and type of drugs. ?So that"019s my theory why this time, and only this one, did I have like adverse affects. ?It also took longer for me to wake up after the surgery and for my breathing to return to normal in the post op room. ?I presume they hit me with a larger amount of drugs to keep me sedated better (maybe they benchmarked off my first procedure, and did things different based on performance during the first one). ? ? 3rd Surgery: ? Final one, and this was the toughest"014go figure. ?When I woke up in the preop room, my breathing was all over the place (way more than the other two times) and I was exercising the crap out of that breathing device. ?It took awhile for my breathing to stabilize (was kind of scary since I could see and hear it dropping so drastically on the pulse ox machine), as the pulse oximetry kept fluctuating between 80s and low 90s (so not good). ?I gotta tell you this was the scariest moment for me. ?Because coming out of a sedation, waking up having difficulty breathing normal and not knowing how bad the complications are is a pretty big head fake for you"014reality is a little distorted still, so subconsciously I couldn"019t tell if I was just freaking out or I was in real danger. ?I based my feelings on my nurse"019s reaction to the whole thing, and she looked concerned"026.but about an hour and half went by and my breathing finally stabilized, and my gag reflex came back. ?
 
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Cyberperro replied to Cyberperro's response:
The positive while in the recovery room for each procedure during my pulmonary function test is that I scored better than I normally did prior to the procedure each time. ?Dr. Pi gave me my discharge instructions, which indicated I should expect to get a fever (wasn"019t on the other two instructions from the other surgeries)"014boy was he right. ?I don"019t know if the amount of times and locations they hit my lungs with the radio frequencies had anything to do with it; but I had pneumonia like symptoms for 4 days (had to call out sick from work 2 of the days in conjunction with my weekend off). ? ? During my recovery days later after the 3rd procedure, I reviewed and compared each procedure"019s BT results; as Dr. Pi provided me with a copy (with lobe pictures) each time with my discharge instructions. ?The first session treated the right lower lobe of lungs, the second treated the left lower lobe, and the third treated the airway in both upper lobes of the lungs. ?So needless to say, this last session had the most RF hits and locations than the other two"014so it was a doozey. ? ? After 7 days had passed, my breathing did not return to normal (was labored even still after taking meds), and nor did the wheezing go away. ?I was at the stage I"019m use to when I know I need to walk into an ER for a breathing treatment and corticosteroids. ?So I was due for my Xolair shot (which by the way I still received monthly despite the surgeries), and explained to Dr. Potter what was going on. ?He gave me a couple breathing treatments and prescribed a 5-day burst of Prednisone. ?This was definitely a smart move instead of trying to tough it out like I did the other two procedures involving wheezing (since it didn"019t go away). ?Something you should definitely recognize, as this made all the difference in the world in recovering. ? ? By the second week, I was 100%--and I"019m talking crazy results. ?I"019ve never NOT been able to go a day without taking one or two hits off my Albuterol inhaler (in addition to long term acting inhaler) for over 20 years--when I wake, prior to or after a workout; and of course we all experience the occasional bad breathing days (where no amount of meds make you feel better) due to weather (winter cold, high pollen, rain). ?So to my total astonishment, I didn"019t need to take a hit off my Albuterol, so I didn"019t. ?I just took my Advair and Spiriva and called it a day. ? ? Turns out, this wasn"019t a fluke of breathing well for a day. ?Today is 7 July 2013 and I"019ve not had to use my Albuterol since 17 May 2013. ?This, so far, has been the most rewarding result of the BT procedure"014I can"019t express the feeling I"019ve had to not have to use that inhaler daily; regardless whether its night, waking up, change of weather or even after a work out"014still good to go. ?Also, I no longer take Zyflo, which is the first med so far that I"019ve shaved off my list of meds. ?It is my hopes that next will be the Xolair shot and Spiriva. ? ? ? Prior to each Xolair shot, a pulmonary function test is conducted. ?So when I tell you my breathing hasn"019t worsened or been negatively impacted by the lack of daily use of Albuterol; trust me, I"019m my own critic, and I"019ve looked at my PFT results for the last 6 months"014I"019m scoring in the 70s, and for the most part prior to the BT, I was scoring between 50s and 60s. ? I"019ll leave you with this, if you are considering this procedure--there obviously isn"019t enough long term test trial research data on the results out there to compare against in determining whether this procedure has a long term beneficial rate; but at least with my case, it has immediate favorable affects, and has increased my quality of life drastically"014so is it worth the risk, no doubt; but there is no doubt in my mind, if you have other medical conditions besides asthma, this may be a VERY risky endeavor to undertake. ?
 
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Cyberperro replied to Cyberperro's response:
Hopefully my experience gives you some insight (from a patient"019s point of view) to the experience. ?I"019ll keep you posted as time goes by, as I"019m optimistic of my goal"014taking Advair and Zyrtec ONLY, and no seasonal attacks. ? I"019m a member of this community, so by all means, if you have any other questions; please do not hesitate to ask them of me. ? ? Sincerely, ? Adrian ?

? ?
 
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asthma84 replied to Cyberperro's response:
My doctor recommend this procedure to me and this has been the most helpful forum I have found. Thank you so much for doing this.
 
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Cyberperro replied to asthma84's response:
Thanks. Good luck--it'll change your life.
 
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jvastoggia responded:
Please update us on how you are feeling. I am considering the procedure and would love to know. Hoping excellent.


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