Atelectasis?

December 2020 update

Since my Collis-Nissen revision surgery, I have exerienced some reflux, though nowhere near what I used to experience.

In 2017, having some oesophagitis which I felt when trying to drink wine, I contacted the nurse specialist who called me in for a scope which confirmed my diagnosis. It was mild and soon healed with maintenance dose omeprazole - confirmed by a second scope at the beginning of April 2018. I decided to remain on omeprazole again.

I also experience the cough but, again, not nearly as severe as the cough I had prior to my first fundoplication.

The scopes confirmed my latest wrap was intact. I think the reflux episodes may be linked to food pooling above the wrap where it takes slightly longer to pass through. A reduced opening also explains the burping after meals. The gas trapped in my stomach has to wait for the way to be clear (from descending food) before it can be released. Sitting upright, the gas can then escape.

In the early hours of Thursday 24 September 2020, I awoke with really intense chest pain. It felt like an elephant sitting on my chest. If I didn't know better, I would have suspected a heart attack. Indeed, when entering the symptom on the NHS111 website, it flashed up red to call an ambulance as I was having a heart attack, but I knew I wasn't and it was probably reflux related. Years ago, I had experienced chest pains from reflux (signals sent via the vagus nerve from a spasming oesophagus) but this was more intense. Checking with my oximeter, my blood oxygen level was very low (around 91% and briefly at 88%). Entering that result on NHS111 website, it told me to get a COVID 19 test but I knew it wasn't that as I had had a test (negatively) just a few days before as part of the Office for National Statistics survey on coronavirus prevalence.

I reasoned it wasn't heart as I've had so many heart tests over the years that have shown it's good, and only had my implanted heart monitor removed last year after 5 years as the battery was flat. It had never recorded any abnormality. Also the pain was upper right quadrant, just above the nipple line - the wrong side for heart.

I surmised it was probably obstructive atelectasis.

Atelectasis is the collapse of a lung or part thereof. Although rare, it can be a consequence of aspirated reflux.

Refluxate aspirating into the lungs is usually cleared by coughing. However, To minimise disturbing my wife, I will often take a cough suppressant lozenge when I go to bed. It delivers a mild anaesthetic to the throat to reduce coughing impulse. It is just possible some of that got into the lung?

If some refluxate or excess phlegm sticks in one of the tiny bronchioles of the lung, it can cause the air sacs beyond to deflate = obstructive atelectasis.

Dealing with atelectasis requires a rapid reinflation of the lungs which I achieved with deep breathing technique of breathing out as far as I could and then breathing in as far as I could, holding it for a few seconds and then a few rapid shallow ins and outs before breathing right out again. (Repeated a couple of times).

For the next few weeks, I felt as if I had a tight band around my chest and needed to repeat the deep breathing exercises a few times, and kept a check on my SpO2 levels which were typically around 93%.

It took about 6 weeks for my lung to feel normal again, which is what textbooks suggest as normal healing time for atelectasis.

Of course, with Covid, I hadn't bothered the doctors so never had this as a definitive diagnosis.

May 2021 update

With the chest pain recurring (though not as bad as 24 September, and shortness of breath when exercising (unable to walk more than a couple of hundred yards or cycle a normal bike for more than a couple of miles) I decided to make a doctor's appointment - which was by phone.

Although I said I was certain the pain was not heart, of course, I was sent for an ECG (+ bloods).

26 April: ECG. Trace looked good and nurse said, although she wasn't supposed to comment, it was one of the best traces she'd ever seen. Had to make another appointment to see doctor: he would phone me on 6 May in afternoon.

Sunday 2 May: notification my blood test results available online on my hospital records. They were as expected. Everything was fine except for high cholesterol - which I always have this time of year. Been on statins previously but thought they exacerbated my restless leg syndrome so stopped using them.

Thursday 6 May: Missed the doctor's phone call as he'd phoned before noon but left message to say he'd call back later. Had phone close all afternoon with no call.

Friday 7 May: Called surgery to ask if I'd have another call. After pushing my case hard, I was told I'd be contacted before 1:00pm by nurse. 12:30 received text to phone surgery for "routine appointment" to discuss blood test results. Phoned and vehemently requested an urgent appointment - not routine. Was directed to an "e-consult" online questionnaire to fill out to provide details so it could be treated other than routine.

Spent ages completing e-consult. But last page wouldn't let me submit it, instead said serious health issues, phone the surgery, which I did, yet again!

Eventually had a listening ear. I asked for Face to Face, as you can't run a stethoscope via mobile phone, but she said that wasn't possible unless the doctor requested it. However, a doctor would phoe me that afternoon - which he did, about 4:30.

He listened and said he wanted to send me for an ECG !!! I felt I was going in circles and asked very strongly that he check my previous records and record I was sure it wasn't heart but lungs. He said he'd make a referral to the chest clinic but that I'd be getting a phone call first, on Monday, from the cardiac unit.

He phoned back again later, having read the records in my file and was now prepared to take what I'd said seriously, even considering the possibility of atelectasis. I am to have chest x-ray on Monday and a face to face appointment on Friday so he can listen to my chest. At last, I feel I'm getting somewhere.

Saturday 8 May 1:00 am. Severe chest pain again. Deep breathing, walking about, chest thumping, nothing worked. Subsided after 2 hours.