I happened to be at work when I got the call from the nurse regarding the fluid in my right lung cavity. The lung cavity is the space between the lungs and the chest wall. (Side note: I am a geologist and work at an environmental consulting firm with amazing people who are like a second family). I closed my office door and just lost it. Uncontrollable crying, sobbing, the whole deal. I kept thinking no one has fluid in one lung cavity and not the other for a “simple” reason. I had a gut feeling that something more complex was going on. When I say more complex, I mean more complex than pneumonia or a chest cold. I was scared because the first thing I thought was “Oh shit, I totally might have lung cancer!” I have never smoked but for a few years of my life in high school I was exposed to secondhand cigarette smoke from being around my grandparents who smoked indoors. Thinking back now, I realize it was not a likely possibility but, hey unlikely outcomes can still be possible.
The nurse that gave me the news of the fluid said I needed to see a pulmonologist either that day or the next to have it drained. She said that going into the ER would not be out of the question either. She even went as far as reaching out to pulmonologists in the area so that she could refer me to someone she confirmed had availability to see me on short notice. She even gave me open appointment times. I gathered myself and called and made an appointment with a pulmonologist at Overlake Medical Center in Bellevue, Washington for the afternoon of the next day. I had been feeling good as far as breathing and didn’t feel like I needed to rush to the ER.
I called my husband Josh and gave him the results of the chest x-ray. He said “Well fluid in the lung cavity doesn’t seem good…” but ultimately, he was reserving any additional thoughts or feelings until we knew more.
I went to my doctor’s appointment, accompanied by Josh. The pulmonologist explained the procedure and performed an ultrasound on my lungs to assess how much fluid there was. She showed me the ultrasound on the right side versus the left side so I could see the difference in my lungs with and without fluid. On the left side when I breathed in and out, I could see my lung on the ultrasound go in and out. On the right side I could not see my lung at all, the ultrasound was just dark from fluid.
The procedure involved using the ultrasound to guide a needle in my back between the ribs to numb the area through to my lung cavity. Once numbed with lidocaine, the pulmonologist would make a tiny incision and insert a tube equivalent in size to one of those small red stirring straws. The fluid would then be suctioned out into a bag with a syringe attached to the tube. Sounds straightforward and easy right? Wrong! I struggled with this procedure. I got lightheaded and almost passed out while the doctor was trying to numb the area. I could feel the needle and lidocaine going in. It was so bizarre and not fun. The doctor took a break and went to see her last patient of the day. I gathered myself and discussed my options with Josh. Option 1) try again or option 2) go see an interventional radiologist who could do the procedure under conscious sedation. I was ready to tap out when Josh gave me a pep talk. He basically told me I think you can do this. We are here, this fluid needs to get drained, I think you should try again. I amped myself up and said OK. Let’s do this. If I could not pass out during the numbing part, I would be OK. The doctor came back in and I was able to get through the procedure. Josh played me cat videos on his phone to distract me and it definitely helped. Apparently, it was partly mind over matter!
I know now that the fluid that was drained is called chyle and when it accumulates in the lung cavity it is called a chylothorax. Chyle is a turbid milky colored fluid that is composed of lymph and emulsified fats and triglycerides. Chyle accumulates in the lung cavity (a.k.a. the pleural cavity) due to either disruption or obstruction of the thoracic duct.
Two liters of fluid were drained. See attached photo. I am smiling in this picture and looking relieved because I had just gotten through the procedure however this was before I was diagnosed. I look at the photo now and think, “Oh that naïve girl, she didn’t even know what she was in for!” The fun was only about to begin!