Around late October 2008, I was having coughing fits and actually was coughing up a little blood.  Went to Solantic and they did a chest X-ray, but said it was okay, the X-ray came back as “normal lung” (see examples at the bottom of this page).  I indicated that it felt like I was gargling blood high up in the throat area.  The coughing of the blood was not constant, off and on, but visited Solantic since if was after normal doctor office hours, but not an emergency room since it was not “real bad”.   (link: http://en.wikipedia.org/wiki/Hemoptysis)

The following day I went to my primary doctor (although have yet to ever see Dr. Prince, but rather say one of the PAs), gave her the same story.  I asked if it could be my lungs, and she said if it was, I would be in the emergency room right now, so I figured it must not be anything to do with my lungs.  She gave me a referral for a upper GI scope to check out my throat/stomach/etc.  

In November of 2008, I went through then endoscopy procedure to check out my GI tract.  That doctor said that I might have a small hiatus hernia  and said to make sure not to eat too late and then go  to bed (lying down right away), perhaps excess stomach acid was causing an issue.  I agreed even though I had never had any issues with indigestion, but I was 39 years old and things change.  He also issued me a proton-prohibitor medicine (a generic Protonix) to help with excess acid build up.  By mid-November it seemed to be fine.   I only  took the Protonix for 30 days and made sure I did not eat anything a couple of hours before bed/lying down.

Time passes, no more coughing up blood, no issues, I guessed it was something to do with stomach/acid/etc.

In February of 2009 I got the flu pretty bad, but again no issues coughing up blood, etc.

In 2009 I switched to a BCBS PPO plan at work.  Katie had also read in the Wall Street Journal that the Mayo Clinic (which has a facility right here in Jacksonville) did something called an Executive Annual Physical program (link: http://www.mayoclinic.org/executive-health).  Mayo accepts BCBS PPO plan, so with Katie’s suggestion, I set up an annual physical there in October of 2009.  I figured that would be a good thing to do since I was going to be turning 40 years old the following March and this would be a great baseline for my current health.

Note: Click here for a list of the items the did during my annual physical visit.

Mayo’s Executive Annual Physical includes a full checkup, blood work, urinalysis, chest X-ray, EKG, body composition, and a tread-mill stress test.   And Mayo is an excellent place to go, so this was a great way to check out where I was health wise.   I had been slowly losing extra weight to help my blood pressure and cholesterol levels, so this was just a next step as a comprehensive baseline.  I knew going in that some of the procedures were “not covered or not full covered” under a normal annual physical, but I figured the out-of-pocket expense was worth knowing.

So, on October 28th (Wednesday) I had my annual physical with Mayo.  The doctor, Dr. Manuel Rodriguez MD (link: http://www.mayoclinic.org/bio/13483803.html), was the doctor doing my main physical.  Dr. Rodriguez was just the nicest doctor, explaining all of things he was checking during the physical and really showing a kindness and concern for his patient.  After all of the tests and procedures I was to have a final meeting with him and that is when he explained that my chest X-ray showed that my upper right lobe was collapsed.   Dr. Rodriguez’s concern and compassion was very obvious, making sure to let me know not to worry and that they are going to take good care of me.  He even gave me his business card and added his personal home/cell phone numbers so if Katie or I had any questions we could call him directly.

They attempted to schedule me for CT scan that same day, but could not get the authorization back from BCBS fast enough, so it was scheduled for the following day, Thursday, October 29th. 

Since I was able to leave the hospital about 2pm that day, I was able to contact Solantic and get a copy of my chest X-ray from the prior year so I could bring in to Dr. Rodriguez on Thursday for a comparison.

I went to the Mayo clinic early that morning for the CT scan, and meet with Dr. Rodriguez that afternoon to discuss the findings.   He showed me the CT scan which revealed that there was something in the right upper bronchial tube obstructing air flow.  The scan showed that some air was able to get in there, but not much.  At this point it was unclear what t was, meaning it could be mucus, a growth, or even possibly something I swallowed incorrectly (bean/etc.).   We also reviewed the chest X-ray from Solantic the prior year and both X-rays looked almost the same.   And as I heard from Dr. Rodriguez, this was a “classic example of a collapsed lung”.  So, apparently the radiologist and/or doctor at Solantic completely missed it and said it was a normal lung.   One good thing from the comparison showed that for at least one year, the upper right lobe of my lung was not functioning.  They said that the upper right lobe only provides about 18% of your air capacity, and that is why I probably never felt any shortness of breath/etc.

The next step was to meet with pulmonary doctor.  The next appoint that was scheduled was not until around 3+ weeks later.  Dr. Rodriguez called he doctor on the schedule, a Dr. Jorge Pascual MD (link: http://www.mayoclinic.org/bio/11203561.html) , to see if it was possible for him to fit me in the next day, which would be incredible.   Dr. Pascual said he could so that appointment was schedule for Friday morning.

Dr. Pascual reviewed the chest X-rays, and the CT scan an explained the next step which would be a bronchoscopy procedure (link: http://www.mayoclinic.com/health/medical/IM04196) to go down and look at the lungs to see what is actually there.  If it is something they can grab/remove, the  can do that, if not, they can biopsy it and proceed to the next step.   So that procedure was scheduled for the following Monday, November 2nd.

The findings from that procedure indicate there was some growth in that upper right-lobe of the lung.  It also indicated that the rest of my lungs looked fine, no issues which was good.  After the growth, the indicated it was vascular in nature, i.e. bloody, so they could not take a chunk biopsy since they would not want it to start heavily bleed, but did feel comfortable taking a couple needle biopsies.

Dr. Pascual contacted me on Wednesday to indicate the results.  He said that the biopsies were not conclusive since they were basically just blood.  Meaning there was no cancer in the blood, but since they were not able to get a chunk, the test is technically inconclusive.   He said the next step would be to get a PET scan to check for cancer in other parts of the body and the schedule a surgical consult to have that upper right section of the lung removed.   He indicated it might be able to be removed with VATS (Video-Assisted Thoracoscopic Surgery, link: http://www.mayoclinic.org/video-assisted-thoracic-surgery), but that would be up to the surgeon.   

The following week I went in for my PET (Positron Emission Tomography, link: http://www.mayoclinic.com/health/pet-scan/MY00238) scan, of which the results of that showed that the upper right lobe of the lung was cancer of some sort, and there were three lymph nodes that also showed a higher metabolism rate.  For the lymph nodes, since they are part of the immune system, that does not necessarily mean cancer, it could mean infection.   But the rest of my body was clean, so it appeared that all that was needed was to cut out the bad lung section.

My surgical consult was not scheduled until November 24th, but I called to check on any cancellations the prior week and was able to see that doctor on November 17th.   The doctor that would be doing the surgery was Dr. John Odell MD (link: http://www.mayoclinic.org/bio/11677872.html).   During that meeting we talked about the surgery, the VATS procedure and if he could not do that, the more invasive type surgery, thoracotomy (link: http://www.webmd.com/lung-cancer/lung-surgery-thoracotomy-for-lung-cancer), which is a larger cut and longer recovery time.  If VATS could be used, then the hospital stay would be 3-4 days, if the other, than 5-7 days.  Well, in any case I felt like I was in good hands, Dr. Odell had been doing this surgery for a couple of decades, and does these 3 or 4 times a week.

At this point they thought it was something called a carsonoid growth/tumor/cancer (click for a good write up on this).   This a rare type of cancer, slow growing, but once it is removed all should be fine.  Dr. Odell indicated until recently it was not even considered cancer, but now is classified as cancer, but in the full spectrum of cancer, this is way on the end of slow growing and normally not something to be worried about.   The most interesting part of the PDF article I link to here is on page #4, under "How Are Lung Carcinoid Tumors Diagnosed?" ... "Some patients with central carcinoid tumors may have a cough, may cough up bloody sputum".   Which was my exact situation back in October 2008.

So, my surgery was scheduled of November 23rd.  This was incredible since it was less than 30 days since my annual physical that discovered it.

On Monday, November 23rd I arrived at Mayo for my surgery with my wife Katie.  I went into pre-operation room about 9am where they set up my IVs, took blood, and hooked up my epidural to my upper back.   I believe it was about 10:30 or so when I wheeled me off to the operating room.

Originally Dr. Odell indicated that the surgery (his part) would normally only take about 1-2 hours.   Apparently I was in there for about 3 or so hours.  The reason was once they go into that area Dr. Odell realized that the section of the lung was worst off that originally believed, it was harder to remove and kind of adhered itself to the chest wall.   He was not able to use the VATS procedure so there was about a 5-6 inch veridical cut under my right arm where they accessed my lung.  They had to use some rib spreaders to gain further access.   

About 3pm or so he came out to talk Katie about the surgery.  He indicated the surgery went well, but during that conversation his beeper went off and it indicated he was needed back since my blood pressure was dropping.  Apparently I coughed or something which broke one of the sutures that was one a main blood vessel.   He went back in and for about an hour or so Katie did not know what that story was, and that was certainly a dark valley for awhile.   After about an hour or so, Dr. Odell came back out to explain that I was doing fine again and all should be good.   I apparently lost about 4 units of blood and was given blood, but all was okay and I was stable again.   He told us later that the last time that happened to him was like 27 years ago.

I moved me to the ICU unit for Monday and Tuesday.   I was pretty much asleep until Tuesday morning/afternoon.   It was Tuesday they removed my breathing tubes and by Tuesday night I was drinking liquids again.  They removed the urinary catheter on Tuesday evening as well.   I still had EKG stuff on my connected to a remote device, a chest tube to drain excessive fluid from the cavity, and my epidural  line going to my back.

By Wednesday I was feeling much better and was ready to move to a normal room, but had to stay in ICU since there was no rooms currently available.   I was already eating and stuff.

Each day I had to get a chest X-ray to check on seeing how the cavity area was doing.  On Friday they decided I needed another chest tube, higher up to help drain additional fluid from that section.  So on Friday  morning I had an additional one added.

By Wednesday they had the results back from testing the lymph nodes and them came back clean.  So, with the removal of the one section of lung, that should do it, no chemo, no radiation, just remove and be done with it.

And as far as the type of cancer, it was not a carsonoid, but rather a mucoepidermoid carcinoma (link: http://www.surgical-pathology.com/mucoepidermoid_carcinoma_lung.htm).  This is another type of rare cancer, apparently only about .02% of the total each year (that’s like 60 cases out of 300,000).  But this is a type that could be a fast growing form of cancer, so I am very happy it was caught early and removed.

Each day I was feeling better, more strength and able to do more walking to exercise the body and the lungs.   When Katie and Ryan visited me on Friday night, Dr. Rodriguez visited which was very nice.

On Saturday they removed my epidural which was great since it was kind of itchy.

Also each day about 7am, Dr. Odell and his team would come visit to see how I was doing.   On Sunday, November 27th when they came in to check me, they indicated my fluids were draining slow enough that I could have the tubes removed and I could go home.

So, Sunday the 27th I got to go home, indicated to return to regular diet and routine.   I took off the next week just to rest and see how I was doing.   I was already feeling about 80% when I left the hospital, and felt better each day once I got home.  A real blessing from God was that I was in almost no pain, and I was not using any pain medicine.  I was using a little Tylenol for the aches, but almost nothing which was great.  By Wednesday I was feeling about 90% and even went to our church services that night with Ryan.  And I was able to drive myself since I was not on any pain meds that would prevent me from doing so.  I joined Katie and Ryan for our co-op home school group on Thursday and we went to the Nutcracker on Friday when them.  By the weekend, December 5th, I was feeling about 95% back to normal so I made the decision to return to work on Monday.  So with the exception of just healing and taking it easy, no heavy lifting, I was doing just great by the 7th.

I go back to see Dr. Odell for a follow-up appointment on December 15th.   And will probably meet with Dr. Pascual which he said I would need to do a periodic CT scan just to check/verify that nothing else is growing for the next couple of years.

So, that’s the story.



God is good!
J


Joe Vogel, 2009





 Example of a real "Normal Lung" of a 40-year old male:







 X-Ray of my chest done by Solantic and indicated as "normal lung" in October 2008:



When you compare this to the example of a real normal one above, you can see how the right side it shifted up and the upper right area is not as dark.

The dark area indicates "air" in the lung (when you get a chest x-ray they ask you to breath in deep).  Also note on the left hand side you see more of a full lung, remembering that the heart is in front of the lung on that side so it does not show up as dark.

But you can tell something is not quite right with the right lung presentation.  Nonetheless, the Solantic doctor indicated it as "normal lung".


 X-Ray of my chest done by Mayo and indicated as "abnormal lung" in October 2009:



So, as you can see, basically the EXACT same!

Which in one way was good since it had not gotten worse, BUT it was the exact same so Solantic totally missed it!

Arg!

So, let's compare ....






 Good illustration of the lobes of the lung, they removed the upper right (smallest) lobe on me:





 So, as of December 2009, with the upper right lobe of the lung removed, my current chest x-ray looks like:

As time passes, they say the two remaining lobes might grow in size to since there is more room, but the doctors say all looks great as of that date.


                             X-ray on follow-up after surgery/recovery - December 15 2009   
                    


CT Scan - 6 months later - June 25th 2010   - Based on the notes from the scan, all appears good (aka "unremarkable")