My experience having a stent placed to expand my narrowing airway
Now that he's had both, a columnist compares flexible and rigid bronchoscopies
A pulmonary fibrosis journey is marked by many firsts, especially in relation to medical tests. Prior to my diagnosis of idiopathic pulmonary fibrosis (IPF) in January 2017, I had a primary care physician, a gastroenterologist who performed routine colonoscopies, and a surgeon who repaired a hernia. That was the extent of my medical team and procedures, except for routine bloodwork.
After my diagnosis, the number of tests I underwent and the number of specialists I saw increased dramatically. My team at Inova Fairfax Hospital here in Virginia uses MyChart, a popular software tool that allows patients to access a wide variety of medical information, from appointment schedules to test results. The number of specialties listed under my care team on MyChart always surprises me. And to ensure I was a good candidate for lung transplant, I had to undergo a multipage checklist of tests and vaccinations.
A new procedure
Although it’s been nearly two years since my lung transplant, I’m still undergoing new tests and procedures.
In a recent column, I shared that my left bronchial stem had narrowed. Last September, I had an exacerbation caused by pneumonia, and the narrowing was discovered in early December during a follow-up flexible bronchoscopy — the first of four over a three-month period. The other three, conducted by Dr. Duy Kevin Duong, were balloon dilations intended to stretch my bronchial stem.
Because the dilations only stretched my bronchial stem temporarily, my team planned to give my body two months to rest before conducting a rigid bronchoscopy to insert a stent. The procedure took place a week ago, on May 9.
Was it different?
Prior to the procedure, Dr. Duong talked my wife, Susan, and me through his plan. He intended to take an initial look at my bronchial stem using a flexible bronchoscope, and if I still needed a stent, he would perform a rigid bronchoscopy. I did end up needing the stent, so I was able to compare the two procedures.
Unlike my previous flexible bronchoscopies, which were conducted on a gurney, the rigid bronchoscopy was conducted in an operating room on a much narrower table that required me to be strapped down.
The second significant difference was that the entire procedure took approximately 90 minutes — twice as long as the flexible bronchoscopies. I had to rely on Susan for this reference since I was under anesthesia.
Findings
My left bronchial stem, which had last been stretched by balloon dilation on Feb. 28 to approximately 13 mm, had narrowed. The opening was down to 6 mm, which was why Dr. Duong decided to insert the stent.
When the team brought me out from under anesthesia, I noticed some discomfort. However, this is fairly common following a rigid bronchoscopy, and not the fault of my care team.
My jaw hurt and my chest was tight. We supposed the positioning of my head and neck to accommodate the rigid instrument caused the jaw pain. It felt like someone had given my jaw a right hook. And I had a lot of congestion, primarily mucus, in my chest.
Tylenol took care of the jaw pain quickly. My team also prescribed two medications, albuterol and sodium chloride, both of which are delivered by nebulizer. I learned that both medications are in high demand and not readily available due to a shortage. It took two different pharmacies to fill the prescriptions.
Outcomes
One week from now, Dr. Duong and his team will conduct another flexible bronchoscopy to ensure the stent placement looks good and there are no concerns. At that point, the stent will stay in place for three to six months to train my bronchial stem.
There are challenges with the stent placement. It is another foreign body that my body will try to reject. There’s also the potential for it to accumulate bacteria, allowing for colonization. My care team will be monitoring both situations.
In the meantime, I will work hard to live every day to the fullest, honoring the gift of life my donor gave me. It’s how I can make every breath count.
Note: Pulmonary Fibrosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Fibrosis News or its parent company, BioNews, and are intended to spark discussion about issues pertaining to pulmonary fibrosis.
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