Cryo-Ablation

Last week I mentioned my upcoming cryo-ablation surgery scheduled for October 22^nd. It’s complete, though the experience was a little more than I bargained for. I checked in at 9am and the admitting and pre-op processes were smooth and well organized. By 11am I was in the OR. I didn’t get a chance to look at the apparatus; I had too many connections (electrodes, IV, etc.) to move around. Then the first blast of anesthesia and it was all over in a minute. Of course it lasted for just over two hours, but the anesthesia makes me feel like no time has passed. I woke up in a recovery room. Everything was fine. I gradually shook off some of the anesthesia and was discharged at 5pm. I stayed groggy and went to bed early.

The surprise came on Friday. Absolute agony. It was so painful it’s hard to describe. Every breath caused a sharp pain that felt like a knife going in between my ribs. But there were no significant wounds. Just a couple of holes near the center of my chest. I was able to medicate the pain down to a tolerable level, but by Saturday morning it was the same agony. I couldn’t move without crying out. I medicated that too. Today, Sunday, things have improved a little more. The problem is that I’ve been completely sedentary and have deconditioned significantly, as most older people do after bedrest.

Where did the pain come from? With a web search I was able to piece together the equipment used and how the procedure is done. Basically, a long cryo-ablation needle does not go straight in. It enters the intercostal muscles that are between the ribs and is pushed at an angle through the muscle until it reaches its destination. It leaves a channel through the muscle, not just a little hole as if it went straight in. In my case there were two needles and each channel was poked twice, leading to further muscle damage. One wound was poked three times, the first being a larger needle used to get a biopsy. Note that this description may be unique to my individual needs. I'm sure that there are many other approaches to cryo-ablation, even specifically on the interior of the chest wall. 

The intercostal muscles are between your ribs and are breathing muscles (along with many other muscles in your upper body). That’s why it hurts when I breathe and when I move even in small way. Ribs are flexible and they move around more than you think. So I went back and looked at my discharge papers, which I reviewed briefly under the influence of morphine when discharged. Sure enough, the pain is expected to last for two or three days. The recommended pain medication is oxycodone and Tylenol. The pain is accompanied by breathlessness due to reduced volume in the chest cavity; the lung is squeezed and cannot fully expand. Fatigue is expected for a week, and the final healing is one to two weeks. It looks like I’m right on schedule.

The doctor who did the procedure said he has multiple clear images that show a favorable result in terms of location and the production of the deadly ice balls. There will be a follow up CT in December and that will be a confirmation of success or failure. But this story isn’t over. There are other suspicious nodules. The two they just froze to death happened to be the ones that were “easy” to get at. The road continues.