Difficult Options

[ScardyCat40]

I typed a great long post and then I lost it but this is the abridged version.

The pleural team want me to consider three options: ligation of the thoracic duct, introducing a embolus into the thoracic duct or an indwelling catheters. The first procedure would involve going to see the cardiothoracic surgeon I saw last time that shot me down. Last time I saw him we did not get as far as discussing what the procedure would involve. The second procedure would be undertaken by a radiologist. They have someone at the hospital that has done it once before I don’t know what it involves. The third procedure might be difficult as when I saw them 3 weeks ago they assessed me for a permanent drain on both sides but did not think it would be possible.

[Cheryl4677]

I’ve lost my post too!

[ScardyCat40 in reply to Cheryl4677]

It’s annoying isn’t it? I was using the app and swiped down and it was gone

[TinaB1]

I was wondering why the surgeon for the first procedure has been difficult. These are some very difficult choices.. xx

[ScardyCat40 in reply to TinaB1]

He was annoyed I had not seen a dietician and not not tried the more conservative options. He said the surgery has a very low success rate and would only be considered as a last option

[TinaB1]

I was thinking that you should go for the best option despite difficult doctor personalities. I wonder which one might be best. Xx

[Lily-Anne]

Okay so if it were me

I’d want more info on 2nd option

Option one has over 90% success rate but if consultant doesn’t inspire your trust I’d ask to see a different one who can do the same procedure

Not feeling option 3

🍀 do let us know before you decide (gives me more chance to research lol)

LA xx

[ScardyCat40 in reply to Lily-Anne]

Where did you get the 90% from? I need more info about both options 1 and 2

[Lily-Anne in reply to ScardyCat40]

ncbi.nlm.nih.gov/pmc/articl...

[ScardyCat40 in reply to Lily-Anne]

Wow thanks for finding that. I have read it through and now understand why this procedure is rare. The techniques required are not used by radiologists because of the advent of scanning techniques and it can be difficult to cannulise the thoracic duct decause of its small size.

The 90% success rate applied to the group that mostly suffered from a traumatic chylothorax ie from surgery or an accident. The nontraumatic group, which would include malignancies the success rate was 70% and this dropped to 50% in the follow up but they don’t really explain the drop. However this is still better than the reported success rate of surgery and conservative management.

I have read a few papers on the ligation of the thoracic duct and most of them imply that it is most successful in the treatment of traumatic leaks but not really used for nontraumatic leaks

[Maus123 in reply to ScardyCat40]

Agree with Lily-Ann but have no medical background. Read good things about option 2: ncbi.nlm.nih.gov/pmc/articl...

Although the text is a bit older, from 2011, the conclusion reads:

--

CONCLUSION

TDE is an important alternative and first line of treatment to patients with traumatic and nontraumatic chylous leaks with no associated mortality, minimal morbidity, and a high success rate.

More research is needed in the subgroup of patients with nontraumatic chylous leaks, with attention paid to better identifying the cause and location of chyle leaks. This could greatly improve both planning and outcomes of TDE.

--

All the best with the treatment.

Maus

[ScardyCat40 in reply to Maus123]

But the 90% success rate applies to the traumatic group which includes those that have had a Chyle leak following surgery. I would fall into the non traumatic group where the success rate is lower and finding a more experienced radiologist may be challenging

[Maus123 in reply to ScardyCat40]

Ah ok. That's a challenge then.

You sound like you researched your options already pretty thoroughly though, and I hope you choose the one that makes the most sense to you.

Good luck with the surgery!

Maus

[ScardyCat40 in reply to Maus123]

Well that post that Lily-Anne posted helped but I probably need to read a few more for a balanced view

[Tesla_7US in reply to Lily-Anne]

LA, you are wonderful. Really, researching this is useful to us all. I applaud your keen mind, curiosity and gumption! Even though in US, I'm travelling this road with all of you and learning much as we each persist.

[ScardyCat40]

I think what concerns me about option 2 is the lack of experience of the radiologist but I guess they don’t see that many chylothorices

[Tesla_7US in reply to ScardyCat40]

Lack of experience is a BIG DEAL! Whatever you decide, be certain the person doing it has done it MANY, MANY times. Medicine is imperfect. Ask for a more experienced radiologist!

[ScardyCat40 in reply to Tesla_7US]

There isn’t a more experienced radiologist this is a very rare procedure

[Tesla_7US in reply to ScardyCat40]

Scardy, I understand. This is a very tough decision and you need a lot more information to make the best choice for yourself. Of course, you would want to go with whatever has the greatest chance of success.

[ScardyCat40]

The big concern for option 3 is that it would help relieve my breathing but I would be constantly losing essential fats and lymphocytes from my system. This could eventually lead to malnutrition and immunodeficiency.

[tara108]

Don't know anything about what you are facing but just wanted to say I am thinking of you and hoping and praying that you find a good and successful solution. Hugs from Australia

[thomas62]

I also want to send you my good wishes. Like tara 108 I also don't know anything about what you are facing but do hope you can come to a successful conclusion as to the best way forward.

[Caroles1]

I too have no experience, but sounds like you have some of the lovely ladies on board and they have your back. You just need to weigh up all your options and see what you are happy with, it’s your body, your choice and go with who you have the most faith in,

Love Carole xx

[koffeekat99]

I have no experience of the options or the decisions you are about to make.

It sounds like there is no right or wrong answer here. So it sounds like you are already doing what I think I'd do, i.e. ask more questions about the favoured options.

X