Was anyone treated with a pleural drainage for 60 days or so? If so, did the pleural effusion reoccur after the completion of thedrainage?
I had a drainage installed on Wednesday. Boy oh boy, what a nightmare it has been so far.
Would appreciate any input in the subject.
I'm sorry to hear you're dealing with pleural effusion. I drained the fluid at home using a PleurX catheter for several months until the fluid was gone. When systemic therapy begins to work, draining is no longer needed.
In case it may help, below from my book, "The Insider's Guide to Metastatic Breast cancer" which is also available as a complimentary .pdf, is a list of drainage options. For information about approved treatments by subtype, contending with side effects, cutting edge research and more, please visit insidersguidembc.com
Pleural effusion, which may accompany lung metastasis, is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. Often the fluid contains cancer cells. Pathology testing should whether the pleural effusion is "exudative" (the fluid has excess protein, blood, or evidence of inflammation or infection) or "transudative" (characterized by a low cell and protein content), based on the chemistry of the fluid. If the fluid transudative it's very unlikely to be malignant, and if it's exudative, malignancy is still a possibility even if malignant cells don't show up when the fluid is tested, so re-testing should be done as warranted, along with any other recommended tests. If the effusion turns out to have malignant cells, testing should be done for ER, PR, and HER2 receptivity, since it is possible that the cancer cells in the effusion may have a different profile than metastasis elsewhere in the body.
For patients who have pleural effusion, there are three methods of draining the fluid to provide relief:
Indwelling (Pleurx or Aspira) Catheter: This is the surgical insertion, under general anesthesia, of a small tube placed temporarily into the pleural space that allows the patient or his/her family member to drain the fluid into a bottle as needed. Patients with an indwelling catheter are fully mobile and are not "attached" to the draining bottle except when draining the fluid. Once there is no more drainage at all, the catheter is removed either in the doctor's office or an outpatient procedure. Overall, indwelling catheters seem to help prevent the fluid from building up again, provided that the patient's systemic treatment is working. The Pleurx catheter works via suction, and the newer gentler model is the Aspira catheter, which is a bit less uncomfortable because uses gravity instead of suction for draining.
Pleurodesis (sometimes referred to as a "talc procedure") is a process in which substances, such as talc, are used to try to get the edge of the lung to stick to the chest wall to decrease the chance of the fluid returning. Although this procedure seems to help prevent the fluid from building up again (provided that systemic treatment is working) it can be painful and usually requires a brief hospital stay. Some patients have reported discomfort months and even years after the procedure. In rare cases, the procedure may fail altogether, rendering it impossible to drain the fluid thereafter because it becomes trapped in a honeycomb of many small pockets (called "loculations"). Of all options for draining malignant pleural effusion, this appears to be the most risk-prone.
Thoracentesis (sometimes referred to as "tapping") is an outpatient procedure that involves placing one needle per required side into the pleural space. Although local anesthesia is administered, this procedure can be uncomfortable and may cause scarring if repeated over time. The procedure also does not hinder fluid buildup again. These tips may make the procedure less uncomfortable: 1) Request a numbing agent before the needle is inserted to feel more comfortable after the procedure. 2) Request that the fluid to be withdrawn slowly in order to avoid low blood pressure or a "fainting" feeling afterwards. 3) Lean forward with a soft pillow supporting your head and upper torso while the draining is underway via your back.
Warning: If a patient is experiencing shortness of breath but the doctor cannot find anything in the lungs that is causing it, the patient should be checked carefully for blood clots as well as for cardiac issues. Either of these issues may cause symptoms that appear to be lung related problems, when in fact they are not. Additionally, a condition called "pneumonitis" (inflammation of the lung), can cause shortness of breath and coughing. Since pneumonitis can be caused by cancer treatments such as chemotherapy and radiation, MBC patients may be particularly susceptible.
Thank you so much for your reply. My question/concern is:: once all fluid is emptied, assuming immunotherapy is working, what are the odds that effusion will return.
Mom had to have three thoracentesis in as many weeks. This was before she was diagnosed. She then had a pleurodesis to stop the fluid from accumulating. All this was before she started treatment on Ibrance/Letrozole. That was about two years ago. She did have the PleurX drain post surgery and it was ok. Happy to answer any questions you may have.! ❤️
Hi Grorge, very kind of you to share your mom's story with the purpose to help. How is your mom, apart from having a wonderful daughter 🙂Hugs and best wishes,
Dully
I'm sorry to hear your going through the "drains" - I did have to have drain put in and they remained in for about 3 months -- unfortunately after the drains were removed - I ended up having them to have them again as the fluid came back about a month later. The good news is that once they tested the fluid they changed my meds and after another 60 days - I was cleared to have them removed and haven't had any issues for 2 years! I'm so thankful that I could manage the fluid with the drains. Although I did have lots of pain and issues with my drains, I was thankful for the option to not have the fluid could live a basically normal life -- nobody knows! And no breathing issues. My advice is to eat healthy (green living), exercise, and meditation carried me through - as well as lots of love from family and friends. And anytime I felt down - I read the book Radical Remission! IT is truly the gift of hope. Sending lots of healing vibes and happy to chat anytime.
Thank you Magsue for your inspiring reply. May I ask some verifications?1. The drainage was inserted in your pleura twice, within a space of a month? They have to cut and insert twice...
2. You were given meds to stop the accumulation? Or your cancer treatment was changed?
3. Have you been clean for Teo years? Cause that would make me happy.
I am TPBC, I'm on Herceptin/Perjeta/Tamoxifen. So far I react to treatment well, so my only nightmare is the pleural effusion.
Hugs and best of wishes,
Dully
Dully - well my situation was a little complex. I was diagnosed w MBC in 2018 (after 8 years after original diagnosis stage 3 - ER+) I had several spots chest,liver, PE left lung - on Ibrance cleared all but liver. So we moved off to a couple more drugs - to tackleLiver Mets - then PE came back and had drains to control fluid in Left lung. Only a single surgery to add drain. After 3 months removed drain…. But had issues and had to have drain put back in. The fluid was triple negative so my meds were Changed again and thankfully was able to remove drain again and haven’t had any issues for 2 years! I remain stable with 2 tiny spots on my liver and I feel great - i believe that the change in Meds along with my Naturpathic approach with all I noted above is why I’m responding so well! Full toolbox! Oh and my Acupunture!! I do think we have to be careful as some of these drugs to solve 1 problem can cause others. Hope that helps - know you will get past this! And the drains are your friend right now - heal… take the time to believe!!
Just confirming that there is nothing to take to stop the fluid - I was moved to a new oral chemo to deal w the triple negative cancer which was in the fluid in the lung. Have they tested the fluid? That is super important to find out if is is a different cancer type as we had to chase that over the assumed ER+ In the liver. Hope that helps
I’d say that is great news! They didn’t tell me it was only 50% accurate when they tested mine and it was positive for cancer cells! I’d go with non malignant!
Nightmare 3 weeks but recovering
Ibrance/Letrozole/blood thinners
EVEROLIMUS & EXEMESTANE
Miami Beach here I come! NOT!!☹️
Update re: pleur x catheter
