So. I got the Nuss Procedure and I’m happy with it. If you want to know what the process was like and if there’s anything I would have done differently this is where’s you’ll find it.

What is The Nuss Procedure

What weird-ass kebab looking surgery is this?

The Nuss procedure is a surgery used to correct the genetic deformity called Pectus Excavatum. It corrects the sunken chest of Pectus Excavatum sufferers by the insertion of metal bars that raise the sternum to the correct level for the patient. This picture isn’t me but it gives you an idea of what the surgery is all about. The bar goes in with a downwards angle and is rotated around to raise the sternum up. In my case there was two bars as the sunken area was quite tall.

What is Pectus Excavatum?

Why do you have an absolute crater for a chest?

You can see the level of pectus excavatum that I was dealing with here.

Sufferers of pectus are generally pretty shy about there chest however it had never particularly bothered me. You get the odd funny look now and then, and comments from kids occasionally but it had never stopped me doing anything. You’re also guaranteed to win the “who’s got the best party trick” competition.

I had the opportunity to be placed on the waiting list for the Nuss procedure when I was around 15-16 years old. I initially refused as the consultant said that my pectus wouldn’t be causing me any health problems. Well I suppose it already was causing me health problems as it had caused a mild scoliosis as my spine had curved around the area that had been pushed back by my sunken chest.

It was only after going for a second consultation that I decided to get placed onto the waiting list for surgery. Due to the surgery being “Low Priority” it was an expected wait of a couple of years which was fine, I was in no rush.

Unfortunately this lined up perfectly with lockdowns during COVID which threw vast amounts of delays into the NHS, pushing my operation back until 5 years instead of the expected two.

Pre-Operation

What it was like getting prepped for the operation.

Health Checks

Xrays and cheek swabs and blood tests oh my!

After finally hearing back from the hospital about the procedure being confirmed I was asked to come in for various tests to ensure I was in good health and to see what state my chest was in.

I’d had xrays done of my chest previously to determine how deeply my sternum had sunken and to see whether it was infringing on the operation of any of my vital organs which it wasn’t thankfully. Apologies for the shoddy quality but I’m luck I could even get a picture of this from the consultant’s computer.

You can see in those two xrays which are from my initial consultation in 2015 and the consultation when I was placed on the waiting list in 2021, that my scoliosis developed quite significantly in those years. Since then it has remained pretty static and only really causes me bother if I’m sitting or standing still for too long which is true for most people anyway.

I was given a CT Scan of my chest as well for a more detailed view of my condition, although I wasn’t able to get an image of that unfortunately. The CT required a contrast dye to be filtered into my bloodstream as well via a cannula in the back of my hand. I’d never had this done before but they did warn me that it would make me feel like I’d peed myself, and indeed I did feel as if I’d peed myself within just a few seconds of them adding the dye to my blood.

Day Before The Operation

You are asked to arrive at the hospital the day before your operation to allow them to give you last minute tests and also to ensure you are sticking to the overnight fasting rules that they have put in place before the operation. I was given blood tests for the usual stuff like kidney function, glucose levels, just boring stuff and I was able to meet the anaesthesiologist so she could run me through what would really happen as I went in for the operation the next morning.

The NHS being the NHS as well this took a lot longer than I expected. I spent most of the day from 15:00 onwards, sitting around in a waiting area in the cardiothoracic ward as various nurses popped in to take bloods and check details with me. Eventually, overnight I was shipped off to a different ward for the night which only had three people in it. That would be the last good night of sleep I’d get in around 4 days. I wish I knew to appreciate it at the time.

The Operation

Pre, Intra and Post Kebabbing.

Before

Operation day. I woke up feeling pretty fresh in the nice quiet ward they’d placed me in overnight. A nurse woke me up around 6:00 as I was to be heading to by operation around 8:00. A couple of towels and a small foil dish filled with what I would assume is a disinfectant soap was provided to me to have a wash with. A pair of white stockings were also provided that were to stop embolisms, I guess because I would be sitting still for so long.

After scrubbing off for the last time before by operation I was asked whether I would need any chest hair shaved off before the operation. As you can tell by that first picture of me, that was a resounding no.

The doctor’s for the operation turned up at just after 8:00. I believe they were junior doctor’s going by their green instead of blue scrubs. They also turned up with a wheelchair which I thought was a bit strange given that there was nothing wrong with my legs. I asked to just walk along to the operating theatre with them which they were fine with. So off I toddled through the hospital in my stylish stockings, reeking of disinfectant.

During

The operating theatre was about what I expected, if anything a bit small. There was quite a few people present including the anaesthesiologist I saw the day prior. I was asked to hop up onto the operating bed and to lie down. I think this was when it started to feel real. It still wasn’t scary, I trusted the people in the room, they all clearly knew what they were doing and were very efficient.

The last thing I remembered was the anaesthesiologist telling me that she was starting to put the anaesthetic into my bloodstream via the cannula on the back of my hand and then her placing the breathing mask on me that put me to sleep. I don’t know how many breaths it took me to fall asleep but the fact I don’t remember probably means it wasn’t many.

After

And then I woke up. It’s a strange feeling waking up when you never meant to go to sleep. I believe I was in the recovery room? Honestly I was drugged to the heavens and was probably still half asleep so I don’t remember much of the recovery room other than that they asked to get a couple xrays of me. I think I fell asleep again pretty soon after that.

Here’s the xrays that they let me see as well. You can see the two bars very clearly. Another thing that may be of note is that the bars are not screwed to the ribs, they are wired to them to allow a minimal amount of movement. I expect that’s what the holes in the ends of the bars are for, to thread the wire through.

The next stop was HDU (High Dependency Unit). I woke up here feeling extremely tired and only a little sore. The nurse explained the painkillers that I was on and how to increase my dose using a green button that was sitting on my bed, a little hand unit, like a remote control with a cable. This magic button was my saviour for the first couple of days. It contained Oxycodone, a synthetic opioid which when I pressed the magic button was fed into me intravenously. There was a sort of cool down timer on the button so I couldn’t overdose myself but essentially I just pressed that whenever the cool down ran out.

I was also on a 4 hourly dose of local anaesthetic that was being sprayed onto the surgical incisions from some wound catheters. It was hard to tell how much of a difference these were making to my pain levels. Especially when one of them started to fall out on the first day so I ended up with anaesthetic dripping down my armpit.

What seemed to be a high priority on the first day was urinating. I think essentially the rule was that you had to pee by the end of day 2 or you would need a catheter. Quite the motivator. It took me quite a few tries to be able to pee, seemed that I needed to stand up to be capable of it. Also not the easiest when even sitting up is painful.

Oh did I mention it was extremely painful. I thought it was bad now. Oh how naive I was.

So here’s me in the HDU once I’d had a visit from my family.

Generally it wasn’t recommended to visit on day one as most of the time patients are too knackered to even talk to anyone but I seemed to be in pretty high spirits so my family came to say hello. You can’t really tell how much of a difference there is in my chest in this picture but it does give you an idea of the amount of cables and drugs I was hooked up to.

It also looks like the surgeons gave up wiping all of the surgical cleaning solution off of me as I had an orange band around my belly for days after operation as I couldn’t get a shower.

Recovery

Starting a crippling addiction to hard drugs.

HDU and Ward 102

I thought I felt pretty rough on the day of the operation. Oh boy it could get a whole lot worse. HDU was like heaven when compared to ward 102, which is where I was moved to after they figured out that I wasn’t going to die on the spot.

I knew I would be in a room with other people but my god could they have been worse people. I got wheeled into the room on my bed and I swear the 3 other men in the room never even acknowledged my presence. They were all 70+ men that looked unbelievably miserable. I thought that’s fine I don’t really need to make friends I’ll be tired anyway I’ll just sleep. Oh how wrong was I.

Sleep Deprivation and Pain

The next 2 days I think I got around 5 hours of combined sleep. The man next to me had obviously had some sort of chest operation that had him coughing up phlegm and all other sorts of body fluids constantly. He also for some reason started pulling out his cannula on the regular and trying to leave his bed which meant he set of an alarm that was so loud you had no chance of sleeping through it. I was miserable.

And as if things weren’t bad enough, they took away my magic green button that pumped painkillers directly into my veins AND the local anaesthetic at the same time and replaced them with… Ibuprofen and paracetamol… Yep, two over the counter painkillers that barely even touched the sides of the agony I was in. I think they did eventually give me some dihydrocodeine which is a mild opioid which again wasn’t doing anything against my mangled chest. I tried to firm it overnight but I once again got no sleep, not that I would have regardless but being in pain certainly didn’t help and around halfway through the next day I needed more pain relief.

The solution was oral morphine which they gave me in a little plastic syringe to control my dose. They just get you to squirt it into your mouth and it tastes like death. Although this was miles better than the tablets they had me on it was still a huge issue as they didn’t give me it unless I asked for it. The issue was that they never told me that. So I was expecting to just get that on a regular schedule but it turned out I needed to ask for it every hour. So yet more pain.

Ward 103 and Pain relief

On my second last day I was moved to ward 103 where I swear the level of care was miles above that of ward 102. Straight away when I came into the ward I was given morphine and also found out you can extend the length of the bed to fit my lanky legs, so I was much more comfortable. The men in this ward were also exceptionally friendly which makes all the difference.

Overnight was still an issue however. I still couldn’t sleep as I was still in huge amounts of pain. I eventually had a nurse come over and see if I was okay as I was sitting up in my chair for hours. She got a doctor down to see me and to figure out what we could do about my pain. It was then decided to take me off of dihydrocodeine as it clearly wasn’t doing anything and to increase my morphine dosage and to try me on slow release morphine the next day. At least there was a plan.

Home and Long Term Painkillers

The final day of being in hospital, the nurses were very keen to have me out of the bed as quick as possible to have another patient take the bed. The doctor’s did their rounds in the morning and had decided on slow release morphine to send me home with along with the oral morphine of the slow release wasn’t quite hitting the spot. Along with the basic like paracetamol and ibuprofen.

My girlfriend was in visiting me in the hospital so was able to give me a lift home which was an uncomfortable drive. That was the first time I’d been out of that hospital in 4 days and it felt extremely good to breathe some fresh air.

Getting home was also a relief. To sit down in your own home after spending that much time surrounded by beeping and shouting and chatting was a peace I never realised I missed so much.

So now I’m living on regular daily painkillers to allow me to move about more and an inability to drive or lift heavy things. I have a consultation and xrays with the consultant in 6 weeks so hopefully by then my pain will be better managed and I’ll be allowed to drive again and maybe start doing some light exercise because I’ve really noticed a drop in muscle mass.

Results

Was the pain worth it to have an action man chest?

So what we’re all here for. How does it look. Given that I had a pretty substantial pectus excavatum case the results should be pretty impressive and I have to say I think they are.

Here’s the before and after.

The minor incisions you can see are a small price to pay for such a huge change in how good my chest looks. Here’s the damage a little closer after a few days of healing (it’s a bit nasty).

Should You Get the Nuss Procedure?

So should you get the Nuss procedure? I certainly think so. If I could recommend you do anything if you get the procedure it’s make sure you’re hassling the hospital staff to get your pain under control as I was far too happy to just sit in agony instead of asking for painkillers.

I’m only a few days into recovery and I’m already starting to feel far better. I’ve got more energy and I’m far more mobile than I was and I’m even getting back to work soon.

Sure it was painful, quite possibly the most painful experience of my entire life but we humans have quite a knack for forgetting how painful something was. I think it’s a bit of self preservation thing. So once it’s been a while you’ll seem to lose the ability to understand how painful it was in the beginning.

Hopefully I managed to explain my experience to you and answered any questions you may have had about the experience.