Preparing for a Successful Lung Surgery

Dr. Shanda Blackmon, M.D., M.P.H., F.A.C.S. & Andrea McNiel, PA-C

LUNG SURGERY

About Lung Surgery

Incision types Lung resections Reasons for Surgery Recovery Time Risks

Incision-Thoracotomy
A thoracotomy incision extends from underneath your armpit to your back. It is usually 10-12 cm long.

Incision-Thoracoscopy
A video-assisted thoracoscopy (VATS) is a minimally invasive surgery where a camera is inserted into your chest cavity. This surgery requires various small (2-3 cm) incisions under your armpit to be made.

Lung Resection

Reasons for Surgery-Cancer

Lung cancer- Early stage non-small cell lung cancers (stage I-II) are often treated with surgery. Later stage cancer is often treated with chemotherapy/radiation therapy and may be followed by surgery. Other types of cancer (kidney, testicular, GI, bone) with metastasis to the lungs may be treated with surgical excision.

Reasons for SurgeryPleural Effusion

Pleural effusions occur when there is excess fluid surrounding the lungs in the pleural space. They can be caused by cancer, infection, heart disease, pneumonia, autoimmune diseases, blood, and various other causes. They will need to be drained when they are causing difficulty breathing or are infectious. Surgery will drain the fluid, remove the scarring from the lung surface (the peal or rind) and reexpand the lung.

Reasons for SurgeryPneumothorax

A pneumothorax is a collapsed lung. This can be spontaneous or caused by injury to the lung. It requires a chest tube if it is large or causing symptoms. If it reoccurs or does not re-expand properly it will require surgery.

Recovery Period
Normally for a thoracotomy you will be in the hospital for 5-7 days, and for a VATS 4-5 days or less. The rest of the recovery time will happen at home and lasts 6-8 weeks.

Risks of Surgery
Infection (pneumonia, urinary infection, wound infection, etc) Bleeding Damage to lung tissue or surrounding organs, blood vessels, or nerves Blood clots in the legs PLEASE ASK Dr. Blackmon ABOUT YOUR SPECIFIC RISK!!

Preoperative Work-upRoutine
History and Examination by your surgeon Blood work- Complete blood count (CBC), Metabolic panel, Blood type, Clotting Time Recent Chest X-Ray, CT Scan, Electrocardiography (EKG) Evaluation by an anesthesiologist Cardiologist clearance

Preoperative Work-up Pulmonary Function Testing

Pulmonary function tests (PFTs) measure how well your lungs take in and exhale air. It consists of taking deep breaths in and out through a tube while your rate of air movement is measured. PFTs are performed in the Smith Tower 3rd floor by appointment only (phone #). Depending on your results your surgeon may recommend additional studies, or may clear you for surgery.

Preparing For SurgeryWeeks Before

You may not smoke before or after your surgery. If you do smoke you must stop at least 2 weeks prior to your surgery. Smoking leads to an increased risk of complications, including pneumonia.
If you need help to stop smoking, please let us know

Preparing for SurgeryWeeks Before

You will need to register with The Methodist Hospital prior to your surgery or procedure. This will be for any surgery, lab work, radiology studies, or procedures. Call Patient Registration at 713-394-6805.

Preparing For SurgeryOne Week Before

Please stop all medication containing aspirin, Plavix, or Coumadin one week before surgery unless instructed otherwise by your doctor.

Preparing for SurgeryThe night before

Bathe with an antibacterial soap. After bathing do not put anything on your skin, including lotions or deodorant. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT. You may continue blood pressure medications with sips of water. Ask your doctor or anesthesiologist about all other medications-including diabetic medication.

Preparing for SurgeryThe Day of

Report to surgery as instructed to Main 3 NW on the 3rd floor, Main building (ph #713-4411034). Do not bring valuables with you. You will be asked to remove clothing and personal belongings (including contacts, glasses, dentures, etc).

Hospital Recovery Period

The next few slides will take you through a routine post-operative course and explain the various IVs or tubes that will be used, pain control, diet, exercises, and preparing for discharge.

Hospital Recovery PeriodLines and Tubes

Breathing tube in your mouth that connects you to the ventilator-this is removed when your lungs are functioning adequately IVs in arms and neck administering medication Chest tubes draining blood and air from chest cavity Foley catheter draining the urine An arterial line in your wrist All of these are removed over the subsequent days as your course progresses.

Hospital Recovery PeriodMethods of Pain Control

There are many different ways to manage postoperative pain, depending on your surgery. 1. Epidural- infuses anesthesia along spinal nerves 2. Pleural-based pain catheter infuses pain medication along ribs 3. Patient Controlled Administration (PCA)-allows pain medication to be delivered at the touch of a button 4. Oral or IV pain medication

Hospital Recovery PeriodMethods of Pain Control

Your doctors and nurses will discuss with you the most appropriate way to manage your post-operative pain. You should tell your nurse immediately when you have pain so that it can be addressed. Pain should be managed early to prevent it from getting out of control.

Hospital Recovery PeriodBreathing and Coughing

Deep breathing and coughing will help to prevent pneumonia. You will be instructed to use an Incentive Spirometer (picture) 10 times every hour while you are awake to help you open your airways. You may also be given aerosolized medication which helps dilate your airways.

Hospital Recovery PeriodExercise

You will be sitting up in bed the same day of surgery. By the next day you should be up walking with assistance. There are physical and occupational therapists that can help you build your strength back after surgery. You will be taught safe exercises to do with your arms to strengthen your muscles.

Hospital Recovery PeriodDiet

Most of the time patients are drinking liquids the night after your surgery. If you tolerate liquids you will be advanced to a regular diet. It is normal to have a decreased appetite after surgery, and if this is the case ask your doctor or nurse for a nutritional supplement or to speak with a dietitian. Constipation is common after surgery because of the pain medication. You may ask for a laxative or suppository.

Preparing to go home
Your healthcare team will assess you everyday for your readiness for discharge. You will be given any new medication that was started in the hospital, including pain medication. You will be instructed on how to care for any wounds or drains. You should take your incentive spirometer home and continue your breathing exercises.

At Home RecoveryWound care

Chest tube site
Remove all bandages after 48 hours. If fluid drains from this site cover it with a clean gauze pad and secure it with tape. Keep this clean and change when soiled. Once drainage stops you may remove the dressing. Stitches that remain will be removed in clinic.

At Home RecoveryWound Care

Incision
Wash your incision daily with soap and water. Do not put any ointments on the incision unless instructed to do so by your doctor. If tape (steri-strips) were placed on the incision you may remove them after one week or when they become loose.

At Home RecoveryPain Control

You will be given a prescription for pain medication upon leaving the hospital. If you run out you may take Tylenol, or another non-aspirin pain medication. If this is not adequate or if you are experiencing pain not relieved by the prescription please call the clinic.

At Home RecoveryActivity
You should try to do a little more each day. You should walk multiple times each day. Continue your breathing exercises with the incentive spirometer until you are evaluated in the clinic. You may resume sexual activity when you feel ready.

At Home RecoveryRestrictions
Do not drive for two weeks or while you are taking the prescription pain medication. Do not lift anything heavier than 10 pounds for 6 weeks after surgery. Avoid swimming, tennis, golf, and other exercises that can overstretch your arm and shoulder muscles for 8 weeks. Discuss with your doctor when to return to work.

At Home RecoverySymptoms to Report

You should notify your health care provider or go to the Emergency Center if you have:
Fever greater than 101 degrees Shortness of breath or difficulty breathing Foul-smelling drainage from the incision Prolonged drainage, redness, or swelling around incision or chest tube site (longer than 2-3 days)

Follow-Up
Before leaving the hospital you will be informed on when your doctor wishes to see you in the clinic. Normally this is 2-4 weeks after discharge. If you were not given an appointment you may call the Surgery clinic (713-441-5141). If you have questions or concerns you may call Andrea McNiel PA-C (713-441-6161) or Dr. Shanda Blackmon, MD, MPH, FACS (713) 4949871 (cell).

Resources and Important Information

To Schedule an appointment: Thoracic Surgery Clinic 6550 Fannin Street, Smith Tower 1661 Houston, Texas 77030 713-441-5141

Resources and Important Information

For problems/questions: M-F 7am- 4pm Andrea McNiel PA-C 713-441-6161 For evening and weekend emergencies: Dr. Blackmons office 713-441-5177, or go to the Emergency Room

Resources and Important Information

The Methodist Hospital: Patient information 713-394-6806. Registration for procedures/surgeries/lab work: 713-394-6805 or online at www.methodisthealth.com- click on OUR HOSPITAL THE METHODIST HOSPITAL ONLINE REGISTRATION

Resources and Important Information

Main 3 NW Day Surgery (Main building of Hospital) 713-441-1034

Resources and Important Information

Pre-admit ScreeningSmith Tower 3rd Floor Suite 383 713-441-7462 M-F 8:30-5:30

Resources and Important Information

Patient Resources -The Cancer Center 713-790-2700 for support groups, patient and family information. -Spiritual Care (Chaplain) 713-790-2381 or after hours 713790-2201 -Social work 713-790-3116