Once the surgeon has reviewed your medical information and discussed with you what your options are, preparations can begin for your surgery. A date can be picked that takes into consideration both your time schedule and your surgeon's schedule. Once that date is chosen, you will also be given a date about 1-2 weeks ahead of your surgery day to come to the Cancer Center for pre-admission testing.
Pre-Admission Testing
All patients who need surgery require routine blood tests, a urine test, and an electrocardiogram (also known as ECG or EKG; a simple test that provides information about your heart health). This pre-admission testing will be done about 1-2 weeks ahead of your surgery day. Also at that visit you will meet with the nurse practitioner who will review your past medical history and complete a physical exam. It is very important that you tell us about all medications you take, and if you have any allergies.
Please make a list of all your medications including the dosages and how often you take them, and bring this list with you to that appointment. The nurse practitioner will discuss with you what medications you will continue and what should be stopped. In general, medications such as aspirin, clopidogrel (Plavix), and warfarin (Coumadin) will be stopped about a week before surgery to decrease the risk of bleeding at the time of surgery.
Other medications such as a multivitamin that contains vitamin E should also be stopped. If you are a diabetic, special instructions will be given to you about your oral medications and/or your insulin. The nurse practitioner will also ask you to sign a consent form giving your permission for surgery and anesthesia.
At this visit you will also meet with an anesthesiologist. This doctor will explain to you how you will be put to sleep for the procedure, and the different methods of controlling pain after surgery. Very often a catheter (thin tube), placed in your back prior to surgery, is used to help you manage pain after surgery. This special catheter is called an epidural catheter, and liquid pain medication is given to you through it.
An incentive spirometer will also be given to you. This is a device that helps you exercise your lungs after surgery, by taking deep breaths. It is normal for you to want to take shallow breaths after the surgery because of the pain; this device encourages you to take deep breaths.
To deep breathe with the incentive spirometer, do the following:
- Exhale (breathe out) slowly until you cannot push out any more air;
- Place the mouthpiece of the incentive spirometer between your lips, grasp it with your teeth, and close your lips over the mouthpiece;
- Take a slow deep breath through your mouth only;
- Hold your breath for 3 to 5 seconds;
- Remove the mouthpiece;
- Exhale.
Repeat this exercise 5 to 10 times during every hour when you are awake.
After Surgery
When your surgery is completed, you will be taken to the recovery room, or post-anesthesia ICU (intensive care unit). The nurses there will monitor you until you are ready to be moved to the intermediate care unit of the hospital (16 South). Some patients, because of their other medical conditions, may require to be more closely monitored in an ICU overnight or a few days.
When you wake up you will notice that you are attached to a heart monitor, an IV line (intra-venous; into a vein), and a Foley catheter (thin tube in your bladder to drain urine). You will also notice that you have drainage tubes coming from the side of your chest where the surgery was performed; these tubes are called chest tubes and will drain fluid and air from around your lungs.
In general, patients have two chest tubes. These tubes will remain in for several days; usually, once they are all removed, you are ready to go home.
Exercises at Home
Some exercises increase the movement in your arm if they are done several times a day. These exercises help to prevent a condition called frozen shoulder (also known as adhesive capsulitis) that is characterized by stiffness, pain, and limited motion in the shoulder joint:
- Raise your hand to touch your ear on the affected side. Try to walk your fingers over your head to reach your opposite ear.
- Stand 1-2 feet away from a wall. With your affected arm extended toward the wall, walk your fingers up the wall as high as you can. With each attempt, try to walk your fingers higher on the wall.
Follow-up Care
About 2-3 weeks after your discharge from the hospital, you will return to the clinic to see your surgeon. We will ask you to have a chest x-ray prior to that visit. At this visit, the surgeon will look at your incision, review the x-ray, and discuss further with you the results from your surgery.
If further referrals to other specialists are needed, these referrals will be addressed at this appointment. The LCEC team will also discuss with you the long-term follow-up care you require.