Pre-operative Rehabilitation Recommendations
You will work together with your thoracic surgeon, nurses, and respiratory therapists, to achieve the best possible physical condition before your operation, to help you recover more easily and more quickly.
Smoking Cessation:
If you are still smoking, you must stop before your operation - at least two weeks, and if possible, four weeks.
If you need help with stopping smoking, please talk with your nurse, or your physician.
Aerobic Activity
- Walking is always good exercise. You should gradually strive to achieve walking a distance of at least 1 mile, twice daily, in less than 20 minutes. You may increase this to 2 miles as desired.
- Stair climbing also assists in improving circulation and breathing capacity. You could climb 2 flights of stairs, 4 times a day. The speed with which you climb these steps should gradually improve.
- If you are concerned about how to start this walking or stair climbing program, please discuss this with your nurse, or physician. If you have other medical problems, or a history of any cardiac problems, please discuss this with your physician.
Nutrition
Eat a well-balanced diet
Monitor your weight to make sure that it is staying in the range recommended by your doctor
Before your operation
Diet:
For the majority of surgeries we recommend no solid foods after midnight, the night before your operation. You may drink clear liquids until 4 hours prior to your operation.
Please be sure to discuss any special recommendations with your surgeon.
VPEC
You and your family will have had an opportunity to visit with the anesthesia nurse practitioner in the Vanderbilt Preoperative Evaluation Clinic (VPEC) prior to your operation. You will be given directions to the admissions area of the Vanderbilt University Medical Center, and instructions on when to arrive. Here you will have an evaluation as well as pre-operative testing including labs and an electrocardiogram.
The Day of Surgery
Please remove any lipstick or nail polish on the day of your operation. Please leave all valuables and jewelry at home or with a family member.
Please arrive at the hospital at the designated time and check into the admissions desk. You will be taken to the pre-operative area, where you will change into a hospital gown. You will meet with an anesthesiologist and an intravenous (IV) line will be started.
When your operation is over your thoracic surgeon will speak with your family members in the 3rd floor family consultation room (number 3111). You will be taken to the recovery room when your operation is completed where you will be monitored until you are fully awake. If you go home after your procedure or operation, you will receive detailed instructions and additional contact information.
All other patients will be admitted to the hospital to the Thoracic Surgery Unit on 9-North. 9-North is a step-down unit with capacity for monitoring heart rate and rhythm, blood pressure, and oxygen by experienced nurses and staff.
Enhanced Recovery After Surgery
After your operation, you will be monitored to ensure your recovery is as smooth and comfortable as possible.
Pain Management
During your operation you may have a block performed or epidural placed to help with post-surgical pain management.
After surgery we use a combination of medications to treat the different components of pain including anti-inflammatories, nerve-specific medications, muscle relaxants and opioid pain medications.
Breathing Exercises
We will encourage you to perform deep breathing and coughing exercises to help keep your lungs expanded and to help bring up any mucus or sputum. You will be provided an Incentive Spirometer to help with deep breathing. The respiratory therapists and nursing staff will teach you how to use the Incentive Spirometer as well as how to brace your incision to help avoid pain while performing these important exercises.
Physical Activity
We will encourage you to start getting out of bed the day of surgery and begin walking the evening after surgery or the following morning. The nurses and physical therapist will help you to walk and assist with the lines and tubes or containers that you have. Walking is an essential part of recovery and we will encourage you to walk a minimum of 3 times daily while you are in the hospital.
For additional information about your specific surgery please choose one of the following links:
Minimally Invasive Lung Surgery
Open Lung Surgery
Tubes and Equipment You May Encounter During Your Hospitalization
Chest Tube
A chest tube may be placed at the end of your operation. This tube drains air and blood which may collect around your lung after the operation. The chest tube is connected to a special collection container at the side of your bed. The nurse will measure the amount of fluid that drains into the container. Your surgeon will remove the tube when the lung has expanded and the air and fluid have stopped draining. The tube usually can be removed in 1-3 days after lung surgery and 5-7 days after esophagus surgery.
Cardiac Monitoring
Electrode pads will be put on your chest and attached to a heart monitor. This machine monitors your heart rate and rhythm and has an alarm that sounds on occasion. It is sensitive and on occasion, may make a sound even if the nurse touches you or if you move around in bed.
Intravenous (IV)/Arterial Line
You may have several IV lines. These are important for giving you fluids and medicines. The arterial line gives important information about your blood pressure, pulse, and amount of oxygen in your blood.
Foley Catheter
This tube drains urine from your bladder. It may be inserted after you go to sleep during your operation. The nurse measures the amount of urine you are making both during and after surgery. This is removed as soon as possible after surgery.
Prevention of Blood Clots
Blood clots, or deep venous thrombosis (DVT) can occur in the legs after any operation. If these blood clots form, they can break off and block off blood flow to the lung. This serious condition is called pulmonary embolism. Subcutaneous heparin and sequential compression stockings will be used to help prevent blood clots in the legs, and pulmonary embolism.
Discharge
When you are ready to be discharged from the hospital, your nurse will go over all the discharge instructions with you prior to leaving.
When to Call Your Thoracic Surgeon
Do not hesitate to call your surgeon for any problem that is of concern to you or your family. Generally, the common questions can be answered by one of our clinic nurses.
Call your surgeon if you have any of the following signs or symptoms:
- A large increase in mucus coughed up from your lungs.
- A change in the color of the mucus (for example, yellow, green, bright red).
- Difficulty breathing or new shortness of breath.
- A fever of 101.5 for more than 24 hours.
- Your incision becomes red or more painful.
Phone number: (615) 322-0064
Recovery at Home
Physical Activity
Begin to resume normal physical activity as soon as possible after your operation. This helps to clear your lungs and helps the circulation in your legs. Begin with short walks gradually increasing your distance every day. Space activities throughout the day. To help the incision heal, don't lift objects weighing more than 10 lbs.; for example, a gallon of milk for up to 4 weeks after surgery.
Bathing
You make take a shower at home. Please avoid soaking in a tub or swimming before your incisions are fully healed.
Breathing exercises
Deep breathing exercise should be continued at home so that your lungs will stay clear. The deep breathing exercises usually are most effective when you are sitting in a chair with your back well supported.
Nutrition
It is normal to lose your appetite for several days after an operation. However, good nutrition is important to help your body recover. Even if you are not hungry, try to eat at least half of each meal or small portions six times a day. Your appetite should return to near normal after a few weeks, especially as your activity increases. If your appetite is poor, try to eat high calorie and high protein foods such as shakes.
Constipation is a common problem after surgery, usually caused by the pain medicines. Drinking plenty of fluids and eating fresh fruit or bran will help prevent this problem. A stool softener may be ordered for you by your doctor. Please tell your doctor if this becomes a problem.
Special Diets
Nissen fundoplication
You will remain on a soft, sloppy diet for 4 weeks after surgery. You will meet with your surgeon to help direct advancement of your diet at that time.
Esophagectomy
Your surgeon will provide you with specific instructions at the time of discharge. You will get a phone call every week to help you to advance what you are taking in by mouth and decrease your tube feeds.
Medications
It is not unusual to have increased pain the first few days you are home and as you increase your activity. You may have pain in your incision for several weeks after your operation, and you will be given pain medicine to take at home. Do NOT take pain medicine before driving or with alcohol.
By 6 to 8 weeks after your operation, most of the pain in your incisions will be gone. You will also notice that the 'bump' along the incision will have flattened. It is normal for the area around your incision to feel numb for many months, and this will improve with time. This numbness may be worse on cold or damp days. Your pain will slowly decrease as healing occurs.
Wound Care
Tightness, itching, numbness or tingling around the incision area are often normal. These feelings may last for about 6 to 12 weeks, or longer.