biopsy results, lobectomy scheduled, questions?

[Minh]

Good morning to all,

Physician assistance called and discussed about the results from biopsies I had two weeks ago. My left lingula 2.6cm nodule is noncancerous. My left pleural fluid is noncancerous. That's mean I only have one cancerous nodule 1.6cm in the right lower lobe from prior biopsy. So, thoracic surgeon agreed to offer lobectomy with condition that I will pass my heart tests because in April I had mechanical aortic valve replacement and triple bypass. The lobectomy is scheduled for November 17th in MD Anderson and I will have to travel there and stay in hotel for this surgery. The surgeon will start out with VATS and then convert to full open if necessary. I have done some googles as to how I should prepare for the recovery process, but I have not found satisfactory answers. So, I would like to pose the following questions and ask for any suggestions and recommendations (assuming normal recovery with no major complications):

1) Will I have problem with flying home and how soon can I fly home after the surgery?

2) How soon can I drive? I am thinking about driving home if I cannot fly. About 18 hours to drive home.

3) How easy to sleep on my back? Any special position is better?

4) Any special diet I need to be aware of? such soft foods or no salts, etc...Should bring my own pots and pans to prepare for any special diet?

5) Can I dress myself since arm motions can be limited in range? Will I need help for dressing?

6) Any special band aid or cleaning agent for incision care?

7) How long should I book hotel for? Longer booking lower costs.

8)Anything else I missed on this list? 

 

I definitely don't want to get stuck in the hotel for Christmas as I will have missed Thanksgiving already. My two high school kids will be by themselves and they are more nervous and anxious than me. I need to get home ASAP after surgery.

 

Thank you,

Minh

[LexieCat]

Lou put together this list of tips and tricks for lobectomy: https://forums.lungevity.org/topic/47249-thoracic-surgery-tips-and-tricks/ It's pretty accurate--the two things I found most helpful were using a wedge pillow to sleep (easier to sleep with your upper body elevated) and doing your breathing exercises as prescribed. They are annoying and will make you cough, but they WANT you to cough, to keep the lungs clear.

You can probably drive as soon as you get your chest tube out (and are not on any heavy-duty pain meds). Driving for 18 hours would be pretty rough, I think. Flying shouldn't be a problem, but that's something to ask your doctor. 

You'll probably be in the hospital for only 2-4 days, but you'll want to stay nearby for post-op for several days--ask your doc, but I would think a couple of weeks would be sufficient.

Moving around may be sore and uncomfortable for a while, but I had no problem dressing myself. 

Unless you have another medical condition requiring it, no special diet needed. You might want to go easy on heavy or spicy foods for a few days.

Honestly, I found my lobectomy to be one of the easier surgeries I've had in my life. My C-section hurt more, and for longer, than my lobectomy.

 

[Tom Galli]

Minh,

My thoracotomy procedures (3) were all open surgeries and performed within the span of 6 months. Thus I suffer chronic pain along the incision scars and flying amps that pain, significantly. This is due to the effect of our bodies when subjected to a cabin pressure altitude of 6 to 8 thousand feet. The expansion of my chest and abdominal cavity, experienced during this pressure condition, gnaws at my chronic pain. Be mindful of this condition. My surgeon didn't know about it until I reported it, then he realized the problem.

Once, I was also sent home with a chest tube. Unfortunately, its location made driving in a car with a seatbelt very painful. So if you are to have a chest tube installed after hospital discharge, be wary of driving. You might be very uncomfortable. I would not have been capable of sustaining an 18-hour drive after discharge from any of my thoracic procedures. I could hardly tolerate a 20-minute drive.

Sleeping for me required experimentation. Thankfully, we had an electrically adjustable bed and a high density foam mattress. My most comfortable position was with the bed elevated to its highest angle. That moved my body weight somewhat off my incisions and transferred it to my hips reducing incision pain dramatically. A high-angle wedge pillow can also achieve this positioning. You might purchase one from an online source and have it sent to your post-operative hotel in Houston. You'll likely need one at home for sometime. Because of my chronic incision pain, I still sleep in an inclined position. Occasionally, I use a recliner to sleep when my chronic pain is amped.

As for diet, I was not prescribed any diet restrictions after surgery. I did however have intense constipation from the morphine administered by IV in the hospital and narcotics in post surgical recovery. I found it useful to take over the counter laxatives daily for sometime to keep things moving.

I couldn't dress myself. In fact, I couldn't put on a tee-shirt without intense pain. So it was button up shirts for quite a while after surgery. I also couldn't twist my torso to grab the open part of the button up shirt, so my wife needed to assist me in dressing.

I was discharged with dressing sufficient for a couple of days. After one of my surgeries, I had a chest tube installed for about six weeks. We purchased dressings at our drug store and they were easily obtained.

I can't forecast a post surgical hotel length for you. After my first surgery, I couldn't wait to get out of the hospital. My second surgery involved a 3 month stay in the hospital including a lengthy stay in the ICU. My third surgery involved a 3 week stay in the hospital and I feel like I should have stayed longer. I do know your surgeon will want to see you after discharge. 

I know it is important to share holiday experiences with family but you might face a very serious surgery and additionally have existing medical conditions. I think it best that planning for your post surgical stay in vicinity to MD Anderson be longer rather than shorter and be based on how you feel and your doctor's opinion on travel rather than family gathering considerations.

Stay the course.

Tom

[Minh]

Thanks Lexie and Tom,

I bought one way ticket to MD Anderson and I have scheduled my stay in hotel for at least 3 weeks. I will stay more as needed, but want to come home before Christmas either flying or driving. I hope no major complications, God forbid! I may not be able to bring everything I wanted but I will pack as many things as I can into two luggages as standard airlines allowed.

According to Mychart, they also scheduled for these additional simultaneous surgeries "THORACIC LYMPHADENECTOMY BY THORACOTOMY, MEDIASTINAL AND REGIONAL LYMPHADENECTOMY". Do you know what these are? Something about either dissection or sampling of lymph nodes. I am not sure which one they will do and how many lymph nodes they will either remove or just sample them? I hope they just remove them instead of just sampling them. I can ask the surgeon during our meeting next week the day before the surgeries. But my curiosity is running high. It's nice to know ahead of time what they will do!

[LexieCat]

They take a sample of lymph nodes (those to which it's most likely to have spread) to check for cancer cells. They don't take them all; you need lymph nodes as part of your immune system.

[Tom Galli]

Minh,

A thoracotomy is an incision between the 4th and 5th intercostal space and spreading the ribs to view and entire lung. A lymphadenectomy is removing one or more lymph nodes. The mediastinal area contains the heart, lungs and esophagus so that defines the area for removal. A regional lymphadenectomy would entail removing lymph nodes in the immediate vicinity of the tumor. I would also suspect the surgeon would also remove the tumor. I would ask the surgeon if this procedure will also include removal of the tumor. Tumor removal may in fact be conditioned on the results of the histology examination. The pathologist will use a microscope to check for cancer cells in the lymph nodes and the medical term for this is a histology examination.

Keep in mind, I'm not a physician, certainly not a thoracic surgeon. What all of these words mean to me is the surgeon is going to do a complete visual inspection of your lung and surrounding area. He or she will remove lymph nodes in the mediastina area and then remove lymph nodes in the area close to your tumor. Each lymph node will be examined by a pathologist (perhaps while the surgery is going on) to check for cancer.

In my diagnostic surgery, my surgeon removed many lymph nodes in my chest. Each was viewed by a pathologist in near real time to check for the presence of cancer. When I asked about the effect of removing so many lymph nodes, he said: "don't worry, you've got a lot of them."

I think your planned hotel stay is a good idea.

Stay the course.

Tom