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Questions for Thoracic Surgeon

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

Hi there! I know a few of you, or more than a few, have had lung mets removed, and I'm meeting with a Thoracic Surgeon on Thursday to discuss removing my 2 small mets. Are there any questions you asked or feel you should have asked prior to the surgery? I'm not even sure I want to go through with it as it can be pretty invasive, but I'm hoping to get as much info as possible. Thanks for your help!!

Phil64's picture
Phil64
Posts: 838
Joined: Apr 2012

I just had a wedge lung resection completed on Friday 6/1. The surgeon used the daVinci Surgery robots which are far less invasive than traditional surgery. I don't know if it is an option for you but I'd certainly ask about it. Here is a link to the web site:

http://www.davincisurgery.com/thoracic/

The surgery was at 2pm on Friday and I was discharged from the hospital about 1pm on Saturday. Recovery did seem like it was going well; however, I am now experiencing some constipation and slightly high temps (e.g. 99.8 to 100.4). I think the pain medicin (norco generic) may be causing the constipation but I am also feeling the most tired / winded since coming home on Saturday.

Wishing you the best!

Phil

barbebarb's picture
barbebarb
Posts: 464
Joined: Oct 2011

Hi Alina-
My first lung met was in lower left lobe-Tumor board reviewed and did VATS procedure....beg. of Feb., 2nd surgery was a thorocotomy and I had tumors wedged and tumors removed from liver with the one incision, done in April.
Whew! Am I glad to be done with these surgeries. No lymph nodes were involved.
My surgery was done at Northwestern Memorial Hospital in Chicago. There was no way I would have considered
my local hospital since this probably isn't the norm.
Second surgery I had an epidural in and was very alert-first surgery they used dilaudal (sp) for pain. Once out of surgery Norco seems to be the go home pain med of choice. It is very constipating-stsy ahead of it with Seneca-S.
I believe peripheral tumors can be wedged easily? I had 4 chemo infusions to shrink everything before the surgery.
Questions: How many cases of what he will perform has he done?
What will lung capacity be after?
How long will recovery time be?
Adjuvant therapy?
Hospital stay? (Mine was 3 1/2 days for each)
Breathing exercises How much walking should I do for healing when I get home?
You probably have thought of questions from our posts.
Please let me know if I can be of further help.

Phil64's picture
Phil64
Posts: 838
Joined: Apr 2012

I talked to my doctor yesterday. She did say that the norco (aka vicoden) was surely causing the constipation. She also said the mild fevor and shortness of breath was most likely due to me slacking off on the breathing/coughing exercises. So I've switched to motrin (over the counter) for pain control as I'm having minimal pain now anyway and I've been doing the breating/coughing exercise hourly and today I feel a ton better than yesterday. No more fevor, no more constipation, and minimal pain. I think the breathing exercises are very important - if I do it again I would take them a lot more seriously as I think they really do help a lot!

taraHK
Posts: 1961
Joined: Aug 2003

Type of surgery (VATS, wedge, lobectomy) -- minimal or more extensive
pain relief after surgery (?most places use patient-controlled pump)
when can you go home? (for me, I had to be able to climb a flight of stairs!)
After you get home, under what circumstances should you be concerned/call (eg if you run a fever....)

My advice/experience:
Don't be a hero about pain relief
Get up and walking as soon as possible
Walk after you get home -- every day if possible. I believe it helps with healing

GOOD LUCK1

Tara

(I've had two wedge resections and one lobectomy -- each time for solitary met. My lung capacity is excellent. I can hike mountains)

Kenny H.'s picture
Kenny H.
Posts: 503
Joined: Aug 2010

Have 7 nodules and 2 have cavitated from current chemo regimine as they were very small. But have larger ones in both lungs so doing surgery on one lung at a time. Have already passed lung function test and was told would only lose 5% of lung capacity. Wondering how long before 2nd lung operation. (forgot to ask) Has anyone had both done?

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

Thanks to everyone for your thoughtful questions and for sharing your stories. It doesn't seem quite as scary. :) Thank you also for letting me know about the pain meds; that is one thing I wouldn't think to ask about. I'm glad you're feeling better, Phil, and that they were able to figure out what the issue was with the fever and pain. I'm really hoping that they can do either the VATS or Da Vinci and not get too invasive.

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

Hi Alina

I don't want you to get the wrong impression that either the VATS or da Vinci robot surgery is not "too invasive."

Whether it's those or a full open thoracotomy, it will hurt. I was the first patient in North Texas to have the da Vinci robot surgery done on the lungs...it was a success, but I found the recovery and pain was actually better with the full open procedure.

Not too long after my da Vinci surgery, just a couple of months actually, new lung tumor appeared...it was pretty big about the size of a tangerine and embedded into my chest cavity. The surgeon had to do a full open procedure....surgeon unable to attain clear margins as a result of tumor location....thus necessitating a full on radiation and chemo campaign that followed over that long year.

The issue will be SPO2 levels...which is your oxygen saturation level....walk as much as possible...do all of the treatments that the respiratory therapists tell you to do....and blow into your spirometer as often as you can stand out.

This will expand your lung back after they collapse it for the surgery...you will have a chest tube inserted to drain the blood and stuff from the lung...you'll have a little carry-on suitcase that you have to tote with you until the blood is able to be re-absorbed back into the body.

Morphine will manage your pain...they will send you home with some of the standard pain stuff....I found that by large, they were not effective me, so I just toughed out the pain...I'd take Tramadol the first few days and then discontinued...it could sometimes help me sleep some and that helped.

There will be some scar tissue build up and you may feel some tighteness in the surgical area...you will probably feel that during your yoga exercises when you bend. I've had two surgeries in the lung, so I'm not as flexible anymore...but with your training, I'm sure you will fare okay.

I caught part of your story...sorry don't know all of it with all I've been involved with the last few months caregiving and burying my father...but the good news for you is that you are new to the battle....your body will be strong and able to handle it, so I feel you will do well.

I've been pretty beat up the past 8-years and have done quite a few surgeries and many treatments....the body is hurting and tired and things are always more challenging than when you are first starting out and have all of that strength and energy to carry you.

Good luck to you and hope for success.

-Craig

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

I really appreciate you sharing your story Craig. Thank you also for clarifying the "too invasive" comment. I think I've just read too many horror stories about broken ribs, and collapsed lungs causing problems, and it really scared me (which is normal, right?). Plus the fact that the mets are in a hard area of the lung to reach, I was getting a little optimistic about possibly getting the VATS procedure. Well, as optimistic as surgery can be. :)

One quick question, do they go back in to remove the chest tubes? Also, how long were you in the hospital for each procedure? I'm so sorry that you have had to go through so much along with caring for and burying your father. My thoughts are with you and thank you again for taking the time to answer little ol' me. *hugs*

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

Alina

Yes, they will remove the chest tubes but it will take a few days...the issue will be when the drainage gets below a certain level, they will remove them...it might be one...last time I had 2 chest tubes...I'm a hard case, lol!

The little suitcase has measurements so they can determine daily how much leakage there is...past a certain point, the body is able to re-absorb that blood and the tube(s) can be removed.

A little hint...tell them to give you a count of 3.....you know, 1...2...3...before they begin to pull, take a big old deep breath...they should pull it quickly instead of steady...it hurts much less that way.

My first lung surgery (da Vinci)...I was in the hospital about 5 days I think....when they did the thoracotomy procedure, I was in there about 13 days.....took me more time to heal before they could yank those tubes out....they won't let you go home with tubes.

I forgot to add.....my last surgery they took out 5 wedge resections and removed 2 ribs...they didn't break 'em....the surgeon just sawed 'em off, LOL! Ouch!

And it is normal to collapse the lung....they have to do that so they can have some wiggle room in there...they will insert the chest tubes to reinflate...and the lung tissue closes in around it to provide a nice tight seal.

Walking and your respiratory treatments and your spriometer will help keep the lung expanded and back to its original position....and you might as well get ready for alot of X-rays....they will x-ray you each morning you are at the hospital...to compare and make sure the lung is holding air...and that they are seeing less of the remaining fluid on the lung from surgery.

And if they go to a full-open procedure...that scared me, but we changed plans seconds before surgery, so I did not have time to think. But if they do, it will be okay...the cuts and scar will be a little nastier.

But I found that I fared better and did better with the open vs daVinci, which is robotic VATS....I think that stems from the fact that they can open up the surgical field and have cleaner access vs the other procedure where the field of vision is narrower.

In my case, with the DaVinci, they 'missed' the other big tumor that surfaced 2 months after the surgery...had they done an open, they just might have seen it and saved me another surgery.

Anyway, that's my story...and I'm sticking to it:)

I hope you do well...let me know if I can help. Hugs.

-Craig

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

And what a story it is! You're so brave and such an inspiration for me Craig! I had been so hesitant about getting any surgery again (even though my colon resection went very well), but you and everyone else have calmed my nerves. I know it's still a huge deal, but I think I can handle it a bit better now.

I talk to the surgeon today, so I know what to ask and what each procedure entails. It makes sense that the open procedure would give them a better look inside thus allowing them to see other lesions that might be there. That was one concern, that I would have the surgery and then others would pop up near the same place. I know it can happen, but the less risk of that the better. I can't imagine how upset you must have been when they found the other tumor after the Da Vinci.

I think I'll print out your responses so that I can have them when I'm loopy on drugs. :)

Phil64's picture
Phil64
Posts: 838
Joined: Apr 2012

Wow. I was lucky in comparison. I only had one nodule removed from the lower right lung with only one night stay in the hospital. I do know they had to collapse the lung as part of the surgery. However, I simply had faith that the surgeon was good and as it turned out I think my faith was well placed.

I was nervous about the removal of the chest tube but the surgeon said it wasn't going to be painful or uncomfortable and as it turned out it was exactly like she said it would be.

As an asside... For the colon resection surgery I had a nose tube (draining from the stomach?), a drain tube coming out of near the incision, and a catheter (spelling?). Removal of the tubes from my nose was horible -- not painful but it was a foreign experience. The nurse did it quickly, so it was over before I really knew what was goin on (kind of like removing a bandaid). Removal of the catheter was uncomfortable (also done quickly). Removal of the surgical drain tube from that surgery was interesting. The nurse that did this told me it would be painful. She gave the the 1, 2, 3 count and as it turned out it was nothing.

Breathing exercises are showing results! I'm pround to say, that after doing the breathing exercises religiously the last several days I've added another 500 ml (from 3000 to 3500) to my exercise. Also, the numbness is starting to subside and I was able to sleep on my right side a little the last couple of nights (side the surgery was done on).

And yesterday I started driving again! That gives me a little freedom.

So, I hope you are going to be lucky too... I will certainly want to hear how your surgery goes.

Phil

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

I'm glad to hear you're doing so well post-op Phil! Yeah, the tubes were the most uncomfortable after my colon surgery; the catheter especially. That's so great about the breathing too. Are you using a spirometer?

I've got my surgery scheduled for June 28th. The surgeon is great and really explained everything to me. It will be a laproscopic procedure going through my right side. They will remove my entire middle lobe and do a wedge resection on my lower lobe. Luckily no rib spreading or anything like that, but I know I'll still have a lot of pain. They think only about 3 days in the hospital as well. I feel so much better having more knowledge and feeling confident in my doctor. I asked a lot of the questions everyone suggested, so thank you again!!

I'm sure I'll be back to update everyone who's interested once I'm through the worst of it. :) By the way, I have a blog if anyone would like to read: alinamo@wordpress.com. Love, love, love to you!

Phil64's picture
Phil64
Posts: 838
Joined: Apr 2012

Yes, I'm using something called a voloyne. It has a tube that I suck air from. A float moves in as I pull air into my lungs. The goal was set at 3000ml. I've been doing 3500ml lately. I used this same device after the colon resection and I was doing 5000ml then so there is a definite impact as one might expect.

I'll be looking for your post surgery report. I'm sure all will go well.

I was also thinking about a blog, to keep everyone updated instead of sending out a bunch of email. But I simply didn't take the time to set one up. How is the blog working out for you?

AlinaM's picture
AlinaM
Posts: 18
Joined: Apr 2012

I definitely recommend starting a blog as a way to help keep everyone in the loop, and as a way to kind of get all of your feelings out there. It's helped being able to type it all out and then, kind of, walk away from it. Mine actually started out being all about yoga, and then I was diagnosed, so I've shifted purpose. I don't do it to get a lot of readers, just for my friends and family and those that might find me in other ways. Also, I've found Word Press to be great and very user friendly, but I know there's one on this website too that could be good.

Keep working that voloyne and you'll be back to 5000ml in no time!

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