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Memorial Hospital
Memorial Hospital

Laurie B. Reeder, MD

Board Certified Thoracic Surgeon

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What I Treat

Non-cardiac thoracic surgery involves evaluation and treatment of benign and malignant problems with the lung, mediastinum, pleura, chest wall and esophagus such as:

  • Lung nodules
  • Lung cancer
  • Mediastinal lymph nodes, masses and cysts
  • Metastatic cancer to the thoracic cavity (lung, pleura)
  • Pleural tumors, effusions, infections
  • Pericardial disease, benign and malignant
  • Chest wall tumors
  • Esophageal tumors

Information About Your Lung Surgery Brochure

Common procedures that I perform include:

  • Bronchoscopy:evaluation of the airway

  • Mediastinoscopy:biopsy and excision of masses and lymph nodes

  • VATS (video assisted thoracic surgery)/Thoracoscopy
    Minimally invasive approach to problems in the chest:
    • Resection of lung cancer (wedge, lobectomy, pneumonectomy)
    • Treatment of spontaneous pneumothorax, bullae resection, pleurodesis
    • Excision of mediastinal, bronchogenic, pericardial, and esophageal cysts
    • Biopsies of pleura, lung, mediastinum, pericardium and chest wall
    • Resection of posterior mediastinal/neurogenic tumors
    • Drainage and treatment of pleural and pericardial effusions
    • Treatment of empyema
    • Symphathectomy for hyperhydrosis

  • Thoracotomy: open approach to problems in the chest

  • Median Sternotomy:
    • Removal of thymus gland for myasthenia gravis
    • Resection of mediastinal and thymic tumors

  • Esophageal resection

  • Port-a-catheter insertion:venous access for chemotherapy

  • PleurX catheter insertion:outpatient drainage of malignant pleural effusions

  • CyberKnife Stereotactic radiosurgery: new technique for medically inoperable patients

What to Expect

Pre-Admission Testing

Call (401) 681-2PAT (2728) for an appointment to meet with nurses at the hospital in advance of your surgery
Monday – Friday 8am – 8 pm; Saturdays 8am – 2pm.

Preparing for Surgery

  • Quit smoking!  Smoking irritates your lungs and decreases your ability to clear secretions. If you are a smoker, you will improve your lung function and efficiency by stopping in advance of your surgery.

  • Maintain your physical activity to help condition your muscles.

  • Breathing Exercises: these are an important part of your recovery. Practice before your surgery
    .
  • If you develop a fever, persistent cough or colored sputum (green or gold) prior to surgery, please call the office immediately. Nutrition: Eat a balanced diet prior to your surgery.
    NOTHING to eat or drink AFTER MIDNIGHT the night before your operation. You may take your heart medicine with a sip of water on the day of surgery unless otherwise instructed.

  • Medications: you must stop certain medications that may cause bleeding in advance of your surgery
    One week before:Stop taking aspirin, Plavix, Ticlid, all other medicines containing aspirin such as Anacin, Excedrin, Fiorinol, Aggrenox  and Alka-seltzer
    Nutritional supplements such as vit E, gingko biloba, fish oil, coumarin, garlic extract, ginseng
    5 days before:Stop taking Coumadin
    2 days before:Stop taking non-steroidal anti-inflammatory medicines (NSAID) such as: Celebrex, ibuprofen (motrin, advil), Relafen, Naproxen (aleve, naprosyn, anaprox)
    1 day before:Stop taking: Lovenox

  • NIGHT BEFORE SURGERY: Do not eat or drink after midnight.

Day of Surgery

  • Enter through the main entrance to the hospital.
  • Please bring with you a list of your medications.
  • You may take your heart medicine with a sip of water unless otherwise instructed but do not take your morning diabetic medicines or insulin.
  • You may bring personal items that will make you more comfortable but please leave all valuables at home.
  • Please do not use personal care products such as hairspray, perfume, gels, aftershave, facial creams, oils, or lotions.
  • Please do not wear makeup or contact lens.

Family Waiting Area
If family members choose to wait during surgery, there is a waiting room outside the Surgical/ICU area. Dr. Reeder will update family members upon completion of the patient's procedure.

Recovery
After surgery you will wake up in the PACU (Post Anesthesia Care unit), otherwise called the Recovery Room, or in the ICU (intensive care unit).
You will be transferred to a surgical floor when you are medically ready. You may have a facemask or prongs in your nose to deliver oxygen, intravenous lines in you neck and/or arms, a bladder drainage catheter and chest drains. You will also have stockings and inflatable boots on your legs that help with your circulation.
On rare occasions, patients will need to remain on a breathing machine (ventilator) after surgery and will be transferred to the surgical ICU. These patients may wake up with a breathing tube still in place. The breathing tube will not allow you to talk, but you should still be able to respond to questions. The nurses and your surgical team will be able to assess and anticipate most of your needs at that time. As soon as you are awake and able to breathe on your own, the breathing tube will be removed.

The nurses will measure your temperature, blood pressure, pulse, breathing and oxygen levels (vital signs) on a regular basis. They will weigh you and record drainage from your chest tubes and bladder catheter

Oxygen, Coughing and Deep Breathing
You will be given oxygen after surgery until it is no longer needed. Oxygen is delivered in different ways. You may wear an oxygen mask or oxygen tubing that fits just inside your nose. Please let the nurses know immediately if you have difficulty breathing or feel any shortness of breath.

You will be instructed on how to use a breathing device called an “Incentive Spirometer.” This device has a mouthpiece that you use like a straw. You need to inhale ten big breaths six times every hour to help open up your lungs after surgery. Some patients will also use a second device called an “Acapella” or “Flutter valve.” You blow through the Acapella device. This helps loosen up secretions so that you can cough them out. These are both useful devices when you go home from the hospital. You can practice your breathing exercises with each commercial on TV.

Coughing is a necessary part of the breathing exercises. Because coughing may be associated with pain after surgery, the nurses will show you how to hold a pillow over your incision to act as a “splint.” Splinting with a pillow makes coughing easier and less painful. Respiratory therapists may visit regularly to administer nebulizer treatments, assist with your breathing exercises or to perform chest physiotherapy.

Pain Control
Pain control is very important for a successful recovery.We will do everything we can to minimize your pain. While we cannot eliminate all pain, we want to make you as comfortable as possible Our pain-control goal is to allow you to cough, deep breathe and move around more easily after surgery. We may use one or more methods to treat your pain.

Please let the doctors and nurses know if you have any discomfort or if you are not getting relief from your pain medication. You will be asked to rate your pain on a scale from 1-10 to evaluate how well your pain medication is working. A score of zero means that you have no pain at all. A score of 10 means that you are having the worst pain you have ever had.

No Pain Moderate Pain Worst Pain
"
1 2 3 4 5 6 7 8 9 10


On-Q Pain Buster
On-Q is a small catheter placed at the time of surgery that is connected to a ball of medicine that runs continuously as long as it is attached to you. This will not interact with other pain medicines.

Pain Medication by Mouth (Oral)
When you are able to eat, you will be switched to oral pain medication. We generally use “opiates” in both long-acting (timed released) and short-acting formulas. Most patients will be on opiates when they leave the hospital. We encourage you to take the medication as prescribed so that you are able to cough, deep breathe and walk throughout the day. The right dose of pain medication is the dose that works. Additionally, we may use muscle relaxants and anti-inflammatory medications to work with your pain medication. Some patients are reluctant to take pain medication because they are concerned about becoming addicted to them. However, most patients are not on these medications long enough to worry about this. We will work with you to wean these medications over time. The most common side effects of pain medications are constipation, nausea and sedation. You will be given stool softeners and laxatives to prevent constipation. And we encourage you to take your pain medication with food to avoid nausea.

Epidural Catheter
Our surgeons may ask the anesthesiologist to place a small catheter in your back before your operation. Pain medication is delivered through the epidural catheter around your spinal cord to decrease your ability to feel pain around your surgical incision.

Pain Controlled Analgesia (PCA)
Some patients will have a pain medication pump attached to their IV line. You will have a button that delivers a small but effective amount of pain medication when you push it. However, you should push the button when you feel pain or before beginning physical activity. The system is designed so that you will only get a small amount of pain medication every few minutes. You do not need to worry about getting too much medication. Do not allow family or friends to push the button for you.

Wound Care
Your surgical dressings will be removed by the second day after surgery. Most surgical incisions are covered with steri-strips to keep the skin edges together. The underlying tissue layers are sutured with an absorbable material that will dissolve after several weeks.

You may shower when your surgical dressings and chest tubes have been removed. You can gently cleanse your incisions with soap, rinse well and pat them dry.
Surgical wounds generally heal in six weeks. The incisions heal more quickly if they are kept clean and dry. We do not recommend applying antibiotic ointments, lotions or creams to your surgical incisions as they tend to keep the skin moist. Moist skin breaks down more easily. Because of this, we ask that you avoid soaking in a tub until your skin has sealed and you have been given permission by your surgeon.

Dry dressings may be applied if an incision is draining. If you develop drainage at home that is cloudy or has an odor to it, please call our office immediately. Any sutures remaining in place when you leave the hospital will be removed at your first office appointment. Numbness, tightness, and itching around your incision are normal. These sensations should disappear over time. Some numbness may be permanent.

Sequential Compression Devices
These plastic inflatable sleeves are wrapped around your lower legs and inflate every few minutes to squeeze your calves. This helps your circulation while lying in bed and prevents the formation of blood clots.

Drains
Chest tubes, also called drains, are placed in the operating room after surgery to remove air and fluid from the area between the lung and your chest wall. These are removed after a few days, in most cases. If there is a lot of drainage or air leaking from the chest tubes, they will remain in place for a longer period of time. You will have frequent chest X-rays to monitor your lungs after surgery.

On rare occasions, patients will be discharged from the hospital with one remaining chest tube still in place. These patients are seen weekly in the thoracic surgery clinic until the chest tube is removed.

Nasogatic (NG) tubes are used after esophageal surgery to keep the stomach empty and prevent nausea and vomiting. These are generally removed when your stomach starts to work again after the operation.

Urinary Catheter
A catheter will be placed in your bladder during surgery to allow your bladder to empty since this is sometimes difficult immediately following an operation.

Medications
You will receive other medications while in the hospital. You will receive a couple of doses of IV antibiotics to decrease the risk of infection. You will receive small Heparin shots under your skin to prevent the formation of blood clots in your legs (known as deep vein thrombosis or thrombophlebitis). The Heparin shots will be stopped when you leave the hospital. Respiratory therapists will be giving you breathing treatments to help with coughing and clearing secretions.

Most, if not all, of your regular medications will be restarted as soon as possible after your surgery. When you leave the hospital, a new medication list and instructions will be provided to you.

Diet
Depending on the type of surgery you have, you may be able to drink and eat as soon as you are awake. Your diet will slowly be advanced as you tolerate regular food. Medications will be available for nausea and to prevent constipation.

Physical Therapy (PT) and Occupational Therapy (OT)
Your nurses will help you sit up on the edge of your bed after surgery. Next you will move to sit in a chair and you will start walking again the morning after your operation. You should initially have someone with you to assist you with your drains and to make sure you are steady on your feet. Therapists may be asked to work with you to slowly increase your activity after surgery.

Discharge from the Hospital
Discharge Instructions
Please call my office to schedule a follow up appointment for 7-10 days after discharge from the hospital. We encourage you to call our office if you have any questions or concerns after you arrive home. However, if you have difficulty breathing, call 911.

ACTIVITY: It is important to be active after surgery. When you leave the hospital you should walk every day. We recommend that you increase the distance you walk every day, but it is not important to increase your speed. Try to plan periods of activity followed by periods of rest at home. And when you are resting, elevate your legs to prevent swelling.

Shoulder range-of-motion exercises will prevent stiffness, especially on the side of your surgery. These should be done two to three times a day. You can also walk your fingers up the wall (on the operative side) to get a good stretch through your shoulder.

Most patients are restricted from lifting more than ten pounds for 4-6 weeks.You may increase any activity as tolerated. You may find that your muscles have become weakened during that time, so proceed slowly and let pain be your guide.
It is normal to feel fatigue while recovering from surgery. It is one of the ways your body responds to the stress of surgery. Fatigue is generally worse immediately after surgery and should improve over time. Strength and stamina are slow to return, but it is important to keep moving!

DIET: Most patients will be eating a regular diet by the time they leave the hospital. A decrease in appetite after surgery is common and can have many causes. Your appetite should return to normal after a few weeks.

Nutrition plays a key role in wound healing. Eating a balanced diet after you leave the hospital is extremely important. Fruits and vegetables will provide the fiber necessary to maintain normal bowel function. Protein is responsible for tissue growth and repair, and carbohydrates provide energy. It is equally important that you drink plenty of fluids.

Frequently Asked Questions

Q. How long will I be in the hospital?
A. Most patients are in the hospital an average of 1-5 days after surgery, depending on the type of surgical procedure performed. Based on the level of care that you need after surgery, you may spend part of that time in the intensive care unit, a step down unit or on the general surgical floor. Occasionally, some patients will need additional recovery time at a skilled nursing facility prior to going home. The Case Managers will assist with any arrangements that need to be made before you leave the hospital.

Q. Can I drive?
A. Driving should be avoided after surgery until you have your follow-up appointment and are cleared by your surgeon. Pain medication and decreased mobility can make driving unsafe. Generally, patients are ready to drive when they can move freely and/or walk a flight of stairs and are NO longer taking pain medication.

Q. When can I return to work?
A.Your ability to return to work will depend on a number of factors. Depending on the type of surgery you have and the type of work that you do, you may feel ready to return to work in a few days. For patients undergoing larger operations, your return to work may take a full six weeks. And for patients needing additional treatment after surgery, it may take even longer. Some patients return to work part-time until they are able to tolerate working full-time. We will work with you and your employer to get you back to work when it is reasonable to do so.

If you are a physician and would like to refer a patient, please call the office or fax us a referral form.We will contact the patient directly to schedule an appointment.

Contact Us
1351 South County Trail - Directions
Building 2, Suite 200B
East Greenwich, RI 02818

Tel: (401) 886-0923
Fax: (401 886-0926

Resources
Early Detection Information
American Cancer Society
Lung Cancer Center
The Society of Thoracic Surgeons

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