This resource will help you care for yourself when you are discharged from the hospital after your esophageal surgery.
- Do not lie down right after eating. It can cause your food to come back up into your esophagus.
- When you lie down, always use a wedge to keep the head of your bed raised at least 30 degrees. Do not rely on pillows to do this because they will only raise your head. You need to raise the upper half of your body. Most patients with cancer at the union of the esophagus and the stomach have regurgitation (spitting back up) before surgery. After your surgery, you are likely to keep having it, since the valve that helps prevent it has been taken out. You must never again lie flat.
- If your liquid intake is not limited, drink as much water or other liquids as you can. Juices are very good to drink. To be able to eat more and not become too full at mealtimes, only drink up to 4 ounces of liquid with meals.
- Avoid contact with people with colds, sore throats, or the flu. You will not be able to fight off infection as easily as you did before your surgery.
- Avoid smoky, polluted, or crowded places.
Do your coughing and deep breathing exercises. Use your incentive spirometer 3 to 4 times a day. Continue doing this for at least 4 weeks. These exercises will help keep your lungs expanded and keep fluid out of your lungs. Below is a review of the steps in deep breathing.
- Relax your shoulders. Place one hand over your stomach to feel the motion.
- Keep your shoulders and upper chest relaxed during the exercise. Breathe in deeply through your nose.
Let your stomach muscles relax and feel the lower part of your stomach expand into your hand.
- Blow out slowly through your mouth with your lips puckered. As you blow out, tighten your stomach muscles and feel your stomach flatten under your hand.
- Breathe slowly and deeply.
Use a humidifier (a device that adds moisture to the air) in your bedroom during the winter months. Follow the directions that come with the humidifier for keeping it clean. After you clean the humidifier, let it dry for a few hours. This will prevent bacteria from growing in it and can prevent infections. Change the water in the humidifier frequently.
Do not smoke. Smoking cigarettes is harmful to your health at any time, but especially after your surgery. Smoking causes the blood vessels in your lungs to close. This decreases the oxygen in the lungs, which can cause problems with your breathing. If you smoke, your doctor, nurse, or social worker will suggest various ways that might help you quit. They can also give you information to help you deal with other smokers or situations when you are around cigarette smoke. For additional help, call (212) 610-0507.
Caring for Your Incisions
Depending on your surgery, you may have 1 to 3 incisions (surgical cuts). The incisions will begin to heal by the time you are ready to go home. Look at them with your nurse before discharge so that you know what they look like and can notice any changes. You should also look at the amount and color of the drainage (liquid coming out of your incisions), if you are having any.
If you go home with paper strips over your incisions, they may fall off by themselves. If they have not already fallen off, remove them 10 to 14 days after you go home. Depending on the amount of drainage, you may have a Band-Aid®, a small dressing, or both, covering the small incision from the chest tube. Change the dressing at least once a day, or more often if the drainage makes it wet. You can leave your incisions uncovered when they are healed and there is no drainage.
Do not take baths for at least 1 week. Unless your nurse or doctor tells you not to, you should start showering about 48 hours after your tubes are removed. Remove the dressing over the area where the chest tubes were removed. Wash the area of the incisions and the tube site with soap and water. Gently dry the area with a clean towel. You may want to place a clean dressing over the chest tube site or the incisions if there is any drainage. That will protect your clothes.
Continue to shower every day. You can use soap when you shower. Gently clean the area of the incision with soap and water. Pat the areas dry with a clean towel after showering and leave them uncovered.
Call your doctor if you have any of the following signs of an infection in your incisions:
- Tenderness or pain that is getting worse
- Redness or swelling that is getting worse
- Drainage from the incision, especially if it is pus
- A temperature of 101° F (38.3° C) or higher
Controlling Your Pain
You will be sent home with a prescription for pain medication. If it is a narcotic medication, such as morphine, acetaminophen and oxycodone (Percocet®), or hydrocodone, it can make you drowsy. Do not drive or drink alcohol while you are on the medication.
When you are discharged from the hospital, you will probably still have some pain. If you do have pain, it should be bearable and not limit your activity. You should not be so sleepy from your pain medicine that you are not doing any deep breathing, coughing, or other type of exercise.
Pain medication takes time to start working. If you allow the pain to become severe before you take the medication, you will need to take higher doses of it to relieve the pain. To avoid this, you should always have some of the pain medication in your body.
Take your medication on a regular schedule. Keep a record of the times you take your medication so you will know when to take your next dose. If you do not feel a lot of pain, you may want to cut down on the medication instead of not taking it at all. Call your doctor if your prescription does not make your pain better. Also, narcotics are restricted drugs and need a special prescription. Not every pharmacy will allow you to refill your prescription over the phone. Call your doctor's office at least 5 days before you run out so that they can mail you a prescription in time.
When your pain starts to go away, try to cut down on the amount of pain medication you are taking. If you have pain after taking less medication, go back to your schedule. Try to reduce it again in 1 or 2 days. Doing the following can help you decrease the amount of narcotics you have to take:
- Place a heating pad (on a low-heat setting) over your incisions
- Take a warm shower, especially before going to bed. It can be relaxing and help you sleep better
- Use acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to supplement narcotics. Do not take ibuprofen on an empty stomach. Do not take them more often than every 8 hours.
Aspirin can cause bleeding problems. Do not take aspirin or products that have aspirin in them without asking your doctor if it is safe.
- Pain medication works best 30 to 45 minutes after you take it. That may be a good time to do your coughing and deep breathing exercises and use the incentive spirometer.
- A warm shower can be relaxing. It helps decrease muscle aches.
- Exercise the arm and shoulder on the side of your incision. This will decrease muscle and joint stiffness. Refer to the exercises shown on pages 5 and 6.
- You will probably be constipated (not able to have a bowl movement) after your surgery, especially if you are taking narcotics for pain relief. If you are, try the following:
- Increase the amount of fiber in your diet to soften your stool (feces) naturally. Some high-fiber foods are:
- Whole grain cereals and breads
- Fresh fruits with skin
- Stewed or dried fruits, such as prunes, apricots, figs, and raisins
- Drinking a lot of liquids will help thin your sputum (mucus that is coughed up) and will also help prevent constipation. A glass of prune juice each morning can also help with constipation.
- Take a stool softener such as docusate sodium (Colace®) 3 times a day. If you have not had a bowel movement in 2 days, take a mild laxative (medicine to help you have a bowel movement), such as Senokot® or Phillip's® Milk of Magnesia, before bedtime. If this does not work, call your doctor's office and speak with the nurse.
- Women should try wearing a comfortable bra with soft padding under the part that touches the incisions. You may also want to go without a bra for a few weeks after you go home.
Before discharge, a dietitian will review some information about your diet with you and your caregiver. You will need to keep track of what you eat to know which foods are best for you. Good nutrition helps your incisions heal and improves your overall health. With time, you will know which diet works the best for you. Unless you are on a special diet for other medical reasons, you should eat well-balanced meals that are high in protein and carbohydrates. These foods are necessary for you to heal and regain your strength.
These tips can help you eat while you recover
- Eat 6 small meals a day
- Limit the amount of liquid you drink during your meals
- Do not eat 2 hours before your bedtime
- Do not drink coffee because it can hurt your stomach
- Avoid foods that can give you gas, such as cabbage, beans, and onions. This will make you more comfortable and will help prevent you from burping up food that may then go into your lungs
Foods high in protein
- Poultry (chicken, turkey)
- Milk and milk products
- Peanut butter
Many of these high-protein foods also have a lot of cholesterol. The following tips will help you increase the protein in your diet without taking in a lot of cholesterol:
- Double the strength of the milk you use. You can do this by mixing 1 quart of whole milk with 1 cup of powdered skim milk. Blend and chill the mixture
- Prepare omelettes or scrambled eggs with 1% low-fat milk, cheese, butter, mayonnaise, or thinly sliced meat. Use recipes with eggs whites (eggs without the yolks) to decrease fat, increase protein, and eliminate cholesterol
- Snack on low-fat yogurt or pudding
- Snack on low-fat cheese or peanut butter
- Add wheat germ to your cereals, casseroles, and yogurts
- Eat desserts that have eggs, such as angel food cake, rice pudding, custard, and cheesecake
- Try instant breakfast drinks, such as Carnation® Instant Breakfast
- Try drinks with vitamin supplements, such as Ensure®
Foods high in carbohydrates
While you are recovering, you need to take in healthy sources of carbohydrates. All of the foods listed below are excellent sources of carbohydrates.
- Enriched (nutrients added) cereal, bread, egg noodles, pasta, and rice
- Dark green vegetables, peas, beans, lentils, and beets
- Fresh or dry fruits such as bananas, pears, apples, and prunes
After eating, some patients can have stomach cramping, excessive gas, and diarrhea. These symptoms can also include feeling sweaty, dizzy, or weak. This is called dumping syndrome. It can occur 15 minutes to 2 hours after eating. Most patients can avoid these symptoms by eating very slowly, in smaller amounts. Certain foods, such as fried foods, sweets, chocolate, and milk (lactose), can cause these symptoms. It will help to write down what you ate when you had these symptoms. Don't eat those foods for a few days and then try them again to see if you have the symptoms again.
Many patients find it helpful to stay away from foods that have lactose for 2 to 3 months after surgery. Milk in particular can cause problems with digestion. Try drinking 100% lactose-free milk instead of regular milk. Decrease the amount of fat in your diet and avoid concentrated sweets. Learning to manage your diet may be difficult at first, but you will eventually become familiar with the size of the food portions you can tolerate.
Starting Your Regular Activities
It is normal to have less energy while you are recovering from your surgery. The amount of time that it takes to return to regular activities varies with each patient. Try to increase your activities each day. Balance activity periods with rest periods. Rest is a necessary part of your recovery. However, your recovery also depends on how active you are. The more you can do, the faster you will recover.
Return to your usual sexual activity when you feel strong enough. Make sure that any pain from your incisions does not interfere and that you do not get too tired.
Walking is an excellent form of exercise. You should walk at least 20 minutes a day and slowly increase the distance you walk. On cold or rainy days, have a family member or friend take you to an indoor area, such as a mall, so that you can walk indoors. Climb stairs slowly and rest or stop if you feel weak or tired. You may also do light household tasks, such as dusting, washing dishes, or preparing small meals.
The following exercises will help you to regain full arm and shoulder movement:
- Sit in a straight-backed chair with your feet flat on the floor. Clasp your hands together.
- Lift your arms up and over your head. Slide your hands to the back of your neck.
- Slowly twist the upper part of your body to the right side. Try to hold this position for 5 seconds while bringing your elbows as far back as possible. Return to the starting position.
- Slowly twist the upper part of your body to the left side. Try to hold this position for 5 seconds while bringing your elbows as far back as possible. Return to the starting position.
Repeat this exercise 5 times a day.
- Stand comfortably with your feet about 6 inches apart.
- Put your arms in front of your body and hold one end of a hand towel in each hand. Bring your arms over your head with your elbows straight, and stretch towards your upper back. Do not arch your back and do not force the movement if it feels difficult. Try to hold this position for 5 seconds. Return to the starting position.
Repeat this exercise _______________.
- Stand. (Repeat as in step 1.) While grasping the hand towel behind your back, lift your arms up as far as possible. Be sure to stand straight. Try to hold this position for 5 seconds. Return to the starting position.
Regaining arm and shoulder function
Use the affected arm and shoulder in all of your activities of daily living. Use them to bathe, brush your hair, and reach up to a shelf. Slowly going back to your normal activity level will help restore full use of your shoulder.
Ask your doctor when you can
Do not drive for about 3 to 4 weeks after your surgery. Driving may cause more strain on your incisions. Do not drive while you are taking narcotic pain medicine.
Do not lift anything over 10 pounds until your doctor says it is safe.
- Start doing intense exercises
Avoid active sports. Do not play golf, tennis, or racket ball. Also, do not swim or do aerobics until your doctor allows you to do so. When you go back to exercising, remember to start slowly and do more when you feel ready.
Most people are able to return to their previous job. The amount of time it takes to go back depends on the type of work, the amount of surgery, and the rate of recovery.
You may find yourself having new and upsetting feelings. Patients have many different responses to serious illness. Many patients have said they felt sad, worried, nervous, irritable, and angry at one time or another.
As time passes, you may find that you have these strong feelings all the time. These emotions are not unusual or abnormal. However, if this happens, you should get some emotional support.
The first step in dealing with a serious illness is to talk about how you feel. Sharing your feelings with family and friends can make you feel better. Your nurse, doctor, and social worker can also support you through this process. You should tell them how you and your loved ones are feeling about your illness. There are many resources available for patients and their loved ones. Whether you are in the hospital or at home, help is available to you.
When you leave the hospital, you will be given a discharge instruction form. It tells you when to make your follow-up visit.
Follow-up visits are a necessary part of your treatment. Keep them even if you are feeling well. Call your doctor if you have any problems before your scheduled appointment date.
Call Your Doctor If You Have
- Pain, redness, swelling, or drainage from your incisions that is getting worse
- A temperature of 101° F (38.3° C) or higher
- Any questions or concerns
Important Telephone Numbers
Your nurse, doctor, dietitian, and social worker are available for you during your recovery. Call them if you have any questions.
Social Worker (212) 639-7010
Outpatient Nutrition Services (212) 639-7312