About Your Thoracic Surgery

This guide will help you prepare for your thoracic surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.

Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Surgery

About Your Thorax

The word “thoracic” refers to your thorax, which is your chest (see Figure 1). Your thorax contains your:

  • Lungs
  • Pleura: 2 thin layers of tissue that surround your lungs. The space between your pleura is called the pleural space.
  • Heart
  • Pericardium: the thin layer of tissue that surrounds your heart
  • Diaphragm: the muscle that separates your chest from your abdomen (belly)
  • Thymus: a gland that helps protect you from infections during childhood. The thymus has no known function in adults.

You have 2 lungs, 1 on each side of your chest. Your lungs are made up of lobes. Your left lung has 2 lobes and your right lung has 3 lobes.

Figure 1. Your thorax

Types of Thoracic Surgeries

There are many types of thoracic surgeries. Your doctor will explain which type you will be having. Examples of some surgeries are described below.

  • A wedge is the removal of a small part of a lobe of your lung (see Figure 2).
    Figure 2. A wedge
  • A segmentectomy is the removal of a slightly larger part of a lobe of your lung (see Figure 3).
    Figure 3. A segmentectomy
  • A lobectomy is the removal of an entire lobe of your lung (see Figure 4).
    Figure 4. A lobectomy
  • A pneumonectomy is the removal of 1 entire lung (see Figure 5).
    Figure 5. A pneumonectomy
  • An extrapleural pneumonectomy is the removal of:
    • One entire lung
    • The pleura
    • Your pericardium
    • Your diaphragm (see Figure 6)
    Your diaphragm and pericardium may be reconstructed during your surgery.
    Figure 6. An extrapleural pneumonectomy
  • A pleurectomy and decortication is the removal of all or part of the pleura (see Figure 7).
    Figure 7. A pleurectomy and decortication
  • A thymectomy is the removal of your thymus (see Figure 8).
    Figure 8. A thymectomy

Other Thoracic Procedures

Figure 9. A pleural drainage catheter

Some conditions can be treated with a procedure that doesn’t remove your lung or the pleura. Three common procedures are listed below.

  • A pleurodesis is a procedure to prevent pleural effusion from coming back. Pleural effusion is a condition in which too much fluid builds up around your lung. During the procedure, a medication is inserted into your pleural space and the fluid is drained.
  • A pleural biopsy is a procedure to remove a sample of tissue from your pleura.
  • A pleural drainage catheter may be placed to drain extra fluid (see Figure 9).

Ways to Do Thoracic Surgery

There are different ways that thoracic surgery can be done. Your doctor will tell you how your surgery will be done and which type of incision (surgical cut) you will have.

How long you stay in the hospital will depend on which type of surgery and which type of incision you will have. Your doctor will discuss this with you before your surgery.

Types of Thoracic Incisions

  • Thoracotomy: 1 large incision one one side of your back (see Figure 10).
    Figure 10. Thoracotomy incision
  • Video-assisted thoracic surgery (VATS): 1 or more small incisions on your side, back, or both (see Figure 11). For VATS, your doctor will use a long, thin video camera and surgical tools during your surgery. This is sometimes called minimally invasive surgery. Your doctor may use a robot to control the video camera and surgical tools. This is called robotically assisted VATS.
    Figure 11. VATS incisions
  • Median sternotomy: 1 large incision in the center of your chest (see Figure 12).
    Figure 12. Median sternotomy incision
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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

Quit Smoking Before Surgery

You’re considered a smoker if you have smoked, even a puff, or used any kind of tobacco product in the last 30 days. This include e-cigarettes, vaporizers, and other types of electronic nicotine delivery systems (ENDS). If you’re a smoker, you need to stop smoking 2 weeks before your surgery.

Quitting smoking before your surgery will help you recover better after your surgery. Quitting will:

  • Help your heart and lungs work better
  • Reduce complications during and after your surgery
  • Help your wounds heal
  • Lower your need for rehabilitation to improve your breathing after surgery
  • Lower your risk of getting an infection after surgery

If you smoke, tell the nurse who works with your surgeon. They will refer to you our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

If you have quit smoking, tell the nurse the date you quit and how much you smoked before you quit. They can refer you to our Tobacco Treatment Program to help you keep from starting to smoke again.

MSK’s Tobacco Treatment Program

You don’t have to quit alone!

To speak with a Tobacco Treatment Specialist, call 212-610-0507.

Our Tobacco Treatment Program has a team of Tobacco Treatment Specialists (TTS) who can help you create a plan to quit smoking or stay quit. A TTS will contact you on the phone and talk with you about the benefits of quitting smoking, especially before surgery.

The TTS may suggest nicotine replacement therapy medication (such as a nicotine patch, gum, lozenge, or inhaler) or cessation medication to help you quit safely and effectively. These medications:

  • Are safe to use before and after surgery
  • Can double your quitting success rate
  • Can help you feel more comfortable during a very stressful time

The TTS will also teach you practical skills to cope with your urges to smoke and help you find ways to manage nicotine withdrawal symptoms.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications (medications prescribed by a doctor), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, and natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medication to help prevent them.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do to prevent problems before your surgery:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

About Benign Prostate Hyperplasia (BPH)

BPH is when your prostate gland is enlarged. If you’re a male, 50 years of age or older, and have a history of BPH, your doctor will give you a prescription for tamsulosin (Flomax®). Taking tamsulosin before your surgery can help prevent problems with urination after your procedure.

Start taking the tamsulosin 3 days before your surgery.

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.

Before your surgery, make sure you’re ready by doing the following things:

  • Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your doctor or nurse at your next appointment, or you can call your doctor’s office.
  • Exercise and eat a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by doing the following things:

  • Read your recovery pathway. Your nurse will give you a pathway with goals for your recovery. It will help you know what to do and expect on each day during your recovery.
  • Start eating and moving around as soon as you can. The sooner you’re able to eat, get out of bed, and walk, the quicker you will be able to get back to your normal activities.

Within 30 Days of Your Surgery

Presurgical Testing (PST)

Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment.

During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you’re unable to communicate for yourself. The person you identify is called your health care agent.

If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it to your next appointment.

Do Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read our resource How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.

Exercise

Try to do aerobic exercise every day. Examples of aerobic exercise include walking at least 1 mile (1.6 kilometers), swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping market. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Eat a Healthy Diet

Eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your doctor or nurse about meeting with a dietitian.

10 Days Before Your Surgery

Stop Taking Vitamin E

If you take vitamin E, stop taking it 10 days before your surgery. Vitamin E can cause bleeding. For more information, read our resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Figure 13. Hibiclens skin cleanser

Buy Hibiclens® Skin Cleanser

Hibiclens is a skin cleanser that kills germs for 24 hours after using it (see Figure 13). Showering with Hibiclens before your surgery will help lower your risk of infection after your surgery. You can buy Hibiclens at your local pharmacy without a prescription.

7 Days Before Your Surgery

Stop Taking Certain Medications

If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read our resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop Taking Herbal Remedies and Other Supplements

Stop taking herbal remedies and other dietary supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should continue. For more information, read our resource Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Hospital (MSK’s main hospital) on the day of your surgery.

3 Days Before Your Surgery

Start Taking Tamsulosin, If Your Doctor Told You To

If your doctor gave you a prescription for tamsulosin, start taking the tamsulosin 3 days before your surgery. For more information, read the “About Benign Prostate Hyperplasia (BPH)” section above.

2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read our resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. If you’re scheduled for surgery on a Monday, you will be called on the Friday before.

The clerk will tell you what time you should arrive at the hospital for your surgery. They will also tell you where to go on the day of your surgery. This will be the following location:

     MSK Presurgical Center (PSC)
     1275 York Avenue (between East 67th and East 68th Streets)
     New York, NY 10065
     B elevator to 6th floor

If you don’t receive a call by 7:00 pm, please call 212-639-5014.

Shower with Hibiclens

The night before your surgery, shower using Hibiclens.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well.
  3. Open the Hibiclens bottle. Pour some solution into your hand or a washcloth.
  4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
  5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
  6. Move back into the shower stream to rinse off the Hibiclens.
  7. Dry yourself off with a clean towel after your shower.
  8. Don’t put on any lotion, cream, deodorant, makeup, powder, cologne, or perfume after your shower.

Sleep

Go to bed early and get a full night’s sleep.

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Do not eat or drink after midnight.

The Morning of Your Surgery

Take Your Medications

If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

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Two hours before your scheduled arrival time, drink the Clearfast® carbohydrate drink your doctor or nurse gave you. After you finish the Clearfast, do not eat or drink anything else. This includes water, hard candy, and gum.

Shower with Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before.

Don’t put on any lotion, cream, powder, deodorant, makeup, cologne, or perfume after your shower.

Things to Remember

  • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
  • Remove nail polish and nail wraps.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuable items, such as credit cards, jewelry, or your checkbook, at home.
  • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.

What to Bring

  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
  • Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
  • Your Health Care Proxy form, if you have completed one.
  • Your cell phone and charger.
  • A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, if you have it.
  • Your toothbrush and other toiletries, if you wish.

Where to Park

Parking at Memorial Hospital
MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212- 639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.

Get Dressed for Surgery

When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse may place an intravenous (IV) line into one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it later once you’re in the operating room.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will receive.
  • Answer questions you have about your anesthesia.

If you’re having a thorocotomy, your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give pain medication.

Prepare For Your Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it’s time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read our resource Information for Family and Friends for the Day of Surgery.

You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you will fall asleep. You will also get fluids through your IV line during and after your surgery.

What to Expect

After you’re asleep, you may have a urinary (Foley®) catheter placed to drain urine from your bladder. You may also have an arterial line (small catheter connected to a machine by a tube) placed in a blood vessel, usually in your arm or wrist. The arterial line will measure your blood pressure during your surgery.

Once your surgery is finished, your incisions will be closed with sutures (stitches) that will dissolve as you heal. You may also have Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (sugical glue) over your incisions. Your incisions may be covered with a bandage.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

In the Post Anesthesia Care Unit (PACU)

When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU).

A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You will get oxygen through a thin tube that rests below your nose called a nasal cannula. You will also have compression boots on your lower legs.

You may have a urinary catheter in your bladder to monitor the amount of urine you’re making. You will also have a chest tube that goes into a drainage device (see Figure 14).

Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them.

You may stay in the PACU for a few hours or overnight, depending on when an inpatient bed becomes available.

In Your Hospital Room

After your stay in the PACU, you will be taken to your hospital room. There, you will meet one of the nurses who will care for you while you’re in the hospital recovering from your surgery. Tell the nurse if you drink alcohol every day or if you have recently stopped drinking alcohol. Tell the nurse if you smoke or if you have recently quit smoking. They will offer you a nicotine replacement therapy to make you more comfortable while you’re in the hospital.

Your nurse will explain the best way to recover from your surgery. Below are examples of ways you can help yourself recover safely.

  • Try to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs and lower your risk of developing pneumonia. You will have tubes and an IV line, so make sure you have help while you’re walking.
  • Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read our resource How to Use Your Incentive Spirometer.
  • Do your breathing and coughing exercises every 1 to 2 hours while you’re awake.
  • Read the pathway handout that your nurse gives you to see what to expect and how to help your recovery while you’re in the hospital.

Read our resource Call! Don't Fall! to learn about what you can do to stay safe and keep from falling while you’re in the hospital.

Commonly Asked Questions: During Your Hospital Stay

Will I have pain after my surgery?

You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. It’s important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.

You may get a prescription for pain medication before you leave the hospital. Talk with your doctor or nurse about possible side effects and when you should start switching to over-the-counter pain medications.

Pain medication may cause constipation (having fewer bowel movements than what’s normal for you). For more information, read the “How can I prevent constipation?” section below.

What is a chest tube?

Figure 14. Your chest tube and drainage device

A chest tube is a flexible tube that drains blood, fluid, and air from around your lung after surgery. The tube enters your body between your ribs and goes into the space between your chest wall and lung (see Figure 14).

When will my chest tube be removed?

Your chest tube will be removed when your lung is no longer leaking air and the drainage from your tube has decreased enough. Usually, this is when there’s less than 350 cubic centimeters (cc) of drainage per 24 hours.

After the tube is removed, the area will be covered with a bandage. Keep the bandage on for at least 48 hours, unless your nurse gives you other instructions.

Most people go home the same day that their chest tube is removed. Sometimes, your doctor may want you to stay in the hospital for another day after your chest tube is removed.

Look at your incisions with your nurse before you leave the hospital. This will help you notice any changes once you’re at home.

Why is it important to walk?

Walking helps prevent blood clots in your legs. It also lowers your risk of having other complications such as pneumonia. Walking 1 mile each day, which is 14 laps around the unit while you’re still in the hospital, is a good goal.

Will I be able to eat?

You will gradually start eating your normal diet again when you’re ready. Your doctor or nurse will give you more information.

When can I have visitors?

You can have visitors between 8:00 am and 10:00 pm every day.

When will I leave the hospital?

How long you stay in the hospital depends on many things, such as the type of surgery you had and how you’re recovering. You will stay in the hospital until your doctor feels you’re ready to go home. Your nurse or doctor will tell you what day and time you can expect to be discharged.

Your doctor will talk with you if you need to stay in the hospital longer than planned. Examples of things that can cause you to stay in the hospital longer include:

  • Air leaking from your lung
  • Having an irregular heart rate
  • Having problems with your breathing
  • Having a temperature of 101° F (38.3° C) or higher

Commonly Asked Questions: At Home

Read our resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and keep from falling at home and during your appointments at MSK.

Will I have pain when I am home?

The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Some people may have soreness around their incision, tightness, or muscle aches for 6 months or longer. This doesn’t mean that something is wrong. Follow the guidelines below.

  • Take your medications as directed and as needed.
  • Call your doctor if the medication prescribed for you doesn’t relieve your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication.
  • As your incisions heal, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort.
    • Don’t stop taking your pain medication suddenly. Follow your doctor or nurse’s instructions for stopping.
    • Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse. Taking too much acetaminophen can harm your liver.
  • Pain medication should help you resume your normal activities. Take enough medication to do your exercises comfortably. However, it’s normal for your pain to increase slightly as you increase your level of activity.
  • Keep track of when you take your pain medication. Pain medication is most effective 30 to 45 minutes after taking it. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

Do the stretching exercises described in the “What exercises can I do?” section below. These will help to relieve the pain on the side of your surgery.

Pain medication may cause constipation (having fewer bowel movements than what’s normal for you). For more information, read the “How can I prevent constipation?” section below.

How do I care for my incisions?

You will have more than 1 incision after your surgery. The location of your incisions will depend on the type of surgery you had. There will be incisions from the surgical site and the chest tube. You may have some numbness below and in front of your incisions. You may also have some tingling and increased sensitivity around your incisions as they heal.

Surgical incision(s)

  • By the time you’re ready to leave the hospital, your surgical incision(s) will have started to heal.
  • Look at your incision(s) with your nurse before you leave the hospital so you know what it looks like. This will help you know if there are any changes later.
  • If any fluid is draining from your incision(s), write down the amount, color, and if it has a smell.
  • If you go home with Steri-Strips or Dermabond on your incisions, they will loosen and fall off on their own. If they haven’t fallen off within 10 days, you can gently remove them.

Chest tube incision

  • You may have some thin, yellow or pink-colored drainage from your incision. This is normal.
  • Keep your incision covered with a bandage for 48 hours after your chest tube is removed, unless the bandage gets wet. If it gets wet, change the bandage as soon as possible.
  • After 48 hours, if you don’t have any drainage, you can remove the bandage and keep your incision uncovered.
  • If you have drainage, keep wearing a bandage until the drainage stops. Change it at least once a day or more often if the bandage becomes wet.
  • Sometimes, the drainage may start again after it has stopped. This is normal. If this happens, cover the area with a bandage. Call your doctor’s office if you have questions.

Can I shower?

You can shower 48 hours after your chest tube is removed. Taking a warm shower is relaxing and can help decrease muscle aches. Remove your bandages and use soap to gently wash your incisions. Pat the areas dry with a towel after showering, and leave your incisions uncovered (unless there is drainage).

Don’t take tub baths until you discuss it with your doctor at the first appointment after your surgery.

What should I eat at home?

Eating a balanced diet high in protein will help you heal after surgery. Your diet should include a healthy protein source at each meal, as well as fruits, vegetables, and whole grains. For more tips on increasing the amount of calories and protein in your diet, read our resource Eating Well During and After Your Cancer Treatment.

If you have questions about your diet, ask to see a dietitian.

How can I prevent constipation?

Your usual bowel pattern will change after surgery. You may have trouble passing stool (feces). Talk with your nurse about how to manage constipation.

  • Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of the body.
  • Both over-the-counter and prescription medications are available to treat constipation. Start with 1 of the following over-the-counter medications first:
    • Docusate sodium (Colace®) 100 mg. Take 3 capsules once a day. This is a stool softener that causes few side effects. Don’t take it with mineral oil.
    • Senna (Senokot®) 2 tablets at bedtime. This is a stimulant laxative, which can cause cramping.
  • If you feel bloated, avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower.
  • If you haven’t had a bowel movement in 2 days, call your doctor or nurse.

For more information, read our resource Constipation.

How can I help my recovery?

  • Exercise for at least 30 minutes each day. This will help you get stronger, feel better, and heal. Make a daily walk part of your routine.
  • Keep using your incentive spirometer and do your coughing and deep breathing exercises at home.
  • Drink liquids to help keep your mucus thin and easy to cough up. Ask your doctor how much you should drink each day. For most people, this will be at least 8 to 10 (8-ounce) glasses of water or other liquids (such as juices) each day.
  • Use a humidifier in your bedroom during the winter months. Follow the directions for cleaning the machine. Change the water often.
  • Avoid contact with people with colds, sore throats, or the flu. These things can cause infection.
  • Do not drink alcohol, especially while you are taking pain medication.
  • Don’t smoke. Smoking cigarettes is harmful to your health at any time. It is even more so as you’re healing after your surgery. Smoking causes the blood vessels in your body to become narrow. This decreases the amount of oxygen that reaches your wounds as they’re healing. Smoking can also cause problems with breathing and regular activities.

    It’s also important to avoid places that are smoky. Your nurse can give you information to help you deal with other smokers or situations where smoke is present.

    Remember, if you need help quitting, MSK’s Tobacco Treatment Program can help. Call 212-610-0507 to make an appointment.

Can I resume my activities?

It’s important for you to resume your activities after surgery. Spread them out over the course of the day.

  • Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed.
  • Do light household tasks. Try dusting, washing dishes, preparing light meals, and other activities as you’re able.
  • Use the arm and shoulder on the side of your surgery in all of your activities. For example, use them when you bathe, brush your hair, and reach up to a cabinet shelf. This will help restore full use of your arm and shoulder.
  • You may return to your usual sexual activity as soon as your incisions are well healed and you can do so without pain or fatigue.

Your body is an excellent guide for telling you when you have done too much. When you increase your activity, monitor your body’s reaction. You may find that you have more energy in the morning or the afternoon. Plan your activities for times of the day when you have more energy.

Is it normal to feel tired after surgery?

It’s common to have less energy than usual after your surgery. Recovery time is different for everyone. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is a vital part of your recovery.

It may take some time until your normal sleep pattern returns. Try not to nap during the day. Taking a shower before bed and taking your prescribed pain medications can also help.

When is it safe for me to drive?

You can begin driving again after you have:

  • Regained full movement of the arm and shoulder on the side of your surgery
  • Stopped taking narcotic pain medication (pain medication that may make you drowsy) for 24 hours.

Can I travel by plane?

Don’t travel by plane until your doctor says it’s okay. You will talk about this during your first appointment after your surgery.

When can I go back to work?

The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. If you need a letter to go back to work, contact your doctor’s office.

When should I start doing arm and shoulder exercises?

Start doing arm and shoulder exercises as soon as your chest tube bandage is removed. This will help you to regain full arm and shoulder movement. To do the exercises, follow the instructions below.

Axillary stretch

Figure 15. Axillary stretch
  1. Sit in a straight-backed chair with your feet flat on the floor.
  2. Clasp your hands together (see Figure 15).
  3. Lift your arms up and over your head.
  4. Slide your hands down to the back of your neck.
  5. Slowly twist the upper part of your body to the right side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
  6. Return to the starting position.
  7. Slowly twist the upper part of your body to the left side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
  8. Return to the starting position.

Repeat _____ times

Towel stretch

Figure 16. Towel stretch
  1. Stand comfortably with your feet about 6 inches (15 centimeters) apart.
  2. Put your arms in front of your body and hold one end of a hand towel in each hand (see Figure 16).
  3. Bring your arms over your head, straighten your elbows, and stretch toward your upper back. Do not arch your back and do not force the movement if it is difficult. Try to hold the position for 5 seconds.
  4. Relax and return to the starting position.
  5. Stand as in Step 1.
  6. Grasp the towel behind your back and lift upward as far as possible. Be sure to stand straight. Try to hold the position for 5 seconds.
  7. Return to the starting position.

Repeat _____ times

When can I start doing other kinds of exercise?

The best exercise is walking, climbing stairs, or doing another kind of aerobic exercise for at least 30 minutes each day. You can start doing this again right after your surgery, unless your doctor or nurse gives you other instructions.

Don’t do heavy exercise or play contact sports until your doctor tells you it’s safe. When you start again, remember that it will take time for you to return to your previous level of activity. Start out slowly and increase your activity as you feel better.

When can I lift heavy objects?

Check with your doctor before you do any heavy lifting. Normally, you shouldn’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 3 weeks. Ask your doctor how long you should avoid heavy lifting. This depends on the type of surgery you had.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

When is my first appointment after my surgery?

Your first appointment after surgery will be 1 to 3 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

During this appointment, your doctor will discuss the pathology results with you in detail. You may also have appointments with other doctors after your surgery.

  • New or worsening shortness of breath
  • Swelling in your chest, neck, or face
  • A sudden change in your voice
  • A faster heartbeat than usual
  • A temperature of 101° F (38.3° C) or higher
  • Pain that doesn’t get better with your medications
  • Redness or swelling around your incision
  • Drainage from your incision that is smells bad or is thick or yellow (like pus)
  • No bowel movement for 3 days or longer
  • Any new symptom or physical change
  • Any questions or concerns

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000. Ask to speak to the thoracic surgeon on call.

MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your healthcare team, view your test results, see your appointment dates and times, and more.

If you don’t already have a MyMSK account, you can sign up by going to my.mskcc.org. For more information about signing up for a MyMSK account, watch our video How to Enroll in the Patient Portal: MyMSK. You can also contact the MyMSK Help Desk by emailing mymsk@mskcc.org or calling 800-248-0593.

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Resources

This section includes a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.

Educational Resources

MSK Support Services

Anesthesia
212-639-6840
Call with any questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Look Good Feel Better Program
800-395-LOOK (800-395-5665)
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.

Patient-to-Patient Support Program
212-639-5007
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

Patient Billing
646-227-3378
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have any questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
Breathing Easier in Lung Cancer Survivorship

646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

The Breathing Easier in Lung Cancer Survivorship meeting is led by social workers and nurses and is designed to help people adjust to life after lung cancer treatment. This may include physical and psychological changes, lifestyle changes, and concerns about the future. We encourage people to share their concerns while getting information from healthcare providers.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

For additional online information, visit LIBGUIDES on MSK’s library website at http://library.mskcc.org or the lung cancer section of www.mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.

External Resources

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A comprehensive resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for those who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance,meet the income criteria, and be prescribed medication that is part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including a online support groups and a database of LGBT friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people obtain medications that they have trouble affording.

SHARE
www.sharecancersupport.org
866-891-2392
Offers support groups for survivors of breast, metastatic breast, and ovarian cancer in Manhattan, Queens, Brooklyn, and Staten Island.

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