About Your Thoracic Surgery

This guide will help you get ready for your thoracic surgery at MSK. It will also help you know what to expect during your recovery.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.

About Your Surgery

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

• Lungs: 2 lungs, 1 on each side of your chest. Your lungs are made up of lobes. Your left lung has 2 lobes. Your right lung has 3 lobes.
• Pleura: 2 thin layers of tissue that surround your lungs. The space between your pleura is called the pleural space.
• Pericardium (PAYR-ih-KAR-dee-um): the thin layer of tissue that surrounds your heart.
• Diaphragm (DY-uh-fram): the muscle that separates your chest from your abdomen (belly).
• Thymus: a gland that helps protect you from infections when you’re a child. The thymus has role in adults.
• Heart

Types of thoracic surgeries

There are many types of thoracic surgeries. Your surgeon will talk with you about which type you’ll have. Examples of some surgeries are described in this section. Your surgeon may also use the lines and pictures in this section to describe your surgery.

• A wedge is when a small part of a lobe of your lung is removed (see Figure 2).

  

• A segmentectomy (seg-men-TEK-toh-mee) is when a slightly bigger part of a lobe of your lung is removed (see Figure 3).

  

• A lobectomy (loh-BEK-toh-mee) is when a whole lobe of your lung is removed (see Figure 4).

  

• A pneumonectomy (NOO-moh-NEK-toh-mee) is when 1 whole lung is removed (see Figure 5).

  

• An extrapleural pneumonectomy is when these parts of your thorax are removed (see Figure 6):
  • One entire lung
  • The pleura around that lung
  • Your pericardium
  • Your diaphragm

Your surgeon may reconstruct your diaphragm and pericardium during your surgery.

• A pleurectomy and decortication is when all or part of the pleura around 1 lung is removed (see Figure 7).

  

• A thymectomy is when your thymus is removed (see Figure 8).

  

Other thoracic procedures

Some conditions can be treated with a procedure that does not remove your lung or pleura. Three common procedures are listed below.

• A pleurodesis is a procedure to keep pleural effusion from coming back. Pleural effusion is when too much fluid builds up around your lung. During the procedure, your surgeon will put a medication into your pleural space to drain fluid from the area.
• A pleural biopsy is a procedure to take a sample of tissue from your pleura.
• A pleural drainage catheter is placed in your pleural space to drain extra fluid from the area (see Figure 9).

Ways to do thoracic surgery

There are different ways thoracic surgery can be done. Your surgeon will tell you which type of incision you’ll have.

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

Types of thoracic incisions

• Thoracotomy: 1 large incision on 1 side of your back (see Figure 10).

  

• Video-assisted thoracic surgery (VATS): 1 or more small incisions on your side, back, or both (see Figure 11). For VATS, your surgeon will use a long, thin video camera and surgical tools during your surgery. This is sometimes called minimally invasive surgery. Your surgeon may use a robot to control the video camera and surgical tools. This is called robotically-assisted VATS. With a robotically-assisted VATS, your surgeon sits at a console and controls a robot that moves the surgical tools. The console has a special monitor where they can see the images from inside your chest in 3 dimensions (3-D).

  

• Median sternotomy: 1 large incision in the center of your chest (see Figure 12).

  

Getting Ready for Your Surgery

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read through this section, write down questions to ask your healthcare provider.

Getting ready for surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.

• I take a blood thinner, such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven® or Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
  There are others, so be sure your healthcare provider knows all the medications you’re taking.
• I take prescription medications (medications my healthcare provider prescribes), 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, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
• I’m allergic to certain medication(s) or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device, such as a vape pen, e-cigarette, or Juul®.
• 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.

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

Here are things you can do before your surgery to keep from having problems:

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
  • Get a headache.
  • Feel nauseous (like you’re going to throw up).
  • Feel more anxious (nervous or worried) than usual.
  • Cannot sleep.
  These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you cannot stop drinking.
• Ask your healthcare provider questions about drinking and surgery. As always, all your medical information will be kept private.

Quit smoking before your surgery

If you smoke, you need to stop smoking 2 weeks before your surgery. This includes e-cigarettes, vaporizers, and other types of electronic nicotine delivery systems (ENDS).

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

• Help your heart and lungs work better.
• Lower your risk of problems during and after your surgery.
• Help your wounds heal.
• Lower your need for rehabilitation to help you breathe better.
• 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 by calling 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 avoid starting again.

MSK’s Tobacco Treatment Program

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

The TTS may suggest nicotine replacement therapy (such as a nicotine patch, gum, lozenge, or inhaler) or other cessation medications.

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. They’ll also help you find ways to manage nicotine withdrawal symptoms.

About sleep apnea

Sleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure.

About benign prostate hyperplasia (BPH)

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

Start taking the tamsulosin 3 days before your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

For help, watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

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:

• Reading 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 healthcare provider at your next appointment, or you can call their office.
• Exercising and following a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by:

• Reading your recovery pathway. This is an educational resource your healthcare provider will give you. It has goals for your recovery. It will help you know what to do and expect each day during your recovery.
• Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your normal activities.

Within 30 days of your surgery

Presurgical Testing (PST)

You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment.

It’s helpful to bring these things to your 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 names and telephone numbers of your healthcare providers.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.msk.org/caregivers or read A Guide for Caregivers.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• To learn more about health care proxies and other advance directives, read Advance Care Planning.
• To learn more about being a health care agent, read How to Be a Health Care Agent.
• If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

Do Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read How To Use Your Incentive Spirometer.

Exercise

Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a Healthy Diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% Chlorhexidine Gluconate (CHG) Solution Antiseptic Skin Cleanser (Such As Hibiclens®)

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Herbal Remedies and Cancer Treatment.

3 days before your surgery

Start taking tamsulosin, if needed

If your healthcare provider gave you a prescription for tamsulosin, start taking it 3 days before your surgery. For more information, read the “About benign prostate hyperplasia (BPH)” section of this guide.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), 2 days before your surgery. NSAIDs can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the time of your surgery

A staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

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

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

The night before your surgery, shower with a 4% CHG solution antiseptic skin cleanser. An antiseptic kills germs that can cause disease.

Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.



 

The morning of your surgery

Instructions for drinking before your surgery

• If your healthcare provider gave you a ClearFast drink, finish it 2 hours before your scheduled arrival time. Do not drink anything else after midnight the night before your surgery, including water.
• If your healthcare provider did not give you a ClearFast drink, you can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

 
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
• Do not wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
• Remove nail polish and nail wraps.
• Leave valuable items at home.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Your breathing device for sleep apnea, (such as your CPAP machine), if you have one.
• Your Health Care Proxy form and other advance directives, if you completed them.
• Your cell phone and charger.
• Only the money you may want for small purchases (such as a newspaper).
• A case for your personal items, if you have any. Examples of personal items include eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles.
• Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can fit over this swelling.
• Your toothbrush and other toiletries, if you’d like.
• This guide. You’ll use it when you learn how to care for yourself after surgery.

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

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

There are other parking garages located on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6^th floor. Check in at the desk in the PSC waiting room.

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

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

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They 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’ll get.
• Answer your questions about your anesthesia.

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 you pain medication after your surgery.

Information for your visitors

At MSK, we make every effort to provide a safe and welcoming environment for our patients and visitors. We may sometimes change our visitor policy to help us do this. Visit www.mskcc.org/visit for the most up-to-date information.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of your care team will help you onto a bed. They will put compression boots 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 to make you fall asleep. You’ll also get fluids through your IV during and after your surgery.

During your surgery

After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.

Once they finish your surgery, your surgeon will close your incisions with staples or sutures (stitches). They may also place Steri-Strips^™ (thin pieces of surgical tape) or Dermabond^® (surgical glue) over your incisions. They may cover your incisions with a bandage.

Your breathing tube is usually taken out while you’re still in the operating room.

Recovering after your surgery

This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.

As you read through this section, write down questions to ask your healthcare provider.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask covering your nose and mouth. You may also have compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Tubes and drains

You will have the following tubes and drains. Your healthcare provider will talk with you about what to expect.

• A urinary (Foley) catheter: This is a tube that drains urine from your bladder. Your care team will keep track of how much urine you’re making while you’re in the hospital.
• A nasogastric (NG tube): This tube keeps your stomach empty. You’ll get the nutrition you need through your feeding tube.
• A jejunostomy tube (feeding tube): This tube goes into your small intestine to give you nutrition while you’re not able to eat.
• A chest tube: This is a tube that drains blood, fluid, and air from around your lung. The tube is placed between your ribs and goes into the space between your chest wall and lung (see Figure 13). Your care team will keep track of how much drainage you have. Your chest tube will be removed when your lung is no longer leaking air. Most people go home the same day that their chest tube is removed
• Drainage device: This device is attached to your chest tube. This is where the blood, fluid, and air drained from around your lung will go.

Pain medication

You’ll get epidural or IV pain medication while you’re in the PACU.

• If you’re getting epidural pain medication, it will be put into your epidural space through your epidural catheter. Your epidural space is the space in your spine just outside your spinal cord.
• If you’re getting IV pain medication, it will be put into your bloodstream through your IV line.

You’ll be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read Patient-Controlled Analgesia (PCA).

Moving to your hospital room

You will stay in the PACU overnight. How long you stay depends on when an inpatient bed comes available. After your stay in the PACU, a staff member will bring you to your hospital room.

In your hospital room

The length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 7 days.

In your hospital room, you’ll meet one of the nurses who will care for you during your stay. Soon after you get there, a nurse will help you out of bed and into your chair.

Your healthcare providers will teach you how to care for yourself while you’re recovering from your surgery. You can help yourself recover more quickly by:

• Reading your recovery pathway. Your healthcare provider will give you a pathway with goals for your recovery if you do not already have one. It will help you know what to do and expect on each day during your recovery.
• Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your normal activities.

Managing your pain

You’ll have some pain after your surgery. At first, you’ll get your pain medication through your epidural catheter or IV line. You’ll be able to control your pain medication using a PCA device. Once your epidural catheter or IV line is removed, your care team will teach you how to give yourself pain medication through your feeding tube.

Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain is not relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications.

Moving Around and Walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.

Read Frequently Asked Questions About Walking After Your Surgery to learn more about how walking after surgery can help you recover.

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

Exercising your lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

• Use your incentive spirometer 10 times every hour you’re awake. For more information, read How To Use Your Incentive Spirometer.
• Do coughing and deep breathing exercises. A member of your care team will teach you how.

Eating and drinking

You’ll slowly go back to eating solid foods starting the day after your surgery. Read your pathway and talk with your care team for more information.

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

Planning for discharge

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 fever of 101 °F (38.3 °C) or higher.

Leaving the hospital

Before you leave, look at your incision with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital around 11 a.m. Before you leave, your healthcare provider will write your discharge order and prescriptions. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.

If your ride is not at the hospital when you’re ready to leave, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.

At home

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

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. To learn more, read About Your Recovery Tracker.

Managing your pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This does not mean something is wrong.

Follow these guidelines to help manage your pain at home.

• Take your medications as directed and as needed.
• Call your healthcare provider if the medication prescribed for you does not help your pain.
• Do not drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
• As your incision(s) heal, you’ll have less pain and need less pain medication. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) are examples of over-the-counter pain relievers.
  • Follow your healthcare provider’s instructions for stopping your prescription pain medication.
  • Do not take too much of any medication. Follow the instructions on the label or from your healthcare provider.
  • Read the labels on all the medications you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Do not take more than one medication that has acetaminophen without talking with a member of your care team.
• Pain medication should help you get back to your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
• Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel like you need to go, though, do not put it off.
• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
• Exercise, if you can. Walking is an excellent form of exercise.
• Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Limit liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.
• Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your healthcare provider before making any changes in your diet.
• Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation, especially if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
  • Docusate sodium (Colace®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Do not take it with mineral oil.
  • Polyethylene glycol (MiraLAX®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
  • Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
  If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed.

Caring for your incision

Take a shower every day to clean your incision. Follow the instructions in the “Showering” section below.

It’s normal for the skin below your incision to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time.

Call your healthcare provider’s office if:

• The skin around your incision is very red.
• The skin around your incision is getting more red.
• You see drainage that looks like pus (thick and milky).
• Your incision smells bad.

If you go home with staples in your incision, your healthcare provider will take them out during your first appointment after surgery. It’s OK to get them wet.

If you have Steri-Strips or Dermabond on your incision, they’ll loosen and fall or peel off on their own. If they have not fallen off after 10 days, you can take them off.

Caring for your chest tube incision

You may have some thin, yellow or pink-colored drainage from your chest tube incision. This is normal.

Keep your incision covered with a bandage for 48 hours (2 days) after your chest tube is removed. If it gets wet, change it as soon as possible.

After 48 hours, if you do not 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 healthcare provider if you have questions.

You may have some soreness in your back or chest after your chest tube is removed. This will go away in a few weeks.

Showering

You can shower 48 hours (2 days) after your chest tube is removed. Take a shower every day to clean your incision. If you have staples in your incision, it’s OK to get them wet.

Take your bandage(s) off before you shower. Use soap during your shower, but do not put it directly on your incision. Do not rub the area around your incision.

After you shower, pat the area dry with a clean towel. Leave your incision uncovered or cover it with a bandage if your clothing may rub it or if you have drainage.

Do not take tub baths until talking with your surgeon.

Eating and drinking

You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.

For more information, read Eating Well During Your Cancer Treatment.

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

Physical activity and exercise

When you leave the hospital, your incision may look healed on the outside, but it will not be healed on the inside. For the first 3 weeks after your surgery:

• Do not lift anything heavier than 10 pounds (4.5 kilograms).
• Do not do any high-energy activities (such as jogging and tennis).
• Do not play any contact sports (such as football).

Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center.

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

Strengthening your arm and shoulder

Stretching exercises will help you regain full arm and shoulder movement.  They’ll also help relieve pain on the side of your surgery.

Do the exercises described in the “Stretching exercises” section. Start doing them as soon as your chest tube is removed.

Use the arm and shoulder on the side of your surgery in all 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.

Loosen your mucus

Drink liquids to help keep your mucus thin and easy to cough up. Ask your healthcare provider how much you should drink each day. For most people, this will be at least 8 to 10 (8-ounce) glasses of liquid each day.

Use a humidifier while you sleep during the winter months. Make sure to change the water and clean the humidifier often. Follow the manufacturer’s instructions.

Smoking

Do not smoke. Smoking is harmful to your health at any time, but it’s even more harmful as you’re healing. 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 is 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.

Driving

Ask your healthcare provider when you can drive. Do not drive while you’re taking pain medication that may make you drowsy.

You can ride in a car as a passenger at any time after you leave the hospital.

Sexual activity

Your healthcare provider will tell you when you can start having sexual activity. This is usually as soon as your incisions have healed.

Going back to work

Talk with your healthcare provider about your job. They’ll tell you when it may be safe for you to start working again based on what you do. If you move around a lot or lift heavy objects, you may need to stay out a little longer. If you sit at a desk, you may be able to go back sooner.

Traveling

Do not travel by plane until your doctor says it’s OK. They’ll talk with you about this during your first appointment after your surgery.

Follow-up appointments

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 surgeon will discuss the pathology results with you in detail.

You may also have appointments with other healthcare providers after your surgery.

Managing your 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 cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

Stretching exercises

Stretching exercises will help you regain full arm and shoulder movement. You can start doing them once your chest tube is removed.

To do the exercises, follow the instructions below. One of your healthcare providers will tell you how many times to repeat each exercise.

You’ll need a straight-backed chair and a hand towel to do these exercises.

Axillary stretch

Towel stretch

When to Call Your Healthcare Provider

Call your healthcare provider if:

• You have a fever of 101 °F (38.3 °C) or higher.
• You have swelling in your chest, neck, or face.
• You have a sudden change in your voice.
• You have not had a bowel movement for 3 days or longer.
• You have pain that does not get better with your medications.
• You’re having trouble breathing.
• The skin around your incision is warmer than usual.
• The skin around your incision is very red or getting more red.
• The area around your incision is starting to swell or getting more swollen.
• You have drainage from your incision that smells bad or is thick or yellow.
• You have any questions or concerns.

Monday through Friday from 9 a.m. to 5 p.m. call your healthcare provider’s office. After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask to speak to the person on call for your healthcare provider.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read through this section, write down questions to ask your healthcare provider.

MSK support services

Visit the cancer types section of MSK’s website at www.msk.org/types for more information.

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

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

Bobst International Center
888-675-7722
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Caregivers Clinic
www.msk.org/caregivers
646-888-0200
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Patient and Caregiver Education
www.msk.org/pe
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

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

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

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call for more information.

Rehabilitation Services
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. To learn more, call Rehabilitation Therapy at 646-888-1900.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
• Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

Virtual Programs
www.msk.org/vp
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.

External support services

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 can’t 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 resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th 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 people 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’s 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 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.

Look Good Feel Better Program
lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

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.health.ny.gov/health_care/medicaid/program/pharmacy.htm
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 get medications that they have trouble affording.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read through these resources, write down questions to ask your healthcare provider.

• Advance Care Planning
• Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
• Diet and Nutrition During Treatment for Esophageal Cancer
• Eating Well During Your Cancer Treatment
• Herbal Remedies and Cancer Treatment
• How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
• How To Use Your Incentive Spirometer
• Patient-Controlled Analgesia (PCA)
• About Your Recovery Tracker