My Surgery: Chest Wall Resection

Pre-Admission Visit

What should I bring to my pre-admission appointment?

• Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
• Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
• Your spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
• All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
• A copy of your power of attorney for personal care and/or advanced directives.
• A list of any questions that you may have about the operation and recovery.
• The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years.
• If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.

What happens during my pre-admission visit?

• You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
• You may also need an electrocardiogram (ECG) to check your heart and a chest x-ray to check your lungs.
• You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have.
• A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before your operation, taking your medications and pain management.
• A pharmacist will review your medications.

Depending on your needs, you may also meet:

• An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after your operation.
• A member of the medicine team, if you have other complex health problems.

The night before your surgery

1. Do not eat or drink after midnight on the night before your surgery.
2. If you smoke, do not do so for 24 hours before your operation.
3. Do not drink alcohol for 24 hours before your operation.
4. Remove all nail polish and body piercings.
5. You must have a shower with soap and water to clean your skin the night before and the morning of your surgery to reduce the chance of infection after your operation.

Stop smoking before your surgery: learn how smoking and tobacco can affect your recovery after surgery, and how quitting can improve your health.

WHAT SHOULD I DO THE DAY OF MY SURGERY?

Arrive 2 hours before your scheduled operation time.

What can I expect to have on my body?

You will be attached to some or all of these machines and tubes:

Incisions, tubes or drains	What to expect
	Incisions: You may have an incision on your side (thoracotomy), down the middle of your chest (sternotomy), under one of your breasts (hemi-clamshell), or under both of your breasts right across your chest (clamshell).
	Stitches or staples: Your surgeon usually uses dissolvable stitches to close your incisions that will go away on their own.
	Dressings (bandages): You will have dressings covering your incisions.
	Chest tubes: You will have 1 to 2 chest tubes coming out of the side of your chest. They remove air and fluid from the inside of your chest area.
	JP drain (Jackson Pratt drain): This small tube helps drain any extra fluid. It is removed when you no longer need it.
	Heart monitor: You will be on a heart monitor while you are in the Step Down Unit.
	Bladder catheter: You will have a tube draining your bladder overnight.
	Intravenous (IV): You have at least one IV in your arm and another one in the side of your neck.
	Arterial line: This line goes into an artery in your wrist during surgery. It looks like an IV but we use it to check your blood pressure and to get blood samples.
	Oxygen: At first, you will have an oxygen mask over your nose and mouth, then you may get oxygen through your nostrils (nasal prongs).

HOW CAN I MANAGE MY PAIN?

We will work with you to manage your pain. We can give you pain medicine in different ways:

Pain relief method	How it works
	Epidural: With an epidural, a doctor puts a small tube in your back. They usually do this right before your surgery. The tube is left in place to give you pain medicine after your surgery. It's attached to a pump, which gives you the medicines.
	Extrapleural catheter: This can be used to manage pain in patients who had a thoracotomy.
	Intravenous (IV) Patient Controlled Analgesic (PCA): A PCA pump is connected to your IV that gives you pain medicine through your IV when you push the button.
	Intravenous (IV) medicine: You get your pain medicine through an IV.
	Medicine by mouth: You may get your pain medicine in tablets that you swallow. This will happen once you are drinking fluids.

You will continue to recover when you return home.

Activity	How to manage at home
	Your appetite should return to normal within a few weeks. Make sure you drink fluids.
	Constipation is common when you take pain medicine. Drink plenty of fluids (a minimum of 6 cups per day unless your doctor or dietitian tells you otherwise).
	It is important to take pain medicine as needed.
	The incisions will not need to be covered unless your clothes are rubbing on them. Do not put lotions or creams on the incisions until they are completely healed. The numbness around your incisions is normal.
	You can shower every day once you get home. Use a mild soap. Pat the incisions dry with a towel.
	You will be off work for at least 4 to 6 weeks. Check with your surgeon when it is safe for you to return to work.
	You should not drive until you are off the pain medicine. You must have full movement of your arm and shoulder before you drive. This is usually 2 to 3 weeks after surgery.
	No heavy lifting, carrying, pushing, or pulling for 4 to 6 weeks. You may lift up to 4.5 kg (10 pounds).
	You may have sex again after your surgery. Avoid positions that cause strain on your incision.
	You may gradually increase your activity. Walk at least once every day as you can tolerate it. You may swim after 6 to 8 weeks, golf after 3 to 4 weeks. Jogging, tennis, aerobics, and racquetball should not be done for 4 to 6 weeks. Please talk to your surgeon about skydiving and scuba diving.
	Please check with your surgeon about travelling We usually recommend that you do not travel by air for 2 to 3 weeks.

Where and when

Four to six weeks after your surgery, you will have an appointment at your surgeon's office and the Medical Imaging Department (for your chest x-ray).

Who do I call with general post-operative questions?

Call your surgeon's office:

Who do I call if I experience complications

Call 911 to take you to the nearest Emergency Department if you:

• Have chest pain, tightness, or significant shortness of breath.
• Have "the worst headache of your life" that does not go away by taking pain medication.

Call your surgeon's office if you notice the following symptoms:

• Your incision is red, warm to the touch or has discharge or a bad smelling odour.
• You have a fever (a temperature of 38°C or higher for 2 days).
• You have pain that is not relieved by your pain medication.
• You have a sharp pain or tenderness in the back of your calf or numbness and tingling in your foot.