It is important that you call your referring physician and ensure that all documents relative to your workup to date be faxed to our office (fax number 703-849-0874) as well that you HAND CARRY all chest x-rays, CT scans, and/or barium contrast studies for your surgeon's review.

The surgeon you meet with will perform your surgery, as long as you are satisfied with him and agree to have him operate. If you would like a second opinion, please do not hesitate to request that, and we will refer you to another surgeon in the group or recommend an outside the group if you wish to journey to another institution.

The specific risks vary according to the physiologic health of the patient, the type of procedure, and the underlying condition requiring surgery. Your surgeon can provide you with more specific information about your individual risk.

All surgery involves risks. Some surgeries can be life threatening. Your physician can discuss your particular risks with you. Overall, the following risks apply:

• wound infection
• pneumonia
• deep venous thrombosis
• arrhythmias (irregular heartbeat)
• myocardial infarction (heart attack)
• renal (kidney) failure

The more active you are both before and after surgery, the significantly less common any complications are, in particular those related to prolonged bed rest, such as pneumonia and deep venous thrombosis.

Once again, particular circumstances will beget different answers. In general, patients are in the hospital one to three days for wedge resection of the lung versus four to five days for a lobectomy or pneumonectomy. Specific length of stay are best determined by your surgeon so he can review your specific medical condition.

Patients recover at different paces, depending on their overall health. However, most patients are up and walking the day of surgery and encouraged to walk four to six times a day in the hallway while they recuperate. Patients remain in the hospital after thoracic surgery is because they have chest tubes. Once these are removed, patients can usually go home.

Patients must strenuous activity including pushups, situps and chinups for six to eight weeks, but almost all other activities are authorized, other than heavy lifting. Returning to work is a patient-specific item, depending on the patient’s individual status and consultation with your physician.

Depending on your medical diagnosis, you may require additional medical treatment after surgery. For patients with cancer, additional therapies, such as chemotherapy and/or radiation therapy, may occur before or after surgery.

You do not need to stop your aspirin before surgery. For patients with coronary artery disease, the antiplatelet effect of aspirin is an aid to your operation.

You will receive instructions about your specific medication from your physician once your surgery is scheduled. Patients taking Plavix, Coumadin, and other anticoagulation agents, and strong antiplatelet agents such as Lovenox, should cease that medication before surgery. Your doctor will tell you how many days before surgery to stop these medications.

Most times, all medications are continued through the day of your surgery. All morning medications may be taken with a sip of water the morning of your surgery, but nothing else is to be taken, including any other water, coffee, or orange juice or food.

Patients on insulin or diabetes medications usually take only half of their usual morning dose and should tell the anesthesiologist and surgeon caring for you.

The more you are able to exercise and walk before surgery and the sooner you resume your walking in the hospital, the easier your recuperation will be from surgery. You should also ensure that your doctor knows all your medications and continues those medications during the preoperative and postoperative phases, appropriate to the specific medications.

The more you are able to exercise and walk before surgery, and the sooner you resume your walking in the hospital, the easier your recuperation will be from surgery. You should also ensure that your doctor knows all your medications and continues those medications during the preoperative and postoperative phases, appropriate to the specific medications

The specifics with regard to other medications, once again, are best discussed with your surgeon preoperatively. Patients taking Plavix, Coumadin, and other anticoagulation agents, and strong antiplatelet agents such as Lovenox, should cease that medication before surgery, the timing of which should be discussed with your surgeon according to your particular circumstances.

Most times, all medications are continued including the day of surgery partaking your usual regimen. All a.m. medications may be taken with a sip of water the morning of your surgery, but nothing else is to be taken, including any other water, coffee, or orange juice, and certainly not any oral diet.

Patients on insulin or diabetes medications usually take only half of their usual a.m. dose, and certainly should bring that to the attention of the anesthesiologist and surgeon caring for you. With regard to beta blockade, certain patients are recommended beta blockade even where they may not be taking such medications prior to their consideration of surgery.

The particulars of that will be discussed with pertinent patients, but if you have any questions, please, do not hesitate to query the use of "prophylactic beta blockade" for patients with some history of coronary artery disease, where beta blockade is intended to prevent excessive pulse rates, thereby diminishing the risk of myocardial infarction.

Additional therapies, such as chemotherapy and/or radiation therapy, may be considered preoperatively (so-called neoadjuvant therapy) or postoperatively (adjuvant therapy), based on the respective preoperative clinical assessment of stage of disease or the postoperative pathologic findings. As has been mentioned above, the specific individual circumstances dominate the discussion in this category.

With regard to thoracic surgery, you do not need to stop your aspirin before surgery. That is particularly true with regard to patients who have some element of coronary artery disease where the antiplatelet effect of aspirin is an aid to your operation, even though as an antiplatelet agent it may cause more oozing. Where patients are undergoing cardiopulmonary bypass, aspirin usually is stopped, perhaps two weeks in advance of surgery.

Once again, our published material with regard to long-term survival for the more common entities, such as carcinoma of the lung and carcinoma of the esophagus, is readily available. Specifics relate to the stage of disease as well as the patient's age and physiologic status, and should be discussed both preoperatively in terms of an estimate, and postoperatively with a better idea of estimated survival based upon final pathology and any possibilities re: adjuvant (postoperative) chemotherapy or radiation therapy that may be recommended.

The definition of recovery varies depending on different patients' attitudes. Most patients are surprised to find out that they are up and walking the day of surgery and encouraged to walk four to six times a day in the hallway while they recuperate. The only reason for staying in the hospital in general after thoracic surgery relates to indwelling chest tubes.

With decreasing drainage and the sealing of any air leaks, patients are usually ready to go home. They are encouraged to avoid pushups, situps, or chinups for six to eight weeks, but almost all other activities are authorized, other than heavy lifting.

Return to work, once again, is a patient-specific item, usually relating to recovery from the effects of anesthesia and the demands of the workplace, which are individual-specific

circumstances, again best discussed with your surgeon.

Once again, particular circumstances will beget different answers. In general, length of stay for a wedge resection of the lung is one to three days, versus four to five days for a lobectomy or pneumonectomy. Specific length of stay and deviations therefrom are readily available from our published experience and, again, best determined in conjunction with discussion of your particular circumstances with the surgeon involved.

There are books written in reference to types and degree of complications. Certainly the risk of death should be spelled out so that you have an opportunity to decide whether you wish to take on the risk of any operation for your condition.

Further discussion as to relevant risks regarding wound infection, pneumonia, development of deep venous thrombosis, arrhythmias, myocardial infarction, and renal failure are better answered on a case-by-case basis.

The more important item, especially with regard to thoracic surgery, is that the more active you can be, both preoperatively and immediately postoperatively in terms of walking in the hospital on the order of four to six times a day, the significantly less common any complications will be,… in particular, those complications relating to prolonged bed rest, such as pneumonia, development of deep venous thrombosis, and the like.