Cancer: Surgery & Recovery

Excerpted from
The Complete Cancer Survival Guide: Everything You Must Know and Where to Go for State-of-the-Art Treatment of the 25 Most Common Forms of Cancer
By Peter Teeley, Philip Bashe

The Day of Surgery

Patients admitted the day of their operation are usually sent to a presurgical area where nurses and other medical personnel finalize any details. Otherwise, if you spent the night in the hospital, there is little else to do hut wait to be wheeled into surgery. Family members will probably be invited to sit in a special waiting room. Once the surgical team has outfitted you with assorted monitoring devices and inserted an intravenous (IV) line in your arm, anesthesia is administered and the procedure begins.

Afterward, you are transferred to either the intensive-care unit (ICU) or the recovery room. A nurse will check on you regularly and monitor your vital signs. Most cancer patients will have received intravenous sedation or general anesthesia. As you gradually regain consciousness, you're liable to feel groggy. If you are in any pain at all, let the stall know, so they can dispense analgesic medication as necessary.

The endotracheal tube often irritates the throat. Sucking on throat lozenges should ease the soreness within a day or two. A dry mouth is another common aftereffect of general anesthesia.

Depending on the nature of the surgery, you may wake up to find tubes emanating from your body: the IV, which is keeping you hydrated, and perhaps drainage tubes for suctioning off blood and fluids from the surgical site. Patients who've had throat surgery experience swelling that prevents them From eating for a few days, so they typically have a soft nasogastric tube (NG tube, for short) inserted through a nostril and into the stomach for feeding purposes. Following prostate-removal surgery, men can expect to temporarily have an indwelling urinary catheter drain their urine into a plastic bag. The thin, flexible tube is introduced into the penis's urethral opening and advanced until it reaches the bladder. Then a small bulb is inflated in the bladder to hold the instrument in place. Any operation expected to last several hours generally requires the placement of a urinary catheter.

Your Recovery

Between the physical trauma of surgery and the effects of lying on the operating table and in bed, a major operation can impair virtually every system. During abdominal surgery, for instance, manipulation of the intestines brings peristalsis to a halt for a few days. Peristalsis is the rhythmic muscular contractions that propel food through the digestive tract. Narcotic pain medications also make the bowel sluggish. Patients are temporarily restricted to a clear-liquid diet consisting of water, juices, tea, coffee, gelatin, ginger ale, seltzer, and fat-free broth. It isn't until the bowels "wake up" and patients pass gas or stool that they can move on to heartier liquids and then to soft, easily digested foods before finally resuming their normal diet.

Two potentially serious postsurgical complications involve the respiratory tract. Inactivity and the pain from the incision can make it painful to breathe deeply. "When a patient doesn't fully expand his lungs." explains Dr. Marie Pennanen, a breast surgeon at the Lombardi Cancer Center, "the tiny air sacs in the kings can collapse upon themselves. This is called atelectasis. Secretions then accumulate there, and that can set the stage for pneumonia."

Major surgery and immobilization also predispose you to the formation of a blood clot in the leg, or venous thrombosis. "The danger there," says Dr. Pennanen, "is that the clot will dislodge and ultimately plug up one of the vessels that supply the lungs." The hallmarks of a pulmonary embolism are chest pain and labored breathing. If clot-dissolving intravenous drugs a rent administered promptly (typically the blood thinner heparin, or, for patients in severe respiratory distress, a more potent thrombolytic agent such as streptokinase), an embolism in the lungs can be fatal.

Exercise and gravity are two of your staunchest allies in helping to reduce the likelihood of atelectasis and venous thrombosis, not to mention indigestion, constipation, and urinary-tract infections. The day after surgery-possibly the same day-the nurses will help you out of bed and assist you as you pad around the hospital corridors. If you're not ambulatory just yet. a nurse or physical therapist will demonstrate exercises you can perform in bed or she'll manipulate your limbs for you. The goal is to improve circulation, which promotes quicker healing, and to keep muscles and joints from atrophying. Whenever resting in bed or in a chair, elevate your legs; this prevents blood from pooling in the lower extremities.

You'll also be encouraged co cough, to rid the respiratory tract of mucus, and to practice inhaling and exhaling deeply. "Most of our surgical patients," says Dr. Pennanen, "are given a small plastic device called an incentive spirometer, which measures how deep a breath they are taking."

When You're Discharged from the Hospital

Your doctor will send you home with various instructions: how to relieve pain, which medications to avoid, and when you can resume vigorous exercise, driving, and other daily activities. You'll also be instructed to notify your physician immediately of any evidence that the surgical wound has become infected:

• Pain, swelling, redness, or warmth around the incision

• Weeding or drainage from the surgical site

• Other signs of infection, such as a temperature exceeding 101 degrees, headache, aching muscles, dizziness, nausea, vomiting, and chills