Problems commonly encountered after breast surgery
Smoking cessation
Patients with all thoracic surgical conditions, whether pneumothorax, or postoperative lung or esophageal cancer, must avoid exposure to tobacco. There is ample evidence linking smoking to recurrence of pneumothorax, recurrence of lung and esophageal cancer, and gastroesophageal reflux after esophageal cancer surgery.
For the health of you and your family, Dr. Choi strongly recommends that you quit smoking.
Pain from surgical incision Pain after surgery usually lasts for a few days, and later the pain will gradually decrease. However, there may be recurrence of pain for a considerable period of time. Because the intercostal nerves emanate from near the spine and travel downward toward the front, pain caused by the surgical incision usually occurs in a strip near the incision. In some patients, pain and numbness near the surgical incision may persist for several years. Patients may be afraid to cough and breathe deeply because of the pain, causing shortness of breath and sputum to become trapped in the lungs. Prolonged chest pain may also affect the patient’s mood and emotions. Therefore, do not ignore the effects of pain and treat chest pain aggressively. Chest pain can be relieved by taking oral pain medications such as Chimantin, Taylanin, and Lexon. It should be noted that certain painkillers (e.g. Fenbendazole) have adverse effects on the heart. In addition, most painkillers are irritating to the gastrointestinal tract and should be avoided on an empty stomach. It is recommended that pain medications be taken under the supervision of a physician.
It should be noted that for postoperative pain it is important to first distinguish if the pain is caused by the incision, and if you are not sure, you need to visit an outpatient clinic.
Coughing
Coughing is a defense measure of the body and a sign of certain diseases. There are many causes of coughing, and for post-discharge coughing, it is important to first distinguish those conditions that are potentially dangerous, such as lung infection, bronchopleural fistula, pleural effusion and tumor recurrence. Of course, the more common causes of cough are pharyngitis, colds, etc. Treatment of the cause of the cough is more important than cough suppression. Various syrups are most commonly used as cough suppressants, and there are many folk remedies to stop coughing. If the cough is accompanied by phlegm, some phlegmolytic drugs can be applied at the same time. If there is pus sputum, blood in the sputum or accompanied by fever, it is recommended to go to the hospital for consultation. After chest surgery, in order to reduce the stimulation of the respiratory tract, you should try to avoid the polluted environment, avoid inhaling cold air, keep your mouth clean, and exercise moderately and properly.
Fever
Fever is more common in the first few days after surgery, but fever after discharge from the hospital must be taken seriously and should be seen by a doctor as soon as possible. Patients who are suspected of having a “cold” but do not feel relieved after resting, drinking more water, or taking cold medication should also be seen by a hospital as soon as possible. It is important to emphasize that the use of antibiotics must be under the guidance of a doctor.
Dressing change and stitch removal for surgical incisions
Many patients do not have their stitches completely removed when they are discharged from the hospital. They should go to the ward or outpatient clinic to review, change medication and remove stitches according to the time agreed with the doctor at the time of discharge. Patients who have had their stitches removed before discharge may come to the outpatient clinic for review if the incision is not healing well. Poor healing of the skin incision at the chest drainage port is relatively common, and crusts on the incision surface should not be treated by yourself, as they usually fall off on their own after the incision has healed. If in doubt, the incision can be reviewed at the clinic. If the incision is open, you need to go to the emergency room immediately.
Psychology of malignant tumor patients
The psychological journey of a malignant tumor patient inevitably involves denial, angry outbursts and sadness. The vast majority of patients can withstand these psychological stresses and traumas and face the reality with peace of mind. There will also be many patients who can make their lives more fulfilling and rewarding, achieving their aspirations and ideals and emotional sublimation in a short and limited period of time.
Dr. Cui does not recommend concealing the condition from patients, and moreover cautions against avoiding diagnosis and treatment for fear that patients will not be able to cope with it. The damage caused by the anxiety of patients suffering from delays in treatment due to concealment is often far greater than the side effects of reasonable treatment. Both the doctor and the patient’s family and friends must keep in mind that the real choice of whether to take the risk for a better outcome in the face of disease belongs to the patient alone. No one has the power to decide whether someone lives or dies. The best choice is for the patient to face the disease squarely and to fight it with a positive attitude together with the doctor. Of course, there are methods and techniques to be used when informing the patient of his or her condition. Generally speaking, from a psychological point of view, weak signal stimuli that are brief and repeated are more acceptable than rapid stimuli, so the principle of gradual telling is often safer. The patient’s personality, occupation, age, experience, education, and mental type should also be considered to determine when, where, and in what way to tell the patient about the condition.
Problems commonly encountered after lung surgery
There are no strict requirements for post-operative review of benign lung tumors, and it is usually recommended to review at the outpatient clinic about two weeks after surgery. The main purpose of the review is to rule out various complications related to surgery. Of course, patients should always be seen if there are changes in their condition.
The most common malignant lesion in the lung is lung cancer. There are detailed requirements for postoperative review of lung cancer, and the general minimum requirement is to review every 6 months for the first 2 years after surgery; and annually after 3 years after surgery. Many doctors still want patients to review every 3 months for the first 2 years after surgery; every 6 months after 3 years after surgery; and attend annual physical examination after 5 years after surgery. The above review schedule can be adjusted by patients and doctors according to the specific situation of each patient. International recommendations for postoperative review of lung cancer are constantly being improved. Overall, frequent reviews can detect changes in the disease as early as possible, but increase the stress and burden on patients and their families.
Taking all factors into consideration, Dr. Cui recommends most patients to review according to the following plan
1. Patients with Beijing medical insurance should be reviewed at 3-month intervals for 2 years; then at 6-month intervals for 2 years; once at 5 years; and annually thereafter.
2.Patients with foreign medical insurance will be reviewed in Beijing every 6 months for 4 years, and the first 2 years can be reviewed locally once between every two visits to Beijing; once at the end of 5 years; and annually thereafter.
3. For patients who consider the economic cost or the difficulty of review, they should be reviewed every 6 months for the first 2 years after surgery; and annually thereafter; and once at the end of 5 years; and annually thereafter.
Post-operative chemotherapy for lung cancer
There are clear international norms for postoperative chemotherapy for lung cancer. It usually starts within 1 month after surgery and is given once every 3~4 weeks for 4~6 cycles. The specific chemotherapy regimen is mainly determined according to the patient’s condition, and the family’s economic status should also be considered. It is especially important to emphasize that post-operative treatment of lung cancer may be a long-term and repeated process, so it is necessary to be psychologically and materially prepared to fight a protracted battle.
Targeted lung cancer treatment
Targeted lung cancer therapy generally requires genetic testing to screen whether it is effective. Targeted therapy drugs for lung cancer can be broadly divided into two categories: one is oral drugs, which generally cannot be used together with chemotherapy; the other is injections, which can be used together with chemotherapy or alone. Targeted therapy drugs have fewer side effects and may have unexpected or even miraculous effects on specific populations, but none of them are currently covered by health insurance and are more expensive. Research on targeted therapies is progressing very quickly, and Dr. Cui suggests that patients who are in a position to do so can choose according to their own situation.
Radiation therapy will be a special note from Dr. Cui for patients who need post-operative chemotherapy.
Common problems encountered after esophageal cancer surgery
Post-operative review of esophageal cancer Regular post-operative review of esophageal cancer is very important for early detection of tumor recurrence and metastasis on one hand, and to address functional problems of digestive and other systems that occur after surgery on the other hand. Dr. Cui recommends most patients to review according to the following plan.
1. 1 to 2 years after surgery, review every 3 months.
2. 3 to 5 years after surgery, once every 6 months.
3.After 5 years postoperatively, review once a year thereafter.
Diet after esophageal cancer surgery Patients with esophageal cancer can usually already eat foods such as rice porridge and noodles when they are discharged from hospital, and they should gradually resume ordinary diet such as rice and steamed buns after discharge. The following points need to be noted.
1. Small amount and multiple meals: It is recommended to eat five times a day, except for three meals a day with family members, and add one meal in the morning and one in the afternoon, which is equivalent to morning tea and afternoon tea for westerners. This arrangement is more convenient and easy to accept for both patients and family members. Do not eat too much at each meal.
2, walk after meals: Do not lie down immediately after meals, it is best to sit and rest for a while after a little activity or a walk.
3, fasting before bed: do not lie down immediately after eating and drinking, otherwise not only increase gastroesophageal reflux, there is a risk of accidental aspiration of stomach contents into the lungs.
4, elevate the upper body: If the bed can not be adjusted, it is best to put the pillow higher.
5.Respect preferences: What to eat should first respect the patient’s own preferences and choices, and never let eating become a burden for the patient. To help patients get used to the digestive system after surgery, and constantly summarize and summarize the diet suitable for the individual situation of the patient.
6.Rational arrangement: On the basis of respecting patients’ preferences, the following details also need to be paid attention to. Those with abdominal distension should eat less soy products; those with obvious acid reflux should eat less corn porridge, groundnuts and other foods. Strong wine should be listed as a taboo.
Post-operative chemotherapy for esophageal cancer
There is no unified international opinion on post-operative chemotherapy for esophageal cancer. Most domestic experts believe that postoperative chemotherapy is beneficial to patients with tumor invasion and lymph node metastasis. It usually starts within 1 month after surgery, once every 3~4 weeks, and a total of 4~6 cycles. The specific chemotherapy regimen is mainly determined according to the patient’s condition, and the family’s economic status should also be considered.
Post-operative radiotherapy for esophageal cancer
International opinions on postoperative radiotherapy for esophageal cancer are also not uniform. Most evidence shows that reasonable postoperative chemotherapy can improve the survival rate.
Post-operative targeted therapy for esophageal cancer
Targeted therapy for esophageal cancer as a whole is still in the exploratory stage. Some small studies have concluded that certain targeted therapy drugs are effective for esophageal and cardia cancers. Because of their high price, they are only recommended to be tried by families with very good conditions.
What to pay attention to after chemotherapy discharge
In principle, the diet after chemotherapy is recommended to choose nutritious and easy-to-digest foods, such as thin rice, fish soup, meat soup and fresh vegetables. Do not eat raw, cold and moldy foods and do not drink strong alcohol. Consume more foods that improve immunity and stimulate blood production, reishi, silver fungus, shiitake mushroom, black fungus, etc. Foods such as cinnamon, red dates and liver are good for the elevation of hemoglobin. According to the individual’s constitution, choosing Chinese medicine meals to supplement qi and blood is beneficial for patients to recover as soon as possible. With the gradual recovery of appetite after chemotherapy, more anti-cancer foods such as cauliflower, cabbage, garlic, soybean, coix seeds, snapper and kelp can be consumed. Consume more selenium-rich foods such as sesame, mushrooms and asparagus.
Dr. Cui suggested not to pay too much attention to the so-called anti-cancer foods, the effect of food to kill or inhibit tumors is very weak. The anti-cancer effect of diet is over-exaggerated in some TV programs and advertising campaigns. Dr. Cui does not oppose to focus on diet health, but just wants to emphasize the importance of a comprehensive, balanced and reasonable diet.
Nausea and vomiting after chemotherapy Nausea and vomiting are very common digestive tract reactions to chemotherapy. It may also be caused by the progression of tumor. It can occur at the time of chemotherapy or a few days or even weeks after chemotherapy.
The following points may be helpful for patients with nausea and vomiting.
1. Eat small and frequent meals to avoid fasting or bloating.
2. do not suppress nausea and vomiting by forcing to eat or drink.
3. avoid foods that are too sweet or greasy and consume foods with a stronger sour or salty taste to reduce symptoms.
4. eat drier foods, such as cookies or toast, after waking up and before exercise to suppress nausea.
5. Do not eat immediately after exercise.
6. Avoid consuming cold and hot foods at the same time.
7. Engage in light activities, such as listening to music, watching TV; or talking with other people to distract attention from the disease; when feeling nauseous, let the body relax and take deep breaths slowly.
8.After meals, rest moderately, but do not lie flat immediately.
9.Stay away from places where there is the smell of grease or odor.
10.Sleeping in a side-lying position can reduce the accidental aspiration of vomiting.
If the above methods do not work, oral antiemetic drugs such as ondansetron tablets can be taken. In severe cases, antiemetic injections can be used, or come to the outpatient clinic.
Regarding routine blood tests and blood biochemistry, is there a drop in white blood cells? Decreased platelets? Liver and kidney function.
1) White blood cell: check routine blood twice a week after discharge from hospital.
If the white blood cell is lower than 4.0 X10^9/L, you need to use Rebaud 1 pc/day (subcutaneous injection); if the white blood cell is lower than 2.0 X10^9/L, you can use Rebaud 2 pcs/day.
In severe cases, the dose can be increased under the guidance of the doctor.
Dr. Cui recommends daily follow-up blood tests until the white blood cells rise above 15 before stopping the white-raising drugs. After that, the routine blood tests should be resumed at least twice a week. If there is fever along with reduced white blood cells, it is recommended to visit the hospital or contact your doctor as soon as possible.
(2) Platelets: thrombocytopenia is relatively rare, and if platelets are below 100, macro and granules can be used. Usually 2 sticks are added to 2ml of sterilized water for injection each time and injected subcutaneously. Pay attention to rechecking blood routine.
(3) Blood biochemistry: recheck once every 2~4 weeks. If liver or kidney function is abnormal, please visit the outpatient clinic promptly.
Post-chemotherapy fever
Once fever appears after chemotherapy discharge, it is recommended to visit the hospital. Be especially alert for elevated body temperature after chemotherapy discharge. Special attention should be paid to the blood count at this time. It is also important to know that because of the suppression of white blood cells after chemotherapy, even with more serious infections, the white blood cell count may not be as significantly elevated as in the general population.
Post-chemotherapy infections
After chemotherapy, the patient’s immune function is low and it is easy to induce infections in the oral cavity and perineum, and oral ulcers are more common. At this time, you should use mild oral rinses such as saline, sterile water and soda to rinse your mouth regularly to dilute the concentration of harmful bacteria in the mouth and keep your mouth clean, and use a soft-bristled brush when brushing your teeth to avoid excessive gum bleeding. Consult specialist guidance at the stomatology clinic if necessary. It is particularly important to point out here that good living habits, exercise and enhancing immune function after chemotherapy are especially important to assist in treatment.
Post-chemotherapy hair loss
Chemotherapy drugs can cause hair loss in patients. The mechanism is that the hair follicle cells caused by chemotherapy die and cannot be renewed and atrophy occurs. Hair loss often occurs 1 to 2 weeks after the drug is administered, and is most significant within 2 months. This is a temporary phenomenon and hair will grow back on its own after chemotherapy is stopped. Paying attention to sun protection on the head and avoiding irritating shampoos can reduce the occurrence of hair loss. Those with heavy hair loss can take the initiative to shave all of their hair, which has the advantage of reducing the psychological stress of seeing the hair shed on the pillow when the patient wakes up. Wigs are recommended for female patients.
About Chinese medicine
Chinese medicine treatment for tumor is mainly to support the righteous medicine, supplemented by the elimination of the evil, to make up for the deficiency moderately, to make up for the deficiency without leaving the evil, Chinese medicine treatment is of great significance to tumor patients after surgery, radiation therapy and chemotherapy to regulate all aspects of physiological functions, improve the function of the immune system and enhance physical fitness. The main drugs are qi tonic, dampness and phlegm remover, and heat-clearing and detoxifying drugs.
Dr. Cui advises not to take Chinese medicine at the same time as chemotherapy, especially not to use Chinese medicine that claims to kill tumor cells. Chinese medicine is undoubtedly a treasure, but it is not common to find Chinese medicine doctors who can be trusted. If you wish to take traditional Chinese medicine, it is recommended to visit a regular Chinese medicine hospital.
Biased prescriptions
Do not believe in so-called biased prescriptions. In cancer treatment, there are many methods that are effective for individual patients, but very few have an overall efficiency that can exceed 20%.
There are many options available for cancer treatment, and Dr. Cui usually has to consider the likelihood of the treatment plan being effective and the patient’s financial status to recommend the treatment method. If a patient is able and wishes to try other options, we can discuss them together.
Problems frequently encountered after spontaneous pneumothorax surgery
Prevention of postoperative pneumothorax recurrence In brief, spontaneous pneumothorax can be divided into two categories. One category is mainly adolescents, commonly young males around high school, thin and tall, and its etiology is the rupture of pulmonary blisters. The other category is mainly middle-aged and elderly, usually suffering from chronic lung disease, most commonly emphysema.
Television thoracoscopic surgery is currently the preferred modality for the treatment of recurrent spontaneous pneumothorax. For both types of pneumothorax mentioned above, surgery has good efficacy, and the overall postoperative pneumothorax recurrence rate is around 2-3%. However, since surgery does not remove the cause of pneumothorax occurrence, especially in the latter type of pneumothorax in middle-aged and elderly people, there will always be patients with recurrence. In fact, there is no definite evidence of which factors, other than smoking, are associated with recurrence of pneumothorax after surgery. Attention to the following matters may help to reduce the risk of recurrence.
1.Paying attention to daily health care and not overexerting the patient’s chest and abdomen in daily life.
2.Avoid exercise for 1 month after surgery and avoid strenuous exercise for 3 months.
3, avoid straining and ensure rest.
4.Pay attention to warmth during the cold season, prevent colds and avoid strenuous coughing.
5.Increase physical fitness, keep your mood relaxed and do not have excessive psychological burden.
What to do if pneumothorax recurs after surgery
First of all, it should be emphasized that post-operative pneumothorax recurrence does not necessarily have obvious symptoms. Therefore, it is recommended to review the pneumothorax at the outpatient clinic within half a month after discharge from the hospital. In case of pneumothorax recurrence, you should promptly visit the emergency or outpatient clinic and take different measures according to the specific situation.
How to contact Dr. Cui’s outpatient clinic: Every Thursday all day, you can come to me by registering the outpatient thoracic surgery number for prescribing medication, review or if you have more complicated problems to consult.
Location: Outpatient Clinic, 3rd floor, Room 15.
Time: 8:00-11:00 a.m. and 1:00-4:00 p.m.
Cell phone: If there is an emergency, you can call 13693693620 directly during working hours. other times, please come to the emergency clinic.
SMS: If you need to make an appointment for hospitalization or have a simple question to ask, you can send me a text message. Please specify the following information in the text message for hospitalization appointment: patient’s name, gender, diagnosis, registration number, desired hospitalization time WeChat: If things are not urgent, you can contact via WeChat.
: There is a personal page of Dr. Cui, so you can leave a message or ask questions.
Cui Yong thoracic surgery doctor associate chief physician, associate professor, postgraduate instructor DUKE University visiting scholar Chinese physicians association of thoracic surgeons branch office secretary, rapid rehabilitation professional group member of the Chinese Medical Association Beijing branch of thoracic surgery professional committee secretary, youth member, minimally invasive group member of the Beijing Biomedical Engineering Society biomaterials and artificial organs professional committee out-of-hospital visits Please keep your out-of-hospital visits in chronological order and paste your labs here. If you have questions for Dr. Cui, or comments or suggestions for Dr. Cui, you can record them here.
Two questions Dr. Cui would like to ask you
1.What is the most satisfying or happy thing about this visit?
2.What is the most painful or unsatisfactory thing during this medical treatment?