Thoracotomy

Tomorrow is the big day. Surgery - a thoracotomy.

Thoracotomy is an incision into the pleural space of the chest.^[1] It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary for access to tumors in the spine.

Thoracotomy is a major surgical maneuver—the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer—and as such requires general anesthesia withendotracheal tube insertion and mechanical ventilation.

Thoracotomies are thought to be one of the hardest surgical incisions to deal with post-op, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading toatelectasis or pneumonia.

Thank you again Wikipedia.

The surgery was supposed to be today, but it was rescheduled so that all the best nurses would be on the case. It is a big deal. Part of what makes it a big deal is that when you go into the chest you have to ventilate that patient because they can't breath on their own. This either requires a special machine or it requires a person manually squeezing a bag that looks a little like a black whoopee cushion. That person doing the breathing for the animal has to pay close attention to how much and how fast they are breathing for the animal. It is all about end title volume... or about how well you are able to oxygenate the patient. There is a measurement called the SPO2 which you can think of as the percentage of blood being oxygenated. The goal is to have that number at or higher than 97%. It kinda sucks to be the person ventilating the patient...no stress there, you're only breathing for the patient. Luckily there are machines that do the job quite well.

Another scary aspect of this surgery is the potential pain factor. The surgeon will be going in from the side. She'll have to spread the ribs apart and work down in a hole, so-to-speak. There will be excellent pain control before, during and after the surgery. He'll be on a Fentanyl drip. Fentanyl is 100 times more potent than morphine. Cody should be in la-la land and feelin' no pain.

The surgeon will remove the lung lobe and the entire mass will be submitted to the lab for analysis. There is still a remote chance it will be something benign, but probably not. Hopefully the surgeon will be able to remove the lymph nodes as well. Those will also be sent to the lab to look for evidence of spread of the cancer into those lymph nodes. If the cancer is in the nodes, then we most likely have a slam dunk decision about chemo - do it. If not in the lymph nodes, then I'll have to ponder it a bit... and of course get more advice from my oncologist friends.

Wish us well. Pray. Cross fingers and/or do whatever you do to send good vibes.
Thanks for your support.