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The first step prior to entering the surgical process is a consultation appointment for an initial evaluation to determine if the patient meets the criteria for benefit from LVRS. You should bring your most recent medical records from your primary care provider and/or pulmonologist, including chest X-rays, chest CT scans and recent pulmonary function testing. The thoracic surgeon and nurse will review these tests with you, take a complete medical history, perform a physical examination and ask you several questions about your current exercise capacities and breathing difficulties. At the end of the consultation, the physician will make recommendations for further testing or medical management, almost invariably prescribing a pulmonary rehab program. The office will contact you to schedule any additional testing or your pulmonary rehabilitation plan.
The effects of LVRS can vary among patients depending on the location or extent of their disease and their exercise capacity. These two characteristics have been found to help predict whether a patient would benefit from LVRS. The National Emphysema Treatment Trial (NETT) study results have identified four sub-groups of patients who had different risks and benefits from LVRS. Specifically:
Group 1: Mostly upper-lobe emphysema and low exercise capacity. These patients were more likely to live longer and were more likely to function better after LVRS than after medical treatment.
Group 2: Mostly upper-lobe emphysema and high exercise capacity. These patients are more likely to function better after LVRS than after medical treatment, but there was no difference between the LVRS and Medical participants in survival.
Group 3: Mostly non upper-lobe emphysema and low exercise capacity. These patients had similar survival and function after LVRS as after medical treatment.
Group 4: Mostly non upper-lobe emphysema and high exercise capacity. These patients had worse survival after LVRS than after medical treatment; both LVRS and medical participants had similar low chance of functioning better.
LVRS candidates who fall into Groups 1, 2 or 3 are the best candidates for LVRS. All LVRS candidates are encouraged to discuss their individual characteristics with their primary care provider or pulmonologist to determine if they are likely to benefit from LVRS.
You will undergo a series of tests that help define your illness and determine the extent of disease. Testing may include:
Your test results will be presented at our bi-monthly multi-disciplinary Emphysema Conference, which is attended by members of the thoracic team. Based on this information, the team may recommend non-surgical medical management, which involves medication and rehabilitation, lung volume reduction surgery, or, in special cases, lung transplantation. You will be contacted by phone five to seven days after the conference as to your specific treatment plan.
If a patient is accepted for surgery, he or she will be referred to a pulmonary rehabilitation program three times a week for a minimum of 16 visits. The University of Maryland Medical Center offers pulmonary rehabilitation services at the Kernan Hospital. These exercises are a crucial part of the patient’s reconditioning and treatment plan. The exercise program is specifically designed to retrain the diaphragm and chest muscles to help the patient breathe easier, as well as to increase endurance. Under the close supervision of therapists, the patient will learn to use treadmills, bicycles and ergometers in addition to upper and lower body exercises. Therapists also pay careful attention to the patient’s breathing efforts, oxygen saturation and usage, and tolerance to exercise.
This part of the treatment plan is intended to be a lifelong change, making exercise and symptom recognition a permanent part of the patient's daily routine. After formal pulmonary rehabilitation, the patient will be ready for perform the exercise program on his or her own, at home or in a local gym.
Once the pulmonary rehabilitation is complete, the patient will return for a final pre-operative check in about one week prior to the termination of the rehab program. At this check, surgery will be scheduled, surgical consent will be obtained and preoperative testing is performed. The preoperative testing will include an evaluation by an anesthesiologist.
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