Patient guide

Why records matter

A patient seeing a chest surgeon usually arrives with a CT scan, a pathology result or a radiology report, often sent by another doctor. The surgeon looks at these first. The American Lung Association (ALA) writes that comparing with earlier CT scans shows whether a nodule is new or has stayed the same for years. So bring every older scan you have.

What to bring

• The CT disc or image file and its written report. The report alone is not enough; the surgeon looks at the images themselves.
• Older imaging: earlier CT, chest X-ray, PET or ultrasound, even if it was years ago or done for another reason.
• The pathology result and biopsy report, if a sample was taken. If the slides or tissue block are held by another centre, write down the centre’s name and the file number.
• Test results, such as blood tests, lung function tests or an endoscopy, if you have had them.
• A referral letter from your previous doctor or a summary from the hospital, if you have one.
• A list of all your medicines with the name, dose and how often you take each. For surgery, MedlinePlus also advises carrying the list with doses and frequency, and bringing the bottles if possible. Include herbal products, supplements and vitamins.
• Your earlier operations and any drug allergies.
• Your insurance card and identity documents.

Do not stop any medicine on your own. If you take a blood thinner, aspirin or a diabetes medicine, just tell the surgeon and leave the decision to them.

What to write down before the visit

• Symptoms: cough, breathlessness, chest pain, trouble swallowing, a hoarse voice, fever, weight loss, night sweats. When did each start and how has it changed?
• Smoking history, including a water pipe: how much, for how long, and when you stopped if you have. ALA says smoking history, family history and environmental exposures are weighed together when estimating the chance of cancer.
• Family history of lung, oesophageal or thyroid cancer.
• Work and surroundings: dust, chemicals, asbestos.
• Other conditions: heart or lung disease, diabetes, high blood pressure, autoimmune disease.
• Your questions. ALA suggests starting with: what is the least invasive way to get the information needed? How soon can the tests be done? If language or culture is a barrier, ask the care team for help.

Who should come with you

If you can, bring a family member or friend who knows your case. A first visit often covers a lot, and worry makes us forget part of it. A companion can take notes. If you are the son, daughter or partner of a patient and you hold the file, bring all the records and the medicine list in one tidy folder.

What happens at the visit

A first visit usually includes questions about your history and symptoms, an examination, and a look at the images and reports. After that it should become clear what the finding means and what is still missing for a decision. The NHS and the US National Cancer Institute (NCI) name tests that may be needed: CT, bronchoscopy, biopsy and lung function tests. See Imaging and biopsy before a decision for details.

After the first visit the result may be one of these: continued follow-up with CT, more tests or a biopsy, or a conversation about surgery. None of these is known before the records are seen and you are examined.

Making an appointment

To request an appointment or a call, use the booking page. The patient support services, including imaging and laboratory help, are on the support page.

Why one image is not enough

A CT shows where something is and what shape it has, but it does not always say what it is. So before any decision, the finding is usually checked in more than one way. The NHS writes that results of some tests come the same day and others after days or weeks. ALA says waiting for results can be the hardest part and advises asking the care team how quickly the tests can be done.

No single person does all of this; radiologists, pathologists and other specialists take part, and their results have to be read together.

Imaging

• CT scan. The NCI describes it as a machine that takes detailed pictures of the inside of the body from different angles and can build a three-dimensional view. It is often the main part of the work-up. MedlinePlus says a lung nodule is usually found and followed with a chest X-ray or CT.
• Comparison with old CT scans. ALA says this shows whether a finding is new or has been there and stayed the same.
• Repeat CT or PET. ALA writes that, to see whether something is growing, the doctor may ask for a later CT or PET. MedlinePlus also mentions repeat X-rays or CT to follow a nodule.
• PET scan. The NHS lists it among the tests done after a cancer diagnosis to see whether it has spread. ALA and MedlinePlus (for mediastinal masses) mention it too.
• Ultrasound. MedlinePlus mentions ultrasound for pleural fluid and for the thyroid.
• MRI is sometimes used for planning (NHS and Cleveland Clinic).

The patient support form lists help with CT imaging (including CT angiography), MRI, PET, ultrasound and plain X-rays. See the support page for details.

Biopsy

A biopsy takes a small amount of tissue or fluid to examine under a microscope. The NCI writes that a pathologist looks at the sample under the microscope to see whether it contains cancer cells.

• A needle through the chest wall. MedlinePlus lists it among the ways to biopsy a lung nodule. The NCI mentions fine-needle biopsy for lung tissue or fluid. A CT can guide the needle (MedlinePlus, on mediastinal masses).
• Bronchoscopy. The NHS describes a thin, flexible tube with a tiny camera that goes through the throat into the lung. The NCI says it lets the doctor see inside the windpipe and large airways and may carry a tool to take a sample. Cleveland Clinic calls it the main way to diagnose tracheal stenosis.
• Mediastinoscopy. MedlinePlus describes it as a way to take samples from the middle of the chest.
• Thoracentesis. A needle between the ribs to take a sample of pleural fluid. MedlinePlus says the fluid is checked for infection, cancer cells and protein.
• Endoscopy and biopsy of the oesophagus. MedlinePlus describes endoscopy (EGD) as an examination of the oesophagus and stomach with a camera tube.
• Fine-needle biopsy of the thyroid (FNA). MedlinePlus lists it among the tests for a thyroid nodule.

Not every patient needs a biopsy. For a lung nodule, MedlinePlus says it may be suggested when the person smokes, has other symptoms of lung cancer, the nodule has grown or changed, or its features make cancer more likely. Ask your doctor what the benefit and the risk of a biopsy are for you, and whether there is another option. MedlinePlus gives exactly this reminder for lung nodules.

Checking lung function and other organs

• Lung function test (PFT). The NCI says it measures how much air the lungs hold and how fast air moves in and out, and counts it among the tests used to check the lungs. The result tells the care team how well your lungs work; your surgeon or treating doctor explains what it means for you.
• Oesophageal manometry and FLIP to measure how the oesophagus moves in achalasia (MedlinePlus).
• Blood tests, including thyroid tests and tests for anaemia or poor nutrition.
• Other tests your doctor asks for based on your age and other conditions. The care team decides the list.

What you can do

• Carry the result of every test and image, and keep your file in order.
• Before any biopsy, ask whether you need to stop a medicine. Do not stop a medicine, especially a blood thinner, without agreeing it with your doctor.
• Some results can take days to weeks. The wait is easier if you ask when the result is expected and what happens next.
• For each procedure, ask: why is it needed? What will the result change? What are the risks?
• Once you have results, go over them with your surgeon or treating doctor. The decision about surgery is made after all the pieces are seen, and the outcome of the work-up is not always surgery.

Signs that should not wait for a test result

If, while you wait, you have sudden shortness of breath or severe chest pain, or you cough up more than a few streaks of blood, do not wait for an appointment; call 115, Iran’s emergency number. The full list is in When should I call urgently?

First of all

Preparation differs a little from one patient to another, because it depends on the type of surgery, the anaesthetic and other conditions. MedlinePlus too says to follow your surgeon’s instructions, since they vary by operation. This page is meant to help you know what to ask, not to replace the instructions of your care team.

Stopping smoking

MedlinePlus writes that stopping smoking and other nicotine products, including e-cigarettes, before surgery can improve healing and the result of the operation. The reasons:

• Smoke reduces the oxygen reaching the cells of the wound, so the wound heals more slowly and is more likely to become infected.
• People who smoke and have surgery develop blood clots in the leg more often than non-smokers. The NHS also lists surgery as a risk factor for deep vein thrombosis.
• Smoking makes the heart and lungs work harder.

MedlinePlus notes that most doctors advise stopping cigarettes and all tobacco products at least 4 weeks before surgery, and that if this reaches 10 weeks or more the risk of problems falls further. Nicotine gum close to the time of surgery is not advised. If you want replacement nicotine or a medicine to help you stop, agree it with the care team and the anaesthetist.

If the operation is near and you still smoke, do not hide it. The surgeon needs to know to plan around it. When the operation takes place is the surgeon’s decision. Read more: Why stopping smoking before surgery matters.

For help, MedlinePlus mentions support from family and friends, asking your doctor about nicotine replacement and stop-smoking medicines, and joining a quit programme. Most people who succeed have tried several times, and earlier attempts teach useful lessons.

Medicines

• A complete list of medicines with name, dose and how often, and the bottles if possible (MedlinePlus). Include herbal products, supplements and vitamins. MedlinePlus says not to take any supplement, herb, vitamin or mineral until the surgeon agrees.
• Blood thinners and painkillers such as aspirin. MedlinePlus writes that some medicines that make blood harder to clot, such as aspirin, ibuprofen, naproxen and clopidogrel, may have special instructions before surgery. Which medicine, when, and whether anything should change at all is decided only by the surgeon and the doctor who prescribed that medicine. Do not stop a medicine yourself, and if you are unsure, ask the surgeon.
• Diabetes and weight-loss medicines. MedlinePlus says medicines that affect diet or stomach emptying, such as semaglutide and tirzepatide, may have special instructions. If you take them, tell the surgeon and the anaesthetist and leave the decision to them.
• Any medicine you are told to take on the morning of surgery should be taken with only a small sip of water (MedlinePlus).

Fasting

MedlinePlus writes that you usually must not eat or drink from a set time, the night before or the morning of surgery; that means both solids and liquids. The treatment centre will tell you the exact time, and you should keep to it. You may brush your teeth and rinse your mouth in the morning.

Washing and skin

MedlinePlus: shower or bathe the night before and the morning of surgery. Use the antiseptic soap the team gave you, or antibacterial soap. Do not shave the surgical site yourself; if it is needed, the team does it. Wash your nails and remove nail polish and make-up.

If you feel unwell before surgery

MedlinePlus says to tell the surgeon’s office if you become unwell before surgery, especially with a new rash or a skin infection, chest pain, shortness of breath, cough, fever, or cold or flu symptoms. But if you have sudden or severe breathlessness, severe chest pain or any other sign from section 1 of the urgent guide, do not wait for the office to reply; call 115, Iran’s emergency number.

What to bring

MedlinePlus suggests:

• comfortable flat shoes with rubber soles, comfortable clothes, light home clothes and clothes for going home
• glasses (instead of contact lenses), toothbrush, toothpaste and toiletries
• your medicine list, important phone numbers and a phone charger
• a cane or walker, if you use one
• leave jewellery and valuables at home

Bring your records in order too: the CT disc, reports and pathology result (First visit and records).

Who should be with you

Choose an adult companion in advance who can stay at the hospital, ask questions and help after discharge. For discharge after lung surgery, MedlinePlus says to ask your surgeon before you drive and not to lift anything heavy for the time the surgeon sets. So arrange the trip home and help with daily tasks beforehand.

Getting the home ready

MedlinePlus suggests removing light, slippery rugs and putting grab bars in the bathroom to lower the risk of falling. The same source says to take stairs slowly, one at a time.

Questions to ask the surgeon

• Which medicine should I stop, and when? Which should I continue?
• Exactly when does fasting start?
• How many days will I stay, and will I have a tube or drain after surgery?
• After discharge, who checks the dressing and the drain? (Care at home)
• Which signs should I report at once, and what number do I call? (When should I call urgently?)

First of all

Your own discharge instructions come before this page. If the surgeon or nurse said something different, follow that. This page is based on the MedlinePlus discharge instructions for three operations, and the numbers are only examples.

If you see any of the signs in When should I call urgently?, do not wait; see the full list.

After lung surgery

Recovery is gradual. MedlinePlus writes that energy takes 6 to 8 weeks to return. You may have pain when you move your arm, twist your upper body or breathe deeply.

The chest tube. A tube may have been in your chest for all or part of your hospital stay. MedlinePlus says the skin around the tube site may be a little tender, and the area around it should be cleaned once a day. If the tube comes out, cover the site with a clean dressing and call the surgeon at once. If you cannot reach them right then, go to the emergency department, and if breathing has become harder, call 115, Iran’s emergency number. Keep the dressing over the tube site for 1 to 2 days after the tube is removed. What is a chest tube?

The wound. Change wound dressings every day, or as often as you were told. Wash with mild soap and water, and shower once all dressings are off. Do not pull off adhesive strips and skin glue; they fall off by themselves in about a week. Do not sit in a bath, pool or hot tub until the surgeon allows it. Stitches are usually removed after 7 days and staples after 7 to 14 days, and stitches under the skin dissolve by themselves.

Breathing exercises. If you were given a breathing exerciser (incentive spirometer), MedlinePlus advises using it 4 to 6 times a day for the first two weeks. Breathing exercises and getting back to activity

Pain. Take pain medicine as prescribed. MedlinePlus stresses not waiting until the pain is bad. Press a pillow over the wound when you cough or sneeze.

Activity. MedlinePlus says to walk two or three times a day, starting with a short distance and slowly doing more. After keyhole (camera-assisted) surgery, do not lift more than about 4.5 kg (10 lb) for two weeks, and after open surgery, for 6 to 8 weeks. Be careful with your arm and upper body for up to 6 weeks. Ask the surgeon before driving, and do not drive while you are taking narcotic pain medicine. Most people take 4 to 8 weeks off work, and some return part-time at first. If your surgeon gives a different figure, theirs is the one that counts.

After oesophagus surgery

MedlinePlus writes about removal of the oesophagus:

• You may go home with a neck drain or a feeding tube. The surgeon removes the neck drain at a visit; the feeding tube usually stays 1 to 2 months and is often used only at night.
• Change dressings every day until the surgeon says it is no longer needed.
• Do not pull off the adhesive strips on the wound; they fall off in about a week. Do not sit in a bath, pool or hot tub until the surgeon allows it.
• Stools may become looser and more frequent.
• On food: soft food for 4 to 8 weeks, small meals, drinking liquids about 30 minutes after eating, and staying upright (sitting or standing) for up to an hour after eating. See section 5 for details.
• You may be told not to lift more than about 4.5 kg (10 lb). Ask the surgeon.

After thyroid surgery

MedlinePlus writes:

• You may go home the same day or after one night in hospital.
• You may have a drain with a small bulb. Empty it twice a day, note the amount, and follow the surgeon’s instructions.
• Neck pain and tenderness, especially when swallowing, are common, and your voice may stay hoarse for about a week.
• Keep your head raised when you sleep during the first week.
• If there is glue or tape over the wound, you can shower with soap from the day after surgery. If you have stitches, ask the surgeon.
• Food is usually not restricted, but at first liquids and soft food are easier.
• For the first few weeks avoid strenuous activity such as running, swimming or lifting heavy things. Do not drive while you are taking narcotic pain medicine.
• In the first year, cover the scar with clothing or strong sunscreen so it shows less.
• After the whole thyroid is removed, you may need hormone tablets, adjusted with blood tests. That decision belongs to your doctor.
• Follow-up with the surgeon is about 2 weeks after surgery; stitches and the drain are usually removed then.

Preventing blood clots

The NHS says surgery, hospital stays and reduced movement raise the risk of a blood clot in the leg, and a clot can happen weeks later. Report pain or swelling in one leg the same day, and if you also have breathlessness or chest pain, call 115, Iran’s emergency number. It is explained under warning signs.

Care at home: what the support form names

In its section on care after surgery, the patient support form names:

• changing dressings
• giving injections at home
• removing a drain
• removing stitches
• oedema bandaging

and, in its section on specialist home treatment and rehabilitation:

• home visits by specialist and sub-specialist doctors
• clinical nursing at home (injections, modern dressings, catheter changes, intravenous fluids)
• physiotherapy and rehabilitation at home

The form presents the after-surgery section as ‘fast appointments and referral’. Which of these you need is decided by your surgeon or treating doctor. A chest tube or any drain is removed only on your own surgeon’s instruction. To arrange them, see the support page.

Safety at home

MedlinePlus suggests removing slippery rugs and putting grab bars in the bathroom. If you smoke, ask your doctor for help to stop, and do not let anyone smoke in the house.

Why breathing and movement matter

After chest surgery, deep breathing and coughing hurt, so people breathe shallowly without meaning to. But MedlinePlus writes that the deep-breathing and repeated coughing exercises the nurse teaches help open the lungs and clear fluid. The NHS says the same for injured ribs: breathe slowly and deeply at regular intervals and cough when needed to clear phlegm and lower the risk of a chest infection.

Breathing exercises

• Breathing exerciser (incentive spirometer). If you were given one, MedlinePlus advises, after lung surgery, using it 4 to 6 times a day for the first two weeks. The nurse or physiotherapist shows you the exact number and method.
• Deep breaths and coughing. Breathe in slowly to the end and cough. The NHS and MedlinePlus both advise pressing a pillow against the wound when you cough or sneeze.
• Control pain before exercising. MedlinePlus says to take pain medicine on time, and not to wait until the pain is severe.
• Sleeping position. For injured ribs the NHS suggests sleeping half-upright for the first few nights. After thyroid surgery MedlinePlus says to keep your head raised in the first week. Your own surgeon will tell you the right position.

If breathing becomes harder, chest pain increases, you have a cough that will not stop, or you bring up yellow, green or bloody phlegm, tell the surgeon the same day. If breathlessness is sudden or severe, chest pain is severe, or you cough up more than a few streaks of blood, call 115, Iran’s emergency number. Warning signs

Walking

For after lung surgery, MedlinePlus writes: walk two or three times a day, start with a short distance and add slowly, rest after activity, and stop anything that causes pain. Take stairs slowly, one at a time. In hospital the care team tells you when you can get out of bed.

The NHS writes that surgery and reduced movement raise the risk of a blood clot in the leg. So take pain, swelling or redness in one leg seriously and report it the same day. If you also have breathlessness or chest pain, call 115, Iran’s emergency number. Pain and swelling in one leg

Returning to daily life

MedlinePlus says about lung surgery:

• Most people take 4 to 8 weeks off work, and some return part-time at first.
• Light housework from about the second week, gardening after 4 to 8 weeks, and push mowing at least 8 weeks later.
• Sex once you can climb two flights of stairs without breathlessness; confirm this with the surgeon too.
• Energy returns in 6 to 8 weeks.

These are examples. Your own schedule depends on the type of operation, your fitness before surgery and how you recover.

Food after oesophagus surgery

MedlinePlus writes about removal of the oesophagus:

• Feeding tube. Usually needed for 1 to 2 months, and often used only at night or at set hours. A nurse or dietitian teaches you how to prepare the liquid and how much to give. Flush the tube with water before and after each feed.
• Soft food. After liquids, eat soft food (mashed, needing little chewing) for about 4 to 8 weeks. Chew tough meats such as steak into small pieces and thoroughly once you are back to normal food.
• Portion size. In the first 2 to 4 weeks do not eat or drink more than about one cup (240 ml) at a time. You can have up to 6 meals a day. The stomach is smaller, and small frequent meals are easier.
• Fluids. Drink about 30 minutes after solid food, and take 30 to 60 minutes to finish each glass.
• Position. Do not eat or drink while lying down. Sit or stand for up to an hour after eating so the food moves into the stomach.
• Stools. They may be looser and more frequent. If you have diarrhoea, ask your doctor before taking any anti-diarrhoea medicine.

The signs MedlinePlus lists for calling the surgeon: being unable to eat or drink, vomiting after meals, a burning throat when lying down, yellow skin or eyes, fever, a persistent cough, and severe leg pain or swelling. Warning signs

The patient support form also names ‘swallowing therapy’ and ‘special diets’; see the support page.

Food after thyroid surgery

MedlinePlus says you can usually eat what you like, preferring healthy foods. Swallowing may be hard at first; liquids and soft food, such as pudding, stewed apple or yoghurt, are easier. Strong pain medicines may cause constipation, and fibre and fluids help. If eating becomes hard or your voice stays hoarse, tell the surgeon.

Mood

If your mood is low after surgery, or fear and worry will not leave you, talk about it with family or your doctor. The support form names ‘psychiatric and psychological counselling’ among its services.

First of all

Most problems before and after surgery can be handled with the surgical team during working hours. But a few situations should not wait. This list does not cover everything. If you are worried or unsure, call. 115 is Iran’s emergency number. If you feel unwell, do not drive yourself; ask someone to take you or call 115. Take your medicines with you (NHS).

Before you leave hospital, ask the surgical team to write down their contact number and how to reach them at night and on holidays, and keep it on the fridge or in your phone.

1. Call 115 (Iran’s emergency number) or go to the emergency department now

Severe or sudden breathlessness

The NHS says to act at once if breathing has become very hard (you are gasping, choking or cannot speak a sentence), your chest feels heavy or tight, your lips or skin have turned pale, blue or grey, or you are suddenly confused. For a collapsed lung (pneumothorax), MedlinePlus mentions sharp chest or shoulder pain, shortness of breath, blue skin, dizziness and near-fainting.

Severe chest pain

The NHS writes that sudden, lasting chest pain or pressure, such as squeezing or burning, especially if it spreads to the arm, neck, jaw, stomach or back, or comes with sweating, nausea, dizziness or breathlessness, needs urgent hospital treatment, because it could be a heart attack. Do not wait to see if it passes. After chest surgery wound pain is common, but do not put down to the wound a pain that is sudden, severe or different from the days before.

Coughing up more than a few streaks of blood

The NHS says that if you cough up more than a few spots or streaks of blood, or even a smaller amount with difficulty breathing, a very fast heartbeat or pain in the chest or upper back, it may be something more serious, such as a blood clot in the lung. Call 115 (Iran’s emergency number) now.

Neck swelling with difficulty breathing, after thyroid surgery

If after neck surgery the wound area swells and at the same time breathing becomes hard, call 115 (Iran’s emergency number) at once. MedlinePlus counts swelling and bleeding from the wound among the reasons to call the surgeon, and the NHS counts severe breathlessness as an emergency. Here, calling the office and waiting for a reply is not enough. Any new difficulty breathing after thyroid surgery, even without visible swelling, is treated the same way.

Chest tube has come out, moved, cracked or come apart at its connection

MedlinePlus says that in these situations, or if breathing suddenly becomes harder or pain increases, you need help at once, even if your breathing feels fine for now. If the tube has come out, cover the site with a clean dressing and call the surgeon at once. If you cannot reach them right then, do not wait for a reply; go to the emergency department. If breathing has become harder, call 115 (Iran’s emergency number).

Vomiting blood

The NHS writes that vomiting blood always needs medical help. The blood may be bright red, brown or black, or look like coffee granules. Go to the emergency department straight away. If you also feel generally unwell, confused, dizzy or faint, or have fast shallow breathing, cold pale sweaty skin, stomach pain or black stools, call 115 (Iran’s emergency number).

Being unable to swallow, with choking or breathlessness

If you eat or drink and suddenly choke or cannot breathe, call 115 (Iran’s emergency number) (NHS, severe breathlessness). If you have myasthenia gravis and your symptoms suddenly get worse, for example severe trouble breathing or swallowing, call 115 (Iran’s emergency number); the NHS says urgent hospital treatment may be needed.

Signs of a collapsed lung, after an injury or without one

Sharp chest or shoulder pain that gets worse with a deep breath and comes with breathlessness. MedlinePlus links a larger pneumothorax with blue skin, dizziness and a fast heartbeat. For injured ribs the NHS says to act as an emergency if the injury came from a serious accident such as a car crash, if breathlessness or chest pain is getting worse, or if you have stomach or shoulder pain or cough up blood, because a rib may have damaged the lung, liver or spleen.

2. Call the surgical team or your doctor the same day

If you cannot reach them that day, go to the emergency department and do not wait until tomorrow.

Breathlessness that is worse than usual but not severe

MedlinePlus counts breathing becoming hard after lung and oesophagus surgery among the reasons to call the surgeon, and the NHS advises urgent medical help for being more short of breath than usual. If it gets worse, or you cannot say a sentence, follow section 1. This entry does not apply after thyroid surgery: any new difficulty breathing then belongs in section 1.

Fever

MedlinePlus counts a temperature of 38.3 degrees Celsius or higher after lung surgery, and 38 degrees or higher after thyroid surgery, among the reasons to call the surgeon. After oesophagus surgery it names the same 38.3. If your surgeon gave a different figure, use that one.

Redness, warmth, swelling or pus at the wound

MedlinePlus names these: the wound bleeds, is red or warm, or has thick yellow, green or milky discharge. Wound pain that does not improve with the prescribed medicine, or gets worse, is also a reason to call. If bleeding is heavy and will not stop, call 115 (Iran’s emergency number).

A drain that comes out, or a sudden change in what it drains

For a chest tube, see section 1. If another drain, such as a neck drain or a bulb drain, breaks, comes out or moves, cover the site with a clean dressing and tell the surgeon at that moment, not at the end of the day. If the amount, colour or smell of the drainage changes suddenly, report that the same day too. The numeric threshold for each drain is set by your own surgeon, so follow any number they gave you.

Swelling and pain in one leg

The NHS describes throbbing pain and swelling in one leg, usually the calf or thigh, with redness or a change in skin colour, as signs of a deep vein clot, and hospital stays and surgery as risk factors. The NHS says a clot may happen weeks later. MedlinePlus counts leg pain or swelling after lung and oesophagus surgery among the reasons to call the surgeon. If you also have breathlessness or chest pain, call 115 (Iran’s emergency number).

A persistent cough, or yellow or green phlegm

After lung surgery MedlinePlus counts a lasting cough and yellow, green or bloody phlegm among the reasons to call the surgeon. If you see only a few streaks of blood in the phlegm, the NHS suggests an urgent appointment with a doctor; in practice, call the doctor the same day.

Swelling of the chest, neck or face

MedlinePlus counts swelling of the chest, neck or face after lung surgery among the reasons to call. If breathing is also difficult, follow section 1.

Not being able to swallow water or food

If you cannot eat or drink, or you vomit after eating, or you have a burning throat when lying down, tell the surgeon the same day (MedlinePlus, after oesophagus surgery). The NHS also counts difficulty swallowing, coughing or choking when eating, a feeling of food sticking, and breathlessness after eating among the reasons to be seen early. If you cannot even swallow your saliva, or food is stuck and will not go down, do not wait until the end of the day; go to the emergency department straight away. If choking and breathlessness are severe, go back to section 1.

Long-lasting vomiting, or black tarry or dark red stools

The NHS advises urgent medical help for vomiting for more than two days and for black or dark red stools. Report it the same day. If you are also vomiting blood, or have dizziness, severe weakness or fainting with black stools, follow section 1.

Yellow skin or eyes, or severe diarrhoea, after oesophagus surgery

MedlinePlus counts yellowing of the skin or whites of the eyes, loose stools or diarrhoea, and a burning throat when lying down among the reasons to call the surgeon.

After thyroid surgery: tingling or numbness of the lips, face and fingers

MedlinePlus counts numbness or tingling of the face and lips among the reasons to call the surgeon. Mention tingling in the fingers as well. Do not leave these symptoms until a routine appointment; report them the same day. If the surgical team cannot be reached, or you also have muscle cramps or spasms, go to the emergency department straight away.

After thyroid surgery: a weak voice, a lot of coughing, trouble eating

MedlinePlus counts these among the reasons to call the surgeon too. A slightly hoarse voice in the first week can be normal. If breathing has become hard, calling the office is not enough; follow section 1.

New chest pain that does not seem an emergency

If chest pain comes and goes or passes quickly but has worried you, the NHS advises talking to a doctor. Do not diagnose yourself. If the pain stays, or comes with breathlessness, sweating or nausea, follow section 1.

If you cannot reach your doctor

If you cannot reach a doctor or the surgical team, or they do not answer:

• If you have any sign from section 1, do not wait for a reply; call 115 (Iran’s emergency number).
• If your sign is from section 2, go to the nearest hospital emergency department the same day and do not wait until tomorrow.
• Take with you: your discharge summary or operation note, your medicine list (especially blood thinners and cortisone, if you take them), the CT disc and reports.
• Tell the emergency doctor: what operation you had and when, whether you have a tube or drain, and what symptom you have. Ask the emergency doctor to call your surgeon.
• Do not stop or reduce any medicine, including a blood thinner, yourself; leave the decision to the doctor who sees you and coordinates with your surgeon.
• Do not drive yourself.

If you are not sure

Call. ‘It may be nothing, but I am worried’ is reason enough. When you call, have this ready: the operation and its date, the medicines you take, when the symptom started, and whether you have a fever.

Before surgery the signs in section 1 apply to you as well. If you become unwell before the operation, for example with fever, cough, cold symptoms, or a rash or skin infection, MedlinePlus says to tell the surgeon’s office.