You have tests before your operation to check:
- your fitness for an anaesthetic, if you need one
- that you’ll make a good recovery from surgery
You might not need all of these tests if you had them when you were diagnosed. Tests include:
- blood tests to check your general health and how well your kidneys are working
- an ECG to check that your heart is healthy
- breathing tests (called lung function tests)
- an echocardiogram (a painless test of your heart using sound waves)
- a chest x-ray to check that your lungs are healthy
Pre assessment clinic
Your pre assessment appointment prepares you for your operation.
You meet members of your treatment team at this appointment and you can sign the consent form to agree to the operation.
Ask lots of questions. It helps to write down all your questions beforehand to take with you. The more you know about what is going to happen, the less frightening it will seem.
You can ask more questions when you go into hospital so don’t worry if you forget to ask some.
At the hospital you might meet:
A member of the surgical team will tell you about:
- the operation you are going to have
- the benefits of having surgery
- the possible risks
- what to expect afterwards
The anaesthetist gives you the anaesthetic and looks after you during the operation. They make sure you’re fit enough for the surgery.
The clinical nurse specialist
The nurse checks your:
- general health
- blood pressure
The nurse also checks what help and support you have to see what you will need when you go home. They are your point of contact and care for you throughout your treatment.
The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.
The physiotherapist also teaches you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.
Learning breathing and leg exercises
Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.
Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.
You start the injections after your operation. You might also wear compression stockings and pumps on your calves or feet to help the circulation.
Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.
This 3-minute video shows you how to do the breathing and leg exercises.
Breathing and circulation exercises after surgery
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a hu. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
Tests to check you are fit for surgery
You have blood tests to check your general health before your operation.
You might also have some other tests to check that you are fit to have an anaesthetic.
If you haven't had certain tests such as a PET-CT scan or a mediastinoscopy to diagnose mesothelioma then you might need to have them before surgery.
You might have a pericardioscopy to look at the covering layers of the heart (pericardium) and take tissue samples (biopsies). It can show the doctor whether pleural mesothelioma has spread into your pericardium.
Lung function tests
Lung function tests measure how well your lungs take in oxygen. Your specialist needs to be sure that your lungs are working well enough for you to recover well from your surgery.
There are different types of lung function test. The simplest involves you breathing out as hard as you can into a tube attached to a machine. This measures how much air your lungs can take in.
Lung ventilation and perfusion scan
This is another type of lung function test where you have two tests to check the:
circulation of air in your lungs called ventilation
blood supply to your lungs called perfusion
You can have these two tests together. They take about 20 minutes.
In the lung ventilation test you may have to breathe in a very small and harmless amount of radioactive gas. This shows up your airways on a scan. The radioactivity involved is very small and goes away within a couple of hours.
In the lung perfusion test you have an injection of a small amount of a harmless radioactive substance. This shows up the blood flowing to your lungs on a scan. It also shows how important each lung is to your overall breathing capacity.
Heart and lung exercise test
You might have a test that checks how well your heart and lungs work when you are resting and exercising. This is called cardiopulmonary exercise testing (CPET or CPEX).
You wear a mask that measures the levels of particular gases in your breath. Your blood pressure and heart rate are also monitored.
First you rest. Then you walk on a treadmill or cycle on an exercise bike for as long as you can. A computer monitors your breath gases and how well your heart is working.
For two hours before the test you shouldn't eat, smoke, drink caffeine drinks or have other stimulants. You should also avoid physical exercise and breathing cold air.
The evening before
You might go into hospital the evening before or the morning of your surgery.
Your nurse might give you a carbohydrate-rich drink to have the evening before the operation. You might also have it the following morning. The drink gives you energy and can speed up your recovery.
When you're in hospital your nurse will check your:
- blood pressure
- breathing rate
You might have fluids through a drip (intravenous infusion) into your arm before your surgery. This is usually if you have been finding it difficult to drink.