Author: Navi Dharampal, M.D., MTM, FRCSC, thoracic surgeon, Providence Thoracic Surgery and Providence Thoracic Oncology Program
The multidisciplinary clinical team at Providence Thoracic Surgery-West offers comprehensive treatment and surveillance for lung cancer, thymomas and chest masses.
In addition, we treat a host of other conditions, such as diaphragm disorders and paralysis, mediastinal masses, collapsed lungs, pleural diseases and tracheal stenosis, as well as myasthenia gravis, a specialty of mine. Joining the Providence Thoracic Surgery team in January 2022 provides me with the privilege of helping patients with this neuromuscular condition receive specialized surgical care.
As a care location of Providence Thoracic Oncology Program, our west-side clinic offers access to clinical trials through the Earle A. Chiles Research Institute, a division of Providence Cancer Institute of Oregon.
Surgical care for myasthenia gravis
Myasthenia gravis is a chronic autoimmune, neuromuscular disease characterized by weakness and rapid fatigue of muscles. Manifestations may include blurry vision, difficulty with speech and swallowing, and profound muscle weakness. Although there is no cure for myasthenia gravis, medications may relieve or control the symptoms. In most cases, a neurologist treats myasthenia gravis with medications such as cholinesterase inhibitors, corticosteroids or immunosuppressants, and in some cases intravenous therapies.
For myasthenia gravis patients with a tumor in the thymus gland, a thymectomy is standard treatment. However, growing evidence suggests removing the thymus gland in some people with non-thymomatous myasthenia gravis can greatly improve outcomes.
In a randomized trial published in The New England Journal of Medicine, patients were treated with thymectomy plus prednisone or prednisone alone. The results showed that thymectomy “improved clinical outcomes over a three-year period in patients with non-thymomatous myasthenia gravis.” Patients undergoing thymectomy required less immunosuppression and were less likely to be hospitalized for myasthenia gravis exacerbations.
These outcomes support the need for collaboration between neurology and thoracic surgery in providing multidisciplinary care for myasthenia gravis patients. At Providence, performing surgery at the same site as the neuromuscular program allows us to provide a dedicated care approach. Furthermore, we can manage complex perioperative incidents with neurology support should a patient require perioperative intravenous immunoglobulin (IVIG) or plasma exchange. This process involves removing the plasma from the blood cells and replacing it with another solution, or treating it and then returning the plasma to the patient’s body.
Thoracic surgery services on Portland metro’s west side
Providence has three thoracic surgery clinic locations in Portland and Newberg. Currently, we offer dedicated thoracic surgery services 24/7 at Providence Thoracic Surgery-West. In addition, we provide lung cancer surveillance for patients referred to us post-surgery, as well as ongoing care for patients with chest wall masses and metastatic cancers of any kind.
Hospital stays usually are only one or two days, and our ability to manage pain is excellent. Patients rarely require an epidural or catheter. We see our patients within a week after surgery and are available to them by phone any time.
Minimally invasive surgical procedures
My training at the University of Calgary in Alberta, Canada, focused on general and thoracic surgery, and during my fellowship in Seattle I received additional training in minimally invasive techniques. I am especially interested in managing thoracic diseases, including thymectomy, with both video-assisted (VATS) and robotic surgical techniques.
Although open techniques often are required, we can treat many patients with minimally invasive surgery, either VATS or robotic surgery, which are associated with decreased pain scores, decreased perioperative narcotic use, a shorter hospital stay and faster recovery.
To learn more or to refer a patient
- Visit Providence Thoracic Surgery-West or call 503-215-2300.
- View Providence Thoracic Oncology Program.
- See our current clinical trials for thoracic cancers and multiple tumor types.
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