Post-operative Information

General Post-Operative Instructions

Many questions arise as to what you should do or should not do after discharge. The following are answers to the most common concerns and questions.

• While the sternum (breastbone) is healing, avoid lifting greater than 5 kilos, or pushing/pulling activities with your arms. The breastbone takes about 6-8 weeks to heal generally.
• The chest belt should be worn at most times during the day for about 6-8 weeks after surgery. You may remove the belt while sleeping (if uncomfortable).
• Showers are permitted only after your incisions are healed. This usually takes about 2 weeks when the doctor would remove the sutures. Until that time you may only have sponge bath and keep wound dressing dry. Avoid extremely hot water which may cause you to feel dizzy or weak. You may gently wash (don’t rub) your incision with soap. Do not use creams or lotions on incisions unless prescribed by your doctor.
• Avoid driving a car for 4-6 weeks after surgery. Your reaction time will be delayed due to weakness, fatigue, and/or medication. You do not want to risk hitting the steering wheel and re-injuring the sternum. When riding in a car for long distances, stop every 1-2 hours to stretch your legs. This will improve circulation in your legs and help prevent swelling.
• Do not cross your legs while lying in bed or sitting. This puts pressure on the veins under the knees and slows blood flow. If your legs or feet swell, you should put them on a chair or stool while sitting.
• Sleep the number of hours that you normally slept before your surgery. Do not stay up very late one night and try to “catch-up” the next. However, if you do plan to stay up late, take a nap beforehand.
• Avoid isometrics : straining to move your bowels, pushing/pulling heavy objects, or working with your arms overhead. These activities disproportionately elevate blood pressure and put an added strain on a healing heart.
• It is important to space and pace your activities to minimize fatigue. If you feel tired, STOP, and rest for a while. Don’t push yourself to finish a task.
• A rest period should be taken at least once a day for a few weeks and, initially, preferably twice, morning and afternoon. Napping is not necessary, but resting is. Be sure to dress daily in regular street clothes. You are on your way to recovery!
• Stair climbing is not discouraged. Avoid pulling yourself up with a handrail, and go slowly.
• Use your elastic stockings (if prescribed to you by your doctor) during the day and remove them at night. You should wear the stockings for at least 2 weeks after discharge or more if your ankles are still swollen. The stockings aid blood flow and help reduce swelling in the legs. It is easiest to put the stockings on before you get out of bed in the morning for the day, however most people put them on after a morning shower. They should fit snugly.
• Your may notice a swelling or lump at the top of your chest incision which could take few months to disappear.
• Most patients experience incisional discomfort in the sternum. This discomfort will decrease in time, but may reoccur when there is as an adverse change in the weather or when you overextend yourself. Do not hesitate to use pain relieving medication as you need it.
• It is important to distinguish incisional discomfort from chest pain (angina) you may have experienced prior to surgery. Contact your physician or surgeon if you are experiencing chest pain.
• If your chest or leg incisions do not appear to be healing (i.e., redness, drainage, swelling, or tenderness is present), notify your surgeon.
  
• Take your temperature every morning for one week after discharge. Notify your physician if your temperature stays above 100 degrees F for more than a day.
• Check your weight every morning for the first two weeks. If you notice a sudden weight gain, notify your physician.
• When you are upset, your heart works harder. It is best to anticipate and avoid situations, people, or topics of conversation that make you tense or angry.
• Remember that your diet, medications, and exercise are prescribed specifically for you. Do not expect your friend or neighbor who has a heart condition to have the same prescriptions.
• Keep a record of your medications and medical history with you when traveling.

Valve Surgery Post-Op Care

Tell any doctor or dentist who treats you that you have had your valve repaired or replaced. They may prescribe antibiotics before procedures, especially dental work, to prevent an infection from settling in your heart.

It is likely that you will be taking Coumadin, (Acitrom or Warfarin) an anticoagulant, commonly called a “blood thinner.” Coumadin causes blood to take a longer time to form a clot.

There are several points you should know about Coumadin:

• You will need regular blood tests (prothrombin time; PT-INR) to regulate the dosage of Coumadin. Your physician will advise you on these periodic tests.
• Look for signs of bleeding while you are taking Coumadin. Notify your physician if you have:
• any abnormal bleeding
• red or black bowel movements
• pink or red urine
• severe headaches, abdominal or lower back pain
• faintness or dizziness
• red or “coffee ground like” vomitus
• excessive bruising
• excessive nose bleeds
• yellow or jaundice skin
• any symptoms that concern you
• Take your Coumadin at the same time every day. NEVER make up for a missed dose by taking double the dose.
• Don’t take any other blood thinners or any “over-the-counter” medications (especially Ayurvedic medications) without first checking with your physician as this can cause bleeding while taking Coumadin.
• Excessive alcohol intake may also cause bleeding while taking Coumadin. Check with your physician about drinking alcohol.
• It is a good idea to carry a wallet identification card indicating that you are taking Coumadin.
• Coumadin activity is altered by many foods such as green leafy vegetables and meat. Consult your dietician or physician for more details.

Recovering from Open Heart Surgery is a Family Affair

Open heart surgery is an event that affects the patient, spouse, children, and significant others. It is similar to the ripple effect in a pond when a stone is dropped. Many waves occur before the pond eventually calms. In addition to the physical recovery that the patient undergoes, there is an emotional aspect of adjustment that the patient, as well as family, experience.

Facing the possibility of changing one’s lifestyle can be quite overwhelming. Some alterations take place immediately, such as diet changes and smoking cessation. Other changes may be more gradual, such as building up to and maintaining an exercise program, or incorporating long term stress management. Of importance to all those involved is realizing that the patient does have control in initiating the changes and in maintaining healthy new habits. This is the patient’s responsibility. Spouses, children, and significant others often struggle with the impossible task of making sure the patient never deviates off course and stays on the “straight and narrow’. Remember, others can assist and encourage, but only the patient can do!

Many lifestyle changes that occur as a result of having open heart surgery have a direct impact on the entire household. When a patient is forced to make changes for health reasons, very often all minds start to think along the same lines. This is especially true for others who might possibly be predisposed to coronary artery disease. Therefore, if the recovering patient has stopped smoking, family members who smoke are now motivated to quit. And when meals now need to be prepared in a heart-healthy fashion, chances are those who dine together will also be making these changes out of practicality for the cook resulting from a renewed awareness of the benefits to the heart.

Recovering from open heart surgery creates temporary role changes and responsibility shifts among family members. When the recovering patient returns home, he/she will have temporary physical limitations and dependencies which the family members compensate.

Just as the family needs to coordinate efforts in assisting the patient during his limitation phase, so should they enable him to increase his independence and regain his level of self reliance. This proves to be a very delicate balance and can be a cause of friction. Staying informed of the doctors recommendations on how the patient should progress can minimize the stress of this transitional period for both the patient and family.

Recovery will be a challenge for the open heart surgery patient and his/her family. There will be days of high energy and of fatigue, accomplishments, moments of temptation, feelings of exuberance and even days of feeling blue or angry, all of which are a part of the physical and emotional healing process that takes place.

If you are feeling emotionally overwhelmed, seek professional advise. A trained counselor can help you to cope more adequately with your concerns. Consult your hospital social worker or physician for this service.

Remember, recovery takes time. All of those involved will adjust according to their ability to assimilate the lifestyle and role changes which inevitably take place. Sharing your feelings and discussing ongoing issues can make for a smoother transition for all.

Sexual intercourse requires slightly more energy, therefore a waiting time of 2-4 weeks is generally recommended. Another consideration will be position. As the sternum has been cut, a modification may be necessary in order to prevent injury to the sternum or incisional pain. Exercise will strengthen the heart and overall physical condition. So as you engage in the home walking program and witness firsthand increased endurance and confidence, you will know when you are ready. The energy expenditure for intercourse is the equivalent of walking briskly or climbing two flights of stairs. The heart rate rarely rises above 120 beats/minute and blood pressure elevations are similarly mild and transient.

The person recovering after open heart surgery may be more conscious of his or her heartbeat, breathing, and muscle tension. This awareness is normal and is no cause for alarm.

Fear of performance and general depression are two psychological factors that can greatly reduce sexual interest and capacity. These are considered normal during convalescence and in most cases disappear within 3 months. If depression continues after 3-6 months, professional counseling should be considered.

Various medications may affect sexual drive and/or function. If this occurs, consult your physician. Often a change in medication or dosage can remedy the problem. Never stop taking any prescribed medication without your physician’s approval.

Some general guidelines :

• Be relaxed and rested before intercourse. Avoid sex if you are fatigued or upset.
• Choose a position that does not restrict breathing or require prolonged muscular support.
• Maintain a comfortable room temperature and familiar surroundings and partner.
• Speak with your physician if you are experiencing any chest pain, angina, shortness of breath, rapid heart rate, or extreme fatigue in relation to sexual activity.
• Wait at least 1 hour after a meal or alcoholic beverages before having sexual activity.
• Open communication is important between partners.