WHAT TO EXPECT DURING RECOVERY
Click on a topic for information on how to manage common problems during the post-operative period and what to expect during your recovery:
Sternal Wound
If your procedure required a median sternotomy, it is important for you to pay close attention to your sternal wound. The incision in your chest will undergo a healing process over the next several months. The surface of the wound will heal quickly. The underlying bone, however, will take longer to heal. The bone had been divided in order to access the underlying heart. The incision in your sternal bone can be thought of as a "broken bone." Wire was used to reapproximate the edges of the bone, and the body will take between eight and 12 weeks to create a solid union of this bone. It is common for the edges of the bone to occasionally click against each other, which is normal. Sometimes this is very distressing to patients and causes discomfort. This will occur particularly when you move quickly, cough, or sneeze unexpectedly. If it occurs more frequently and is worrisome to you, contact your surgeon.
It is important for you to look at the surgical wound regularly in order to detect any signs of redness or drainage. If the wound develops swelling, drains or becomes progressively more painful, contact your surgeon. While the risk of an infection is low, if one occurs and it is treated quickly, more serious circumstances can often be prevented.
Leg Wounds
Some cardiac surgical procedures require a leg incision, which is done in order to remove veins for bypass grafts or to gain access to the femoral artery for connection to the heart-lung machine. These incisions have been closed in layers with sutures. It is important for you to observe these wounds regularly. If excessive swelling, redness, or drainage develops, contact your surgeon. It is not uncommon for these incisions to actually be more uncomfortable than the sternal incision. Be cautious not to be too active in the early period following surgery. It is important for you to keep your legs elevated as much as possible. This helps to prevent the accumulation of fluid and swelling in your legs. Excessive swelling in the legs can pull the edges of the wound apart, allowing an infection to develop.
Support stockings should be worn for three weeks following surgery since they help support the legs and prevent the development of swelling. They should be worn during the day and removed at night. The body clears swelling in the legs and ankles during the night. You should put the stockings back on as soon as you awaken in the morning because swelling will redevelop quickly once you get up and begin to walk around. Waiting an hour or two before putting the stockings on will result in a significant amount of swelling.
If you notice increased swelling, redness, or increased pain in your leg incisions, contact your surgeon. While the risk of an infection is low, the potential is present for several weeks following surgery. If one occurs and it is treated quickly, more serious circumstances can often be prevented.
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Swelling/Shortness of Breath
In the early post-operative period, swelling and shortness of breath often alarm patients and require attention. Occasionally, patients develop retention of fluid in their bodies. You will notice this because you appear to be gaining weight. You should weigh yourself on your home scale every day. If you begin to gain weight, contact your surgeon. Excess fluid retention may also be seen in the legs or ankles, or it may accumulate in the lungs, leading to shortness of breath.
If you experience an increase in your weight, swelling in your ankles, or shortness of breath, your surgeon will likely prescribe a diuretic for you. This medicine will correct the problem by causing your body to excrete the excess fluid.
Atrial Arrhythmias (Rapid Heart Rate)
While you were in the hospital, you may have experienced an irregular or fast heartbeat called atrial fibrillation or atrial flutter. This abnormal heart rhythm is relatively common after cardiac surgery. It occurs because the upper chambers of the heart have been irritated by the surgery. It is usually a problem that is self-limited. If you had this problem in the hospital, you would have been placed on medicine to help to control the heart rate. There is a chance that an abnormal heart rhythm will be experienced again at home. The prescribed medication should keep atrial fibrillation from being a major problem. If you feel your heart racing, contact your surgeon. Usually by a week or ten days after the operation, atrial fibrillation will resolve. If not, your surgeon will probably prescribe a permanent regimen of anticoagulant therapy.
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Exercise
While in the hospital you were given a small booklet that describes a recommended exercise regimen to follow during the immediate post-operative period. It is important to get moving during the first three to four weeks after surgery. The best exercise is walking, and there are specific goals for your walking in the booklet. You should do your very best to achieve those goals. It is important, however, to avoid excessive exercise with your upper extremities. The muscles that control your arms are attached to the chest wall. Any activity with the upper part of your body will put extra stress on the incision.
Patients sometimes feel well enough to begin activity with their upper extremities earlier than recommended. It is not uncommon for a patient who disregards this advice — and decides to rake leaves or clean out the garage two weeks after surgery — to experience significant discomfort in their incision following such activity. You are strongly advised not to overdo physical activity during the first month after surgery. You have been through a major operation and it is important to give your body a chance to recover.
On the other hand, it is important that you become active and not sit around doing nothing. You should get up each day, get dressed, and join the family for meals. You will promote a quicker recovery if you follow the exercise routine outlined in your booklet.
Cardiac Rehabilitation
Two to three weeks after surgery, you will be seen by your physician, who will examine your incisions and check that you are making an appropriate recovery. The surgeon will report your recovery progress to your cardiologist and your primary care physician and recommend when you can start a rehabilitation program. Cardiac rehabilitation is very useful to patients following surgery. Your regular physicians will schedule your rehabilitation program.
(For more information, click Cardiac Prevention and Rehabilitation Program.)
The empowerment associated with cardiac rehabilitation is critical to your recovery. During this time, you will learn a set of life skills that will enable you to better take care of yourself in the future.
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Diet
Most patients have little appetite and find it difficult to eat after surgery, while some seem to have a normal appetite. During the immediate post-surgical period, it is important to eat well enough for your body to have the fuel necessary for its recovery. A nourishing, balanced diet in moderate portions is important during the first month after surgery.
The dietitians in the hospital will have given you and your family a diet that focuses on reducing fat and cholesterol, which is the best diet for you to follow. Diet has a particularly important role in the development of coronary artery disease. It does not usually make much difference in patients who primarily have valve disorders; however, everyone can benefit from a prudent diet. During your time in the rehabilitation program, you will be exposed to more detailed dietary instruction. There are many books in the stores concerning diets designed for patients with coronary artery disease. For more detailed information, you can refer to books by Dean Ornish, the American Heart Association Cookbook, or one of the Pritikin books.
Most patients are prescribed a cholesterol-lowering drug following surgery since, as science currently suggests, the lower your cholesterol is, the better. Although it may be difficult at times to adhere to a heart-healthy diet, it is important for you to do your very best to understand and abide by the rules of prudent eating.
Driving
You should not drive for the first three weeks following surgery. You may not be able to handle the wheel of an automobile adequately in an emergency because of your incision. There is also the possibility of an automobile accident compromising the healing of your sternal wound. You may, however, go for a ride in a car as a passenger, and, in fact, it is good for you to get out within reason.
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Lifting
It is recommend that you do not lift anything with your upper extremities that weighs more than ten pounds during your recovery because your wound is not healed. People who use their upper bodies too quickly have wounds that do not heal well. You also can damage your wounds if you become active too quickly. It is important for you to give your body a chance to heal. You ultimately will gain greater benefit from your operative procedure if you follow these recommendations.
Work
When to return to work is one of the most frequently asked questions following surgery. Your attention span following a major operation will be significantly shortened simply from the stress of surgery. Your ability to do physical work will certainly be compromised by the operation as well. There are no specific restrictions about doing work; particularly if it is relatively easy, and can be done in short stretches. It is certainly acceptable to talk on the telephone, and you can do desk work in the first two weeks following surgery if you feel well enough. Most people find, however, that their attention span is short and trying to concentrate and focus for any length of time frustrates them. This lack of focus will resolve within two to three weeks after surgery, after which time you will be able to return to work without restrictions.
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Sexual Activity
The resumption of sexual activity is something you can decide for yourself. Comfortable sexuality requires uninterrupted focus that is sometimes difficult in the immediate post-operative period. Do not be surprised by your disinterest, or your inability to perform or enjoy sexuality in the first four to six weeks after surgery. Once you have had a chance to recover physically from your operation, your sexuality will return to its pre-surgical state.
Post-Operative Blues
Following surgery of any type and particularly cardiac surgery, patients frequently go through a period where their self-esteem is low and they feel "down in the dumps." Clinically, this is called post-surgical depression. Sometimes patients and families are very sensitive about the use of the word depression and simply do not like to use it. In this context it does not imply any significant psychiatric abnormality. It is perfectly normal for patients to feel a little bit out of control and to be concerned about the future. Patients report not sleeping well, waking up late at night or laying awake in bed for hours on end. Occasionally, patients experience episodes of tearfulness and a sense of worthlessness. To a degree these feelings are present in almost every cardiac surgical patient. It is important for you to understand these feelings are normal, and it is also important for you to know, these feelings will resolve with time. Do not be frightened by these feelings. Simply tell yourself that given time these feelings will fade. It is very unusual for patients to need any medicines to deal with this aspect of recovery. It usually takes care of itself.
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