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Post-Operative Information

Although everyone recovers at a different rate, you’ll need about six to eight weeks of healing before you can go back to your normal routine. If you have undergone Off Pump Coronary Artery Bypass Surgery and/or endoscopic vein harvesting during your bypass surgery, you may find your recovery to be quicker. During that time, keep in touch with your doctor and follow his or her instructions. The following post-op instructions are provided for your review:

  • General Post-Operative Instructions
  • Valve Surgery Post-Operative Instructions
  • Getting the Family Involved
  • Sex after Surgery

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.

Do: Do not:
Shower with warm water, not extremely hot. Lift over 10 lbs or engage in pushing or pulling activities.
Prevent swelling by stopping every 1-2 hours to stretch your legs when driving long distances. Take a tub bath, rub your incision with soap, or use creams and/or lotions on your incision
Sleep the number of hours that you normally slept before your surgery. If you do plan to stay up late, take a nap beforehand. 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.
If your legs or feet swell, you should put them on a chair or stool while sitting. Cross your legs while lying in bed or sitting. This puts pressure on the veins under the knees and slows blood flow.
Space and pace your activities to minimize fatigue. If you feel tired, STOP, and rest for a while. Use isometrics (see Exercise for more information): straining to move your bowels, pushing/pulling heavy objects, or working with your arms overhead.
Rest at least once a day for a few weeks and, initially, preferably twice, morning and afternoon. Pull yourself up stairs using the handrail but you can take the stairs.
Be sure to dress daily in street clothes. Hesitate to use pain relieving medication as you need it.
Wear your elastic stockings during the day for at least 2 weeks after discharge or until swelling subsides. They should fit snugly. Do not expect your friend or neighbor who has a heart condition to have the same prescriptions. Use your own prescriptions.
Contact your physician if you are experiencing chest pain. Push yourself to finish a task.
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. Seek out or participate in stressful or tense situations, conversations, and/or people.
If your chest or leg incisions do not appear to be healing (i.e., redness, drainage, swelling, or tenderness is present), notify your physician.
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.
Keep a record of your medications and medical history with you when traveling.

You may notice a swelling or lump at the top of your chest incision which could take several 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.

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, 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) to regulate the dosage of Coumadin.
  • Your physician will arrange these tests for you.
  • 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 aspirin, any medication containing aspirin or any “over-the-counter” 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.

Recovering from Open Heart Surgery is a Family Affair

Open heart surgery is an event that affects the entire family. 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. The husband will need to shop and carry packages for his recovering wife who can neither drive herself to the store nor lift heavy packages. The son or daughter will have to mow the lawn and take out the garbage for their recovering father, who now has to limit exertion while he rebuilds his strength.

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.

Tips for your continued successful recovery:

  • Encourage each other to express and discuss your feelings. Open communication can minimize misunderstandings.
  • Seek support by talking with others who have experienced similar circumstances. Sharing common concern can be reassuring.
  • Reach out for help. Having to focus on changing several habits can be overwhelming. Behavior modification groups (i.e. Smoke Enders) provide structure as well as the mutual support helpful for success.
  • Become knowledgeable about your condition.
  • Be inquisitive, attend lectures, and explore literature. Being informed can reduce anxiety.
  • Begin and maintain an exercise program for your physical and mental well being. Exercising with others can create added motivation.

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.

If you are feeling emotionally overwhelmed, seek professional advice. 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.

Sex After Surgery

There is a great deal of pleasurable sexual activity that is not sexual intercourse. Being near someone, holding, fondling, caressing, are all activities that enhance closeness and pleasure. Since these activities require very little energy, you may engage in these anytime after leaving the hospital. Many couples find that this expression of love allows them to return slowly to a full sex life with confidence.

Sexual intercourse requires slightly more energy, therefore a waiting time of 1-3 weeks is generally recommended. As the sternum has been cut, position modifications 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.

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.

Ways to prepare for the resumption of sexual activity:

  • Exercise as mentioned above.
  • Be tolerant of each others emotions. For a brief time following open heart surgery, emotions are delicately balanced and subject to rapid mood swings. Try to keep day to day events in perspective and remember that a good sense of humor is a good ally.
  • Try to adjust mutual sexual expectations. Emotional response, as well as physical responses, sometimes make the resumption of sexual relations fearful, and that is normal. Therefore, don’t expect too much at first.

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.
Texas Surgical Associates