It is not uncommon to leave the hospital feeling anxious and a little scared. The complete treatment team will provide you with a feeling of safety. For hire only, you will be discharged only when your surgeon feels you are ready. You can call the surgery office at any time after you go home if you have any questions or concerns about your recovery process. Follow-Up Consultation You will return to see your surgeon 3-4 weeks after discharge from the hospital. This pre-visit will be set up by a nurse specializing in thoracic surgery before you are discharged, or you can contact the surgery office at home. Your personal physician and cardiologist will update your surgeon on your recovery process. Activity Progress You will return to see your surgeon 3-4 weeks after discharge from the hospital. This pre-visit will be set up by a nurse specializing in thoracic surgery prior to your discharge, or you can contact the surgery office at home. Your personal physician and cardiologist will update you with information sent by your surgeon about how your recovery is proceeding. Once you return home, it is important to resume your daily routine. You should plan to get up every morning, shower daily, and wear casual clothes. Your tiredness will get better with time. Staying in bed or on the couch all day will only make you feel weaker. Your surgeon will want you to plan daily walks. You can usually walk 1 mile a day by the time the patient is home for 4 weekends. You will need to reach this goal gradually. Everyone’s recovery is different. Your age and general condition will affect your ability to walk distances. The point is to walk 1-2 times a day. 1. Start by walking the distance you walked in the hospital. Each day you should try to walk farther and longer. You may want to start by walking 5-10 minutes in the morning and 5-10 minutes in the evening. 2. We encourage you to walk outside, to the mall or to the store as soon as you are able. In very hot and humid weather, you should walk in the morning and in the evening when it is cooler. In very cold weather we recommend that you walk when the temperature is right. In slightly colder weather, you can go outside if you feel comfortable and dressed warmly. 3. When you walk, do not walk excessively. It is normal to feel tired and slightly sweaty when walking. When you feel very tired, sit down and take a break, after the break you can continue to move. 4. Do not participate in other types of activities such as tennis, cycling or bowling. Do not participate in other types of activities such as tennis, cycling or bowling until you have discussed them with your surgeon at your monthly check-up. We encourage most post-cardiac surgery patients to participate in out-of-hospital cardiac recovery activities 4-6 weeks after discharge from the hospital. These activities provide individualized exercise prescriptions tailored to each person’s cardiac needs. The beginning phase of these activities includes cardiac monitoring with a telemetry device during an exercise class. These classes often include group activities such as using a trigger press, rowing machine, and bicycling. It is especially important to learn to incorporate daily activities into your lifestyle habits. The exercise activities and rehabilitation programs recommended by your physician and equivalent will not only strengthen your heart muscle, but also deplete your circulating cholesterol. Exercise Perform upper extremity exercises again daily for 2-3 weeks after discharge or until stiffness and pain are gone, and use a respiratory function exerciser twice daily for 1-2 weeks after discharge, which will help continue to fully expand your lungs. Go up and down the stairs If you like, go up and down the stairs, keeping in mind that it takes more energy to go up the stairs. You should walk slowly (only a few stairs at a time) and take breaks when you feel strained or short of breath. During your first 2-4 weeks at home, you should limit your stair trips to 2-3/day. Driving You are not allowed to drive for the first few weeks of your stay at home. This will give ample time to drive only when you feel more comfortable and normal. You may be a passenger as long as you feel comfortable getting into the car. Do not plan long trips until you have been examined by your surgeon. Carrying heavy objects It takes about 8-12 weeks for the sternum to heal and for the pain to go away after surgery. You should avoid heavy lifting, pushing and pulling objects over 10-15 kg during this time. Some of these activities are carrying grocery boxes, carrying small children, suitcases or small animals. You should avoid pushing lawn mowers, vacuum cleaners or household furniture. Avoid opening and closing tight windows, turning tight bottle caps or pushing and pulling heavy doors. When you see your surgeon for your post-operative review, ask when you can do these activities again. As soon as you feel stronger, you can perform lighter household activities such as dusting, cleaning up your desk, washing in the automatic washing machine or helping with cooking. Do not perform heavy chores such as vacuuming, mopping, moving and weeding until you have seen your surgeon. Incision care Sutures, if any, will be removed prior to discharge. A sterile dressing will be applied to the area after the sutures are removed. Some sterile dressings may come off when you shower. These do not need to be changed. Please remove all adhesive plasters when you go home for 1 week. Once you are home, you may bathe and shower as normal, with soap and water over the wound. Do not apply any bathing lotion or emulsion to the wound. You may find it helpful to have a plastic bench or chair in the shower. Sitting down in the shower will be more comfortable and less fatiguing. There may be some redness, swelling, tenderness and possibly numbness while the wound is still healing. You should check the wound every day. You should consult your surgeon if you notice any opening of the wound or any flow of fluid, or if the redness worsens. Normally, the lower extremity from which the vein was taken will be swollen for several weeks. Therefore, you will need to rest your lower extremity on a footstool or another chair to elevate it while you are sitting. Remember to keep your legs on stilts. Elastic stockings You will need to wear elastic stockings for 2-4 weeks after you leave the hospital. This helps to reduce swelling and improve muscle tone in your lower extremities. You can take them off when you rest at night. Do not wear stockings (pantyhose, athletic socks, decorative socks) over your compression stockings. If you need another pair of compression stockings, you can buy them directly from your local medical store without a prescription, remembering that you need to measure your lower limb to get the right size stocking from the pharmacy. Sexuality You can resume your sexual life whenever you want. Remember that your chest and lower limbs will still hurt for a while. Choose a suitable position and avoid bearing weight on your upper limbs and sternum. We recommend that you do not eat or drink alcohol for 2-3 hours before sex. Sex requires varying degrees of energy. If you still feel comfortable after a walk up the stairs or at party speed, then you can comfortably have sex. Rest Phase Your body needs more rest during the recovery process. You should plan to sleep for 8-10 hours a day. You should also rest for half an hour after each meal. This does not mean that you must sleep in the upper gears. Digesting food is another burden on your heart, and rest will help with this process. Fatigue It is normal to feel tired during the first few weeks after discharge. Your recovery process will continue for another 4-8 weeks after you leave the hospital. Your energy level will gradually increase during this time. It is important to space out your daily activities and not overexert yourself. It is common for things like eating breakfast, washing and dressing to take up a morning when you first get home. Mood swings After heart surgery you may feel frustrated, irritable, discouraged and depressed. These are often the result of fatigue and a desire for a quicker recovery. They usually improve with time. Few patients experience prolonged post-operative depression. Recreation If you are comfortable with it, you can participate in low-activity recreational activities. These can be eating out, playing cards, watching movies or doing needlework. Guests Socializing and talking with old friends can be tiring. When you are home for the first 2-3 weeks, it may be tempting to limit your guests, use your own judgment and do not hesitate to make excuses when you need to leave the room for a break. Smoking It is very, very important that you do not start or resume smoking when you get home. The nicotine in tobacco can increase your heart rate and narrow your blood vessels. Many places have special programs to help you quit smoking. We highly recommend these programs if you want to quit smoking. Return to work When you return home from the hospital the healing process is not complete and you will continue to need higher nutritional requirements for at least 1 month. You should not make any attempts to lose weight during this time. Consult your surgeon about when to start a weight loss diet if necessary for you. After your recovery is complete, it is important for you to reach and stay at your ideal weight to reduce the stress on your heart and to help reduce blood cholesterol levels and high blood pressure. Start your post-operative nutrition program by reducing your intake of fats, satiated fatty acids, cholesterol and salt, and increasing your intake of high fiber foods (fruits, vegetables, legumes and grains) among other lifestyle changes. Local bookstores have specific cookbooks that will help start your diet plan. Ask a nurse specializing in thoracic surgery or a nutrition specialist for a list of recommended foods. Nutrition goals DD meet your daily requirements for protein, vitamins and minerals DD achieve and maintain your ideal weight DD limit your intake of total fat DD limit your intake of saturated fat DD limit your intake of coffee and alcohol DD increase your intake of high-fiber foods If you have questions about your nutrition plan after you return home during your hospital stay, a member of our Nutrition and Dietetics Department will be happy to If you have questions about your nutrition plan after you return home, a member of our Nutrition and Dietetics Department will be happy to answer them. If you need further information on nutrition after you leave the hospital, you can see your internist. You may be more likely to become constipated after surgery. This is usually associated with inactivity, poor appetite, fluid restriction and the effects of certain medications. You may choose to use laxatives or increase the amount of fiber in your food to address this. If you take iron supplements, this can also cause constipation and darken your stools. When your heart is beating, blood fills your arteries. This blood flow is touched at several points in the arteries of your body near the skin. The beat that coincides with your heartbeat is called a pulse. Your heart rate or pulse rate changes as your body needs it. When you exercise, your body needs more oxygen and your pulse rate increases to meet that need. When you rest, your body needs less oxygen and your pulse rate decreases. There is no ideal or normal pulse. The average pulse rate is 60-100 beats per minute. It is a good idea to know how to test your pulse. This will help monitor the effects of certain medications and irregular heart rhythms. The process is easy to learn and does not require much practice. The thoracic nurse will help you practice until your family finds it easy. There are several areas where you can test the pulse. The most common area is the wrist. Place your index and middle fingers gently at the base of your thumb on your wrist until you can feel a pulse. Count the number of pulses in 15 seconds, which will be the number of pulses or heartbeats you have per minute. If you have chest pain that you know is angina, you may take nitroglycerin. If you find that you must take nitroglycerin within the first few months after discharge from the hospital, please call the surgery office and let us know. Remember that the nitroglycerin in the bottle will only be effective for about 3-4 months. Digoxin, Lamoxin (Digitalis) Digoxin enhances the contractility of the heart muscle. It helps to improve the pumping function of the heart and also helps to help the heart contract regularly. Sometimes there are certain side effects of taking digoxin. Please wait for the surgical office if you have: 1. nausea, vomiting, appetite or diarrhea more than 2 times a day 2. blurred vision or seeing objects with a yellow or green halo 3. irregular heart rhythm or pulse 4. pulse less than 50 beats per minute Furosemide,Hydrochlorothiazide These are diuretics that help remove water from the body. They will help reduce the burden on the heart and reduce swelling in the lower extremities. When diuretics are applied you should take potassium supplements. This is because potassium will be excreted along with water. If potassium supplements are not prescribed, you should include potassium-rich foods in your daily diet. Foods high in potassium include: bananas, oranges, apricots, grapes, and fresh dried tomatoes, beans and green vegetables. You should take your medication in the morning and afternoon, as this will increase your urine output throughout the day. If you have abnormal weight gain (greater than 2-3 pounds or more) every day, notify your surgeon. Betalactam These medications help treat the arrhythmia and maintain a more regular heartbeat. Notify the surgical office if you have: 1. rash 2. chills and fever 3. joint pain 4. nausea and vomiting for more than 48 hours Quinidine Quinidine helps regulate your heart rhythm. Notify the surgery office if you have: 1. diarrhea, nausea or vomiting 2. blurred vision or tinnitus Verapamil (Isopein, Calan) This drug is used to treat arrhythmias and angina pectoris. Please notify the surgical office if: 1. abnormal swelling of the upper extremities 2. vertigo Nitropatch, Transderm Nitro, Nitrodur This nitroglycerin drug is absorbed through the skin for a certain duration. The patch can be applied to any part of the body, but usually to the upper extremities or chest. The patch should be applied to a different part of the upper body every morning and removed at bedtime. Ferrous Gluconate, Ferrous Sulfate This medication is used to replenish the body with iron. Iron is very important in the formation of hemoglobin (red blood cells). This drug can increase your blood count and help you feel stronger. DD When you take iron supplements, your stool will turn dark, which is normal. DD This medication can cause constipation DD Take iron with meals to reduce stomach irritation Tylenol#3 (Tylenol with Codeine) This medication is used to relieve the discomfort of incisions. Many people find that taking it before waking up will help relieve some of the stiffness and soreness after a night’s sleep. It will help with sleep when taken before bedtime. Codeine in DD may cause constipation DD is an addictive drug and should only be used under supervision Percocet (Oxycodone with Acetaminophen) This drug is used to relieve the discomfort of an incision. Many patients find that taking it before waking up helps relieve some of the stiffness and soreness after a night’s sleep. Taking it before bedtime will help with sleep. DD This medication can be addictive and should only be taken under supervision DD Remember, this medication should not be re-added by calling the pharmacist. If you need to add more, call the surgery office 2-3 days before the medication runs out and we will send it to you or bring you in to the office. Tylenol Tablets, Fortified Tylenol, Datoil, Anacin-3, Panadol (Acetoninephen) (Non-Aspirin pain medication) You may use any of the non-aspirin pain relievers in place of your prescribed pain medication if you wish. Many patients find these medications helpful when wound discomfort becomes less severe. Alternating with non-aspirin prescription pain medications can control pain throughout the day and may reduce the need for stronger pain medications. Other medications: Coumadin Coumadin is an anticoagulant (blood thinner) used to prevent blood clots from forming. Clotting (coagulation) of blood is a normal process. Anticoagulants can purposefully slow down this process. Coumadin is needed in certain medical situations and in patients with certain artificial (prosthetic) heart valves to prevent thrombosis. coumadin is used especially in valve surgery to prevent the formation of small emboli in the valve. A blood test for clotting time (also called Protime or P.T.) in seconds tells how long the blood takes to clot, and this blood test can determine the amount of Coumadin used to keep the clot in the therapeutic range. The amount of Coumadin the patient takes. The therapeutic range for patients taking Coumadin is 1.5-2 times the normal clotting time, which is 12 seconds, so most patients receiving Coumadin need to make the clotting time between 18-24 seconds. The clotting time should be checked daily during your hospital stay. After discharge from the hospital you can have your clotting time checked every 1-2 weeks. The frequency of checking your clotting time can be tapered over 1-2 months after your Coumadin dose has stabilized. As long as you are taking Coumadin, you will need to have your clotting time checked every 4-6 weeks. It is important to remember the following rules when taking Coumadin 1. Do not take medicines containing aspirin while taking Coumadin. Aspirin products such as Bufferin, Anacin, Bayer, Excedrin and Alka-seltzer are all mild anticoagulants that can increase the effect of Coumadin. 2. Learn to read the label on the bottle. Some cold medicines contain aspirin 3. You can use aspirin-free or non-aspirin hemostatic medicines such as Tylenol, Panadot and Anacin-3 as mild painkillers 4. Notify your doctor if you notice any of the following signs: —- bleeding gums —- nosebleeds —- bloody or black stools —- bloody or strawberry-colored urine —- increased menstruation —- hemoptysis or vomiting —- severe abdominal pain —- severe headache —- excessive petechiae 5. Learn to regulate the dose of Coumadin in terms of milligram units, not by the number of pills 6. limit alcohol intake to no more than 2 drinks in 24 hours, alcohol will interfere with the absorption of Coumadin 7. wear a medical alert bracelet or necklace indicating that you have a prosthetic valve and are taking Coumadin 8. if traveling long distances, inform your doctor that you can regulate the monitoring of clotting time while you are away There are various doses of Coumadin available. You will be referred to one by a nurse specializing in thoracic surgery based on the appropriate dose of Coumadin for you after discharge. You will likewise be advised when a blood sample is taken to check the clotting time.