Most bypass patients are discharged from the hospital after experiencing about a week of inpatient recovery after surgery. But after discharge, they have to go through 2-3 months of further recovery to reach a better physical condition. I have listed here some common problems and precautions for recovery to share with patients, one of whom, his daughter, is very concerned about him. Anxiety and fear: It is not uncommon to leave the hospital feeling anxious and a little scared. A full treatment team in the hospital will provide you with a feeling of safety. In reality, however, you will only be discharged when your doctor feels you are ready to go. You can call us at any time after you go home if you have any questions or concerns about your recovery process. Follow-up: You will return for a follow-up appointment 3-4 weeks after discharge. Your doctor will make some necessary tests and treatment adjustments based on your specific situation. You can come back for your follow-up appointment according to your primary care doctor’s clinic schedule. Information about 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. Lying in bed or on the couch all day will only make you feel weaker. Your surgeon will want you to plan daily walks. Recovery varies for each person. 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 (below 32 degrees) we recommend that you walk in the morning and in the evening when it is cooler. In slightly colder weather, you can go outside if you feel comfortable and dressed warmly. 3. 3. When you walk, do not walk excessively. It is normal to feel tired and sweat a little while walking. When you feel very tired, sit down and take a break, and 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 will also deplete your circulating cholesterol. Perform upper extremity exercises again daily for 2-3 weeks after discharge, or until stiffness and pain are gone, and use stimulated breathing twice a day 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 1-4 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 pounds 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 Stitches, if any, will be removed prior to discharge. 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 notify the surgical office if you notice any dehiscence or flow of fluid from the wound, or if the redness worsens. Normally, the lower extremity from which the vein was taken will be swollen for several weeks. As a result, you will need to rest your lower extremity on a footstool or another chair to elevate it while you sit. Remember, do not sit with your legs crossed. 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 walking up stairs or at a normal pace, 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 go to bed. 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. No patient will experience prolonged post-operative depression. Recreation If you are comfortable with it, you can participate in recreational activities that are low in activity. These may 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. Begin your post-operative nutrition program by reducing your intake of fats, saturated fatty acids, cholesterol and salt and increasing your intake of high fiber foods (fruits, vegetables, legumes and grains) and 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. Nutritional goals DD meet your daily needs 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 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 this 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.