Advice after By-pass surgery
The operation you have undergone was
designed to bring additional blood supply to the areas of the heart previously
deprived of blood. This deprivation was due to the narrowing of the arteries
supplying the heart muscle. The area in the artery that was narrowed or
completely blocked was bypassed by veins taken from the legs. One end of the
vein was connected to the aorta and the other end was inserted into the side of
the coronary artery below the area of narrowing or obstruction. For one or two arteries
a blood vessel from the chest wall called internal mammary artery is used to
bypass this blockage. Most patients suffering from cardiac pain as a result of
the inadequate blood supply have significant improvement in their symptoms. In
some instances patients are free of cardiac pain, in others the pain although
still present, is milder and more manageable. Only the passage of the time and
the gradual resumption of full activity will define will define the amount of
improvement you will enjoy.
Before your operation you were
cautioned that heart surgery is very taxing, you will find yourself tiring
easily for a while and having to stop and rest frequently between activities.
Your strength will return slowly and steadily over the coming months. Although
your surgery was done to benefit your physical well being, you may not be fully
aware of these benefits until several months after your surgery. Do not get
discouraged at your initial fatigue. You strength will return.
Most patients are fit to return home
within 10 days of the by-pass operation. This indicates that recovery after
by-pass surgery is very rapid and very gratifying both for the surgical team
and patient. It is always rice to return home after a successful operation and
recovery. However you may experience a feeling of apprehension and anxiety,
having left the carefully monitored environment of the postoperative recovery
ward. You may experience a period of depression after returning home. Neither
you nor your family should worry unduly about this. It is a natural reaction to
the considerable stress and excitement of major heart surgery. As the days pass
however, you will find that you are more able to assess your own progress are
concerned.
Most patients find that it takes
around 6 to 8 weeks after the operation for them to make a full recovery.
Obviously there is considerable variation depending upon the severity of the
heart disease and the type of operation preformed. In general, recovery tends
to be quicker after by-pass surgery than after valve replacement surgery. Also,
age is relevant since older patients tend to require a longer convalescence
than younger patients.
At home after 2 or 3 days of
reasonable rest you can begin to increase your activity level. Steady exercise,
particularly walking, is ideal. If the weather is suitable, get out of the
house with a companion and start on a modest walk, ideally on the level.
Getting into the fresh air and continuing your deep breathing exercises is both
helpful to your recovery and good for the morale. Do not worry if, as you begin
to increase your walking an exercise you feel discomfort around chest, neck,
shoulders or back. This is an inevitable part of the rehabilitation process as
the muscles and bones around the chest continue to heal after operation. You
may also find that you feel a little short of breath as you begin to exercise.
This also will improve with passing days.
Activity after By-pass surgery
1. Try to get as much sleep
as you require at night. Also recommended is a mid afternoon rest.
2. Mild exercise will
hasten your mobility. Set aside short periods, several times to do the
following exercises.
a. Walking: Walking is one
of the most important overall exercises you can do. Walk at a comfortable pace,
daily increasing the length of time you walk. Dress appropriately for the
weather. Avoid walking in severe cold/stormy weather or in severe heat.
Extremes of temperature cause your heart to overwork to maintain body temperature.
b. Wall climbing exercise:
Stand 6-8 inches away from a well. Place the palms of your hands against the
wall at chest height. Gradually “climb” the wall by placing one hand over the
other. Continue placing one hand above the other as height as you can comfortably
reach. Keep your feet flat on the floor. Do this exercise 5-10 times per
session. Do 2-3 sessions per day.
c. Making circle with both
arms: Stand with legs slightly apart, feels flat on floor, extend your arms out
to side at shoulder level. Make small circle with your entire arm. Gradually
increase the size of the circle. Reverse direction and repeat above procedure.
Make 5-10 circles in each direction during each session. Do 2-3 sessions per
day.
d. Sit-ups: If sit-ups are
part of your exercise routine, it is suggested that they be done with your
knees bent and your feet flat on the floor. This will cause less strain on your
chest incision. Do 3-5 sit-ups per session, 2-3 sessions per day. Sit-ups are
recommended but not push-ups.
e. Riding a stationary bicycle:
Keep setting at a low tension and slowly increase your daily time. If you do
not own a stationary that you purchase one. Other exercises are equally
beneficial.
f. Weight lifting: You may
lift small hand weights. Gradually increase the weights but do not exceed 5
pounds in any hand.
3. Stairs: The heart must
work harder when you climb stairs, so it is best to rest at landings.
4. Car rides: You may go
for rides in the car if you wish. On long trips, stop frequently to stretch
your legs. Avoid driving a car yourself for at least two months after your
discharge from the hospital.
5. Consult with your
doctor before planning plane trips.
6. Bathe and shower daily,
using soap as desired. Treat the area of incision gently. Notify your doctor if
you notice any redness, swelling or discharge from the incision.
7. Your doctor will advise
you when you may return to work.
8. Avoid any exercises
that cause shortness of breath or fatigue.
Incisional pain and discomfort
It is important to emphasise that
most patients experience non-cardiac chest pain relate to the insicion
(operation line) down the centre of the breastbone or to the ribs on either
side of the sternum. This is usually different in character than the cardiac
pain you have experienced in the past. It is important to distinguish between
the two. Nitro-glycerin will not relieve the pain arising from the incision.
The incisional pain will diminish in time, but may reoccur when there is an
adverse change in the weather of when you overdo physically. The pain may be
aggravated by coughing, sneezing or sudden changes in body position. Incisional
pain will become less frequent and bothersome as time goes by. Do not hesitate
to use the pain relieving medication as ordered by our physician. The long
incisions on the leg were made to remove sections of the vein for use as
grafts. There may be local swelling and discomfort in the area of this incision
for some months to come. There may also be numbness of the skin on either side
of the incisions. You may notice some swelling of the ankle on the same side as
the incisions because of a slight impediment of the return flow of blood and
fluid form that leg. This will disappear in time and should not cause concern.
Report any drainage of fluid or redness either in the chest or the leg incisions
to your own doctor immediately.
Driving
Most surgeons prefer that their
patients do not begin driving a car again for 4 to 6 weeks after the operation.
When you do resume expect to feel some heaviness or discomfort around your
shoulders or arms as you move the steering wheel.
House work
Light work around the house should be
introduced into your regime when you feel fit and able for it. Avoid any heavy
lifting for the first 3 months following the operation. Light gardening may be
undertaken but heavy digging or any form of heavy work involving the arms and
shoulders should be avoided for the first 3 months.
Sex
Apply the same common sense approach
in resuming sexual relations as you don to build-up your general physical
activities. Most doctors suggest waiting for around 4 weeks after the operation
before resuming sexual intercourse. It will be necessary to find a position
which is most comfortable for you remembering not to stress your chest wound of
restrict your breathing. It is most helpful if you and your partner can adopt a
relaxed attitude towards the resumption of sexual relations. Neither of you
should worry if early attempts are unsuccessful or seem difficult. Your normal
routines will soon be re-established.
Bathing
Bathe exactly as normal and remember
that little flakes of scar tissue from around the wounds will fall off, and
perhaps even small lengths of skin suture material may appear and fall away.
This is part of the skin wound healing process, and is entirely normal.
Remember that the deep sutures in your heart and chest wall are firm and secure
and are not affected by the changes you see around the skin. If you take
showers instead of baths you may find it helpful initially to put a stool in
the shower cubicle where you can sit for the first few times.
Diet
The majority of the specialists in
the area of coronary artery disease believe that for most patients, a small
reduction in the amount of animal fat and dairy products that they eat is a
sensible precaution. This means reducing the numbers of fried meals, and
limiting the intake of cheese, eggs, and cream. When cooking, vegetable oils
and margarine are preferable to animal fats. Many dietitians advice that fish,
turkey and chicken are preferable to a diet based solely upon red meat for
example beef, lamb etc.
The above dietary measures are
suggested, as part of the overall approach to increasing fitness. It is
important not to become obsessed with dietary restriction, but rather to adopt
a sensible balanced and nutritious diet. It is important however for fitness in
general and for heart functions in particular that you avoid any are
significantly overweight, they will ask the dietitian in the hospital to advise
you on weight reduction. This should be continued be continued after your operation
and can be supervised by your family doctor.
Alcohol
During the initial 6 weeks recovery
period it is best to limit the amount of alcohol you drink. Small quantities,
for example a pint of beer or a glass of wine a day, will do no harm. Excessive
alcohol should be avoided and in particular and in particular you must remember
that if you are being prescribed sleeping tablets, tranquilizers or mild pain
killer, alcohol will have a more powerful effect. If you are taking warfarin
anticoagulant process and caution again is advised.
Warning signs
Many of the aches, pains and feelings
are normal part of the recovery process after heart surgery. If any of the
following signs develop then it is advised that you should contact your family
doctor.
1. New onset of frequent
palpitations
2. Severe shortness of
breath
3. Excessive sweating or
the presence of a fever
4. Sudden disturbance in
vision or severe dizziness.
Six to eight weeks post operation
This is the time when you will return
to the hospital for an outpatient appointment with the surgeon or cardiologist.
This is an important appointment. It allows your doctors to assess the progress
of your recovery and gives them the opportunity to change your drug
prescriptions if necessary. This visit also gives you the opportunity to
discuss any questions which have arisen in your mind or any symptoms which you
have experienced during the recovery period which may be troubling you. It is
common to have a final ECG and X-ray at this visit and possibly other blood
tests including blood sugar level, cholesterol level and kidney functions
tests.
Return to work
It may be encouraging for you to know
that most studies have shown around 75 to 80% of patients who have heart
surgery return to their previous employment. The timing of return to work
depends on the kind of work involved. As a general rule, patients with light
occupations can consider returning to work any time from around 2 months after
the operation. Those who have heavy manual occupations may not be able to
return to work for at least 3 months after the operation to give time for the
muscles, bones and joints of the chest wall to complete their healing process.
The decision to re-tune to work should be taken in consultation with your
doctor, and your employers who may well be able to give you lighter duties for
the initial period before you resume your full duties again.
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