Recovery after PTE
It will take many weeks to months before you start to feel like yourself again. Many patients find their breathing has significantly improved within the first weeks after surgery. There will be times when recovery seems to be slow, and you will have “good” and “bad” days both physically and mentally. This is normal after any major surgery.
During the first month at home, patients report a number of common concerns:
At first, whenever you try to do something new, you will tire easily. It is important to balance rest and activity. Your activity program will help increase your strength and confidence.
- Rest at least two times every day.
- Do your exercise and walking program after resting.
To reduce pain in your incisions, shoulders, and back, it is important to take pain medicine regularly, as prescribed. Patients report that taking pain medicine in the morning and at bedtime, is especially helpful in the first days at home.
As the pain eases, switch to acetaminophen (Tylenol® or Extra Strength Tylenol®). This will help you stay comfortable and decrease the problem of constipation which may occur with narcotic pain medicines.
If your pain gets worse, contact your doctor.
Patients say they often fall asleep very easily but cannot stay asleep. Sometimes this is due to sleeping too much during the day, especially late in the day. Pain in the incisions can make the problem worse. Make sure your pain is under control. Occasionally, you may need to take medicine to help you sleep if prescribed by your doctor.
Nausea, Poor Appetite, Constipation
Some stomach upset after surgery is common. The medicines you are taking can also upset your stomach and may contribute to constipation. You may notice your sense of taste is decreased or absent. With time, this improves.
During recovery, patients report other concerns, but not as often. These include:
- Numbness and tingling in some fingers
- Slight changes in vision
- Short attention span
- Sweats without fever
- Irregular heartbeat. If this is new or your heart rate is very fast, call your doctor.
- Mood swings
With time, you will be able to do a great deal more. Be patient. It just takes time.
It is normal for your chest incision to:
- Be slightly red and sore
- Be uneven or bumpy
- Be numb in some areas
- Feel tight, pull or itch
- Drain a small amount of clear yellow liquid
- Have a lump or swelling at the top of the chest incision
Call your doctor if your incision is:
- Warm to the touch
- Excessively red and sore
- Draining pus
- More painful than on discharge
- Also call if you develop a fever
Some discomfort/soreness in your incision is common in the early weeks after surgery. However, if you continue to feel weak, have flu-like symptoms, a slight fever, pain when you take deep breaths or general aching of all body muscles, call your doctor.
These could be signs of an inflammatory syndrome that happens sometimes after surgery. It is called post-pericardiotomy syndrome and may be treated with anti-inflammatory medicines. We are very cautious about using these medicines when you are taking Coumadin®. Discuss this with your doctor.
Do not lift more than 2 to 4 kilograms (5 to 10 pounds) for the first six to eight weeks after surgery. Lifting heavy objects interferes with the healing of the breastbone. Your breastbone is broken and although it is wired together with special stitches made of surgical stainless steel, it has to mend just like any other broken bone. Activities such as pushing and pulling should be limited as well.
Take showers rather than baths when you first get home. You may feel weak and tired after a shower. You may wish to use a chair to sit on while taking your shower. Use water that is comfortably warm, rather than hot. Ask someone to be close by in case you need help. You may need help washing your hair.
Wash your incision gently with mild soap (avoid perfumed or deodorant soap). Rinse well and pat dry with a clean towel. Lotions or creams on your incision are not recommended.
Once you are stronger and able to use your arms more (six to eight weeks), then you may resume bathing in the tub. Get up slowly and have help nearby when you start taking tub baths again.
You can help with light work when you first get home. For example:
- Setting the table
- Making breakfast
- Doing handicrafts
- Trimming flowers
- Light dusting
- Folding clothes
For the first eight to twelve weeks after surgery, you should avoid heavy work such as:
- Scrubbing floors
- Raking leaves
- Mowing the lawn
- Shovelling snow
- Chopping wood
Accept offers of help from your family and friends to do the heavy work.
After six to eight weeks, you can begin activities such as:
Start gradually and listen to your body. Begin new activities with a family member or friend. If you are very tired after starting a new activity, it may still be too much for you.
Wearing a Bra
Some women are uncomfortable because the weight of their breasts seems to pull at the chest incision. In this case, wearing a bra may decrease the discomfort. Other women find wearing a bra uncomfortable for the breastbone incision. Putting some gauze over the incision where it is in contact with your bra may help.
Wearing a cotton sports bra may be more comfortable. Front closing bras are easier to get on. Wearing a bra one size larger than you normally wear may also be more comfortable for you. Another alternative is buying a bra extender so that you will be more comfortable.
Resuming sexual activity is an individual decision. It is normal during the early stage of recovery to be too tired to think about sex. Some medications may also interfere with your interest in sex. This is usually temporary. Generally the rule of thumb is that if you can climb two flights of stairs without becoming too short of breath, you will be able to resume sexual activity.
As you begin to feel better, plan to have sex at a time when you are feeling rested and comfortable. You should wait for several hours after you’ve had a large meal before having sex. Also, make sure your position during intercourse does not put pressure on your chest incision.
Check with your surgeon at your post-operative visit. Your surgeon will let you know how soon you can drive. The insurance industry follows the surgeon’s guideline. Generally, this is about six weeks after discharge from the hospital.
You must wear your seatbelt. If it bothers your breastbone incision, use your “teddy” or a small towel under the belt.
Airbags: You should sit in the back seat of your car with your belt on. If it is difficult to get into the back seat of the car and you choose to sit in the front, make sure the seat is back as far as possible and wear your seat belt.
Post-Surgery Nutrition Tips
TOP 10 TIPS FOR HEALTHY EATING
Making healthy food choices doesn’t have to be overwhelming. These tips will get you on your way.
- Cook at home more often. Cooking at home makes it easier to avoid processed foods. It can be as simple as scrambled eggs, whole grain toast, tomato and cucumber slices.
- How you eat is as important as what you eat. Enjoy mealtimes and the food you eat! Don’t multitask. Avoid distractions like your computer or TV while you eat. Sit down and enjoy a meal at the table. If you live with others, make family dinner a priority.
- Listen to your body. Eat when you’re hungry and stop when you feel satisfied.
- Eat at regular times. Eat breakfast within 1 to 2 hours after waking up. Don’t wait too long between your meals. It’s harder to make healthy choices when you’re hungry.
- Plan healthy snacks. Try whole grain crackers and peanut butter or hummus, a piece of fruit and a few unsalted nuts, or frozen berries and plain yogurt.
- Eat a variety of vegetables and fruit at every meal. Enjoy brightly coloured whole vegetables and fruit. Fresh or frozen, try them in different ways—raw, roasted, or sautéed.
- Eat whole grains more often. Switch to brown rice, whole wheat pasta, dark rye bread or oatmeal. Try something new in your soup, salad or casserole like quinoa, bulgur or barley.
- Eat fish at least twice a week. Trout, salmon, tuna, and sardines are some tasty options. Try fresh, frozen or canned.
- Include legumes like beans, chickpeas, lentils, nuts, and seeds more often. Add them to salads, soups and grain dishes such as rice, quinoa or couscous. Legumes can replace meat in your meals. Try a vegetarian chili.
- Don’t be afraid of fat. You need fat for good health and it adds flavour to your cooking. Use plant-based fats such as olive or canola oil.
IF YOU CAN’T EAT A FULL MEAL OR YOU ARE LOSING WEIGHT:
Sometimes, sometimes after surgery, your appetite can decrease. You may lose weight without trying.
Here are some tips to help:
- Eat smaller amounts of foods more often. Try eating every 2-3 hours.
- Eat more food when your appetite is best.
- Make every bite count. Eating half of a meal is still better than having nothing.
- Ideas for nutritious snacks include whole grain crackers and peanut butter or hummus, a piece of fruit and some cheese, frozen berries with granola and plain Greek yogurt or an egg, chicken salad or tuna sandwich.
- Opt for milk, milkshakes, yogurt beverages or oral nutritional supplements such as Ensure (trademark symbol) instead of low energy fluids such as water, broth, tea or coffee.
- Have easy to prepare meals and snacks readily on hand for when you don’t feel like cooking. Suggestions are granola bars, nuts, Greek yogurt, pudding or cheese, and crackers.
- Add fats and oils at each meal. Top your salads, vegetables, pasta or rice with a few teaspoons of liquid oil such as olive or canola. Spread margarine or butter on your bread, vegetables, and potatoes. This will increase the energy content of your food.
- Avoid reduced-fat foods such as foods labelled “light”, “low fat” or “fat-free”.
- Try adding powdered milk or protein powder to your soups, breakfast cereal, puddings or scrambled eggs for extra protein.
PROTEIN HELPS YOUR BODY AND WOUND HEAL. GOOD SOURCES OF PROTEIN INCLUDE:
- Fish, poultry, and meats
- Dried beans, peas, lentils or other legumes
- Soy products—tofu, tofu puddings, and soy milk (found in the produce section of the grocery store)
- Nuts, seeds and nut butters including peanut butter
- Dairy products—milk, yogurt, cheese, and puddings
- Skim milk powder added to foods or whey-based protein powder
IF YOU ARE TOO TIRED TO MAKE MEALS, TRY THE FOLLOWING:
- Have family or friends help prepare meals for you. You can even store meals in the freezer for later dates.
- Use meal delivery services like Meals on Wheels until your strength returns.
CONTROLLING YOUR NAUSEA
- Nausea can be caused by an empty stomach so make sure to eat regularly, every 2-3 hours.
- Try snacking on plain crackers as soon as you start to feel nauseated. Other helpful foods are toast, an English muffin, a bagel, graham wafers, rice cakes, white rice, plain noodles, mashed potatoes, Social Teas® or ginger cookies• If possible, stay away from the kitchen while foods are cooking.
- You may find cold foods easier to manage.
- Mixing solids and liquids, or example, cereal with milk, stews or soup with crackers can increase nausea
If your appetite does not improve, be sure to speak with your doctor. Some changes to your
medications may be needed to help reduce your symptoms.
Once your appetite returns, follow the top 10 tips to healthy eating.
Make sure to eat regularly as constipation can be due to not eating enough. Choose foods high in fibre such as:
- Whole grain, whole wheat, multigrain and flax seed bread
- High fibre cereals such as All BranTM, All Bran Buds™, Fibre One™ and oatmeal
- Whole wheat pasta, brown rice, and barley
- Eat at least seven servings of vegetables and fruit per day.
- 1 serving = 125 ml (½ cup) vegetables or fruit OR 250 ml (1 cup) salad OR= 1 medium size fruit or vegetable
- For more information see Canada’s Food Guide which can be obtained by calling 613-957-8329 or visiting the website.
- Drink at least 6-8 cups (1.5-2 l) of fluid per day (if you are on a fluid restriction follow your guidelines).
Many communities have programs like Meals on Wheels and other supports that may be helpful in the early recovery period to decrease the burden of food preparation. Let family and friends know that meal preparation is one way they can help you in your recovery.
If you have kidney disease, you might need a special diet. If you have not already met with a registered dietitian, ask to see one so that you can get help to build a healthy eating plan.
If you have diabetes, managing your blood sugars helps healing and recovery. Follow a Heart Healthy Nutrition Plan and refer to the additional diabetes information in the Heart Healthy Living Guide.
If you need to have blood work done, many laboratories have a program where a technician will come to your home to take blood. There is a charge for this program but it may be more convenient for you. Get your blood work done early in the day so that the results can be called to your doctor’s office by the afternoon.
Using a “Teddy” at Home
A “teddy” is a small rectangular pillow that helps you support your breastbone when you are changing positions or coughing.
Some patients prefer to use the support of a teddy at home. We will give you a teddy to take with you, compliments of our alumni organization. It is up to you whether or not you need this support. If you find you are having trouble restricting your arm work, a teddy may be a helpful reminder.
Before you leave the Heart Institute, you will receive a prescription for all the medications we want you to take from now on. Please take only what is prescribed. When you get home, please call the doctor who sent you to Ottawa for surgery (referring doctor) and arrange an appointment within the first one to two weeks. We telephone the referring doctor to let him/her know about your discharge and progress. All of the medical information will be sent to the referring doctor, including the medications you were discharged on. Your doctor will likely make adjustments in your medicines as you recover.
Please be very careful about taking any over the counter medicines. Because you are on Coumadin®, check these with your pharmacist.
Do not take your medicines with juice, in particular, grapefruit juice. Some evidence suggests other juices may also cause problems with medicines. The best choice is to take your medicines with water.
Coumadin® is taken at supper time. Until you are settled, if you wish, we can help with your INR until your doctor takes over in your community. While you are in Ottawa and after you are discharged from the Heart Institute, we will give you requisitions for your blood work. There is a laboratory on the 2nd floor of the Heart Institute, open from 8:00 a.m to 4:00 p.m. We will help regulate your INR until you travel home.
Return to Work
This is very individualized. Discuss this with your surgeon or doctor when you have your follow-up appointment. We are very proud when our patients can go back to work. Most who do return to work do so within three to five months.
Suggestions for Family Members
Look after yourself while your family member is in the hospital.
When your family member returns home, he/she will need to have someone with them as much as possible for the first weeks after discharge. This takes a great deal of energy and if you are exhausted, it will be difficult for you.
Try to keep up as much of your normal routine as possible while the patient is in hospital. Do your best to get a lot of extra rest. This is a stressful time for you as well.
Your family member will have “good” and “bad” days. Although difficult, try not to feel guilty when the days are not going so well. Share in the exercise program and go for walks together.