- Protect your breastbone. Do not push, pull, or lift anything heavier than 10 lbs with your arms. Follow the techniques you were taught while in hospital.
- Get your prescriptions filled and only take the medications prescribed at your discharge from hospital. Ask your local pharmacist for help to ensure you are not taking duplicate medications.
- Eat well to help your healing and recovery.
- Call the Surgical Nursing Coordinator if you have any concerns after you are discharged: 613-696-7000, press 0 and ask for the Nursing Coordinator.
Though every patient is different, the average length of stay in the hospital after surgery is four to seven days. Once you are able to be up and walking in the halls, you should plan on being able to go home soon.
BEFORE AND AFTER DISCHARGE
Your surgeon or nurse will usually notify you the day before you are going to be discharged from the hospital. In some instances, because of blood tests or a change in medications, the discharge will be confirmed based on blood results on the morning of discharge. In this event, patients are aware of this. Discharge time is 9:00 a.m. It is important that your family is prepared to pick you up at the discharge time as waiting can be tiring for you and you cannot drive yourself. Please make sure your family brings clothing and shoes for you for the trip home.
BREASTBONE PRECAUTIONS (STERNOTOMY PRECAUTIONS)
If you have an incision through your breastbone (sternum), you have a fracture that needs to heal. Even though the breastbone is held together with surgical stainless steel stitches, the bone needs time to mend just like any other fracture. That is why it is essential that you follow these precautions:
- For the first eight weeks after your surgery, you cannot lift, push, or pull anything heavier than 10 pounds (4.5 kg) with your arms.
- This includes not using your arms to push or pull yourself out of bed or out of a chair. For these activities, use the methods recommended by the nurses and physiotherapists at the Heart Institute.
- Do not take baths until your breast bone is healed because it is hard to get out of the tub without a lot of arm work. Showers are fine.
- Continue to use the techniques you were taught in hospital to protect your breastbone.
- You can do many things that do not require heavy arm work such as washing and drying dishes, very light housework, or setting the table.
TIPS FOR FAMILY AND CAREGIVERS
- Expect the first week home to be stressful and demanding. Take care of yourself as well.
- Accept offers from family and friends to visit so you can take time for yourself.
- Talk openly and celebrate milestones together.
- Write down questions as they occur to you and your loved one who has had surgery. Bring these questions with you to the first visit with the surgeon.
Incisions: What’s Normal? What’s Not?
It is normal for your chest incision to be:
- Swollen at the top
- Tender and slightly red
- Itchy, or tight-feeling
- Numb or tingly in some areas
- Draining a small amount of clear yellow fluid
If the left or right internal thoracic artery was used in surgery:
- The side of your chest where the artery was taken may feel numb
- You may feel “pin-prick” sensations at times
- Your skin over that part of your chest may be very sensitive and tender
If your leg vein was used in surgery:
- Your leg may be a bit swollen and uncomfortable
- The swelling in your leg increases during the day
- Whenever you are sitting down, elevate your feet to waist level, a footstool is not enough to help decrease the swelling
- Avoid crossing your legs
- It may take weeks to months for the swelling to decrease
If your wrist (radial) artery was used in surgery:
- Your arm may be slightly swollen and your fingers may be slightly puffy
- You should be able to move your arm freely
- You may occasionally feel tingling in your fingers
- Go to Emergency if:
- You get a sharp pain in your arm or hand
- If you lose feeling in your hand
- If your arm becomes very swollen and tight Infection is always a concern after any surgery. Contact your surgeon or the Surgical Nursing Coordinator if your incision becomes:
- More painful instead of less
- More swollen than when you left the hospital
- Draining pus or leaking large amounts of fluid
- Open and gaping
- Red and tender
- You develop a fever
- Feeling unwell
- Flu-like symptoms (general aching, low-grade fever)
- A sharp pain when you breathe in in the neck, shoulder, back or ribs that does not respond to pain medicine
If you have these symptoms, contact your Surgeon or the Surgical Nursing Coordinator: 613-696-7000, press 0 and ask for the Nursing Coordinator.
Issues During Recovery
Recovery takes time. It can take longer to recover than most patients expect. Some days will be better than others as you progress through your recovery. Most patients are walking 20 to 30 minutes by three weeks after surgery and are starting to feel a little better. Generally, most patients start to feel better around six to eight weeks after surgery. As you recover, you may experience some of the following effects of surgery, all of which are normal.
This is the most common problem patients report after surgery. The biggest challenge most patients have is learning how to conserve energy. That means doing the prescribed walking program and daily activities with frequent stops for rest. Make sure you take at least two planned rest periods each day. At three weeks, most people can walk slowly for 20 minutes twice per day.
Besides the walking program, try to get up and move around a little every hour during the day. Physical activity helps you get stronger.
DIFFICULTY SLEEPING AT NIGHT
You may have difficulty sleeping at night after you are home. To help get to sleep, consider taking pain medication before you go to bed so you can sleep comfortably. You may also occasionally need a sleeping pill to help you sleep the first week or two after discharge. The problem most patients report is waking up frequently. Have your afternoon nap early and try not to sleep for more than one hour. Avoid napping after supper and reduce your caffeine intake. (Remember caffeine is in coffee, tea, some energy drinks and certain carbonated beverages like cola or Mountain Dew™.)
It will take you time to get a good night’s sleep after you leave the hospital. Patients report it takes a couple of weeks to get back to what is “normal” for them.
PAIN AND DISCOMFORT AT YOUR INCISIONS, IN YOUR BACK, AND YOUR CHEST MUSCLES
Take your pain medication regularly—before the pain gets too bad, especially for the first few days you are home. Take your pain medication before you start your exercises or any other physical activity. Patients report that taking pain medicine first thing in the morning and the last thing at night helps them be more comfortable.
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. This includes wearing it when you are asleep. 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.
You may experience sweating, especially at night. This is very common. However, if you have a fever at the same time, call the Surgical Nursing Coordinator.
FORGETFULNESS, DIFFICULTY CONCENTRATING
These are all common after surgery. Give yourself extra time to accomplish tasks, and ask for help if you need it.
Try to spend some time each day doing activities that require you to concentrate, such as reading the paper and doing crossword puzzles.
Expect that your memory, concentration, and mood will gradually improve with time.
UPSET STOMACH OR POOR APPETITE
Eat nutritious foods that you enjoy and ensure that you rest after each meal to help with digestion.
See the Heart Healthy Living Guide and nutrition tips after surgery later in this book.
It is very important to eat well after surgery so you can heal your incisions and have the energy for your activity program.
If you are not on a fluid restriction, try to drink at least 6 to 8 cups (1.5 to 2 litres) of water each day. Eating foods high in fibre can help. Consider using a stool softener such as docusate sodium (Colace®) for the first week at home. Do not strain. Please refer to the information on fibre in the Nutrition Tips section.
Are common after heart surgery, patients describe having good and bad days. Keep in mind that recovery after heart surgery is difficult and can sometimes feel overwhelming. Include activities that you enjoy, ask for help and be specific. Most family members and friends want to help but are often unsure how. Give yourself time, and don’t let yourself become overtired.
Depression can occur after surgery and will interfere with your recovery. If this is a problem, see your family doctor as soon as you are able.
MILD BLURRY VISION
You may experience slightly blurred vision after surgery. This will improve over time. If you suddenly experience black spots in your vision or your sight suddenly becomes worse, go to Emergency.
MILD SHORTNESS OF BREATH
Generally, you can expect that mild shortness of breath will improve with time and with more regular activity.