Recovery Guidelines

General Guidelines

SHOWERS

You can take a shower if your incision is not leaking. Make sure you have someone with you the first few times. Try sitting on a chair in the shower to make things easier. Patients are usually very tired after a shower. It is a good idea to have a rest when you are done. Patients often find the spray of the shower directly on their chest to be very uncomfortable. Turning at an angle or with your back to the spray will make this more comfortable.

Use a gentle, non-drying soap on your incisions and do not use any creams, lotions, oils, ointments or powders on your incision.

Once your breastbone is healed and you are able to use your arms more, you can take a tub bath. Do not take a tub bath until the breastbone is healed (usually about eight weeks).

DRIVING

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, which is usually between four to six weeks depending on the type of surgery and your recovery.

You must wear your seatbelt. If it bothers your breastbone incision, use your “teddy” or a small towel under the belt.

Airbags: It may be very uncomfortable if your airbag deploys. It is advisable to 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.

DAILY ACTIVITY

Listen to your body. You will be tired when you go home and it will take time for you to build up your strength. If you are unusually tired after an activity, it may be too soon.

During the first weeks that you are at home, you can:

Walk every day as prescribed in your program

  • Complete your post-surgery exercises daily
  • Attend church, but avoid kneeling
  • Dine out
  • Fishing along a bank
  • Putt a golf ball
  • Do light housework
  • Go to a movie or attend the theatre
  • Visit the hairdresser or barber
  • Visit with friends

Six to eight weeks later, you can:

  • Gradually start to do housework, such as sweeping the floor
  • Bicycle
  • Fish from a boat
  • Start golfing, gradually work up to nine holes
  • Start swimming—use a floatation device and do not swim alone

Three months following discharge, you can:

  • Start to resume some heavier work, such as scrubbing, raking leaves, ironing or vacuuming
  • Bowl, play tennis, curl
  • Hunt
  • Cross-country ski
  • Mow the lawn
  • Do home repairs
  • Golf 18 holes
  • Horseback ride
  • Snowmobile

SEXUAL ACTIVITY

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.

RETURNING TO WORK

Your return to work will depend on how well your recovery is going and on the type of work you do. At your post-operative clinic appointment, discuss this with your surgeon.

VISITORS AT HOME

Keep visits short and with only one or two people at a time. For your own health, advise your visitors to delay coming over if they have a cold, flu or diarrhea. As you start your walking program, consider including friends and family that come to visit.

Minimally Invasive Surgery

In some situations, coronary artery bypass surgery may be done through a small incision called a “mini-thoracotomy”. This less invasive approach is possible for some patients.

AFTER MINIMALLY INVASIVE SURGERY

You will start to feel better and be able to do more compared to patients with the breastbone incision.

INCISION CARE

You will notice that the left side of your chest will be quite swollen above and below the incision. It will take time for the swelling to decrease. It may be numb for some time and you may feel a “pinprick” sensation as the swelling decreases.

DEEP BREATHING AND COUGHING EXERCISES

Patients report a feeling of breathlessness after this surgery. Continue to do the deep breathing and coughing exercises you were taught while at the Heart Institute. Do these three to four times a day for the first few weeks.

Use your “teddy” to support your incision. This will make it more comfortable for you.

RESTRICTIONS ON LIFTING

There are no formal lifting restrictions while recovering from minimally invasive surgery. However, general guidelines include:

  • When you feel ready to lift light objects, you can go ahead. This can be as early as one week after the operation.
  • Because the breastbone has not been cut, there is no danger of breaking it.
  • If you experience pain or feel a cracking sensation when you lift an object, you are doing too much. This is your body telling you that you are not ready for this activity.

DRIVING

If you are able to comfortably walk for more than 15 minutes in one session without shortness of breath and fatigue, you may drive. Generally, this happens about three weeks after discharge.

Wear your seat belt. If it is uncomfortable for the incision, use your “teddy” or a folded towel under the seat belt to relieve the pressure on the incision.

RETURN TO WORK

Discuss this with your surgeon when you come for your check up after surgery.

You can expect to be off of work for about 12 weeks after your surgery. However, you can confirm with your surgeon at your follow-up appointment in 4-6 weeks after your discharge when is the best time for you to return to work.

Valve Surgery Discharge Guidelines

GENERAL PRECAUTIONS

As your body recovers from surgery and adjusts to the new valve or valve repair, it is important to weigh yourself every day for the first month at home and report to your surgeon any steady weight gain greater than 2 kg (4.5 to 5 lbs) over two to three days. A quick weight gain is a sign of fluid retention.

Report any of the following symptoms to your doctor:

  • Increasing shortness of breath
  • Numbness or weakness in your arms or legs
  • Blurred vision
  • Flu-like symptoms, such as feeling unusually tired
  • Rapid or a newly irregular heart rate
  • A fever of greater than 37.5 degrees Celcius
  • Infections of any kind

PREVENTING DENTAL COMPLICATIONS

Bacteria in your mouth can enter your bloodstream through your gums and infect your heart tissues and valves. You can lower this risk by following regular oral hygiene practices including brushing and flossing your teeth.

When you go to the dentist:

  • Be sure to tell your dentist that you have had valve surgery.
  • Do not have dental work done for at least six months after your surgery unless there is an urgent problem, for example, a toothache or an abscess.
  • After that time, see a dentist at least once a year.
  • You must take antibiotics before any dental cleaning or treatments.
  • Your dentist or family doctor will give you a prescription before your appointment.

PREVENTING OTHER INFECTIONS

Your skin is a barrier against infections. Pay careful attention to any breaks or cuts in the skin.

Contact your doctor if you develop:

  • A fever
  • Abscess
  • Cuts that become swollen or tender and drain pus
  • Any other suspected infections, including urinary tract infections

Avoid getting new body piercings or tattoos.

Get the pneumonia vaccine (Pneumovax, the effects of this vaccine last several years) and the annual flu shot. This will reduce your risk of pneumonia and is recommended after your valve surgery. Please wait for one month after discharge from surgery to get your flu shot.

If you are on Coumadin® (Warfarin), refer to page 23 for specific instructions.

NOTIFY YOUR DOCTOR & MEDICAL ALERT

It is important that any health care professional involved in your care know that you have had valve surgery. Notify any health care staff that you consult that you have had valve surgery and wear your medical alert bracelet at all times.

If you do not have a medical alert bracelet with your new valve information, you should get one. You can add any other important medical information onto it as well (ex: allergy information).

FOLLOW-UP CARE

All patients who have had valve surgery at the Heart Institute receive follow-up calls from the Cardiac Surgery Valve Clinic.

Regular tests of your valve using ultrasound (echocardiogram) will also be arranged or coordinated if you do not have your own Cardiologist. Sometimes, if you have moved, it is difficult for the Valve Clinic to contact you. Let them know if you have changed your address.