Recovering at Home

Q: What can I expect when I am recovering at home?

A: Within 5 to 10 days, most patients are eager to leave the hospital despite some apprehension about giving up the security of an expert medical team. It is important to be patient with the pace of recovery, even after discharge from the hospital.

Remember, fatigue is normal after a major operation like heart surgery. You shouldn't be surprised to find that one day you feel strong, while the next day you feel tired and weak. Don't get discouraged; your recuperation period will allow the body to heal, replenish its blood content, and increase its strength and endurance.

CUMC has both in-patient and out-patient cardiac rehabilitation programs. We can refer patients to a variety of home health care agencies if necessary for post-discharge home care and cardiac rehabilitation. Please speak with your physician and social worker about these options.

Q: How do I pace myself once I am home?

A:

  • Rapid change of position (sitting to standing or vice versa) may be accompanied by dizziness if done too quickly.
  • Rest whenever you get tired.
  • Rest between activities. If you need to rest for more than one hour after an activity, you may be pushing yourself too hard. Do a little less the next day.
  • Avoid placing undue strain on your chest region by sitting in one position for long periods of time.
  • When sitting or standing, use your leg muscles—do not use your arms to lower or raise yourself from your chair.
  • Do not cross your legs—it interferes with blood flow.
  • Avoid prolonged periods of inactivity (like long car trips or air travel).

Q: What does a daily routine look like?

A: We suggest you identify and stick to a regular daily routine. This will I help you build your strength and help you recover faster.

  • Try to get 6 to 8 hours of sleep each night. Go to bed at the same time each night.
  • Wake up and shower each morning at approximately the same time.
  • Weigh yourself daily.
  • Take your temperature (if you feel warm or if you have chills).
  • Get dressed in regular daytime clothes. This will make you feel more like being active.
  • Eat breakfast.
  • Take your medication.
  • Plan your day during breakfast to help you from getting too tired.
  • Follow the walking plan provided by your physical therapist.
  • Avoid prolonged naps in the daytime—they may prevent you from sleeping at night.

Q: How should I shower and take care of my incision(s)?

A: You may shower if your surgeon has approved this prior to discharge. Your incisions may itch or feel sore, tight or numb for a few weeks. Some bruising around the incisions is also normal.

  • Use warm (not hot) water.
  • You may wash your incisions gently with soap and water, but do not scrub them.
  • Pat your incisions dry.
  • Do not take baths or use powders or lotions near the incisions.

You may have white pieces of tape on your chest. These are called "steri strips". They will gradually fall off. If they have not fallen off in two weeks, gently peel them off.

If you find it more comfortable, a thin layer of gauze may be placed over the incision(s). Women may wish to place cotton or soft material between the bra and incision.

Q: Should I weigh myself?

A: Weigh yourself daily. Rapid weight gain can be a sign that your heart is not pumping efficiently. If you gain more than 2–3 pounds in one day or more than 3–5 pounds in one week, call your cardiologist.

Q: Should I take my temperature?

A: If you feel warm or chilled, take your temperature 3 times a day (morning, afternoon and evening). Call your cardiologist if your temperature exceeds 100.4 degrees.

Q: What is the best meal plan to follow?

A: You may notice that after surgery you have lost your appetite for food or just feel too tired to eat. This is very common, but you need nourishment to enable your body to heal and get stronger.

  • Eat a balanced diet and drink adequate fluids to encourage a return to your normal bowel pattern. Do not take laxatives unless specifically instructed by your doctor.
  • If your physician recommends a diet based on your individual needs, you should have received written information to help you follow the plan at home.
  • Eat a variety of foods. You may want to eat many small meals throughout the day instead of three larger meals.
  • Avoid too much saturated fat and cholesterol.
  • Eat foods with adequate starch and fiber.
  • Avoid too much sodium/salt.
  • Avoid too much sugar.
  • Maintain ideal weight (consult your physician).

Q: What are the rules about medications?

A: Take all medications prescribed by your doctor as directed. Do not change the dosage of your medication without your doctor's approval.

Q: How is pain relief managed?

A: If your doctor did not prescribe a pain medication prior to discharge, Extra Strength Tylenol™ is an effective painkiller for pain around your incisions or your chest. If Tylenol™ does not control the pain or the pain becomes more severe or happens more often, call your surgeon or your cardiologist.

Q: What if I have swelling?

A: Your legs may swell a little, especially if you had veins removed from your legs during surgery. This occurs because excess fluid collects in the tissue when you are not moving around as much. To control the swelling:

  • Get up once an hour and walk around for a few minutes.
  • When sitting or sleeping, keep your leg(s) elevated. To help with circulation, avoid crossing your legs.

Q: Exercise Program.

A: The following exercises are to be done in conjunction with the walking program.

Leg Strengthening-Sitting

Purpose: To strengthen your thigh muscles.
Position: Sit on a firm chair with both feet flat on the floor.
Action: Lift your foot slowly until leg is completely straight. Hold. Slowly lower your foot down. Repeat.

Foot Taps-Sitting

Purpose: To increase motion in your ankles, to improve circulation, and to improve the strength of your ankle muscles.
Position: Sit in a chair and place both feet flat on the floor. (This can also be done lying in bed).
Action: Leaving your feet on the floor, tap your foot up and down. Each time, raise your foot as high as possible. Repeat.

Knee Raises-Sitting

Purpose: To Strengthen your hip muscles.
Position: Sit in a chair with both feet flat on the floor.
Action: Raise one knee up towards your chest as high as possible. Slowly lower it. Repeat.

Shoulder Exercise

Purpose: To increase the motion in your shoulder and/or to strengthen your shoulder muscles.
Position: Stand with your arms at your side
Action: Raise your arm straight up above your head. Lower it back down and raise other arm up. Relax. Repeat.

Q: What is the usual walking program?

A: Studies have shown that people who exercise at least 30 minutes per day, 5 days a week remain healthier and experience fewer problems. They may also live longer. Most patients should be capable of walking at least 1-1.5 miles per day at one month after surgery.

As you recover from heart surgery, walking represents the best form of exercise for you. You should consult with your doctor before taking up more vigorous forms of activity such as swimming or biking.

When you begin a walking routine, or using a treadmill, pick a time that is convenient and stick to it. Walk on level ground, in a rhythmic and even pace, letting your arms swing at your sides. Wear comfortable walking shoes and dress appropriately for the weather.

Avoid exercise for up to 1-1/2 hours after eating, and don't walk outdoors when the temperature or weather makes you uncomfortable. When the weather is severe, walk indoors at a shopping mall or at a health club with an indoor track or treadmill.

If you begin to feel very tired, short of breath or dizzy, rest immediately and reduce the distance you walk the next day. If you experience chest pain, nausea or vomiting, headache or pain in your jaws, teeth, arms or ears, or any of the symptoms you experienced before your surgery, contact your doctor immediately and do not resume walking unless your physician approves.

Q: What other activities should I do or avoid?

A: As you feel stronger, you can go out and do more. At first, keep activities to about an hour.

Activities to try:
  • Crafts, painting, knitting
  • Cards or table games
  • Walks with friends
  • Shopping, movies or sports event
Activities to avoid:
  • Swimming
  • Driving
  • Golfing
  • Strenuous activities

Q: Is sexual activity OK?

A: Thousands of heart patients have learned that having heart disease, a heart attack, a stroke, or undergoing surgery does not mean an end to a satisfying sex life. After the first phase of recovery is complete, patients find that the same forms of lovemaking that were pleasing before are still rewarding.

Many myths surround sex after heart disease. The most common one is that resuming sex often brings on a heart attack, stroke or sudden death. This simply isn't true. There's no reason why a heart patient can't resume usual sexual activity as soon as they feel ready to do so. Talk with your doctor if you have any concerns.

Fear about performance and general depression are two psychological factors that can greatly reduce sexual interest and capacity. After recovery, heart patients may feel depressed. This depression is normal, and in 85 percent of the cases it disappears within three months. However, it tends to exaggerate whatever previous sexual problems were present between partners.

  • Feel free to resume sexual activity once you've checked with your doctor.
  • Until your sternum has healed to its full strength (approximately 6 weeks), it is suggested that the patient is located in the bottom position or a side-by-side position is utilized.
  • Choose a time when you are rested, relaxed and free from the stressful feelings brought on by the day's schedules and responsibilities.
  • Wait one to three hours after eating a full meal so that digestion can take place.
  • Select a familiar, peaceful setting that is free from interruptions.

Q: When do I call my doctor?

A: If you experience any of the following symptoms, it is essential for you to let your doctor know:

  • Chills, or fever above 100.4 degrees
  • Fainting or a severe headache
  • Drainage from an incision
  • Loss of consciousness
  • Pain not relieved by pain medication
  • Blood in urine or stool
  • Fluttering in the chest or a rapid heart rate (palpitations), angina or any of the symptoms you experienced before your surgery
  • Shortness of breath that does not go away with rest
  • Nausea, vomiting or diarrhea
  • Increased swelling, redness or bruising in or around the incisions
  • Marked swelling of legs, ankles and/or feet

Q: What should my caregivers know?

A: Open heart surgery affects not only the patient but family and friends, too. Caregivers can be the most important person in the patient's recovery. That is why you are an important part of the healing process. Patients, family members and friends have helped us to develop this section so that you are aware that you are not alone.

  • Take care of yourself because you need your physical and mental strength in order to support the recovery of the patient.
  • Recognize that in addition to your loved one, you may also feel angry or depressed. Try to talk openly about your feelings. You may want to talk with a friend or other family member first.
  • It is beneficial to designate one family member or friend to maintain communication with your surgeon and the healthcare team. This will enhance the flow of information and decrease the chance for miscommunication.
  • Respect the privacy of other patients and families by observing the visiting hours and rules of the floor.
  • If you are sick, please limit your visits to the floor. Open heart surgery and transplant patients are more susceptible to infection during their recovery.
  • Encourage loved ones to exercise. If you can, exercise with your loved one to give support and stay healthy too!
  • Join the Heart of Hearts Support Group that meets once a month at Columbia University Medical Center or join one in your area. Call 212.305.9470 for more information.

Q: How should I take care of my heart?

A: Now that you've got your heart back in optimal working order, you owe it to yourself and your family to keep it that way.

The continuing threats to coronary health, even after successful bypass surgery, are numerous: smoking, high cholesterol levels, high blood pressure, inactivity, diabetes, obesity, and a family history of heart disease.

The good news is that many of these risk factors are largely within our power to change. One of the best things you can do for your heart is to steer a course in your lifestyle that reduces these risks as much as possible.

Cigarette smoking deprives the heart of needed oxygen and contributes to the build up of fatty deposits in the coronary arteries. If you smoke, do yourself a favor and kick the habit. If you can't do it alone, join a smoking cessation group, or get help from friends, family or your primary physician.

High blood pressure is another risk factor that can be controlled by careful adherence to proper diet, exercise and medication. During the recovery period after heart surgery, individuals who are troubled by chronic stress can benefit from relaxation therapy and the avoidance of conflict.

Q: Some tips to remember.

A: During your first few weeks at home, keep these tips in mind:

  • Take your medications as directed
  • Call your cardiologist if you have any of the warning signs.
  • Move carefully to protect your incision and your breastbone.
  • Pace yourself so you don't feel rushed or overtired.
  • Exercise at least 5 days a week. Increase your time and pace slowly to reach a minimum of 30 minutes a day.
  • Talk with your family and close friends about how you feel and what you need from them.