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Bypass surgery
What is it ?
OPCAB (Off Pump Coronary Artery Bypass)
The bypass surgery done without connecting the patient to of heart-lung machine or pump is called OPCAB.
The location and degree of coronary artery blockages are determined before surgery by using a procedure called heart catheterization, or coronary angiogram. This procedure provides an outline, like a road map, of the arteries of the heart.
Factors favoring bypass surgery -
Bypass surgery is often recommended over angioplasty when the left main coronary artery is narrowed by more than 50 percent, when angioplasty does not relieve angina, when many arteries are narrowed, or when the heart's left ventricular pumping function is substantially impaired. Bypass surgery is also preferred over angioplasty in diabetic patients who have two or three vessels involved.
Benefits -
Bypass surgery can very effectively relieve angina and can even prolong life in people with severe coronary
heart disease, such as those with three-vessel involvement associated with impaired left ventricular pumping
function. However, the success of bypass surgery on symptoms and on survival depends upon several factors,
including the pattern and extent of arterial narrowing, the general progression of coronary heart disease over
time, and the blood vessels used for bypass. In general, bypass surgery is more likely than angioplasty to
provide complete revascularisation.
About 95 percent of people who have narrowing of several arteries have improvement or complete
relief of their angina immediately after surgery. About 85 to 90 percent of people remain angina-free at one to
three years after surgery, and about 75 percent of people remain angina-free or free of major coronary events at
five years after surgery. By 10 years, about one-half of all grafted vessels become narrowed or occluded, and by 15
years, about 85 percent of grafted vessels become narrowed or occluded. These late events usually require a second
surgery
Recovery from bypass surgery -
It usually takes a while to recover from even routine bypass surgery.
However, about 70 to 80 percent of people who have this surgery are eventually
able to return to work; this is about the same as the percentage of people
who are treated medically and are able to return to work. Factors that
appear to have a role in a person's ability to return to work are the
presence or absence of angina after surgery, employment status before
surgery and income, the function of the heart's left ventricle, and age.
Why is it Done?
Bypass surgery is done to restore blood flow to those areas of the heart
which are supplied by coronary arteries that are blocked. If the blood
flow to theses areas is not restored, then the heart muscle will be irreversibly
damaged affecting the functioning of the heart.
How is it done?
A team of surgeons performs coronary artery bypass surgery. The operation
takes 3 to 6 hours, depending on how many blood vessels need to be bypassed.
One cut (incision) is made in the center of the chest at the breastbone
to allow the surgeon to see the heart and for detaching an artery in the
chest, called the internal mammary artery, for doing the bypass surgery.
Another incision may be made in your leg to remove a vein that will be
put in your chest. If required the patient is then connected to a heart-lung
machine that supplies oxygen to blood and circulates
it back into body while the surgery is performed. At EHIRC, majority of
operations are done without the heart lung machine.
If a vein is used for the bypass, one end of it is sewn
into the aorta (the main artery from the heart to the body). The other
end is sewn into the area below the blockage in the coronary artery. If
the mammary artery is used, the lower end of the mammary artery is cut
and reattached to the coronary artery beyond the blockage. In either case,
the blood then uses the new vessel as a detour to bypass the blockage.
When the surgery is finished, heart-lung machine is
disconnected, breastbone is closed with wire, and skin is closed with
stitches.
If the blocked coronary arteries are on the front side
of the heart, it may be possible for the surgeon to do the bypass through
a small incision in the upper chest. This approach does not require cutting
the breastbone and makes recovery much easier, but it is not appropriate
for most people. (MIDCAB or lateral thoracotomy).
When it is done/advised ?
Any patient suspected of having coronary artery disease undergoes
angiography. Angiography shows the obstruction, along with its severity,
location and condition of the blood vessel. A cardiologist after a thorough
review of the film will advise which patients will
benefit from surgery.
There are various consideration in taking this decision,
like age and general condition of the patient, the number of vessels involved,
various locations of the obstructions, the quality of vessel beyond the
obstruction, presence of diabetes, and of course patients' own preference.
Before ... Precautions & prerequisites
Prior to Surgery
The average hospitalization after heart surgery is about 7 days. Hospitalization
can vary greatly depending on the type of operation performed and the
degree of disability before surgery. Home recuperation continues over
a period of eight to twelve weeks after discharge. Before your operation
ask your doctor about activities and limitations during the convalescent
period.
Blood donation.
People who undergo heart surgery will need some blood transfusion during
and possibly till few days after surgery. The amount required will vary
depending upon the particular surgical procedure. However, 4 units of
blood are kept ready in the blood bank before the surgery is undertaken.
In your interest, you must arrange for 4 donors within your family and
friends, preferably of your own blood group. The blood can be donated
in our blood bank on all working days, between 9.30 am and 4.00 pm excluding
half an hour lunch break between 1.00 pm and 1.30 pm. Please contact MSW
or officer-in-charge blood bank for coordinating the blood donation.
Scheduling
Your surgeon will tell you the day he expects to perform your operation.
Sometimes, though, surgery may be delayed or postponed due to an emergency
requiring the surgeon's immediate attention, or due to unexpected findings
from preoperative testing, or as a result of an illness, such as cold
and fever.The surgical team will make every effort to perform your surgery
on the scheduled day. If it cannot be done on that day, you will be informed
as soon as possible regarding your rescheduled date.
Patient Education Programme
Patients and their family members are invited to participate in-group
meetings conducted both prior to and after the surgical experience. For
more information regarding the group meetings, please contact medical
social workers.
Emotional Preparation
Emotional preparation for surgery is as important as the physical preparation.
Both factors will play an important role in the ease and speed of your
recuperation. It is normal and natural to be anxious and concerned about
your heart surgery. The best thing you can do is to discuss your concerns
openly and frankly, with those who can assist you, such as your family
physician, the cardiac surgical team, the nursing staff or Medical Social
Worker. In the hospital, nurses, physicians and MSWs are always available
to explain what to expect before, during and after surgery. They will
explain to you the normal routine during your hospitalization and after
discharge. The important thing to remember is that the overwhelming majority
of patients who have undergone heart surgery experience an improved quality
of life.
Breathing Exercises
While you are in the hospital awaiting your scheduled surgery, certain
preparations will take place before the operation. Preparation of the
lungs is one of the most important activities as lungs are vulnerable
to infection and other problems after major surgeries like open heart
surgery. This includes exercise like deep breathing and instruction for
coughing. To help with deep breathing and coughing, the patient will be
instructed by the hospital staff and will be encouraged to practice preoperatively.
Here are some more deep breathing exercises:
In a sitting position, place your hands over the upper
region of our abdomen, just between the two angles of your ribcage. Now
take a deep breath through your nose, then, let the air out slowly with
your lips pursed as though you were blowing out a candle (observe your
ribs moving down and your abdomen tightening when you are letting the
air out).
In performing this breathing exercise, your shoulders and upper chest
should remain essentially quiet, while your hand resting between the angles
of your ribs will rise on inhalation and fall on exhalation. What you
are feeling is, in fact, the full expansion of your lungs, down to their
bottom (basal) segments. The process is then followed by a slow-pursed
lip expiration.
In order to cough and expectorate secretions from the lungs, follow these
instructions
Take a deep breath as you were just instructed; hold your breath; quickly
tighten your abdomen and cough the air out (instead of blowing it out
as you did before). Feel for the contraction of your stomach muscles under
your hands. The sensation of contraction tells you whether you have coughed.
Clearing your throat will not give you this feedback.
After surgery, patients have found it helpful to "splint" their
incision by either hugging a pillow or placing their hands alongside the
incision while coughing. This makes coughing less uncomfortable.
One of the most important measures in preparation for surgery and as a
lifelong consideration is to STOP SMOKING, preferably a few weeks before
surgery.
Incentive Spirometer
Learning and practicing deep breathing exercise before surgery will not
only keep your lungs in perfect condition-while you are awaiting surgery,
it will also make it easy to follow instructions for deep breathing and
coughing after surgery. Spirormeter will help you achieve this. This exerciser
measures the volume of air you inspire and shows you how effectively you
are filling your lungs with each inhalation.Normally, you take many deep
breaths each hour without being aware of it. They are spontaneous and
automatic and occur in the form of sighs and yawns.
In certain instances, however your normal breathing
pattern can change when you are experiencing pain following chest or abdominal
surgery, e.g. breathing tends to become shallow and deep breaths are suppressed
in an effort to minimize pain.
In this instance, it is important that you strive to
resume your normal breathing pattern, despite any discomfort you may have.
Taking the deep breaths (you might ordinarily suppress), will help prevent
the possibility of respirator complications.
By carefully following your physician's instructions
you will begin receiving the benefits of slow, deep breathing exercise.
With the help of this program, you can hasten your recovery and you should
be well on your way towards better breathing.
The day before
You will have many visitors from the hospital staff.
The anesthesiologist will come to visit you preoperatively to discuss
how you will be put to sleep, and how all your vital functions will be
monitored during surgery and for a time after surgery. He/she will ask
for information about your medical and surgical history, especially any
allergies. Members of the cardiology staff will also be coming to examine
you and they will be following you along with the cardiac surgical team
during your hospital stay. Members of the laboratory staff will be coming
to obtain numerous blood and urine samples so that abnormalities, if any,
may be detected.
Shaving
On the evening before surgery, hair over your body will be shaved. This
is to reduce the chance of any infection. In addition, you will be asked
to shower with a special cleansing soap to prepare your skin for surgery.
Remember to:
Hand-over personal items, clothing and all valuables,
including rings, to your relations for taking them home. Slippers, dentures,
glasses, toilet articles, hearing aids etc. may also be taken back and
can brought again to you one or two days after the operation when the
need arises.
Nil orally after midnight
You also may find that some of your cardiac medication may be adjusted
in the day immediately before surgery. After midnight, you will told not
to eat or drink anything except sips of water for some medications, if
need be. You will be given medication so you can sleep well.CommunicationSince
the operation is long, and visiting is restricted, unnecessary crowding
in the hospital is not encouraged. After the operation, the doctor will
contact the family waiting in the lobby, through the receptionist. One
of the attendants will be able to visit the patient in the recovery room
and talk to the surgeon about the surgery.
Morning briefing
Daily briefing session is held every morning in the Medical Social Worker's
office on the ground floor, to brief your attendants about your progress
and future plan while you are recuperating in the postoperative critical
care areas.
Assistance in the lobby
Assistance desk, manned by a Medical Social Worker and/or the lobby manager
provides help, assistance, guidance and information to the patients and
the attendants visiting the hospital.
Internet/SMS
Update on patient's condition will soon be available over the Internet
at www.ehirc.com and through SMS services on cellular phones. Contact
Information counter or go to "Track patient progress."
Family visit
Two members of your family will be able to visit you on the day of your
surgery between 6.30 a.m. and 7.00 a.m.
Before shifting to operating room
On the morning of surgery, you will be given medicines and injections.
These are prescribed by your anesthesiologist and are intended to make
you feel better, control anxiety and may make you somewhat drowsy. The
side-rails will be placed up so as to act as a subtle reminder not to
get out of bed without assistance. Shortly after receiving these medications,
you will be transported to the operating room. Those in distant wards
are not given the sedatives.
In the Operating Room
Once in the operating room your anesthesiologist will begin intravenous
fluids and attach you to the electro-cardiogram monitor. Anesthesia will
then be administered.Most of the patients who undergo open-heart surgery
have their surgery performed through splitting of breastbone. This means
your incision will extend from where your breastbone begins (slightly
below your clavicles) to about where it ends. To close the incision, the
two edges of breastbone are wired together. These wires remain in the
bone permanently (the only time you will be able to see the wires is if
you have opportunity to see your chest X-ray). The skin on the chest is
closed with sutures. The entire procedure takes about 5-6 hrs.
Know the wards you will be in after surgery
You may be spending time in some or all of these units prior to your discharge
from the hospital.
Recovery Room (RR)
When the operation is finished you will be taken to the Recovery Room
(RR) or Intensive Care Unit. These areas are designed specifically to
give you constant specialized care and monitoring. Doctors, nurses and
other highly skilled people work together with you toward the goal of
a smooth recovery. Most patients remain in the Recovery Room for approximately
24 hrs. Some patients may have to remain longer if deemed necessary. Since
visiting is limited to one person per patient and is very brief, it is
recommended that it be restricted to the immediate family.
Intensive Care Unit (ICU)
The Intensive Care Unit like RR, has been specially designed and equipped
to provide maximum nurse observation and care of patients during the period
of recovery. Much patient centered activity occurs in both these areas.
You may find the Intensive Care Unit a bit strange. For one thing, it
is hard to keep track of time in a place where the lights are always on
and there is a constant bustle of activity. Under such conditions, it
is possible that your senses will mislead you and you will feel somewhat
disoriented and confused. It is as if there is no night. The medication
given to reduce pain also may also add to your sense of confusion.
The temporary confusion that you may feel is just that-"temporary".
It is not serious, and it will resolve within a day or two after you are
transferred to quieter quarters. Once you are able to catch up on your
rest, you will be able to think clearly again and return to your normal
sleep pattern.Visiting in ICU is also limited to one person at a time.
Intensive Coronary Care Unit (ICCU) Coronary Care Unit (CCU) Intermediate
Care Ward (ICW)
These are the other step-down units where you stay for about 24/48 hrs.
The monitoring and nursing care is just the same in these units. As the
visiting time increases and you become gradually more ambulatory, you
start feeling much better and are then shifted to the postoperative ward.
Post operative floor
Once in a regular room you will be able to sleep for longer undisturbed
periods. You will continue to receive the necessary medical and nursing
care designed to return you to "normal". You will be encouraged
to take an active role in the activities of daily living while being closely
monitored by the health-care team.
After
Care after surgery
Once in recovery room most patients regain consciousness
slowly following heart surgery. As you wake up you might even be wondering
when the operation will begin only to be told that it is over. You will
probably feel very tired and sore in chest, neck or back and you may be
confused as to where you are. There will be many people around your bed,
but this is no cause for alarm because they are there to help you. There
will be a tube in your throat, and you will not be able to speak till
such time that this tube is in place. During this period you will be able
to communicate through gestures or by writing on a piece of paper provided
by you nurse The tube will be removed shortly and then you can talk.
As you become aware, you will notice that there are
electrodes (pads) on your chest and transducers, which are connected with
electrical wires to the cardiac monitor. This will give a constant readout
of your heart rate and rhythm (ECG) and blood pressure. This monitor also
has a built-in warning system to alert the doctors and nurses should any
changes happen outside the normal range. Two drainage tubes are placed
in your chest at the end of surgery. They remove air and fluid and are
connected to vacuum containers at the side of your bed. These containers
make a bubbling sound you will be able to hear. These drains are generally
removed 24 to 48 hours after surgery.
Normally there is a tube placed in your bladder when
you are asleep so as to allow all the urine your kidneys produce to be
collected and monitored constantly. Your urine output is one measure of
your kidney functioning. It is generally removed a day or two following
surgery.Almost every patient has "standby" pacemaker so that
the surgeon can speed up a slow heart rate or control an irregular heart
rate by just adjusting the pacemaker box. This is not a permanent pacemaker.
The pacemaker box will be removed before you are transferred to a regular
room. The wires themselves will be removed a day or two before you go
home.
When you are asleep in the operating room, but before
surgery begins, the anesthesiologist will insert a "breathing tube"
into your throat. This tube actually is placed through your vocal chords
into trachea (windpipe) and when in place will not let you speak as mentioned
earlier. This tube is inserted to assist you in breathing while you are
sleeping. At surgery, the breathing tube is connected to a respirator,
which moves air and oxygen in and out of your lungs. It also helps in
removing secretions or mucus from your lungs and breathing passages. As
you recover from the effects of anesthesia, the respirator also allows
you to do more of breathing for yourself.
When you are able to perform an adequate job of breathing
on your own and when you are fully awake, the breathing tube will be removed
(usually 6-16 hours after surgery). Within hours after the breathing tube
is removed, most patients are able to drink and eat. Oxygen by way of
a mist mask will be given to you for few days, so as to provide your blood
with additional oxygen reserve.You will be fed through your veins for
a short period after surgery, though you will also begin eating during
this period. One or more tiny plastic tubes will be in arm veins, and
through them you will receive fluid and medications.
How rapidly you progress through the patient care units
will be determined by your condition, your body's response to surgery
and most important your will power. During the first few days you will
be observed constantly by the healthcare team. Your blood pressure will
be taken frequently and doctors and nurses will observe your other vital
signs carefully. Each day you may have a chest-X-ray and an electrocardiogram
taken and blood tests done. The tubes in your body will be removed as
you improve.
You will be given medication for your discomfort. "Pain" medication
does alleviate most of the discomfort, but all of the discomfort is not
removed. An effective "pain" medication makes it easier to cough
and deep breathe, make the discomfort easier to deal with, and makes it
easier for you to work towards your recovery.Your active participation
is essential for your recovery.
Doctors and nurses will carry out their duties of constant
monitoring and giving medications when necessary but your contribution
is equally vital in keeping your lungs clean and open. You are helped
to turn from side to side. Foot and leg exercises stimulate your circulation.
Due to all the activity, the lack of sleep and the constant noise of the
critical care area, you may find it hard to determine what day it is or
what time of day it is. It is not uncommon for patients to experience
"weird" dreams or be slightly confused as to recent events.
All of these things are transitory and will disappear as soon as you get
adequate sleep and a quieter environment. One of the most important ways
you can help yourself is by coughing and deep breathing. The breathing
exercise you practiced before surgery will be continued every hour for
a while so as to clear your lungs of mucus. To facilitate deep breathing
and promote circulation, you may be allowed to get out of bed to sit in
a chair.
On the post-operative floor
By the time you move into your room, most of the tubes will be out and
you will be eating and drinking. Now mobilization and rehabilitation begins
and you will be encouraged to get up, walk, cough and do other things,
which may seem overwhelming to you. You will still have chest X-rays,
ECG, and blood tests, but not as frequently as before. You will have access
to telephone and television in your room so you will feel much more in
touch with outside world. You will also be able to sleep for longer, undisturbed
periods.
During the postoperative period it is not uncommon for patients to experience
some heart arrhythmias. These arrhythmias are generally due to the irritability
of the heart and temporary metabolic changes in the body following surgery.
Family members should be aware that they might also
receive the brunt of the patient's depression or anger because it is easier
and safer to direct feelings at them rather than at the hospital staff.
The doctors, nursing staff as well as the cardiovascular nurse and cardiovascular
social worker, will be valuable resources to assist the patient and family
during the difficult time.
How you Feel ?
Often, emotions are unstable at this time. It is not uncommon to feel
depressed or angry or out of control at this point. There are both psychological
and physiologic reasons for your emotional upheaval. Firstly, the heart
carries with it many psychological connotations in our society; it is
thought of as the seat of 'love' and 'emotions'. Also, the desire to get
better and to go home conflicts with the reality of residual soreness
and the desire to be protected from further discomfort. Manifestations
of this depression can be a lack of appetite or apathy or crying but all
of these symptoms should go away with time. All of these transitory personality
changes should disappear by two to three months postoperatively.It may
be a while before you feel a marked improvement in the sense of being
well. During your recuperation you will experience "good" days
and "bad" days. The recovery period can be emotionally and physically
trying for both the patient and the family. Many patients feel isolated,
as they begin to make the transition from illness to health. Unpleasant
emotions such as anger, denial, frustration, depression and hostility
can occur.
YOUR RECOVERY AT HOME
Going home
Now that your heart surgery is completed and you are in the process of
healing, it is time to prepare for your return home. If you have any other
questions, please ask your doctors, nurse or cardiovascular social worker
about them. It is not unusual to feel apprehensive or depressed about
leaving the hospital. The hospital has provided you with a sense of security.
Just remember that you will not just discharged until your doctor feels
you are fit. The key to a successful home recovery is moderation especially
with your activity. Plan for plenty of time to relax as you begin returning
to your normal activities. The following general guidelines and your doctor's
specific instructions can help your home recovery to be a safe, relaxing
time for you.
Your home routine
Once you are home, try to resume a normal routine. It is important to
arise at a reasonable hour, shower daily and dress in street clothes.
Never stay in sleeping clothes during the day. It is important for you
to think of yourself as healthy and active rather than sick.Take a mid-morning
and mid-afternoon rest following periods of activity. Rest periods are
helpful following activity, so after taking a morning walk come home and
take a short nap. You will be able to perform more activities as more
time passes, so be patient. And walking is particularly good exercise
and will speed your recovery.
Your recovery graph
Your initial recovery from surgery should take six to eight weeks. Given
below is your recovery graph. It is full of ups and downs. During that
time expect to have some good days and some days that are not as good.
This is all part of the normal healing process. It is common for patients
to feel sad or "blue" after surgery. This may be due to not
knowing what to expect when you return home. It may also be related to
not being not able to perform simple tasks without becoming fatigued.
These are normal responses that will gradually go away over the first
few weeks after you resume regularly activities.Also, it is very common
to experience vague pains in your chest, shoulders and back region during
the first six to eight weeks. These are not heart pains, these are the
healing pains. Do not get upset by these muscular pains. You could seek
reassurance from your family physician whenever they occur.If you become
bored and feel that time is standing still, if you find that you are feeling
depressed, the best way to feel better is to talk about your feelings
with your spouse, family or close friends. Sometimes family members can
contribute to your depression without knowing it, so discuss this too.
Many patients report that this is a very trying time. You and your family
may experience anger and frustration. As a rule, these feelings will subside
as you resume your usual activities.
Walking
Your walking programme should begin from the 3rd or 4th day of your surgery.
Walk slowly. Gradually increase the distance covered each day. Remember
not to over-tire yourself, alternate your activity with rest and never
take a walk immediately after your meals.
Climbing stairs
It is all right to climb stairs from the day of discharge but do it slowly.
Rest frequently if you become tired, short of breath or dizzy. You should
try to limit climbing stairs to once a day for the first two weeks after
discharge.
Household chores
You should not plan to assume total responsibilities for the household,
care of children, or meal preparation until after your checkup with the
surgeon. As you feel stronger, you may help with light household duties,
such as dusting the furniture, setting and clearing the table or assisting
with meal preparation. Avoid any activity that causes incisions discomfort
or causes you to tire easily.
Lifting and staining
Try to avoid lifting anything weighing more than 3 kgs., such as grocery
bags, suitcases or briefcases and even small children. Anything that creates
force in your chest/upper arms can interfere with breastbone healing while
you recover.
Getting up from a chair
Try not to put your body weight on your hands while getting up from a
chair. Use armrest for help but not for total support.
Getting out of bed
Getting out of bed is easier if you do the following:
Move closer to the edge of the body by rolling over
on your side.
Swing your legs to the floor and push your upper body up with your elbow;
use side rails for help but not for total support of the body weight.
Sit on the side of the bed for a couple for minutes to make sure you will
not be dizzy.
Stand up
Pushing and pulling
To limit strain on your breastbone, avoid pushing or pulling anything
heavy like furniture items, mowing the lawn, mopping, vacuuming, straining
to open a stuck window, twisting a bottle cap or jar lid or pushing open
heavy door.
Driving
Since it takes 7-8 weeks for your breastbone to heal let others drive
during this time (arm motion from steering can intensify your chest pain).
Your medications may also make you drowsy and slow your driving reflexes.You
are permitted to ride in a car, but extended automobile trips should be
avoided. If you have a long drive home, stop every one-hour. Get out of
the car and walk around for ten minutes before continuing the trip.
Incision care
Many patients and attendants feels that they should not leave the hospital
till all the stitches are removed. It is really not necessary, if you
maintain personal hygiene and do proper cleaning and dressing of your
stitches. This is very important in order to avoid infection. Remember
that your stitches are quite safe if you take care of the following points
while handling them at home:
The incision site should not become wet.
The stitches should be cleaned with Betadine lotion everyday.
The attendant must wash hands properly; the nails should be clipped before
cleaning the stitches.
Pour Betadine lotion in a clean and dry bowl.
Betadine lotion should never be diluted.
Do not use cotton wool for cleaning the stitches. Use sterile gauge or
sterile pads instead.
You need to take four pieces of sterile gauge/pad (cut it in four pieces).
Dip one piece of gauge/pad in Betadine lotion and gently clean the stitches
in one direction.
Do not press or rub hard. Repeat the process four times.
Do not keep touching the stitches or place hand on the chest while sleeping.Clean
the leg stitches also in the same manner. Patients with leg stitches should
not sit cross-legged.
Avoid sitting on floor/low stools etc. Do not use Indian-style toilet
seat. If you have to sit on a chair for a long time, place your legs on
some stool/another chair i.e. at hip level. This will prevent swelling
in the feet, which is otherwise very common.
Let the lotion get absorbed for at least 5 minutes before
you put on your clothes.It is fairly easy to do the dressing and you do
not need any professional help for this. Thus, there is no need to come
to the hospital for the same.Till the stitches are removed, daily sponging
is required. Use lukewarm water with few drops of Dettol or Savlon in
it. Use a clean towel and make sure that the wet towel does not touch
the stitches.
Wear the crepe bandage everyday for the coming eight
to ten weeks. It helps prevent pain and swelling in the legs. It is important
to wear it at the nighttime also till the stitches are not removed.
The crepe bandage should be washed every day with cold
water. Do not use brush or squeeze hard to remove access water. It shouldn't
be hung to dry. Put it on a railing/back of the chair etc.
Bathing
After the stitches are removed you could start taking bath. Please take
care of the following points:
It is advisable to sit on chair/stool while bathing.
Avoid putting any oil or ointment on the incision site before bathing.
Use lukewarm water for bathing.
If using bucket, it should also be placed on another stool of equal height;
do not lift or shift the bucket yourself as it would put pressure on the
chest.
Clean the incision site with any ordinary soap. There is no need to buy
any medicated soap. Do not rub the soap cake directly on the incision
site. Always first apply on the palm and then clean the site.
After taking bath, pat dry the incision site with clean and soft towel.
Always sit on the chair while wearing the clothes, as some times one can
lose the balance.
Recreation
Physical activities such as tennis, swimming, bowling, golf other than
walking, should be postponed for seven to eight weeks from the day of
the operation. You may participate in those activities that do not require
physical exertion, such as playing cards, going to the theatre, restaurant,
needle work, reading, writing, visiting friends etc.
Sex
Many patients and their partners feel anxious about resuming sexual activity
about surgery. Rest assured that sex won't interfere with your healing
although you may feel more comfortable sharing your affection in non-sexual
ways, like going out to diner, dancing or just being close for the few
weeks after surgery. Talking about your feelings with your partner can
help you both feel at ease. Resuming sexual relations after open-heart
surgery depends on how you feel mentally and physically. Sex, like any
other activity should be performed when you are rested and comfortable.
The exertion reached by patient during intercourse is similar to walking
approximately half a mile at a brisk pace or climbing one or two flights
of stairs. So, when you can perform these activities without becoming
fatigued or short of breath, sexual activity can be resumed.
When you feel ready for intercourse, any position is
fine, as long as it is conformable, relaxing and allows for easy breathing.
For the fist six weeks, refrain from assuming the upper prone position;
rather take the supine (lower), side to side, or sitting position. Women
should check with a doctor about the adequacy of previously used birth
control methods and advisability of pregnancy. Women may notice some delay
in the resumption of menstrual periods due to stress of surgery. This
is normal. Try to make all activities intermittent and take regular rest
periods. Progress is made by gradually increasing the length of time for
an activity as well as the level of energy.
Rest periods
During the four to six weeks recovery period you should plan to get eight
to ten hours of sleep at night. The body requires more sleep during the
healing process. Activities should allow time for at least two rest periods
a day to avoid becoming overtired. It is not necessary to go to bed or
to sleep during the rest periods, just rest.
Visitors
Support from your friends and family can help you feel better, but you
need rest and relaxation too. Feel free to ask your visitors to leave,
or excuse yourself, when you begin to feel tried. During the first few
weeks, two visitors a day are usually plenty.
Return to work
You may return to work in approximately eight weeks after discharge. Because
it is impossible to predict the rate of recovery after your discharge,
please check with your local doctor as to the exact date of your return.
When you go back to work or school, try to arrange to begin on a part
time basis until you feel ready to assume full time daily.
It takes a little longer for patients who have complications before during
or after surgery. Also for associated problems like valve disease, cerebro-vascular
accidents, renal complications etc. take a longer time to resume work.
Diet
There will be no dietary restrictions for the time being, unless you are
a diabetic or have some other special problems. This will give the body
time to heal. You should eat well-balanced meals. It is a good idea to
avoid fatty, fried foods and foods high in salt and cholesterol. For the
first four to six weeks take a high protein diet. You need the iron and
protein rich diet to help promote healing and rebuild the red blood cells
that were lost during surgery. Spinach and leafy green vegetables are
also high in iron and should be added to the diet. Your cardiologist will
regulate you diet in four to six weeks when your body has a chance to
recover from the surgery. The dietician will help you to plan your long-term
diet.
Patients, who have undergone valve replacement surgery
and are on anticoagulant therapy, should avoid excessive amounts of foods
high in vitamin K such as green leafy vegetables, like spinach, cabbage
and others like tomatoes and cauliflower.
Drinking
Never drink alcohol during the recovery period. Remember painkillers,
tranquilizers or sleeping pills, will increase its effect. Drinks with
10-12% alcohol content like wines are allowed to an extent of 120 ml every
day. Drinks with 40% alcohol content like whisky, rum, gin, vodka etc.
are allowed to an extent of 50 ml. every alternate day.
Smoking
Smoking has been proven to be an important risk factor in the development
of heart disease. It is very important that you stop smoking and do not
resume it. Smoking increases the heart rate, narrows the blood vessels,
raises blood pressure and damages the lungs. It will be difficult to quit
smoking but it is very important you do so.
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