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Trans Myocardial Laser Revascularisation (TMLR)
What is it ?
Trans Myocardial Laser Revascularisation (TMLR) is an innovative way attempting to increase the blood supply
in those areas of heart which are deficient in supply due to blockages in their coronary arteries.
The procedure is done with the help of a special Heart LASER Machine. Laser beams fired from this machine
make multiple holes from the cavity of the heart to the heart muscle thus creating channels which are supposed
to carry blood.
When it is done/advised ?
TMR can be done in patients who have defused Coronary Artery Disease
and are not suitable for any other method of myocardial revascularisation.
TMR can be done as an isolated procedure or can be combined with Coronary
Artery Bypass Grafting (CABG).
If TMR is combined with CABG it is done by median sternotomy and when
it is done as an isolated procedure, it is generally done by thoracotomy
(opening of the chest cavity from side).
TMR can also be combined with Minithoracotomy, when through the same incision,
laser procedure can be performed.
Before ... Precautions & prerequisites
Prior to Surgery
The average minimum hospitalization after heart surgery is about 07 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. This booklet will give you a general guideline as to what you
will and will not be able to do, although these activities often cannot
be determined until after surgery. It is best to discuss your questions
in the presence of your spouse or family; then everyone knows the guidelines
and has a chance to have all questions answered.
Blood donation.
People who undergo heart surgery will need some blood transfusion during
and possibly till several days after surgery. The amount required will
vary depending upon the particular surgical procedure . However, 6 units
of blood are kept ready in the blood bank before the surgery is undertaken.
In your interest, you must arrange for 6 donors within your family and
friends, preferably of your own blood group. The blood bank must be donated
in our blood bank, between 9.30 am and 4.00 pm, with 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 unexpected results of
preoperative testing, or for 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 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. This
booklet is designed to complement the group 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, your nureses, physicians and MSWs are always
available to explain what will happen to you before, during and after
surgery. They will explain to you the normal routine during your hospitalization
and after dischage. The important thing to remember is that the overwhelming
majority of patients who have undergone heart surgery experience an improved
quality of life.
Begin to formulate your discharge plans before surgery. Use this time
to the fullest to prepare yourself for what is ahead. It is in your best
interest to discuss your concerns and work for a clear understanding of
what is happening and what it means to you.
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
for infection and other problems after major surgeries like Open Heart
Surgery. This includes exercise in deep breathing and instruction in 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 yur abdomen
tightening you are letting the air out).
In performing this breathing exercise, your shoulders and upper chest
shuld remain essentially quiet, while your hand resting between the angles
of your ribs will rise on inspiration and fall on expiration. 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 eigher 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 practising 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. Spiormeter 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 usually with 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.
brething tends to become shallow and deep breaths are suppressed in an
effort to minimize pain.
In these 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 bigin 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 yur way towards
better breathing.
The Day before your cardiac care team
You will have many visitors from the hospital staff. The anesthesiologist
will come to visit yu 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 aks 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 alongwith the cardiac surgical team during your hospital stay. Members
of the laburatory 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, practically your entire bodywill 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.
to prepare your skin for surgery.
Hand-over personal items
Also, on the day before the operation, your clothing and all valuables,
including rings, are to be taken home. Slippers,dentures,glasses, toilet
articles, hearing aids etc. may also be taken back and can brought back
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 on the day of the
surgery, you will receive nothing by mouth except for some medications.
These restrictions include water. You will be given medication so you
can sleep well.
Communication
Since 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 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
A morning briefing session is organised in the Medical Social Worker's
offie on the ground floor, to brief your attendants about your progress
and future plan while you are recuperating in the post operative critical
care areas. Your family members will be able to talk to your caring surgeon
across the table and hae their questions answered.
Assistance
Assistance Desk, manned by a Medical Social Worker and/or the lobby manager
provides help, assistance, guidance and information to the patients and
the attendents visiting the hoss\pital.
THE MORNING OF SURGERY
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 ansethesiologist 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.
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 a median sternotomy approach. This means your incision
will extend from where your breastbone begins (slightly below your clavicles)
to about where the sternum ends. To close the incision, the two edges
of breast-bone 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 usually closed with
sutures. The entire procedure takes about 5-6 hrs.
PATIENT CARE AREAS
You may be spending time in some or all of these units prior to your discharge
from the hospital.
Recovery Room (RR)
Recovery Room (RR)
When the operation is finished you will be taken immediately 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. The patient may remain longer if deemed necessary. Since visiting
is limited to one person and is very brief, it is recommended that it
be restricted to the immediate family.
Intensive Care Unit (ICU)
The Intensive Care Unit just like RR, has been specially designed and
equiped to provide maximum nurse observation and care of patients during
the period of acute illness. Much patient centered activity occurs in
both these areas. You may find the Intensive Care Unit a bit strange.
For on ething, 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 nigh. The medication
give to reduce pain also can increase 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 recovery 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 little ambulatory you start
feeling much better and are then shifted to the post operative 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
Recovery Room and Intensive Care
Once in recovery room most patients regain consciousness slowly following
heart surgery. As you wake up you might even be wondering when the opration
will begin only to be told that it is over. You will probably feel very
tired ans sore in your 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. You may be surprised
at the machine and tubes connected to you just before or during heart
surgery. You will be able to communicate through gestures or by writing
on a piece of paper provided by you nurse.
Heart Monitor
As you become aware, you will notice that there are electrodes (pads)
on your chest which are connected with electrical wires to the cardiac
monitor. This will give a constant readout of your heart rate and rhythm
(ECG). This monitor also has a built-in warning system if the heart rate
is too slow to too fast.
Blood Pressure
Your blood pressure will be constantly monitored.
Chest Drains
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 abe to
hear. These drains are generally removed 24 to 48 hours after surgery.
Urinary Catheter
This tube placed in your bladder when you are asleep so as to allow all
the urine your kidney 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.
Pacemaker Wires
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.
Respirator
When you are asleep in the operating room, but before surgery begins,
the anesthesiologist will insert a "breathing tuble" into yur
mouth. This tube goes into your mouth, through your vocal chords and into
your trachea (windpipe). 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 the work of breathing for yourself. When you are bale
to perform an adequate job of breathing on your own and when you are fully
awake, the breathing tuble will be removed (usually 16-24 hours after
surgery).
With the breathing tube in place, you will not be able to talk or eat
or drink, once the tube is removed (extubated), you can talk although
you may find your voice harse and throat slightly sore. These effects
will go away. 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 several days, so as to provide your blood with supplemental oxygen.
Intravenous Tubes
You will be fed through your veins for a short period after surgery, though
you will also begin eating during this period. Two or more tiny plastic
tubes will be in arm veins, and through them you will receive fluid and
medications.
The first few days
How repidly 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 electrocarbiogram taken and blood
tests done. The tubes in your body will be removed as you imporve.
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 whant 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
ddeep 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 and ever take a few steps soon after
surgery.
On the post-operative floor
By the time you move into your room, must of the tubes will be out and
you will be eating and drinking. Now mobilization and rehabilitation begin
and you will have 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 be allowed to have a telephone
and a television in your room so you will feel much more intouch with
outside world. You will also be permitted 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 temnporary metabolic changes in the body of the surgery.
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 psychologic
and physiologic reasons for youremotional 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 your sense of
well-being. During your recuperation you will experience "good"
day 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.
Family members should be aware that they may also received 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 specialist and cardiovascular
social worker, will be valuable resources to assist the patient and family
during the difficult time.
YOUR RECOVERY AT HOME
Going home
Now that your herart surgery is completed and you are in the process of
healing, it is time to prepare for your return home. This section of the
booklet will answer your questions and give you guidelines to follow in
your recovery at 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, sholwer 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 be 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, pace yourself. Walk slowly, pace yourself. Gradually increase
the distance covered each day. Remember do not 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 becoming 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 houshold,
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 tale or assisting
with meal preparation. Avoid any activity that causes incisions discomfort
or causes you to tire easliy.
Lifting and staining
Try to avoid lifting anything weighing more than 3 kgs, such as grocery
bages, suitcases or brifcases 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 arm rest 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 siderails for helpo 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 lib or pushing open
heavy door.
Driving
Since it takes 7-8 weeks for your brestbone 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 ot
of the car and walk around for ten minutes before continuing the trip.
Incision care
Many patients and attendents feels that they should not leave the hopsital
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 Betabdine lotion everyday.
· The attendant must wash hands properly; the nails should be short,
before they clean the stitches.
· Pour Betabdine lotion in a clean and dry dowl.
· Betadine lotion should never be diluted.
· Do not use cotton wool for cleaning the stitches. Use sterile
gauge or sterile pads insteads.
· 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 stiches in one direction. Do not press or rub hard. Repeat the process
four times.
· Do not keep touching the stitches or placed hand on the chest
while sheeping.
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 toilet seat. Ilf yu 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 mins before you put on your
clothes.
It is faily easy to do the dresing 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 stiches are removed, daily sponging is required. Use luckwarm
water with few drops of Dettol or Savlon in it. Use a clean towel and
make sure that the wet towel dose not touch the stitches.
The Crepe bandage
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 night time also till the stitches are present.
The crepe bandage should be washed every day with cold water. Do not use
brush or squeeze hard to remove access water. It shouldnot be hanged 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, othe 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,
tore, 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 confortable sharing your affaction in non-sexual
ways, 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 yu 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 will their partners is similar to
walking approximately half a mile at a brisk pace or climbing one or two
flights of stairs, when hyou 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 assure
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 pregenancy. Women may notice some delay in the resumption
of menstrual period s 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 atleast two rest periods
a day to avoid becoming overtired. It is not necessary to got 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 is 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 pain killers,
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. Beer should be
taken because of its glycerol content.
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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