LIFE AFTER HEART OPERATION

A question often faced by persons after heart operations is about the life after. Will it ever be the same? In short let me tell you – It’s not going to be same. In fact, it is going to be better!

Believe me, this is not a statement by an overenthusiastic cardiac surgeon. Having observed patients over 15 years, I am convinced about the excellent improvement in quality of life after successful heart operations.

But this does not happen by chance or by magic. It is brought about by the combination of excellent operation, careful planning by the rehabilitation team comprising the doctors, nurses, physiotherapist and dietician and most importantly honest adherence to the plan by the patient.

In the following pages, we try to provide you with some guidelines regarding your activities after surgery. Remember, these are only recommendations, not rules. Some individual variations are normal for every person.

What to expect during first few weeks?

1. Tiredness: This is quite common after a major operation. The body is busy doing the repairing process of the wound. Heart is getting accustomed to the changed scenario. Allow adequate rest for the body and mind. Engage yourself in light recreations like reading and listening to music. Take a short (half an hour) afternoon nap. Watching TV excessively is not good as eye strain may cause exhaustion. As the days progress, you will feel better.
2. Reduced Appetite: There are several reasons for loss of appetite. Distaste caused by some of the medications (especially antibiotics and pain killers) is a common problem. Acidity caused by stress and some medicines is another reason. Pain and discomfort from the wounds can at times be disturbing.
3. Pain: is the commonest problem. We are all aware of the bad effects of some of the pain medicines like acidity and kidney problems. This apprehension prevents many patients and relatives of patients from using adequate pain relief. Remember there are safe pain killers which may be used regularly until pain in relieved fully. It is important to take regular pain medications in the first two weeks – at least one in the morning and one at bedtime.
4. Sleeplessness: Anxiety and pain are the villains. In the first few weeks you require adequate pain relief. Along with this, many patients need a mild anxiety relieving medicine to help them to get comfortable sleep. The medicines prescribed by our team are mild and the addiction potential is very low. So do not be afraid to take these for a short period. As the health improves, your normal sleep habit will return.
5. Swelling of legs: Mild or even moderate swelling of feet and legs are common after veins have been removed during CABG. This is because the venous blood return is affected. This is not a disease. The deep vein system will take care of the blood circulation adequately. It takes some time for the body to make this adjustment. The Swelling is usually absent or minimal in the morning when you get up. It gradually increases over the day as ‘gravity’ acts. Simple methods like leg elevation and crepe bandages or elastic stocking can relieve this problem. However, if there is redness, severe pain or discharge in the wounds, you must contact your doctor.
6. Sore throat: The plastic tube which is kept in the windpipe during anesthesia and immediate post operative period can cause mild inflammation and pain in throat during first few days. Mild pain killers and warm saline gargles can take care of this.
7. Numbness: One of the most common and consistent complaints after bypass operation is the pain and numbness in the left side of chest. Fine nerves along the Internal Mammary Artery (IMA) are cut while harvesting this artery for bypass. These are nerves that supply the front of chest. There may be numbness, burning pain, different feeling during touch or shooting pain. Usually Left IMA is taken. So the symptoms are on the left side of chest (may involve breast in women). If both IMA are used these symptoms can occur on both sides. The symptoms gradually resolve. In some cases it may persist for up to one year. On the same count similar symptoms may appear in the leg along the vein harvesting wound.

How wounds heal? 

Body has a natural reparative process for healing wounds. Generally wounds take about 6-8 weeks to heal completely. Bones may take a little longer. The new tissues will need some time to get used to the stress and strain of activities of daily life. This process is called the remodeling. It is natural to experience some discomfort during healing and remodeling stages. 

How are these wounds stitched and are there any stitches to be removed? 
The surgical wounds are stitched using special needles and suturing threads. Some materials are bio-degradable or self absorbing. They need not be removed. Some need to be removed after the necessary period (like silk and nylon). 
Generally all the wounds of heart operation are repaired using self absorbing stitch materials. These can not be seen outside and need not be removed. Small wounds are sometimes repaired using silk or nylon sutures. These are usually removed just before discharge. 

What precautions one has to take during the recovery period? 

• Wound care and cleanliness: Wounds have to be kept clean and dry. During bath the wounds can be washed with mild soap and dried with clean towel. Wound should be cleaned with antiseptic solution.
• Bone takes 6-8 weeks to heal. It is mandatory that strain on the sternum be avoided during this stage. One should avoid weight-bearing on the hands until 6 weeks. While getting up from bed and lying down, back should be supported by someone. Assistance during bathing is also required.
• 40-70% of CABG patients are diabetics depending on the geographical location and ethnicity. Diabetics are prone to infection. Apart from wound and body hygiene, one should be careful not to contract infection from external sources.
  • Avoid visitors at least during first three weeks and restrict until two months.
  • Avoid crowded places and public functions.
  • In case of fever, wound discharge, productive cough or urinary symptoms, contact doctor.
• Strict adherence to medicines: Some of the medicines prescribed after heart operation are to be taken lifelong. Get advice from your doctor and clear your doubts. Do not stop or modify medicines without consulting your doctor.

Exercise – What and How much? 
Immediate post-operative period is not the time for heavy exercise schedules. The aim is to get back to routine life style and be active. Let your body decide how much you can exercise! In the first two weeks, walking indoors for 10 minutes each 2-3 times a day along with mild stretching and deep breathing exercises as prescribed by your doctor would suffice. By this time intensity of pain and other discomforts would have settled significantly. After first follow up visit, most patients are advised to walk outdoors and increase the time and speed of walking. By about 4 weeks one should aim to do 1km gentle walk (in about 30 mts) daily. Gradually the speed can be increased. By 8 weeks most patients are able to walk 2km in 30 minutes. Remember, these guidelines differ depending on the pre-operative condition of the heart and the capacity of the heart to exercise. So ask your doctor what is suited for you. Generally, one can get back to normal activities and do full weight bearing on hands by 10-12 weeks. Continue the stretching and breathing exercises. Shoulder joints should be given special attention, as inactivity can make this joint very stiff. This can lead to painful Shoulder Periarthritis or Frozen Shoulder. 
Exercise and Activity schedule after heart operation (link) 

Getting back to work – When and How? 
One of the biggest concerns in patients’ minds while considering heart surgery is whether he would be able to do the same work as before. On a positive note let me assure you that most of the patients undergoing heart surgery would return to normal physical activity and work pattern in about 3 months. However this depends on certain factors. Most important of these is the pre-operative condition of the heart and the time required for heart to return to normalcy. For example, if the patient has suffered multiple major attacks in the past and the pumping capacity (LV function and Ejection Fraction) has suffered badly, there would be a limit to the level of physical activity possible after heart surgery. Also, recovery is an individual feature and varies from person to person. Mental strength and preparedness plays an important role in smooth recovery. Some people are back to normal in 4 weeks while some take up to 6 months to recover. It does not matter! As a rule most office work can be resumed after 4-6 weeks. Work involving moderate to severe physical activity (driving, lifting weights, prolonged hours of standing etc.) can be resumed only after 3 months. When you get back to work, start with simple and less strenuous tasks and gradually increase the level of activity.