Recovering at home after your cardiac surgery

What kind of follow-up appointments will I need after my heart surgery?

Once you are home from the hospital after your heart surgery, please arrange the following appointments:

• Within the first week you are at home, call to make an appointment to see your family doctor to have your sutures or clips removed. Remember to bring the removal kit you were provided with before you left the hospital.
• Your heart surgeon may see you two to three months after your surgery for a follow-up appointment. Please refer to your personal discharge documents for details. Call 604-522-6800 to arrange this appointment.
• You should also expect a call from a cardiac rehabilitation program. Referrals are made automatically when you are discharged and you do not need to initiate this call yourself.

How do I care for my incision wounds at home following my heart surgery?

After your heart procedure, you may have incision wounds that you need to care for. It is important that you leave your incisions uncovered unless they are draining or you are instructed otherwise.

If your sutures or clips have not been removed before discharge, your family doctor will remove them during your post-operative visit. At this time, your doctor will also and will inform you of any further measures which need to be taken after removal. Be sure to take the removal kit you were provided with when you left the hospital.

If the incision is draining, you can cover it with a loose clean dressing, which you should change when it gets wet and before it gets soaked.

A wound infection may not be noticeable for several days or even weeks after surgery. As your incisions heal, it is important that you watch for the following warning signs of an infection:

• Redness
• Warmth
• Puffiness
• Drainage
• Pain or tenderness
• Fever (100˚F or 38˚C or higher)

Make an appointment with your family doctor if your incision continues to drain and/or you note any signs of infection.

When will my incision heal into a scar and how do I care for it?

It takes a few months for scars to form on any of your incisions. During this time you can use an unscented lotion if your incision becomes itchy. Some patients develop a thick, tender scar called a keloid. Your family doctor can arrange a consultation with a plastic surgeon if you develop this overgrowth of scar tissue and wish to have it addressed.

How do I care for an incision in my arm?

Some patients will have an incision along the inside of their forearm. This incision is made when the radial artery is used as a bypass graft. When the radial artery is removed the patient no longer has a radial pulse in that arm.

Patients with a radial artery bypass need to take a medication to prevent spasm in this artery bypass for three months after surgery. It is also important that for three weeks after surgery, you avoid having needles of any kind injected into this arm.

Please make an urgent appointment with your family doctor if this arm becomes cold, white, numb or weak.

How do I start to rehabilitate my arm after surgery?

If you have an incision in your arm, it is recommended that you do the following hand exercises two times a day for the first four weeks. Repeat each exercise 10 times:

1. Make an “O” by one at a time touching the thumb to each of the fingertips.

2. Make a fist by opening your hand wide and then closing it.

3. Place your wrist and fingers on a flat surface, put your thumb under the first or pointer finger and then flick the thumb out.

What should I expect to experience as my chest incision heals and what should I do?

It is normal for a small amount of clear or straw-colored fluid to leak from your chest incision. This leakage should stop within the first seven days. Please make an appointment with your family doctor if the leakage does not stop after the first seven days, or if it gets worse at any time.

It is also normal to feel or see a lump at the top of the chest incision. This can be quite noticeable at first but it will gradually flatten as you heal over time. The area in and around the incision may also be numb to the touch (similar to the feel of dental freezing). Much of the numbness may go away as the nerves in the skin that were cut grow again. However, sometimes this numbness may be permanent.

It is also common for the chest incision and surrounding area to ache and feel tight like it is being stretched, pulled or grabbed. Please call your family doctor if these feelings get worse or feel unbearable.

What should I do if I feel pain or clicking in my breastbone after heart surgery?

Cutting through a patient’s breastbone (sternum) is how most heart surgery is done. If your breastbone was cut, think of it as a broken bone with the edges being held together by permanent wires. It is normal to feel some clicking noises or sensations during certain movements or activities. If this happens, simply stop the movement or activity that brought on the click or sensation.

Please make an appointment with your family doctor if you sense movement in your breastbone beyond an occasional click or if your breastbone incision is painful when you are at rest.

Can I wear a bra after heart surgery?

The choice of whether to wear a bra or not as you recover from heart surgery is up to you. Many women find it more comfortable to wear a bra. If you do choose to wear one, it should be loose-fitting, very comfortable, easy to wash and it should not have underwire, which can cause discomfort and interfere with drainage. Bras which close at the front are recommended as they are easier to put on. It is important that the bra stay clean so as not to introduce bacteria to the area. Wash your bra before wearing if there is any drainage or staining on the fabric.

What should I expect as my leg incision heals after heart surgery?

As with your chest incision, your leg incision may also leak a small amount of clear or straw-colored fluid. There can also be some pain and numbness in your leg incision from damage to small nerves which may also be noticeable for a long time.

If you wore compression bandages in the hospital they are generally removed before you leave. In some instances, however, persisting leg swelling may occur. If that is the case for you, the nurses on the ward may wrap your legs when sending you home. If this happens to you, do not disturb the dressing. A home care nurse will attend to you and your dressing after your discharge from hospital.

What do I do if my ankles, feet or legs swell after heart surgery?

For the first few months after surgery, it is normal for the leg with the incision to swell, especially at the foot and ankle. While your leg recovers, try not to cross your legs, so you do not restrict blood and fluid flow to the area. To keep the swelling down:

• Keep your feet up when you sit or lie down. For example, when you lie on the couch put your feet on the armrest.
• Do the ankle-pumping exercises you were taught in the hospital.
• Walk.

It is important to do the following home exercises once a day for the first four weeks after your surgery, unless instructed otherwise by your care provider.

How should I resume exercise and activity after heart surgery?

You recover from heart surgery not only by resting, but also by being active. Mild exercise will help you get your strength back and prevent the problems caused by inactivity. Use your common sense and always listen to your body so that you will be able to balance rest with activity. As you get stronger you should need less rest. After heart surgery you may notice:

• General muscle stiffness
• Decreased flexibility in your trunk and limbs
• Poor posture
• Poor breathing pattern
• Fatigue

So keeping in mind these physical issues, your activity should progress at the rate that is comfortable for you. Slow down and rest if you experience any of these signs that you may be overdoing your activity level:

• Feeling clammy
• Difficulty breathing
• Dizziness
• Sudden fatigue
• Nausea

Recreation is also important to help fight any boredom you may feel during recovery. For the first eight weeks, consider doing light activities such as:

• Walking
• Playing cards
• Playing miniature golf
• Practicing your putting
• Reading
• Doing handiwork or crafts

After eight weeks, you can resume normal activities.

Which rehabilitation exercises should I do at home while recovering from surgery?

You should do the home exercises outlined in the image below once a day for the first four weeks after your surgery, unless instructed otherwise by your health care provider.

For each of the following home exercises, perform one set of 10 repetitions once a day for up to a month. Make sure to reduce the number of repetitions if you have pain. It's advisable to wait at least 30 minutes after eating before you begin a long exercise session. Remember to never hold your breath while stretching or exercising. Your breathing should be relaxed at all times.

How do I manage deep breathing and coughing exercises while I am recovering with a chest incision?

If advised by your physiotherapist, continue with your deep breathing and coughing exercises when you get home. If you have been diagnosed with chronic obstructive pulmonary disease (COPD) in the past, please ensure that you exhale all the air through pursed lips after deep breathing exercises.

To protect your chest incision and reduce any discomfort, grab your elbows with your hands and hug a pillow to your chest as you cough. This will give support to the sternal incision and also be less painful. Do these exercises five to 10 times per hour while you are awake.

These deep breathing and coughing exercises are important to help you in your recovery. They help:

• Prevent or treat atelectasis, a condition characterized by the collapse of some of the small air sacks in the lungs. This can occur one hour after heart surgery and continue for up to eight weeks.
• Reduce your chance of getting pneumonia
• Maintain an adequate oxygen supply to your body
• Clear mucous from your airways
• Improve your breathing pattern
• Speed your recovery time

How soon after my heart surgery can I drive again?

Do not drive a vehicle for at least four weeks after your surgery. During this time, weakness, fatigue and medications may slow your reaction time, putting you at greater risk of having an accident. Consider your own safety and the safety of others and please do not drive until you are fully recovered. While relying on others to help you get around may be difficult, driving too soon after surgery is dangerous. Consider taking a bus or cab if there is no one to drive you.

What do I do if wearing a seatbelt hurts my incision?

Heart surgery does not excuse you from riding as a passenger in a vehicle without a seatbelt. Some patients find it more comfortable to use a small pillow as padding between the breastbone and the shoulder belt.

How soon can I travel after heart surgery?

Generally speaking, you can travel right after discharge from hospital after your surgery. Although your driving will be restricted for at least one month, you can be a passenger in a vehicle, airplane, train, etc.

Make sure to stretch your legs at least every hour on long car or plane trips. You should also check your health insurance coverage if you plan to travel outside the province, in the event you need to seek urgent care for your heart condition.

After heart surgery you will require some time to recover before resuming your regular activities, such as returning to work and engaging in sexual activity.

When can I expect to return to work after heart surgery?

You should expect to be off work for two to three months following cardiac surgery. Exactly when you return to work is based on the individual and depends on:

• Your doctor(s) medical opinion of your condition
• How your recovery has gone
• The type of job you do

During recovery, some patients think about retiring, quitting or changing to a new job. Try to delay a major decision like this until you have fully recovered and after you have talked it over with your family doctor or cardiac surgeon. Some patients have even found it helpful to wait until they are back on the job for a few months before they decide how to handle their future work life.

Please note that the general rule of taking two to three months off work also applies to unpaid work such as taking care of your family, your children, your home and your yard as well. Often patients don’t think about these household tasks as work and try to do too much too soon. It is important for you to seek help in managing household tasks and caring for your family during this time, so you can heal properly.

When can I resume sexual activity after heart surgery?

Sexual activity is not as demanding on your heart as you may think. If you can easily walk up two flights of stairs or walk briskly, then your heart can meet the demands of sexual activity. However, it is important that you do not support your body weight on your arms for the first eight weeks following your heart surgery. As a result, you may need to modify your sexual activity to take this into account.

You should also be aware that some medications may come with side effects that reduce your sex drive. Some men find that certain drugs may make it more difficult for them to achieve or maintain an erection. Talk to your family doctor about your options if you are unable to resume a satisfying sex life.

After you leave hospital after your heart surgery, it is important that you start the following walking program to aid your recovery, unless you are told otherwise by your health care provider.

What kind of exercise plan should I follow at home to speed my recovery from heart surgery?

It is important to include mild to moderate activity as part of your recovery from heart surgery. After you leave the hospital, you should start the following walking program, unless advised otherwise by your health care provider.

During the first two weeks:

• Walk short distances at a slow to moderate pace
• Walk three times a day for five minutes at a time
• Walk indoors or outdoors (weather permitting) in a flat area

After the first two weeks:

• Day one: Walk half a block.
• Day two: Try to increase the distance by a quarter to a half a block, as long as the first half a block you walked on the first day was fairly easy and not too tiring.
• Days three to 14: Try increasing your distance every day by an extra quarter to a half a block. However, if the distance you walked the day before was too long and tiring, decrease the distance and work up more slowly.

After two months, most heart surgery patients who did not develop a complication are able to walk about 3.2 kilometres (2 miles) per day without difficulty.