Part 3: Discharge Instructions After Open Heart Surgery

This is the third in a series of articles I have written on Open Heart Surgery. These are not meant to replace specific instructions given by your own physician or health care providers and are general guidelines only.

Before leaving the hospital, your Nurse should provide you with a prescription and a clear discharge instructions, including follow-up care.

Discharge Instructions:

1. Wounds: Most wounds are closed with surgical clips or internal sutures. Clips are typically removed 7-14 days after surgery by a nurse or doctor. The purse-string sutures that closed the Chest Tube sites must also be removed when the sites are well healed. If wounds are draining or there is any concern, specific followup will be recommended.

A normal, healing wound can look slightly red due to inflammation, but increasing redness or new drainage of any type should be reported immediately to a doctor. Developing a fever or flu-like symptoms should also be reported right away. We recommend not to use Mineral Oil or any powders around the wound as these can increase scarring and delay healing.

2. Hygiene: Showers are recommended. Plain soap and water is best for healed incisions. It is best not to have the shower spray directly on the sternum for obvious reasons until it is well healed. Tub baths are not recommended as soaking of wounds can cause the healing lines to soften and open up, and it is impossible to get in and out of a tub while following sternal precautions.

3. Pain: Hopefully acetaminophen (Tylenol) can be tolerated and should be taken as prescribed for pain. Narcotics may be prescribed at the discretion of your physician, only take as prescribed.

4. Exercise: continue to increase walking as tolerated. Patients are told not to resume strenuous exercise until given the ok by their doctor. Contact sports should be avoided as well as sports like golf and tennis which can strain the sternum.

5. Rest: My favourite advise to give is, "Listen to your body!". It is quite normal in the recovery phase to next extra naps or rest time. Sometimes sleep is disrupted due to discomfort or limited sleeping positions from the sternal precautions so it is normal to feel tired. The body is hard at work healing, and this requires more sleep!

Also, don't let well-wishers overwhelm you. It is great if you have a companion who is able to say, "We'd love to see you, we'll call you when ____ is up to it!"

6. Diet and Alcohol: follow the recommendations you were given. In general, low-fat, low-salt, moderate intake is recommended. Many patients prepare some meals ahead of time to freeze as cooking big meals is too much activity in the initial recovery phase. Soups, sandwiches, and lighter meals suit most people. Diabetics may find their blood sugar levels continue to be difficult to regulate in the healing phase, due to the stress response by the body . Check blood sugar levels more frequently and follow the advise of your doctor.

7. Smoking: not recommended! You have not smoked while in hospital, so use the opportunity to kick the habit which has contributed to your heart disease. Ask any smokers in your house or family to support you by joining you in quitting.

8. Medications: Make sure you understand your prescription as some of your medications will be new and some old one may have been changed or discontinued. Make sure you know what you have already had on your discharge day, so you are not confused about what to take when you get home. Many hospitals provide a medication calendar. Check also about any vitamin, mineral or other supplements before taking them as many can interact with prescription drugs. If you are prescribed Coumadin (Warfarin) or other blood thinners you should have added instructions including when to have laboratory testing to follow their effect.

9. Lifestyle: While you are recovering, take some time to think about ways you can prevent Heart Disease. Achieving a more ideal Body Mass Index (BMI), setting goals for a more active lifestyle, taking measures to control cholesterol and blood pressure through diet and medication, and not smoking. Heart Surgery is not a "cure", the factors which lead to the heart disease can also cause it to recur.

10. Bowels: Many patients are precribed iron after heart surgery to promote red blood cell regeneration. Iron, pain medications, and decreased activity can all lead to constipation. Stool softeners are often given for this reason in the hospital, talk to your nurse or pharmacist about this if you are concerned about constipation. Straining with bowel movements is potentially dangerous after Open Heart Surgery.

11. Reasons to go the Doctor:

You have had major operation. If you have a feeling that something is wrong, DO NOT HESITATE to see a doctor! You know your body the best. Make sure you understand when you are discharged if there are any specific concerns you should follow up on.

- concerns with wound healing

- fever or flu-like illness

- feeling of "racing heart", palpitations, or a rapid or irregular pulse

- dizziness or fainting

- weight gain of 3-5 lbs in a day, or excessive swelling in the ankles

- feeling short of breath, or sudden discomfort with breathing

- coughing up green, brown or red sputum

12. Mood:

I am including this as it is a key component of recovery, and is especially important for families and caregivers to understand. Facing Open Heart Surgery means facing one's own mortality: the possibility of death has been imminent to the person facing surgery. This can trigger a flood of past emotions, as well as new ones. It is NORMAL for a person recovering from this operation to have a fluctuating mood: feeling overwhelmingly grateful for a new lease on life one moment, and feeling unexpectedly tearful in the next. Patients and their families have told me about unexpected outbursts of sadness, anger and elation. If you understand that this is normal, talking about your feelings usually helps the person. However, if you are feeling 'blue" and it is not going away, please talk to your doctor - as occasionally major surgery can trigger Depression.