Pain after surgery.

Unfortunately all surgical procedures involve some pain and discomfort. All patients are discharged with a prescription for pain medication. Common pain medications include Vicodin (hydrocodone plus Tylenol), Percocet (oxycodone plus Tylenol) or Dilaudid (hydromorphone). These are powerful pain medications that must be taken as directed and you must not drive while on these medications. Usually these are only required for a couple of weeks after surgery. As pain begins to subside you may be able to get off of these medications and take an over-the-counter pain medication such as Tylenol, Advil or Aleve. Ask your which of these may be right for you. If your pain is not being adequately controlled or if you have a sudden increase in pain that is unexplained you may need to contact your doctor.

Caring for your incision.

After surgery you will have at least one incision to take care of on your chest. You may also have smaller incisions on your arm or leg. The area around the incision can be red, itchy, sore and sometimes numb for many weeks. You may also have bruising especially on your inner leg if vein was taken for bypass surgery. The incision may leak a small amount of fluid in the first several days. Care for your incision is usually quite easy. We recommend that you wash your incision every day with warm soap and water or in the shower. Do not put lotion, cream or powder on the incision. Do not sit or soak the wounds in water for one month.

If the incision leaks smelly, cloudy yellow fluid or if there is hot, bright pink-red skin spreading out from the incision or if you have fever over 100 degrees, call our office or your doctor for advice.

When can I resume normal activities and work?

Daily Activities. Maintaining activity and mobility is very important after surgery. While being tired is normal it is good to resume most of your regular daily activities around the house and do some extra walking in addition. Showering is good and incisions should be washed with soap and water. Do not soak incisions in the tub for the first month. Because it takes the breastbone about 3 months to completely heal, some activities should be avoided if you have had a heart operation that required your breastbone to be split. These include any activity that puts a lot of stress on the muscles and bones of the chest and arms. You should avoid any heavy lifting, pulling or pushing with the arms. You should also avoid sleeping on your side for the first few weeks as this puts weight on the shoulders and breastbone. As a general rule you shouldn’t do anything that causes significant pain to your chest. This is a sign that stress is being put on the breastbone. When you cough it may be helpful to stabilize the chest by grasping a pillow which will also help reduce pain.

Work. When you return to work after surgery depends on your overall health, the rate of your recovery and the type of job you have. If you have a desk job, you may be able to return to work in the first couple of weeks. If you have a physically demanding job it may be 4 or more weeks before you are able to return to work. When you see your surgeon at follow-up you can discuss plans to go back to work.

Sex after surgery.

It’s normal to worry about having sex after major surgery. Most people can resume normal sexual activity within 2 to 4 weeks after surgery but there is no set timetable. You must be ready physically and mentally to enjoy sex. As with any activity after heart surgery you need to take care not to disrupt the breastbone which takes about 3 months to heal completely and you should choose a position that doesn’t strain your arms and chest.

Many people have a temporary decreased desire for sex after major surgery. This is normal and as your body adjusts and heals your sexual desire will return.

Sports and Exercise after surgery.

Depending on your condition and the type of surgery you had, returning to exercise and sport activities may vary. If you had heart surgery and your breastbone was split, it usually takes 3 months for the bone to heal completely. Walking is appropriate and encouraged immediately after surgery. If you are physically able you should take a walk for about 10 minutes 2 to 3 times each day. Some low impact exercises, like riding a stationary bike, may be appropriate a month after surgery. Most exercising like running and weight lifting or sports that involve swinging the arms, such as tennis or golf, should wait until 3 months after surgery.

Driving and Travel after surgery.

Driving can resume after surgery as soon as you are feeling well and alert and off all prescription pain medication. Driving while taking prescription medications is dangerous and illegal. Always wear your seatbelt.

It is usually best to stay close to home within the first several weeks after surgery so that you have access to your doctors and surgeon should concerns or complications arise. There is no set time that you must wait before air travel and you should review travel plans with your doctor. Always remember to bring enough of all of your medications and always pack your medications with your carry-on luggage so that you have it if your checked luggage is lost or delayed.

Drinking alcohol.

It is ok to resume drinking moderate amounts of alcohol after surgery once you are off all prescription pain medications. Drinking alcohol while taking prescription pain medications can be very dangerous.

Diet after surgery.

Eating a wide variety of healthy foods will give you the nutrients you need for a speedy recovery. Healthy foods include foods made with whole grains, like breads, pasta, and rice, lots of fruits and vegetables, and lean meats like chicken and fish. Avoid high fat foods and fried food.

Many people have a low appetite after surgery and some will lose weight. This is fairly common and if you do not have much of an appetite you should continue to eat and focus on regaining your strength. Nutrition is very important to healing your wounds. If you appetite is low you should eat whatever foods appeal to you until your appetite improves. Liquid shakes or supplements (such as Ensure, Boost or Carnation) may be very helpful in getting enough calories and nutrition.

If you are overweight and need to lose weight, do not go on a diet in the first several weeks after surgery. Concentrate on good nutrition and healthy foods. Once you have recovered it may be appropriate to concentrate on limiting your calories and changing your eating habits.

Sleep issues after surgery.

Many people have issues with sleep after surgery. Your body has been through a major change and it takes time for body systems to adjust and return to normal. In the first several days after surgery it may be appropriate to take pain medications before bed. This will help reduce discomfort and let you fall asleep. As your body heals and adjusts a normal sleep pattern will return within a few weeks.

Why do I always feel so tired?

It is very normal to feel tired in the days and weeks after major surgery. While the operation is over and you have started to make a recovery, you body still has a lot of internal healing to do which drains a lot of energy from your body. It’s ok to take a few naps during the day as long as you get up and walk and remain mobile. You may be anxious or depressed about your lack of energy. Give yourself time – most heart surgery patients report that it takes almost 3 months before they can say "I feel myself again."

Is it normal to feel depressed or anxious after surgery?

Many people feel anxious, depressed, guilty or even angry about having a heart or lung condition. Adding a major surgery and hospitalization as well as discomfort and weakness can make things even worse. These are all perfectly normal feelings to have, especially as your body adjusts and you recover after surgery.

You will feel better in time. However, negative feelings that keep you from your normal activities can be harmful if they last too long. Here’s a plan of action to help reduce your stress and deal with negative or unpleasant feelings.

1. Talk to someone. Share your feelings with family members and friends whom you trust. This will help them feel better too! Other people you can talk to include your spiritual advisor, such as a minister, priest or rabbi. Talk to your doctors to gain a better understanding of your illness and feelings.
2. Get the facts. We often make a situation worse than it is because we don’t have all the facts. Remember – what you don’t know CAN hurt you. It can make you feel more anxious or depressed than you need to be. Learn as much as you can about your health and what you can do to help yourself recover.
3. Make a plan. Once you have the facts, you can make a plan. You will feel better as you focus on what you WILL DO instead of doing nothing at all or dwelling on what you can’t do. A positive attitude plays a big part in how well you recover.

What symptoms should I look out for to notify my doctor?

Palpitations. Rapid or irregular heartbeat or ‘palpitations’ are due to abnormal electrical activity or conduction in the heart. While many people notice their heartbeat more after surgery and may feel a sensation of pounding in their chest, if you notice a very rapid or irregular heartbeat this may be a sign of an abnormal heart rhythm and you should notify your doctor.

Chest Pain. Chest pain is normal after surgery but if you have sudden changes in the severity or kind of pain or begin to feel pain in your chest that is similar to the pain you had before surgery, like angina, you should notify your doctor.

Shortness of breath. Some degree of shortness of breath is normal after surgery. Your lungs take time to expand and adjust. However, if you have a significant increase in shortness of breath or it is getting worse and worse, tell your doctor.

Fainting or lightheadedness. If you feel very light headed, especially after sitting or standing after lying down or if you have a fainting spell, tell your doctor. Tell your doctor if your incision:

• Becomes more red, painful, hot and swollen.
• Is pulling apart or draining more than a small amount of clear or pink fluid.
• Is swollen or leaking smelly or cloudy yellow fluid.
• Looks concerning and you are having fevers over 100°.

What can I do about swelling in my legs?

Some amount of leg swelling may be normal after surgery. Sometimes you will be prescribed diuretics, or “water pills”, like furosemide or hydrochlorothiazide which will cause you to urinate more frequently to get rid of excess water. If you have leg swelling you should not drink excessive water and keep your legs elevated while sitting or in bed.