Recovery time is different for each patient and each operation. The usual stay in the hospital after heart surgery ranges from 3 to 5 days. You will usually see your surgeon for follow-up in the office. 2 to 3 weeks after discharge.

During this time, keep in touch with your doctor and follow his or her instructions. The following post-op instructions are provided for your review:

• General Post Operative Instructions
• Valve Surgery Post Operative Instructions
• Getting the Family Involved
• Sex after Surgery

General Post-Operative Instructions

Many questions arise as to what you should do or should not do after discharge. The following are answers to the most common concerns and questions.

• While the sternum (breastbone) is healing, avoid lifting greater than 10 pounds, or pushing/pulling activities with your arms. Complete healing of the breastbone takes 6-8 weeks.
• Showers are permitted but tub baths are discouraged for 4-6 weeks or until your incisions are healed. Avoid extremely hot water which may cause you to feel dizzy or weak. You may gently wash (don't rub) your incision with soap. Do not use creams or lotions on incisions until they are healed.
• Avoid driving a car until you see your surgeon for follow up. He will examine you and let you know when it is safe to begin driving. Your reaction time will be delayed due to weakness, fatigue, and/or medication. You do not want to risk hitting the steering wheel and injuring the sternum. When riding in a car for long distances, stop every 1-2 hours to stretch your legs. This will improve circulation in your legs and help prevent swelling.
• Do not cross your legs while lying in bed or sitting. This puts pressure on the veins under the knees and slows blood flow. If your legs or feet swell, you should put them on a chair or stool while sifting.
• Sleep the number of hours that you normally slept before your surgery. Do not stay up very late one night and try to "catch-up" the next. However, if you do plan to stay up late, take a nap beforehand.
• Avoid isometrics: straining to move your bowels, pushing/pulling heavy objects, or working with your arms overhead. These activities disproportionately elevate blood pressure and put an added strain on a healing heart.
• It is important to space and pace your activities to minimize fatigue. If your feel tired, STOP, and rest for a while. Don't push yourself to finish a task.
• A rest period should be taken at least once a day for a few weeks and, initially, preferably twice, morning and afternoon. Napping is not necessary, but resting is. Be sure to dress daily in street clothes. You are on your way to recovery!
• Stair climbing is not discouraged. Avoid pulling yourself up with a handrail, and go slowly.
• Use your elastic stockings during the day and remove them at night. You should wear the stockings for at least 2 weeks after discharge or more if your ankles are still swollen. The stockings aid blood flow and help reduce swelling in the legs. It is easiest to put the stockings on before you get out of bed in the morning for the day, however most people put them on after a morning shower. They should fit snugly.
• Your may notice a swelling or lump at the top of your chest incision which could take several months to disappear.
• Most patients experience incisional discomfort in the sternum. This discomfort will decrease in time, but may reoccur when when you overextend yourself. Your physician will prescribe pain medication.
• It is important to distinguish incisional discomfort from chest pain (angina) you may have experienced prior to surgery. Contact your physician if you are experiencing chest pain.
• If your chest or leg incisions do not appear to be healing (i.e., redness, drainage, swelling, or tenderness is present), notify your physician.
• Take your temperature every morning for one week after discharge. Notify your physician if your temperature stays above 100 degress F for more than a day.
• Check your weight every morning for the first two weeks. If you notice a sudden weight gain, notify your physician.
• When you are upset, your heart works harder. It is best to anticipate and avoid situations, people, or topics of conversation that make you tense or angry.
• Remember that your diet, medications, and exercise are prescribed specifically for you. Do not expect your friend or neighbor who has a heart condition to have the same prescriptions.
• Keep a record of your medications and medical history with you when traveling.

Valve Surgery Post Op Care

Tell any doctor or dentist who treats you that you have had your valve repaired or replaced. They may prescribe antibiotics before procedures, especially dental work, to prevent an infection from settling in your heart.

It is possible that you will be taking Coumadin, an anticoagulant, commonly called a "blood thinner." Coumadin causes blood to take a longer time to form a clot.

There are several points you should know about Coumadin:

• You will need regular blood tests (prothrombin time) to regulate the dosage of Coumadin. Your physician will arrange these test for you.
• Look for signs of bleeding while you are taking Coumadin. Notify your physician if you have:
• any abnormal bleeding
• red or black bowel movements
• pink or red urine
• severe headaches, abdominal or lower back pain
• faintness or dizziness
• red or "coffee ground like" vomitus
• excessive bruising
• excessive nose bleeds
• yellow or jaundice skin
• any symptoms that concern you
• Take your Coumadin at the same time every day. NEVER make up for a missed dose by taking double the dose.
• Don't take aspirin, any medication containing aspirin or any "over-the-counter" medications without first checking with your physician as this can cause bleeding while taking Coumadin.
• Excessive alcohol intake may also cause bleeding while taking Coumadin. Check with your physician about drinking alcohol.
• It is a good idea to carry a wallet identification card indicating that you are taking Coumadin.

Recovering from Open Heart Surgery is a Family Affair

Open heart surgery is an event that affects the patient, spouse, children, and significant others. It is similar to the ripple effect in a pond when a stone is dropped. Many waves occur before the pond eventually calms. In addition to the physical recovery that the patient undergoes, there is an emotional aspect of adjustment that the patient, as well as family, experience.

Facing the possibility of changing one's lifestyle can be quite overwhelming. Some alterations take place immediately, such as diet changes and smoking cessation. Other changes may be more gradual, such as building up to and maintaining an exercise program, or incorporating long term stress management. Of importance to all those involved is realizing that the patient does have control in initiating the changes and in maintaining healthy new habits. This is the patient's responsibility. Spouses, children, and significant others often struggle with the impossible task of making sure the patient never deviates off course and stays on the "straight and narrow'. Remember, others can assist and encourage, but only the patient can do!

Many lifestyle changes that occur as a result of having open heart surgery have a direct impact on the entire household. When a patient is forced to make changes for health reasons, very often all minds start to think along the same lines. This is especially true for others who might possibly be predisposed to coronary artery disease. Therefore, if the recovering patient has stopped smoking, family members who smoke are now motivated to quit. And when meals now need to be prepared in a heart-healthy fashion, chances are those who dine together will also be making these changes out of practicality for the cook resulting from a renewed awareness of the benefits to the heart.

Recovering from open heart surgery creates temporary role changes and responsibility shifts among family members. When the recovering patient returns home, he/she will have temporary physical limitations and dependencies which the family members compensate. The husband will need to shop and carry packages for his recovering wife who can neither drive herself to the store nor lift heavy packages. The son or daughter will have to mow the lawn and take out the garbage for their recovering father, who now has to limit exertion while he rebuilds his strength.

Just as the family needs to coordinate efforts in assisting the patient during his limitation phase, so should they enable him to increase his independence and regain his level of self reliance. This proves to be a very delicate balance and can be a cause of friction. Staying informed of the doctors recommendations on how the patient should progress can minimize the stress of this transitional period for both the patient and family.

Recovery will be a challenge for the open heart surgery patient and his/her family. There will be days of high energy and of fatigue, accomplishments, moments of temptation, feelings of exuberance and even days of feeling blue or angry, all of which are a part of the physical and emotional healing process that takes place.

Remember, recovery takes time. All of those involved will adjust according to their ability to assimilate the lifestyle and role changes which inevitably take place. Sharing your feelings and discussing ongoing issues can make for a smoother transition for all.

Sex After Surgery

There is a great deal of pleasurable sexual activity that is not sexual intercourse. Being near someone, holding, fondling, caressing, are all activities that enhance closeness and pleasure. Since these activities require very little energy, you may engage in these anytime after discharge from the hospital. Many couples find that this expression of love allows them to return slowly to a full sex life with confidence.

Sexual intercourse requires slightly more energy, therefore a waiting time of 1-3 weeks is generally recommended. Another consideration will be position. With sternal incision, a modification may be necessary in order to prevent injury to the sternum or incisional pain. Exercise will strengthen the heart and overall physical condition. So as you engage in the home walking program and witness firsthand increased endurance and confidence, you will know when you are ready. The energy expenditure for intercourse is the equivalent of walking briskly or climb two flights of stairs. The heart rate rarely rises above 120 beats/minute and blood pressure elevations are similarly mild and transient.

The person recovering after open heart surgery may be more conscious of his or her heartbeat, breathing, and muscle tension. This awareness is normal and is no cause for alarm.

Fear of performance and general depression are two psychological factors that can greatly reduce sexual interest and capacity. These are considered normal during convalescence and in most cases disappear within 3 months. If depression continues after 3-6 months, professional counseling should be considered.

Various medications may affect sexual drive and/or function. If this occurs, consult your physician. Often a change in medication or dosage can remedy the problem. Never stop taking any prescribed medication without your physician's approval.

Ways to prepare for the resumption of sexual activity:

• The first step is to exercise as mentioned above.
• The second step is to be tolerant of each others emotions. For a brief time following open heart surgery, emotions are delicately balanced and subject to rapid mood swings. Try to keep day to day events in perspective and remember that a good sense of humor is a good ally.
• The third step is to try to adjust mutual sexual expectations. Emotional response as well as physical responses sometimes make the resumption of sexual relations fearful and that is normal. Therefore don't expect too much at first.

Some general guidelines:

• Be relaxed and rested before intercourse. Avoid sex if you are fatigued or upset.
• Choose a position that does not restrict breathing or require prolonged muscular support.
• Maintain a comfortable room temperature and familiar surroundings and partner.
• Speak with your physician if you are experiencing any chest pain, angina, shortness of breath, rapid heart rate, or extreme fatigue in relation to sexual activity.
• Wait at least 1 hour after a meal or alcoholic beverages before having sexual activity.
• Open communication is important between partners.