Discharge Planning

Returning Home

Getting discharged from the hospital is usually a great relief, but can sometimes cause some anxiety. Be assured that we would not discharge you unless we were confident in your progress and felt you were physically able to return home.

When you are discharged from the hospital, you will receive instructions about your home care from your surgery team and nursing staff. These will include your rehabilitation program, any medications you may require, your return appointment time and any other information you may need. This information will be added to your Patient Handbook, so be sure to have this at your bedside.

Convalescence at home usually takes four to six weeks depending on your condition before surgery. Minor aches and pains are normal in the first few weeks following surgery. If you are too uncomfortable to exercise, take your prescribed pain pills as directed 30 minutes to one hour before activity.

Follow-Up Appointments After Heart Surgery

Cardiovascular Surgery Post-Op Clinic: 1-2 weeks after surgery

One to two weeks after surgery, you will meet with a nurse practitioner who will check your incision and cardiopulmonary status. Your nurse will let you know if you need further tests or evaluation.

Cardiologist: 6-8 weeks after surgery

A report of your surgery and your progress during your hospital stay will be sent to your cardiologist after you leave the hospital. As soon as you return home from the hospital, call your cardiologist to make a follow-up appointment. Your appointment should be six to eight weeks after your surgery.

At this appointment, your cardiologist will determine how well you are healing, as well as give you instructions on medications, resuming activities, driving, and returning to work. You will also be scheduled for future follow-up visits.

Any time before your appointments, you should call your doctor if you:

• Experience chest pain or discomfort similar to what you felt before surgery.
• Have new or increased swelling of the legs and feet.
• See any signs of infection at the incision line.
• Gain weight of more than 2 pounds in one day.
• Have a fever higher than 101 degrees Fahrenheit (38 degrees Celsius).
• Experience new or increasingly rapid or irregular heart beats.
• Have shortness of breath or dizziness even when you are resting.

Pain Management and Medication After Heart Surgery

Your pain should be mild to moderate by the time you are discharged from the hospital. To help you get up and moving, you should use your prescription medication as instructed. By the time of your follow-up appointment, your pain should be minimal. Some patients experience pains in their chest and shoulder areas and become alarmed thinking it may be angina. This pain is usually due to muscle and bone aches, but if you have any doubt, call your physician.

By effectively managing and treating pain, you will heal better, enjoy greater comfort, and have fewer complications following surgery. You will be able to start walking and doing breathing exercises sooner, which will help you get your strength back, as well as avoid problems such as pneumonia and blood clots.

Where Will I Feel Pain?

While you recover after surgery, you may feel pain, pressure or burning sensation in your chest, especially at the incision site and while the chest tubes are in place. You also may feel pain when the chest tubes are removed and you start moving around, sitting up, coughing or walking.

Besides the incision site, you also may feel pain in different parts of your body. The breathing tube that was in your throat during surgery may make your throat feel sore or scratchy. You may feel pain in your arm or leg if a vein or artery was removed. Because you are lying down during surgery and in the ICU, you may feel pain in the muscles in your chest, shoulders, and back.

Numbness of Incision Area

A few patients report that they have temporary numbness in the chest, leg or arm incision or the hand where the arterial line was placed. This is due to manipulation of the nerves during surgery. It may take several months for sensation to return.

How Will My Pain be Monitored and Controlled?

After your anesthesia wears off while you are in the intensive care unit (ICU), your pain medication will be given through an intravenous (IV) line. Once you are out of the ICU, your pain medication will probably be in the form of a pill or suppository, but may also be given through an IV line. As your nurses regularly check your vital signs (blood pressure, heart rate, temperature), they will ask you to rate your pain to make sure you are treated and as comfortable as possible.

Pain Rating

To help your doctors and nurses better understand and help minimize your pain, they will ask you to rate your pain on a scale of 0-10. Tell them how you really feel. A rating of 0 means that you are not feeling any pain, and a rating of 10 means that you are in extreme pain. Please use the chart below to help you rate your pain.

When Should I Ask for Pain Medications?

You should tell your nurse as soon as you feel pain or discomfort before it becomes too severe. Also ask for pain medication before getting out of bed, walking, or doing breathing exercises if these activities worsen the pain. Don't hesitate to ask for pain medication, because it is harder to ease pain once it has started.

Pain Medication at Home

When you are ready to leave the hospital, your doctor may prescribe pain medication for you to take when you are home. These prescriptions may or may not be the same pain medication that you took in the hospital. Because it's important for your healing and recovery, you should take your home medication according to your doctor's instructions. Let your doctor know if you feel that your pain medication is not working, your pain increases, or if you feel that you need more pain medication to keep your pain under control.

If your pain medication makes you feel tired, drowsy, or dizzy, call your doctor. If your pain medication causes constipation, drink 8-10 glasses of water a day and eat a well-balanced diet that includes fruits and vegetables. If you are still having constipation, try a gentle laxative.

Information About Pain Medication

Morphine and Fentanyl

• Purpose: Morphine and Fentanyl are used at the hospital immediately after surgery to control severe pain.
• Side Effects: Severe drowsiness, nausea and often times constipation.

Percocet, Datocet, Tylenol #3

• Purpose: Used at home, these drugs are very effective at controlling mild to moderate pain.
• Side Effects: Drowsiness, upset stomach. Should be taken with food to lessen upset stomach.

Tylenol, Feverall

• Purpose: Controls mild to moderate pain. Easily tolerated by most patients and rarely interact with other medications.
• Side Effects: Taking more than is prescribed can cause liver problems.

Ibuprofen (Advil), naproxen sodium (Aleve), rofecoxib (Vioxx), celecoxib (Celebrex)

• Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDS). Reduces swelling and inflammation and will relieve mild to moderate pain associated with swelling. Ibuprofen and naproxen sodium are available without a prescription but take only as directed by your doctor. Vioxx and Celebrex require a prescription.
• Side Effects: Stomach upset, dizziness. Should not be taken if you have kidney problems, a history of stomach ulcers, heart failure or are on other blood thinner medications such as Coumadin (warfarin).

Pain Medication Tips When Travelling Home

• Before leaving the hospital, have your prescriptions filled, and if possible, have a second set of prescriptions filled in case of emergency.
• Always have your pain pills with you. If you are flying, keep your pain pills with your carry-on luggage.
• Wear comfortable clothes for the trip.
• If you're a woman, wear a surgical bra.
• Take your coughing and deep breathing pillow with you.

Dealing with Pain and Using Pain Medication at Home

• When at home, always follow your doctor's instructions for taking pain or any other medication.
• Follow your doctor's instructions regarding your physical activity. You may be advised to take pain medication before any activity.
• Taking your pain medication at bedtime will help you sleep and get enough rest. If you continue to have trouble sleeping, talk to your doctor.
• Continue to use pillows to support you when you sleep and during your coughing and deep breathing exercises.
• Continue to use heating pads and other alternative methods for pain control.
• Also take your pain medication before you come to the hospital to have your sutures removed.

General Tips for Using Medication

• When at home, always follow your doctor's instructions for taking pain or any other medication.
• Try not to miss any doses and try to stick with your prescribed schedule. If you miss a dose, take it as soon as possible. If it is almost time for your next dose, do not take both the missed dose and the next dose, only take one dose.
• Learn both the generic and brand names of each medication.
• Do not take other medications unless they have been prescribed by, or discussed with one of the doctors/nurses. This is especially true for over-the-counter drugs or herbal supplements bought without your doctor's prescription.
• Store all of your medications away from heat and direct light. Do not keep medicines in the bathroom cabinet since heat and moisture can cause deterioration.
• Keep your medications in their original containers since the label on the container always shows the expiration date, the prescribing doctor, the original prescription date, and the direction for taking the medication.
• Keep all medications out of reach of children.
• If you want more information about your medication, ask your doctor or one of the nurse coordinators.

Pain Medication Frequently Asked Questions

Question: Is pain medication addictive?

Answer: As long as you take pain medication only when necessary and follow your doctor's instructions, you shouldn't be worried about becoming addicted. Studies have shown that pain medication, if taken properly, does not lead to addiction.

Question: Because of my light weight and small stature, I am easily affected by medicine. Will a normal dose of pain medication be too much for me?

Answer: If you have concerns about how much pain medication you should have, talk to your doctor before surgery. Your medication during surgery will be determined by your anesthesiologist, based on your body weight. While you recover after surgery, your healthcare team will adjust your dosage according to how you respond to pain medication.

Question: How do I know that the pain medication will be enough to control my pain?

Answer: Before surgery, your doctor and anesthesiologist will discuss with you regarding your comfort level and tolerance to pain. Honestly tell them your concerns, and they will tailor a specific pain treatment plan that will work for you.

Question: In addition to the pain medication that was prescribed, can I take my over-the-counter pain medication, like Tylenol, to help with the pain?

Answer: Always talk to your doctor before taking any other medication other than what is prescribed to you. Taking Tylenol and other over-the-counter pain medication in addition to your prescribed medicine may be too much medication and may make you sick.

Alternatives to Pain Medication

Besides medication, there are other ways that you can ease pain.

Heating Pads
Use heating pads for muscle aches, placing a towel between your body and the heating pad. Make sure that you do not fall asleep while the heating pad is on. Do not place the heating pad against your incision sites.

Pillows
Pillows will cushion your chest incision as well as help with pain during coughing and deep breathing exercises. Continue to use the pillow at home to find a more comfortable position as you sleep, as well as during your coughing and breathing exercises.

Surgical Bra
For women, pain and discomfort may be felt from the incision site being pulled by the weight of the breasts when lying down. Women should wear a non-underwire surgical bra 24 hours a day for one month after surgery. Adjustable bras that have velcro closures will support the chest as well as ease pain.

Guided Imagery
Guided imagery is a relaxation technique that relieves stress and creates a sense of peace and tranquility. It helps you quiet your mind to allow you to relax so that your body may heal and be able to better cope with stressful situations, like surgery. It can also help you deal with pain, anger, depression, insomnia and other medical problems and illnesses. If you are interested in using guided imagery, please contact your doctor.

Taking Care of Your Incisions After Heart Surgery

After leaving the hospital, you will need to follow the advice of your healthcare team so that you can recover as quickly as possible. Depending on your surgery, your chest incision may extend through layers of skin, muscle and bone. Your skin should be healed by the time of discharge, your breastbone should take six to eight weeks, and your scar should fade in approximately six months to one year. Tingling, itching, and numbness are normal sensations associated with surgical wounds and will eventually disappear. During the first six months after surgery, protect your incisions from the sun by wearing a shirt or sun block. For women, wearing a soft bra to support your breasts will minimize incisional discomfort.

Types of Incisions

Traditional: In a traditional type of incision, strong sternal wires are used to close the breastbone. The chest is then closed with special internal or traditional external stitches.

Minimally Invasive: In a minimally invasive technique, smaller incisions are made that may or may not go through the sternum. Small incisions also may be made on the groin, leg or arm.

Other incisions may be present after surgery, from chest tubes, pacemaker wires or intravenous (IV) sites.

Taking Care of Your Incisions While Traveling

Going Home by Plane

When you are making flight reservations, let the airline know that you are recovering from surgery. If you had heart surgery, the sternal wires placed during surgery may set off the airport alarms. Because the distance may be too far to walk, ask for a wheelchair to take you to and from the plane. Once in the plane, stand up in the aisle and stretch your legs for a few minutes every hour to get your circula­tion going. If possible, also walk up and down the aisle.

Going Home by Car

When riding in a car, remember to stop every hour and walk 5 to 10 minutes to get your circulation going. You should wear your seatbelt, placing a small towel in between the seatbelt and your incision. If your car trip is longer than two hours, we recommend that you stay overnight in a hotel, get a good night's rest, then resume the next morning.

Taking a Shower or Bath

You may shower as usual using warm, rather than hot water. It is OK to let warm water run down over your incisions; however do not take a tub bath, soak in a Jacuzzi or go in a pool for approximately four weeks. Have someone help you get in and out of the shower until you regain your strength.

Consider using a shower stool if you feel weak or unsteady. Wash your incision gently every day with warm water and mild soap then pat dry with a soft towel. Do not apply lotion, powder, or ointments until the scab has fallen off (approximately 3-4 weeks). If you have paper strips on your incisions, they should peel off as you shower daily. If they don't, you may gently peel them off five days following discharge.

If the sutures are in your chest, shower with your back facing the water spray. If you cannot take a shower, a quick 10 minute bath is okay, but do not soak in the bathtub. Use only normal soap, not perfumed soap or body wash. Do not put the soap directly onto the incision and do not rub the incisions. Put soapy water on your hand or washcloth and gently wash your incisions. Only use a washcloth to rub when the scabs are gone and the skin is completely healed. After the shower or bath, dry yourself thoroughly. Pat your incisions dry, making sure not to rub them.

Signs of Incision Infection

It is important to look at your incisions periodically for signs of infection. Call your surgeon's office if you see any of these signs of infection:

• increased drainage, swelling or oozing from incision
• opening of the incision line
• redness around the incision
• warmth along the incision line
• increased body temperature (greater than 101 degrees Fahrenheit or 38 degrees Centigrade)

Dealing with Discomfort

Itching, tightness or numbness along your incisions is normal when you go home after surgery.

It is also normal to have muscle or incision discomfort in your chest if you are doing an activity. But you should not have the same pain that you had before surgery; if you do, let your doctor know. Also, if your sternum (breastbone) feels like it moves, pops or cracks when you move around, call your doctor.

If you had bypass surgery and saphenous vein grafts were taken, you also may have pain or discomfort in your legs from the incisions. To help ease this discomfort, try walking or doing activities that will move and stretch your legs.

Swelling in Your Legs and Feet

Removing a vein from your leg sometimes impairs the ability to return blood to the heart efficiently. The result is swelling in your feet and lower legs. If you have leg incisions, you should continue to wear your white support stockings given to you at the hospital. These should be worn as long as swelling persists during the day and removed in the evening before going to bed.To help alleviate the swelling:

• Prop your feet up when you are sitting or lying down, so that your feet are higher than your heart level. If you are sitting on the couch, put your feet up on a higher chair or ottoman. If you are lying down, put pillows under your legs and feet.
• Do not cross your legs.
• Even if your legs are swollen, walk daily to help circulation.
• Try using hospital support hose to cut down on the swelling.

If swelling persists or worsens, notify your doctor.

Listen to Your Body

You may be asked to do the following to help check on your healing. If so, do them as instructed by your health care provider.

• Weigh yourself daily and write down your weight.
• Take your pulse daily. Keep track of your results.
• Take your temperature daily to check for a fever.
• Watch for other signs of infection, such as a warm, oozing, or tender incision.

Your Emotional and Mental Well-Being After Surgery

Emotional Well-Being

Surgery can sometimes make the patient sad or depressed after leaving the hospital. These emotions may come from anxiety about the future, or they may be the result of being tired or irritable because of the surgery and medication. You should know that these feelings are often temporary, and should go away with time, especially as you get back to your normal routine and activities.

If you continue to feel a strong sense of sadness or our doctor or mental health specialist. Studies have shown that depression can raise the risk of heart attack and coronary disease. There are options to help you feel better, including support groups, one-on-one counseling, and medication. Other treatments include alternative and complementary, self-help, and spiritual. Even a change in your diet may help.

Some tips to relieve depression:

• Change into your day clothes, go outside and take a walk every day.
• Share your thoughts with your trusted family and friends.
• Resume your daily itinerary, hobbies and activities.
• Try not to nap during the day so you can get a good night's sleep.

Mental Performance

Although you may not feel as sharp mentally immediately after surgery, your mental (cognitive) functions should return after you've recovered and rested. Over time, your memory, concentration, orientation, and verbal understanding should return to normal. It may take a few weeks before you can resume performing mentally stressful tasks, so be patient.

After Surgery: Sleeping

Resuming Normal Sleeping Patterns

You should return to your normal sleeping patterns within 2-3 weeks. Try these tips to help you sleep:

• Make sure you take enough rest breaks in between your normal daily activities, but avoid napping during the day.
• Talk to a trusted family member or a friend if you have something on your mind.Get it off your chest so it worries you less when you are trying to sleep.
• Avoid caffeine, especially after dinner. Remember that there's caffeine in regular coffee and some sodas, as well as chocolate and tea.
• Take a relaxing shower (or bath, if permitted). Listen to relaxing music.
• Take your pain medication about ½ hour before bedtime.
• Find a comfortable sleeping position by arranging the pillows.

If you still have problems sleeping after 2-3 weeks, call your doctor.

Night Sweats

Patients often complain of night sweats for the first few weeks. Should you experience this, check your temperature to make sure that you do not have a fever. If your temperature is 101 degrees Fahrenheit or greater, call your doctor. If you do not have a fever, there is very little that can be done, but you should make yourself as comfortable as possible while waiting for the night sweats to go away. Change your linens and pajamas so you do not sleep in a damp bed. Night sweats usually disappear in a few weeks.

Disturbed Sleep

Following surgery, some patients experience nightmares or insomnia. This will also disappear with time. To help you sleep better, try shortening your naps during the day and/or increasing your afternoon activities so that you will feel tired in the evenings. It is OK to sleep on your back, side or stomach. You will not hurt your incisions.

Diet and Nutrition

Healthy Diet and Nutrition

Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.

Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.

Tips to healthy eating:

• Eat a variety of healthy foods.
• Choose foods low in fat and cholesterol.
• Eat less salt or sodium.
• Cut back on sugar and sweets.
• Eat more carbohydrates (potatoes, rice, pasta, vegetables) and fiber ("roughage").
• Limit portion sizes.

Poor Appetite and Nausea

Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.

Constipation

Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.

Caloric Restriction

Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.

Cholesterol and Saturated Fat Restriction

Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."

In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after surgery. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.

Foods high in cholesterol & saturated fats

• Animal products
  Liver and organ meats, luncheon meats like liverwurst & salami, other meats, egg yolks, whole milk, butter, cream, and whole milk cheeses.
• Vegetables high in saturated fats
  Coconut, palm, and cocoa.
• Other
  Fried foods.

Note
Instead of frying your foods, try to bake, boil, or steam when preparing foods.

Foods high in monosaturated and polyunsaturated fats

• Meats and other protein foods
  Lean meats, low fat dairy products, and fatty fish (salmon, tuna, trout, bluefish).
• Vegetable fats
  Olive oil, corn oil, soybean oil, sesame oil, sunflower oil, and tub margarine.

Concentrated Carbohydrate Restrictions

You may be asked to cut down on the amount of sugar and concentrated sweets in your diet as well. Carbohydrates not only add to calories, but large amounts may contribute to an increase in the Triglycerides on the blood.

Fluid and Sodium Restriction

Salt is made up of two minerals - Sodium (Na+) and Chloride (C). It is the sodium portion of salt that we are concerned with in your diet. Sodium must be restricted in your diet because it causes your body to hold fluids.

You must also control your sodium and fluid intake since Prednisone causes your body to hold both of these. The result of holding fluid and sodium is that extra fluid builds up in your veins and arteries. To avoid this fluid and sodium build up, you should cut down on both.

To cut down on fluids, choose solid foods instead of liquids; for example, eat fruit instead of drinking juice. To cut down on salt, your doctor may prescribe a sodium-restricted diet for you. Your diet order may read: "No added Salt" or 3 to 4 gram Na+ diet. The doctor may also prescribe a water pill to help get the sodium and fluid out of your system.

Foods High in Sodium (Na+) Content

• Meat and Other Protein Foods
  Ham, canadian bacon, bacon, luncheon meats, frankfurters, sausages, scrapple, pepperoni, dried beef, chipped beef, corned beef, canned meats, pastrami, canned fish, sardines, herring, lox, anchovies, smoked salmon, caviar, cheese, regular peanut butter, and frozen TV dinners.
• Vegetables
  Sauerkraut or other vegetables prepared in brine, olives, pickles, relish, vegetables packed with sauces or seasonings, salted mixed vegetable juice (V-8), regular tomato juice, regular spaghetti sauce, tomato sauce or tomato paste, frozen peas, and lima beans.
• Breads & Cereals
  Bread and rolls with salt toppings, corn chips, potato chips, salted pretzels, salted popcorn, and other salted snack foods.
• Fats
  Bacon fat, salt pork, olives, salted nuts, party spreads and dips.
• Soups
  Canned broth soups, commercially prepared stews, bouillon cubes, and instant or dried soups.
• Other
  Be careful of monosodium glutamate (MSG) used in Chinese food. When you order Chinese food, you can request that it be prepared without MSG.

Note
You should check with your doctor or dietician before using salt or salt substitutes.

How to Keep Your Heart Healthy

To help keep your heart healthy, make some lifestyle changes. Exercise and healthy eating are two ways to help keep your heart and body healthy. Before you start making these changes, talk with your health care provider. He or she can help you plan how to make exercise and healthy eating a safe part of your daily life.

Exercise Regularly

Like any muscle, your heart works best with routine exercise. Being active also reduces stress, lowers your cholesterol, and helps you lose weight. Before you start exercising, talk with your health care provider. He or she may suggest a cardiac rehabilitation program at a local hospital or community center.

Choose an Aerobic Activity

Exercise that works your lungs and heart can improve the way they use oxygen. Choose an activity you enjoy. Make it fun. You may even want to ask a friend to join you. Here are some ideas:

• Walking
• Swimming
• Climbing stairs
• Bicycling
• Dancing
• Jogging

Start Slowly and Keep at It

Plan to start slowly. Here are some tips:

• Begin exercising daily for 5 to 10 minutes.
• Slowly build up to at least 30 minutes on all or most days of the week. You don't have to do all your exercise in one session. You can reach this goal by being active for 10 minutes 3 times a day.
• Plan exercise sessions in advance. Write them down on your calendar.
• If you have chest pain while exercising, stop and call your doctor right away.

Eat Heart-Healthy Food

Changing the way you eat can lower your cholesterol, blood pressure, and weight. Food doesn't have to be bland and boring to be healthy. Start by working some healthy changes into your present diet. Try some of the tips below. Also, ask your health care provider for other tips. Better eating habits can help your whole body.

Less Fat

• Eat fewer fatty cuts of meat and more fish. Use less butter, margarine, and lard.
• Avoid foods containing palm and coconut oil or hydrogenated (check the label) oils.
• Eat fewer high-fat dairy products like cheese, ice cream, and whole milk.
• Get a heart-healthy cookbook and try some new, low-fat dishes.

Less Salt

• Don't add salt to food when cooking, and keep the salt shaker off the table.
• Don't use sauces or cooking aids that are high in salt such as soy sauce, MSG, baking soda, and baking powder.
• Instead of salt, season your food with herbs and flavorings such as lemon, garlic, or onion.

More Fiber

• Eat more fresh fruits and vegetables.
• Add oats, whole-grain rice, and bran to your diet.
• Eat more beans and potatoes. They are great sources of fiber.
• When you eat more fiber, be sure to drink more water to prevent constipation.

Stop Smoking

If you smoke, quit. It's one of the best things you can do for your heart. If you smoke, your heart gets less oxygen. Plaque builds up faster in your vessels. And your risk for a heart attack is increased. Quitting reverses these risks. Even if you've tried to quit before and haven't, don't give up. Many smokers try quitting 4 or 5 times before they succeed.

First, Plan to Quit

• Start by firmly deciding to quit.
• Ask your doctor about stop-smoking programs, aids such as nicotine patches and gum, or prescription medications that can help you quit.
• Contact the American Heart or Lung Associations about programs that can help you quit.
• Pick a quitting program and a quit date that feels right for you. Then quit.

Next, Get Support

• Find someone to quit with you.
• Tell your friends and family that you've quit smoking. Let them know how they can help.
• Visit a stop-smoking clinic or join a support group.
• Spend more time with friends who don't smoke.
• Write down all the reasons why you've quit. Read them whenever you feel the urge to smoke.

Don't Give Up

• Be persistent. Quitting takes time and willpower.
• Avoid places where people are smoking.
• Stock up on sugar-free gum, vegetable sticks, or hard candy for when you feel like smoking.
• Think of daily activities or routines that give you the urge to smoke. Then change those routines, if you can.

Resuming Activities and Exercise After Heart Surgery

Lifting and Reaching

If your surgery required an incision on your sternum (breastbone), it will take about 6-8 weeks for your sternum to heal. During this time, you may do light household chores, such as laundry, shopping, cooking, light gardening, dusting, and washing dishes when you feel up to it.

Do not lift, push or pull objects heavier than 5 pounds until your doctor says it is okay to do so.

Try not to stand in one place for longer than 15 minutes. Do not sit for more than an hour; take a break for a few minutes and walk around or move your legs.

Physical Activities

You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.

To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.

Climbing Stairs and Steps

Unless restricted by your doctor, it's okay for you to climb stairs and steps. Because you may be off-balanced after surgery, be careful and hold the handrail when walking up and down stairs. If you need to, stop and rest before you finish walking up or down a full flight. Try not to use the stairs immediately after surgery, and try to plan your activities so that you use the stairs only when necessary.

Fatigue

Fatigue is probably the number one patient complaint following heart surgery. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.

Driving and Riding in a Car

You should not drive for 3-4 weeks from the date of your surgery or while you are still taking narcotic pain pills. During this time your reaction time may be dulled, and if an incision was made on your sternum, your breastbone will still be healing. You may be a passenger in a car at any time. Make sure to wear your seat belt. You may cushion your incision with a soft towel or pillow.

Returning to Work

Returning to work depends upon the type of work you do and your energy level. It usually takes 4-6 weeks before most patients feel they have returned to their full energy level. The decision to return to work should be made jointly between you and your surgeon. You may want to consider working half days at first.

Traveling

Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.

Sex

You may resume sexual activity after your surgery. In the first few weeks after surgery, however, you may find that pain along your incision may limit your activity to a certain extent. Just remember that during the first eight weeks after surgery, any activity or position that causes pain or pulling across your chest, such as bearing weight on your arms, must be avoided.

Exercise

Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.

Tips for exercising:

• Check with your doctor or cardiac rehabilitation specialist regarding exercises that are safe for you to do immediately after surgery and in the long term.
• Make your exercises a regular/daily routine. Try to walk every day and gradually increase your distance over time.
• Instead of going for a straight distance, you may want to walk around your block several times so that you are always close to home.
• Don't worry about how fast you are walking, but concentrate on how much you are walking.
• Take someone with you the first few times you walk.
• Always wear comfortable clothes and shoes.
• Don't exercise if the weather is bad, or if it's too cold or too warm outside. Because of the controlled temperature, an indoor shopping mall is a good place to walk.
• Make sure you are not exercising too hard. Stop if you are exhausted, short of breath, feel dizzy, or have discomfort in your chest. Call your doctor if these symptoms persist and you are not able to do your regular exercises.

When to Call Your Physician

1. Fever > 101 degrees Fahrenheit or > 38.5 degrees Centigrade.
2. Extreme fatigue
3. Difficulty breathing
4. Dizziness or fainting
5. Palpitations or fast, irregular heart beat
6. Increased redness, tenderness or drainage of any surgical incision
7. Unrelieved nausea or vomiting
8. Excessive wound drainage
9. Persistent cough

After Your Heart Surgery - In Case of Emergency
What To Do If...

You Need Immediate Help

Go to your local emergency room or call emergency number if you are experiencing:

• Chest pain or discomfort (angina-like) similar to the pain you had before surgery
• Fast heart rate - more than 150 beats per minute, especially if you are short of breath
• New irregular heart beat
• Shortness of breath NOT relieved by rest
• Fever with chills
• Coughing up bright red blood
• Sudden numbness or weakness in arms or legs
• Sudden, severe headache
• Fainting spells
• Severe abdominal pain
• New onset of nausea, vomiting or diarrhea
• Bright red blood in bowel movement

You Have Concerns

Call your doctor if you are concerned about:

• Weight gain - 1 to 2 pounds per day for two days
• Worsening ankle swelling or leg pain
• Worsening shortness of breath
• Sharp pain when taking in a deep breath
• Pain in calf that becomes worse when leaning head toward toes
• Urinary tract infection - frequent urination, burning or urgency with urination
• Temperature higher than 101 degrees Fahrenheit, twice in 24 hours
• Bleeding, drainage or oozing from incisions that has increased
• Incisions that are red, warm to touch, swollen or opening
• Skin rash
• Extreme fatigue
• Acute gout flare-up

Also call your doctor if:

• you have questions regarding your surgery or your incisions.
• you have questions regarding your medications or other symptoms not listed here.
• you can't decide whether your symptoms require you to go to the emergency room