Open Heart Surgery: Recovering Safely at Home

Part 3 of 3 (See all 3 parts here)

By Mike DuBose with Dr. Surb Guram, MD and Blake DuBose

Making the decision to have open heart surgery and undergoing the procedure are just the first steps you will take on your journey to better health. From the first postoperative days to years down the line, how you care for yourself after your open heart surgery will determine how effective it is in extending your life and improving its quality. Recovery times will vary based on your age and overall health, but whoever you are, the experience will be tremendously taxing on your body, and it can also be very tough on your state on mind. For the fastest possible recovery and best results, it’s important not only to take care of yourself physically, but mentally and emotionally as well.

When you arrive at home after having your open heart surgery—whether you flew to another city, as I did, or had your procedure performed locally—you will probably be exhausted. No matter how much you feel like you have missed or need to catch up on, take it easy! You cannot rush recovery. However, there are some simple actions you can take to heal your body and regain your strength in the fastest, healthiest possible manner:

Check in with your doctors. Once you have been released by your team at the hospital where your open heart surgery was performed, see your local internist within 3-5 days and your cardiologist within 10 days. Be sure to take your hospital records with you. Your internist will run blood and other tests to assess your overall wellbeing, while your cardiologist will focus on your heart condition. Always ask for copies of any tests so that you can monitor your improvement. Don’t be alarmed if your blood levels are abnormal; this is typical for someone who has just had open heart surgery.

Travel safely. You should not drive until it has been six weeks after your surgery, or until your doctor releases you to operate an automobile. If you wreck, the airbag could deploy and tear into your sternum, damaging your heart again! When riding with others, sit in the back seat to avoid airbags. If you take a long trip, stop every hour and stretch your legs. Do the same when flying to avoid blood clots, which can cause serious health problems.

Beware of germs. Your immune system will be weak after such a major surgery, and you will be more susceptible to serious—or even deadly—illness. Even seemingly healthy people can carry germs that can be fatal to you! After my open heart surgery, I stayed at home and avoided other people for several weeks. When I went to my doctor or was out in public, I wore a face mask that I purchased from the drugstore.

Once you are home from the hospital, some people will want to bring over meals and love on you. Let them! You will find out who your true friends are during this time, and seeing caring faces can lift your spirits, promoting a faster recovery. Amazingly, however, sick people sometimes visit individuals who have recently undergone major surgeries, so have your spouse serve as an intermediary and politely ask those who are sick to visit at a later time. Remember that you are in a fragile state, and there will be plenty of time for visiting later!

Prevent (or fight) anemia: Many people who have major surgeries suffer afterward from anemia, a lack of iron in the blood. Research various foods that are high in iron, and after your surgery, incorporate some into your diet to boost your iron intake. Some may fall outside of the diet that was prescribed to you, but if you are anemic, you need to address that problem first. Iron-rich foods include:

• Red meat
• Egg yolks
• Dark, leafy greens (like spinach, kale, and collards)
• Dried fruit (especially prunes and raisins)
• Iron-enriched cereals and grains (check the labels)
• Nuts
• Mollusks (oysters, clams, and scallops)
• Turkey or chicken giblets
• Beans, lentils, chickpeas, and soybeans
• Liver (chicken or beef)
• Artichokes
• Sardines

Follow a low-fat, low-sodium diet: Consider taking classes on nutrition and other health matters that can help you recover faster and extend your life. I thought that all they would do was preach, but I have actually incorporated many of my nutritionist’s suggestions into my diet! Sure, I still like my fried chicken from Kroger, but now I buy sharp cheese made with 2% milk, which tastes very good. I have lost 30 pounds and feel great. You are going to lose weight as a result of the surgery, and taking a nutrition class is a great way to learn how to keep it off. (Read my article at www.mikedubose.com/weightloss for more tips on losing weight.)

If you smoke, stop! I know it is hard because I used to smoke up into my twenties. However, if you don’t address this risk factor, you could be facing another open heart surgery down the road (or worse—premature death caused by a heart attack).

Take your heart medications and work with doctors to adjust if needed. Consume your medicines with food at the same time each day, but beware of foods and drinks that can hamper their effectiveness, like grapefruit or grapefruit juice. Research all of the medicines you will be taking, like blood thinners, ACE inhibitors, beta blockers, etc., and know the side effects. The most common side effect is dizziness, so when you get up out of a chair or bed, do it slowly and wait for any dizziness to go away before moving. (See my article about the dangers of medicines and supplements at www.mikedubose.com/supplements for additional information.)

Twelve months after my surgery, I began to experience headaches and frequent nausea. Through trial and error, my doctor and I traced these problems to the blood thinner I was taking. We discontinued that medication, and I now take Eliquis. I suggest avoiding the blood thinners Warfarin or Coumadin, which have side effects and require blood tests. The firm that manufactures Eliquis offers a small co-pay to offset its high costs at www.Eliqis.com.

Wean yourself off pain medications as soon as possible. They have addictive properties, contribute to insomnia, and can slow your digestive system, causing severe constipation. For gentle relief, drink orange-flavored Metamucil or another fiber supplement several times a day (morning, noon, and night) and eat lots of fruits and vegetables while on painkillers.

Exercise slowly and carefully to regain your strength. Beginning around the house and then moving outside, walk as much as possible (avoiding hills). Walking not only works the lungs back to their normal capacity, but if you can move briskly enough that you are huffing and puffing, you will rebuild red blood cells and fight anemia. Avoid stairs until your stamina is up to par, and take them slowly. Remember not to exert yourself, pull or push anything, or lift anything weighing more than 10 pounds until your doctor tells you it is okay. Otherwise, you may find yourself having another open heart surgery!

As soon as your internist and cardiologist approve, enroll in a cardio exercise program (I chose one at Lexington Medical Center). It is usually a 36-session program that you can knock out in three months. You will be hooked to a heart monitoring device and will exercise according to a routine designed by experts. I was initially reluctant about joining the program, but it was fun, made me exercise three times a week, and allowed me to meet others who were in situations similar to mine. Some of the patients signed up to continue in the rehab program upon completion to exercise.

Once you recover, continue exercising to support and maintain your heart. Due to your surgery and its impact on your body, you may particularly benefit from working with a certified personal trainer who has the training and experience necessary to develop a safe but effective heart-strengthening workout for you (visit www.dubosefitness.com for information on selecting a personal trainer).

Practice emotional self-care. Your body and mind have been through a very traumatic experience, and you could face some psychological problems such as insomnia, sadness, anger, depression, isolation, feelings of helplessness, and suicidal thoughts, all of which are normal for open heart surgery patients. I found it helpful to talk to others who have had open heart surgery. No one knows what this experience is like unless they have gone through it themselves. It can be very therapeutic to share your feelings with other members of the “zipper club!”

You and your family will need to monitor and report any behavior changes to your doctor. Depression, for example, can contribute to an increased risk of heart attack and coronary disease, so it is important to get treatment right away if you have any symptoms. Try to stay away from stressful situations, problems, or people who make you angry during your recovery; they can cause your heart to work harder. Above all, don’t rush back to work! You may need to talk to a trained counselor about your feelings or take antidepressants for a while, but give yourself some time for natural recovery. I highly recommend Dr. Fredrick Mau as a counselor and Dr. Josh Fowler, MD as a psychiatrist if you are located in Columbia, SC.

Promote healthy sleep patterns. You need restful sleep to recover, so if you are having any issues with insomnia, ask your doctor for a sleeping aid. Unfortunately, not all sleeping medications work for everyone, so you may have to experiment a little. Ambien CR (12.5 mg) worked well for me right before the surgery, but did not work after the surgery. After trying several other sleep aids, my doctor and I settled on 30 mg of Restoril (its generic is temazepam, which usually costs less than $10 per month). The frustrating part is when you must see a doctor, make a co-pay for a 30-day supply, and then, if the prescription does not work, begin the process over again. Ask your physician if you can try samples of several brands, or just ask for several five-day short-term prescriptions and pay cash for them.

Avoid naps during the day if possible, as they will increase your chances of nighttime insomnia. Short naps may be necessary, but be careful not to get your days and nights mixed up. You may want to sleep in a room by yourself so you do not disturb your spouse. Try to avoid taking any non-prescribed medicines or supplements at night since they can also cause sleeplessness; ask your doctor if you can take them in the morning instead.

Stay vigilant for signs of A-Fib. If your heart is fluttering, racing, or out of rhythm, notify your cardiologist and/or internist immediately. You may be experiencing atrial fibrillation, or A-Fib, a dangerous condition caused by open heart surgery that can lead to strokes and heart attacks! I had A-Fib, and my heart felt like it was coming out of my body. It would suddenly start beating 210 beats per minute versus the normal 73. Several times, I collapsed and could not breathe. Eventually, I had a small transient ischemic attack (TIA) stroke where my arms flew around uncontrollably and I could not talk (fortunately, there was minimal brain damage).

A-Fib is hard to detect sometimes and may not show up in your blood pressure readings, and attacks are very unpredictable as to when they will occur. If you feel like you are having any A-Fib symptoms, your doctor will probably require you to wear a heart monitor. I liked the one my cardiologist assigned to me, which I could wear like a jacket and take off for a shower. I wore it for three weeks and pressed a button every time I felt my heart go out of rhythm. I am now on medication to keep my A-Fib under control. Unfortunately, operations sometimes cure one problem and create another!

Monitor your vital signs. Buy both an old-fashioned glass thermometer and an electronic one, and take your temperature in the morning and at night with both devices for the first month. Elevated temperatures after surgery are normal, but tell your doctor if your readings go over 100 degrees Fahrenheit, which could indicate an infection.

Purchase a home blood pressure monitoring machine from a drugstore and take your readings daily while sitting still with your legs uncrossed. Consumer Reports recommends the Omron or Relion; I have both and prefer the Omron. Both can store multiple readings on yourself and other family members.

Document your blood pressure and temperature findings each day and share them with your doctors when you see them. I kept a journal of all my symptoms, side effects, and unusual conditions, which proved to be invaluable when I visited my physicians. Using my records, they were able to pinpoint patterns and recommend treatments to help me progress faster.

Watch out for infection! Even if you had open heart surgery several years ago, the Centers for Disease Control (CDC) recommends that you stay vigilant for symptoms of infection, such as night sweats, muscle aches, weight loss, fatigue, or unexplained fever. Some hospitals that conduct open heart surgeries utilize “heater-cooler devices,” which, according to the CDC, “might have been contaminated during manufacturing and could put patients at risk for life-threatening infections.”

In fact, several people who had operations in upstate South Carolina have died from infections stemming from these machines in the past few years. Each year in the US, there are more than 250,000 heart bypass procedures that use heater-cooler devices, so there’s a significant probability that yours may have, too. Speak with your doctor if you have concerns or experience any symptoms of infection. Some research has indicated that the bacteria can stay in your system up to four years after surgery!

Brush and floss regularly. It is important to practice excellent dental care, including flossing, to help prevent infectious endocarditis, an infection of the heart chambers and valves caused by bacteria or fungi. In the past, heart doctors and dentists recommended that patients take strong doses of antibiotics before any dental work, but have since stopped the practice since consuming too many antibiotics can create an immunity to them. In addition to dental cleanings, infectious endocarditis is also possible when you have any other procedure that may cause bleeding (like a colonoscopy, invasive tests, surgery, etc.). Speak to your physicians about how to prevent it.

Be gentle on your skin. Don’t shower with perfumed or moisturizing shampoos or soaps. Instead, use unscented soaps and baby shampoo during your healing period. Avoid baths until your incision has closed up. A few weeks after surgery, when your incision has begun to heal, place Vitamin E on it in the morning and Mederma at night (or vice versa) to help reduce the appearance of your scar.

Support your body. Wear support hose during the day to prevent blood clots, but take them off at night. Putting these on is difficult and can cause strain, so you will need assistance. The secret is to roll them up and put them on like a sock. You will also be given a pillow to hold against yourself for support when you are coughing, sneezing, laughing, and sometimes, just breathing. I did not use it much, but some swear by it.

Beware of “pumphead!” You may experience postperfusion syndrome, or as some surgeons call it, “pumphead.” Recent studies by Duke University researchers have found that diverting blood to a pump during open heart surgery releases microscopic bubbles into the blood that travel through your brain. This may cause patients to feel like they are thinking through a fog and/or cause short-term memory, concentration problems, and attention deficits. Most patients improve after several months, while others have reported serious memory problems years after the surgery (I still experience some short-term memory issues, even five years later). You and your family should monitor these issues carefully. For more information, search “open heart surgery pumphead” on the Internet.

The bottom line: While some aspects of open heart surgery are predictable, every patient reacts differently to the procedure and its aftermath. There is no one-size-fits-all solution. As you go down this difficult road, remember what Winston Churchill said: “Never, never, never give up!”

Even while experiencing severe medical problems in the hospital, I found great comfort in the knowledge that God was with me and was looking after me, and I hope that you will, too. I wish you well on your journey. Hang in there, and it will get better! You may contact me through my non-profit website at www.mikedubose.com if you would like to discuss any concerns that you have that you were not able to address with your doctors or through online research.

For the detailed version of this article, visit www.mikedubose.com/openheartsurgery.

(See all 3 parts of this article here)

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected].

Mike DuBose received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

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