Linda’s wise advice about open heart surgery

~ Carolyn Thomas

by Carolyn Thomas   ♥  @HeartSisters

At age 61, retired Canadian high school math teacher Linda Vardy underwent triple bypass surgery – after being told for almost a year that all of her cardiac test results were “inconclusive”.  Later, Linda sent me this list of what she had personally learned before, during and after that open heart surgery experience – tips that she hopes can help future patients facing the same procedure.

(NOTE:  As always, discuss any new  medical options with your own doctor).

While in the Hospital for Surgery

1. “Attend any patient lessons offered. Open heart surgery is major surgery. Have your family learn when lessons are and if possible, have them attend with you.”
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2. “Watch the hospital discharge video early.”
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3. “Someone – a family member or friend – needs to be in charge of your care and advocate for you. I once waited 35 minutes to receive a response to ringing my hospital call bell!”
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4. “It’s good if someone is always with you whenever you are talking with the doctor. Your brain isn’t working as well as normal, and you need someone else to hear the information that you are being given.”
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5. “Hospital discharge can be at anytime – not just the 11:00 a.m. that is written. I received mixed messages from the nurse and doctor about when I would be discharged. It’s all about bed turnover, NOT patient care! (Staff want you out of there so there is another bed for another surgery patient!)”

Recovering From Heart Surgery

1. “You will cough naturally; so, you don’t really need to try to make yourself cough.”
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2. “When using the heart pillow when you cough, give it a big bear hug. This helps to keep your ribs from pulling apart and tugging on your incision when you cough.”
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3. “Deep breathing and shoulder shrugs are as good as the incentive spirometer or forced coughing for clearing your lungs.”
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4. “Managing post-op pain is critical. Be sure to take pain meds before the pain gets beyond you.  Younger patients and women seem to suffer more sternum (breast bone) central chest pain. Extra-strength Tylenol or anti-inflammatory drugs may not work. What works for sternum pain is Oxycodone or its replacement for up to two weeks. Some people metabolize meds faster and need another pain med before four hours. (My experienced nurse requested mine be given every three hours.)”
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“NOTE FROM CAROLYN:  Post-stent Sternal Pain Syndrome may  appear within months post-op and affects women more than men.(1) Please see your doctor immediately if your sternal pain becomes suddenly worse instead of better.”
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5. “For moderate pain, the best thing to do is walk.”
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6. “Gravol helps with sleep and relaxation.”
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7. “I found any position other than vertical increased my sternum pain. So, when trying to sleep, I propped myself up with pillows so that I was at about an 80 degree angle. I also put pillows under my arms to keep them more forward to relieve the stretch across the front of my chest.”
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8. “Your iron levels are frequently low following heart surgery. I was initially prescribed Proferrin which was very expensive, but I was  soon able to switch to regular ferrous gluconate.”
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9. “To aid in bathing, we rented bath aids from Shoppers Home Health Centre. We rented a stool and a hand grip that could be attached to the side of our bathtub at home. We also bought a flexible hose for the shower.”
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10. “Be sure to keep all your out-of-pocket receipts for income tax purposes. It’s amazing how things add up. You can claim expenses for yourself and spouse, including gas mileage, hotel bills, parking, meals.”
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11. “In many ways, the whole event, surgery and recovery, are harder on the spouse. They feel so helpless.”
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12. “If you, your spouse or caregiver are offered an opportunity to participate in a Cardiac Rehabilitation or Recovery Program, take it. Although much of the educational part you already know, it’s good to be reminded. The opportunity to do some strengthening and cardio while being monitored helps with your self-confidence.”
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For women only: “The whole bra issue”

13.  To wear or not to wear? You are damned if you do and damned if you don’t!  If you do, your bra line beneath your breasts cuts right across your chest tube spots. If you don’t, the weight of your breasts pulls on your incision. My surgeon’s receptionist suggest buying camisoles from Zellers which have bra supports in them. They worked reasonably well as they weren’t as tight along the bra line; but still gave support. I found with sports bras, the top line put too much pressure across my incision. The best thing is to go around topless and let the air get at the incision! Not always practical!”

♥

Thank you, Linda for sharing these important tips! 

I later wrote about Linda’s second and third surgical cardiac procedures. One was to implant a pacemaker to address her slow heart rhythm. This wasn’t an uncommon scenario (over 3 million heart patients in North America have pacemakers). What was remarkably uncommon however in Linda’s case: the third surgery happened after 19 months of daily discomfort when she had the first pacemaker removed and replaced with an appropriately smaller pacemaker – this time one that was placed in a less-problematic location in her chest. 

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1. Bordoni B et al. “Post-sternotomy pain syndrome following cardiac surgery”. Journal of Pain Research. 2017 May 15;10:1163-1169.

Q:   Can you share any other tips on preparing or recuperating from open heart surgery? 

♥

NOTE FROM CAROLYN:   I wrote more about our cardiac procedures in my book, A Woman’s Guide to Living with Heart Disease. You can ask for it at your local library or favourite bookshop (please support your favourite independent booksellers) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

See also: 

♥ Open heart surgery  including “Extreme How-To: Step-By-Step Heart Surgery” via Popular Mechanics!  Seriously.

♥  Watch this important new post-op cardiac rehab initiative called “Keep Your Move in the Tube”

♥ “Don’t lift anything heavier than a fork”: really bad advice after heart surgery

♥  How long does it take to heal from open heart surgery?

Published by Carolyn Thomas

20 thoughts on “Linda’s wise advice about open heart surgery”

  2. Hello Carolyn,
    Great advice. I had a wonderful rehab nurse in the hospital who took time to sit with me and go over a lot of things that I had no idea about.

    My husband was not a great caregiver so I had to do a lot of the personal care myself. May I add:
    don’t lift your arms above your head, and don’t wear button down shirts cuz you have to pull your shoulders back. Don’t be surprised by the bruising.

    I could not sleep in the recliner after the first night. By night 3, I was in my own bed. I used blankets to put along my sides for my arms in bed.

    One crazy thing I did cuz it always worried me about, is some women have a lump at the top of there scar where they tie the wire. I did not want that so my ICU nurse told me to put pressure on that spot. I did it all the time and I have no lump – whether it was cuz I pushed on it or that my surgeon was that good.

    I wear bras that are almost sport bras but with a little more support. But I still opened the bottom of my incision.

    2 yrs later I still have pain where my drain tubes were. I also get pain on my left side that feels like shingles, it’s not – it’s just muscle skeletal pain from the surgery, I’m told.

    I always say that if I don’t see my scar(I don’t wear any thing that shows it) I don’t know I have had triple bypass.
    I can’t even remember the pain anymore.

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    1. Hello Susan – I’ll start with your last sentence, which I think is SO encouraging for other heart surgery patients: “I can’t even remember the pain anymore!”

      That’s a goal we all aim for, isn’t it?

      Thanks for adding those extra tips (don’t lift your arms above your head = very important!) The new cardiac rehab initiative called “Keep Your Move In the Tube“ reminds open heart patients to keep their upper arms firmly close to their sides as if trapped by a big imaginary tube. As the physio who developed this new plan says: “You can do anything you want as long as your upper arms stay within that tube!” It’s great advice for brand new open heart patients!

      So interesting about how successful putting pressure on the top of your scar turned out to be (helped, I’m sure, by your doctor’s skill!)

      Take care. . . ❤️

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  4. Hi Carolyn,

    This was a very informative read as I’m a listed heart transplant candidate.

    To date I’ve had a drug-eluting stent implanted in my main coronary artery, LAD at the very top and also an A-ICD (defibrillator) implanted. But before placement I was given a ton of educational information on my A-ICD as well as being sent the video surgeries of the two ways that they were placed.

    But with my luck, I ended up doing a 30 class before being prepared for the implant because there was now a third placement procedure. My device was placed on my right side because I’m left-handed.

    I have been worried about the chance of chest pain when the time comes. But from the stent placement to my A-ICD implant, I’ve never had any chest pain.

    It appears that my number one Cardiovascular problem is a full sentence long but the deadliest, “Coronary artery disease involving native coronary artery of native heart without angina pectoris.”

    I suffered an AMI/STEMI widowmaker heart attack and had NO chest pain, I went to the hospital for what I thought was an uncontrollable asthma attack.

    The heart hospital I am at has a mandatory cardiac rehab program following any cardiac procedure. The only way a patient doesn’t go is if the patient or their cardiologist declines.

    I have done cardiac rehab twice and am in the continous maintenance program. After my A-ICD was implanted, it was six months before I was able to return to do rehab and return to the maintenance program.

    The program that I now have has two cardiologists and each thought the other had sent in the paperwork. The hospital sent for the paperwork because there was a big chance that I wouldn’t be able to return. I’m happy to say that both cardiologists returned me to do rehab and maintenance.

    They have very carefully taught me what I can’t do with my right arm and when I have to stop when moving heavy objects.

    Robin

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    1. Hello Robin – you must be a fascinating case study for visiting doctors and med students!

      It’s very good news that your two cardiologists got on the same page to allow you to return to rehab and maintenance!

      Take care. . . . and watch out for those heavy objects! ❤️

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  6. Other thoughts I had:

    – A gently elastic camisole supports breasts and takes the pulling pain off of the incision.

    – Practice getting up strategies such as side rolling and pushing with arms.

    – Engage a mental health professional – depression is very common after heart surgery and professional help can help shorten the suffering. My PTSD and depression lasted for years.

    – Find others who have been through open heart surgery and join support groups – no one knows like someone who has been through it.

    That’s the short list. Know that you will survive this, too, and rest when you need to rest, sleep when you need to sleep, take your medications!
    Anne

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    1. So many good points, Dr. Anne! I’m so glad you mentioned mental health support. Very important, and sadly under-valued by many clinicians.

      Tackling practical issues like side rolling and pushing with arms is also covered in the new “Keep Your Move In The Tube” rehab improvements – very useful video here.

      Thanks for your tips! ❤️

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  7. Very useful info. Thanks for this. My open heart surgery was an emergency, done to repair a hole made accidentally by a doctor during another procedure, so no time to prepare. I would add:

    – Be very careful not to use your hands to push down to get out of a chair. Got to keep arms around that pillow so you don’t push the wired sternum sections apart

    – Surgeon prescribed meds to prevent constipation for a couple of weeks- straining can put pressure on sutures; pain killers can make constipation more likely

    – A close friend of ours was dating a plastic surgeon at the time- she suggested using scar-a-way to reduce the scar after surgeon gave ok to use it

    – the surgeon advised me to wear a chest wrap- kind of a cloth strip 8-10 inches wide that wraps around and fastens with velcro – was told to wear all the time until incision area healed as the weight of boobs- whether tiny or big – can tend to pull the incision area apart..

    – be patient – it takes awhile- I was told to avoid crowds

    – coughing, sneezing and laughing hard will hurt!

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    1. Hi Helen – YES! Any patient receiving opioids/narcotics for pain relief MUST be prescribed meds to prevent constipation!!!!

      When I worked in hospice care, one of our palliative care physicians used to pronounce, in his lovely British accent:

      “The hand that writes the opioid scrip must also write the stool-softening scrip!”

      I wasn’t familiar with the chest wrap suggestion – that’s a good one!
      Take care. . . ❤️

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      1. Also, if you know in advance that you need open heart surgery – if ok with doc – good idea to do some ab strengthening exercises. (I had been working with a trainer for a couple of years before the heart surgery so my abs were in good shape) but strong abs make it much easier to get out of chair or bed and keeping arms around the heart pillow and reducing strain on the whole chest area.. and yes… the bra wrap thing is so easy to use.

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        1. What a great suggestion, Helen – for anybody with upcoming surgeries planned, but especially for open heart patients.

          Every health advantage to help healing is a smart plan. ❤️

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  8. Can you please write a blog post on how women who live alone and have no immediate family, and with friends but none that can take the place of a husband or children, successfully navigate the post-op time period? Thank you.

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    Reply

    1. Hello Carol – many people are in the same situation you describe. You’re right – friends can’t take the place of a devoted husband – but ironically, not every husband is able (for many reasons) to step up during the time when heart patients need help the most. Even happily married women with husbands and family in town often enlist others in advance to help them out after surgery during recuperation – entirely depending on the family’s ability and availability.

      I can offer two personal examples: several years ago a seriously ill friend was hospitalized for over five weeks. No husband, no family in town. A few of her friends came up with a makeshift volunteer schedule of visitor shifts. Volunteers included neighbours, church groups, former work colleagues and sometimes even strangers (friends of friends) who offered to help where needed.

      A second example: another unmarried friend was seriously injured in a car accident. When she was finally discharged from the hospital after surgery, her recovery needs were far more complex than friends (or any husband!) could handle, so while still in the hospital, the staff helped her arrange a temporary convalescent home before being able to go home on her own.

      We often assume (and hope) that spouses are the obvious candidates to carry the load – but that’s not always possible. The hospital social worker can help make arrangements before hospital discharge for those who need home care, and most communities have volunteer organizations also offer practical help with driving, groceries, appointments, etc.

      As Linda writes in this list of tips, “…the whole event, surgery and recovery, are harder on the spouse.” So even patients with devoted husbands need other people to pitch in.

      Take care, Carol . . . ❤️

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    2. As a retired nurse who worked in the open heart ICU and has had Open Heart surgery twice. . . and recovered at home by myself, I do have a few comments.

      Pain: Getting on top of it before it is overwhelming is important, as Linda said. However, everyone’s pain tolerance is different and the medication combination that works for you is individual.

      The important thing to remember is the goal of pain medication: To relieve excessive pain that makes you unable to participate in your recovery, deep breathing, moving, walking, sleeping at night.

      Being totally pain free yet awake and participating in your recovery may not be possible. Oxycodone is not always tolerated – it makes me nauseous and I found alternating Tylenol and Tramadol worked for me.

      Deep Breathing and coughing: Your instructions may include Deep Breathe and Cough and/or incentive spirometer every hour. This is to open up your lungs and prevent secretions from settling in your lungs and causing problems. The incentive spirometer does just that. It incentivizes sleepy patients by sitting at their bedside as a reminder and it offers a measure of how well you are doing with your breathing and challenges you to improve.

      Sleeping: If at all possible borrow or purchase a recliner if you don’t have one. It not only allows you to sleep upright but also to elevate your legs and reduce swelling.

      If you must recover at home alone, your preparation for this before surgery is crucial. Move dishes and toiletries to easily reachable levels. Stock up on easy cook or prepared meals you can warm in the microwave. Do all your laundry before surgery. Have an emergency contact and a medical resource, like your surgeon or cardiologist on speed dial for help and questions that are less than a 911 call.

      Don’t drive for 4-6 weeks, whatever your doctor says. There are many other options to drive you to appointments.

      Have all your prescriptions where you can reach them. Use a bath chair in the shower for safety. If you are unable to handle recovery at home on your own SAFELY, tell your doctor that you need a Skilled Nursing Facility to recover in after surgery.

      Cardiac Nursing was my life for 30 years. But most importantly educate yourself before surgery with materials that are factual and not just experiential.

      Know your own needs, speak up, ask for help, don’t let doctors or nurses intimidate you, they are there to help you.

      Blessings!

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      1. Lots of great info, Jill. Your recliner suggestion is a winner. I had purchased my red LaZBoy recliner exactly one year before I was hospitalized in 2008 – same week I’d also moved from a 2-storey home into my no-step condo with an elevator – and in a terrific village location (almost as if I’d predicted I would need this easier and more convenient life some day!)

        I LIVED in that chair for the early weeks following hospital discharge – I napped, and ate lunch, and talked to our visitors and looked up stuff about cardiology on my laptop. I’m writing this now from that red chair! (Extra bonus about LaZBoy recliners, by the way: they have a lifetime warranty on all of the reclining mechanisms. A friend just had her very old and newly-wonky chair picked up, delivered to the LaZBoy workshop, completely repaired, all parts replaced with new, and then returned to its old spot at no charge. What other furniture company does that?

        During your 30+ years working in cardiology, Jill, you’ve seen and heard it all – a goldmine of firsthand clinical experience and knowledge! Thanks for sharing here. . .❤️

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        1. Many years ago, I purchased a lifting recliner for my mother when she came to visit. It was a life saver after my first open heart surgery.

          When I booked a hotel room near Mayo Clinic in Rochester, MN, for the days before and after my second heart surgery, the hotel guaranteed they would have a recliner for me when I got out of the hospital. Such a blessing!

          I too still use my recliner MANY hours a day. . .some days too many LOL!

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          1. Those lifting recliners are an amazing invention, aren’t they? And how lovely of your Rochester hotel to arrange that recliner for you in your room. That’s such good service.

            I’ve stayed at the Marriott on 1st Avenue on two different trips to Mayo and was so impressed by the remarkable kindness and care of the hotel staff.

            I have a hunch that all the hotels near Mayo are very good at going above and beyond expectations for patients. Like an extension of the clinical care – all the signage in Mayo buildings say: “The needs of the patient come FIRST!” and it shows.

            Now wonder we love to spend all those hours in our recliners – they are SO comfy! Just this morning, I spent a busy morning with two crafting friends and by the time I got home, I could not wait to sink into that chair to relax!! 🙂

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