As a patient, you are a part of our team. We think it is important for you to know what to expect before, during and after your surgery. We believe that when you know what to expect you will not worry as much, and you will recover better from your surgery.
Exercise and ActivitiesFollowing discharge from the hospital, it is normal to feel tired and weak. Immobility or bed rest can cause low back pain, shoulder pain, stiffness and depression. When you get home you need to balance periods of activity with periods of rest. Gradually increase your activity level. Do something every day. The first day you skip a walk makes it that much easier to skip the next day. Walking helps to improve your circulation, muscle tone, strength, and the way you feel about yourself. Walking is a form of conditioning, and should be done daily with a gradual increase in distance and speed.
A basic increase in activity could be as follows. This should be tailored to your abilities.
- Week one: walk five to 10 minutes, three to four times a day
- Week two: walk 10 to 15 minutes, two to three times a day
- Week three: walk 20 minutes, one to two times a day
- Week four: walk 25 to 30 minutes once a day
It is a good habit to take a few deep breaths at the beginning or end of each walk. If you still have your incentive spirometer from the hospital you can use it to help you with your deep breathing. Exercise should feel comfortable. You should feel like you are doing something - but not overworking. Some general activity guidelines include:
- Take several short walks with rest periods in between, rather than one long walk.
- Avoid temperature extremes such as hot humid summer afternoons or cold, rainy, windy winter days. These weather extremes can increase your fatigue. Go to a mall or college campus to walk if the weather is inclement. You may want to contact your local mall to find out if there are ideal times to walk or if they have organized walking groups that you could join.
- It is easier to begin walking on flat surfaces such as those found in shopping malls, athletic tracks, or your own neighborhood. Remember to keep moving and do not stop to window shop until you have completed your walk.
- Wear comfortable shoes, soft absorbent socks, and clothes that are comfortable and loose fitting. In cold weather, dress warmly and wear layers of clothing so that you can remove some of them as you warm up.
- Do not resume more strenuous exercises such as golf, tennis, jogging, swimming contact sports, sit-ups, push-ups, digging, heavy gardening or returning to work until you have checked with your doctor.
- You should not be doing any activities that would require a pulling or pushing motion for six to eight weeks after discharge.
These activities include but are not limited to:
- Mowing the lawn
- Shoveling the snow
- Raking leaves
- Lifting weights
- Driving
- Walking the dog
- Moving furniture
- Lifting babies or children
- Vacuuming
- Using your arms to push up from a chair or bed
Lifting
You should not lift anything over 10 pounds for the first eight weeks after your surgery including children, grocery bags, suitcases or briefcases. In addition, do not open stuck windows, unscrew jar lids, push open heavy doors, or move heavy furniture. Basically do not do any activity that would stress or twist the sternum (breast bone) until you have had your follow-up appointment with your surgeon and get the "go ahead" for these activities.
Household Chores
It is normal to feel tired or weak when you first return home. As you regain your strength you will begin to do more, but you should remember to spread your activities out during the day and to increase them gradually. You should not expect to resume total responsibility for household duties when you first go home. During the first few weeks you may feel like setting and clearing the table, making minor household repairs, or dusting furniture and potting plants. These activities are fine. Activities such as vacuuming, moving furniture, weeding, raking or mowing the lawn, gardening, mopping, lifting, and carrying items weighing more than 10 pounds put stress on the chest incision and require more energy and should be avoided.
Stairs
There is no reason to avoid stairs. However, climbing stairs does require more energy than walking. Before you leave the hospital you will climb between 10 and 13 stairs with your nurse or physical therapist to ensure that you can do so safely. Take your time and go slowly. You may want to pause and rest at the mid-point or whenever you feel tired. Do not use the use the handrail to pull yourself up the stairs. Use the handrail for balance only.
Sitting
You should not sit in one place for longer than an hour at a time. Get up every hour and walk around for five to 10 minutes. While watching TV, get up and walk during every other commercial. While sitting, keep your feet elevated on pillows or sit in a reclining chair with your legs elevated above the heart. Swelling of the feet and ankles is common following surgery. This swelling can be minimized by:
- Keeping legs elevated above the heart when you rest
- Not crossing your legs when sitting
- Wearing stockings or socks with non-constrictive tops
If swelling in feet, ankles or legs persists after six to eight weeks, report it to your primary care doctor.
Driving
You will not be able to drive for at least four to six weeks from the date of your surgery or until your surgeon dictates. Reasons for not driving are mainly safety issues but also include:
- Decreased concentration and reflex time
- Changes in vision (blurring) are common after surgery. These changes usually resolve within eight to 12 weeks after your surgery.
- Shoulder, arm, and leg flexibility are limited post-operatively due to stiffness and soreness
- Incisions on your leg may impair braking time
- If you were involved in an accident, there would be a chance of hitting the steering wheel and injuring the sternum (breast bone)
- Twisting movement of the sternum when driving
It is recommended that you wear your seat belt whenever you are riding in a car. When traveling longer distances, stop every hour and walk around for five or ten minutes. This will improve circulation in your legs and help prevent swelling. Before going on any lengthy trips during your first month home, check with your local cardiologist or primary care doctor.
Sexual Activity
There are no restrictions on sexual activity unless your doctor specifically tells you so. You may resume sex when you feel physically and emotionally ready. The work of sexual activity has been compared to the work involved in climbing 2 flights of stairs. When you are able to comfortably climb 2 flights of stairs without shortness of breath or fatigue, you probably have the stamina to resume sexual activity.
Rest and Sleep
During the initial recovery period, your body considers all activity as "work." Therefore, routine activities such as bathing, shaving, or brushing your hair can be tiring. This simply means you need more rest during this time. Plan or build rest periods into your day. By balancing periods of activity with periods of rest, you will not get overtired.
Try to get a usual night sleep each night. Avoid staying up late one night and trying to "catch up" the next. If you are having difficulty sleeping at night you may be taking too many naps during the day. However, it is not uncommon for patients to have some restlessness when they first return home. Your chest may be sore especially when you lie flat and turn from side to side. For some patients it is more comfortable to sleep in a reclining chair for a period of time, until their chest is less sore. You may want to take some Tylenol or your prescription pain medication about 30 minutes before going to bed. This frequently relieves muscle soreness and allows you to sleep in a more comfortable position. If sleeplessness persists call your primary care doctor.
If you have a waterbed you may not be able to get in and out of it for several weeks. If at all possible arrange to sleep on a conventional mattress for the first month or two after surgery.
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