Coronary artery bypass graft surgery: Self-care for recovery
What are my responsibilities during my recovery from CABG surgery?
You have several responsibilities while you are recovering from coronary artery bypass graft (CABG) surgery, including:
- Caring for your wounds.
- Taking your medicines.
- Monitoring your weight.
- Improving your heart and lung health.
- Attending cardiac rehabilitation.
- Making changes in your lifestyle.
Everyone heals at a different rate, but following your doctor's orders can help you achieve a fast and comfortable recovery.
Settling in at home
It may be worthwhile to keep all of your medical information together and handy during your recovery, including:
- Self-care instructions: instructions from your medical team about how to care for yourself. You may want to have a folder or binder to keep this information organized.
- Medication information: a list of all the medicines you are prescribed after you leave the hospital. (Note that these medicines might be different from medicines you took before your CABG surgery.)
- Contact information: a list of the names and phone numbers of your primary care physician, cardiologist, and cardiac surgeon, in case of an emergency. You may also want to keep a calendar with the dates and times of scheduled follow-up appointments.
- Insurance information: a card with information on your health insurance coverage in case you need to return to the hospital. (You may want to keep this in your wallet in case you are not at home.)
Caring for your wounds
A major aspect of your recovery is caring for the incision (sternotomy) made to open your chest during CABG surgery. Because it is so important that this incision heals properly, many limitations are placed upon you during your recovery. You also need to take care of the skin around your arm or leg incisions. All of your incisions need to be taken care of so that they can heal quickly and without infection. To do this, you need to:
- Take a warm (not hot) shower every day.
- Apply an antiseptic, such as povidone-iodine (Betadine, for example), to your incisions after you shower.
- Inspect your incisions every day.
- Tell your doctor if you notice excessive pain, redness, or swelling or if you have a fever.
- Remove the tape from your incisions (it will come off by itself).
- Take baths.
- Scrub or rub your incisions.
- Use lotion or powder on your incisions.
- Overexpose your incisions to sunlight.
Your surgeon may cut through your chest bone, or sternum, to perform your CABG surgery. Unlike other bones in your body, your sternum cannot be placed in a cast while it heals. Instead, your surgeon wraps heavy wire around it to hold the edges together. The sternum can heal properly only if the ends are held together constantly for several weeks. Therefore, you should not engage in strenuous activities that could shift the two edges apart during the first 4 to 6 weeks of your recovery.
Two activities that can shift the edges of your sternum apart and therefore should be avoided are:
- Lifting objects heavier than 5 lb (2.3 kg), including small children, trash baskets, and bikes.
- Driving (even a minor car accident may cause your chest to hit the steering wheel).
Your arm or leg
Your arm or leg incision may be swollen and painful. This results not only from the incision that cut through your skin and muscle but also from losing a blood vessel in your arm or leg that would normally circulate blood in the area of the incision. It will take a little time for your arm or leg to adjust to the missing vessel and for your incision to heal.
To help your arm or leg recover faster and more comfortably, you can:
- Keep your swollen arm or leg elevated.
- Wear special supportive hose (available from your doctor).
Taking your medications
You may need to take medicines after your CABG surgery. Your doctor or nurse will give you written instructions for taking your medicines before you leave the hospital. These new medicines may be in addition to or instead of the medicines you were taking before your surgery. Make sure that your doctor or nurse explains very clearly to you what medicines you should be taking.
You need to know:
- The names and dosages of your medicines.
- What each medicine is and what it does.
- How much to take of each medicine.
- When to take each medicine.
- What side effects to watch for with each medicine.
- What nonprescription medicines, vitamins, or herbal substances you cannot take because of a possible bad interaction with your prescribed medicines.
You need to do the following:
- Take each medicine regularly and on time.
- Bring your medication sheet to every doctor's visit.
- Report any side effects to your doctor.
- Refill your medicines before they run out.
- Bring enough medicine with you when you travel.
- Keep your medicines away from children.
- Do not increase, decrease, or stop a medicine without asking your doctor.
- If you forget to take a medicine, do not double your dose. Call your doctor's office or pharmacy for instructions.
- Check with your doctor before taking any nonprescription medicines.
One of the medicines you may be prescribed after CABG surgery is an anticoagulant, such as warfarin (Coumadin, for example). This medicine helps prevent blood clots. You will likely need regular blood tests to check how the blood thinner is working. If you are having home health care, your home health nurse may take your blood test. If you do not have home health care, you will go to your doctor's office, a lab, or the hospital for your blood test.
When taking anticoagulants:
- Take the medicine at the same time each day.
- Know your dosage.
- Keep track of blood test results.
- Use a soft toothbrush to brush your teeth.
- Use an electric razor to shave.
- Check with your doctor before taking aspirin, other nonsteroidal anti-inflammatory drugs (such as ibuprofen), and other nonprescription medicines.
- Tell your doctor if you have bruising or bleeding.
- Do not change your intake of vitamin K–rich foods, such as broccoli, brussels sprouts, cabbage, asparagus, lettuce, spinach, and some vegetable juices. It is most important to maintain a consistent level of vitamin K foods in your diet.
- Do not drink alcohol excessively. If you drink, do so only in moderation. Alcohol decreases the effect of warfarin.
- Do not use tobacco of any kind.
- Avoid playing contact sports or engaging in other activities where you could get bruised or otherwise injured.
Monitoring your weight
It is important to watch your weight very closely after your surgery. A sudden increase in your weight is often a sign of fluid retention. This fluid retention can indicate an underlying problem, such as worsening heart function and kidney failure.
To monitor your weight, you should:
- Weigh yourself at the same time every morning.
- Keep a record of your weight.
- Bring your weight record with you when you visit your doctor.
- Call your doctor if you gain 3 lb (1.4 kg) or more in 2 to 3 days.
Improving your heart and lung functions
While you are recovering from your CABG surgery, you will need to work on increasing your physical activity, or exercising. You need to become more physically active because you need to restore your full lung function. You also need to improve the blood circulation throughout your body. This will help your body heal properly.
If you do not exercise, you risk developing blood clots within the blood vessels of your legs. This is a painful condition that can cause several complications, including blockage of a blood vessel.
Walking is an excellent exercise after CABG surgery. Walking is safe and someone else can easily walk with you. Your leg will be sore if your surgeon removed blood vessels from your leg to use during your surgery. Despite this pain, it is important to your recovery that you continue to walk.
Attending cardiac rehabilitation
Based on your health and rate of recovery, your doctor will recommend that you enroll in a cardiac rehabilitation program to help you recondition and strengthen your heart. Usually, the program will start 4 to 6 weeks after your surgery. This type of cardiac rehabilitation program is known as a phase II program. (A phase I program refers to any rehabilitation steps you begin right after your CABG surgery).
In the phase II program, a specially trained nurse will help you improve your heart's strength and overall health in sessions of supervised exercise using a treadmill or a bike. In addition, you will also receive education about healthy eating and lifestyle habits each week. For more information, see the topic Cardiac Rehabilitation.
Some tips for exercising after CABG
Work with your doctor and rehabilitation specialist to develop a rehabilitation plan. The following is a general guideline for increasing your exercise:
- Take several walks each day. Spread the walks throughout your day.
- Don't overdo it: Stop and rest if you get tired.
- Gradually increase the distance and duration of your walks. Add one city block to your walk each week.
- Do not walk by yourself.
- Take stairs at a slow pace.
- Don't pull on the banisters with your arms to avoid straining the surgery site.
- Don't do too much at once.
Although you may be weak, tired, or experiencing chest soreness as a result of your surgery, many people with coronary artery disease (CAD) can work their way back up to normal activity levels by participating in a structured cardiac rehabilitation program or by working with their doctor to develop a home exercise program.
Making changes in your lifestyle
Your doctor probably told you that certain aspects of your lifestyle (such as smoking, an unhealthy diet, or high stress) make your cardiac health worse. Now that you have had your diseased arteries repaired with open-heart surgery, you want to be sure that your CAD does not get worse. In particular, it is important to keep your new bypass grafts healthy. Your doctors, nurses, or rehabilitation team members can help you take steps to quit smoking, start eating a heart-healthy diet, and reduce the stress in your life.
Resuming sexual activity
You will be able to resume sexual activity after you recover from surgery. But several factors may discourage you from resuming sexual activity.
- You may have fears about your performance.
- You may be afraid you will have angina or even a heart attack.
Professional counseling may help you to understand and deal with your fears.
When you and your partner decide to start having sex again, it might be helpful to keep in mind the following:
- Talk honestly to your partner about your concerns and feelings.
- Be aware that anxiety on the part of either partner and the use of some medicines may interfere with sexual arousal and performance.
- Discuss any difficulties with your doctor.