Category Archives: Recovery

What to Expect After Heart Bypass Surgery — Part 2

A cell phone, notebook, pen, thermometer, pill organizer, blood pressure machine and a pulse oximeter are among the thing I regularly use.

A cell phone, notebook, pen, pill cutter, thermometer, pill organizer, blood pressure machine and a pulse oximeter are among the things I regularly use.

Today (June 26) marks my 6 month anniversary date since my heart attack on December 26. After surgery life has been mostly good. I have made adjustments and learned to get used to them.

It’s been a few weeks since the last substantial post and this entry to this blog.  This entry is the continuation of the first part of this series “What to Expect After Heart Bypass Surgery“.

The immediate time after my release from the hospital is well documented in this blog. In this part the discussion focuses on things regarding the longer term.

Years of consuming fast foods contributed to my heart disease.

Years of consuming fast foods contributed to my heart disease.

MEALTIME: One of the first things all bypass patients have to do is make changes to their diet. For me, this was major.

For most of my life I was more or less a “junk food junkie”, which meant eating out a lot to buying and choosing fast / convenience foods nearly all of the time. While I have some minimal cooking skills, for the most part it was easier to get a take out meal or something “instant” that could be popped into the microwave. I did this for years… decades… likely from the time I was in college…. The Bee Gees and disco was a big thing then. That was long ago.

Over time all of the salt, fat, cholesterol and God knows what else built up in my system. On December 26 my body revolted. I had a heart attack.

Today I mostly eat simple home cooked foods such as fish, an occasional chicken (skinless, boneless, white meat recommended), toast, broccoli with raw vegetables and fruit. I usually prepare the cooked foods with the microwave oven or steam sautéing in a shallow pan. No oil, just water.

For breakfast I eat at least one orange a day if possible and other raw fruits such as strawberries, apples, bananas and grapes. Fruits are a good substitute for sweets such as candy and baked desserts.

I used to eat at McDonalds, Burger King, Jack in the Box and a slew of other fast food restaurants. Most of those are mostly out. I recall stopping at McDonald’s only once or twice this year, and both times I got a small side salad that I used the contents for a home made sandwich.

Flowers

Nature’s small daily gifts can be better appreciated while you are on a walk.

EXERCISE: One of the hardest things for me to do is exercise. As a non-athlete and someone who hated participatory sports, exercise is something I totally avoided.

I had to change that so for the time being I’ve taken up walking. This is something that I have been doing off and on since at least 1997. I now have to put more effort into it.

I walk about a mile or two a day. I never officially measured the mileage. I do measure the time that I walk which on the low end is 30 minutes and 90 minutes on the higher end.

Shortly after being released from the hospital, I could barely walk 10 to 20 feet without running out of breath. This is normal. When you first start walking it will be difficult. Walks will be slow and short. If you keep pushing yourself, the distance that you cover will improve in time.

My walking distance gradually increased from 20 feet a session to at least one block a day or several times around the inside of the nearby WalMart Store. After that I was walking from my apartment building near Don Quijote to Ala Moana Beach Park, Magic Island and more.

Walking to the Magic Island / Ala Moana Beach Park area is one of my favorite walks. Other times I enjoy walking along the Ala Wai Canal area or walking to either Waikiki Beach or the other way to the Blaisdell Center complex. You can see a lot of things while walking. It is a good idea to take at least your smart phone or a small camera to take a picture of any interesting along the way.

MEDICATIONS: Once you are out of the hospital trying to make sense out of the many medications you may be required to take can be confusing. However it is best to take the medications requirements in stride and learn how to manage your times and dosages as fast as you can. Your medications will be with you for the rest of your life.

What medications heart patients are required to take differ among every individual. There is no point in telling you what I take because what you take may be something entirely different.

That all said, some of the best things to remember regarding medications are the following:

  • Take them diligently and on time in the prescribed amounts.
  • Do not take more than what is prescribed.
  • If you miss taking your medication at a prescribed time, consult your physician or health care provider for advice on follow-up.
  • Follow instructions on the medication’s container.
  • Get a pill organizer if most of your medications are in tablet or capsule form.
  • Get to know the names and dosages of each medication.
  • Order them well ahead of time when supplies begin to run low.

Last but not least, use common sense and keep medications away from children and other adults who are not authorized to use them.

MEDICAL EQUIPMENT: Having some of your own medical equipment is a nice thing to do. Monitoring your health with the following items keeps you informed on a timely basis:

  • Thermometer: For taking your temperature.
  • Bathroom Scale: Keeping track of your weight.
  • Pulse Oximeter: Measure your heartbeat.
  • Syphgmomanometer (Blood Pressure Monitor): Monitor your blood pressure
  • Spirometer: Measures air capacity of your lungs
  • Pill Organizer: For organizing your medications
  • Logbook: A small tablet where you can keep track of your day to day activities such a meals eaten, medications taken, appointments and places you walked to.

I’ll write about some of these tools and devices in an upcoming entry.

DOCTOR VISITS: You will have several follow-up visits with your primary care physician as well as those doctors and specialists who got you through the surgical process. In the long run however, you will mostly consult with your primary care physician who will refer you to a specialist as needed.

It is important to maintain a schedule of regular follow-up visits with your doctor.

HOME CARE: Last but not least, the most important thing that you can have as a new heart bypass patient is a good home care network or persons. In most cases, the heart bypass patient will rely on a spouse, adult child, parent, friend, sibling or relative.

Having someone help with your home care for at least the first 4 to 8 weeks is invaluable. When you are released from the hospital there will be a lot of things that you won’t be able to do. Things that we take for granted like walking, changing your clothes, taking a shower, using the toilet, following up with your medications and doctor visits, and a while lot more will be much easier if there is someone helping you nearly every day. Driving is also out of the question as doctors recommend against it so that you are able to heal properly in the chest area.

This person (like my sister Sandra) should be accommodating to your needs yet be firm and focused. Your home care person is not there to be your mother so don’t expect to be “babied” by them. A good home care person will not only help you but also encourage you to become more independent.

As time goes the new heart bypass patient will ultimately become more independent, cooking their own meals, walking farther each day, driving again and in time lead back to a hopeful and healthy normal life.


If I left something out, let me know in the comments below or drop me an email: macpro3000@yahoo.com.

 

 

 

 

 

 

What to Expect After Heart Bypass Surgery — Part 1

Heart and function monitors after surgery in intensive care. Photo by Mel.

Heart and function monitors after surgery in intensive care. Photo by Mel.

So you are going to have heart bypass surgery. This post will be about what to expect after your surgery as you spend the next several months in recovery.

AT THE HOSPITAL

First day you’ll be in intensive care, legs up with a number of tubes and other sensors plugged into your body. These are all hooked up to monitors that track your health condition for the time you are there. The stay in intensive care is 24 to 48 hours. It was 36 hours for me.

The stuff plugged into you are gradually removed before you move to the recovery ward.

More than likely after your brief stay in intensive care you will be moved to a telemetry ward. There the hospital staff will monitor your progress. Doctors will occasionally visit you, encourage you to start eating and walking. Nurses are there all the time and help you with just about every aspect of early recovery. Nurses are the lifeblood of most hospitals. Without them the system would probably collapse.

While confined mainly to a bed you will be encouraged to eat, and especially walk. Nurses and other personnel may / will come and visit you to work on your basic motor skills such as standing and walking. You will need help to go to the bathroom or use the bedpan. I chose the bathroom all of the time…

Before that happened though you are hooked up to a catheter which takes care of the urinary functions for the short term. Later the thing is removed and you are free to use the bathroom. I don’t like catheters, especially when it goes in and even comes out. One word: pain.

Speaking of which.

PAIN will be your constant companion for quite some time. Pain will be apparent every time you cough. The intensity of the pain shortly after surgery is high. Your pain level for every cough will be in the area of 8 to 9 on the 10 point pain scale. The pain from coughing will gradually wane. Sneezing also brings about the same chest pain.

The cause of the pain is fluid buildup in the lungs and the fact that your chest pounds against the healing wounds of your ribcage which is located just above your heart (see Wounds below). I tried to suppress my coughing but that was futile. It could have made things worse. As my doctors told me, “cough it out”. Be sure to use the “heart pillow” every time you cough.

WALKING: From early on you are encouraged to walk. You will find walking to be difficult, especially in the beginning. Your walking range after surgery will be short. A walk around the hospital ward will be considered “good”. Walking helps build your strength and gives your newly repaired heart a workout. While in the hospital you are hooked up to a heart monitor that is tracked on computers in the telemetry area. That is kind of cool I think. I used to always like to walk around the telemetry area to check my vitals like pulse and respiration that was displayed on a large flatscreen monitor.

Walking in those first days after surgery will be slow, short and maybe labored. My heart rate was between 100 to 120 beats per minute (bpm) while I walked. While idle I think my heart rate was at around 92 bpm. It gets better as time goes on.

Daily walking will be a recommended activity after your discharge.

EATING: You probably won’t have much of an appetite shortly after surgery. But that improves in time. One thing about eating is that if you were a junk food junkie like me (which more than likely brought about my heart condition) you definitely will have to change your daily menu. Divorce yourself from sugary carbonated drinks, beef, pork, sweets, candies, hamburgers, etc. Think more fruits, vegetables, water and fish. I will write more about meals later.

MEDICATIONS: You will be given a lot of medications shortly after surgery. Nurses are good at being timely in administering your medications. Some will be given through tubes while others will be given in pill form. Before you are discharged from the hospital a long list of medications will be prescribed to you for home use during your recovery and beyond. Be sure to dutifully take your medications. They are vital to sustaining your heart and life.

TUBES AND STUFF: More than likely there will be several tubes stuck into your body. All of these were inserted while you were in surgery. Thankfully you were spared the pain of the insertion since you were under anesthetic at that time. However, the tubes will have to be removed during hospitalization. Some like the catheter and the one going into your chest will be briefly painful when they are removed. The chest tube looks kind of gross upon removal… yellow/brown slime coats it. Yeah, you needed to know that.

There will be at least 1 or 2 intravenous tubes inserted into your arms for blood testing and medication purposes. These will be removed shortly before discharge. From the times you are poked with needles, you will find that your arms will become bruised.

Since you may also be on blood thinning medications, the chances of being bruised increases even after your discharge.

WOUNDS: Everyone who goes through heart bypass surgery will have two major wounds on their body. The first and most obvious wound is the large cut that go from the top of your chest to the bottom just above your tummy. Surgeons cut this area of your chest to gain access to your heart. They also had to break the bones on your rib cage to get to your heart. After the bypass veins are placed around your heart the bones have to be mended with a wire mesh that will stay inside of you for the rest of your life. Then the wound is stitched. It looks pretty gross when you first see it after the big bandage is removed a few days after surgery. Think Frankenstein’s monster… heh.  The chest wound will heal but will be a permanent scar on your body. The resulting scar is called “The Zipper” by many bypass survivors.

The Zipper.

“The Zipper” and tube wound just below that. Photos by Jerry Stanfield.

The other major wound will be on your leg at the lower end of your thigh just above the knee (at least it was in my case). Basically it is a big hole where the surgeons extracted your own veins for insertion around your heart (hence the word “bypass”). There will be a small tube coming out of that for drainage after surgery which will be removed before discharge.

Taking care of your wounds and being mindful of the condition of your healing heart and ribcage will be an important part of your recovery. The ribcage takes a while to heal. Patients have to be mindful in following instructions to prevent the ribcage mesh from accidentally dislodging itself which would probably result in a medical emergency that will probably require surgery and hospitalization to repair.

The reason for much of the chest pain associated with coughing is attributed to that healing ribcage area.

Below the chest incision wound will likely be a hole from which the gross tube was removed. It will be bandaged and will take time to heal. You have to keep it cleaned and medicated until it heals. The healing time for this wound is about 2 to 3 months.

I think I covered most of the things that happen after surgery. This post ended up being about care during hospitalization. The next post will be about home care. Fun stuff.

 

 

 

Back to the Emergency Room & Hospitalization

THROWBACK THURSDAY (#TBT)

Kaiser Moanalua

Kaiser’s Moanalua Hospital. File photo by Mel.

So like this blog has fell behind. My second hospital confinement is being labeled as “Throwback Thursday” since it happened more than 3 months ago now. I’m doing well today. But on January 10 I ended up in the emergency room only 5 days after being released. The following is a brief account of that time.

I was released from the hospital on January 5.

I started keeping a log of my meals, medications and more in a tablet starting on January 6. The following are brief summaries from entries I wrote in the log after my initial release from Kaiser Moanalua.

January 6: Took my morning medications: Oxycodone for pain; and then later Amiodarone, Low Dose Aspirin, Famotidine, Furosemide, Metoprolol, and Terazosin. At the time these and a few more for my evening routine were / are considered essential to my post-up survival. My evening meds included some of the above in addition to Atorvastatin and Warfarin. It was difficult at the beginning to get used to the medication names, dosages and times of day to take each one.

Meals were limited to small portions of fish, fruits, veggies and cereal with low fat milk during breakfast. In those early days after my initial discharge, things were tough.

Walking was a chore. I moved very slowly because my breathing accelerated and grew tired quickly after walking only a short distance. However walking was the key to my recovery as the doctors encouraged more walking many times every day.

Besides walking, PAIN was… well a pain! I was also encouraged to cough the mucus out that built up in my lungs after surgery. I was still required to hold the heart pillow against my chest. For the month of January, the pain level at every cough was a severe 6, 7 or 8 on the numeric pain scale of 0 to 10.

Pain was a constant companion after surgery for many weeks and is still around today but not as intense as it was in January.

Shortly after my release from the hospital I bought a blood pressure monitor. I also have a Pulse Oximeter which I bought for my Mom in 2014. I got it back after she passed away last year. The former device measures your blood pressure and the latter measures your breathing and heartbeat. The blood pressure monitor also gives out a heartbeat reading.

It is a good thing I had these devices at home.

January 6Pulse: 96 bpm O2 – 95: I learned early on that a pulse rate of 96 is considered high. That pulse rate was with me after my surgery and would spike higher when I walked around in the hospital.

January 7 — 8:00 am — Pulse 96 bpm O2 – 93 | BP 125/85 Later that day: BP 144/89

January 7 – 6:30 pm — BP 149/89 Pulse 97 bpm

January 8 – 5:30 am – I had a higher heart rate that morning when I walked a very short distance: Pulse 112 bpm. A blood pressure reading one hour later: 117/74 Pulse 102 bpm 10:30 am – Pulse 96 bpm BP 123/84 8:40 PM BP 120/83 Pulse 88 bpm

January 9 – 11:15 am BP 115/78 Pulse 90 bpm

January 10 – I had a hard time breathing that morning. Shortness of breath. I could hardly walk or move around without running out of breath. It was decided early that morning that I would be driven to the hospital emergency room. Sandra and I were originally going to take a taxi from the hotel to Kaiser Moanalua. That did not work out. I tried to walk out of the room and in the hallway but rapidly ran out of breath. I could feel the shortness of breath as well as my accelerated heartbeat. Had I continued walking I probably would have collapsed. Therefore I turned around and walked slowly back to the room.

We called 911.

The Oximeter reading that morning showed an O2 rate of 94 (normal) but a pulse of 112 bpm. The paper log stopped after the that for 2 days.

THE AMBULANCE RIDE: It took about 20 minutes (again) before the City’s EMS ambulance arrived. Two paramedics came up to the room and took me away on a gurney. Sandra accompanied me on the ambulance. She rode in the front seat with the driver. She was quite impressed as to how quickly the vehicle moved and more than that, how quickly other drivers in front of the ambulance moved out of the way. I was fully conscious and aware of where we were going. We raced up Keeaumoku St., turned left on Beretania than again on Piikoi to take the on-ramp to the H1 freeway. We got to the emergency room in about 15 minutes. All the way there I was hooked up to an EKG monitor as well as other devices while the paramedics read off numbers and communicated with the hospital.

HOSPITALIZATION…. AGAIN: I spent about two hours in the emergency room before the doctor on call decided to admit me and keep me “under observation”. I was taken to a nearby complex of small rooms where patients are placed “under observation”. It was not the same telemetry ward that I was in during my initial hospitalization. For the next two days I was hooked up to a constant IV drip of Amidarone (for heart fibrillation) among other medications.

I vividly remember is that while being moved out of the emergency room and to one of the observation rooms, they had my heart hooked up to an audio heart monitor. It played out each heartbeat which sounded like a Pong game gone wild. The chaotic heartbeat was a sure sign that something was wrong with me. If this was not treated I could have had a stroke. Fluid buildup in my left lung was also a culprit.

In time, the drug therapy worked and by the afternoon on January 12 I was discharged.

January 13 – Out of the hospital and back at “home”. 8:16 am – O2 94 Pulse 83 bpm. 10:00 am Blood test at Kaiser Clinic on Pensacola St.

January 14 – Walking more; down the hallway and to the lobby. Better than Jan. 10. Pulse sitting 99 bpm. At 3:10 pm that day I noticed higher heartbeat rates of 106, 108, 109, 111, 103, 97 and more just sitting in place after walking. I called Kaiser’s cardiology department and talk to Nurse Ruth. Can’t remember exactly what she told me then, but I think it was to keep monitoring and call her again the next day.

By this time I was taking Amidarone twice a day, once in the morning and again in the evening. Over time the Amidarone did its job. My heart rate, fibrillation eventually slowed down to “normal” levels.

The Kaiser Medical Team

Some of the that helped me. Photos from Kaiser Permanente.

Some of the that helped me. Photos from Kaiser Permanente.

This post has been sitting on the server for at least a month. Yep, haven’t updated this blog… so I am now in catch-up mode. So here we got a short list of Kaiser doctors that helped me get through the heart attack and surgery. Was not easy but without them, I’d be pushing daisies today.

Dr. George Wilkinson, MD – Cardiac surgery – Was Dr. Wilkinson on loan from another location? Do I even have the right person. His connection to Kaiser is not listed online. I definitely met him before surgery. He is the doctor who did my open heart surgery.

Dr. Jeffrey Wu, MD – Cardiac surgery; “There is a Steely Dan song with your name on it”. Dr. Wu was also on my surgical team. As I understand it, he was second to Dr. Wilkinson.

Dr. Steven K. Kramer – My primary health care physician. Conveniently located at Kaiser Honolulu Clinic on King and Pensacola Streets. Mild mannered and listens.

Dr. Ali Z. Merchant – Cardiologist; consulted with him on heart follow-up.

Dr. John Lee – PAC – Encouraged me to cough early on; cardiology dept. Mac guy. 🙂

Dr. Timothy Skovrinski – Emergency room, 1-10-2016

Dr. Sue Lim, I liked her. “It’s okay to swallow the mucus you cough up”.  Her specialty is “hospital medicine”. She wrote some of my prescriptions.