Tag Archives: Medication

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.

 

 

 

Stress, Fribillation, Pain, and Release

Heart Pillow

Heart shaped pillow given to Kaiser heart surgery patients during the holidays.

At only 3 entries in, I found that this one is one of the hardest to write. The main reason is that shortly after my surgery was done, I was extremely stressed and worried about a lot of things, some not even with my health condition. Not being overly detailed in describing this part, I have to say that I was so stressed that I did get angry at some people for doing things that was out of my control (intense questions “I wish you were dead” and pre-mature release of my health status to a group of people that I best did not want to let know regarding anything in my life). These just made my recovery much more stressful at the time. As a result, I think these stresses only a couple days after surgery contributed to my “heart fibrillation” that I suffered through the next 5 days in the hospital.

Now that I have made my condition known through this blog on my own time, I am OK about people knowing. I just did not want it to happen so early.

Anyways, I’d like to say “sorry” to everyone that I have offended.

That all said, briefly going into the next few days of my January 2016 hospitalization before I hopefully zoom into the present day….

January 1, 2016 started with an early rise (for medications, etc. How can anyone actually sleep in the hospital when nurses are coming in and out at hourly intervals to give you medication and check your status?) to catch the first sunrise of 2016.

I told the nurses that one of the things I always did in past years was to take a photograph of the first sunrise for the new year. In recent years that usually occurred at Diamond Head Lookout or somewhere at Ala Moana Beach Park or Kaka’ako. This year, given the state that I was in that Friday morning, all I simply wanted to do was take my tiny camera and get an image of the sunrise from the Kaiser Moanalua hospital balcony just outside the 3rd floor.

The nurses in charge of my care obliged with my request to be taken out to the balcony and see the sunrise and get my shot. I was not strong enough to walk very far, so I was wheeled out by an assistant nurse. I lingered on the balcony for more than 45 minutes and was just so thankful to be there and live to see the first sunrise of the new year. I got my shot, not the best in the series, but it was a shot. I was happy.

I think it was later that afternoon after I met two visitors, that things started to go south. By the end of the day I had the heart fibrillations. I think I was put quickly put on new medications and my heart was probably monitored more intensely.

January 2 to January 5: Subsequent days in the hospital I was highly encouraged by the medical staff to “exercise” and start walking around. I was weak, but I did take short, painful, feeble walks around the 3rd floor facility. I had to push or pull the IV rack around with me as I was on a constant flow of medications….. even while I walked around. Plus I had the heart sensor device (about the size of a large iPod) with wires hooked up to my chest 24-7 monitoring my heart rate and all that stuff.

I remember walking past the heart monitoring station where a bank of computer screens kept track of each patient in cardio care. My heart rate while walking around was high at around 120 beats per minute. I am sure this was due in some part to my fribillations and that I was still feeling stressed.

Over the next several days the tubes that were initially stuck into me during surgery were removed one by one. The two that I remember the most was the long suction tube or whatever it was that they had inserted just below my chest. I think I had to hold my breath while they pulled that foot long tube out of me. It was a weird sensation and that thing had a wet iodine color coated on the outside when removed.

Later the catheter was removed from the private place where the flow should be one way out only. It was briefly painful when the nurse pulled that sucker out. Ouch! I hate those things.

Let me tell you about pain. You would think that after going through such an intense surgery that I would recover quickly, be free of pain, and just walk out of there in a couple of days. Nope… not happening!

Pain was my constant companion and to this day still is. However pain a day and a few more after surgery was intense. The most intense pain happens during the process of coughing. It seems like coughing is part of the process in recovering from heart bypass surgery.

From what I understand, since my breastplate bones were cut and then put together again with a fragile wire mesh (which allows new bones to grow in place), whenever I coughed, the motion (I think) forces my heart and other organs back there to hit up against the breast, causing intense pain per cough! Ouch.. Ouch… OUCH!!!!!

The reason for coughing I had been told was to get the liquid build up out of my lungs. Apparently after surgery your body produces a lot of liquid that ends up in the lungs and a couple of other places like your legs. The lung ones are a problem because you don’t want a large build-up of liquid mucus in there. Best way to get rid of it is to cough it out.

Let me tell you about the hospital’s pain scale that they use. The one that Kaiser Permanente uses is the Nurmeric Rating Scale (NRS 11) which “is an 11–point scale for patient self-reporting of pain. It is for adults and children 10 years old or older.” The breakdown of each pain threshold is as follows:

Rating Pain Level
0 No Pain
1–3 Mild Pain (nagging, annoying, interfering little with ADLs)
4–6 Moderate Pain (interferes significantly with ADLs)
7–10 Severe Pain (disabling; unable to perform ADLs)

The pain that I experienced while coughing was in the neighborhood of 7, 8 and 9. Extremely painful per cough. Imagine 10 being equal to the pain of having a shark bite a limb off you… well 9 is just short of that hugely intense pain factor.

Fortunately they give you two tools to help ease the pain.

The first tool I got was a “heart pillow” that the people at intensive care gave me. You can see a photo of it at the top of this blog post. Fact is I got two of them from IC. The red and green one was a holiday design since I had my surgery shortly after Christmas. Nice.

What you do with the heart pillow is hold it tightly against your chest whenever you cough. While it doesn’t totally alleviate the pain, it lessens the blow. Use of the pillow is to also lessen the impact of support the chest while coughing, assuring the wire seems holding the cavity together do not come apart. I still use pillows.

The second remedy I got were strong pain killers (pills, drugs, what have you). This medication is given to help patients reduce the amount of pain they are experiencing. Unfortunately the medications do not totally alleviate the pain in totality when I cough.

For comparison’s sake let me tell you that the pain I felt during my December 26 heart attack was about a level 4 or 5. Not as intense as one would think.

The result was I learned very quickly to hold back on the coughing. That would prove to be the wrong move in a few days.

Eating: Before I had my surgery, I was eating OK. After surgery I lost my appetite and only ate a little every day. While we had a choice of “healthy” food from the hospital menu on a daily basis, most of it I found either bland or tasteless. Bland would be in the future of my eating habits…. more on eating in another post.

Discharge: January 5, 2016 came around fairly quickly. The doctors seemed to want to get me out of the hospital as soon as possible, even suggesting an earlier date. However I had several issues (like not being able to go home and no one to care for me) before I could leave. Lucky for me, my sister Sandra showed up from the Big Island of Hawaii on January 5. She came in the morning and I was discharged later that afternoon.

The first major changes to my life had happened with more to come.