Patient Discharge Instructions.

ACTIVITY
A certain amount of activity is good for you during your recovery, while other activity should be avoided. Please use you Cardiac Rehab instructions as a guide. Do not lift, push, or pull more than 10 pounds for 6 weeks after discharge. You will be allowed to lift up to 40 pounds from then until 3 months after your surgery unless given other instructions. You can climb stairs slowly as tolerated. Sexual activity can usually be resumed 2-3 weeks after discharge, or when you can easily climb a flight of stairs. Take time to exercise daily according to the guidelines provided by Cardiac Rehab or the staff. Daily activity is not sufficient. You will probably be contacted in a few weeks for enrollment in outpatient Cardiac Rehab or you can contact your local hospital/clinic to sign up and get started. Until then, exercise regularly and increase your activity/exercise level gradually as you tolerate it. At the time of your postoperative office visit, your surgeon will discuss when you may to return to work.

TRAVEL
Do not drive for two weeks after your discharge or longer if you are still taking pain medication unless you have been told you could do otherwise. You may ride as a passenger at any time. Please wear your safety belt. If riding for long distances, stop every hour or so and walk around for 10-15 minutes. You may fly on an airplane at any time during your recovery. You should not have difficulty going through the metal detector at the airport. If you are traveling long distances, where you will be sitting for more than 1 1/2 hours at a time, try to get up and walk or stretch your legs.

DISCOMFORT
Mild amounts of post-operative discomfort commonly continues for several weeks following surgery. Remember to take your pain medication as needed throughout the day and at bedtime if you need it. You may want to write down the time you take a pain pill to help give you adequate but not too much pain medicine. As you wean yourself from the pain pills, you may take Tylenol for general aches and pains. If you have no history of kidney disease/problems, you may also use Ibuprofen. Continue to exercise daily as instructed because this will help reduce muscle stiffness. You may use a heating pad as directed. Call your cardiologist if you ever have chest discomfort similar to any angina pain(chest pain) you may have had before surgery.

Temporary numbness, tingling, and discomfort sometimes occur in some of the fingers. This is caused by the stretching of the chest at the time of surgery and should improve gradually over 6-12 weeks. Many patients experience hypersensitivity of the skin of the chest, resulting in discomfort with light touch or the contact of clothing. This is also normal and improves as the wound heals. Many patients have increased tenderness and numbness off to the side of the sternum if a mammary artery was used for bypass. This will improve gradually over six months.

A sore, scratchy throat can occur from the insertion of your breathing tube and may last for several weeks. You may also notice some hoarseness in your voice. If not improved by your chest-up, we may refer you to an ENT (ear, nose, and throat) physician for further evaluation.

SLEEPING
Your sleeping pattern may change temporarily after surgery. Insomnia may be caused partly by discomfort and inactivity. You may find that you only sleep for a few hours at a time at night. You can take 1 or 2 short daytime naps to help fight fatigue, but do not oversleep during the day. You may want to take a pain pill at bedtime to help you sleep comfortably. Sleeping pills are not suggested, but Tylenol PM is acceptable, however do not take with pain medications as they both contain Tylenol. You can sleep in any position but may be limited in the beginning because of discomfort in some positions. Call your surgeon if you wake up short of breath or need extra pillows in order to breathe comfortably at night.

BREATHING
Mild shortness of breath with exercise/activity is common after surgery. This feeling should go away with a few minutes of rest. If you notice shortness of breath or difficulty breathing at night or when resting, call our office. Continue to use your Voldyne breathing exerciser a few times each day for 1-2 weeks at home. You may have a productive cough for a few weeks: this is normal. Call your surgeon if you cough up bloody/tan or yellow/green phlegm or if you have a persistent dry cough.

DIET & APPETITE
Due to inactivity and medication effects, it is fairly common to have a poor appetite for several weeks post-operatively. Changes in your sense of taste and smell are also common and are temporary. Eating smaller portions more frequently is recommended. Your low-fat, low-cholesterol diet is not restricted for the first month at home in order to encourage a better appetite. However, you do need to follow your diabetic and sodium restrictions. After that, you should follow the diet that was taught to you in the hospital.

If you were discharged home on an Iron supplement, you may experience black stools. Once the Iron prescription is completed, this will resolve. Take medication with food unless you are directed to take it on an empty stomach. Call your surgeon with persistent nausea or vomiting. If you are diabetic and you experience vomiting or a poor appetite, it is important that you call the physician managing your diabetes because this can change your blood sugar.

WOUND CARE
Your incision care is simple. Wash incision daily with plain soap (i.e. Dove, Ivory, or Dial). Avoid using perfumed soaps. Use warm water and pat dry. Use a separate rag for the incision and another one for the rest of your body. Do not use hot water and do not rub incision. Try not to touch your incisions unless it is necessary. You may shower but do not soak in the tub until the scabs are off your incision. Do not apply any lotion, powder, cream or ointment to incisions until after the scabs have fallen off. Leave them open to air unless there is drainage present; then cover with a dry gauze dressing daily after washing the area. Your chest tube sites may drain a blood-tinged to clear yellow fluid on and off for two weeks. Sometimes the fluid will come out in a “gush”. This is normal and you shouldn’t be alarmed. Keep them covered with dry gauze when they are draining. Numbness and itching along the incision line are normal. Your chest incision is likely to have a bump or swelling at the top. This is normal and will gradually return to normal in 2-3 months. Signs of possible infection to watch for include: redness, swelling, warmth, drainage, or tenderness. Call your surgeon if you experience any of these signs.

STOCKINGS (TEDS)
Wear the knee-high or thigh-high stockings that were provided on both legs for three weeks after discharge from the hospital. You may take them off at night and will probably need some help putting them on daily. Your stockings can be washed in your regular laundry but do not place them in the dryer.

SWELLING
Elevate your legs 2-3 times daily for 30-60 minutes. This means your legs should be 24 inches above the level of your heart. Sitting in a recliner or chair with your legs on a footstool is not adequate. Lying on the couch or in bed will be more effective. Avoid sitting for prolonged periods of time. Remember not to cross your legs at the knee when sitting because it decreases blood circulation in your legs and increases swelling. If a vein or artery was taken from your arm, try to elevate the arm on a pillow when resting for the first 2 weeks. Avoid blood pressure or blood draws from this arm for one month, if possible. Report any sudden change in temperature or sensation of this arm to your surgeon promptly.

WEIGHING YOURSELF
If you have been prescribed a diuretic (water pill), you should weigh yourself daily and record it. Put your scale on a hard, level surface and weigh yourself at the same time each day, preferably without clothes on. Call your surgeon with any weight gain or loss of 5 pounds in 3 days.

TEMPERATURE
It is fairly common after surgery to feel sudden rushes or warmth and/or cold. A lot of sweating, especially at night, is common. Take your temperature if you ever feel warm, flushed, have the chills, or have wound drainage. Call your surgeon's office if your temperature is higher than 101.0 degrees.

WEARING A BRA
Some female patients feel more comfortable if they wear an elastic/sports bra after surgery. The support is especially important for larger breasted women and may be helpful to wear 24 hours a day initially. While wearing your bra, please keep dry gauze between your breaths and on the portion of your incision where your bra will rest.

MEDICATION REFILLS
If you need pain medication refills, you should contact your surgeon’s office. All other refill requests should be directed to your cardiologist or family doctor’s office.

COUMADIN
Coumadin is a pill taken every day to prevent blood clots from forming in your body. If you are discharged on Coumadin or the generic form called Warfarin, you will need periodic blood tests called a PT and INR to make sure your results are in the right and safe range. It is best if your test is done in the morning so we can get results the same day. We will call you generally between 3:00 p.m. and 5:00 p.m. on the day of your blood test to tell you if your dose will change and when your next blood draw should be done. It is also important that you take you Coumadin at the same time every day to ensure a level dose in your blood. It is preferable it you take your Coumadin around suppertime every day.

DENTAL VISITS
If you had a valve repair or replacement, you should try to avoid routine cleanings or non-emergent work on your teeth for 3 months following your surgery. Then, prior to dental visits, you will need antibiotics to prevent an infection of the valve. This is routinely done 1 hour before your visits and is usually prescribed by your dentist. If you or your dentist has questions about this, please feel free to contact our office. It is also important to visit the dentist regularly ( about every 6 months) because teeth in bad repair can lead to valve infections.

SMOKING
Absolutely and positively refrain from smoking.

FOLLOW-UP APPOINTMENTS
∙You need to make an appointment to see your surgeon in 4-6 weeks following discharge from the hospital unless you have been told otherwise by your physician. Call our office at (414) 649-3990 or 1-800-421-1904 as soon as possible to schedule your visit.

∙You need to make an appointment to see your cardiologist,in 4 weeks following discharge.

∙Also contact your primary medical physician (family doctor). Notify them that you’ve had surgery and schedule an appointment to see your primary care physician in follow-up.

SPECIAL INSTRUCTIONS
**If before your office visit with the surgeon you notice any of the following, please call our office:

• new or increasing shortness of breath
• new or increasing swelling
• slow, fast, or irregular heartbeat
• weight gain or loss of 5 pounds in 3 days
• any signs of infection as listed under” wound care” above
• chest discomfort similar to pre-op angina (chest pain)
• temperature of 101 degrees or higher
• any other concerns you may have about your recovery