Preparing for and Recovering from Heart Surgery: A Researcher—and Patient’s—Perspective

By Mike DuBose with Dr. Surb Guram, MD

“It’s an ascending thoracic aortic aneurysm. You’ll need open heart surgery.” When I heard the words coming from my doctor’s mouth, I was stunned! My cholesterol and blood pressure were healthy, and I had absolutely no symptoms, family history of heart disease, or chest pain. I felt great! But a simple EKG had turned up something odd, so my internist ordered an ultrasound, nuclear stress test, and, eventually, a CT scan. These tests confirmed that I had an ascending thoracic aortic aneurysm, which, at that time, was just a lot of big words I had never heard before. Without treatment, my doctor explained, the aneurysm would eventually grow to the point where it would rupture, and I would die.

For three years, my excellent local physicians (internist Dr. Surb Guram, surgeon Dr. Reid Tribble, and cardiologist Dr. Barry Feldman) monitored the aneurysm as it expanded. During this time, I researched my condition, learning that the aorta is the largest artery in the body. It carries oxygen-rich blood from the heart through the chest and abdominal area, where it divides the blood and sends it to each of the legs. I also learned how deadly aortic aneurysms can be, with 45,000 Americans per year passing away due to diseases affecting the aorta and its branches. Of those people with ruptured aortas who make it to a hospital, only 25% survive!

My research underscored the seriousness of my condition, but I knew that open heart surgery also carries with it some major risks. At that point, all I could do was wait. One day, as my family and I were literally walking out the door to leave for Hawaii, Dr. Guram called and said that the aneurysm had grown to an operative stage of 5.5 cm. That I would soon need open heart surgery was not what I wanted to hear right before a fun vacation, but I was somewhat relieved that the time for action had arrived.

In 2012, I had open heart surgery at the Cleveland Clinic in Ohio. Since that time, I have continued to learn about my condition and have helped many others prepare for and recover from heart surgery. I decided to write about my adventure to share information that I didn’t find in my research and was never warned about by others. I just stumbled across it during my experience!

I am not a medical doctor. The purpose of this article is simply to share, as both a patient and a researcher, my experience of having heart surgery, along with tips for you to consider as you travel down this road. Of course, my advice is no substitute for the attention of a medical professional, and I highly recommend working closely with your doctors to decide your course of treatment. 

Learning About Your Condition

My initial recommendation is to establish a relationship with a competent internist. If you have yearly comprehensive wellness exams, your doctor can identify and treat medical problems in their early stages—one key to extending your life. Note any unusual symptoms, because the more details you can tell your doctor, the higher the chances of accurate diagnosis and treatment. Encourage your doctor to run as many tests as he or she feels necessary to come to a good conclusion. They can be time-consuming and costly, but it was one such test that revealed my aneurysm!

I have learned over time that, to make effective decisions, you should research your problem with an open mind, understand its causes, seek input from different perspectives, develop several options, and then make a timely decision based on the facts before you. In addition to doing your own research, listen to your doctors’ counsel so that you can intelligently discuss your prognosis with them and take an active role in your treatment.

Reputable websites are an excellent source of information for better understanding your health issues. If you are not comfortable with Internet search engines like Google, ask a friend or family member to research the condition for you and print out relevant articles. Another resource that may be helpful to you is an article I recently published with Dr. Surb Guram about how to work effectively with your doctors. You can read “How to Get Excellent Care from Your Doctor: Tips That Could Save Your Life”.

Selecting a Cardiologist

Once you have been diagnosed with a heart condition, locate a competent cardiologist. Survey your doctors, nurses, neighbors, coworkers, church members, relatives, other heart patients, and friends to find professionals that they have either heard great things about or have received good care from. I chose Dr. Barry Feldman in my town of Columbia, SC because he has a great reputation. He and Dr. Guram talk closely (effective communication between all of your doctors is very important). Dr. Feldman patiently explains his patients’ problems to them, is humble and smart, and does not rush you out of the door. His cardiac nurse practitioner, Phyllis Williamson, is also brilliant.

If you keep hearing the same names or practices being recommended, you are on the right trail. Ideally, you want to select an experienced cardiology physician with heart surgeons in the same group. Once you pick a cardiologist, ask your internist for a referral, which will secure an appointment faster than calling yourself. Have your internist’s office send a copy of your medical records to the cardiologist to expedite treatment, and call the cardiologist’s office before the appointment to confirm that the records were received. Before any doctor visit, create a detailed list of your problems, questions, and concerns so that the meeting will be productive.

Determining the Venue for Your Surgery

Open heart surgery has become increasingly common, with more than 500,000 individuals in the US undergoing it each year. There are many conditions that may require heart surgery, such as artery bypasses, valve replacements, aneurysm repair, rhythm adjustments, and transplants. New technologies are constantly being developed to save even more lives. For example, doctors are now employing robotics to conduct less invasive heart surgery, and for some conditions, repairs may now be made through the groin (or other body entry points) rather than the sternum. There are plenty of places across the US where you can receive great care.

If a thorough assessment indicates that you will need heart surgery, think carefully about the hospital where you want to have the procedure done and the surgeon who will perform it. You should always perform research before committing to any major surgery (including heart surgery), as there is a small possibility that you could die during the procedure. If your condition does not require immediate action, take your medical records to another cardiologist or surgeon outside of your doctor’s practice for his or her opinion.  

Because of the complexity of my condition, Dr. Guram felt that I needed to have my surgery performed at a well-known hospital with an experienced staff and one of the best surgeons in the nation. We both independently researched the possibilities and came up with the same surgeon and hospital as our top picks. In fact, US News and World Report ranks the Cleveland Clinic in Ohio, where I chose to have my open heart surgery, as the best cardiology and heart surgery facility in the nation (see http://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery for the report).

There are several great heart hospitals other than Cleveland Clinic that may also suit your needs. All of these have been noted as top choices by US News and World Report in recent years:

• Mayo Clinic
• New York—Presbyterian Hospital of Columbia and Cornell
• Massachusetts General Hospital
• Duke University Hospital
• Northwestern Memorial Hospital
• Cedars-Sinai Medical Center
• Johns Hopkins Hospital

Consumer Reports also offers hospital rankings at www.consumerreports.org/health/hospitals/ratings, which you can search by location. You can then filter the rankings by factors like overall heart bypass surgery performance and avoiding infection.

The official US government Medicare website also offers a helpful tool at www.medicare.gov/hospitalcompare where you can search for hospitals in your area and assess how many “stars” (ranging from 1-5) each has been awarded. The stars are based on patient experience surveys; “timely and effective care” (how long it takes patients to receive medical attention for different ailments); surgical complication and infection rates; hospital readmission and death rates (within 30 days of a hospital stay); usage of medical tests (particularly, whether they perform too many unneeded tests); and value of care patients receive for their money. While all of these factors are important, you should pay special attention to the surgical complication, infection, hospital readmission, and death rates when selecting your hospital.

Traveling away from your home area to go to a highly-ranked hospital has pros and cons. Research on open heart surgery places the death rate at 3%, depending on the experience of the surgeon, the hospital, and their staff, but going out of town to a more prestigious hospital requires expensive hotel stays and separates you from your local support system. If you choose to travel for your surgery, some hospitals (including Cleveland Clinic) will send you an information packet that includes discounted hotel rates. (If not, call local hotels to ask about unadvertised rates that are connected to the hospital.) Also, explore the hospital’s website and ask about special rates for local services. Cleveland Clinic contracted with a limo service to provide me and my family with one free pickup and return to the airport.

All the pre-surgery tests and appointments can be time-consuming, so if you are having your surgery a significant distance from your home, I suggest making the trip alone or with one person during that period and having your family members come up a few days before the surgery. If possible, try to see some sights and have fun before your hospitalization so you go in relaxed and happy. The night before my surgery, we went out to dinner and had a good time!

If you select a local hospital, pick the one with the most experience in heart surgery. Consumer Reports ranks hospitals by state, which can help guide your selection. Usually, the best surgeons and medical staff can be found in larger metropolitan areas.

Pre-Hospitalization Tests and Documentation

Having been through many medical tests, I have seen firsthand how widely results can vary between different machines and technicians. An ultrasound at one hospital can produce images and measurements of a heart that are different from those taken at another. Doctors like to run tests at facilities with modern equipment and operators they trust, and they will usually want you to have future images taken at the same place so that they can compare them to your baseline over time.

When choosing a surgeon, cardiologist, test location, and hospital for a future heart surgery, ensure that they are all located near each other. Because I live in South Carolina, I followed my doctors’ advice and had most of my tests run in Cleveland the week before the surgery to avoid making multiple trips.

CT scans offer the best views of the heart from different angles, and chances are you will need at least one. However, CT scans shower patients with far more radiation than other diagnostic tests. For example, a routine head CT generates the same amount of radiation as 400 dental x-rays, and the dose from a chest CT equals more than 100 chest x-rays. That radiation can wreak havoc at the cellular level, breaking or altering DNA strands and causing mutations that can lead to cancer. Studies from Columbia University and the National Cancer Institute have predicted that radiation from CT scans could kill 15,000 to 29,000 people a year! Doctors and manufacturers are beginning to address these dangers by encouraging other tests and developing new machines for diagnosing conditions with less radiation, according to the Wall Street Journal.

I had two CT scans before to going to the hospital for surgery, four at the hospital before and after surgery, and a seventh at a local hospital when I returned home and experienced complications, so I have been exposed to the radiation equivalent of approximately 700 chest x-rays. I believe that some of these scans were needed and others were just done because they generate fast and detailed results.

Don’t sit and wait to be told what tests to have—understand and give input into your treatment options. Explain your concerns about radiation to your surgeon and ask if you can opt for high-contrast MRIs instead. MRIs work with magnetic imaging and take longer than CT scans, but they don’t expose you to large amounts of radiation. Some hospitals now use modern CT scan equipment that emits lower levels of radiation, but I still caution against them. You don’t want to fix your heart condition only to raise your risk of cancer later! However, sometimes CT scans are necessary, especially in emergencies.

Prior to surgery, your surgeon will most likely order other tests, like an ultrasound, echocardiogram, blood analysis, and most importantly, a heart catheterization (often referred to as a heart cath). In this procedure, cardiologists typically insert a thin line with a camera on it through your groin or other body entry point to look inside your heart and assess the condition of the valves and arteries. Then, surgeons use the findings to decide the extent of the surgery that you will need (e.g., if your arteries are blocked, and if so, how many need repairing). I was glad to hear that, apart from the aneurysm, surgeons scored my heart a 10 out of 10!

Your cardiologist and surgeon will need all of your medical records prior to surgery. I suggest picking up both the hard copies and imaging test CDs personally from the relevant doctors and test centers. Then, deliver them personally to the surgeon’s office or send via Federal Express (with a tracking number) to the medical facility. Hospitals are big places, and it is easy for things to get lost in the mail there. If mailing your records, get the exact physical address, the name of person who needs to receive them, and their telephone number; then check to make sure they have been delivered prior to meeting with the surgeon. Although my records were verified as delivered to the hospital, my surgeon’s staff never received them. I would also suggest carrying additional copies with you!

Insurance Verification and Pre-Admission

My 2012 surgery and tests at Cleveland Clinic cost $175,000, but were almost completely covered by my insurance. Before you schedule your surgery, be sure that the facility you select is considered “in-network” by your insurance company or, if you are on Medicare or Medicaid, that the hospital accepts it. Otherwise, it will be a very costly out-of-pocket expense. I always ask the registration folks to conduct a pre-certification to ensure I am covered and to give me an estimate of my co-pays or deductibles. If you have reason to believe that you may need heart surgery in the near future, you may want to choose a more expensive monthly insurance payment with lower co-pays and deductibles during your work’s open enrollment period. The hospital will contact you prior to surgery to obtain your basic information. It is important that all of this paperwork is completed and received prior to testing and surgery. I had to go through two pre-certifications, one for testing and another for surgery.

Also, instead of bringing all your medications in a bag, simply make a list of them (separated into prescribed, supplement, herbal, and over-the-counter categories), their dosages, and your pharmacy’s contact information. You won’t be able to take your own medicines in the hospital. Make several copies of your list for the doctors you will visit as you prepare for surgery so they can easily see all of your medications at one glance. You will probably be asked to discontinue any blood thinning medications (like aspirin and fish oil) several days before surgery. Carefully read all of the information the hospital sends you! While a lot of it is repetitive or unnecessary, there will be some helpful morsels of information in the packet.

Mentally Preparing for Surgery

Heart surgery is no picnic. Expect some pain after your surgery, but keep telling yourself and your family, “Things may be hard for a while, but I will get better and live longer.” Patience and a positive attitude are keys to preparing for and recovering from open heart surgery. Quite frankly, I was excited about having the surgery because I wanted to get it behind me, but I have seen others who were very depressed, scared, and worried prior to their surgeries. However, a depressed mood can add weeks or months to your recovery, whereas a positive outlook expedites it! Delaying your surgery will only make the mental stress worse.

At the same time, no surgery is risk-free. Although it sounds morbid, get everything in order before your surgery as if you will not live through it. You simply have to “hope for the best and plan for the worst.” Every day I plan to die, while hoping that my future will be bright and long, and I recognize that every day is a gift from God.

If you are spiritual, ask others to pray for you. Our family doesn’t often pull the big “prayer trigger” with others, but more than 1,000 Christians across the world were praying for me when I had my open heart surgery. I could feel those prayers after the surgery!

Meeting with Your Surgical Team

Your surgeon and his or her team will meet with you the day before the surgery to inform you about the process, gather information, complete forms, and prepare for the procedure. This is your time to ask questions and make requests, so write down any concerns ahead of time. Bring your list of medications and supplements, and be prepared to answer the same questions repeatedly because some facilities’ computer systems do not share information. During your tests, on the day of your surgery, and after the surgery, expect staff to constantly ask you for your name, date of birth, and your procedure to ensure you are the correct patient. I’m glad they did—once, they almost gave me someone else’s medicine!

Ask for copies of all your records for your local doctors so they may treat you properly when you return home and include their names, addresses, and fax numbers on your admission papers. I also suggest that you ask for anti-nausea medications prior to and during surgery. I was severely nauseated for days after my surgery, and it was worse than the surgery itself! This is also a good time to request alternatives to CT scans.

The Morning of Your Surgery

You will probably have to arrive at the hospital at some ungodly hour the morning of the surgery. There is no use in taking more than one family or member or friend with you; you can just ask the rest to come later when the surgery is over. Leave valuables at home or in your hotel safe. The person accompanying you should have your license, insurance information, and a credit card in case co-pays are required, but you will probably have paid prior to this time. Once you arrive at the hospital, you might have to check in with the admissions office again but may be able to avoid it if you asked to be cleared for surgery in advance. You will then proceed to the pre-op area.

During the pre-operation period, they will begin an IV and prepare you for surgery. I prefer to be second in line for surgery to ensure that the surgical team is “warmed up.” Often, you just sit in bed and wait until the surgical team is ready, which can take a while. You may want to ask for extra blankets during the pre-op, as it will be very cold in the operating room.

From the pre-op, you will be rolled into the operating room, which will look like something from Star Wars. Repeat your desire to the anesthesiologist (who will be one of the first to see you) for anti-nausea medications during surgery. I joked with my surgical team, saying, “I hope everyone is in a good mood today!”

Your surgery and post-recovery will likely take 3-5 hours. I suggest that family members stay near the hospital but not in the family waiting area, which will just add to their anxiety and worry. They should bring reading materials, earphones, and devices such as a CD player or smartphone to listen to music while they wait. They could even visit nearby shops and businesses, grab a bite to eat, or do anything else that helps distract them and put them at ease (by the way, the food in the Cleveland Clinic’s restaurants is excellent, but patient food was not!). The Cleveland Clinic gave my family a beeper to alert them when the procedure was almost over. Most places will contact your family roughly 30 minutes before the surgery is complete and they need to come meet with the surgeon.

The Intensive Care Unit (ICU)

After surgery, you will be transferred to a cardiac intensive care unit. You will probably be unconscious for a while, and visitation will be limited. Your family should be prepared to see you hooked up to all types of scary wires, tubes, and equipment and not looking your best. Most likely, you will just want to sleep and will probably not want any visitors.

If I had to do it over again, I would probably ask for few, if any, post-operative pain medications like morphine. Most pain medications cause nausea and serious constipation. If you are in extreme pain, you should take painkillers; however, if you are nauseated like I was, avoid them—they will make it worse. (Expect medical staff to push them, however!) It is up to you, but if you do accept pain meds, try to take as few as possible and stop them soon after the surgery.

You will be monitored to ensure that your condition is stable before you are sent to a regular room on the cardiac ward. The level of care and monitoring in the ICU is usually excellent because of the few patients there and the small staff-to-patient ratio.

Transfer to the Cardiac Ward

The nurses and staff on the cardiac ward will be attending to a lot of patients, so don’t expect an immediate response if you call for assistance. A few suggestions:

1. Forget about bringing a bunch of clothes. A loose-fitting sweat suit will work perfectly. The nurses have seen just about everything and will not be offended if you are dressed casually or in a hospital gown!
2. Hospitals can be noisy. Take a CD player or smartphone and small noise-cancelling earphones to listen to your favorite music. Most hospitals don’t have electrical outlets near the bed to recharge your electronic devices, so bring chargers with extra-long cords.
3. Learn how to work all the bed equipment (how to raise and lower your upper body, how to call a nurse, etc.) so that you can be comfortable.
4. If you are nauseated, tell the nurse and doctor and ask for medicine. If one type of medication does not work, ask to try others until the nausea subsides.
5. Keep a small cooler with a few drinks on your bedside table and ask staff to fill it occasionally. Bring some crackers with you as well, since you will probably not have much of an appetite for other foods. Real ginger ale and soda crackers make a good combination, especially if your stomach is upset.
6. Request a daily sponge bath. With so many wires hooked up to you, it will be impossible to take a shower until the day of your release—four or five days later! Don’t assume that you will get a sponge bath without asking, though.
7. Ask for a bedpan and bottled water so you can brush your teeth in bed.
8. If you are diabetic, ask the surgeon or your doctor before surgery if you can measure your sugar levels with your own machine and regulate insulin. Most hospitals will require you to use their insulin for safety reasons, but I personally found that they did not do a good job.
9. Request that hospital staff turn your body every day (even if you don’t want to move) so you don’t develop bedsores, which could get infected and complicate your treatment.
10. Expect to have blood drawn many times! I left the hospital with black-and-blue arms.
11. Do not expect to sleep well during your hospitalization. Doctors and nurses will be coming in to check your vitals and/or take blood at all hours of the day and night.
12. To prevent blood clots, you will need to wear support hose, both at the hospital and at home. The nurses will probably have to wrestle with them, since they are very hard to put on.
13. As soon as you are well enough, walk around the hospital as often as you can to get your lungs going and build red blood cells.
14. Expect bad hospital food (but if you are hungry and ask nicely, nurses might authorize a one-time cheeseburger)!
15. Ask that a trained nurse (preferably, a cardiac nurse practitioner) provide your discharge summary, not a regular nurse on the cardiac ward, who may just read the information to you. You need a specialized professional to have a dialogue with you about what will happen when you leave the hospital. Pay close attention to what they say, take notes, and carefully read any materials that you are given. Be sure that another family member is present during the discharge to help you remember important points.
16. You will probably need to stay at the hospital for 3-5 days after your surgery. Don’t push doctors to release you early; you don’t want to go home too soon and experience complications.
17. You will be taking many medicines to prevent strokes and other problems; they will be gradually tapered off the first month after your surgery. The day before your release, ask your doctors for prescriptions so you can have them filled at a nearby or hospital pharmacy. Call the pharmacy to make sure that they have the medications in stock.
18. On the day before your release, obtain hard copies of all of your medical records and a CD of any imaging records (this will require a medical release form). Your local internist and cardiologist will need them, and it is like pulling teeth to get them from the hospital once you return home!
19. If you are from out of town, I recommend staying at a nearby hotel for 1-2 days after surgery in case you experience problems. Cleveland Clinic has a hotel attached to their hospital, which was very convenient but expensive (however, it was worth the price so that visiting family members could walk inside to the hospital). Airlines will usually work with you to change your flight itineraries with no penalties, but be prepared to give them the names and telephone numbers of your doctor and hospital. It is nearly impossible to know the exact date and time that you will be released since there are so many variables that can impact when you are ready to leave the hospital.
20. Ask for a copy of your post-surgery blood test results before leaving the hospital, and keep a close watch on your hemoglobin readings. During surgery, you were probably hooked to a lung machine that breathed for you, with your blood diverted to a pump, because surgeons prefer to work on dry hearts. However, blood being diverted through the pump can remove red blood cells, which can cause anemia. According to the Mayo Clinic, symptoms of anemia are difficulty breathing, no energy, pale color, fatigue, dizziness, irregular heartbeat, cognitive problems, cold hands and feet, and headaches—all of which I had! My hemoglobin dropped below 8; normal levels are 12.5-17. If your reading is below that, you will suffer from anemia, which was the worst part of the whole experience, in my opinion! It took me about a month to recover from the anemia. If you are anemic, ask the doctor to start you on an iron supplement immediately, preferably before you leave the hospital. Beware: iron supplements can have side effects, including “gorilla breath!” Take them at night with food. 
21. If you are flying home, ask for wheelchair assistance when checking in and upon arrival at your local airport. Don’t pick up anything weighing more than 10 pounds, including suitcases.

Returning Home

When you arrive at home, you will probably be exhausted and should take it easy. You cannot rush recovery, but there are some things you can do to enhance your chances of a good outcome:

1. Beware of germs. Your immune system will be weak after such a major surgery, and you will be more susceptible to serious—or even deadly—illness. Even seemingly healthy people can carry germs that can be fatal to you! I stayed at home and avoided other people for several weeks. When I went to my doctor or was out in public, I wore a face mask that I purchased from the drugstore.
2. Some people will want to bring over meals and love on you. Let them! You will find out who your true friends are during this time. Amazingly, however, sick people sometimes visit individuals who have recently undergone major surgeries, so have your spouse serve as an intermediary. Remember that you are in a fragile state, and there will be plenty of time for visiting later.
3. If you have anemia (which is highly likely), you need to be on an iron-rich diet. Research various foods that are high in iron. Some will fall outside of the diet that was prescribed to you, but if you are anemic, you need to address that problem first. Iron-rich foods include: red meat; egg yolks; dark, leafy greens (like spinach, kale, and collards); dried fruit (especially prunes and raisins); iron-enriched cereals and grains (check the labels); nuts; mollusks (oysters, clams, and scallops); turkey or chicken giblets; beans, lentils, chickpeas, and soybeans; liver (chicken and beef); artichokes; and sardines.
4. Beginning around the house and then moving outside, walk as much as possible (avoiding hills). Walking not only works the lungs back to their normal capacity, but if you can move briskly enough that you are huffing and puffing, you will rebuild red blood cells and fight anemia.
5. See your local internist within 3-5 days of leaving the hospital and your cardiologist within 10 days. Be sure to take your hospital records with you. Your internist will run blood and other tests to assess your overall well-being, while your cardiologist will focus on your heart condition. Always ask for copies of any tests so that you can monitor your improvement. Don’t be alarmed if your blood levels are abnormal; this is typical for someone who has just had open heart surgery.
6. Your body and mind have been through a very traumatic experience, and you could face some psychological problems such as insomnia, crying, anger, depression, isolation, feelings of helplessness, and even suicidal thoughts, all of which are normal for open heart surgery patients. You and your family will need to monitor and report any behavior changes to your doctor. Depression can contribute to an increased risk of heart attack and coronary disease, so it is important to seek treatment right away if you have any of these symptoms. Try to stay away from stressful situations, problems, or people who make you angry during your recovery; they can cause your heart to work harder. Above all, don’t rush back to work! You may need to talk to a trained counselor about your feelings or take antidepressants for a while, but give yourself some time for natural recovery. In Columbia, SC, I highly recommend Dr. Fredrick Mau (www.watermarkcolumbia.com) as a counselor and Dr. Josh Fowler, MD as a top-notch psychiatrist.
7. You may also experience postperfusion syndrome, or as some surgeons call it, “pumphead.” Recent studies by Duke University researchers have found that diverting blood to a pump during open heart surgery releases microscopic bubbles into the blood that travel through your brain. This may cause patients to feel like they are thinking through a fog and/or cause short-term memory loss, concentration problems, and attention deficits. Most patients improve after several months, while others have reported serious memory problems for years after the surgery. Keep note of any issues that could be caused by pumphead and tell your doctor. Even now, I still experience some short-term memory issues.
8. Talk to others who have had heart surgery. No one knows what this experience is like unless they have gone through it themselves. It can be very therapeutic to share your feelings with other members of the “zipper club!”
9. You need restful sleep to recover, so if you are having any issues with insomnia, ask your doctor for a sleeping aid. Unfortunately, not all sleeping medications work for everyone, so you may have to experiment a little. Ambien CR (12.5 mg) worked well for me right before the surgery, but was insufficient after the surgery. After trying several other sleep aids, my doctor and I settled on 30 mg of Restoril (its generic is temazepam, which usually costs less than $10 per month). The frustrating part is when you have to see a doctor, make a co-pay for a 30-day supply, and then, if the prescription does not work, begin the process over again. Ask your physician if you can try samples of several brands, or just ask for several five-day short-term prescriptions and pay cash for them. Also, avoid naps during the day if possible, as they will increase your chances of nighttime insomnia. Short naps may be necessary, but be careful not to get your days and nights mixed up. You may want to sleep in a room by yourself so you do not disturb your spouse. Try to avoid taking any medicines or supplements that can cause sleeplessness at night; ask your doctor if you can take them in the morning instead.
10. Try to wean yourself off of pain medications as soon as possible—they contribute to insomnia and can slow your digestive system, causing severe constipation. For gentle relief, drink orange-flavored Metamucil or another fiber supplement several times a day (morning, noon, and night) and eat lots of fruits and vegetables.
11. Remember not to exert yourself, pull or push anything, or lift anything weighing more than 10 pounds until your doctor tells you it is okay. Otherwise, you may find yourself having another open heart surgery! If you take a long car trip, stop every hour and stretch your legs. Do the same when flying to avoid blood clots, which can cause serious health problems.
12. You should not drive until it has been six weeks after your surgery, or until your doctor releases you to operate an automobile. If you wreck, the airbag could deploy and tear into your sternum, damaging your heart again! When riding with others, sit in the back seat to avoid airbags.
13. As soon as your internist and cardiologist approve, enroll in a cardio exercise program (I chose one at Lexington Medical Hospital). It is usually a 36-session program that you can knock out in three months. You will be hooked to a heart monitoring device and exercise according to a routine designed by experts. I was initially reluctant about joining the program, but it was fun, made me exercise three times a week, and allowed me to meet others who were in situations similar to mine. You should also consider taking classes on nutrition and other health matters that can help you recover faster and extend your life. I thought that all they would do was preach, but I have actually incorporated many of my nutritionist’s suggestions into my diet! Sure, I still love my fried chicken! But now I buy sharp cheese made with 2% milk, which tastes very good. I have lost 30 pounds and feel great. You are going to lose weight as a result of the surgery, and taking a nutrition class is a great way to learn how to keep it off.
14. IMPORTANT: If your heart is fluttering, racing, or out of rhythm, notify your cardiologist and/or internist immediately. You may be experiencing atrial fibrillation, or A-Fib, a dangerous condition caused by heart surgery that can lead to strokes and heart attacks! I had A-Fib, and my heart felt like it was coming out of my body. It would suddenly start beating 210 beats per minute versus the normal 73. Several times, I collapsed and could not breathe. Eventually, I had a small transient ischemic attack (TIA) stroke where my arms flew around uncontrollably and I could not talk (fortunately, there was minimal brain damage). A-Fib is hard to detect sometimes and may not show up in your blood pressure readings, and attacks are very unpredictable. If you feel like you are having any A-Fib symptoms, your doctor will probably require you to wear a heart monitor. I liked the one my cardiologist assigned to me, which I could wear like a jacket and take off for a shower. I wore it for three weeks and pressed a button every time I felt my heart go out of rhythm. I am now on medication to keep my A-Fib under control.
15. Buy both an old-fashioned glass thermometer and an electronic one, and take your temperature in the morning and at night with both devices for the first month after surgery. Elevated temperatures after surgery are normal, but tell your doctor if your readings go over 100 degrees Fahrenheit, which could indicate an infection.
16. Purchase a home blood pressure monitoring machine. Consumer Reports recommends the Omron or Relion; I have both and prefer the Omron. Both can store multiple readings on yourself and other family members. Record blood pressure readings while sitting still with your legs uncrossed and report your findings to your doctors when you visit for follow-ups.
17. I kept a journal of all my symptoms, side effects, and unusual conditions, which proved to be invaluable when I visited my physicians.
18. Avoid stairs until your stamina is up to par, and take them slowly.
19. Don’t shower with perfumed or moisturizing shampoos or soaps. Instead, use unscented soaps and baby shampoo during your healing period. Avoid baths until your incision has healed.
20. In a few weeks, when your incision has begun to heal, place Vitamin E on it in the morning and Mederma at night (or vice versa) to help reduce the appearance of your scar.
21. If you require any type of procedure that may cause bleeding (like a colonoscopy, invasive tests, surgery, etc.) take care to prevent infectious endocarditis, which is an infection of the heart chambers and valves caused by bacteria or fungi. It is important to practice excellent dental care, including regular flossing, to help prevent this condition. In the past, heart doctors and dentists recommended that patients take strong doses of antibiotics before any dental work, but have since stopped the practice because consuming too many antibiotics can create an immunity to them.
22. You will be given a pillow to hold against yourself for support when you are coughing, sneezing, laughing, and sometimes, just breathing. I did not use it much, but some swear by it.
23. Wear support hose during the day to prevent blood clots, but take them off at night. Putting these on is difficult and can cause strain, so you will need assistance. The secret is to roll them up and put them on like a sock.
24. Take your medicines with food at the same time each day, but be wary of foods and drinks that can hamper their effectiveness, like grapefruit or grapefruit juice. Research all of the medicines you will be taking, like blood thinners, ACE inhibitors, beta blockers, etc., and know the side effects. The most common side effect is dizziness, so when you get up out of a chair or bed, do it slowly and wait for any dizziness to go away before moving. (See my articles about the dangers of medicines and supplements, which can be found at www.mikedubose.com, for additional information.)
25. Follow a low-fat, low-sodium diet, and if you smoke, stop! I know it is hard because I used to smoke, but if you don’t address these two risk factors, you could be facing another open heart surgery down the road (or worse—premature death caused by a heart attack).
26. Twelve months after my surgery, I began to experience headaches and frequent nausea. Through trial and error, my doctor and I traced these problems to the blood thinner I was taking. We discontinued that medication, and I now take Eliquis. I would suggest avoiding the blood thinners Warfarin or Coumadin, which have side effects and require blood tests. The firm that manufactures Eliquis offers a small co-pay to offset its high costs at www.Eliqis.com.
27. Even if you had heart surgery several years ago, the Centers for Disease Control (CDC) recommends that you stay vigilant for symptoms of infection, such as night sweats, muscle aches, weight loss, fatigue, or unexplained fever. This is because some open heart surgeries utilize “heater-cooler devices,” which, according to the CDC, “might have been contaminated during manufacturing and could put patients at risk for life-threatening infections.” Each year in the US, there are more than 250,000 heart bypass procedures that use heater-cooler devices, so there’s a significant probability that yours may have, too. Speak with your doctor if you have concerns or experience any symptoms of infection. Some research has indicated that the bacteria can stay in your system up to four years after surgery!