In the first two articles, we discussed preparations for bypass surgery. Today’s article will focus on the initial recovery process, beginning with the morning after surgery. In most cases, patients will be awake, extubated and out of the bed, sitting in a chair by 6 a.m. the morning after surgery.
If the patient is hemodynamically stable, or not requiring intravenous medications to maintain heart function; many of the intravenous lines, like the yellow Swan-Ganz catheter and other medical equipment will be removed. After breakfast, the patient will be assisted out of the chair, to take the first of a series of many, many walks. Soon after that, many patients will be transferred to the telemetry or step-down unit so they can focus on completing the steps necessary for getting better and going home.
Understanding the recovery process
Post-operative recovery is more like training for a marathon than most people realize. We like to use the example of an out—of-shape athlete getting ready to run his first marathon after a long hiatus.
It’s also more patient driven that most people understand. That means that the patient is not a passive recipient of care in this situation. The patient is the driving force in pursuing wellness and restoration of health. Whether the patient walks or not can determine how quickly (or if) the patient gets better and goes home.
Less technology = Better
Most people think, “Technology = Superior” but that’s often just not the case. Many times, simpler interventions are far more effective than even our most advanced (and costly) technologies. That is particularly important when we talk about breathing, and pulmonary toileting after cardiac surgery.
We have the technology to intubate and ventilate patients with machines. We can even start powerful drugs like nitric oxide to enhance oxygenation in patients who are in respiratory failure despite being on a breathing machine. But in cardiac surgery, these technologies represent a failure or a poorer prognosis than our less invasive, and less fancy treatments. That’s a hard concept to convey to generations of people who have been sold on medical technology - but it is true.
The easiest and best ways for patients to get better after surgery – aren’t fancy, they aren’t expensive, and they aren’t high tech. But these interventions are amazingly effective, if we can get our patients to perform them. Too often people can’t get past preconceived notions about heart surgery and that hinders our care.
Not a melodrama
Now think about that – and mentally prepare yourselves. For many patients and their families, this is a huge change in their expectations. Years of “General Hospital”, “Grey’s Anatomy” and other quasi-medical shows along with popular culture have shaded the public’s perceptions of health care and surgery. These television shows, along with other melodramas have led many people to envision in-hospital post-operative recuperation from cardiac surgery as being a long, drama-filled and drawn out process filled with a lot of handwringing, audible prayers and indrawn breaths from everyone in the vicinity, particularly from the significant other.
Babying the patient back into intensive care
Put away your hanky, and re-focus on the reality. For the vast majority of patients, this is not the case. Not only that – but these kind of over-solicitous, “here, let me feed you, help you, do-that-for-you” attitudes and behaviors will actually slow and hinder the patients recovery. In fact, many of the most frequent complications are more common in patients who have families who spend more time catering to, and babying patients than listening to experienced physicians and health care providers.
Not a democracy
The first thing to understand as you or a loved one goes thru this process, is that as many surgeons say, “It’s not a democracy.” This is important because as we discussed above, families don’t always know what’s best for their loved ones, and this is a hard concept for many people to swallow.
Patient care isn’t dictated by popular vote, or whether we want you to like us – it’s based on scientifically validated and evidenced-based practices. This means that the family’s desire to soothe, no matter how well-intentioned, comes secondary to our duty to heal the patient through cardiac rehabilitation measures such as fluid restriction, frequent respiratory exercises and walking.
But he’s thirsty!
Yes, we know the patient is thirsty, but no, you can’t bring a gallon of sweet tea. Patients often gain large amounts of fluid during the surgery and immediate post-operative period. Pounds and pounds of water weight in some cases. All that fluid has to go somewhere, and it usually settles in the lungs. So doctors and healthcare providers work hard at getting that fluid off, by encouraging the patient to do breathing exercises, and giving the patient medications to make them urinate. But there is a limit to the amount of medication we can give without causing other problems like kidney failure so we strongly limit the amount of fluids some patients can take in after surgery.
All these body water shifts along with mouth-breathing during surgery give patients an amazing thirst. It’s unquenchable. Patients can drink gallons of fluid, and their mouths still feel dry. But drinking all of that extra fluid compromises breathing and puts the patient at increased risk of pneumonia and respiratory failure. It can even cause heart failure in our sicker, frailer patients. That sweet tea we mentioned earlier, is an even worse idea because all of the sugar will cause a serious hyperglycemia or high blood sugar in our patient. This hyperglycemia happens even in non-diabetic patients and it puts the person at risk for other serious consequences like poor wound healing and infection.
Friends and family play an important role in the care of loved ones
The “He’s thirsty” is just one of the battles we often encounter between families and health care providers and it illustrates how even the best of intentions from family members can have serious consequences for loved ones. But that doesn’t mean that friends and family can’t play an important role during this time. In fact, there is one role that family members can do to shorter recovery, decrease complications and help their loved ones feel better, and it’s something families and friends do better than anyone else: Cheerleader.
Encouraging and cheering your loved one to good health
The best way for families and friends to help their loved one starts by working as a team with health care providers. Help us care for your parent, spouse, sibling, child or friend by encouraging the patient to participate in cardiac rehabilitation activities. Walk with patients and therapists, and encourage the patient to walk farther and more frequently each day. Remind the patient to use their incentive spirometer to prevent pneumonia or to splint their incision when coughing to decrease pain and discomfort.
Caring friends and family can also participate in patient education sessions by taking notes and asking questions during sessions on diet, medications and post-operative activities. Learn what sternal precautions are, and help patients follow these precautions to prevent pain and injury.
Lastly, take care of your loved one by talking to us. We want to hear what you have to say, particularly if you’ve been at the bedside all day, because we can’t be. We want your insights, so tell us your concerns, and ask questions but remember to listen to our answers.
In the next article, we will talk more about the recovery process and restoring health and wellness after coronary artery bypass (CABG) surgery.