CONGRATULATIONS ! You are now returning home after a successful bypass surgery. It is extremely important that you continue your walking program to help you recover as quickly as possible.
FIRST WEEK AT HOME
It is important for you to pace your activities at home, especially during the first week. At times small amount of activity may get you tired and out of breath. Do not worry, as this is not unusual. When you do feel tired, take a short rest before resuming your activity. At the same time, you must not give in to those tired feelings and spend all day in bed. During your first week at home, you may experienced several mixed emotions. It is quite normal after a surgery to feel sad or depressed. These feelings usually do not persist for more than 4 weeks. It is also normal to have some feeling of anxiety. However, if these emotions trouble you a lot and prevent your from sleeping, consult with your doctor, who may put you on medication. Day by day you will recover your strength and you should be back to ‘normal’ within 4 to 6 weeks.
In between activities it is important to rest. At times you may feel full of energy and will want to do a lot more than what you are permitted to do. While activity and exercise is very important for your recovery there is a fine line between the right activity and excessive activity. Just as you plan your activity it is also important to plan your rest periods. Make sure you get adequate sleep at night,at least 7-8 hours. Also, plant to take a short nap every afternoon for the first few weeks.
During your stay in the hospital you will have started a walking program. Exercise improves your strength after surgery and also helps increase your cardiac capacity and reduce your risk for future heart disease. Before you begin, you should do a warm-up. When you exercise, let your heart rate (pulse) and rate of perceived exertion (RPE) be your guide. Please read the guidelines on how to use the RPE scale. Your target heart rate range (THRR) is from beats per minute. Your RPE should fall between 11 and 13. After 5 minutes of exercising, stop and check your pulse. If it is too high, slow down; if it is too low, speed up your pace, but not to an uncomfortable level. Make sure you check your heart rate again during the middle of exercise and of course if you feel you are working too hard.
It is beneficial to do some light stretching or conditioning exercises before walking. Start walking slowly and gradually increase your walking speed (pace). This allows your body to move comfortably and adjust safely to the increase in work.
After exercise it is important to gradually bring your heart rate down to resting. During exercise, the working muscles help return blood to the heart. If this help is suddenly taken away, the blood tends to pool in the lower extremities which may cause dizziness, muscle cramps, hyperventilation, and/or “fainting.” Cool -down by sluvving down your pace and coming to a halt gradually. Follow this with gentle stretching exercises, deep breathing maneuvers, and slow movements.
How to Count Your Pulse
- Turn your hand over palm side up. Put the first two fingers from your other hand at the base of the thumb on the wrist.
- Feel your pulse by pressing lightly in the little groove.
- The number of times you feel your heart beat in one minute is your heart rate. Use a watch with a second hand. Count for 15 seconds and multiply by 4 if your pulse is regular. If your pulse is irregular, count it for a full minute
Exercise at a comfortable pace, remembering to use your heart rate and RPE as guides for speed. Remember that the purpose of your exercise is to strengthen your heart muscle, not to see how fast you can walk! Under NO circumstances are you to jog or run.
Week Walking Program
Below is a sample -walking program. There are always individual differences and you need to adjust your program depending on ‘how you feel’ and using the RPE guidelines. Do not worry if you are unable to follow the program exactly.
Avoid exercising outdoors in extreme temperature situations such as the hotter parts of the day. Remember not to exercise within two hours of eating a meal. Wear supportive walking shoes and comfortable clothing.
Please Note: If your ejection fraction (the pumping capacity of the heart) is on the lower side (less than 40%), you will need to progress on a slower basis. Start with 5 minutes the first week and stay on the lower side of the suggested guidelines.
|Week No.||Suggested Distance (aprox)||Duration(MINS)||Times Per Day|
|1||100-400 M (Metres)||5-10||3-4|
Do Not Exercise or Stop Exercising if you note any of the following:
- Excessive fatigue that lasts more than an hour after you finish exercising.
- Chest, neck, jaw, teeth, shoulder, or arm pain that is unusual. Remember you may experience some discomfort in t he c hest d ue to t he fact that your breast bone (sternum) was cut during surgery and requires 6-8 weeks to heal completely.
- Excessive shortness of breath.
- Dizziness or nausea.
- Ankle swelling or increase in weight.
- Heart rate too much over target.
- Skipped beats that appear more frequently than usual.
- Joint, muscle, or ligament pain/problems.
Please record your progress on the sheet provided so that we may monitor your progress, make any necessary adjustments, and answer questions that may arise concerning your independent activity.
WHAT ABOUT CLIMBING STEPS
For the first few weeks, if there is an elevator available, it is better to use it to reach your destination. If, however, you do not to climb steps do so in a gradual manner. Take a break for a few seconds after every few steps. Listen to your body- if you feel breathless and need to take a longer break, go ahead and do so. After complete recovery it’s a good idea to climb steps as part of your everyday activity.
Follow the instructions given by your doctor at the time of discharge. Your surgeon will want you to make a follow-up appointment to check your progress. The date and time of your follow-up appointment will be on your discharge instructions sheet.
As instructed by the physiotherapist, continue to do your breathing exercises after your discharge. Coughing and deep breathing are still important to prevent infection in your lungs.
Do not lift anything heavier than 10 pounds for 6 weeks. A 1 litre bottle of water weighs about 2 pounds. Heavy lifting can cause the bone in your chest to separate, and prevents it from healing. The surgeon will tell you at your follow- up appointment when you can start lifting heavier objects.
ABOUT HEART DISEASE
Since you have suffered from heart disease it is extremely important for you to identify the causes of heart disease, which will help you take the appropriate steps to avoid it in the future.
WHAT IS HEART DISEASE?
When we commonly refer to ‘heart disease’ we mean coronary heart disease’, which happens when blockages build up in the coronary arteries. These blockages are called atherosclerotic plaque and the process by which they build up is called atherosclerosis. This is also called coronary artery disease’. These blockages may lead to a ‘heart attack’ but it is not necessary that they will.
What is a heart attack?
A heart attack is injury or death of part of the heart muscle. It is also called a m ocardial infarction’. There are 2 major ways in which a heart attack can occur:
- Blockages get worse. As the blockages get larger there is less blood flow to the heart muscle. At one point the heart muscle no longer can get the blood and oxygen it needs. When the blood supply is cut off for more than about 30 minutes, the heart muscle cells begin to die, and a heart attack occurs.
- The atherosclerotic plaque cracks. Most heart attacks are caused as a result of ‘cracking’ or ‘rupture’ of the plaque (blockage). The plaque becomes unstable and cracks, forming a blood clot which travels and completely blocks the flow of blood through the artery, and causes a heart attack
What are risk factors?
Scientific studies have shown that certain traits and lifestyle habits increase the risk of a heart attack These danger signs are called “risk factors.” The progression of heart disease is a long-term process in which cholesterol and other substances build up in the inner lining of artery walls. They form plaques, which block the flow of blood to the heart muscle. Risk factors tend to speed the development of plaque, and by reducing them; we can block the progression of plaque formation and decrease the chances of having a heart attack. Risk factors that can be modified are:
Risk factors which you cannot change:
- Age: The incidence of atherosclerosis increases as we get older.
- Sex: Males tend to develop atherosclerosis at a higher rate and at a younger age than women. However, this effect lessens as women complete menopause.
- Heredity: A family history of CAD puts you at increased risk for developing it. Although you cannot control these risk factors, it is especially important that you take steps to reduce any that you can change.
Risk factors you can control or change:
- Cigarette Smoking / Tobacco Chewing
- A smoker’s risk of having a heart attack is more than twice that of a non-smoker. Smoking speeds up the development of plaque in the arteries, reduces the level of the good HDL cholesterol, and increases the stickiness of blood cells causing blood clots inside the arteries. However, as soon as you quit, your risk of heart disease begins to drop.
Elevated Cholesterol Levels
When there is excess cholesterol in the body, it deposits in the walls of the arteries supplying blood to the head and starts the build-up of plaque. There are different types of cholesterol, but the two most important ones are LDL and HDL LDL is called “bad cholesterol”, while HDL is the “good cholesterol.” A total blood cholesterol of less than 200mg% is recommended. Your LDL cholesterol must be kept below 100 mg/dl.
High Blood Pressure
High blood pressure or hypertension is often referred to as the “silent killer.” This is because people often are not aware that their pressure is high. A high blood pressure has been defined as either the higher number, called systolic pressure being over 140 mm of mercury or the lower number, called diastolic pressure being over 90 mm of mercury. The first line of treatment is regular aerobic exercise and reducing the amount of salt in the diet. If these do not work your doctor might start you on medication to lower the BP. Normal BP is 120/80 or less- this is for people of all ages. Blood pressure should not increase as you get older.
Indians have one of the highest genetic risks for diabetes. It is a very serious disease in itself and leads to complications in the eyes, kidneys, and blood vessels, besides being one of the major risk factors for heart disease. Normal fasting blood sugar is 70-110 mg/dl.
This is the easiest risk factor to avoid, and yet for many people it seems to be the hardest. You do not need to be a marathon runner to reap the benefits of physical activity 30 minutes of aerobic exercise, such as walking on most days of the week is enough to significantly reduce your risk for a heart attack.
Obesity can lead to diabetes, high blood pressure, as well as other complications such as arthritis. A sensible diet, combined with an exercise programme is the best way to shed those pounds. Crash diets and fad diets do not work in the long term, and may actually be harmful to the body.
The role of stress in development of atherosclerosis is unclear, but it is advisable that you identify personal stressors and plan how to decrease them. You should also plan ways you can relieve stress
CARDIAC REHABILITATION PROGRAM
We offer an outpatient cardiac rehabilitation program that works with you to attain your personal level of peak health. During these sessions we are able to work with you on safe levels of exercise and activity to get you back to doing those things you want to do. We also address and work with you in reducing your risk factors for heart disease and to ensure the long-term success of your surgery.
If you have any questions about any of these options, please call us at 5698- 6665. We’re looking forward to seeing you outside of your hospital room and working with you to achieve health.