When it comes to matters of the heart, prevention is better than cure. But sometimes life catches you off guard and a heart surgery such as a bypass or an angioplasty is the only way to save your life.
But heart surgery is not the end of your treatment plan. In fact, it’s the beginning of a long, healing process in which it is essential that you do the right things and refrain from doing the wrong.
Often, due to lack of awareness about post-operative care, cardiac patients feel insecure and nervous about their health.
It becomes important that they understand their current health and take required steps to maintain it. This is where cardiac rehabilitation comes in.
The aim of cardiac rehabilitation is to help you get back to your normal life after heart surgery such as CABG [coronary artery bypass graft], as soon as possible time and help you prevent cardiac events in the future.
The components of cardiac rehabilitation are:
Physical activity
For about six weeks after surgery, you are advised to avoid exertion. This means no isometric exercises like lifting, pushing or pulling heavy weights or straining when passing stools. The wound is has just begun to heal and is relatively fresh.
Walking is the best exercise to start with. And you must walk on a levelled surface. You can even take up cycling or walking on the tread mill. Choose an exercise you enjoy, to begin with, as you are more likely to stick to the plan.
It is natural to feel tired in the first few weeks, but this will improve with time. Set realistic goals and accept your limitations. For the sake of convenience, divide your walking into two phases.
Start with level one and gradually progress to level two. Always start with a warm up and end with a cool down of five minutes each. And consult your cardiologist before engaging in any physical exercise.
Level 1: This includes walking when engaging in daily activities such shopping for groceries, playing with children and walking around the house. You can do these activities 3 ? 4 times a day. The goal is to walk for a total of 30 minutes.
During this level, it is important to consider the duration of the walk and not the pace. To know if you are walking right for your capacity, do the ‘talk test’. While walking, try talking—you should be able to talk comfortably, without breathing too hard.
Then, try singing—you shouldn’t be able to sing comfortably. Another, more technical way of assessing your workout intensity in level one is to reach 50 per cent – 60 per cent of your maximum heart rate. To calculate your maximum heart rate [MHR] subtract your current age from 220.
Once you are comfortable with this level of activity for 30 minutes, increase your pace gradually.
Level 2: Move to this level only after 3 ? 5 weeks of doing level one comfortably. Aim to reach your target heart rate to 60 ? 75 per cent of maximum heart rate.
Initially, start with 10 minutes of level two and then drop the pace back to level one for the remaining 20 minutes. It is important to gradually switch from level one to level two.
Start with three days a week in the beginning. Add extra days only when you feel comfortable performing three days without ill-effects.
Pay attention to your body’s reaction while walking and if you feel chest pain or discomfort, take it seriously. Slow down or stop exercising immediately and seek emergency medical advice. Avoid exertion soon after meals or bathing.
Diet and nutrition
Following a healthy diet helps keep your risk factors [hypertension, diabetes mellitus, and elevated cholesterol] in control. A heart patient’s diet should comprise:
Variety: Have foods from all major groups like whole grains, vegetables, fruits, low-fat dairy products, white/lean meat and legumes.
High-fibre foods: Eat more fibre-rich foods such as oats, vegetables and fruits like pear, oranges, sweet lime, apple and apricots.
Low-cholesterol foods: Choose foods that have more unsaturated fats [olive oil, soybean oil, safflower oil, almonds, walnuts] and avoid eating foods that are high in saturated fats [butter ,whole milk, cheese, ice-cream] and trans fats [cakes, cookies, animal products]. Prefer low-fat cooking methods like boiling, baking, roasting to high-fat cooking methods such as frying.
Less salt: Have less than 2.5g of sodium or less than 1tsp of salt per day. For this reason, stay away from foods that have more salt such as ready-to-eat or packaged foods.
Other lifestyle changes
Weather: Limit your exposure to environmental stressors such as extreme cold, heat and humidity.
Weight lifting: During the first six weeks after surgery [or till your surgeon recommends], avoid lifting heavy weights. Always exhale when you exert [lift weight]. Don’t hold your breath or strain during a lift.
Smoking/alcohol: Habits such as these are what lead you to surgery; give them up.
Wound care: Wear a chest support [belt] and stockings till six weeks. Remove the stockings at night.
You can resume other activities such as driving and sexual activity after six weeks. Take as much rest as you can after surgery, it helps heal faster.
Emotional support
Having to undergo an open heart surgery is a challenge not just for the patient, but also for family members.
Stress and depression are common during this phase for all involved. The cause of stress is multi-factorial. Uncertainty about the future course of health, financial setback incurred due to high expenses of surgery and recuperating during convalescence period are some of them.
Stress delays healing and affects the predisposing factors [blood sugar, blood pressure] of heart disease. Strong social support is a must to protect you from the negative effects of depression.
- Be well-informed and do not hesitate to ask questions to you cardiologist.
- Share your fears and anxieties with friends and family.
- Be happy that you are alive and think positive.
- Plan your day and keep yourself busy [without feeling stressed].
Remember, recovery takes time. In spite of taking all precautions, if you still feel low, seek professional help.
Medical follow up
Adhere to the check up schedule and take medicines regularly. Failure to do so spells disaster. Normally, the first comprehensive check-up is done three months post surgery, and then after every six months [earlier in case of ill health].
Self-monitoring
Self-monitoring is important. It helps maintain health and prevent unfavourable events in the future. Wound care, blood sugar, blood pressure, pulse rate and weight are some of the parameters to be monitored.
Life after a major heart surgery need not be viewed as if it’s all over. Take heart, and celebrate this new lease of life… a healthier life.