After your stay

Post-surgery checklist

• Medication
• Doctor's appointments
• Wounds
• Diet
• Legs
• Physical exercise
• Prevention

Medication

When you leave after your surgery, you will be provided with sufficient medication for the first two days following discharge. Please ensure that you follow the dosing schedule provided.

Doctor's appointments

Please arrange to be seen by your general practitioner or one of the physicians at your usual practice as soon as possible, and certainly no later than two days following discharge. Should you develop acute symptoms or a raised temperature, please contact your physician immediately.

Wounds

If your wounds are both clean and dry, you may shower as usual but not for longer than 5 minutes. Please ensure that soap-based cleansing products and skin care products do not come in direct contact with the wound. Please refrain from having baths until after you have begun rehabilitation. You should also avoid sitting in direct sunlight for extended periods of time.

Diet

With regard to the amount of fluids you should be consuming per day, you should try and follow our recommendations. Please ensure that you continue to eat a diet that is rich in vitamins and fiber, and which complies with the recommendations of the German Nutrition Society (DGE). Please refrain from any tobacco use.

Legs
If you have swelling in your legs, this may continue for a number of weeks. You should therefore refrain from standing for long periods of time. and, when sitting, you should avoid bending your legs, as well as ensuring that you keep your legs raised as much as possible.

Physical exercise

You should not exercise beyond the level set as part of your physiotherapist-led mobilization. Please avoid any unnecessary trauma to the chest. You should avoid heavy lifting and working with your hands raised above shoulder height for a minimum of 6 weeks. You should refrain from driving a car until the end of your rehabilitation. The same applies to cycling within the grounds of the hospital/rehabilitation center. Sexual intercourse is associated with a considerable degree of physical exertion and, depending on the nature and severity of your condition, it may be advisable for you to refrain from sexual intercourse until after the end of your rehabilitation. Once you have completed your rehabilitation, and depending on the planned level of activity and the level of strenuousness of your travel plans, you should also be able to enjoy going on holiday once more.

Prevention
Patients with prosthetic heart valves are asked to ensure that they follow the guidance on antibiotic therapy for the prevention of endocarditis. This guidance can also be accessed by clicking on the following link: www.flexikon.doccheck.com

Exercise and mobility following heart surgery: What is and isn't permitted?

You are back at home following your surgery and waiting to start your cardiac rehabilitation - what type of physical exercise is permitted and what is not permitted?



Generally speaking, a sensible level of exercise will aid recovery. It is not advisable to choose the option of "rest and recuperation on the sofa".



By the time you have been discharged, your wounds will be dry and intact and will not stop you from becoming more active. The sternum (breastbone), however, will need to be treated with care, as it takes approximately 6 to 12 weeks to heal completely. During this time, it will continue to be stabilized with sternal wires. This is why you are advised to refrain from heavy lifting and strenuous garden work, as well as avoiding any work around the house that involves lifting your hands above head height.

Furthermore, you are advised to refrain from swimming until after you have completed your rehabilitation, as the arm movements used during swimming place severe strain on the sternum (breastbone).



You should not cycle prior to starting rehabilitation. This is because tripping over whilst getting on or off the bike, or falling whilst cycling, may result in serious problems involving the sternum (breastbone).



Regular walking (e.g. taking the dog for a walk), on the other hand, is highly encouraged.



In fact, all you need to do is to leave the house once a day, preferably accompanied by another person, and have a good walk. Naturally, the question as to what constitutes a good walk will depend on your own general health and fitness, and it is necessary that you do not overexert yourself

.

Many of our patients ask us which sleeping position is best. During your stay in hospital, you will have been advised not to sleep on your side so as not to interfere with the sternal healing process. With time, this rule can be relaxed a little. Try to find a sleeping position that you find comfortable whilst also avoiding any jerky movements. You should of course refrain from sleeping on your front.



Once you have completed your rehabilitation - and unless directed otherwise by your treating physicians - you will be able to sleep and move as normal. You will be able to exercise again, with the idea being that you select a moderate level of intensity without overexerting yourself.



Once you have completed your rehabilitation, you will be able to start driving again, but you will not be exempt from wearing a seatbelt. Seatbelts save lives even in people who have undergone heart surgery that required a sternotomy.



We highly recommend you purchase a blood pressure and pulse monitor, as your blood pressure should never exceed 140 mmHg (top value) - even when working in the garden or cycling - and your pulse should never exceed 130 beats per minute. When you are at rest, e.g. when watching TV in the evening, your pulse should be below 100 beats per minute, while your blood pressure should not exceed 130/90 mmHg. You will need to keep a record of your blood pressure and pulse.



If you have diabetes and you inject insulin and/or are taking anticoagulants, you will need to record both your blood sugar levels and/or your INR values. Your general practitioner will need these data in order to determine what adjustments may need to be made to your medication.



You should also weigh yourself once a day and record your weight.



These steps may seem a little involved and may cause a certain degree of inconvenience, but they are likely to benefit the long-term outcome of your treatment. When it comes to positively influencing your own quality of life and life expectancy following heart surgery, the degree to which this is possible will very much depend on what you are prepared to do for yourself.

Dietary considerations following heart surgery

Once you have returned home and you are waiting to start your rehabilitation, it is important that you maintain a dietary regimen that will not negatively impact the healing process. Generally speaking, you should adhere to any dietary regimen previously recommended to you or a new dietary regimen should we have recommended one, e.g. if you have diabetes or high blood cholesterol levels, or if you need to follow a diet low in vitamin K because you are taking Falithrom™ [phenprocoumon]. If required, we will provide you with any relevant information leaflets.



As people have a tendency to be less active following major surgery, their energy expenditure is reduced, and it is therefore important to avoid consuming too many calories. In most cases, it is also important to ensure an adequate intake of fluids, preferably in the form of water or tea. Some patients, however, who may have been instructed by their physicians to restrict their fluid intake - for instance due to fluid retention which is being treated with medication - must of course follow the advice that they have been given.

A balanced diet is important. This should contain plenty of fruit and vegetables with animal fats, beef and pork strictly limited. Salt and spices should only be used sparingly. It is better to eat little and often than it is to consume a few large meals. Foods that are rich in sugar and fat, such as cakes, ice cream and salted snacks, should only be consumed sparingly.

You may have been advised by your physician to abstain from alcohol completely, which may be because of pre-existing disease or as a result of the impact that surgery has had on your organs. Whatever the reason, please ensure that you follow this advice. Alcohol may also be contraindicated in combination with certain medications, and if necessary you will be advised accordingly.
Otherwise, you may consume alcohol in small amounts. As a guide, men should not drink more than one glass of wine OR one bottle (0.25-0.3l) of beer a day, while women should reduce these guideline amounts by about a third. Strong alcoholic beverages are most definitely not beneficial to the healing process. This includes alcoholic beverages that are said to aid digestion, such as some types of "schnapps", and even includes beverages like eggnog.

You should refrain from self-medicating using over-the-counter medicines without first seeking medical advice. There is a real risk of dangerous drug interactions, which can increase or decrease the effects of the drugs you were prescribed. Please check this with your general practitioner.



You are advised to refrain from smoking altogether.



During your rehabilitation you will be given advice on how to adopt a healthy diet that will help to ensure the long-term success of your treatment. A healthy diet not only leads to successful weight management but it also increases your life expectancy. This is scientific fact.



You can still eat the foods you like, as long as you ensure that you adhere to the dietary restrictions and advice that you have been given. You should also try to eat a little less than normal. A good rule of thumb to follow in this regard is to "eat until you are only three quarters full" or to "refrain from going for seconds".

How to contact the Department of Heart Surgery

Immanuel Klinikum Bernau Herzzentrum Brandenburg (Brandenburg Heart Center)

Ladeburger Straße 17
16321 Bernau
bernau.herzchirurgie@immanuel.de

How to contact the Nursing and Care Team

Should you have any questions at all, please do not hesitate to contact a member of our Nursing and Care Team at any time.

• Ward 5
  T: +49 3338 694-500
• Ward 8
  T: +49 3338 694-801
• Ward 7

  T: +49 3338 694-700