Chest/sternal pain

[ETC908]

I am just about 10 weeks out from OHS. I received mixed instructions on restrictions after surgery. In the post-operative book that I was sent home with, they said not to lift more than 10 pounds for the first 8 weeks, and then no more than 20 lbs for weeks 8-12. When I met with the PA three weeks after surgery, she told me to avoid any lifting more than 10 lbs until I was 12 weeks out, and to avoid any activities, like skiing for example, where the sternum could be jeopardized. However, in the paperwork she later filled out for me for work, their instructions were no lifting for 8 weeks post-surgery. Either way, I remained very diligent for the first 8 weeks. I really didn't lift anything. I've dealt with the evolution of various chest wall musculoskeletal pains as time has gone on, but nothing seemingly out of the ordinary.

I've been doing cardiac rehab since early December, walking, using the stationary bike (trying not to put to much stress on my arms/chest), and doing some core. Since passing the 8-week mark I will admit that I've gotten a little impatient and have pushed it a bit more. I've done some planks, and have put a bit more stress on my arms while on the bike as I push the effort a little bit. In addition, there are things in every day life, especially after returning to work, that are unavoidable. A heavy door that I need to open, for example. I turned awkwardly in bed last week and put increased stress on my chest, and felt pain in the sternum. Last weekend I had no choice, and had to quickly lift my 3 year old, who weighs about 30 pounds. Other than that, and the planks, I have not knowingly lifted any more than 10-20 pounds over the past 2 weeks or so (and did zero lifting before that). I've added some lower body strengthening, and continue to do some core work as tolerated.

Over the past few days I've noticed some increased pain in the sternum. It's not excruciating, and there is no clicking or anything like that. Certain positions or movements seem to cause it.

I guess I'm wondering what others' experiences were as they tried to increase their physical activity...did you have persistent pain, did you work through it, scale back, etc? After clearing the 12 week mark I'd like to eventually return to pushups, chest presses, a bit heavier weight etc...but I'm not sure how much residual pain is normal/expected, vs a sign that I should scale back. I'm trying to balance an increase in my activity vs doing any damage to the surgical site. I appreciate any input and experiences you've had.

 

[pellicle]

basically (as far as I know) if the 8 week mark is passed and the sternum is not showing signs of being mobile then it should be good to go.

I'd definitely discuss with your team (they poke you in the chest firmly and feel for the joint not being fully closed) and ask their opinion.
I understood that the symptom is more like a painless grinding feeling.

From your description it sounds like the fine muscles between the ribs and perhaps also the costal cartilage that has been tested and is now complaining.

When is your next visit to the surgeon for followup?

 

[KatherineA]

I started yoga at 9 weeks because my instructions said the usual lifting restrictions you have discussed. No one would tell me if certain poses were ok or not. Downward Dog and plank are “lifting” the body. At least to me.

So I did arm stretches, shoulder work. I found an NIH study that had an actual post cardiac surgery traditional Hatha yoga class with the class completely diagramed each pose named (Sanskrit) so I followed that class. Lots of standing poses like WII and W 1. I also found some low pressure Yin stuff and did that for more stretching

I noticed pec muscles and upper arm muscles were sore. Belly muscles for sure after all that laying around. But things seemed like normal muscle pain to me

I was so frustrated by the lack of specific guidance on various activities I stopped asking and took it easy, for another 8 weeks, and paid attention to what hurt and sought out gentle massage if I thought I overdid stuff.

I found this website site searching for yoga and weight lifting. It has been a godsend

 

[KLS39]

My cardiac surgeon had told me in our first meeting that it would be no lifting more than 10 lbs for 3 months and no more than 30 lbs for 3-6 months. I followed this to the best of my ability even though my discharge papers said no more than 10 lbs for 5 weeks because honestly it hurt when I lifted even light things for quite a while. I had my innominate artery replaced so I think some of my pain was from that and not necessarily the sternum but it did make me overly cautious. When I started rehab at 3 months post op I did have some discomfort in the sternum when I did the machines that involved arms but rarely have any now. I do still have times when my scar "hurts". I hope you can get answers from your doctor.

 

[ETC908]

From your description it sounds like the fine muscles between the ribs and perhaps also the costal cartilage that has been tested and is now complaining.

This was my thought (and hope) as well. From what I understand, the sternum is 80% healed at 6-8 weeks out. My assumption is that they put the 12 week mark on there so that we avoid any type of heavy trauma to the chest and full fusion can be achieved. I would like to think that a plank, or putting some stress on the chest during a stretch, wouldn't cause significant damage at 10 weeks out, but I don't know.
I share the frustrations that KatherineA expressed as well. They give you lifting restrictions, but what about push/pulling, laying on your side, getting up from the seated/laying down position, etc. There are things we encounter in every day life that require some exertion from the upper body, and I didn't get clear guidance on that.
As it turns out, my surgical team has discharged me. At 3 weeks out, they poked and prodded on my chest, attempted to mobilize it, etc and said that it looked great. They actually cleared me to drive at that time, and sent me on my way. I was dealing with other issues at the time so didn't belabor some of the finer physical questions.
So I don't have any set follow-up right now, other than the cardiologist in 6 months. I'll continue to track it and reach out to them if it doesn't improve. I'm also curious if anyone continued to deal with pain at the surgical site after working out, even months after their surgery.

 

[pellicle]

I would like to think that a plank, or putting some stress on the chest during a stretch, wouldn't cause significant damage at 10 weeks out

I would agree ... its not really stressing it in a way that will apply lateral shear on the long axis of the sternum

So I don't have any set follow-up right now

wow ... I met my surgeon at discharge, 3 months and one year. I've met him about every 5 years and my cardiologist about every 2 (after an initial shorter follow up time of 6 months, then 1 hear).

Differences in systems I guess

I'm also curious if anyone continued to deal with pain at the surgical site after working out, even months after their surgery.

no pain, but I had a steady "niggle" in my chest which of course was the infection I had (have?). That is no doubt unusual.

 

[d333gs]

I am just about 10 weeks out from OHS. I received mixed instructions on restrictions after surgery. In the post-operative book that I was sent home with, they said not to lift more than 10 pounds for the first 8 weeks, and then no more than 20 lbs for weeks 8-12. When I met with the PA three weeks after surgery, she told me to avoid any lifting more than 10 lbs until I was 12 weeks out, and to avoid any activities, like skiing for example, where the sternum could be jeopardized. However, in the paperwork she later filled out for me for work, their instructions were no lifting for 8 weeks post-surgery. Either way, I remained very diligent for the first 8 weeks. I really didn't lift anything. I've dealt with the evolution of various chest wall musculoskeletal pains as time has gone on, but nothing seemingly out of the ordinary.

I've been doing cardiac rehab since early December, walking, using the stationary bike (trying not to put to much stress on my arms/chest), and doing some core. Since passing the 8-week mark I will admit that I've gotten a little impatient and have pushed it a bit more. I've done some planks, and have put a bit more stress on my arms while on the bike as I push the effort a little bit. In addition, there are things in every day life, especially after returning to work, that are unavoidable. A heavy door that I need to open, for example. I turned awkwardly in bed last week and put increased stress on my chest, and felt pain in the sternum. Last weekend I had no choice, and had to quickly lift my 3 year old, who weighs about 30 pounds. Other than that, and the planks, I have not knowingly lifted any more than 10-20 pounds over the past 2 weeks or so (and did zero lifting before that). I've added some lower body strengthening, and continue to do some core work as tolerated.

Over the past few days I've noticed some increased pain in the sternum. It's not excruciating, and there is no clicking or anything like that. Certain positions or movements seem to cause it.

I guess I'm wondering what others' experiences were as they tried to increase their physical activity...did you have persistent pain, did you work through it, scale back, etc? After clearing the 12 week mark I'd like to eventually return to pushups, chest presses, a bit heavier weight etc...but I'm not sure how much residual pain is normal/expected, vs a sign that I should scale back. I'm trying to balance an increase in my activity vs doing any damage to the surgical site. I appreciate any input and experiences you've had.

Broken bobe healing stages; Bone Healing – How Long for Bones to Heal | Foot Health Facts - Foot Health Facts

 

[tom in MO]

The correct time to begin strenuous activity varies by doctor/practice and probably patient too. Manual laborers have stated here they have been told to stay off the job 6 months but had to go back at 3 months for the money with pain but no problems.

I'd ask the people at Cardiac Rehab, that's what I used to do. The Cardia Rehab PTs have more collective hands-on knowledge than a single valve patient on this forum or probably even the surgeon.

 

[d333gs]

People keep on talking about fatigue. I understand the need to rest while the chest wound heals but what about the heart? How long does it take the heart to adapt to the new valve? I have heard that the heart starts to pump happily right away with a new normal-sized valve , so why such a long period to get back to long energetic walks?

 

[AZATADINE]

I think it takes about 10 to 12 weeks for the new tissue to form around the valve ring/stitches to dissolve (just something that I've heard but might not be absolutely accurate in terms of time).

 

[almost_hectic]

I used to think about sternum pain a lot! I had it for several months after my surgery. I think the pain may not have always been from the bone healing. I did suspect that the pain may have been in large part to the new wires and any possible movement of the wires on and against the surrounding tissue until new scar tissue grew around it and it stabilized... does that sound possible? Thats just my guesstimation of what took place

 

[KLS39]

Can anyone else feel the wires if they touch the top of their scar?

 

[pellicle]

Can anyone else feel the wires if they touch the top of their scar?

I could before they were removed.
In the after period of my 2nd surgery they were getting more and more pronated (poking up) and you could see the knob of something under my skin. Hits on it proved very painful, I was doing Aikido at the time and no doubt all the tumbles and rolls played their part. So I had them removed

In the period after my second surgery they were a source of harbouring and transferring infection from my incision (propionibacteria) down into the sub-sternal area (quite close to my heart) and were removed ...

So no of course I can't feel them

This is an X-Ray from before they were removed (so just after valve implantation in surgery 3).

Circled in yellow are various staples ...

The facts of how they are removed is part of why they are often not. The risks from cutting one end and pulling the other (now sharpened with the side cutters) through and out increases the risk of nerve damage and pulling through an infection to a bad place.

If they are bothering you then I recommend you discuss it with a surgeon, my cardiac surgeon did this on both occasions.

Oh, and looking at the build up of junk in there should in itself be a good reminder on why one should not trivialise redo-surgery.

Best Wishes

 

[ETC908]

The correct time to begin strenuous activity varies by doctor/practice and probably patient too. Manual laborers have stated here they have been told to stay off the job 6 months but had to go back at 3 months for the money with pain but no problems.

I'd ask the people at Cardiac Rehab, that's what I used to do. The Cardia Rehab PTs have more collective hands-on knowledge than a single valve patient on this forum or probably even the surgeon.

Funny you mention this, I had cardiac rehab this morning and had a good discussion with them about it. They were actually surprised at the 12-week guidance I was given, as they said most patients are cleared to do lifting after 8 weeks. The exercise physiologist suspected the pain I have was more muscular from disuse, rather than anything more sinister. The pain has decreased over the past day or so, which is promising. Their only concern about the planks was ensuring my heart rate doesn't get too high, but I monitor that when I work out at home and it was fine. They otherwise did not think it was a big deal to have done the stuff I've done.
They are going to do some planks and mild upper body exercise with me on Friday so they can monitor how I do, in addition to progressing to some jogging.
So it seems talking to the folks at rehab is great advice!

 

[almost_hectic]

Funny you mention this, I had cardiac rehab this morning and had a good discussion with them about it. They were actually surprised at the 12-week guidance I was given, as they said most patients are cleared to do lifting after 8 weeks. The exercise physiologist suspected the pain I have was more muscular from disuse, rather than anything more sinister. The pain has decreased over the past day or so, which is promising. Their only concern about the planks was ensuring my heart rate doesn't get too high, but I monitor that when I work out at home and it was fine. They otherwise did not think it was a big deal to have done the stuff I've done.
They are going to do some planks and mild upper body exercise with me on Friday so they can monitor how I do, in addition to progressing to some jogging.
So it seems talking to the folks at rehab is great advice!

Without the advice from any doctor, and mostly out of frustration at about 10 or 12 weeks (not really sure) I decided my sternum pain was instability. No idea whether or not there was any truth to that. But in my mind the way to combat that instability was to strengthen my chest, so I did pushups. Starting with just a few at a time and building up... doing them did hurt some, but it wasn't like injury pain, just very sore. I cant say if that was a good idea or not, but it seemed to work. As my strength increased the pain subsided. When I explained to my cardiologist what I did to get rid of sternum pain, he looked at me as though I was crazy... but he said, hey if it worked good for you.

 

[almost_hectic]

Can anyone else feel the wires if they touch the top of their scar?

I used to be able to feel my wires under the skin, didn't like touching there as it weirded me out. Now I cant feel them so whatever scar tissue or bone has grown around/over them I guess.

 

[Paleowoman]

I went back to weight lifting post surgery, even though I still had sternum pain, under guidance of cardiac rehab cardiac nurse who did weight lifting (I used to do quite heavy weight lifting for a woman). A few years later I was getting extremely bad shoulder pain in left shoulder and continued sternum pain. Rheumatologist thought it was a shoulder problem, had steroid injections and physio but it all got worse. Then I had an MRI of my sternum which showed I had an effusion at the left sternoclavicular joint which specialist said would have been caused by the sternotomy - problems in that joint cause referred pain to shoulder. Why I'm saying this is that sternum pain and other pain can be caused by sternotomy and not surface for some time. I just have to exercise very carefully now because the sternoclavicualr joints are involved with a lot of movement - even holding a phone next to my ear used to cause shoulder pain due to the angle of my arm - now it does not....but I can't do heavy weight lifting anymore

 

[Superman]

I still feel mine. My sternum has hard bumps on it. Doesn’t hurt and isn’t uncomfortable at all though.

 

[almost_hectic]

that joint cause referred pain to shoulder. Why I'm saying this is that sternum pain and other pain can be caused by sternotomy and not surface for some time.

Interesting... I often have left shoulder pain, kind of deep behind my shoulder blade. Its not really painful but like a deep tight muscle soreness. Kind of feels like something is out of place and when laying on my back my shoulder blade doesn't lay flat unless I consciously think about tucking it under. I never attributed it directly to surgery, but it definitely wasn't an issue I was aware of prior to surgery. Ive heard they can contort your body into some very unusual positions and thought that might have aggravated something

 

[carolinemc]

Broken bobe healing stages; Bone Healing – How Long for Bones to Heal | Foot Health Facts - Foot Health Facts

It is the sternum and it is not broken. The muscles have been through trauma and takes about a year for the muscles to heal up. Takes time.