Getting ready for recovery

[Guest]

I am awaiting a date for a valve and root replacement and my question to people who have come out the other side is what advice they would give regarding preparation to aid a speedy recovery.

I am a 54 year old mad who is asymptomatic - my medical student son uncovered the condition when demonstrating his stethoscope technique. I'm actually pretty fit; swimming and cycling but as my bicuspid value has become more stenosed and the root more dilated I've started to pick up a bit of pain at the start of exercise; hence planning surgery soon.

I really want to get back to an active lifestyle and accept that it may be a few months before I can start doing much but I am wondering if there is much that I can do now to improve my chance of a speedy rehab. Were there things people found useful in their experience or, with hindsight, wish they had done? Perhaps there were some exercises that help?

Liam

 

[almost_hectic]

If it hasn't already been discussed with your doctor or surgeon, I would ask about getting into a cardiac rehab program. It may sound like something you don't need if you're pretty fit already. But its great to commit to going three days a week as well as feeling confident that you are pushing yourself enough but not too much because you'll be monitored the entire time with wireless ECG. Its probably unlikely but you can push yourself too much and that could slow your recovery. Best to be patient. I thought at three months I was doing pretty well. Now that Im six months I can't believe how much farther along I am. I thought I felt pretty good then but now I feel great. Id break it down into two phases, healing and recovery. You really can't expect much of a recovery until you are fully healed internally and that just takes time, nothing you can do to speed that up but take care of yourself and wait. Eat a good diet and stay active (walk) instead of sitting in front of the TV the entire time. You will need rest, but just don't be a slug. Sometimes thats easier said than done because you'll have very low energy and if you're like me a lot of pain and pain meds.

 

[epstns]

Hi, Liam,
It sounds like you're on the right track so far. I'd keep up with exercise, to the limits of what you can tolerate - right up until you head to the hospital for the surgery. I was 63 when I had my valve replaced, and was jogging until about a week prior to surgery (that's when I had the pre-op angiogram, and had to drop the running for a bit). Stay healthy and in good shape until surgery. I feel that this helps you to recover better and sooner.

I agree with almost_hectic about cardio rehab. As I mentioned, I went into surgery in pretty good shape for an old gym rat, but the surgery took the wind out of my sails. (Read my old posts to see how many speed bumps I hit on the recovery road.) I finally started rehab at 12 weeks out from surgery, and by the end of the 12-week program, I was back in the gym 5 days a week at almost my pre-op intensity. My rehab program was 3 days a week for 12 weeks, and on the "off" days I just went to my own fitness center and did the same routine as I did at rehab, just without the supervision. I wear a heart rate monitor, so I could at least ensure that my heart rate was behaving as it did in the rehab sessions. Rehab proves to you how much you can do without harm, and the presence of trained technicians to monitor you gives you confidence.

A couple of things from my personal experiences:
1. The meds used during surgery and during your first few weeks of recovery will include pain meds. These will wreak total havoc with the digestive systems of many patients. They brought mine to nearly total stop. I suffered so much digestive distress that 4 weeks after heart surgery I had to be readmitted to the hospital to deal with my intestinal distress. Don't let this happen to you. Talk with your doctors about what you can do to avoid intestinal slow-down issues. One of our members (pellicle) recommends daily ingestion of a serving of kimchi (Korean cuisine), and swears that this kept him in fine shape. I recommend something more palatable to myself - Miralax. After my repeat trip to the hospital for digestive issues, the docs recommended daily use of Miralax to keep things moving. Your docs may recommend a different product, but do have the conversation so that if your system stops, you are prepared to deal with it before you need to go back to the hospital.
2. Keep track of your moods and mental situation. We haven't talked much about it lately, but depression is quite a common side effect after heart surgery. You need to read a bit about the symptoms and be honest with yourself in assessing your condition. Most patients are able to deal with minor depression just by being able to recognize it and to take simple steps to control their condition (the psychologists call this "behavioral modification"). I'm not a psychologist, but I recommend that you remain aware of the potential and take action as appropriate. In these cases, it is not any sort of stigma to seek professional help if you need it. Most of us recognize the simple symptoms like crying for no reason, and we just live with it and laugh about it. . . as long as it doesn't linger for months and months. You can find a good bit of information about this on this site, too.

Recovery will not be as easy as it looks on TV - where the patient is having a party in their hospital room the day after surgery. It isn't that bad, either. I was home after 9 days (complications, remember?), and by then I was fully able to get into and out of bed without help, walk up and down stairs multiple times daily, and to do most personal care tasks unaided. I had little stamina at first, but things progressed well and I was back to work part-time by about 5 or 6 weeks. By 4 weeks or so I was walking a mile at a time on an indoor track while my wife did her workout routine at the fitness center.

One of the most important aspects of recovery is your personal attitude. Just think of it this way. . . "If you think you can, you will. If you think you can't, you're probably right." YOU CAN!

 

[LiamF]

Thanks guys - this is very reassuring.

I hadn't actually given much thought to the mental health side of things - it's funny what you assume in life until reality teaches you otherwise.

I'm in the UK and I'm wondering what kind of rehab provision is available on the health service (you get access to the best surgeons and treatment in the world for free - but the timing can be a bit off!). More research needed I think.

I think the dogs are in for some long walks!

Liam

 

[Paleowoman]

I'm in the UK and I'm wondering what kind of rehab provision is available on the health service (you get access to the best surgeons and treatment in the world for free - but the timing can be a bit off!).

Hi LIam - Rehab is availalbe on the NHS yes You will probably find that the rehab is either at the hospital where you have your surgery or at your local hospital if the cardiac one is far away. They offer rehab to heart attack patients at more local hospitals and so if that's where you went for rehab you might find those patients there. My cardiologist didn't want me to have my rehab there as I was very fit prior to surgery so I was referred to a cardiac nurse who does tailor made one-to-one rehab privately - he got me doing interval training, and when I injured my foot, he changed it to weight lifting which I really love anyway so it suited me particularly well. I got my surgery on Bupa via my husband's work policy, but Bupa wouldn't pay for rehab so I had to pay for it myself - worth every penny though. Walking is always good too, with or without doggies.

 

[Bean Counter]

I was 38 when I had my valve replaced (2010) and my recovery was quite smooth; no speed bumps at all. I feel this was due to being in great shape heading into surgery. I was a pretty serious runner (average around 80 miles a week until my condition got to the point where my cardiologist was no longer comfortable with me putting in that mileage (he "limited" me to 10 miles a day). Anyway, both he and the surgeon did not think that I would benefit much from Cardiac Rehab. This was partly due to my desire to actively recover and partly due to knowing that my wife (an ICU nurse at the time) would be there to monitor me and pull back the reigns when needed.

As far as returning to an active lifestyle, it took me about 2 months before I was able to run again. My recovery was mostly walking, but in hindsight, I should have spent more time on a stationary bike to work the heart a bit harder than I did. In the early stages of recovery, walking was sufficient, but I got to the point where I had to really push the walking pace to get my HR up. One thing I learned about recovery is that it is not linear. I would have a a few really good days where I was improving, but then a few days where I felt like I was not improving. It was a bit discouraging, but knowing that helped mentally.

Good luck!

 

[honeybunny]

My advice is to not get discouraged if you are not recovering as quickly as you think you should. I had great expectations for myself and became worried when at six weeks I still wasn't getting around on my own very well. (Turns out I had pleural effusion [still have a little, in fact], which explained why I couldn't take a few steps without stopped to take a deep breath.) The folks here cleared my misconceptions about recovery and validated that I was doing just fine, though it seemed slow to me. I think you should be aware of this particularly because you are so fit; your expectations will be higher than mine.

Glad your son caught your condition in a timely manner. Best of luck going forward.

 

[epstns]

One other thing to keep in mind after surgery is the meds they send home with you. Some of the meds, particularly beta blockers used to control heart rate and blood pressure, have a profound impact on your stamina and exercise tolerance. Immediately after surgery, I was prescribed Metoprolol (a beta blocker) to keep my propensity for atrial fibrillation under control and to manage blood pressure. It did its intended job, but it also limited how high my heart rate could go - severely. I made it through cardiac rehab at my original dosage of 100 mg/day, but at my 6-month check-up, I negotiated with my cardio to reduce the dosage to 50 mg/day. That made a noticeable difference. I no longer felt like I was dragging a sled full of rocks around all day. I went like that for another 6 months or so, then again negotiated with my cardio to reduce my dosage again, to 25 mg/day, where I remain.

The second reduction has allowed me to feel "almost normal" after all the surgery and meds. The reduced dosage has kept me out of afib, and controls my blood pressure well enough for doc. It still limits my upper heart rate to around 140-145 BPM, which feels like a limitation to me, but my cardio wants to keep it there. I'm not going to argue this time.

I am not writing this to tell you to start lobbying for reduced dosage on your meds. I just wanted to give a real example of how some of the meds may affect you, and how some of us are able to manage in spite of them.

 

[Ryan CA]

Hey Liam,

Staying positive is a huge help. I was actually excited to get it done, believe it or not, and I think that helped quite a bit. Also, while I had to reduce my physical activity in the months prior to surgery, I continued to ride my bike and walk up until two days before, just at a lower intensity. Also, I went ultra healthy in my diet. Tons of greens, zero red meat, lots of super foods like sweet potato, avocado, spinach, etc.

I couldn't find much info regarding pre-surgery diet; but, I do know that ultimately, your body begins the healing process on the cellular level. Eliminating preservatives, artificial sweeteners, bad fats, cholesterol and the like make for more efficient cellular activity. After surgery, I continued with this diet for a couple months and stuck to the walking regimen the surgeon gave me. At 8 weeks I was back on my bike and at 6 months I was back to 20 mile bike rides.

My recovery has been better than I could have hoped for. How much of that is due to the measures I took before hand....I cant say, but I feel like I did everything I could.

And like EPSTNS