Still having lots of pain and depression 6 weeks post-op....any ideas?

[DocJ]

Hi all, I am in need of additional "expertise" from those of you who have gone through this. I am 6 weeks out from BAV replacement and ascending aortic aneurysm repair (seeing the surgeon for 1st follow-up this week), but do not feel I have made a ton of progress. My chest still hurts badly. I have a new goose-egg type lump at the base of my sternum and I still cannot sleep lying prone or on my side (need to be propped up). Even then, when I sit up, I experience a lot of pain when it feels like the bones move and "reseat" themselves in my chest. Additionally, I still feel a great deal of anxiety. I recognize (as a clinical psychologist) that much of that has to do with situational stress (i.e., an upcoming move to a different town and starting a new job in January, plus financial woes, etc.), but how long did it take for those of you experiencing emotionality after the surgery to feel normal again? I guess I had expectations that after 6 weeks, the sternum would be healed and I would be resuming most of my activities (I guess that was naive?) When I was told that the healing took 2 months, I was under the impression that I would be feeling much better by now. Have you had similar experiences? I need to be doing better as I have so much work to get done. Any ideas how I might progress at a faster pace? I am getting no information from my cardiologist or surgeon; all I get is that this all sounds "routine", but no information on what to do to move forward is forthcoming. As always, I appreciate any information that you have to share. Best to everyone, Jules.

 

[Greg a]

Your chest hurts due to the treatment it got in the procedure ....not only was your sternum split but the RIB SPREADERS do just that ....they spread them out so Doctor has a clear field of vision......spread enough that usual back pain occurs BUT THIS IS ALL TEMPORARY and as to the mind it N EVER .....meanwhile here is why http://heartdisease.about.com/b/2004/04/26/pump-head-cognitive-impairment-after-bypass-surgery.htm

so don not be insulted if you are called a pump head

 

[DocJ]

Greg, I understand what occured to cause the pain, I am rather questioning how people recovered and how long they experienced pain and changes in emotions. Luckily, I do not believe I have had any cognitive changes, but am much more anxious and "blue". Was just wondering what others have experienced. And was hoping to have made more progress by now.

 

[Roberta]

HI DocJ,

I am sorry to hear that you are going through a difficult time. It is very common for many of us to experience 'the blues' or cardiac depression post-op. I can tell you that I didn't 'feel myself' and experienced some depression for a good couple of months post op. I don't recall when it 'lifted' but I do know that starting cardiac rehab, setting some realistic goals for myself helped get me back on the road to recovery. I think I had too high an expectation of how I would be feeling after surgery and my docs didn't mention much about the 'emotional' side of the recovery. I also found that reading posts from others also helped. If you go to the search button and type in cardiac depression you will find some other discussions on this topic.
Be gentle with yourself and remember that all aspects of recovery take time. 6 weeks is only a guideline and we are all different.

Take care,

P.S. I was in very good shape going into surgery and I can tell you that 6 weeks post-op I wasn't feeling close to 100% physically as well. Although I was 'better, I was still experiencing discomfort from my incision and fatigued easily. This too passed.

 

[Jkm7]

First question my cardiologist asked at my first appointment with him post op my first OHS was: "How are you handling the depression"? At that time, I had no idea it was so common for heart surgery patients to experience it. Having been on this site for years, I have come to learn a very large percentage of us go through the 'blues' and it can last varying lengths of time. It is something that can be helped, as you know, and why suffer when help is available. Emotional health is just as important to our healing as physical but I imagine I'm preaching to the choir.

If I may suggest, speak up with one of your docs and get some help. They almost seem to expect it from us valvers.

I also want to add that I went into my second surgery in good shape, good attitude, and eager to 'get on with it'. I healed well and without complications or particular set backs but I was no where near fully healed in six weeks. I was doing most of my usual mundane functions at that point but was still sore, fatigued, unambitious and had lots more recovering ahead of me. To expect to be back close to yourself so quickly is not likely for most of us.

 

[Allisoninoz]

Hi Jules, six weeks is not long at all! Are you doing rehab and/or able to walk every day? It's weird, but now I'm 19 months post surgery, it's actually difficult to remember how long the sternum recovery took. I know that my neck and back gave me a lot more pain than my chest. I wrote about my experience for a Melbourne newspaper - you can see it at http://www.heraldsun.com.au/ipad/a-diary-of-open-heart-surgery/story-fn6bn9st-1226058541539
I think I was teary on and off for a couple of months after the surgery. I was certainly frustrated that I had to rely on others to cook, drive me places and generally 'watch over' me. I think I probably started 'work' after about the five/six week market but I do work for myself, so it was far easier for me ... I was able to just go into my home office, ring a few clients, send a few emails, and then lie on the bed for a while. I do remember hoping to be able to enjoy some dvds I'd always meant to watch but I was way too tired to do that ... my mind would just wander off or I'd doze off.
I think that rehab/walking and taking it easy on yourself is absolutely the best thing to do at this stage. Were you fit before the surgery? If not, it will take a while to obtain the fitness. If you weren't fit, you'll need to get to that point, which is a lot to ask of your body.
And are you on painkillers or other meds still? Obviously they're going to have an impact (as you'd appreciate given your job).
Do you have good people around you?
Just be kind to yourself.

 

[Fundy]

I've got no ideas as to how to progress at a faster pace. But end of week 5 to end of week 7 was the worst for me in terms of pain and hurt. I think the best you can do to improve is probably continue range of motion movements with your body and continue with deep breathing exercises.

 

[Mom2izzy]

I don't know if I was depressed, but I had a complete lack of focus and an extreme case of the "I don't wanna's" (as in I didn't wanna do ANYTHING). Rehab definitely helped, as did getting back to work. I would say I was at least 7 to 8 weeks post-op when I finally snapped out of it.

As for the physical pain, I was feeling better by around 4-5 weeks. I remember being given the OK to pick up my 30 lb daughter again...it still hurt, so I waited a little longer.

I found that walking straight and tall, shoulders back, was helpful. I couldn't do it at first, but I would straighten up a little more every few steps until I was all the way up. Also found that much of my pain was muscle related and a good therapeutic massage did wonders!

 

[Allisoninoz]

Yes Mom2izzy ... remembering to walk straight with shoulders back was important for me, otherwise I'd end up slouching to protect the incision ... it did hurt, but it worked eventually. And I spent a fortune on masseurs and physio. Helped my shoulder/back/arm pain a lot.

 

[Laggard]

Pain for about a month. Nothing horrible. Just hurt to roll over. Emotionally 8 weeks out I was pretty fragile. It's been 4 months now and i have no real after effects.

 

[epstns]

Doc,
I had such a bumpy recovery that I didn't feel much like doing anything for a long time. The mind may have been willing but the body had other ideas. I was re-admitted to the hospital at about 4 weeks to resolve some digestive issues resulting from the meds given at surgery. After that, I had all the usual recovery stuff. I wasn't even cleared for cardiac rehab until 12 weeks, although I had been driving and back to work (desk job) at about 5-6 weeks. Like some of the others, I was in very good shape (age adjusted) before surgery, but I was nowhere near prepared for how weak I would feel after surgery. That's the bad news. The good news is that all this passes. Don't worry about any schedule or plan for how fast you will recover. You just can't control it. As a clinical psych, I'm sure you have counselled clients about how to deal with things that they cannot control. When it comes to recovery, we are all just along for the ride. You can assess where you are and try to push just a bit more each day, but in general your body will tell you how much you can or cannot do. (P.S. After 12 weeks of cardiac rehab, I was back at my 5 days/week routine at the gym. I'm no Olympic athlete, but I can do more now than I could do in the couple of years before surgery.)

I used some pain meds for the first few weeks after surgery, but after the first week I was using them only in low doses to aid in sleeping. In the pain category, I was one of the lucky ones. After the first week or two, the only pain I had was when I coughed. I wanted to get away from the pain meds as soon as possible for two reasons. First, because I would not be allowed to drive until I was off the meds, and second because the meds made me so constipated that I was in constant discomfort from that.

The actual healing of bone, such as the sternum, is said to take about 8 weeks. That said, it may or may not hurt for longer than that. Also, pain in the upper chest area may be from the healing of muscles that may have been cut or otherwise disturbed during surgery. For quite a while after surgery, far longer than 8 weeks, I could not do push-ups because the muscles just hurt too much. Even now, nearly 2 years after surgery, I have had to cut way back on push-ups because it just hurts too much in too many places. This getting old stuff is not for sissies!

 

[neil]

sorry you are going through a rough patch, we all progress at different rates so its so hard to but a timer on it, some brezze through others it can be a struggle, 6 weeks is still early, cricky i was still getting my grapes peeled lol, try to stay positive, and you will do just fine

 

[SCCWS]

I am 7 weeks away from surgery and I still think that every body is different, every surgery is different and as a result every recovery is as well. I had literally no pain after surgery but I had a major problem coughing. I am usually an up beat person and my wife tells me she has seen no difference since the surgery. I also thinkpeople's bodies react differently to the medication combinations during recovery. As several have posted, I think you need to go at your own pace and let your body tell you how fast. But keep in mind that the pace could change as medications are adjusted and as the body gradually progresses. But depression should get attention as it may hinder your physical progress.

 

[carolinemc]

I have never heard the healing of the strenum of only two months. What I believe is that someone is going by a person who is in the entertainment business, with no heavy lifting, was told he was fine at two months. Not. The sternum from bypass take anywhere from 6 months to a full year. The trauma to the muscles of the sternum has to have time to heal. Most surgeon and heart doctors know this. Just take your time and allow your body to heal itself. It will let you know when it is fully recovered from the surgery. Good luck on the new job, just listen to soothing music to relax. Hugs for today.

 

[carolinemc]

I was slouching three months post-op, working at the keyboard at work. Did some resaearch and found that the was normal for those who had sternum trauma. It took me the rest of the 10 moths to work out the slouching over the keyboard before it stopped. I was glad when it did, I would get stiff and have to slowly unwind myself to regular position at times, in pain. But have been fine since, that was over 11 years ago, when I did that. Been better since. Hugs for today.

 

[CarolM]

I am just over 4 weeks post surgery, and don't feel anything near "normal", but do feel better each day. My pain is just discomfort, unless I do something stupid like lift something. Just until last week, I have been sleeping in a recliner, so you are not alone. I still prop myself up in bed.

I am disappointed that I only walk for 15 minutes and feel winded, but am starting cardiac rehab tomorrow and hope that helps.

Although I am mostly very positive and extremely grateful for successful surgery, I do get bouts of sadness, too. There seems to be an emotional component to heart surgery, and I think it's so helpful to have this forum to share our feelings.

My best wishes for brighter days ahead for you.

 

[pellicle]

Keep at it, don't look 2 steps ahead. Just like driving follow the 2second 12second rule. Keep an eye on what's right there but keep looking ahead.

As you get better the speed of improvement tapers off, but doesn't stop.

Chin up! You are in a good situation and keep telling yourself that.

 

[anutherbuddy]

My husband started feeling like himself at about 6 weeks - when he could drive again. That lifted his spirits tremendously and he could finally see that he was making progress and life was getting back to normal. I still see him "tear up" sometimes (he's 8 weeks post op now), which is definitely not like him but it's certainly understandable. The cardio rehab definitely helps too. He says "that's where they keep the whips" but I can tell he actually looks forward to it now.

 

[Patrickh]

AF! Sorry, this is rather long...

Hi! Sorry to hear you are still not great following surgery, but you are not the only one…here is my story so far (11 weeks post aortic valve replacement).

Hi…I thought my experience might prove useful to others…and I’m also interested to know if anyone else had a similar experience.

I was diagnosed with Aortic stenosis in 2005 and told I would need a valve replacement op in the next 5-10 years. At the end of 2011, my echocardiogram showed that my valve was getting pretty narrow. I also had an angiogram, which fortunately showed my Heart to be pretty much A-OK apart from the valve.

In march/april 2012 I started getting symptoms…breathlessness when walking a few hundred yards or climbing a single flight of stairs. Even breathlessness when lying flat in bed at night. Sometimes I would sit up in the night suddenly because I could not catch my breath. The doctor prescribed Furosemide to reduce fluid retention, as I was also getting swollen lower leg/ankles.

I saw the surgeon April/May, and got put on the list for late July, so I could attend my daughters Masters graduation. I was scheduled for 29th July, with operation on 30th, but my white blood cell count was high so they put me on antibiotics and delayed the op.

On Friday 27th July driving home from work I had a chest pain. After about 40 mins it had not gone away, so I called the ambulance and they took me to accident/emergency. They told me it seemed I had a heart attack. The next day, I felt well enough to go home, but they wanted to keep me in for tests. On 2nd August they did another angiogram. My heart looked fine, with no problems with arteries, just the aortic valve problem. The cardiac team explained away my chest pain as either pain caused by the valve problem, or possibly a bit of the plaque in the valve breaking off and getting into an artery. I was discharged a few days later, and went into hospital for my op on August 22nd. The op went ok. The surgeon said the valve was in pretty poor condition. The day after the Op, I had an episode of Atrial Fibrillation (AF). I was not too good for a while, but medication helped. They decided to cardiovert my heart (electric shock) to get it back in rhythm. All went well, and I was discharged August 30th. 6 weeks later, the surgical team discharged me to the care of my local cardiology team, at the same time stopping the Amiodarone that I had taken for AF. Two weeks later I went to the hospital for my first cardiac rehab session. The physiotherapist noticed my BP was high, with rapid, irregular heartbeat, and sent me off for an ECG. This showed that my AF had returned. Over the past few weeks I have started getting breathless when walking/climbing stairs. I get breathless lying flat in bed. My ankles are swelling. i.e. all the symptoms I had before my valve was replaced have returned. I googled AF and found a paragraph in Wikipedia which exactly described my symptoms. I’m currently back on Amiodarone, and waiting for cardioversion again.
So, I reckon that the symptoms I experienced in the months before my operation were due to AF, and that is why they came on so quickly. None of the doctors I saw diagnosed AF, or sent me for an ECG. Now, having had my valve replacement, I am still suffering, because of the AF.

So, if you experience rapid heartbeat (120/minute), breathlessness walking or climbing stairs, sudden breathlessness lying in bed at night and swollen ankles, it is probably due to Atrial Fibrillation, and not your valve!

Needless to say, since all the pre-operative symptoms have returned, I feel pretty P’d off some of the time. If I walk up 12 stairs I’m breathless. I went to the supermarket the other day and parked my car. Walking from the car to the store, I had to stop twice due to breathlessness!! This is no fun, and my Cardiology appointment is not til 14th January 2013!!! I am lucky I still have my sense of humour! I think if I get too fed up, then I will turn up at the local Accident & Emergency and invent a few extra symptoms so that I get seen, and maybe sorted out.

As for chest pain….soon after the OP, I had a strange, indescribable, tingly feeling, which stretched 6 inches or so either side of my sternum. It felt like I had a small swarm of bees or wasps buzzing around in there. And I had the usual sharp pain if I sneezed or coughed. Now, the pain is more centralized, an inch or so either side of the sternum. I’m hoping this means that the outer part has healed.

Hope this Helps! Best wishes for a speedy recovery.

 

[Patrickh]

Carol...you might want to read my long-winded story further down. 4-6 weeks after my aortic valve replacement, I was walking 4-5 miles a day. Then I developed Atrial Fibrillation (AF) and I cannot walk 100 yards without feeling breathless. I'm currently 11 weeks post op.