Responses to some FAQs i've been asked…
"…I want you out of bed and walking, walking, walking immediately after surgery. Your sternal wires really should make that incision stable, and if they’re not, the patient needs to say something and the physicians need to do something." ¹
—Dr. Steve Bolling (Heart Surgeon)
Whilst the quotation above is not from one of my doctors, it is certainly true that the cardio team certainly wants the patient to aim for mobility earlier rather than later. I'd spent several days before the surgery building up my strength by walking the corridors every day (my "marathon training" as i called it. I was walking one to two miles a day up and down the corridors; the nurses thought I was mad, but it sure helped me after the surgery).
Open heart surgery is a bitch. They first make an incision to open you up, then they saw into, and split your sternum apart. The surgeons need to get access to whatever bit of your heart they need, which usually means getting everything (skin, sternum and the ribs) out of the way whilst keeping you alive with external machinery that oxygenates and pumps your blood for you. Normally they will stop the heart for the duration of surgery, as operating on a wriggling heart can't be easy.
Following the procedure, and once they've restarted the heart, the docs then have to close you up. In most cases this means wiring the sternum together using either stainless steel or titanium wire, and sealing the skin with either sutures or a wound glue (basically a variant of the superglue you can find in hardware stores). in my case, I had the latter, which leaves a less impressive scar (there's no classic 'zipper" scar appearance) but I'm told that it heals better and cleaner. Time will tell.
Whatever, I was left with a visible scar (quite impressive at about seven inches!) that was initially tender and uncomfortable continually. The second bit (invisible but nonetheless impressive) is the healing sternum (held together with internal wires, don't forget). To begin with, every movement is painful. Getting out of bed or sitting on the loo was a wrench until I mastered the skills required to avoid twisting and pushing myself. Reaching across my body or stretching up was incredibly painful (I'm still aware of it nearly ten weeks after the operation). Reaching to put on my seatbelt, or to get something from the top kitchen cupboards requires delicacy and forward planning. Getting up out of a chair is tricky if I've slipped back into it too deeply (as when i have an inadvertent nap). When i left hospital they prescribed two painkillers, acetaminophen and a mild opioid called Tramadol. Other than a couple of the acetaminophen I've not needed to take any pain meds, thankfully.
Tending to myself is fairly straightforward; a daily shower takes care of the scar cleanliness, but care is needed when drying off. i'm careful to pat it dry rather than vigorously rub it with a towel. Afterward I apply a little cream (as recommended by a close friend—thanks, Dryad!) which smooths and moisturises the skin, and which will help the scar heal faster and narrower and be less visible. I've never felt so vain in my life as I watch the healing progress (saying nothing about my denuded chest hair). I've had no problem with infection, but my chest itches like crazy (given both the wound healing and hair regrowth). The cream helps with that too. Showering is possibly my biggest worry. Losing my balance or slipping could result in my straining to regain stability and cause myself a painful injury to my healing sternum.
I's not the scar that i worry about, it's the sternum. When patients talk about their surgery, you may hear them describe it as "having their chest cracked". This is not an exaggeration. Obviously the surgeons can't use a bone saw to go all the way through the sternum, given that the heart is right underneath and they do not want to saw through that. So they saw part way through and then use a tool to separate the sternum the rest of the way, just like popping apart two crackers at the perforation. A grim thought, but it's worth it given that they're doing all his to keep you living longer. Wiring the sternum together gives it enough stability to heal naturally, but it's not strong enough to withstand the stress of a cough or a sneeze (they are excruciatingly painful events).² To protect against both pain and injury to the healing bone, i was given a pillow large enough and firm enough that, were I to feel a cough coming on, i could clutch it to my chest. Believe me, it works. The unprotected chest feels like it's being torn in two during a good cough, hiccup or sneeze, but hugging a pillow tightly reduces discomfort by a significant degree. Adding a little story to this, another good friend (thank you, Madison!) was kind enough o bring me a large stuffed polar bear which is large enough to double as a protective pillow and to protect my chest from the discomfort of wearing a seatbelt in the car. Do i sleep with him? you bet. I long ago stopped caring what people thought about a 68-year-old man carrying a large white teddy bear into the cafe or pub. comfort and healing take priority.
So what do I do while all this healing is going on? you may ask. Well whilst I rest as much as possible, i try to get out every day. I walk to take out the trash, i can drive to town and navigate around (walking is definitely good for me, building muscle tone and exercising both heart and lungs). i try to walk at least half an hour a day (on a good day, and with a walking frame) I can manage up to two miles (one mile out to the local store, one back). I'm doing okay. Some folk told me to 'get well fast', but there is no 'fast'; it takes time and I'm not rushing to start my marathon training just yet.
i's not just the chest that needs healing, the lungs need to be worked too. after my surgery my lungs had a tendency to retain fluid (the technical medical term is forgotten! pneumothorax? no, that's air, silly.) In any case, i was given a spirometer to reinflate the collapsed alveolae and i still exercise with it daily. It may look silly but it's remarkably hard work, and it helps.
Then there's the postperfusion syndrome. in my case this manifests itself with mild depression and irritability. Someone from the aftercare team calls me every couple of days to check that I'm doing okay and reassures me that i'm doing well. I tell them that the medical bureaucracy is my worst enemy, which of course they are powerless to resolve. but the counselling helps. Still
I get up every morning, tell myself it is good to be still alive, take a gentle stretch and get on with my day. That helps too. Ever the bloody optimist, I say that it's better than the alternative.
¹P.S. i was walking two days after my surgery. The cardiac team were very happy with me for this. One day I walked a mile, up and down the corridor.
² To illusrate how serious this could be, one of my neighbours in hospital, recovering from similar surgery, developed pneumonia and would spend most of the night coughing. Eventually this resulted in the wires holding his chest together giving way, meaning that he had to get more surgery (which i believe was screwing a titanium plate to the bone). The nurses assured me that this was extremely rare and that i was unlikely to suffer the same fate.
$ xclip -o | wc -w
1185