Everyone carries scars in life, and heart patients are no exception. In addition to the physical scar from an invasive procedure, like pacemaker installation, coronary artery bypass grafts (CABG), or valve surgery, are the sometimes deeper emotional scars of heart disease and recovery. After open heart surgery (OHS) or any major cardiac event, both types of healing must be addressed.
Incision care and exercise
Invasive heart surgeries occur in more than 500,000 people across the United States every year. Physical post-op recovery is, of course, a primary focus. Care and instructions about the incisions vary but revolve around keeping the wounds clean, dry, and infection free. Some doctors opt to cover the wound and others leave it open to the air, but all look for signs of healthy skin in the first four to eight weeks after surgery.
A few common themes recommended by the Society of Thoracic Surgeons, and surgical or rehab teams across the country, to help scars heal include:
- Avoiding lotions or anything but mild (often hospital-provided) soap while the incision is still open or scabbing
- Blocking the sun, with physical barriers like towels or shirts at first, to avoid permanent discoloration of the scar from melanin changes that darken the new skin
- Washing the area with mild soap daily in the shower, and patting — not rubbing — the area dry
Of course, everybody heals differently, so there is no set timeline for you to be comfortable with clothing or gauze touching the scar. Redness, itchiness, and even peeling are normal parts of recovery that come and go as the area heals in the months just after surgery. With time, the scar will lose any scabs, flatten and shrink, and lighten in color. At this stage, sunblock and other typical lotions are safe to use, but your skin might still feel tight as you begin to stretch the chest muscles and exercise more.
Some warning signs that your incision isn’t healing as expected include:
- Spreading redness or warmth, sometimes accompanied by a fever (> 101 degrees F) and chills
- Swelling or re-opening of the incision
- Oozing or pus
When can you exercise again?
A big question before surgery is how long it takes to recover and exercise again. Many patients are eager to return to aggressive fitness routines or at least to work-life roles they avoided because of heart symptoms. But the body has experienced a major trauma: multiple surgical incisions, stopping the heart with circulatory bypass, heavy anesthesia, and more. Your body needs to heal, and your heart needs to recondition in a structured way.
Although small stretches (like seated leg or arm rotations) and walking are supported as soon as possible after surgery, most professionals recommend approximately six weeks before returning to work or exercise. Some patients find that three months is just right to start slowly increasing exercise and daily activities, and this is when cardiac rehabilitation professionals officially lift sternal precautions, too.
Most challenging movements, like twisting, bending over and tying shoes, lifting groceries, or lying on your side, are discouraged at first to protect the sternum or stitched chest muscles. Although sternal guidelines exist, it’s always best to listen to what your own surgeon recommends for your specific health situation.
Finding your way
The heart is intricately and inexplicably linked with emotional well-being. Even successful surgeries carry documented emotional scars, which cause as least as much upheaval as physical ones. The physical and mental fatigue of surgery can lead to swinging emotions, from tears to anger, and sensitivity to changes in your environment, like interruptions of meals by visitors or different sleeping arrangements because of discomfort, too.
It’s valuable to directly address concerns like fear about the surgery, anger about the disruption to routine, or helplessness during recovery — especially common if you are a primary family caregiver or if your surgery is a surprise. Talking about emotions before surgery sets up coping strategies and personal connections to help with emotional challenges throughout recovery. Some challenges are natural results of the changes in medications, sleep habits, and routines. But studies also note temporary cognitive and even personality changes that may occur after surgery with heart-lung bypass. Patients might notice “pumphead” changes like poor focus and memory, or slower mental processing.
Sometimes you can’t shake off the sadness or worry after surgery; these unchecked emotions can lead to clinical anxiety or depression, which occurs consistently in approximately one third of patients with coronary heart disease. Signs that you might be struggling with more than just anticipated surgical worries include:
- Decreased pleasure in hobbies
- Increased bouts of crying
- Pretending to others that nothing is wrong
Changing behaviors — avoidance of enjoyable people or places because of anxiety, overreliance on caregivers, and an inability to focus without feeling overwhelmed — also are red flags. Caregivers and professionals look for overt signs or symptoms like these during recovery, but it’s partly up to you to be honest about how you feel. If you think these describe you, try the Mental Health America depression screening.
Poor recovery can be more difficult to notice and address than physical healing in part because difficult emotions do not develop linearly; they flare repeatedly, especially when the stresses of old routines, like work or caregiving, are reintroduced. If you do see anxiety, anger, or sadness creeping in, try some proactive steps to navigate the emotional recovery roller coaster:
- As a comfort strategy, prayer (rather than attendance at a religious service) appears to reduce anxiety and depression immediately after heart surgery and later, regardless of your age.
- Similarly, optimistic outlooks and encouragement from spouses limit anxiety, and building peaceful habits like journaling or mindfulness establish calming routines.
- Exercising to release endorphins can counter anger, and keeping to-do lists gives you time to focus on your health first.
As you journey from post-op heart surgery patient to a recovered heart-healthy life, don’t forget to appreciate the small joys.
Nicole Van Hoey, PharmD, is a freelance writer and editor for consumer and professional health publications. She underwent open heart surgery in August, 2016, and writes about the experience, including cardiac rehab, for HealthCentral. She can be found on Twitter at @VHMedComm.