Cardiothoracic surgeon Joseph Auteri, MD, FACS has helped hundreds of patients recover from cardiac surgery. We asked him about a patient's physical as well as emotional well-being following heart surgery, and ways to help improve both.
In regards to activity level following surgery, what is the importance of not "overdoing it" and also not "underdoing it" or being sedentary?
I think it is important for patients to stay active after surgery, to prevent blood clots in their legs, and to prevent pneumonia. We ask patients to walk as much as they are comfortable afterwards. We ask them to start walking a day or two after surgery while still in the hospital, and to continue this daily at home. Often during the winter months it can be hard to get outside to walk, but they can have a family member drive them to the grocery store and they can walk up and down many aisles (even though they don't have anything to buy) while leaning on a grocery cart.
We don't want patients using a treadmill or other machinery at home or at the gym until they are seen by their surgeon and cardiologist and cleared for more activity (usually this would be done in the outpatient rehab setting).
How common is it for patient to feel depressed?
Depression can occur after heart surgery. Usually it is mild, and self-limited. Rarely does it reach the level that would need anti-depression medication. It is not clear why this is so. I suspect having thoughts, and perhaps discussions about one's own mortality can weigh on some patients more than others and may lead to a sense of depression. Often a spouse will notice changes more than the patient will.
What are some tips for managing depression after heart surgery?
I think returning to a normal routine as quickly as possible can help. If patients are in a regular foursome of golf, or routinely 'meet the guys for our breakfast club' I tell them to return to that activity as quickly as they can, even if it means riding the golf cart with your friends and drop a ball at the green to putt with them (before they are cleared to take a full golf swing). I think a quicker return to normal activity helps patients manage any depression that may develop.
How should patients handle intimacy issues?
I think patients after surgery can and should engage in sexual activity (with their spouse) as they are comfortable. This can be as soon as a week or two after discharge from the hospital, as long as they are comfortable. Again, I think a quicker return to normal activity can have a very beneficial effect on overall healing (mental as well as physical).
How important is cardiac rehab for not only physical well-being, but emotional as well?
I think that cardiac rehabilitation is very important for patients after heart surgery. I am a firm believer that the physical well-being is very tied to the mental/emotional well-being of the patient. Cardiac rehab can benefit patients greatly, in both areas. Often very modest successes in cardiac rehab can have a very positive effect on the mental and emotional well-being of the patient, as they are tied closely together.
Where can patients go for help/support with these lifestyle issues?
Many patients are very shy or timid about bringing up these issues with their doctor. I think as a physician we hear many questions, very few of which we haven't heard before. I think it is very common to have these questions (depression, sexual activity, etc.) and patients should feel comfortable asking their cardiologist or cardiac surgeon. It can be very important to hear the answer aloud (with the spouse hearing it as well) to allay some of the fears that patients naturally have following heart surgery.
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