Sunday, March 8, 2015

Advance Directives -- CABG

We all hope never to face the need for CABG -- Coronary Artery Bypass Graft Surgery -- but this procedure is no longer the cutting edge procedure (no pun intended) that it once was. It does involve, however, several enabling surgical techniques that can be life-threatening as well as the life-extending benefits of a successful outcome. This from NIH is food for thought.

I'm not telling anyone what to do. I'm blessed to have lived past seventy never having to face heart problems. But my instinct is that one's age has a lot to do with whether or not this is appropriate. Twenty or thirty years ago I would have had little hesitation telling the doctors to go ahead. But now I'm not sure. And I feel confident saying that ten years from now I would say "Nope. Call the palliative care people, and tell me if I'm certified for hospice."   
What To Expect After Coronary Artery Bypass Grafting
Recovery in the Hospital

After surgery, you'll typically spend 1 or 2 days in an intensive care unit (ICU). Your heart rate, blood pressure, and oxygen levels will be checked regularly during this time.

An intravenous line (IV) will likely be inserted into a vein in your arm. Through the IV line, you may get medicines to control blood circulation and blood pressure. You also will likely have a tube in your bladder to drain urine and a tube to drain fluid from your chest.

You may receive oxygen therapy (oxygen given through nasal prongs or a mask) and a temporary pacemaker while in the ICU. A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms.

Your doctor may recommend that you wear compression stockings on your legs as well. These stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

While in the ICU, you'll also have bandages on your chest incision (cut) and on the areas where an artery or vein was removed for grafting.

After you leave the ICU, you'll be moved to a less intensive care area of the hospital for 3 to 5 days before going home.

Recovery at Home

Your doctor will give you specific instructions for recovering at home, especially concerning:
  • How to care for your healing incisions
  • How to recognize signs of infection or other complications
  • When to call the doctor right away
  • When to make followup appointments
You also may get instructions on how to deal with common side effects from surgery. Side effects often go away within 4 to 6 weeks after surgery, but may include:
  • Discomfort or itching from healing incisions
  • Swelling of the area where an artery or vein was removed for grafting
  • Muscle pain or tightness in the shoulders and upper back
  • Fatigue (tiredness), mood swings, or depression
  • Problems sleeping or loss of appetite
  • Constipation
  • Chest pain around the site of the chest bone incision (more frequent with traditional CABG)
Full recovery from traditional CABG may take 6 to 12 weeks or more. Less recovery time is needed for nontraditional CABG.

Your doctor will tell you when you can start physical activity again. It varies from person to person, but there are some typical timeframes. Most people can resume sexual activity within about 4 weeks and driving after 3 to 8 weeks.

Returning to work after 6 weeks is common unless your job involves specific and demanding physical activity. Some people may need to find less physically demanding types of work or work a reduced schedule at first.

Ongoing Care

Care after surgery may include periodic checkups with doctors. During these visits, tests may be done to see how your heart is working. Tests may include EKG (electrocardiogram),stress testing, echocardiography, and cardiac CT.

CABG is not a cure for coronary heart disease (CHD). You and your doctor may develop a treatment plan that includes lifestyle changes to help you stay healthy and reduce the chance of CHD getting worse.

Lifestyle changes may include making changes to your diet, quitting smoking, doing physical activity regularly, and lowering and managing stress.

Your doctor also may refer you to cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Doctors supervise these programs, which may be offered in hospitals and other community facilities. Talk to your doctor about whether cardiac rehab might benefit you.

Taking medicines as prescribed also is an important part of care after surgery. Your doctor may prescribe medicines to manage pain during recovery; lower cholesterol and blood pressure; reduce the risk of blood clots forming; manage diabetes; or treat depression.

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