Download Going home after a Bypass or Valve Operation

ST. JAMES’S HOSPITAL
KEITH SHAW
CARDIAC SURGERY
UNIT
GOING
HOME
after a Bypass or Valve operation
You may be feeling anxious about going home and worry about how you will cope. These guidelines have been
written to help you return to optimum health as easily as possible. We hope that you will enjoy a healthier and
more active lifestyle than you had before.
You have had a Bypass operation
It is important to remember that the operation was performed to relieve your angina so you should be able to return to a
more active and positive life than before.
The heart muscle receives blood providing oxygen and nutrients via the coronary arteries. These arteries can become
narrowed by a fatty substance being deposited in plaques, on the lining of the artery, which reduces the supply of blood
to the heart.
When the heart needs to work harder, for example during exercise, its greater demand for oxygen cannot be met by a reduced blood supply. This gives rise to chest pain, known as angina. If a blood clot forms on the surface of a plaque, an
artery may become blocked. An area of heart muscle is then completely deprived of its blood supply and dies. This is
known as a heart attack or myocardial infarction.
During your bypass operation, pieces of a vein taken from your
leg are joined to the aorta (the main blood vessel leaving your heart)
and to a point on the coronary artery beyond the narrow section. Sometimes an artery in the chest called the internal mammary artery, is used.
Blood now flows through these new channels, bypassing the narrowed arteries and giving your heart muscle a renewed and improved blood supply.
This will relieve angina and reduce the risk of a heart attack or angina in
the future.
Valve operation
Valves inside the heart (as in the diagram overleaf) ensure that blood is only pumped in one direction completing a circuit
around the heart, lungs and body. This provides the whole body with a constant supply of freshly oxygenated blood essential for life. A valve may become narrowed. This may restrict blood flow or allow blood to flow in both directions. The
heart has to work much harder to maintain adequate circulation, leaving the sufferer very weak.
Valve replacements are either mechanical (made of artificial parts) or natural tissue (from a pig). Mechanical valves are
very intricate and are likely to attract any clots that may be in the blood stream. Therefore, people with these valves must
take a drug called warfarin (an anti-coagulant) for the rest of their lives. Those with tissue valves may require anti-coagulants for a short time. The knowledge and experience of your cardiac surgeon will have guided him in making the decision as to which valve is most suitable for you.
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Dental care and infection after a valve operation
Infection of the heart valve (endocarditis) can be very serious and difficult to treat. It is important to detect it early.
The early stages are very like flu, for example high temperature, shivering, sweating, aches and pains and feeling generally unwell. If you have these
symptoms for more than a few days you should see your GP.
Endocarditis can commonly be spread via the blood stream
from the teeth. You should have a dental check up at least
every 6 months to keep your teeth clean and in good order.
The dentist will need to know you have had a valve replacement so he/she can give you antibiotics to prevent any infection
if you need any work on your teeth. He/she also needs to know if
you are taking warfarin so that any bleeding can be avoided.
After your heart surgery
The average hospital stay, post heart surgery, is five to six days depending on the progress you make. Now that you
have had your heart surgery, your recovery is well under way. You may be thinking about going home and have many
questions. This book will answer some of your questions. It will tell you what you can do after heart surgery. Talking
about your surgery with others can be helpful. Just remember that each persons experience is different. The medicines,
activities and rate of recovery depends on the type of surgery you had and how active you were before surgery. It also
depends on your progress since surgery. The information your doctors and nurses give you and this book can help you
towards a smooth recovery.
Prior to your discharge
The cardiac rehab nurse invites patients and family members to a
meeting which covers discharge advice and activity. Cardiac Rehabilitation and referral to a rehabilitation centre will also be discussed.
On day of discharge
On the day of discharge, plan your activities to include as much rest as
possible. Since the excitement of going home can be very tiring, you
may need to plan a nap for when you arrive home. In addition, you may
want to ask a nurse for pain medication just before you leave hospital.
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THE HEART TEAM
NOW THAT YOU’RE ON
YOUR WAY HOME
Getting there
You will not be permitted to drive yourself home from the hospital. However, it is not necessary to go home in an ambulance. Organise a lift home a few days before your discharge. If you are travelling long distances, you may need to stop
during the trip to take a break or stretch your legs.
It takes 3 months for your breastbone to heal. You must not drive for a minimum of 6 weeks. You should resume driving
only after discussing it with your surgeon at your first clinic appointment.
You’re Home!
Make arrangements that you’re first day at home is as restful as possible. Discourage visitors and any visitors that do arrive should only stay for short visits. It is usually quite exciting to be going home and can be quite tiring so plan plenty of
rest.
Pain Relief
We would advise you take regular pain relief for at least two weeks after your surgery to enable you to do your exercises.
Rest
It is recommended that you get at least 8-10 hours sleep per night. Sleep disturbance is not uncommon following the surgery, but it will resolve in a couple of weeks. In the first few weeks you may feel that an hours rest during the afternoon is
needed. Get as much rest as you feel that you need in whatever way suits you best. You may prefer to lie on the couch
rather than go to bed.
Stairs
Going up and down stairs does require more energy than walking, so it is important that you take the stairs slowly. Avoid
unnecessary trips up stairs in the first few weeks. If your bathroom or bedroom is located upstairs there is no need to
make alternative arrangements, just take it slowly. If you become dizzy, breathless or light headed sit down and rest.
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Bathing
You may shower or bath daily. If possible, the first time you bath it may be
advisable to have someone nearby. Run the water over your wounds, do
not rub soap into them, dry by dabbing with towel. Do not use very hot
water. If you feel light headed or dizzy sit down. You should wash your
wounds gently, do not scrub them.
Wounds
It is normal for your wounds to be sore, itchy and numb for the first few
weeks after surgery. You will get a prescription for painkillers and instructions on when to take them. This should help control the pain in the wounds.
Your Public Health Nurse will be contacted by the hospital and will come to
assess your wounds. Usually no dressing is required.
Sometimes a small swelling or lump develops at the top of the wound in your chest. This is normal and can be seen and
discussed at your visit with the Doctor. If you notice any extra redness, swelling, tenderness or any discharge from the
wound contact your G.P.
Stockings
You will be given special stockings to help improve your circulation until you resume normal activity. You will not require
them at home. Your legs will probably be swollen after surgery keep your legs elevated on a stool when sitting down.
FOR THREE MONTHS YOU SHOULD
AVOID HEAVY LIFTING, PUSHING OR PULLING, OR ANY ACTIVITY THAT WOULD
PUT A STRAIN ON THE WOUND, JERKING OR TWISTING, WHICH MAY OCCUR IF
WALKING A DOG ON A LEAD, OR PLAYING WITH YOUNG CHILDREN.
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Emotions
It is absolutely normal to feel a change in your mood after surgery. Some of the most common feelings after surgery are
those of anxiety and depression. These feelings can present themselves in many ways e.g. poor sleeping patterns, lack
of concentration, irritability, feeling let down, inability to relax. These feelings do tend to resolve with time as you become
more active. You can discuss these feelings with any member of your team, your G.P. or the Rehabilitation team. It is not
uncommon for family members to be anxious when you return home, this is normally due to concern for your well being.
Attending hospital visits with you and reading the literature provided may help to put them at ease. When family members are well informed about your recovery they can be of great help and support.
Resuming Sexual Activity
Most people, both partners, tend to worry about having sex after a heart operation. Everyone worries that having sex
may cause injury to the breastbone, cause exhaustion, or damage the heart. Provided you feel relaxed, rested and ready
for sex, none of the above should be a problem and sexual activity can normally be resumed after a couple of weeks.
Talk to your partner about this and both of you should feel confident about resuming sex. If some positions cause discomfort in the chest area, avoid them or try alternative ones.
If pregnancy after surgery is to be considered it is very important that you discuss this with your doctor, as recovery time
before pregnancy is extremely important.
Returning to work
Returning to work will be assessed on an individual basis. You will not return to employment before your 6 week check
up with your surgeon. Mostly, it will depend on the type of work that you do. Participating in the Cardiac Rehabilitation
programme will help to prepare you for returning to work, both physically and mentally. If you have any doubts or questions about returning to work discuss them with your team.
Cardiac Rehabilitation
You will have met some members of the cardiac rehabilitation team during your stay in hospital. The team is made up of
a number of specialists who provide a special recovery programme for cardiac patients. It includes Doctors, Nurses, Dieticians, Physiotherapists, Pharmacists and Social Workers. They all work together to provide information and advice
about heart disease and lifestyle, for you and your family. There are regular education sessions and an exercise programme run in a gym. Our aim is to restore you to your best potential after surgery. Cardiac Rehabilitation is an important part of your treatment and will be discussed with you during your stay. You will be referred to the rehab centre in
your local hospital post discharge.
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Exercise
Continued activity is a very important part of your recovery. Like any muscle your heart works best with routine exercise.
One of the simplest ways to help yourself recover is to walk. When you walk, blood is pumped back to your heart, improving blood flow through your whole body.
Remember to use pain relief as prescribed when you are discharged as this will enable you to exercise more easily and
sleep better.
Begin to increase activity slowly. Start with a five minute walk. Each week, walk a little farther. Start on level surfaces.
Wear supportive shoes to prevent ankle injuries while out and about. Slowly build up to 30 minutes of walking most days
of the week. You don’t have to do all your exercise at once: 10 minutes, 3 times per day is a good option.
The following is a guideline only. Each person is an individual and will progress differently.
WEEK 1
5 minutes of exercise per day.
WEEK 2
10 minutes of exercise per day.
WEEK 4
20 minutes of exercise per day.
WEEK 3
WEEK 5
WEEK 6
15 minutes of exercise per day.
25 minutes of exercise per day.
30 minutes of exercise per day.
WEEK ONE BEGINS ON THE FIRST DAY AFTER YOU ARE DISCHARGED.
Wait for one hour after a meal before exercising.
Wrap up well if the weather is bad or walk indoors, for example, in a shopping centre.
Rest
Remember to stop to rest if you feel tired. Listen to your body. Pop your legs up on a stool/chair when resting to prevent
swelling.
STOP if exercise brings on chest pain, dizziness or light headedness. If these symptoms persist consult your doctor.
Your other exercises
Continue your breathing, shoulder, neck, leg and upper body exercises for at least two weeks when you go home.
Posture
Always check your posture in sitting and standing. Head up, shoulders back and tummy muscles firm.
Concerns Post Discharge
If you have questions or problems once at home please phone us on 01-410 3389 and we will answer your questions.
If you are admitted to another hospital following discharge from the Keith Shaw Cardiac Unit please contact us or ask
your medical team to do so.
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Medications
Things you should know about your medicines
❤ It is important to remember that your medicines after surgery may be different from the ones you took before surgery.
For example, any medicines you were taking to prevent angina will be discontinued after bypass surgery. Drugs for
other conditions, such as, diabetes, depression and raised cholesterol levels will be restarted after your operation. If
you have medicines you no longer need we will be happy to dispose of them for you before you leave the hospital.
Otherwise, please take them to your local pharmacy to be destroyed.
❤ Whatever medicine you take it is important to know the following:
The name of the medicine
When and how to take it
Why you are taking it
What side effects might be expected
Before you leave hospital, the pharmacist will give you a Green Medication Card with the details of your current medication.
Note: Brand names on the card may differ from the drug name. Ask your pharmacist to fill in the brand name they
have dispensed for you.
❤ If you forget to take your medicine, the general rule is:
If you remember later that day, take the medicine as usual.
If you don’t remember until the next day, leave out the missed dose, don’t take double doses.
❤ Side Effects:
All medicines can cause side effects, usually these only affect a small number of people.
Talk to your doctor or pharmacist if you develop any unusual symptoms.
Do not increase, decrease or stop the amount of medication without your doctor’s advice.
❤ Please note that many different manufacturers make medicines. Manufacturers always give their medicines a brand
name. Throughout the booklet brand names may be recognised by the symbol ®. For example, the brand name of
Amiodarone is Cordarone®.
You will find more details on specific medications in the following pages. Please read the information carefully and ask if
you do not understand anything or if something requires clarification.
DISCLAIMER
The information about medication in this booklet is not exhaustive. Ask your doctor or pharmacist for advice or
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ANTI THROMBOTIC DRUGS
Common Preparations:
ASPIRIN
(You should be taking one of these brands only):
Nuseals®, Caprin®, Lowasa®
Why are you on aspirin?
Aspirin is very beneficial for people with any type of heart condition e.g. people with angina or those who have had a
heart attack. Aspirin acts by reducing the stickiness of the platelets in the blood, which makes the blood less likely to clot,
so aspirin will reduce the risk of further cardiac complications.
How to take it
Aspirin is usually taken once a day, in the morning.
Aspirin comes as a dispersible tablet and a coated tablet. The dispersible tablet (Lowasa®) should be dissolved in a glass
of water and taken with or after food. The coated tablet (Nuseals® / Caprin®) should be swallowed whole with a glass of
water. Avoid taking indigestion remedies at the same time as the coated tablet.
Side effects
Aspirin can cause stomach upset but this is unusual with the dose you are taking. It is less likely to occur if you take it
with or after food, and is unusual with the coated aspirin. If you suffer from this or any other troublesome side effects,
consult your doctor.
This list is not exhaustive.
Note: You should avoid Aspirin as a painkiller (eg. Disprin®/Anadin®) when taking Aspirin for your heart. Paracetamol is a
safe painkiller. If in doubt ask your pharmacist.
Brand name:
Plavix®
CLOPIDOGREL
Why are you on clopidogrel?
Clopidogrel is another medicine that prevents clots forming, in a similar way to aspirin. It is often used instead of aspirin
in people who cannot take aspirin. It is also used in combination with aspirin for a period of time (6 weeks – 1 year) after
a stent has been inserted or certain heart conditions.
How to take it
Take one tablet daily, usually in the morning.
Side effects
Possible side effects of clopidogrel are nausea and vomiting, diarrhoea, constipation, stomach irritation and rash. If any
of these side effects develop and are particularly troublesome, please consult your doctor or pharmacist.
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WARFARIN
What is Warfarin used for?
Warfarin is an anticoagulant. Anticoagulants make your blood less likely to clot. This is particularly important for people
with artificial or damaged heart valves and in certain other conditions where the risks of clotting are increased.
How do I take Warfarin?
Once a day in the evening, preferably at the same time every day. You may take Warfarin with or without food.
Why are blood samples taken regularly?
Blood samples are taken to measure your INR (International Normalised Ratio), which is a measure of how quickly your
blood clots. The number and strength of tablets you take changes depending on your INR. It is important to attend for
blood tests as requested.
Warfarin is available in three different strengths:
1mg BROWN
3mg BLUE
5mg PINK
How long will I be taking Warfarin for?
Until your doctor tells you to stop. For some patients it is only six weeks and for others it will be a life-long treatment.
Are there any precautions I need to take?
❤ Before you go home you will receive a yellow anticoagulant booklet that notes your current dose and the results of
your INR. You should always carry this booklet with you in your wallet or handbag and show it to your doctor or dentist whenever you are treated by them. Show it to your pharmacist when you are having a prescription dispensed and
when purchasing medicines. It is a universal booklet so everyone will recognise it.
❤ Warfarin may cause bleeding. Inform your doctor immediately if you notice any of the following signs:
Prolonged bleeding from cuts.
Bleeding that does not stop by itself.
Nose bleeds.
Bleeding gums.
Red or dark brown urine.
Red or black stools.
For ladies, increased bleeding during periods.
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Should I avoid any other drugs while taking Warfarin?
❤ Avoid drinking too much alcohol in one go, as it may seriously upset the effect of this drug. It is safer to have one
drink daily than to have a binge infrequently.
❤ Only take Aspirin if it has been prescribed for you by your doctor. Aspirin is present in many painkillers and flu medicines and may not be displayed clearly on the container. If you need a painkiller take Paracetamol.
❤ Certain other medicines, especially those used to treat arthritis, can affect the dose of Warfarin required. Do not take
any new tablets without checking it is safe to do so while taking Warfarin. Do not buy any over the counter medicines
without checking with the pharmacist that they are safe to take with Warfarin.
CHOLESTEROL LOWERING DRUGS
(STATINS)
Common Preparations:
Pravastatin (Lipostat®, Pravitin®) Atorvastatin (Lipitor®)
Fluvastatin (Lescol®) Simvastatin (Zocor®, Sivatin®) Rosuvastatin (Crestor®)
What are Statins used for?
They reduce levels of cholesterol in the blood. High levels of cholesterol may clog up the arteries that supply blood to the
heart muscle.
How do I take my Statin?
Take at night before going to bed. Your body produces most cholesterol when you are asleep.
The Statin can be taken with the evening meal if stomach upset is a problem.
Are there any side effects I should know about?
Most people taking this drug feel very well. A few people may develop rashes, headache, abdominal pain, nausea, constipation or diarrhoea. You should discuss any of these side effects with your doctor if they become troublesome.
Any of the following should be reported to your doctor straight away:
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Swelling of the face and neck.
Muscle and joint pains.
High temperature and flushing.
Difficulty breathing.
Avoid excessive amounts of alcohol—such drinking combined with the drug may put you at risk of developing liver problems.
Treatment with these medicines is in ADDITION to a cholesterol reducing diet—not instead of one! !
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AMIODARONE (CORDARONE® )
What is Amiodarone used for?
Amiodarone is used to control certain fast or irregular heart beats.
How should I take Amiodarone?.
Amiodarone should be taken according to your prescription.
Amiodarone may be stopped if your heart returns to a regular beat.
Are there any side effects I should know about?
There are a number of unwanted effects of Amiodarone which you may experience.
● Amiodarone can increase the sensitivity of skin to direct sunlight. When taking Amiodarone you should protect your
skin from the sun, using clothes or a sun block cream with a high ‘protection factor’, eg sun protection factor SPF 30.
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Rarely it causes headaches, tiredness, dizziness, pins and needles or a metallic taste in the mouth.
Other very rare side effects may occur if you take the drug for a long time. These include:
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Persistent cough and/or shortness of breath.
Difficulties with vision. (Some patients may experience difficulty with vision at night time by lights from on
coming cars).
Extreme restlessness and/or loss of weight.
Extreme tiredness and/or weight gain.
If you suffer from these or any other unusual effects and they become troublesome, consult your doctor.
Common Preparations:
DIURETICS
Furosemide, Frumil®, Frumil LS®, Fruco®, Centyl®,Centyl K®, Low Centyl K®, Burinex®,
Dyazide®.
What are Diuretics used for?
Diuretics are often called ‘water tablets’. They are used to remove salt and water from the body. They are used to treat:
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A build up of fluid which may be experienced as ankle swelling or breathlessness.(eg. Furosemide, Frumil®)
High blood pressure.(eg. bendroflumethiazide (Centyl®))
How do I take my diuretic?
They are usually best taken early in the day as they can increase the production of urine, which may be inconvenient at
night. If you are prescribed diuretics twice a day, take the first dose in the morning and the second dose in the early after-
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Are there any side effects I should know about?
Most people experience few or no side effects from their diuretics but they can occasionally cause unwanted effects.
Certain diuretics may cause you to lose potassium. You may be given a medicine containing potassium, or a different
type of diuretic that prevents potassium loss.
Occasionally the diuretics may work too well and remove too much water. If this occurs, it will make you feel very dry and
thirsty. Please continue to take your medication but inform your doctor.
Common Preparations:
ACE INHIBITORS
Captopril (Capoten®) Enalapril (Innovace®) Perindopril (Coversyl®) Ramipril (Tritace®,
Ramilo®), Lisinopril (Zestril®, Lisopress®), Quinapril (Accupro®)
What are ACE Inhibitors used for?
ACE Inhibitors may be used to treat high blood pressure. They make it easier for the heart to pump blood to all parts of
the body and protect the kidneys from damage in diabetic patients.
How do I take my ACE Inhibitor?
The dose of this medication will depend on the type of ACE Inhibitor you have been prescribed. Follow the instructions
that are given with the medication and if in doubt, ask your doctor or pharmacist for advice. ACE inhibitors may be taken
with or without food.
Are there any side effects I should know about?
Most people taking this drug feel very well but sometimes it causes flushing, dizziness or a headache. These side effects
tend to occur when you have just started taking the medicine or if your dose has been increased, but they should subside
after a few days. ACE Inhibitors may cause a dry cough. Try sips of water for this cough or a sugar free sweet. If the
problem persists, please consult your doctor who may change you to a different drug.
Common Preparations:
BETA-BLOCKERS
Metoprolol (Betaloc®/Metocor®), Bisoprolol (Emcor®/Cardicor®/Bisopine®), Atenolol (Amolin®,
Atenomel®, Tenomin®, Atecor®), Carvedilol (Eucardic®) Nebivolol (Nebilet®)
What are Beta-blockers used for?
The beta-blockers are a group of drugs used for the treatment of angina, high blood presure, and/or an irregular heartbeat and are used after a heart atack. They work via several different actions to slow the heart rate and reduce the
amount of work the heart has to do.
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How should I take it?
The choice of beta-blocker and the dose depends on the condition being treated. Do not stop taking your beta-blocker,
unless your doctor tells you.
Are there any side-effects I should know about?
Side effects include tiredness, depressed mood, cold or tingling fingers and toes, dizziness and light-headedness (on
standing up), vivid dreams, and rarely, impotence. If you suffer from any troublesome side effects or become short of
breath, consult your doctor.
This list is not exhaustive.
Note: You should not stop taking Beta-Blockers suddenly. Discuss the medication with your GP if you are experiencing
any problems.
PAINKILLERS
It takes about three months for your sternum (breast bone) to heal and in this time aches and pains can be expected.
If pain is not controlled by medication prescribed on discharge from Keith Shaw Ward, please contact your GP.
Common Preparations:
Paralief ®,
PARACETAMOL
Panadol®, Paramol®, Solpadeine®, Solpadol®, Tylex®, Kapake®
(All of these painkillers contain Paracetamol).
When and how often do I take my painkillers?
All of the painkillers listed above contain Paracetamol. The usual dose is TWO tablets up to FOUR times a day as required. On the first few days at home, you should take TWO tablets in the morning to stop the pain when you start moving around and at night so you can sleep without pain. Take no more than TWO tablets at any one time and no more
than EIGHT tablets in 24 hours.
Is there anything else I should know?
Paracetamol is also contained in non-prescription drugs that you can buy over the counter such as Lemsip® and
Sinutab®.
If you are not certain whether a product contains paracetamol, ask your pharnacist.
Common Preparations:
The strength is 50mg.
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Zydol®,
TRAMADOL
Tradol®,Tramake®,
Xymel 50®.
How do I take Tramadol?
Take ONE or TWO capsules up to FOUR times a day as required for strong pain.
Take no more than two capsules at any one time and no more the EIGHT in 24 hours.
Only take Tramadol if strong pain relief is required.
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Are there any side-effects I should know about?
You may experience some side-effects such as:
— nausea, vomiting, indigestion, constipation
— dry mouth
— headache
— drowsiness. If affected do not drive or operate machinery.
Common Preparations:
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DIHYDROCODEINE
DF118 Tablets 30mg
How do I take Dihydrocodeine?
Take ONE or TWO tablets up to THREE times a day as required for strong pain.It can be taken in addition to paracetamol. Only take dihydrocodeine if strong pain relief is required, that is not relieved by paracetamol alone.
Are there any side-effects I should know about?
You may experience some side-effects such as:
— nausea, vomiting, indigestion, constipation
— dry mouth
— headache
— confusion, dizziness
— drowsiness. If affected do not drive or operate machinery.
Is there anything else I need to know about Tramadol or Dihydrocodeine?
Do not take alcohol when taking these tablets—as this may make you sleepier.
Tramadol or Dihydrocodeine can be taken at the same time as paracetamol
DISCLAIMER
The information about medication in this booklet is not exhaustive. Ask your doctor or pharmacist for advice or
see the patient information sheets in medication boxes.
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Nutrition
All cardiac surgery patients will be seen by the Clinical Nutritionist while in hospital.
The following are:
1) A guide to nutrition immediately after heart surgery.
2) Long term heart healthy eating guidelines
A guide to nutrition immediately after heart surgery
It is important to eat well after your operation. A varied diet will help your wounds to heal. It will also help you get your
strength and energy back.
Try to eat meals of normal size. If your appetite is poor eat smaller meals and take nourishing snacks/drinks between
meals:
Nourishing snack suggestion:
❤ Glass of milk
❤ Yoghurt
❤ Custard
❤ Milk Pudding
❤ Beans on toast
❤ Crackers and cheese
❤ Breakfast cereal with milk
❤ Small sandwich e.g. meat or chicken or fish or egg or cheese
When you have recovered from surgery and your appetite has returned to normal it is time to change to a heart
healthy cardioprotective diet.
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Heart Healthy Eating Guidelines
1 Eat a wide variety of foods.
2 Maintain a healthy weight. Watch your portion sizes of food carefully.
3 Eat less fat, especially saturated fat
❤ Grill, Bake, Boil, Stew, Steam or use microwave instead of frying.
❤ Limit fast food/takeaways to not more than one a month.
❤ Have no more than 4 eggs per week.
❤ Choose low fat dairy products e.g. low fat milk, low fat yoghurt and low fat cheese.
❤ Use a small amount of low fat poly- or monounsaturated spread instead of butter.
❤ Keep cakes, pastries, desserts, biscuits, chocolates and crisps as “treats”.
4 Eat more fruit, vegetables and salads. Aim for five or more portions daily.
5 Try to eat oily fish twice a week e.g. salmon, sardines, herring, mackeral or trout.
6 Avoid salt and eat less salty foods. Use pepper, herbs and spices instead.
7 Eat wholemeal bread, wholegrain breakfast cereals, wholewheat pasta and brown rice regularly.
8 If you drink alcohol, only drink alcohol in moderation.
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What changes should you make to your lifestyle?
UPDATED JANUARY 2008