Cardiac Patient Education Guide

Introduction

We Welcome You Welcome to the cardiac surgery specialty area at Carilion Roanoke Memorial Hospital. We are proud of our heart program and will do our best to make your stay here as pleasant as possible.

A Bit of History Caring for hearts has been a priority at Carilion Roanoke Memorial Hospital (CRMH) since the first heart patient entered our doors in 1899. Over the years, we have added many stateof-the-art services which help us diagnose and treat heart problems. Today, in addition to our heart surgery program, we offer a wide variety of heart services including cardiac catheterization, stress testing, nuclear imaging, electrophysiology, cardiac rehabilitation, echocardiography, angioplasty, laser, stent, rotablation and robot-assisted surgery. So you see, caring for heart patients is a top priority at CRMH.

There’s No Substitute for Experience At Carilion Roanoke Memorial, about 700 heart surgeries are performed each year. Even though this surgery is routine for us, we know that it is not at all routine for you. It is only natural that you have questions about your heart surgery and recovery. This book has been specially designed to answer some of these questions. It is yours to write in, share with others and take home with you.

It does not, however, take the place of one-to-one talks with the professionals who will care for you. As questions come up during your stay with us, please do not hesitate to ask us. The better you understand, the better we can work together toward a successful surgery and speedy recovery.

Remember, this book is a handy resource for you throughout your surgery and recovery.

Please take the time to read it. We hope your family and caregivers will review it also, and don't forget to take it home with you when you are discharged from the hospital.

Again, ask questions at any time!

How to Use This Book This book is divided into sections so that you can quickly find the answers to your questions.

The tabs identify each topic for you. There are 16 in all. On the following page is a brief guide to what is in this book: © 1985 Carilion Clinic – All rights reserved – 4th edition, January 2010 Produced by Carilion Clinic Strategic Development

Introduction DVD and Videotape The DVD and videotape in the front of this book include a lot of information about heart surgery. We provide both of these resources for your convenience, but the information is identical on each of them. We will review the DVD/videotape with you before you leave the hospital.

Like this book, the DVD and videotape are yours to keep and take home.

An Introduction to Your Cardiac Surgery Team A look at some of the people who will be caring for you About Your Heart ✽ Coronary artery disease (CAD), angina, and heart attack ✽ Risk factors for developing heart disease ✽ Cardiac valve disease ✽ Congestive heart failure (CHF/HF) ✽ Heart diagrams ✽ Infective endocarditis Other Types of Heart Surgeries A brief description of the heart operations performed at CRMH other than traditional bypass and valve surgery Before Your Surgery ✽ Care that you will need after you go home from surgery ✽ Things you need to do before coming to the hospital ✽ What to bring with you ✽ What will happen before surgery ✽ Skin preparation The Day of Surgery What to expect before, during and immediately after your operation The Cardiac Surgery Progressive Care Unit Patient Recovery Progress Guide

Getting Ready for Discharge ✽ Answers to frequently asked questions ✽ Helpful tips about getting well Home Care Guide After Sternotomy Instructions for patients with a middle chest incision Home Care Guide After Thoracotomy Instructions for those with a side chest incision Foods That Heal: Nutrition After Surgery Eating to maintain your heart's health Medications Safety tips to help you Checking Your Pulse Information on how to do it correctly Emergencies What to do and how to call Cardiac Rehabilitation An important outpatient program that includes exercise and education Hospital and Surgeon Information ✽ Phone numbers ✽ Photographs and credentials of some of your care providers ✽ Maps to doctors’ offices Personal Section ✽ Notes ✽ Keeping track of appointments A Glossary of Terms Definitions of the terms that we use

Your Cardiac Surgery Team During your stay with us, you will come in contact with many members of our highly skilled team. We all work together with you to achieve the most successful outcome to your heart surgery. Our team members have the opportunity to practice anywhere, and many of them are nationally known. We are happy that they choose to practice here in Roanoke. Here is an introduction to some of them.

Cardiologists: These doctors specialize in diagnosing your heart problem. They also treat heart problems using methods other than surgery, when appropriate. These doctors may be checking on you during your hospital stay to observe your progress and make recommendations. You will see your cardiologist in his/her office after you go home from the hospital.

Cardiac surgeons: Our highly trained heart surgeons work closely with your cardiologist and other doctors to decide the type of surgery you need. These surgeons perform your surgery and closely monitor your progress afterward. A surgeon will see you daily while you are in the hospital and later in his office after you go home from the hospital. Photographs and credentials for each surgeon are included under the “Hospital and Provider Information” tab in this book.

Anesthesiologists: These doctors give and monitor medicine to keep you asleep and pain-free during your surgery. They talk with you before surgery to explain the effects of anesthesia and answer your questions, then closely observe you throughout your surgery.

Physician’s assistants (PA) and nurse practitioners (NP): These team members assist with your care during and after heart surgery. Under the supervision of the cardiac surgeons, they monitor your progress throughout your hospital stay.

Like the surgeons, pictures and information about these individuals are included under the “Hospital and Provider Information” tab.

Nurses: You will come in contact with a number of nurses who are specially trained in heart care.

Some specialize in intensive care, some assist in surgery and others will care for you in a special cardiac progressive care unit. Whatever the location, you will be closely monitored and a nurse will personally care for your needs around the clock. After discharge, cardiac nurses will work with you again in a specialized cardiac rehabilitation program.

Respiratory care staff: Respiratory therapists will teach you how to breathe and cough deeply after surgery. They continue to work with you until discharge, using breathing exercises and other therapies to keep your lungs healthy.

Clinical nurse specialist: This nurse is specially trained to care for heart surgery patients and their families. She will monitor your progress during and after surgery and answer questions about the recovery period. She works with the nursing staff to help provide the best possible care for you after

Your Cardiac Surgery Team surgery. If you have questions about any portion of the surgery or recovery, ask for the clinical nurse specialist. A photograph and credentials can be found under the “Hospital and Provider Information” tab.

Mended hearts volunteers: These trained volunteers have had heart surgery themselves. One will visit you to give you emotional support before and after surgery. Because of their experiences, they may be able to answer questions in a way that the staff cannot. These volunteers are also available in the patient/family lounge on the sixth floor to help your family members with any needs they may have while you are in surgery.

Dietitians: Your diet affects your long-term health and recovery. If you need to make dietary changes, our cardiac dietitians are there to give you many helpful tips.

Social workers: You may need special services for help at home or to go to a rehabilitation or nursing center after leaving the hospital. Our social workers will help you make these arrangements. They can also help with financial matters, so feel free to ask if you have questions.

Nurse case managers: If you need help with discharge plans or home health care, a nurse case manager can help you. They work hand-in-hand with your healthcare team to make sure that your home care needs are addressed before you leave the hospital.

Perfusionists: The heart-lung (cardiopulmonary) bypass machine does the work of your heart and lungs during surgery. Perfusionists are trained professionals who operate this machine. Because you will be asleep, you probably won’t remember seeing the perfusionist who assisted with your surgery. Credentials of our perfusionists are included under the “Hospital and Provider Information” tab in this book.

Your family physician: This doctor is also an important member of our team. He/she will be updated on your progress as needed while you are in the hospital and also when you go home from the hospital. This communication ensures good follow-up care after discharge.

Chaplains: In addition to physical needs, many patients have spiritual needs, too. Our chaplains offer counseling, prayer, emotional support and a listening ear on a one-to-one basis with you or your family. Feel free to ask that the chaplain be called for you.

Other team members: Many other skilled and caring people are working behind the scenes to make your hospital stay a pleasant one. Only those with whom you will have the greatest amount of contact have been mentioned.

About Your Heart Your heart is a hard-working muscle that is only about the size of your fist. Its job is to keep blood pumping throughout your body every minute of every hour, every hour of every day, and every day of your life! In order to work properly, your heart must have a good supply of blood to nourish it. All parts of the heart must be in good working order without defects or faults. Let’s talk a bit about the most common heart problems: coronary artery disease (CAD) and cardiac valve disease.

Coronary Artery Disease (CAD) Coronary artery disease is the number 1 cause of death in the United States. It is very important for you to understand it. The heart muscle does not get its nourishment directly from the blood that is pumped through it every day. Instead, small blood vessels called coronary arteries are responsible for feeding your heart muscle with blood, oxygen, and other nutrients. Two large arteries (the left and right coronary arteries) branch off into smaller arteries. These smaller arteries travel along the surface of the heart and then go deep into the heart to carry blood and oxygen to every single cell.

Healthy coronary artery

90% blocked artery

Healthy coronary arteries have smooth linings with no blockages. Blood can flow through these arteries very easily. When the blood flow is decreased or blocked completely, blood carrying oxygen and nutrients cannot flow through the artery to the heart muscle that needs them. Blood flow can be decreased or blocked in two ways: when the wall of an artery is damaged or narrowed by a buildup of cholesterol, fat, or other substances, or when the coronary artery temporarily contracts or goes into a spasm. If the artery has a buildup of fat or other substances, this process is called atherosclerosis, sometimes referred to as “hardening of the arteries.”

When the heart is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of this problem, it is called a heart attack, or myocardial infarction.

What are the risk factors for CAD? The American Heart Association has identified risk factors for heart and blood vessel disease. Some of these factors can’t be changed, but some can. Others, called contributing factors, are also associated with an increased risk of heart and blood vessel disease.

You should know YOUR risk factors for Coronary Artery Disease. Take a look at the following factors. What risk factors do you have?

About Your Heart Risk factors that you CAN’T change: Your age. Coronary Artery Disease is more common as you age. In fact, death from Coronary Artery Disease is most common in people who are 65 years or older. You should know that women who have heart attacks are at higher risk of death soon after their heart attacks than men.

Your gender. Men are more likely to have a heart attack than women, and they also experience the attack at a younger age than women. Men are more likely to die from heart disease, even though women’s death rate from heart disease goes up after menopause.

Your genes. If your parents had heart disease, you are more likely to develop it. If you have a strong family history of heart disease, you probably have one or more other risk factors for heart disease.

Your race or ethnicity. If you are African American, you are more likely to have severe high blood pressure than Caucasians. You are also more prone to developing heart disease. You are also at higher risk for heart disease if you are Mexican American, American Indian, or native Hawaiian. Some Asian Americans also have greater risk of heart disease.

Since you can’t change your age, gender, heredity, or race, you need to work hard to treat and control the risk factors that you CAN change: Smoking and exposure to tobacco smoke. Even if you don’t smoke at all, being exposed to tobacco smoke increases your risk of heart disease. If you DO smoke, you have a 2-4 times greater risk of developing coronary heart disease than a non-smoker. If you have Coronary Artery Disease AND smoke cigarettes, your risk of sudden cardiac death is twice as great as non-smokers. Cigarette smoking, in combination with other risk factors, greatly increases your risk for Coronary Artery Disease. If you smoke a pipe or cigars, your risk of dying from Coronary Artery Disease (and maybe stroke) is higher than those who don’t smoke, but is still not as high as those who smoke cigarettes.

Your blood cholesterol. If you have high blood cholesterol, you have a greater risk of Coronary Artery Disease. If you also have high blood pressure, your risk is even higher.

Your blood pressure. Remember that the heart is a hard-working muscle. The heart’s workload is increased when your blood pressure is high. When the heart muscle has to work harder, it can become thick and stiff, which affects its ability to pump blood efficiently. If you have high blood pressure, your risk of heart attack, stroke, kidney failure, and heart failure are increased. If you have high blood pressure and are also obese, smoke, have high blood cholesterol or diabetes, then your risk of heart attack or stroke is several times higher.

About Your Heart Your level of physical activity. Being physically active can help you control your weight and blood cholesterol (along with diabetes, if you are diabetic). It even helps some people control their blood pressure. If you aren’t physically active, though, you are at greater risk for Coronary Artery Disease. The American Heart Association recommends that you have regular, moderate-to-vigorous physical activity to help prevent heart and blood vessel disease. The good news is that you gain more benefit from activity that is more vigorous.

Don’t be discouraged, though: even moderate activity is beneficial if you do it regularly and over time. Be sure to talk with your healthcare provider, though, before beginning any exercise program Your weight. If you are overweight, you are more likely to develop heart disease and stroke.

This is especially true for people who have excess body fat at the waist. Remember, the heart is a muscle. Being overweight requires the heart to work harder. Excess weight raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (“good”) cholesterol levels. Being overweight increases your risk for developing diabetes. We know that it may be very hard for you to lose weight. But the benefits are huge: if you lose even a few pounds, you can lower your risk of heart disease.

Having diabetes mellitus. If you have diabetes, you are at high risk for developing heart and blood vessel disease, which is a leading cause of death for diabetics. If you have diabetes, it’s extremely important to keep it in good control. Work with your doctor to manage diabetes and control as many other risk factors as you can.

Other factors: Your stress level. Your response to stress may put you at greater risk for Coronary Artery Disease. Researchers have seen a relationship between Coronary Artery Disease risk and personal stress, health behaviors and socioeconomic status. If you don’t manage stress well, you may eat too much, start smoking, or smoke too much, which are also risk factors for Coronary Artery Disease. To cope with stress, try to avoid the things that upset you. You can also try increasing your physical activity and limiting your caffeine intake. Cardiac rehabilitation programs can provide you with tips on coping with stress. Also, don’t hesitate to talk to your doctor to learn more.

Drinking alcohol. Drinking too much alcohol can raise your blood pressure, lead to stroke, and weaken your heart. It can also play a role in high triglycerides, obesity, alcoholism, suicide, accidents, cancer and other diseases. If you didn’t drink alcohol before surgery, don’t start now. If you do drink alcohol, limit yourself to one beer (12 ounces), a glass of wine (4-5 ounces), OR liquor (1-1 1/2 ounces) per day.

Now that you’ve read about the risk factors for developing heart and blood vessel disease, what are YOUR own risk factors? If you have questions or concerns about this, please ask your doctor.

About Your Heart Coronary Artery Bypass Graft (CABG) Surgery Many tests are used in order to decide whether Coronary Artery Disease (CAD) is causing chest discomfort or caused a heart attack. Once we know that CAD is truly the problem, several treatment options are open. One of those options is Coronary Artery Bypass Graft (CABG) surgery.

The goal of Coronary Artery Bypass Graft Surgery is to create a new pathway – or bypass – around the blocked part of your coronary artery. This pathway will permit oxygen-rich blood to reach your heart muscle. Your surgeon will use a blood vessel from your chest, leg, or arm as a graft to bypass the blockage in your coronary artery. In the case of a leg or arm blood vessel, one end of that vessel is attached to your aorta (the large artery that comes out of the heart) and the other end is attached to the coronary artery beyond the point where it is clogged. If a chest artery (internal mammary artery, or IMA) is used, only one end has to be attached to the coronary artery since the other end already connects directly to the aorta. The vein or artery that is taken from the chest, arm, or leg is not replaced. Other blood vessels in the area will take over the workload of these vessels after they are removed.

Your blocked coronary artery in your heart is not removed, just bypassed with the graft. The blood is re-routed and can once again flow freely to your heart muscle. If you have more than one blockage, more than one bypass may be needed.

Take a moment to look at the picture on the next page. Your doctor or nurse can draw the location of your blockages and the placement of your bypasses after surgery.

About Your Heart

Coronary Arteries of the Heart

Left main coronary artery

Right coronary artery

Circumex artery

Diagonal arteries

Right (acute) marginal artery

Posterior descending artery

Left anterior descending artery

About Your Heart Cardiac Valve Disease You have four valves inside your heart. Two valves are on the left side of your heart and two are on the right. These valves help blood move through the heart by opening and closing at the right times. When a valve doesn’t open completely, blood cannot get through it. This is called stenosis. When a valve doesn’t close completely, blood leaks where it shouldn’t. This is called regurgitation or insufficiency. As a result, blood cannot move through the heart like it should. The heart must work harder to move blood along.

Biological Valve

If you have problems with any heart valve, you may experience one or more of these symptoms: ✽ Shortness of breath when exerting yourself or even when lying down ✽ Weakness or tiredness ✽ Dizziness or fainting spells ✽ Swollen ankles ✽ Chest pressure or pain ✽ Irregular heartbeat Why do valve problems occur? Valve problems can be caused by a small birth defect that’s not repaired and gets worse later in life. A heart valve can also wear out as you age.

Problems with a heart valve can also be caused by an infection that scars or damages the valve. Coronary artery disease is another cause of heart valve problems.

People with heart valve disease usually have a heart murmur that the doctor can hear when he listens to the heart. After a series of tests, your doctor may decide that your heart valve needs to be repaired or replaced so that you can feel better.

Repair of Heart Valves Sometimes, a heart valve can be repaired in surgery. Be sure to ask your heart surgeon if this is an option for you.

Replacement of Heart Valves Two kinds of artificial heart valves are available to replace a damaged heart valve. They are mechanical (man-made) and biological (tissue).

Mechanical heart valves are made of steel and carbon. Lifetime bloodthinning medicine will be required in order to keep blood clots from forming on these valves.

Mechanical Valve (St. Jude)

About Your Heart Biological heart valves are made from heart tissue of pigs, cows or humans. These valves usually don’t require lifetime blood thinners. Some do not last as long as mechanical heart valves.

Your doctor will discuss with you and your family which heart valve is the best for you. Many factors are considered in making this decision. Your surgeon makes the final decision during surgery to ensure that you receive the valve best suited for you.

Take a moment to look at the picture on the next page. Your doctor or nurse can show you which valve(s) is causing your problem and what type of valve was used to replace it if it could not be repaired.

What is congestive heart failure or heart failure (CHF)?

Heart failure is a condition in which the heart is not able to pump blood as well as it should.

Remember that the rest of the body depends on the heart to deliver blood, important nutrients, and oxygen so that it can function well. When the body doesn’t get enough blood and nutrients, it doesn’t function as it should. As a result, shortness or breath, tiredness, and fatigue can occur, which can make even routine activities (such as walking) difficult.

There are many causes of heart failure, including Coronary Artery Disease and Cardiac Valve Disease. Although it is a serious condition, heart failure can often be managed with medicines and changes in lifestyle. Even though there is no cure for heart failure, people with this condition can still lead full lives. The more you know and understand about heart failure, the better you can manage the symptoms.

Heart failure warning signs It is very important that you know the warning signs of heart failure so that you can watch for them and get in touch with your doctor right away if any of these signs appear: ✽ Sudden weight gain (two or more pounds in one day, four or more pounds in one week) ✽ Shortness of breath not related to exercise or exertion ✽ Swelling of the legs or ankles when you wake in the morning ✽ Swelling or pain in the abdomen ✽ Trouble sleeping (waking up short of breath, using more pillows) ✽ Frequent dry, hacking cough ✽ Increased fatigue Keep in mind that retaining fluid after heart surgery can also give you these same symptoms.

About Your Heart

Normal Heart and Valves

Aorta

Pulmonary artery Aortic valve

Right atrium

Left atrium

Tricuspid valve

Mitral valve

Left ventricle

Pulmonic valve

Right ventricle

Infective Endocarditis

What is infective endocarditis?

Infective endocarditis (also called bacterial endocarditis) is an infection of the heart’s inner lining (endocardium) and/or the heart’s valves. It can damage or even destroy heart valves. People with certain heart conditions are at an increased risk for this infection.

How does it occur?

Germs and bacteria normally live on various parts of your body, such as the mouth, the nose, the intestine and the skin. Germs can be dangerous if they get into the bloodstream and lodge on abnormal heart valves or other damaged heart tissue. Although endocarditis is a very serious disease, it can be treated with antibiotics.

Who is at risk?

Endocarditis rarely occurs in people with normal hearts. However, if you have certain heart conditions, you are at an increased risk for endocarditis. Some of these conditions include having: ✽ ✽ ✽ ✽ ✽ ✽ ✽ ✽

An artificial (prosthetic) heart valve A history of endocarditis Heart valves that have been damaged by conditions such as rheumatic fever Certain congenital heart defects Hypertrophic cardiomyopathy A heart transplant and developing a heart valve abnormality A pacemaker An implantable cardioverter defibrillator (ICD)

What are the symptoms?

It is important that you know the symptoms of endocarditis so that you can report them to your doctor right away if you have them. The symptoms are unexplained fever, chills, sweating, fatigue, muscle aches, loss of appetite, nausea and headache.

Prevention is Key Having and keeping a healthy mouth is critical in the prevention of endocarditis. Practice good oral hygiene every day and get regular dental check-ups. Routine brushing and flossing of your teeth and gums is a must. Make sure that your dentist knows if you have a heart problem. Carefully follow your doctor’s and dentist’s instructions when they prescribe special medications such as antibiotics.

Infective Endocarditis Antibiotics Antibiotics destroy or control the germs that cause endocarditis. You may be asked to take antibiotics before certain medical procedures that can introduce germs into your bloodstream. Be sure to talk to your healthcare provider about taking antibiotics when you have certain procedures if you have any of these conditions: ✽ An artificial (prosthetic) heart valve ✽ A history of infective endocarditis ✽ Certain congenital heart defects (ask your doctor about your risk of endocarditis if you have a congenital heart defect) ✽ A transplanted heart that has valve disease If you have any of these conditions, also ask your healthcare provider for an American Heart Association wallet card that explains the guidelines for antibiotic use. A copy of the card follows. Since the information on the card can change, make sure that you have the latest version. Visit the American Heart Association website for the most recent card: http://www.americanheart.org/presenter.jhtml?identifier=3003000 The wallet card will help you remember to tell your doctors and dentists about your condition and to ask about your need for antibiotics. Please remember to show it to all your doctors and dentists.

In the past, antibiotics were recommended before certain medical and dental procedures for people with a number of heart conditions. In 2007, however, the American Heart Association revised those guidelines. Now, antibiotics are only recommended before those procedures if you have one of the four conditions listed above. The wallet card contains the latest guidelines. Always talk with your healthcare provider about your risk of endocarditis and whether you need antibiotics before medical or dental procedures.

Please call the office of your family doctor, cardiologist, dentist or heart surgeon if you have any questions about your risks for endocarditis or your need for antibiotics.

Infective Endocarditis

Infective Endocarditis

Other Types of Heart Surgeries

Other Types of Heart Surgeries Several other types of heart surgery are performed routinely at CRMH. Here’s a brief description of those operations: MIDCAB (Minimally Invasive Coronary Artery Bypass) This bypass operation requires a small incision on the side of the chest. The heart-lung bypass machine is not used. This surgery is done while the heart is still beating and is intended for use when only one or two arteries will be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision.

OPCAB (Off-Pump Coronary Artery Bypass) This bypass operation is performed through an incision in the middle of the chest while the heart is beating. During the surgery, the heart and lungs continue to function independently (without the aid of the heart-lung bypass machine). Unlike the MIDCAB operation, multiple arteries can be bypassed.

Port Access This heart surgery technique allows surgeons to operate on the heart through small openings in the chest wall between the ribs. These openings are called “ports.” The heart-lung bypass machine is used so that the heart can be safely stopped during the surgery. Port access involves many of the same steps as traditional open-heart surgery, but requires only a small side-chest incision (thoracotomy).

TMR (Transmyocardial Revascularization) In this procedure, a laser cuts a series of channels in a sick heart muscle to increase its blood flow. This operation is used for patients who continue to have chest pain despite good medical therapy.

Minimally Invasive Aortic Valve Surgery Sometimes the aortic valve can be replaced through a small chest incision which is about half the size of the usual opening.

Congenital Heart Defect Repair Occasionally, adults need repair of heart problems with which they were born. One example of a congenital heart defect is atrial septal defect (ASD). Sometimes these repairs can be made through a small chest incision.

Before Your Surgery

"Before surgery, a nurse told me not to worry about the breathing tube. She said, ‘You'll be fine. I know what to do.’ And she was right – the nurses were great."

– Benny Keister

BEFORE Coming to the Hospital Make arrangements with a family member or friend to stay with you at home after discharge. YOU MAY NOT STAY AT HOME ALONE AFTER SURGERY. Please understand that we make NO exceptions to this rule. We require that you have someone at home with you 24 hours a day for the first week after going home, and at night for at least one more week after going home. Patients who live alone often feel better staying with friends or relatives after discharge. You may, however, prefer that friends or family stay in your home with you instead. If you live alone and have no friends or family to help you after surgery, you may need to go to a nursing home or rehab center for a short time before returning to your home alone. PLEASE THINK ABOUT THESE OPTIONS BEFORE COMING TO THE HOSPITAL FOR SURGERY. Before your surgery, we will ask you for the name of the person(s) who will be caring for you after discharge. If you need help with these arrangements, simply ask your nurse to contact our social worker for you. She will be happy to work with you.

After midnight on the day before your surgery you may not eat or drink anything (except medicine that we may instruct you to take). Remember to quench your thirst before the clock strikes midnight.

What to Bring For patients being admitted to the hospital on the day of surgery: Bring only those items you will need prior to going to surgery (for example, a toothbrush, something to read, etc.). Your family should bring personal items to us the day AFTER surgery.

For patients being admitted to the hospital before the day of surgery: Pack lightly for your hospital stay. Bring only your gown or pajamas, a robe, nonskid slippers, underwear, and toiletry items (toothbrush, comb, etc.).

Before Your Surgery All female patients will be fitted with a soft bra after surgery. Unsupported breasts can cause strain to the chest incision, causing pain or other problems. If you want to bring your own front-opening bra or “sports” bra, that is fine.

Many patients ask us what kind of clothes they should bring to wear home from the hospital. A SOFT shirt or dress that buttons in the front and does not have to go over the head is best.

You can also go home in a gown or pajamas if that is most comfortable for you.

When to Arrive For patients being admitted to the hospital on the day of surgery: You will be instructed about the date and time to arrive at the hospital.

For patients being admitted to the hospital before the day of surgery: Please plan on arriving at Carilion Roanoke Memorial the morning of your admission day. Go to the information desk in the lobby and tell the receptionist that you are here for heart surgery. Our staff will take it from there!

What Will Happen Before Surgery Before surgery, it’s normal to feel nervous. We know that, even though we routinely perform this surgery, it is NOT routine for you! Every person who undergoes surgery is anxious.

Please know that we are totally committed to you and your family and will do our best to make this as easy as possible for you.

To prepare for surgery, we may need to perform a chest X-ray, an electrocardiogram (EKG or ECG) to evaluate your heart rhythm, and several blood tests. You and your family will also be meeting and talking with some of the cardiac surgery team members, such as your surgeon and anesthesiologist. A respiratory therapist and Mended Heart visitor may also talk to you before surgery. Take advantage of these meetings and have your questions ready. If you have concerns, no question is too small to ask.

The Night Before Surgery Your surgery team at Carilion Roanoke Memorial Hospital would like you to use a special “prep” product to cleanse your skin before surgery. Using this product can reduce the risk of infection at the surgical site. For this prep, you will use disposable cloths moistened with a rinse-free, 2 percent Chlorhexidine Gluconate (CHG) antiseptic solution to cleanse your skin. Please read the directions below COMPLETELY before beginning the prep. If you have a sensitivity or allergy to aloe vera, please notify your surgeon.

Before Your Surgery

Directions: 1. You will cleanse your skin using the special CHG prep cloths at about 7 p.m. on the night before your scheduled surgery.

2. If you wish to shower, bathe or wash your hair, do so several hours before you cleanse your skin with the prep cloths. Do not shave before or after using the cloths. You should stop shaving if possible at least two days prior to your surgery on all areas of your body, including your face, legs and underarms.

3. Make sure that your skin is completely dry and cool before using the CHG cloths. When applied to sensitive skin, CHG may cause skin irritation such as a temporary itching sensation and/or redness. Showering or shaving immediately before applying CHG may also increase sensitivity. Allergies to CHG or aloe vera may enhance this effect.

4. If you have skin allergies, use a cloth on a small area first, checking for any reaction.

If itching or redness occurs, rinse that area and stop using the product. Contact your heart surgeon for advice.

5. AVOID TOUCHING THE EYES, EARS OR MOUTH with the CHG cloths.

6. You will use a total of six 2 percent CHG cloths (three packs with two CHG cloths in each one) to clean your skin. Use the cloths just as you would a wash cloth.

Follow these directions. ✽ Use one cloth to wipe your neck, chest and abdomen (#1) 1 ✽ Use another cloth to wipe both arms, 2 2 starting at the shoulder, down to the fingertips and ending under your arm (#2) 3 3 ✽ Use another cloth to wipe your left and right hip, followed by each groin (#3) ✽ Use another cloth to wipe both legs, 4 4 starting at your thigh and ending at your toes (#4) ✽ Use another cloth to wipe your back, starting at the base of your neck and ending at your waistline (#5) ✽ Use the last cloth to wipe your buttocks and rectal area (#6)

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Before Your Surgery 7. Allow your skin to air dry. Do not rinse or apply any lotions, moisturizers or make-up after using the cloths. It is normal for the skin to have a temporary “tacky” feel for several minutes after using the cloths.

8. If you received a special set of these instructions from your nurse, remove the Prep Check sticker from the package and place it on that sheet. Beside the sticker, write in the date and time that the prep was completed. Give the sheet to your nurse after the prep is finished, or bring it with you to the hospital the following day.

9. Discard the cloths in a trash can. On the day of your surgery, we will complete the prep again with you in the hospital.

"Cardiac Rehab, for me, was one of the most important parts of recovery. They told me straight answers and got me moving again." – Cindy Stachelski

The Day of Surgery

Bill and Judy Griggs of Salem participate in the Lion’s Golf Tournament.

Before Your Operation On the morning of surgery, our nurses and assistants will prepare you for surgery. Hair will be removed from your chest and/or legs as needed. This does not hurt and only takes about an hour. We will also clean your skin again with the CHG cloths. Then you may be given medicine to make you sleepy. If so, you will quickly become drowsy and may not even remember leaving your room or arriving in the operating room.

When you enter the operating room, many different monitors will be placed on and around you. These monitors allow your nurse and doctor to know what is happening inside your body, including information about your lungs, kidneys and heart.

After you are asleep (but before your operation begins) a breathing (or endotracheal) tube will be placed in your windpipe. The other end of the tube will be just outside your mouth.

We connect this end of the tube to a ventilator, or breathing machine. This ventilator will breathe for you while you are asleep.

Your family will keep your belongings with them until you are moved to the Cardiac Surgery Progressive Care Unit after surgery. Many patients spend only one night in the Cardiac Surgery Intensive Care Unit (CSICU). If you usually wear dentures, glasses or a hearing aid, ask your family to give those items to the CSICU nurse caring for you.

During Your Operation We have three operating rooms dedicated to heart surgery. They are located on the 6th floor of the South Pavilion. While you are in surgery, your family will wait in the Family Waiting Area just down the hall from the operating room. This waiting area is open 24 hours a day.

A pay phone is available, as well as a telephone for making free local calls. Two additional house phones will permit you to call CSICU (or CSICU to call you). If needed, you may receive outside calls at 540-982-8958 or 540-981-8927.

Several hours each weekday, a Mended Hearts volunteer is in the waiting area to answer

The Day of Surgery questions and assist with any needs. Your family and friends may not receive any information about you or your surgery until it is nearly completed. Heart surgery can last from three to six hours or even more, depending on the type of surgery. Family members might want to bring needlework, a book or other hobbies to help pass the time.

Bruce Blevins of Princeton, WV, enjoys traveling and visiting new places.

"Relax and do what the professionals tell you to do. One of the hardest things for me was to walk and use the breathing spirometer, but they are also very important." – Darrell Bandy

Immediately After Your Operation After your surgery, you will be taken to the Cardiac Surgery Intensive Care Unit (CSICU). You will be drowsy much of the day and may not fully awaken until later that night. As you are waking, you will begin to notice the equipment that we use to monitor you during and after surgery. Don’t worry about accidentally pulling out or dislodging this equipment. As you awaken, your nurse will remind you of equipment that is in place. You can still move about in bed even with this equipment in place.

Your nurse will help you move in bed for your comfort. As you waken, it may be hard to open your eyes at first. We apply gel to your eyes during surgery to keep them moist while you are asleep. You will also notice the breathing tube in your mouth. When you are able to breathe on your own, this breathing tube will be removed. It will feel strange to you. It is held in place by tape around your mouth. You will not be able to talk while the tube is there, but your nurse reads lips and understands motions and gestures very well. We also may ask you to write down your needs or questions for us if you are able. We want to know if you need something even though you cannot talk. The breathing tube allows the machine to breathe for you and also gives the nurses a way to remove mucus from your lungs. This removal process is called suctioning. A long, skinny tube is placed through your breathing tube in order to clear your lungs. Suctioning may cause you to cough or feel like you are choking, but we will try to do this entire procedure very quickly.

Remember that the breathing tube is removed as soon as you no longer need it. Many people cannot even remember it.

The Day of Surgery Many patients have questions about pain after surgery. Of course, no surgery is pain-free.

Remember that we know about this pain, and we will help you manage it. At first, your CSICU nurse will give pain medicine to you. Later, you may be able to give your own pain medicine by using a special I.V. machine. The nurse will explain this system to you in detail.

Some patients tell us they felt as if they could not move their arms or legs when they first woke up after surgery. For a time, you will be under the effects of medicines used during surgery, which causes these VERY NORMAL feelings. Your nurse will be nearby to explain these feelings to you.

You might be interested in some of the devices used during and after surgery, although you probably won’t need them for very long. ✽ I.V.’s (intravenous needles or cathers) are placed in your veins as you are going to sleep. Through your I.V.’s, you will receive fluid and medicine. When you are taking liquids well by mouth, the I.V.’s will be removed. ✽ An arterial line is a small needle placed in an artery in your wrist. This line monitors your blood pressure. The nurse can also draw blood from it so that you don’t have to be stuck with a needle each time blood work is necessary. ✽ A Swan-Ganz catheter is a long thin tube that is put into a vein in your neck and advanced into your heart. This catheter is only used for patients who need it. It checks the pressures inside your heart’s chambers. This catheter is taped securely to the neck and forehead. It will be removed in a day or so. ✽ A heart monitor is attached to your chest by sticky pads. It constantly records your heart rate and rhythm. Do not worry about beeps and buzzes. Alarms on this monitor are routine and do not necessarily indicate that something is wrong. Your nurse is closely watching them. ✽ Chest tubes are placed at the bottom and/or to the side of your chest incision. The purpose of these tubes is to drain fluid from the surgical area and to help your lungs inflate better. The tubes can usually be removed in one or two days. ✽ A temporary pacemaker is about the size of a small remote control. It is attached to your heart by a set of tiny wires. This pacemaker is only used if the doctor or nurse needs to change your heart rate. The tiny wires will be removed before you go home. ✽ A bladder catheter is a small tube that is placed in your bladder. Although you may feel like you need to pass water, you don’t have to worry about it while this catheter is in place. It collects urine for you. This catheter is usually removed in one to two days.

The Day of Surgery

Managing Your Pain There is usually pain with any surgery, and heart surgery is no exception. There are several causes of pain after heart surgery. First, for most heart surgeries, the breast bone (sternum) is opened and the muscles are separated. Second, the devices you have in place that we just described can cause pain. For most patients, it is almost impossible to relieve all of the pain after heart surgery. We do, however, want your pain to be at a level that you can tolerate. Please know that we will do our best to help you with your pain.

We can help you best when we know about your pain level.

Going for birdie, Russell Burkholder takes to the links in Hillsville.

At the hospital, we use a scale of zero (0) to ten (10) to find out how you are feeling. On this scale, zero (0) is no pain at all, and ten (10) is the worst pain that you can imagine. Our goal is to get and keep your pain at a tolerable level. On our ten point scale, that is about “5” or lower. We will ask you often what number you would assign to your pain. Please be honest with us. If we know about your pain, then we can work to help control it.

We help with your pain by using a combination of pain-relief methods. A very important method of achieving pain relief is IV (intravenous, in your vein) pain medicine. This medicine is given by an IV machine, called a Patient Controlled Analgesia (PCA) pump. The pump allows you to give yourself IV pain medicine when you need it by pushing a button. This way, you don’t have to wait for the nurse to give your pain medicine. The nurse can help, however, until you are fully awake and can push the button when you like. Your family members should not push the button, though, unless you ask them to do it. The PCA pump is very safe: it is programmed to give the right amount or dose of medicine at the right time intervals. It will not permit you to give yourself too much medicine or too often. If you push the button too often or too early, the machine will not allow the medicine to be given. This is an important safeguard. The pain medicine given by the PCA pump usually takes 5-10 minutes to start working and lasts for about 30-60 minutes.

Another method we use to control your pain is medicine that is in pill form. We often use pain pills along with the PCA pain medicine. We can give you pain pills when you are able to take liquids by mouth. Remember that a pain pill usually takes 30-60 minutes to start working, but it will help with your pain for 3-4 hours. You may ask for a pain pill every 4 hours if you need it. Hopefully, the pain pill will decrease the pain enough so that you won’t have to use the PCA medicine as much. We are usually able to stop the PCA medicine within 1-2 days after surgery because the pain pills provide good pain control.

We need for your pain to be in good control because it is very important that you be able to do your breathing exercises, coughing, and moving about in the bed and chair. These activities help you get your lungs healthy and strong again and help prevent pneumonia and other problems. You may need to give yourself pain medicine or ask the nurse for a pain pill in order to be able to do these things. Do not let pain get too severe before you take or ask for pain medicine. Your nurse will show you how to use your “Cough Buddy” teddy bear to

The Day of Surgery help you with coughing and breathing deeply. When you hug your bear tightly, you should have less pain in your chest when you cough. Be sure to take your bear home to use it during the first few weeks while your chest is healing.

Remember … let us know if the medicine (either IV or pill) is not controlling your pain.

We will review your medicines and do all that we can to help.

Other Things to Expect You will have an incision in the center of your chest (sternotomy) or on the side of your chest (thoracotomy). If you have had coronary artery bypass surgery, you may also have incisions on the inside of one or both legs, and/or both arms. If you have valve repair or replacement only, you will not have leg or arm incisions.

You will be drowsy through much of your stay in CSICU. But if you are awake enough to look about your room, you will notice that you are in a large, pleasant room with big windows. Each patient has a nurse nearby. He/she will be working closely with you and is aware of your needs at all times.

Blood Sugar Monitoring Some patients know that they have diabetes before their heart surgery. Remember, diabetes is a significant risk factor for Coronary Artery Disease. Research shows that high blood sugar levels are dangerous, Cardiac rehabilitation therapy can especially before, during, and after heart surgery. take many forms according to Billy Here is an important fact: Even if you haven’t been Bowles of Dublin. told that you are diabetic before surgery, your blood sugar can be elevated now related to the stress of surgery and the surgery itself. Regardless of the reason, if your blood sugar is too high during or after surgery, we will give you intravenous insulin to keep your blood sugar closer to normal. We will also continue to monitor your blood sugar closely throughout your stay with us. In addition, an endocrinologist (a doctor who specializes in blood sugar problems) may also be following you to make sure that your blood sugar stays in good control.

You may need to take medicine for your blood sugar and check your blood sugar frequently at home after discharge from the hospital. If that is needed, we will work with you so that you know how to take care of these issues at home. A home health nurse may also see you after discharge to help with this and to answer questions. You will also need to see the endocrinologist or family doctor a few weeks after surgery so he or she can see if you need to continue this medicine. Sometimes the blood sugar issues resolve. If they do not, you may be diagnosed with diabetes. If you DO have diabetes, it is very good to find this out now so that you can work closely with your healthcare provider to manage it.

The Day of Surgery

Heart Rhythm Changes After surgery, we will closely monitor your heart rhythm. It is important for the heart to pump properly to ensure that your body gets the oxygen and nutrients it needs. Frequently, we see changes in heart rhythm that we can treat with medicine. One common type of irregular heartbeat after surgery is atrial fibrillation. Normally, your heart beats regularly. In atrial fibrillation, however, the upper chambers of your heart (the atria) beat irregularly, sometimes too fast or too slow.

With atrial fibrillation, you may notice an irregular or rapid heartbeat, heart palpitations or rapid thumping inside your chest. You could also have dizziness, sweating, chest discomfort, shortness of breath, or anxiety. Atrial fibrillation may also make you feel weak or tired.

Brief periods of atrial fibrillation are common. If it continues for a longer period, though, it will require treatment. Please tell your doctor or nurse about any unusual sensations in your chest or if your feel that your heart beat is too fast, too slow, or irregular.

Visiting in Cardiac Surgery ICU You and your family are sure to have questions about our visiting policy. After your surgery, a CSICU nurse or volunteer will talk with your family. Your family members can see you, even though you will be drowsy at that time. It is usually very difficult for family members to see their loved ones for the first time after surgery because they are attached to so much equipment. We will discuss this with your family on their first visit after your surgery.

If your family members have questions after they visit you in CSICU, they should ask your nurse. The nurse can answer questions and provide information as it is available. In order to provide the best possible care for you, we ask that your family help us by following these guidelines: ✽ Please call the CSICU (77631) from the waiting area each time you want to visit. If a receptionist/volunteer is in the waiting area, he or she will assist you. You can call the CSICU by using the wall telephone just outside of the CSICU. ✽ Visitors are welcome between the hours of: 9 a.m. – 6 p.m. and 8 p.m. – 10 p.m. ✽ We try to permit all visitors who want to see the patient immediately after surgery to do so on the first visit. After that visit, only two immediate family members should visit at any one time. Length of visits will be left to the discretion of your loved one’s nurse. ✽ Children under 13 are permitted to visit only under special circumstances. ✽ Exceptions to the above visiting times may be permitted under special circumstances.

At times, visitors may not be able to enter during the scheduled hours. The nurse will tell you when the next visit can occur.

The Day of Surgery ✽ Family visits in CSICU are important. There will be times, however, when we may have to ask that you leave your loved one’s room for procedures, emergencies, or to routine care.

Please keep in mind that in addition to your love and support, your loved one also needs rest. For this reason, visiting may be limited. ✽ To ensure the privacy of other patients, visitors are asked to stay in the patient’s room during the visit. ✽ Having a loved one in the hospital is stressful. We encourage your family and friends to leave the hospital at night to rest. Assistance with accommodations is available at Guest Services in the lobby. All visitors who choose to stay in the hospital after 10 p.m. must stay in the waiting area. Please understand that blankets and pillows cannot be provided for visitors. Those staying in the hospital after 10 p.m. may call to check on the patient but will not be permitted to visit during the night. ✽ The Chapel is accessible 24 hours a day and is located on the second floor of the South Pavilion.

Pastoral services are also available and can be requested by talking with the nurse.

Dancing and being outdoors makes me good, says Peggy Housman of Rocky Mount.

✽ Use of cellular phones is permitted in the waiting rooms only. Please remember to turn off your cell phone before entering CSICU. Pay phones and restrooms are available in the waiting areas. ✽ An ATM and additional pay phones and restrooms are located on the ground or lobby floor. The hospital restaurant is located on the third floor of the South Pavilion. ✽ Carilion Roanoke-based facilities are tobacco-free. Please refrain from using any products containing tobacco while on our campus.

Privacy Codes To ensure safety and privacy, each patient is assigned a privacy code. Families are asked to select one family spokesperson to receive and share information with other family members and friends. Only the family spokesperson will be given the privacy code. The code must be provided each time the spokesperson calls for patient updates. It is very helpful if only the spokesperson calls so that the nurse’s time away from your loved one is brief. When the patient leaves CSICU, the privacy code may no longer apply.

The family telephone number for CSICU is 540-981-7631.

Cardiac Surgery Progressive Care Unit (CSPCU) When you are ready to leave the Cardiac Surgery ICU, you will be moved to the progressive care unit (CSPCU). There, you will continue to wear a heart monitor. On that unit, it is important that the people who will be caring for you after discharge spend time with us so we can teach them how to care for you at home. We do, however, want your caregivers to feel free to leave or go home for frequent rest periods for themselves. Your caregiver can set up specific times to review your discharge information with your nurse. The care you will need is not difficult, but your caregiver's presence will permit us to get his or her questions answered, as well as yours.

On CSPCU, we will keep you very busy each day with blood tests, X-rays, teaching, breathing treatments and exercise. You will probably be tired and may not want extra visitors. Your family should ask friends to limit phone calls and visits, and to send a card or flowers instead. Of course, your family can feel free to visit at any time. You have a room telephone, but if family members or friends want to call the nurse's station, the telephone number is 540-981-8250.

We often hear questions about postoperative soreness, coughing/breathing exercises and leg exercises. Here are a few tips to help you with these.

Post Operative Soreness During the first two or three days after surgery, you will experience the most soreness. We believe that sitting up, getting out of bed, moving around, and exercising your muscles will reduce stiffness and soreness. Also, please take your pain medicine. You will be able to move about, cough and relax much better if you do. Pain medicine is especially important while the tubes are still in place. When the tubes are removed, the soreness will improve. If all goes well, you should be walking about 24 hours after surgery – with help, of course! At this time, you will need your clothing (robe and slippers). Keep in mind that you will feel better and stronger each day.

Breathing and Coughing Exercises Deep breathing and coughing are two very important exercises after surgery. They help clear your lungs of mucus, which can cause pneumonia.

To prevent pneumonia, we will ask you to cough frequently. We will also teach you how to take deep breaths to open small air sacs in your lungs. Nurses and respiratory therapists will help you.

Bowling helps keep Floyd Ashworth of Bassett active during the winter months.

Cardiac Surgery Progressive Care Unit (CSPCU) Coughing and deep breathing will hurt, but they will help you get well much quicker. Keep in mind that you may need to take your pain medicine before or after these exercises. Sit up tall in your bed or chair and follow these two easy steps: 1. Every three to four hours take five deep breaths. Place your hands on your lower rib cage and feel the chest expand with each breath. Use your plastic breathing machine (incentive spirometer) as a gauge of how deeply you are breathing.

Slowly, take in as much air as possible and slowly blow out as much air as possible.

2. After deep breathing, place a pillow or your cough bear tightly over your chest incision and cough. Coughing is very good for your lungs, even if you don’t cough up any mucus.

After you go home, you should still do these coughing and deep-breathing exercises several times daily to improve your breathing.

Leg Exercises While you are in bed, we want to make sure that your leg muscles remain strong and that blood flows freely. To help with this, follow these steps: 1. Push your feet against the foot of the bed 2. Point your toes toward your head 3. Move your feet around in a circular motion Do these exercises several times a day when in bed. Once you are up walking, these exercises will no longer be necessary. Support stockings are suggested for your recovery in the hospital and at home especially if you have incisions on your legs. These stockings improve your blood flow and lessen fluid build-up.

Relaxing in the garden, Linda Angelelli of Bluefied, WV, “takes time to smell the roses.”

Paul Dye of Salem, and his daughter Addison, run errands while spending the day together.

Cardiac Surgery Progressive Care Unit (CSPCU) Patient and Family Progress Guide You and your caregiver should take time to study the patient and family progress guide that follows. This guide will give you an idea of what to expect each day. Remember, though, each patient is unique and you may have a dierent rate of recovery.

DATE

TEACHING

DIET

ACTIVITY

Day of surgery

-CSICU environment -Monitors -How to call CSICU -Visiting -Condition reports

I.V. uids

Bedrest, turn in bed with help; sit on side of bed after tubes are removed

Post-operative Day 1

-CSPCU -Pain management -Visiting -Monitors -Coughing, deep breathing

Liquids, moving to solids; sugar-free for diabetics

Leg exercises while in bed or chair; up to chair at least twice; walk in hall

Post-operative Day 2

-Coughing, deep breathing -Personal hygiene -Incision care -Support stockings -Increasing activity

Heart healthy and/or diabetic with supplements

Up to chair 2-3 times; walking in the hall with help at least 2-3 times; do part of own bath. May shower 24 hours after all tubes are gone.

Post-operative Day 3

-Coughing, deep breathing -Personal hygiene -Incision care -Support stockings -Pain management -Home care

Heart healthy and/or diabetic with supplements

Walk in the hall at least 3 times; be out of bed as much as possible; may shower 24 hours after all tubes are gone.

Post-operative Day 4 and thereafter

-Getting ready to leave the hospital -Medication review -Appointments

Heart healthy and/or diabetic with supplements

UP!!

Getting Ready for Discharge Keep in mind that recovering from heart surgery, like any major surgery, takes a lot of strength and energy. You may find yourself tiring easily, but your strength will improve slowly and steadily over the coming months. Soon you will start to feel the benefits of your surgery.

Recovery from heart surgery takes about four to six weeks on the average. Gradually, you will start doing more of your usual activities and will feel stronger every day. Be patient with yourself, and allow enough time to heal. Do not try to do too much too soon.

Before you leave our hospital, we will talk with you about your care at home and any special needs you may have.

Make sure you know the answers to the following questions before you leave us.

Will I need help at home after discharge?

Even though you will be on the road to recovery when you leave us, you will still need help and supervision for a time. You MAY NOT go home alone after surgery. There are no exceptions to this rule. We require that you have someone at home with you 24 hours a day for the first week after going home. The following week, you will still need someone with you at night, and you may also need to have someone stay with you during the day. Patients who lived alone before surgery often decide to stay with friends or relatives after discharge. You may prefer Albert Renaud of Meadows of Dan that friends or family stay in YOUR home with you takes a break after a day of activities. instead. If you have no friends or family to care for you after surgery, you may need to go to a nursing home or rehab center for a short time before returning to your home. If you need help with these arrangements, simply ask your nurse to contact our social worker for you. She will be happy to work with you.

Can I go home from the hospital in a car?

Yes, you can. If your drive home is longer than an hour, stop at least once each hour to walk around and stretch your legs. Remember to wear your seat belt.

What kind of care do my incisions need?

You may shower while you are in the hospital (24 hours after all tubes are removed). Use a mild soap without perfumes or deodorants. You may use a lotion containing lanolin if itching or dry skin is a problem. Never use powder or talc around wounds.

If you had stitches or staples that were removed before you left the hospital, paper strips called steri-strips may have been placed across an incision. These strips support the incision during the final phases of healing. They will usually fall off within a few days after going home. If any remain after one week, soak these areas to remove the strips.

Getting Ready for Discharge At home you should follow the instructions given to you for cleaning your incisions while you were in the hospital. Immediately report any drainage of fluid from your chest incision to your doctor. Also, if an area of any incision becomes red, swollen, warm or begins to drain cloudy fluid, this may be a sign of infection. Don't treat this yourself – contact your heart surgeon’s office RIGHT AWAY for instructions.

Are there any special instructions about my leg and/or arm incisions?

Working around the house continues to be a favorite pastime for John Hagy of Princeton, WV.

If you have had coronary artery bypass surgery, you may have incisions on your arms or legs. Use the same routine in cleaning these incisions as for your chest incision. You may notice some swelling and soreness for a while. The skin may be numb on either side of the incision. At times, small parts of the incision may be slow to heal; this is not a serious problem. If you have a leg incision, you may see some swelling of the ankle on the leg(s) with the incision(s). When sitting, elevate the leg(s) so that the swelling will not worsen. While you have your legs up, move them from time to time. Also, don’t cross your legs or ankles. If you have an arm incision, continue to use the hand and arm and exercise it daily. Use the squeeze-y heart that you were given while you were here. Another good exercise is opening and closing the hand and moving the fingers as if you are playing the piano.

What about the support stockings?

You should wear your support stockings for one month after you go home, or until you return to see your surgeon. You do not, however, need to wear these stockings at night.

They provide support to affected legs and help prevent blood clots and swelling. Try to get all the wrinkles out of the stockings as you are putting them on. These stockings are supposed to be tight, and you may need help putting them on.

What tasks can I do at home?

You may perform light tasks. If you try to do something that tires you, stop and rest.

Remember, however, that it’s good to stay active. Light exercise helps you recover.

What are my lifting limits?

If you have a mid-chest incision, you will need to wait two to three months for the breastbone (sternum) to completely heal. For the first month at home, do not lift anything heavier than 10 pounds. Do not attempt to pull any heavy objects, including yourself!

Don’t pull yourself over in bed, and don’t pull yourself out of bed or a chair. Sit in a seat with arms so that you can push yourself up. Remember to use your legs to help you reach a standing position. Your surgeon will discuss lifting limits with you when you see him in about a month. Until then, avoid any strenuous activity such as shoveling snow, heavy raking, mowing grass or heavy cleaning. If you are interested in sports, ask your doctor about this.

Getting Ready for Discharge For patients with a side chest incision, also limit lifting to 10 pounds until you have seen your surgeon for a postoperative visit. Generally, these patients have no lifting restrictions after the first four weeks after surgery.

Taking a break, Emma Fulton of Galax rests in the shade on her back porch.

What about stairs?

You may walk up and down stairs when you get home. You will need to take them more slowly than before, and remember to stop and rest if you get tired.

What are my guidelines for walking?

Walking is a great way to exercise after surgery. You should go for short walks daily, provided the weather is neither too hot, cold or windy. If the temperature is below 32 or above 80 degrees Fahrenheit, you should walk in an enclosed area such as a shopping mall, indoor track or large store. Here are some guidelines for walking: First week at home: Second week at home: Third week at home: Fourth week at home: Fifth week at home: Sixth week at home:

10 minutes, three times a day 10-15 minutes, three times a day 15-20 minutes, two times a day 20-25 minutes, two times a day 25-30 minutes, two times a day 30-40 minutes, once a day

Be sure to reduce the times above if extreme fatigue occurs. If you have chest pain, dizziness or shortness of breath at any time during your walk, stop and rest for several minutes. When the discomfort goes away, continue what you were doing at a slower rate. If the pain continues, take your nitroglycerin and call 911.

Is there anything I can do to help "loosen up" stiff muscles?

Yes. The following exercises will help ease the tightness and stiffness in your chest, arms and shoulders after surgery. Each exercise should be performed several times daily.

1. Raise your arms as high as you can over your head and then lower them.

2. Spread your arms apart, bring them together and lower them.

3. Shrug your shoulders and then relax them.

Is posture important?

You bet it is. Please try not to round your shoulders or slump. Whenever you sit, stand or walk, keep your shoulders, back and spine erect – and don’t be afraid to move!

How often should I do my breathing exercises?

You should use your incentive spirometer every hour while you are awake. These exercises should be a part of your daily routine for the first month at home. They will help you clear your lungs and make breathing deeply much easier.

Getting Ready for Discharge When can I drive?

If you have a mid-chest incision, you should not drive a car for four weeks. If you have a side chest incision, you may drive a car in two weeks. Please do not drive if the weather is bad or if you do not feel up to it. Use common sense! After two to three months, most patients are able to take long-distance road trips or ride in a plane. ALWAYS wear your seat belt! Place a small pillow over your chest incision if the shoulder harness bothers you.

How do I handle incision or surgery pain?

You will have some chest wall pain related to the separation of your breastbone or your ribs during surgery. Many patients have pain between the shoulder blades and in the side and back, too. You may have muscle spasms in the areas around the incision. These are normal. You will notice that all of these pains are different from the heart pain that you may have experienced before your heart surgery. Chest wall pain (not heart pain) may occur when you overdo, cough, sneeze or move suddenly. This pain is best relieved by changing to a more comfortable position, using a heating pad on a low setting or by taking your pain medicine. Taking the medicine will help you move about, cough and sleep better. Many patients tell us that taking this medicine before going to bed at night allows them to get to sleep, and they are able to rest better as a result. Some patients complain of the incisions being very sensitive and not being able to allow even clothing to touch them. Call your doctor if this occurs.

What if my pain “breaks through” before it is time to take more pain medicine?

Feel free to call your doctor about this. It is sometimes necessary to change your pain medication or its frequency. We want to make sure that you are taking the best medication for relieving your soreness.

What should I do if I have angina (heart) pain after I go home?

It is uncommon to have angina or heart pain after sur- While strolling through a local park, gery, but it CAN happen. If it occurs, take your nitroRonald Dingler of Roanoke looks at glycerin as you did before surgery. If you do not have an antique tiller. nitroglycerin at home, ask us about this before discharge.

Take the nitroglycerin as prescribed, and if the pain does not go away, call 911. Even if the pain IS relieved with nitroglycerin, you should still call your cardiologist or family doctor to let him or her know about the pain.

Do I need to watch my weight?

Definitely! It is best to be at the recommended weight for your height. Weigh yourself every morning after going to the bathroom. If you gain two pounds or more each of or two consecutive days, or four or more pounds in one week, you should contact your family doctor. This weight gain may be a sign of fluid buildup and may require medicine to correct it.

Getting Ready for Discharge Are there any other signs that I might be retaining fluid?

Yes. It is very important that you know when you might be retaining fluid. Get in touch with your heart surgeon if any of these signs appear: ✽ Sudden weight gain (two lbs. or more on each consecutive day or four pounds or more in one week) ✽ Shortness of breath not related to exercise or exertion ✽ Swelling in the legs or ankles when you wake up ✽ Swelling or pain in the abdomen ✽ Trouble sleeping (waking up short of breath, using more pillows) ✽ Frequent dry, hacking cough ✽ Increased fatigue How much sleep do I need?

You should try to get a good night’s sleep every night. Sleeping medicine may be used if you need it. Try not to sleep much during the day so that you can sleep better at night.

Do I need to follow a special diet?

Nutrition is a very important part of your recovery from open-heart surgery. Please refer to the “Foods That Heal” tab of this book to read about keeping your heart healthy with good eating.

Kenichi Ujie enjoys an afternoon When should I call my heart surgeon’s office? jog near his home in Lexington. ✽ Any drainage from your chest incision ✽ Warmth, heat, redness or cloudy drainage from any incision ✽ Fever of 102 degrees or higher ✽Surgery pain unrelieved by pain medication ✽Weight gain of more than two pounds from one day to the next on two consecutive days, or four pounds or more in one week ✽Swelling of the legs or ankles when you wake in the morning ✽ If you need to change an appointment ✽ An unexpected reaction to medicine ✽ Unexpected or worsening nausea, vomiting or diarrhea ✽ Any other questions or concerns you might have regarding your surgery How do I reach a heart surgeon?

For NON-urgent questions or concerns, wait until daytime hours (8:30 a.m. – 5 p.m.) on any weekday and call the surgeon’s office at 540-853-0100.

If your need is urgent OR it occurs on a weekend or holiday, call the Carilion Roanoke Memorial Hospital operator at 540-981-7000 and ask that the heart surgeon’s nurse practitioner or physician’s assistant on-call be paged for you. He or she will return your call.

What if I have an emergency?

For emergencies (ESPECIALLY EXTREME OR SEVERE SHORTNESS OF BREATH), call 911.

Getting Ready for Discharge When is it okay to resume my recreational and social activities?

Resume these activities slowly at first. Remember to listen to your body and slow down when you start to feel tired. After you get home, it’s also a good idea to wait two to three weeks before accepting many visitors so you will be rested and can enjoy the visits.

Will it ever be okay for me to smoke?

The answer is no. This is absolutely necessary now, and if you smoked before surgery, you should never return to smoking. Smoking is one of the major risk factors for developing heart disease.

We want you to receive the maximum benefit from your heart surgery, so please do not smoke. Contact your family doctor if you are having difficulty quitting. Support group help and medication are available to assist you with this effort. The SMOKELESS™ program offered at Carilion Clinic is an excellent program to help you stop this habit. Call 800-422-8482 for further information.

William Willis of Bluefield, WV, enjoys time at his family reunion.

Can I drink after surgery?

If you didn’t drink alcohol before surgery, don’t start now. If you do drink alcohol, try not to drink too much. One beer (12 fluid ounces), a glass of wine (4 to 5 fluid ounces) or 1 to 11⁄2 fluid ounces of liquor per day should be your limit.

When can I have sexual intercourse?

You may resume sexual relations when you feel that you are ready. Female patients should ask their doctors about pregnancy and birth control especially if they are taking newly prescribed medicines.

Will my menstrual periods change after surgery?

Female patients still having menstrual periods may have a menstrual period while in the hospital. You also may notice some delay in starting your next period. Both of these are expected effects of major surgery and are not serious.

I just had coronary bypass surgery. Can I still have a heart attack?

Yes. Coronary artery bypass surgery is not a cure for coronary artery disease. You can still develop blockages in arteries that were not bypassed and in the bypasses themselves.

You should always know the heart attack warning signs described by the American Heart Association and not wait to seek help right away. Remember, those signs are: ✽ Chest discomfort or pain that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain. ✽ Discomfort in other areas of the body. You might have pain or discomfort in one or both arms, your back, neck, jaw, or stomach. ✽ Shortness of breath. This can occur with or without chest discomfort. ✽ Breaking out in a cold sweat ✽ Nausea ✽ Lightheadedness

Getting Ready for Discharge If you have ANY of these signs and you don’t have nitroglycerin to take, call 911. If you do have nitroglycerin, take it as prescribed and call 911 if the pain isn’t relieved. Remember to contact your cardiologist even if the pain WAS relieved by nitroglycerin.

Why should I call 911 for any of these signs?

Calling 911 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they arrive – up to one hour sooner than if someone gets to the hospital by car. EMS staff is also trained to revive someone whose heart has stopped. It is best to call EMS for rapid transport to the emergency department.

When should I go to see my family doctor?

After you leave the hospital, we will be in touch with your family doctor. He or she will know about your surgery and the medicines that you are taking. Make sure you have an appointment with your doctor within one to two weeks of returning home. Please remember to take a list of your medicines or your medicine bottles with you to all doctor's appointments.

How common is depression after heart surgery?

Feeling depressed or “blue” is very common after any major surgery. After returning home, you will have good days and bad days. Please don’t be alarmed if at times you feel tearful or sad. These mood swings are common and will resolve in time. Contact your family doctor if you are having trouble managing depression.

"It's not as painful as family and friends might tell you.

Listen to your doctors and nurses, and read the book."

– Gene and Tracy Brady

Getting Ready for Discharge After discharge, when will I see my heart surgeon?

You will be given an appointment at discharge to return to see your heart surgeon about one month from the time that you leave the hospital. It is important that you bring your caregiver with you, and please bring along a list of your medicines or the medicine bottles. A map to the surgeon’s office is included in the back of this book. Do not hesitate to call the office if you need to change the appointment you were given or if you need directions to the office.

Should I listen to the advice of well-meaning friends and relatives?

Please follow only the instructions given to you by the doctors and nurses who cared for you here and know your specific needs. For any questions, you should call your doctor’s office.

Do you have any recommendations for coping with stress?

Most importantly, try to avoid things that upset you while you are recovering. Gradually increase your physical activity as your doctors advised and remember to limit your intake of caffeine. Give yourself time to work through stressful and anger-provoking situations.

You will also learn coping strategies for stress while you are participating in a cardiac rehabilitation program. If you need help coping with stress, talk to your doctor.

Where can I learn about CPR classes and training?

Call the American Heart Association at 877-242-4277 (AHA4CPR). An operator will direct you to agencies that conduct CPR training in your area.

"Don't be afraid. They will take good care of you." – Gibo Luck

Home Care Guide After Mid-Chest Incision First Week After Discharge: ✽ Someone needs to stay around the clock with you for this entire week! ✽ Be up and about as much as possible. ✽ Follow the instructions given to you at the hospital for cleaning your incisions. ✽ Remove paper strips from incisions one week after going home if they haven’t already been removed.

Pictured left to right, Doug Lindamood sings with ✽ Take your medicine as prescribed.

Lisa Kegley, Lynn Loftus, and BJ "Bucky" Lawson at Remember to take your pain medicine the First Annual Pulaski County Christmas Store when you need it.

Gala. ✽ Wear your support stockings during the day. You may remove them at night and stop wearing them after two weeks if you have no swelling in your legs. ✽ Eat a low fat diet and try to stay away from salt. If you are diabetic or have had high blood sugars, watch your sugar intake! ✽ Weigh yourself every morning and write it down. If you gain more than two or more pounds on two consecutive days or four or more pounds in a week , call your heart surgeon’s office. ✽ Don’t forget to use your breathing device (spirometer) every one to two hours while you are awake (take about five deep breaths each time). ✽ Cough after deep breathing, but don’t forget to use your cough bear for support! ✽ Walk 10 minutes three times daily. Stay on level ground this week. Walk indoors if it is colder than 32 degrees or hotter than 80 degrees outside. ✽ No lifting over 10 pounds! ✽ Leave the driving to someone else. ✽ If any incision becomes red, begins to drain or look infected, please call your surgeon’s office right away.

Home Care Guide After Mid-Chest Incision Second Week After Discharge: ✽ Someone should spend nights with you this week at least. ✽ Continue cleaning incisions as you did last week. When the crusts are gone, you may apply a lanolin-containing lotion or vitamin E twice daily. ✽ Continue to wear your support stockings during the day.

If they irritate your ankles, knees or incisions, leave them off. ✽ Don’t forget your breathing and coughing exercises!

Playing the piano keeps Elizabeth Jones, of Duhring, WV, entertained nearly everyday of the year.

✽ Walk 10 to15 minutes three times daily. Inclines are okay now. ✽ No lifting more than 10 pounds. ✽ Still no driving! ✽ Observe the same diet as last week (watch that salt!). Continue daily weights. ✽ You’ll probably be seeing your family doctor sometime this week. Don’t forget to take your medicine list or bottles with you. ✽ If you have not received an appointment to see your cardiologist, please call his/her office to make one.

Third Week After Discharge: ✽ You no longer need someone to spend nights with you. ✽ Stop wearing your support stockings. If you notice swelling in your ankles, you should begin wearing them again. ✽ Walk 15 to 20 minutes twice daily. ✽ Continue your present diet! ✽ Still no driving! ✽ Remember, no lifting over 10 pounds. ✽ You will probably be seeing your cardiologist sometime this week (if you haven’t already).

Don’t forget to take your medicine list or bottles with you.

Home Care Guide After Mid-Chest Incision Fourth Week After Discharge: ✽ Walk 20 to 25 minutes twice daily. ✽ You will be seeing your heart surgeon sometime this week. Don’t forget to take your medicine list with you. ✽ Please check in the back of this book for a map to the surgeon’s office with parking information. Remember to ask him: When you can increase your lifting limit When you can return to work If there are any changes to your medicines If you need to return to see him again

"The willingness to give explanations, the exceptional care, and the sincere compassion shown toward me and my family from the Carilion staff helped make my experience of having bypass surgery and spending time in the hospital much more bearable. I cannot thank them enough for taking care of me and getting me back on my feet as quickly as they did. I will always be grateful." – Danny Bowen

Home Care Guide After Side Chest Incision First Week After Discharge: ✽ Someone needs to stay with you 24 hours a day for this entire week. ✽ Be up and about as much as possible. You may lift your arms and do light arm exercises (no weights) twice daily. ✽ Do not lift more than five pounds at a time this week. ✽ Follow the instructions you were given at the hospital for cleaning your incisions. ✽ If you have them, remove the paper strips from incisions one week after going home if they haven’t already been removed. ✽ Take your medicine as prescribed. Remember to take your pain medicine as you need it. ✽ Wear support stockings during the day. ✽ Eat a low-fat diet and try to stay away from salt. If you are diabetic or have had high blood sugars in the hospital, watch your sugar intake!

Leon Burchett of Vinton enjoys an afternoon of car washing and being outdoors.

✽ Weigh yourself every morning and write if down. If you gain more than two pounds from one day to the next for two days in a row or four or more pounds in a week, call your heart surgeon’s office. ✽ Don’t forget to use your breathing device (spirometer) every one to two hours while you are awake (take about five deep breaths). ✽ Cough after deep breathing, but don’t forget to use your cough bear for support! ✽ Walk 10 minutes three times daily. Stay on level ground this week. Walk indoors if it is colder than 32 degrees or hotter than 80 degrees outside. ✽ Leave the driving to someone else!

Home Care Guide After Side Chest Incision Second Week After Discharge: ✽ You no longer need someone to stay with you. ✽ Don’t lift anything over 10 pounds this week. ✽ Continue cleaning your incisions as you did last week. ✽ Continue to wear your support stockings during the day. ✽ Don’t forget your breathing and coughing exercises!

Martinsville resident Alvin Wood poses for a picture while relaxing at home.

✽ Walk 10 to15 minutes three times daily. Inclines are okay now. ✽ No driving. ✽ Observe the same diet as last week (watch that salt!). Continue daily weights. ✽ You’ll probably be seeing your family doctor and cardiac surgeon sometime this week.

Don’t forget to take your medicine schedule with you to the office visit.

Third Week After Discharge: ✽ You can lift up to 20 pounds this week. Next week, you can lift anything you like! ✽ Walk 20 to 25 minutes twice daily. ✽ Stop wearing your white hospital stockings. If you notice swelling in your ankles when you on your feet for longer periods, you should begin wearing them again. ✽ Continue your present diet. ✽ You may drive! ✽ You will probably be seeing your cardiologist sometime this week or next week (if you haven’t already). Remember to ask him/her: When you can return to work If/when you need to see him again If there are changes in your medicines

Foods That Heal Nutrition is a very important part of your recovery from surgery. You need extra calories and protein for proper healing. They are also needed to give you energy to perform your daily activities. This chapter includes lots of great information for making healthy food choices – not only to help you heal in the next few months, but changes you can make to help make your heart healthier!

Over the next month, the main focus should be on getting enough calories and protein to help your body heal. If you are diabetic or have had high blood sugar while in the hospital, you need to limit your intake of concentrated sweets (foods with sugar). It is also important to avoid salt (to help prevent fluid retention) and caffeine (to help prevent heart rhythm problems). After surgery, your appetite may not be the same, but it’s important to continue eating so you can soon go back to your normal activities.

After one month, you need to follow a heart-healthy diet to help prevent future heart problems. It can also help lower your blood pressure and control your diabetes!

A heart healthy diet is: ✽ ✽ ✽ ✽

Low in sodium (less than 2,000 m.g. per day) Low in cholesterol (less than 300 m.g. per day) Low in saturated fat (less than 7 percent of calories per day) Full of fruits and vegetables (three fruits and three vegetables per day)

It is very common to have a poor appetite for several weeks after surgery. Protein however, helps to heal wounds. You should try to include a protein food at each meal or snack.

Protein sources: Meat

Poultry

Fish

Eggs

Milk products

Cheese

Yogurt

Nuts

Pudding

Dried beans

Peanut butter

It is also common to experience loss of appetite, nausea, vomiting and changes in your sense of taste/smell. Here are some suggestions to help with these side effects.

Loss of Appetite ✽ Try to eat several smaller meals throughout the day instead of three larger meals. ✽ Eat frequently during the day, including a snack before you go to bed. Have snacks available at all times. Taking just a few bites or sips of liquid every hour or so can help you get more calories and protein. ✽ Eat small amounts of food often and slowly. ✽ Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling. ✽ Sip liquids throughout the day, except at meal times. ✽ Eat foods at room temperature or cooler. Hot foods may add to the nausea.

Foods That Heal ✽ Avoid eating in an area which has strong cooking odors or smells that might disagree with you. ✽ Avoid foods that are spicy, fatty, greasy, very sweet, or have strong odors.

Try the following foods: -Dry toast -Crackers -Oatmeal -Skinned chicken, baked or broiled (not fried) -Fruit and vegetables that are soft and bland -Pretzels -Sherbet/sorbet

Vomiting ✽ Do not attempt to eat or drink until you have the vomiting under control. ✽ Once you have the vomiting under control, try small amounts of clear liquids, such as fruit juice, chicken broth and Jell-O. ✽ When you are able to keep down clear liquids, try some full liquids, such as milk, cream soups and ice cream. ✽ When you are ready for solid foods, try some bland foods such as dry toast, crackers, and canned peaches. ✽ Slowly work up to your regular diet.

Altered Sense of Taste ✽ ✽ ✽ ✽ ✽

Choose and prepare foods that look and smell good to you.

Try using flavorful seasonings such as basil, oregano and rosemary.

Try tart foods such as citrus fruits or lemonade that may have more taste.

Serve food at room temperature.

Help the flavor of meat, chicken or fish by marinating it in sweet fruit juices, wine, or Italian dressing.

3Hester Wade of Martinsville enjoys going to church and spending time with family and friends.

4Smoke from burgers, chicken, and kabobs fill the air as Bob Bandy of Roanoke works the grill.

Foods That Heal Homemade Milkshakes If you are not eating well you may need to add a high calorie, high protein shake into your meal plan. You can buy an already prepared nutritional drink (such as Ensure or Boost) or you can make your own. Below are some sample recipes. Try to drink at least two to three eight-ounce shakes each day if you are unable to eat solid food. If you have diabetes or are watching your blood sugar, use Carnation Instant Breakfast, no added sugar and sugar-free ice cream.

Here are some recipes to try. For each recipe, place all ingredients in a blender. Cover and process on high speed until well blended. Each recipe makes one serving.

Shake

Instant Breakfast Flavor

Milk

Ice Cream

Fruit

Add In

Carnation Instant Breakfast Shake

Any

1 cup

1 2

High Protein

Any

1 cup

1 2

Chocolate

Chocolate

1 cup

Strawberry Yogurt

Strawberry

1 cup

Peach Melba

Vanilla

1 cup

1 tsp raspberry preserves

Mocha-Banana

Vanilla

1 cup

1 small ripe banana

⁄ tsp instant coffee

Orange Juice (OJ) and Cinnamon

Vanilla

1 cup

3 tbsp frozen OJ concentrate

1/8 tsp ground cinnamon

Peanut Butter Protein

Vanilla

1 cup

Add In

⁄ cup

1 4

⁄ cup

⁄ cup egg substitute

11⁄2 cup 1 2

⁄ cup strawberry yogurt

2 tsp wheat germ

6 ice cubes

1 2

⁄ cup peach yogurt

1 2

2 tsp peanut butter

6 ice cubes

1 4

⁄ cup egg substitute

If you continue to have difficulty eating or have any other nutritional concerns, please call the hospital at 540-981-7000 and ask the operator to page a registered dietitian.

Foods That Heal Thirty days (about one month) after surgery you will need to start making lifestyle changes.

Making lifestyle changes can be difficult, so it’s best to start out small and make gradual changes toward improving your lifestyle.

Setting goals can give you something to work toward. It takes about 30 days to make a behavior change, so there is no need to change everything all at once – start slow and keeping working to make these lifestyle changes stick!

Start with something small - a goal you know you can achieve. Get a buddy – your spouse, child(ren), friend, relative - to help you make a change. Write down your goal and keep it somewhere you’ll see each day. Once you achieve one goal, move on to your next goal until each habit becomes a part of your lifestyle.

Small changes can add up to big results! Try one of these small changes every week and watch your body change. ✽ Take away the salt shaker from the table. Instead, season your food with herbs and spices. ✽ Carry a water bottle with you every day and make sure you get in 6 to 8 cups (4864 oz.) each day. Ask your doctor how much fluid you should have in a day if you have heart or kidney failure. ✽ If you need to lose weight, cut 100 calories from your typical diet every day and you’ll lose one pound in just over a month. Some easy ways to do this – skip the mayo or cheese on a sandwich, eliminate a can of soda, or switch to diet. ✽ What is another way to lose the weight? Walk an extra 20 minutes each day – just 10 minutes in the morning and 10 in the evening and you can drop a pound each month. ✽ Still craving dessert after dinner? Try a piece of fruit (apple, orange, berries) instead of a sweet. ✽ Do a milk swap. If you’re used to whole, try 2%. Or, for even less calories, try 1% or skim milk. Remember to be patient and give yourself time to get used to this change! ✽ Read labels in the grocery store – pick no-salt added canned goods and sugar-free products.

Write down three changes that you feel you could successfully achieve.

Example: Reduce the portion size of meats to 3 ounces. Bake chicken instead of frying.

1.__________________________________________________________________________ 2.__________________________________________________________________________ 3.__________________________________________________________________________ When these goals are reached you need to develop new ones. Ideally you should expect to be following a heart healthy lifestyle in three to six months.

Foods That Heal

A Guide to Choosing Heart-Healthy Foods FOOD GROUP Meats, Poultry, Fish, Eggs, Shellfish * No more than 6 ounces per day A 3 ounce portion = -A piece of meat the size of a deck of cards.

-1⁄2 chicken breast -a chicken leg with thigh (without skin) -3⁄4 cup of flaked fish -Two thin slices of roast beef (3”x3”x 1⁄4”)

FOOD GROUP Fruits and Vegetables * At least two fruits and three vegetables per day

RECOMMENDED * Preferred cooking methods: bake, broil, grill, roast, boil, microwave, pan-fry with cooking spray * Skinless white meat poultry * Fish and shellfish * Beef: round, sirloin, chuck, loin * Pork: tenderloin, leg, shoulder * Limit pork and beef to three servings per week * Low fat deli meats: turkey breast, chicken breast, lean roast beef, (small portions). * Egg substitutes or whites * Dried beans/ soy foods * Tuna, chicken, and salmon canned in water. * Venison

RECOMMENDED * Vegetables: fresh, frozen, canned in "No Added Salt" * Fruit: fresh, canned in its own juice * Choose raw, fresh fruits and vegetables for more fiber

USE SPARINGLY * Deep fat frying * Regular processed luncheon meats: bologna, salami, etc. * Organ meats * Frankfurters * Bacon * Poultry with skin * Sausage * Beef: regular ground beef, corned beef, short ribs * Pork: spareribs, blade * No more than three servings of beef or pork per week * Canned meats * Tuna canned in oil * Processed meats * No more than three egg yolks per week.

USE SPARINGLY * Vegetables prepared with creams, sauces, fatback, butter, or in brine * Fried vegetables * Coconut * Fruit canned in heavy syrup

Foods That Heal FOOD GROUP Starches, Breads, Rice, Cereals, Pasta, Legumes * At least six servings per day At least half of the servings should be made from whole grains – look for whole wheat or whole grain as the first or second ingredient.

FOOD GROUP

RECOMMENDED * Regular breads: white, whole wheat, rye, pumpernickel, etc. * English muffins, pita bread, bagels, rolls, buns * Cereals: oatmeal, grits, cream of wheat, most dry cereals * Plain white, brown, and wild rice * Plain pasta and noodles * Pancakes, waffles, French toast, muffins and corn bread made with oil, skim milk and egg whites * Low fat, low sodium crackers * Dried peas, beans, and lentils

RECOMMENDED

Dairy Products * At least two servings per day

* Skim, or 1% milk * Non-fat yogurt * Non-fat or low fat cheese (no more than three grams fat per slice) * Non-fat cream cheese and sour cream

USE SPARINGLY * Quick breads * Canned breads * Pastries, croissants, sweet rolls, doughnuts * Dry cereals made with saturated fat: granola, Cracklin Oat Bran, etc. * Rice, pasta, and legumes prepared with cream sauces, butter, or oils * Fried rice * Crackers made with saturated fat and salt * Biscuits * Hard taco shells

USE SPARINGLY * Whole and 2% milk * Regular yogurt * Cream, half and half, and powdered creamers * Whipped toppings * Regular cheese * Regular cream cheese and sour cream

Foods That Heal FOOD GROUP Desserts and Snacks If you have diabetes, be aware of the high carbohydrate content of these foods.

RECOMMENDED * Non-fat ice cream, frozen yogurt and frozen desserts * Sherbet * Non-fat pudding * Gelatin * Jams, jellies, and honey * Pure sugar candy: gum drops, gummy candy, jelly beans, hard candy, etc. * Non-fat or low fat cakes and cookies * Low-fat popcorn, low-fat pretzels, low-fat potato chips, low-fat tortilla chips

USE SPARINGLY * Regular ice cream and frozen desserts * Regular cakes, pies, and cookies * Regular fried snacks: potato chips, corn chips, etc. * Candy bars, chocolate, and coconut * Regular cheese and chip dips

Miscellaneous FOOD GROUP Others

RECOMMENDED

USE SPARINGLY

* Herbs and spices

* Salt

* Herb-spice blends: Mrs. Dash, McCormick Salt Free Blends, etc. * Low sodium seasonings: low sodium soy sauce, low sodium steak sauce, etc. * Low fat, low sodium frozen entrees: Healthy Choice or Lean Cuisine dinners * Low sodium canned soups: Healthy Request * Very low sodium bouillon cubes

* Lite salt * Highly salted seasonings: soy sauce, garlic salt, etc. * Regular frozen entrees * Regular canned soups * Regular bouillon cubes

Foods That Heal Good Fats are Mono or Polyunsaturated

Bad Fats are Saturated or Trans Fats

Monounsaturated

Saturated fats

Trans fats (partially hydrogenated oils)

Polyunsaturated

(omega 3’s and omega 6’s) Olive, canola and soybean oil

Oily fish – Salmon, trout, herring, tuna

Full fat dairy, vegetable oil, cheese

Baked goods - cookies, breads, cakes, desserts

Peanut butter

Walnuts, sunflower seeds, almonds

Beef, sausage, bacon

Fried foods

Food

Instead of...

Use this...

On bread

Butter or hard margarine

Soft nonhydrogenated margarine

On a sandwich

Regular mayonnaise

Light mayonnaise, such as Miracle Whip Light

On your salad

Regular salad dressing

Salad spritzers, or light or fat free dressing

To prevent food from sticking

Butter, lard

Cooking spray - try regular, butter canola, or olive oil flavors

Baking oil

Vegetable oil

Canola oil

Cooking oil

Palm, palm kernel, coconut oil

Olive, peanut, safflower, sunflower or corn oil

Foods That Heal FOOD GROUP Fats * Use sparingly

RECOMMENDED * Fat-free spreads and sprays * Soft tub or liquid margarine * Liquid oils: canola, corn, olive, soybean, sesame, safflower, sunflower, cottonseed * Non-fat salad dressings * Non-fat mayonnaise * Non-fat gravies * Natural or regular peanut butter * Avocado

USE SPARINGLY * Animal fats: salt pork, gravies, fatback and lard * Partially hydrogenated oils and shortening * Coconut, palm and palm kernel oils * Regular salad dressings * Regular mayonnaise

There are good fats and bad fats. Bad fats can clog your arteries and increase your cholesterol. Good fats are important for the body and can help improve your cholesterol. Try these simple switches below: You can reduce saturated and trans fat by:

SWAP

FOR

Butter, lard, shortening and hard stick margarine

Soft, nonhydrogenated margarine

Vegetable, coconut, palm oil

Olive, canola, sunflower and soybean oil

Saturated fats can increase total cholesterol and LDL cholesterol (the bad kind). You should have no more than 7 to 10 percent of fat in your diet from saturated fat.

Trans fats can increase total cholesterol and LDL cholesterol AND lower HDL cholesterol (the good kind). You should try to eliminate trans fat from your diet.

Monounsaturated fats may help control your blood sugar and can decrease total cholesterol and LDL cholesterol and raise HDL cholesterol.

Polyunsaturated fats are important since they are necessary for the body, but cannot be made by the body. They can also lower total cholesterol and LDL cholesterol.

Foods That Heal Cholesterol Cholesterol is another thing which affects your heart. Your body makes most of its cholesterol, but you also get cholesterol from food. There are two kinds of cholesterol, LDL (bad) and HDL (good). High levels of LDL cholesterol can increase your risk for a heart attack or stroke. LDL cholesterol can increase by eating foods with saturated and trans fats.

There are three things which affect your cholesterol: ✽ Diet – saturated and trans fats can increase your LDL and total cholesterol levels.

Eating foods high in cholesterol can also increase your cholesterol. You should limit your total cholesterol to less than 300 mg per day. If you eat less fat, you will automatically eat less cholesterol. ✽ Weight – being overweight tends to increase your cholesterol. ✽ Physical activity – regular physical activity can help lower the bad cholesterol and raise the good (HDL) cholesterol.

Fiber Why do you need fiber?

Fiber is found in many fruits, vegetables, whole grains and legumes (beans and peas).

Fiber can help lower your cholesterol, blood pressure and prevent heart disease! High fiber foods tend to be low in calories and are very filling. For many people, this can help you lose weight! Men need 30 to 38 grams a day; women need 21 to 25 grams a day. Fiber is like exercise for your intestines and helps keep you regular.

How can you get more fiber?

Eat several servings of fruits, including berries and citrus fruits throughout the day. Make sure to include more vegetables in your diet, especially dark green leafy vegetables like mustard greens. Read the food label and choose whole grain/whole wheat breads and cereals which are high in fiber. A very good source of fiber has 5 or more grams per serving.

Increase your fiber intake slowly over several weeks.

Steps to Cooking Right How can you begin to cook healthfully? A healthful eating plan means more than choosing the right foods to eat. It's important to prepare foods in a healthy way. Some ways of cooking are better than others when it comes to cutting cholesterol, fat and calories, while getting as much nutritional value as possible. You don't have to give up taste or the things you love, just learn some heart healthy cooking techniques.

Foods That Heal What are good ways to cook?

Roast - with a rack so the meat or poultry doesn't sit in its own fat drippings. Set the oven at 350 degrees to avoid searing. Baste with fat-free liquids like wine, tomato juice or lemon juice.

Bake - in covered cookware with a little extra liquid.

Braise or stew - with more liquid than baking, on the stove or in the oven. Refrigerate the cooked dish and remove the chilled fat before reheating.

Poach - by immersing chicken or fish in simmering liquid.

Grill or Broil - on a rack so fat drips away from the food.

Sauté - in an open skillet over high heat. Use nonstick vegetable spray, a small amount of broth or wine, or a tiny bit of canola oil rubbed onto the pan with a paper towel.

Stir-fry - in a wok with a tiny bit of vegetable oil.

Microwave - needs no extra fat; in fact, you can drain food of some of the fat by placing it between two paper towels while it cooks.

Steam - in a basket over simmering water.

Heart Healthy Seasoning When seasoning food, be sure to season with less fat. Instead of butter, margarine, oil, fatback or lard try: ✽ Butter Buds or Molly McButter ✽ I Can't Believe It's Not Butter fat-free spray ✽ Non-stick cooking sprays, they come in olive and butter favors ✽ Bouillon cubes (low sodium) ✽ Herb-spice blends. (Mrs. Dash comes in the following blends: Table, Spicy, Garlic, Onion, Lemon-pepper and Original. McCormick has several Salt-Free season blends also.)

Remember, the less fat the better. Before adding fat to your food, think of a low-fat alternative.

How can I cut fat without losing taste? ✽ After browning, put ground meat into a strainer; press the fat out of the meat with a fork while running water over it to remove as much fat as possible. ✽ To make gravy without fat, blend a tablespoon of cornstarch with a cup of roomtemperature broth by shaking them together in a jar. Heat the rest of the broth and add the blended liquid, simmering until thick. ✽ Make scrambled eggs or omelets using only one egg yolk per portion, and a few extra egg whites to the batch. Or use an egg substitute product. ✽ Use water-packed tuna, salmon and white meat chicken. ✽ Don't overcook vegetables. Steam or bake them instead of boiling so they keep more of their natural flavors. ✽ Mix creamy salad dressing with plain low-fat yogurt, or use a low-fat version of salad dressing, mayonnaise, and sour cream. ✽ Use herbs and spices to add flavor to foods.

Foods That Heal Herb or Spice

Popular Use

Allspice

Cakes, cookies, plums, peaches, apples, breads and muffins

Basil

Eggs, pasta, chicken, tomatoes and fish

Bay leaves

Meat stews, soups, game and pot roast

Capers

Fish, salad, tomatoes and eggplant

Caraway

Meat, cabbage, turnips, noodles and breads

Cardamom

Cakes, cookies, breads, apples, rice and fish

Cayenne

“Hot” on any food

Chives

Fish, baked potatoes and salad

Cilantro

Ground meat, stir fried dishes, beans, salad and Mexican food

Cinnamon

Pork, apples, breads, muffins, cakes and cookies

Cumin

Pork, fish, lamb, poultry, dried beans, chili and vegetables

Dill

Fish, shellfish, meat, cucumber, salad, eggs and green beans

Garlic

Salads and dressings, meat, fish and poultry

Ginger

Fish, shellfish, poultry, meat, stir-fried dishes, apples, cakes and cookies

Horseradish

Fish, shellfish and meat

Marjoram

Lamb, poultry, salad and green beans

Mint

Lamb, peas and fruit

Nutmeg

Vegetables

Oregano

Fish, meat, poultry, tomatoes and green beans

Paprika

Fish, pork, potato salad and other cooked salads

Parsley

Fish, meat, poultry, salad and vegetables

Pepper

Fish, shellfish, meat, poultry, salad and vegetables

Rosemary

Beef, lamb, pork, chicken, and vegetables

Savory

Fish, shellfish, ground meat, poultry and lentils

Tarragon

All meats, poultry, tomatoes and salads

Thyme

Clams, fish, meat, poultry, pasta and rice

Turmeric

Fish, shellfish, chicken, pasta and rice

Foods That Heal VEGETABLE

SEASONING

Asparagus

Garlic, lemon juice, onion or vinegar

Corn

Green pepper or pimento

Cucumbers

Chives, dill, garlic or vinegar

Green Beans

Dill, lemon juice, marjoram, nutmeg or pimento

Greens

Onion, pepper or vinegar

Peas

Green pepper, onion or parsley

Rice

Chives, pimento or saffron

Squash

Brown sugar, cinnamon, ginger, nutmeg, onion or cumin

Tomato

Oregano, rosemary, garlic, onion or basil

How can I reduce sodium?

Salt is added into many foods to keep make them last longer and give flavor. Eating more sodium (salt) than the body needs can lead to high blood pressure in some people. People with high blood pressure are more likely to develop heart problems or have a stroke. ✽ Avoid adding salt at the table. ✽ Use herbs and spices instead of salt. ✽ When using canned vegetables, drain the liquid and rinse them in water before cooking. ✽ Watch for hidden salt – bouillon cubes, meat tenderizers, marinades and soy sauce are often loaded with salt. Try low sodium and salt-free versions instead. ✽ Read food labels carefully; choose foods with no more than 300 mg of sodium per serving. ✽ Sodium Free – a product that contains 5 milligrams or less of sodium per serving ✽ Very Low Sodium – a product that contains 35 milligrams or less of sodium per serving ✽ Low Sodium – a product that contains 140 milligrams or less of sodium per serving How can I reduce sugar?

In most recipes the sugar can be reduced by at least half without making much difference.

Bring out the flavor of foods with spices that give the impression of sweetness, like allspice, cardamom, coriander, cinnamon, ginger, mace and nutmeg. Or use vanilla extract to add flavor to muffin, quick bread, cookie and cake recipes.

How can I reduce oils/margarine?

Use liquid vegetable oils that have no more than two grams of saturated fat per tablespoon when cooking requires using fat and brown meat using a nonstick pan with nonstick spray.

When baking, if the recipe calls for 1 cup oil you can substitute 1 cup fruit puree or applesauce instead.

Foods That Heal Recipe Substitutions to Reduce Fat, Saturated Fat, Cholesterol, Refined Carbohydrate and Salt:

INGREDIENT

SUBSTITUTION

Whole milk (1 cup)

1 cup skim milk

Heavy cream or evaporated milk (1 cup)

1 cup evaporated skim milk or 1⁄2 cup low-fat yogurt and 1⁄2 cup plain low-fat cottage cheese

Sour cream

Low-fat cottage cheese plus low-fat or non-fat yogurt Fat-free sour cream is also available

Cream cheese

Light or fat-free cream cheese

Butter (1 tbsp.)

1 Tbsp. polyunsaturated margarine or 3⁄4 tbsp. polyunsaturated oil

Shortening or lard (1 cup)

2 sticks polyunsaturated margarine

Eggs (one)

2 egg whites or 1⁄4 cup egg substitute

Baking chocolate (1 ounce)

3 tbsp. cocoa plus one tbsp. polyunsaturated vegetable oil

Fatback

When cooking green or dried beans add 1 tsp. peanut butter and low sodium bouillon for added flavor

Hard cheese (1 ounce)

1 ounce low-fat cheese

Tuna or salmon packed in oil

Tuna or salmon packed in water.

Gravy

Make with low-sodium bouillon granules or broth and thicken with flour or cornstarch

Mayonnaise

Fat-free or reduced-calorie mayonnaise or plain yogurt plus 1 tbsp. mayonnaise

Regular gelatin

Sugar-free gelatin mix or fruit juice mixed with unflavored gelatin

One can condensed cream soup

Homemade white sauce (1 cup skim milk plus 2 tbsp. flour and 2 tbsp. margarine- add 1⁄4 cup chopped mushrooms or celery if desired)

Syrup-packed canned fruit Fat in baked recipes

Juice-packed canned fruit Use no more than 1 to 2 tbsp. of oil per cup of flour; increase liquid slightly to add extra moistness or for 1⁄3 to 1⁄2 cup oil use an equal amount of applesauce.

Sugar in baked recipes

Reduce amount by up to 1⁄2 of the original amount; use no more than 1⁄4 cup added sweetener (sugar, honey, molasses, etc.) per cup of flour. Add vanilla extract, cinnamon and nutmeg to increase sweetness. Try a sugar substitute.

Bouillon cubes or granules

Low-sodium bouillon

Garlic, onion and celery salt

Garlic, onion and celery powder

Salt in recipes

Reduce amount or eliminate

Canned vegetables with salt

Fresh or frozen vegetables or canned without salt

Foods That Heal How to Avoid the Off-Cigarettes-On-With-the-Pounds Syndrome The American Cancer Society reports that nearly one-fourth of quitters gain an average of 10 pounds and may gain as much as 30 pounds. The gain usually occurs in the first six months off of cigarettes. GOOD NEWS! Weight gain can be prevented: 75 percent of smokers quit without gaining weight.

What causes a quitter to pack away pounds? ✽ Changes in eating habits including an increase in the amount of food consumed ✽ Changes in the types of foods they eat ✽ Changes in the rate at which the body burns calories

Changes in Food Habits It is a fact that when smokers quit they eat more. The more a person smoked, the more weight they may gain upon quitting. Often quitters, especially those who smoked over one pack per day, experience an increase in hunger.

Cravings When smokers first quit, they often replace cigarettes with food. Try the following to help your cravings: ✽ Delay the cigarette, the craving will pass whether you smoke or not ✽ Breathe deeply for relaxation ✽ Drink water, this will help to flush nicotine out of the body ✽ Distract yourself by doing something else until the craving passes

For Out-of-Control Hunger Keep low-calorie foods like popcorn and raw vegetables on hand. The extra fiber can help relieve constipation. Also, see the attached heart healthy snack list to help you in making good choices. Suck or chew on cinnamon sticks or straws. The hand-to-mouth motion of smoking is part of the habit. Keep hands busy. Build something, play cards, write, draw, paint, work a puzzle or play with silly putty... do something!

Boredom and Stress Smokers tend to smoke more during times of stress and boredom. If smokers quit without learning new ways to cope they will eat more. Increasing exercise or starting a hobby may be helpful. It is important to fill time with enjoyable activities.

Sense of Smell and Taste Quitters often notice an improved sense of taste and smell. This in turn may trigger an increased interest in food. If this becomes a problem, keep a food record, drink lots of water and begin exercising.

Foods That Heal Food Triggers The "it's coffee time" or "let's go have a drink" or "in the car" cigarette are powerful associations. All of these trigger cravings, therefore, change your routines. Do not linger at the dinner table, switch to tea instead of coffee and drink non-alcoholic beverages.

Changes in Types of Foods Upon quitting, smokers often crave sugar. Indulge a sweet tooth now and then to keep from feeling deprived, but also try other strategies such as eating a piece of fruit or only a small portion of your favorite dessert. To quit smoking is tough, and a new non-smoker wants to be rewarded. Food is a common reward, but an even better option is a non-food reward such as clothes, music or a book.

Changing Metabolism Nicotine in cigarettes may be responsible for the increased metabolic rates reported in some smokers. The increased rate amounts to about 100 to 200 extra calories burned each day. Aerobic exercise is the best counter-attack for quitters because it prevents the metabolic rate from slowing down. Remember to check with your physician first. Exercise has many payoffs. It helps increase metabolic rate, helps manage stress and forces the exsmoker to start breathing fresh air instead of toxic smoke.

From a quadruple bypass to a halfmarathon, Wayne Driscoll exemplifies the best recovery possible through a commitment to rehab, diet and nutrition, and exercise. After the first race, Wayne also ran another 10k and halfmarathon just weeks later.

Foods That Heal Heart-Healthy Snack Ideas Snacks can be an important part of your heart-healthy meal plan. They can prevent you from becoming overwhelmingly hungry which can lead to inappropriate food choices and/or overeating at meal times. Keep the following snack ideas in mind when hunger strikes. Portion control is essential to maintaining your weight, so remember to check the serving size on the food label. A heart-healthy snack contains less than 3 grams of fat, one gram of saturated fat, and 300 mg of sodium per serving. Here are some examples of hearthealthy snacks to look for next time you are at the grocery store:

Fruits Fresh or canned fruits can be a refreshing snack. They can be eaten alone or several kinds can be mixed together to make a fruit salad. Fresh fruits usually have the best flavor and are less expensive when in season. Try apples, oranges, bananas, grapes, pears, watermelon, cantaloupe, honeydew, strawberries, blueberries, raspberries, peaches, nectarines, plums, mangoes, papayas, star fruit, kiwi – just to mention a few.

Vegetables Fresh vegetables can be cut up into bite-sized pieces and eaten plain or with a low-fat dip or hummus. You can buy fat-free dip (Kroger Sour Cream Dip or Kraft French Onion Dip) or make your own using fat free mayonnaise, yogurt or sour cream as a base and add lowsodium seasonings such as onion, garlic, herbs or spices. Try carrots, celery, cucumbers, broccoli, cauliflower, green peppers, red peppers, yellow peppers, tomatoes, yellow squash and zucchini.

Bagels and English Muffins Blueberry, cinnamon raisin, sourdough, wheat and onion are a few of the many flavors available. For a satisfying snack try topping them with fat-free cream cheese, fruit or fruit spread, low-fat cheese, vegetable slices or salsa. They can also be toasted or grilled using cooking spray and seasoned with herbs or sodium-free spice blends.

Crackers There are many varieties of low-fat and reduced-fat crackers on the market, but be sure to check the fat and sodium content. Some heart-healthy crackers include: ✽ ✽ ✽ ✽ ✽ ✽ ✽ ✽ ✽

Low-fat Wheatables Reduced-fat Toasteds Reduced-fat Ritz Crackers Reduced-fat Triscuits and Wheat Thins Reduced-fat Town House Crackers Snackwells Wheat and French Onion Crackers Melba Toast (onion, whole wheat, bacon, sesame, vegetable, rye and plain) Wasa Crisp Breads Rye Krisps

Foods That Heal Popcorn Air-popped popcorn can be seasoned by using butter flavored cooking spray and lowsodium seasoning such as chili powder, onion powder, garlic powder, Butter Buds, Molly McButter or an herb/spice blend like Mrs. Dash. Reduced-fat microwave popcorn is available, but most brands contain 300 to 400 mg of sodium per serving. Some brands to look for include Healthy Choice, Orville Redenbacher Smart Pop, Pop Secret 94% Fat Free and Cousin Willie’s.

Pretzels Regular pretzels are too high in sodium, so look for unsalted pretzels, like Snyder’s. Soft pretzels (prepared without the salt packet) also make a good snack. They can be found in the freezer section at the grocery store.

Chips ✽ ✽ ✽ ✽

Baked Tostitos (salsa and sour cream or plain) Baked Lays Potato Chips (mesquite BBQ, sour cream and chives, cheddar and sour cream) Baked Ruffles or Baked Doritos Fat-Free Pringles (barbecue, sour cream and onion)

Low-Fat Cheese Healthy Choice makes low-fat cheddar and mozzarella cheese. Alpine Lace makes several reduced-fat cheeses, but they still have 5 to 8 grams of fat per serving, so they should be used sparingly. Try adding small amounts of grated cheese to snacks to add flavor.

Rice and Popcorn Cakes These come in a variety of flavors such as caramel, butter, plain, cheese, apple cinnamon, banana nut and chocolate. They can be eaten plain or with one of the heart-healthy toppings listed above.

Cereal It can be eaten dry as a finger food, or with skim or 1 percent milk. Try mixing dry cereal with raisins or other dried fruit or you can mix several types of cereal together for a more interesting flavor.

Some good “finger cereals” include: ✽ ✽ ✽ ✽ ✽ ✽ ✽

Chex (Wheat, Corn, Rice, and Multigrain) Life (Cinnamon or Regular) Cheerios (Regular, Apple Cinnamon, and Honey Nut) Quaker Oat Squares Frosted Mini Wheats Healthy Choice Multi-Grain Squares Store brands are also available for many of these cereals

Foods That Heal Frozen Desserts Most are high in sugar and calories so use in moderation and remember to follow the serving size. Try fruit juice bars from Welch’s, Dole and Tropicana or Yoplait frozen yogurt bars. A few brands that offer heart-healthy ice cream and frozen yogurt are Healthy Choice, Breyer’s Fat-Free or Double Churn, Kroger low-fat and fat-free, and Edy’s fat-free.

Pudding and Yogurt Fat-free pre-made puddings come in a variety of flavors like French vanilla, tapioca and double chocolate fudge. Cook-and-serve and instant puddings are low in fat if made with skim or low-fat milk, but some have more than 300 mg of sodium per serving so be sure to read the labels. Fat-free or low-fat yogurt is a nutritious snack and can be mixed with fresh fruit, low-fat granola or cereal for a little crunch.

Granola Bars and Fruit Bars Low-fat granola bars and fruit bars from brands like Quaker, Kroger, Snackwells and Health Valley come in a variety of flavors and can be easily eaten on the go.

Low-Fat Cakes, Cookies and Candy These products are high in calories and sugar, so they should be used sparingly. Remember to read the label to be sure that the product is heart-healthy and follow the serving size.

Dan and Betty Farley of Princeton, W.V., enjoy tending to their serenity garden at GlenWood Park Retirement Village, where they are administrators.

Foods That Heal

Simple recipes Spicy Steak Fries Serves 4 Ingredients: 2 large potatoes 2 Tbsp. salt-free spicy seasoning blend 2 Tbsp. olive oil 1 clove garlic, minced Directions: 1. Wash and cut potatoes into wedges, do not peel. Dry potato slices on paper towels.

2. In a large bowl, toss potatoes with spicy seasoning blend, olive oil and garlic.

3. Spray baking sheet with no-stick cooking spray and lay wedges on baking sheet.

4. Place potatoes in preheated 425° F oven and bake for 20 minutes. Turn the potatoes and lightly spray with no-stick cooking spray. Bake another 15 minutes or until wedges are browned and tender.

Nutrition Information per serving: Calories: 200 Total fat: 7 g Saturated fat: 1 g Unsaturated fat: 6 g Sodium: 10 mg *Recipe taken from the American Dietetic Association at www.eatright.org.

10 Minute Marinated Veggie Toss Serves 6; 1/2 cup per serving Ingredients 1 14-ounce can quartered artichoke hearts, rinsed and well drained 1/4 medium red bell pepper, thinly sliced 1/4 cup thinly sliced red onion 1/4 cup packed fresh baby spinach leaves, torn if desired 9 small black olives, halved 2 teaspoons cider vinegar 1 1/2 teaspoons sugar 1 teaspoon olive oil 1 medium garlic clove, minced Directions In a medium bowl, stir together all the ingredients. Let stand for 10 minutes. For peak avors, serve immediately after the standing time.

Tip: For additional nutrients and color, spoon the vegetables onto a bed of spinach leaves.

Foods That Heal Nutrition Information per serving: Calories: 36 Total fat: 1.5 g Saturated fat: 0 g Unsaturated fat: 1.5 g Sodium: 152 mg *Recipe taken from the American Heart Association at www.americanheart.org.

Chicken Spinach Risotto 1 Tbsp olive oil 1 lb. boneless, skinless chicken breasts, cut into bite-sized pieces 4 cups baby spinach leaves, washed and dried 1 cup grape or cherry tomatoes 1 1⁄2 cups instant white rice, uncooked 1 can (10.5 oz) low sodium condensed chicken broth 1 ⁄4 cup water 1 ⁄4 cup Kraft Grated Parmesan Cheese

Four weeks following surgery, Rick Robbins of Lexington returned to his passion of building bamboo fly rods, which he has done for more than 35 years.

Heat oil in large, deep, non-stick skillet on medium heat. Add chicken; cook 10 minutes or until chicken is cooked through, stirring frequently. Add spinach, rice, tomatoes, broth, and water; mix well. Bring to a boil. Reduce heat to low; cover. Simmer 5 minutes, stirring occasionally. Stir in Parmesan cheese. Enjoy!

Additional ideas: Sauté the chicken with any combination of minced garlic, basil, oregano and black pepper.

Add red peppers, mushrooms, onions, broccoli florets or any favorite vegetable.

Use cooked brown rice instead of instant white rice.

Nutritional Information per Serving: Calories: 350 Total fat: 10 g Saturated fat: 3 g Fiber: 2 g Sodium: 254 mg *Recipe taken from Kraft’s website www.kraftfoods.com

Medications

When they’re not riding their bikes, Scott and Beth McDonald help support the Salvation Army’s Christmas store. Scott has helped provide more than 10,000 bikes to children.

Before you leave the hospital, we will explain your current medicines. We will also give you a new schedule of your medicines to take home with you.

You will see that some of the medicines you were taking before your surgery will be continued and others will be stopped. It is very important that you know what medicines you are taking and how to take them correctly. You should follow your doctor’s directions exactly.

If you have trouble remembering to take your medicine, it may help to try to take the medicine at the same time every day. Many people use special pill containers like “day-ofthe-week” boxes to help them take the right medicines on the right day. Family members and those who live with you can also help by reminding you about your medicines.

Reminder notes are also very helpful.

What else should you know about your medicines? ✽ Take your medicine exactly as it was prescribed. ✽ Never stop a prescribed medicine without checking with your doctor. ✽ If you have any questions about your medicine, ask your doctor or pharmacist. ✽ Keep all medicine in original containers. Follow your pharmacist’s instructions for proper medicine storage. ✽ Report all medicine side effects to your doctor. ✽ Ask your doctor or pharmacist before taking any over-the-counter medicine. ✽ Always keep a current list of the names and doses of medicines you are taking.

Take the list or the medicine bottles with you to all doctor’s appointments. ✽ Refill your prescriptions on time. ✽ Keep all medicines out of the reach of children.

Medications Some Information About Aspirin and Coumadin Patients who have had coronary artery bypass surgery will probably take a baby aspirin each day after surgery. Aspirin is a mild blood thinner and will help keep your bypass grafts open. If you are taking this aspirin, you should not take any extra aspirin unless your doctor prescribes it. Some over-the-counter medicines contain aspirin, so be sure to read labels carefully! For pain, fever or other discomfort, take acetaminophen. Be sure to follow label instructions for correct doses.

Some patients will need to take a stronger blood-thinning medicine, called Coumadin.

This drug can be especially important if you have had your heart valve replaced or have an irregular heart rhythm. Coumadin is given to reduce the chance of blood clots. While you are taking this medicine, frequent blood tests will be required to determine the right dose for you. These tests (called a Prothrombin Time and I.N.R.) can be performed at Carilion Roanoke Memorial Hospital, at the Carilion Anticoagulation Clinic, or in your doctor’s oďŹƒce, whichever is easier for you. You will receive written information about Coumadin before leaving the hospital. It is essential that you read and understand this information. Please ask questions as needed.

A Word About Nitroglycerin If you have used Nitroglycerin spray or tablets under your tongue for chest pain (or angina) in the past, continue to carry it with you. If you have this kind of pain, take your Nitroglycerin as you would have before. Also report this pain to your family doctor or cardiologist as soon as possible. If Nitroglycerin does not relieve your pain, call 911!

Taking Your Pulse Knowing how to check your pulse or heart rate can give you and your healthcare provider important information about your heart. It can tell us that your heart is pumping correctly and also how it is responding to medicines or to exercise.

Taking your pulse will tell you how fast or how slow your heart is beating. If you are taking medicines that can affect your pulse, it is important to be able to take your pulse so that we can see if medicines are working correctly. When you begin your cardiac rehabilitation exercise program, you will also be taking your pulse so they can tell if your exercise is right for you. It is a good idea to take your pulse once per day and anytime you have a concern, such as when your heart feels as if it is too fast, too slow or irregular.

Your heart pumps blood through your blood vessels every time that it beats. There are several places where blood vessels are close to the skin’s surface, making it easier to feel the pulse. We like for you to be able to count your pulse or heart rate at your wrist (radial artery) or at your neck (carotid artery). If you had an artery removed from your arm for bypass surgery, use the other wrist or your neck artery. Taking your pulse should be easy for you, and you should take time to do it daily. While you are in the hospital, ask your nurses to make sure that you are taking your pulse correctly. With practice, it becomes easier to do.

As your doctor about the appropriate range for your pulse and when you should notify him or her.

You will need a watch or clock with a second hand in order to be able to count the number of heartbeats that you have in 60 seconds.

How to Take Your Radial Pulse 1. You can take your pulse on either wrist UNLESS you have had an arm artery removed for bypass surgery. In that case, use the other arm or your neck artery to feel your pulse.

2. With your palm up, place the tips of your second and third fingers of your other hand between your wrist bone and the tendon on the thumbside of your wrist. Do not use your thumb.

3. Gently feel the pulse. Apply just enough pressure so you can count each beat.

If you push too hard, you will cut off the blood flow to your hand.

4. Count the number of times your heart beats in one full minute (60 seconds) by using the second hand on your watch.

5. Keep a record of your pulse rate along with the day and time taken and notes about how you felt at the time.

Taking Your Pulse

How to Take Your Carotid Pulse 1. You can take your carotid pulse on either side of your neck.

2. Do not press on the carotid arteries on both sides of your neck at the same time.

This may cause you to become dizzy or faint.

3. Use the tips of your second and third fingers to feel the pulse on one side of your neck in the groove beside your windpipe, just below the corner of your jaw.

4. Apply just enough pressure so you can count each beat. Do not push too hard or you may cut off the blood flow.

5. Use the second hand on your watch to count the number of heart beats in one full minute (60 seconds).

6. Keep a record of your pulse rate along with the day and time taken and notes about how you felt at the time.

A Few Tips on Taking Your Pulse ✽ Ask your doctor about the appropriate range for your pulse, and when you should notify him or her. ✽ Take your pulse at the same time every day and anytime that you feel your heart is beating too fast, too slow, or irregular. ✽ Count your pulse for one full minute. ✽ Keep a record of your pulse rate along with the day and time taken and how you felt at the time. Bring the record with you to every doctor visit.

Emergencies

Emergencies For NON-URGENT questions or concerns: Wait until daytime hours (8:30 a.m. – 5 p.m.) on any weekday and call the surgeon’s office at 540-853-0100.

For URGENT needs or those that occur on a WEEKEND OR HOLIDAY: Call the Carilion Roanoke Memorial Hospital operator at 540-981-7000 and ask that the heart surgeon’s nurse practitioner or physician’s assistant on-call be paged for you, and he or she will return your call.

For EMERGENCIES (especially severe or extreme shortness of breath):

Call 911.

Cardiac Rehabilitation Once you have had some time to heal from your surgery, we recommend that you consider participating in a cardiac rehabilitation program. Carilion Clinic’s cardiac rehabilitation services are designed to help those who have experienced coronary artery disease, angina, heart attack, angioplasty, stent placement, coronary bypass surgery, valve replacement surgery, or congestive heart failure recover faster and resume active and productive lives with minimal limitations.

Cardiac rehab is an out-patient program offered at many hospitals. It includes exercise to help you regain your strength, endurance and confidence. It also involves education to help you and your family make any necessary healthy changes in your diet and lifestyle. A referral from your doctor will be obtained before you start cardiac rehab. Most insurance policies cover at least portions of the program for those who are eligible.

Program Services Cardiac rehab services are divided into three phases: ✽ The initial phase begins in the hospital. A cardiac rehab nurse will visit with you and your family to answer questions about the program. She will also determine with you which program is most convenient for you to attend. ✽ Your outpatient exercise program can begin one to two weeks after your discharge from the hospital. Several times each week, you will engage in a structured exercise session that has been tailored specifically for you based on your general health, your heart problem, your doctor’s recommendations and your own preferences. Your exercise program will include: Aerobic exercise that raises your pulse rate and helps improve the flow of oxygenrich blood throughout your body.

Strength training, such as using weights, which improves your muscle strength and stamina.

Your exercise program may include some or all of these types of equipment: stationary bike, treadmill, arm cycle, weights and wall pulleys. During each session, you will be closely monitored by a cardiac rehab nurse and/or an exercise physiologist. Checking how your heart reacts and adapts to exercise is an important part of cardiac rehab. You may be connected to an EKG transmitter or other types of monitoring equipment while you exercise.

Your cardiac rehab team is trained to handle emergencies should they arise.

This phase of your rehab also includes education about all aspects of your condition, maintaining your exercise program at home and reducing your risk for further heart problems.

Family members are strongly encouraged to attend your rehab sessions. ✽ Upon completion of the outpatient program, it is best to continue your structured exercise. Programs are available in Roanoke, the New River Valley and Franklin County. These programs also promote healthy lifestyles through risk factor modification and help individuals continue their exercise programs under the supervision of rehab staff.

Cardiac Rehabilitation Remember…

The most important member of your cardiac rehab team is you. Be an active member of your team by: • Learning about your heart condition • Following your treatment plan • Asking questions • Reporting any symptoms or problems Make a habit of the heart-healthy lifestyle you learn in cardiac rehab. It will have life-long benefits!

Cardiac rehabilitation is the next step in your recovery. Congratulations on your progress!

Cardiac Rehabilitation Program Locations Roanoke Area 540-981-7619 Cardiac rehab facilities are located near the Carilion Roanoke Memorial Hospital campus at 127 McClanahan Street This facility offers a full range of exercise and monitoring equipment. An expert team of caregivers including registered nurses specially trained in cardiac rehab, a dietitian and an exercise physiologist will monitor your exercise and provide teaching. This team helps you achieve your maximum performance and assures that you progress at the proper pace and reach the appropriate intensity.

Maintenance cardiac rehab options are available in the Roanoke area after the completion of your initial sessions in the monitored program. These options are offered at the Roanoke Athletic Club (RAC) and the Botetourt Athletic Club (BAC). One membership allows you to enjoy top-of-the-line exercise equipment, water exercise and specially trained staff. At both facilities, you can continue your maintenance phase of healthy lifestyle adjustments outside the hospital setting. An on-site registered nurse and exercise specialist continue to supervise your exercise sessions there.

Bedford 540-587-3373 Bedford Memorial Hospital offers a supervised cardiac rehab program. The program uses a full range of exercise and monitoring equipment and is staffed by cardiac nurses and an exercise physiologist.

New River Valley Cardiac rehab facilities are located at Carilion New River Valley Medical Center (540731-2612) and Carilion Giles Memorial Hospital (540-921-6099). These programs offer a

Cardiac Rehabilitation full range of equipment and a rehab team consisting of nurses and an exercise physiologist. Carilion Giles Memorial Hospital’s maintenance program is also available at the Celco Wellness Center. Carilion New River Valley Medical Center’s maintenance programs are offered in the Cardiopulmonary Rehab department at the Medical Center.

These programs also promote healthy lifestyles through risk factor modification and help individuals continue their exercise programs under the supervision of rehab staff.

Home exercise therapy and education for individuals at less risk is offered through Carilion Clinic’s Home Care Services in Radford.

Franklin County 540-489-6336 Cardiac rehab facilities are located at Carilion Franklin Memorial Hospital. This program offers a full range of equipment and an expert team of caregivers who supervise your progress and work with you and your family to modify your lifestyle to reduce the risk of future heart problems. In addition to the hospital, a medically supervised exercise program is available at the YMCA in Rocky Mount. Staffed by a team of registered nurses, this program enables individuals who are at risk for illnesses such as heart disease, or have diabetes, obesity, hypertension and arthritis to make full use of the YMCA facilities to help reduce their risk.

Lexington 540-458-3221 The Cardiac Rehabilitation program at Carilion Stonewall Jackson Hospital offers a comprehensive program which is physician supervised and implemented by a team consisting of nurses, dietitians and vocational rehab counselors. The program, a risk modification program, combines exercise, education, counseling and behavioral intervention. It is designed for each participant to control cardiac symptoms, stabilize or reverse the disease process and enhance quality of life.

Tazewell 276-988-8765 Name of cardiac rehab facility:_________________________________________ Phone: ____________________________________________________________ Contact person:_____________________________________________________ Referring physician:__________________________________________________ Seen by:___________________________________________________________ Carilion Clinic Cardiac Rehabilitation Services For more information, call 800-422-8482.

Hospital and Provider Information Hospital Visiting Information Cardiac Surgery Intensive Care Unit (6 South) Telephone: 540-981-7631 Visiting hours: 9 a.m. – 6 p.m.

8 – 10 p.m.

Cardiac Surgery Progressive Care Unit (9 South) Telephone: 540-981-8250 No visiting limits except by patient/family request and/or other special circumstances Cardiac Surgery Family Waiting Area (6 South) Telephone: 540-981-8297

Hospitals Bedford Memorial Hospital Carilion Franklin Memorial Hospital Carilion Giles Community Hospital Carilion New River Valley Medical Center Carilion Saint Albans Behavioral Health Carilion Roanoke Community Hospital Carilion Roanoke Memorial Hospital Carilion Stonewall Jackson Hospital Carilion Tazewell Community Hospital

Website CarilionClinic.org

More Health Information 540-266-6000 or 800-422-8482

540-586-2441 540-483-5277 540-921-6000 540-731-2000 800-284-8898 540-981-7000 540-981-7000 540-458-3211 540-988-2506

Hospital and Provider Information

Cardiac Surgeon Information Carilion Clinic Cardiothoracic Surgery 2001 Crystal Spring Ave., Suite 201 540-853-0100

Joseph W. Baker, M.D. Fellowship: Cardiothoracic Surgery, University of Virginia Residency: General Surgery, University of Virginia Internship: General Surgery, University of Virginia Medical Degree: Duke University Medical School

W. Scott Arnold, M.D. Fellowship: Cardiothoracic Surgery, University of Virginia; Surgical Oncology, National Institute of Health Residency: General Surgery, University of Virginia Internship: General Surgery, University of Virginia Medical Degree: University of Virginia School of Medicine

Peter S. Mikhail, M.D. Fellowship: Cardiothoracic Surgery - University of Florida Residency: General Surgery, University of Toronto Internship: General Surgery, University of Toronto Medical Degree: McGill University

Joseph F. Rowe III, M.D. Fellowship: Cardiothoracic Surgery, University of Alabama Residency: General Surgery, University of Alabama Internship: General Surgery, University of Alabama Medical Degree: Medical College of Virginia

David A. Wyatt, M.D. Fellowship: Cardiothoracic Surgery, University of Virginia Residency: University of Virginia Medical School Internship: University of Virginia Medical School Medical Degree: University of South Alabama

Hospital and Provider Information Nurse Practitioners Tennille Smelcer, M.S.N., R.N., A.C.N.P. Undergraduate: East Tennessee State University Graduate: University of Virginia Acute Care Nurse Practitioner, CertiďŹ ed

Jamie Wilson, M.S.N., R.N., A.C.N.P. Undergraduate: Wytheville Community College, Radford University Graduate: University of Virginia Acute Care Nurse Practitioner, CertiďŹ ed

Hospital and Provider Information Physician Assistants R. Steven Andrews, MPAS, P.A.-C. Undergraduate: Easet Tennessee State University P.A. Program: Jefferson College of Health Sciences Physician Assistant-Certified Susan Campbell, MPAS, P.A.-C. Undergraduate: North Carolina State University Graduate: University of Nebraska P.A. Program: Jefferson College of Health Sciences P.A. Surgical Residency: Norwalk/Yale Physician Assistant-Certified Anil Ganga, P.A.-C. L.P.N.: Jefferson College of Health Sciences P.A. Program: Jefferson College of Health Sciences Physician Assistant-Certified

Maggie B. Lance, MPAS, P.A.-C. Undergraduate: Roanoke College P.A. Program: Jefferson College of Health Sciences Physician Assistant-Certified

Carmen H. McLean, P.A.-C. Undergraduate: University of North Carolina P.A. Program: Jefferson College of Health Sciences Physician Assistant-Certified

Laura G. White, MPAS, P.A.-C. Undergraduate: Georgia State University, University of Florida Graduate: Georgia State University P.A. Program: University of Florida Physician Assistant-Certified

Hospital and Provider Information Clinical Nurse Specialist Cathy D. Jennings, R.N., D.N.P., M.S.N., ANCS-BC Undergraduate: Radford University Graduate: Duke University Doctor of Nursing Practice: Case Western Reserve University Clinical Nurse Specialist - CertiďŹ ed

Perfusionists Thomas M. Akers, B.S., C.C.P. Undergraduate: Hampden-Sydney College Perfusion program: Medical University of South Carolina Bruce C. Banning, B.S., C.C.P. Undergraduate: Roanoke College Perfusion program: University of Pittsburgh Medical Center Lance Scott, B.S., C.C.P. Undergraduate: Medical College of Pennsylvania Perfusion program: Medical College of Pennsylvania Donna R. Garrett, B.S., C.C.P. Undergraduate: Pennsylvania State University Perfusion program: Milton S. Hershey Medical Center

Medical Director for Cardiac Services Paul T. Frantz, M.D. Fellowship: Cardiothoracic Surgery, University of North Carolina, Chapel Hill Residency: General Surgery, University of North Carolina/Chapel Hill Internship: General Surgery, University of North Carolina/Chapel Hill Medical Degree: Georgetown University

Hospital and Provider Information

Notes Important Names and Numbers Doctors: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chaplain: ____________________________________________________________________________ Social workers: ____________________________________________________________________________ Other: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Room number: ____________________ Room telephone number: _________________________ CSICU (6 South): 540-981-7631 CSPCU (9 South): 540-981-8250 Family Waiting Area (outside CSICU on 6 South): 540-981-8927 Main Hospital: 540-981-7000 Carilion Cardiothoracic Surgery OďŹƒce: 540-853-0100 American Heart Association (Roanoke area): 540-989-2810 Carilion Direct: 540-981-7641 or 800-422-8482

Notes Personal Notes: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Keeping Track of Appointments: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

A Glossary of Terms We use many complicated and confusing words to describe our equipment and techniques.

We want you to be able to understand. Remember to ask questions anytime. Here is a list of terms that we commonly use: Aerosol treatment: A way in which medicine can be breathed into the lungs.

Antibiotics: Drugs used to kill or control infections caused by bacteria or other organisms.

Arterial line: A special tube that is used to monitor blood pressure all the time and to permit blood sampling.

Arterial blood gas (ABG) or blood gas: A blood test used to measure the amount of oxygen and carbon dioxide in the blood. This test will also measure the amount of acid or alkaline in the blood.

Blake drains: Small tubes that drain blood and fluid from the chest.

Cardiac: Having to do with the heart.

Cardiac monitor or “the monitor”: A machine that records the electrical activity of the heart. It may also show blood pressure and pressures within the heart. It may make a continuous soft beeping sound.

Cardiac surgeon: A doctor who performs heart operations.

Cardiac Surgery Intensive Care Unit (CSICU): A specially equipped area where patients are cared for immediately after heart and chest surgery.

Cardiac Surgery Progressive Care Unit (CSPCU): A special area where patients are cared for after they leave CSICU but before going home.

Cardiologist: A doctor who specializes in diagnosis and medical treatment of heart problems.

Chest tubes: Large tubes that drain blood and fluid from the chest.

Clear liquid diet: A diet which includes water, ice chips, soft drinks, juices, coffee, tea, Jell-O and bouillon.

Culture: A sample of blood or other body fluids tested for bacteria or other organisms.

Echocardiogram (echo): A sonogram picture of the heart, its chambers and valves.

Electrocardiogram (EKG or ECG): A tracing of the heart’s electrical activity.

Electroencephalogram (EEG): A tracing of the brain’s electrical activity.

A Glossary of Terms Endotracheal Tube (ET): A plastic tube in the trachea (windpipe or breathing tube) of the patient to deliver oxygen to the lungs. It assists with breathing and with removing uid from the lungs. Placing an endotracheal tube into the windpipe is called intubation. Removal of the tube is called extubation. Patients cannot speak with an endotracheal tube in place.

Face mask: A plastic mask that provides the patient with extra oxygen. Patients can speak with a facemask in place.

Foley catheter: A tube placed in the bladder to remove urine.

Full liquid diet: A diet that includes all clear liquids plus ice cream, milk and soups.

Graft: A piece of vein or artery used to bypass a blockage in a coronary artery.

Heart-lung bypass machine: A machine that provides the body with oxygen and blood while the heart and lungs are still during heart surgery.

Hyperalimentation (TPN): A special solution given into a vein for patients who are unable to eat regular food.

Incentive spirometer: A device that encourages patients to take deep breaths.

I.N.R. (internal normalized ratio): A blood test that helps your doctor determine what your Coumadin dose should be.

Isolation: A method for keeping patients who have contagious diseases or patients who are at risk for infections separated from other patients.

Intravenous (I.V.) catheter: A small plastic tube that is placed in a patient’s vein in order to give medicines, nutrients, salt water (saline) solutions, blood or sugar water (glucose) solutions.

Myocardial infarction (M.I.): Heart attack.

NPO: The patient can have nothing to eat or drink by mouth.

Nasal cannula or catheter: A small plastic tube that is placed at the nostrils to deliver extra oxygen. Patients can speak with a nasal cannula in place.

Nasogastric (N.G.) tube: A plastic tube inserted through the nose and into the stomach.

Special foods can be put into the stomach or uids can be removed from the stomach through this tube.

Neurologic: Having to do with the brain.

Operating room (O.R.): The place where surgery is performed.

A Glossary of Terms Pacing wires: Small wires placed on the heart during surgery that will be connected to a pacemaker if needed to regulate the heart’s rate and rhythm. The wires are removed before you leave the hospital.

Percutaneous endoscopic gastrostomy (PEG): A feeding tube placed into the stomach through a small abdominal incision.

Prothrombin time (P.T.): Like the I.N.R., this blood test helps your doctor determine the right dose of Coumadin for you.

Pneumonia: Swelling and irritation of the lung usually caused by bacteria or other organisms causing fluid or pus to collect in the lung.

Pulmonary: Having to do with the lungs.

Pulmonary artery catheter (Swan-Ganz): An I.V. that is usually placed in a neck vein. It measures the pressures in the chambers in the heart. If present, this catheter will probably be taped to the neck and forehead immediately after surgery.

Renal: Having to do with the kidneys (also “nephrology”).

Respirator or ventilator: A machine that is attached to an endotracheal tube to deliver oxygen to a patient’s lungs and to help with breathing.

Risk factors: Characteristics or factors that increase the risk of coronary artery disease and heart attack.

Rounds: Periodic visits by physicians and/or nurse teams to discuss the condition and plans for an individual patient.

TED stockings: Knee-high support socks. They help to prevent leg swelling and promote good blood flow.

Temporary pacemaker: During surgery, this machine is attached to your heart by small pacing wires. It helps to adjust your heart rate or rhythm if needed.

Total parenteral nutrition (TPN): A special solution given through a vein for patients who are unable to eat regular food.

Tracheostomy or “trach”: A small hole placed in the patient’s trachea (windpipe or breathing tube) to help with breathing and removal of excess fluid from the lungs.

Tracheostomy tube or “trach tube”: A plastic tube placed into a patient’s tracheostomy.

Valve regurgitation or insufficiency: A condition in which a heart valve doesn’t close properly, allowing blood to leak where it shouldn’t. Also called “valve incompetence.”

Valve stenosis: A condition in which a heart valve doesn’t open enough or doesn’t let enough blood flow through.

Acknowledgements

Special thanks to the following for providing key information for this book and DVD: American Heart Association Mayo Clinic Tony and Gini Lefkowicz Rawlings Gallagher Sue Perigen, RN, BSN, CCRN-CSC Cathy Jennings, RN, DNP, ACNS-BC