Heart surgery more difficult to recover from than many imagine

AS HEART patients survive ever more complex surgeries, they are often surprised by how tough it can be to bounce back after the operation.

While recovery can be a long slog after any major surgery, invasive procedures on the body’s most vital organ can be especially traumatic. During heart surgery, the body’s natural inflammatory response to injury can be dramatically amplified, leading to complications such as altered liver and kidney function.

Patients may emerge physically frail and have trouble with brain function due to heavy anaesthesia.

As much as 40% of patients suffer from depression after cardiac surgery, research shows.

And in older patients, psychological and social issues such as isolation and a lack of a strong support network can limit recovery, according to a study published in April in the journal Experimental Gerontology.

“Cardiac surgery is not just a physical thing but a big stressor on cognitive function, psychological health and overall health, and it distresses your social and personal environment as well,” says study co-author James Rudolph, associate professor at Brown University’s medical school and director of the Centre of Innovation in Long-Term Services and Supports at the Providence VA Medical Centre in Rhode Island.

“Medicine doesn’t do a good job of taking some of those things into account,” he says.

Surgeons typically discuss with patients a detailed list of potential complications and recovery issues, including depression, but often patients and their families are so nervous they may not take it all in, says Robbin Cohen, associate professor of cardiothoracic surgery at University of Southern California Keck School of Medicine.

While informing patients about what they face in recovery, “it’s important not to scare them so much they don’t want to have surgery”, adds Cohen, who is also medical director of cardiothoracic surgery at Huntington Hospital in Pasadena, California.

The Society of Thoracic Surgeons recently launched a website that includes tips for patients recovering after surgery. Some heart patients are so afraid of their limitations after surgery that they cannot resume normal activities, “and it is a long time before they believe they can engage in living without the fear of dying”, says Barry Jacobs, a clinical psychologist in Philadelphia and a spokesman for the American Heart Association.

Younger and fit patients may want to rush back into life and push themselves so hard they have to backtrack, he says. And unforeseen complications after surgery can derail even a seemingly smooth recovery.

Anthony DiLemme Jr, a 33-year-old science teacher who lives in Redlands, California, was diagnosed with an aortic valve disease as a child. He managed to lead an active life into adulthood, doing contact sports, hiking, running and rock climbing. But his condition advanced, and he also developed an aortic aneurysm, a bulge in the heart’s main artery that can burst.

In November 2013, he had surgery to replace the valve and repair the aneurysm. He immediately began planning for his recovery, attending several weeks of cardiac rehabilitation while heeding his doctors’ advice not to overdo it.

Three-and-a-half months later, however, he had worrisome symptoms, including shortness of breath. Tests indicated he had a serious infection requiring emergency surgery to replace the valve. It was a far more complicated and lengthy procedure than the first one and the recovery turned out to be more difficult as well.

“I definitely felt very down after the second one,” DiLemme says. “I was really afraid I wouldn’t be able to do all the things I had done before and that my heart wouldn’t work as well.”

His parents moved in for several weeks, which he says helped him get through the immediate aftermath. As a form of coping he started chronicling his experiences in a blog. He set goals to return to exercise and activities like running and rock climbing. He also began volunteering with an American Heart Association support network to help others going through surgery.

“Keeping yourself busy is one of the biggest things you can do to stay out of or get out of depression,” he says. “Everyone’s situation is different, but for the most part you can get back to life. It will continue,” he says.

Patients who are optimistic and have feelings of gratitude may do better in recovery, while those who feel hopeless are less likely to follow a regimen to help them recover, according to Jeffrey Huffman, director of the cardiac psychiatry research programme at Massachusetts General Hospital in Boston and an assistant professor at Harvard Medical School.

Recalling good events, remembering past successes and “imagining a better future” can help speed recovery, he says. Having emotional support also helps.

Research published in JAMA Surgery in February found that patients who are divorced, separated or widowed had an approximately 40% greater chance of dying or developing a new functional disability in the first two years following cardiac surgery than their married peers.

Mike O’Meara, 70, battled diabetes and high blood pressure for years. He suffered a stroke in 2009 and then needed emergency triple-bypass surgery in 2013 as a result of severe heart failure, which renders the heart unable to pump blood efficiently. His wife, Beth, who works in cancer research, took time off to care for him.

She helped manage his multiple medications and therapy regimens, and dealt with complications including skin ulcers that would not heal.

O’Meara says he was just happy to be alive after surgery. Depression “isn’t a word in my vocabulary”. But he easily tires and has had to make lifestyle changes, no longer enjoying a cold beer or a highly active social life, and he has given up golf partly because of a lack of strength and stamina.

“I always felt physically that I could fight 10 rounds any minute, and then all of a sudden I couldn’t do any of that stuff,” O’Meara says. “I’m not over the hump yet and my body tells me every day I have restrictions.”

Beth O’Meara says her husband gradually started meeting friends for lunch and attends a favourite weekly political breakfast.

The couple, who live in Huntingdon Valley, Pennsylvania, got a puppy and they volunteer to help other patients and families with questions about heart failure and caregiving through an American Heart Association support network.

“Mike has been slow and steady in his healing process but never gives up and doesn’t complain,” says Beth O’Meara. “He has a good sense of humour, which has helped him in his recovery.”

O’Meara’s advice to recovering patients: “You have to fight so you don’t get yourself into the doldrums. Get up, shower, shave and see what you can do every day.”

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