The chest muscles take 4 to 6 weeks to heal. Here are some suggestions for protecting your chest incision and helping your chest muscles heal properly:

• Maintain a good body posture by relaxing your upper body and keeping your back straight.
• Avoid lifting anything more than 5 pounds per arm or exerting more than 5 pounds of force on each arm. Examples of items that weigh approximately 10 pounds: full bag of groceries, garbage bags, wet laundry. One gallon of milk is 8 pounds.
• Try not to work for prolonged periods of time in a stooped or bent position, such as the position people use when gardening.
• For 1 month, avoid extreme arm reaches or stretches or any activity that will place pressure on your chest. Strenuous arm motions such as weight lifting or muscle building should be avoided.
• Avoid activities or sports for 4 to 6 weeks that cause you to twist or reach with your arms and upper body, such as vacuuming.
• Avoid driving for 4 to 6 weeks and then drive only after your doctor approves. This is so your breastbone can heal properly.
• If you are riding in a car, you should wear the shoulder seat belt. However, you may be more comfortable if you place a small pillow between the shoulder belt and your chest incision. Avoid riding in a seat that is subject to airbag deployment.
• Avoid long trips. Do not travel by airplane for 4-6 weeks without the approval of your cardiac surgeon. If you must travel long distances and have obtained your cardiac surgeon’s approval, take a break every 45 minutes by getting up, relaxing, and walking around to improve blood flow to your legs.
• Avoid riding a regular bicycle or motorcycle for 4 to 6 weeks after surgery.
• Protect your incisions from cold. Exposing your incisions to cold can be painful.
• Avoid exposing your incisions to the sun for at least 6 months to one year. Sun exposure may increase the spreading and intensity of the scar.

Take your temperature EVERY MORNING!
Take your temperature every morning until your first post-operative visit with your physician. If your temperature is over 100.4° F (38.0° C) by mouth, notify your cardiac surgeon.

Bathing
• Gently wash the incisions and pat dry.
• Use any type of mild soap.
• Use warm, not hot, water.

You may feel weak during the first few showers, so have someone available to help if necessary. Sitting on a waterproof bench or chair may be helpful, because showering may take as much energy as a short walk, and you may feel tired.
• Put a chair or stool near the shower in case you need to rest.
• Do not bend down to dress or dry off. Sit down and pull your pants on by bringing your leg up and crossing it over the other leg.

Check Your Incisions Daily
Since it takes about 4 to 6 weeks for your incisions to heal, inspect your incisions daily for signs of infection. A mirror might be helpful for hard to see areas.

Report immediately to your cardiac surgeon if you notice one or more of the following signs:
• The incision is opening
• Increasing redness
• Swelling
• Drainage
• Soreness
• Thick, creamy drainage (pus)

The number to call in San Francisco is (415) 833-3707 for the Cardiac Advice Nurse or (415) 833-3800 for the Cardiac Surgery Clinic.

Stitches and Staples
If you have stitches (sutures) and staples, they should be removed by a medical professional within 10 days. This may be done before discharge, but can be done at your local Kaiser Permanente Surgery Center.

Tape Strips
If tape strips are on your incisions, feel free to trim off any loose edges with a pair of scissors. You can remove the strips the fifth day after your surgery. Do not replace tape on incisions once it falls off. The tape will come off easily when wet with warm water.

What you should expect during normal healing
• Bruising, itching, soreness: Some bruising, itching, feelings of soreness, tightness or numbness are all normal signs of healing.
• Bumps and swelling: A bump or swelling at the top of your chest incision will gradually return to normal in two to three months.
• Numbness: The area at or around your incisions may be numb for up to a year.
• Tightness and scarring: Incisions in areas such as the knees and the groin may be tight and have a thicker scar. As you return to your normal activities, these areas will gradually loosen up.
• Liquid discharge: In areas where tubes were removed, and in leg incisions, a small amount of pink liquid is normal. A small bandage may be used over these areas to prevent the liquid from soiling your clothing.
• Swelling and puffiness: If your legs have incisions where veins were removed, you can expect swelling and puffiness for up to 6 months, especially in the ankle and foot. This is because fluid collects in the tissue when you are not moving around much.

How to control swelling in your feet and legs
• Walk: Walk around at least once every hour for a few minutes. Walking helps stimulate the growth of new veins (collateral circulation) in these areas.
• Elevate your legs: Keep your leg elevated when not eating or walking. Your leg should be level with your body or a little higher. Rest your feet on a footrest or on the arm of a couch or support your lower legs with pillows when you sit or lie down.
• Wear elastic stockings: Your doctor may want you to wear elastic stockings during the day. Do not wear them when you go to sleep at night. Generally, you do not need to wear them after you are discharged from the hospital, but they may be helpful for extreme cases of leg swelling.

In time, the scars from your incisions will get better and become lighter.

Things to avoid:
• Creams and lotions: Avoid putting lotions, ointments, creams, sunscreen, vitamin E, salves, medicated ointments or powders near your incisions until they have closed entirely (at least 6 weeks).
• Reuse of tape: Do not replace tape on incisions once it falls off.
• Hot baths or tubs: Avoid bathing in a bathtub or using a hot tub or swimming pool for at least 4 to 6 weeks after the operation. Bacteria may get into the incisions and cause an infection.
• Prolonged sitting: If you have swollen feet or legs, avoid sitting for more than one hour with your feet on the ground. Sitting for more than one hour with your feet on the ground can make the swelling of the legs and feet worse.
• Wearing elastic: Do not wear elastic stockings at night. Generally, they are not required after discharge from the hospital, but may be used for extreme cases of leg swelling.