CARDIAC SURGERYPPaattiieenntt IInnffoorrmmaattiioonn

Before Your Surgery 1

In The Hospital 2

Going Home 3

Diet 4

Activity 5

Risk Factor Reduction 6

Medication 7

Home Health 8

Cardiac Rehabilitation 9

Additional Resources 10

4/07

BEFORE YOUR SURGERY

Tests/UnitIf your surgery is scheduled at the office,you will be instructed where to report forPre-surgical Testing and given an appointment.

You will need blood tests, chest x-ray and EKG

If you are already in the hospital, these will bedone either before surgery or before you gohome to wait for surgery.

Treatments/Special EquipmentThe night before surgery, please do thefollowing:

n Shower using anti-bacterial soap

n Shampoo hair

n Trim nails and remove polish

n Medications/Pain Control

n Stop all aspirin and aspirin products(Ibuprofen, Motrin, Plavix) seven (7)days before surgery.

n Bring a list of medicine you take toPre-surgical testing.

n The anesthesia doctor will tell you whatmedicine to take the morning of surgery.

Breathing ExercisesYou will be instructed in how to deep breatheusing an incentive spirometer (IS). Practiceusing this device before surgery because yourlungs will need to be exercised frequentlyafter surgery.

Coughing is also necessary to help clear thelungs of excess fluid.

ActivityContinue normal activity unless otherwiseinstructed by your doctor.

DietEat whatever you would like for dinner theevening before surgery, but do nnoott eat or drinkanything after midnight. You may have sipsof water in the morning with medications youwere instructed to take.

TeachingThere is a video and a booklet available thatexplains what to expect before and after surgery.

Discharge PlanningIf you live alone, plan to have someone staywith you around the clock for about one totwo weeks after surgery.

Before Your Surgery 14/07

IN THE HOSPITAL

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Tests/UnitYou will go immediately from surgery to theCardiac Surgery Unit (CSU) located on the8th floor at Borgess.

Recover from surgery in the CSU.

Blood tests, chest x-ray and EKG are done.

Treatments/Special EquipmentIn the CSU you will have the followingequipment:

n Breathing tube connected to a breathingmachine. This is removed once you areawake and strong enough to breathe onyour own.

n I.V. catheters will be in your arms andneck.

n Drainage tube entering through yournose to the stomach.

n Foley catheter to drain urine.

n Chest drainage tubes that exit belowyour breastbone.

n You will be on a heart monitor at all times.

Medications/Pain ControlMedication will be used that will help yourelax and control pain.

Your nurse will frequently check with you tomake sure that you are comfortable.

Breathing ExercisesIt is important to use the incentive spirometer(IS) every hour whenever awake. Your nursewill assist you in CSU.

When coughing, hold a firm pillow over yourchest to help support the incision and thebreastbone as it heals.

ActivityAfter the breathing tube is removed, the nursewill assist you to sit on the side of the bed(dangle) a couple of times during the first day.

DietYou may have sips of water to take medicationas instructed in Pre-Surgical Testing the morningof surgery.

You may have ice chips once the breathingtube is out and sips of liquids once the stomachtube is removed.

VisitorsWe welcome immediate family members tovisit their loved ones after surgery. Understandthat patients require a great deal of rest soplease limit the amount of time each visit.

No children under age 16 allowed in the CSUto visit.

Your nurse will be glad to answer questionsyour family may have.

In the Hospital 24/07

POSTOPERATIVE/RECOVERY PHASE

Tests/UnitTransfer to the Cardiac unit when you are stableand ready to leave the CSU.

n Staff will monitor your heart 24 hoursa day.

n Lab test third day after surgery.

n Other tests or exams as needed.

Treatments/Special EquipmentThe telemetry box used to monitor your heartfits in a pocket on your gown with wires thatare attached to adhesive patches on your chest.

n Temporary pacemaker wires are ofteninserted during surgery and are removedbefore going home.

n Oxygen is provided for a few daysafter surgery.

n Blood oxygen levels are measured daily byplacing a clip on your finger connected toa monitor.

n When your level is above 90 percent,the oxygen will be discontinued.

n If you use oxygen at home, it will becontinued throughout your stay.

Medications/Pain Controln Pain medication is ordered for you to have

every 4 hours as needed.

n Let your nurse know when you are in pain.

n If you were taking any medications athome before surgery and think you shouldbe receiving it after the surgery, let yournurse know.

Breathing ExercisesContinue to use the IS every hour while awake.

Activityn Sit up in chair the morning after surgery.

n Walk a short distance or as far as you feelyou are able to go with help.

n Receive instructions on how to movewithout hurting your chest.

Dietn Advance to Cardiac (low salt and

low fat) diet.

n Limited liquid intake and nnoo ccaaffffeeiinnee.

In the Hospital 34/07

n For diabetics, use 1800-calorie ADA diet.

n It is not unusual to have a low appetiteand food may not taste as good to youfor a while.

n Your family can bring in food from homeafter checking with your nurse.

Teachingn Learn how to care for your incisions.

n Ask questions about your diet.

n If you smoked cigarettes before surgery,you will be counseled about smokingcessation.

Discharge Planningn Meet with a Case Manager (Registered

Nurse) after surgery.

n Discuss plans for care at home.

n The Case Manager talks to your insurancecompany to make sure that servicesprovided at home are covered by yourpolicy.

In the Hospital 44/07

DISCHARGE/REHABILITATION PHASE

Tests/Unitn Stay on cardiac unit until you are ready

to go home.

n Discharge to home is usually within 3 to5 days after surgery.

n Everyone heals at a different rate, therefore,the time frame for you is adjusted to howwell you are recovering.

Treatments/Special Equipmentn Staff will monitor your heart rate

and rhythm at all times until youare discharged home.

n If you cannot maintain a blood oxygenlevel above 90 percent at all times, youmay require oxygen at home until youimprove.

n The Respiratory Therapist will evaluatefor oxygen at home, if necessary.

Medications/Pain Controln You will be given a prescription for pain

medication. Call your surgeon’s officefor a refill.

n Aspirin is to be taken daily to help keepyour new by-pass graft open for goodblood flow to the heart muscle. Yourdoctor will order the dose.

n Review your list of medications withyour nurse when you are discharged.

n Ask questions if the medications aredifferent than what you have at home.

n Make sure you have prescriptions fornew medication.

Breathing Exercisesn The IS will go home with you.

n Continue to use the IS device every hourfor the next 3 to 4 weeks.

Activityn A nurse will walk with you four times a

day and monitor your blood pressure andpulse before and after.

n Walk alone if you are steady on your feetor with a family member during othertimes in order for you to get strongermore quickly.

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n A referral for cardiac rehab will be made.

Dietn Remain on the Cardiac diet.

n Keep fluid intake to about 2 liters(2 quarts) per day.

n DDoo nnoott aadddd ssaalltt ttoo ffoooodd; eat processedfoods, or food high in sodium (processedcheese, lunch meats, ham, bacon).Sodium (salt) leads to retention of fluidin the body tissue.

n Eating several small meals a day isrecommended.

n Focus on eating foods high in proteinto promote healing.

Going Home 54/07

Teachingn Read and follow the heart surgery

notebook provided.

n Your and your significant other shouldread all of this information.

n Ask questions about what to expect afterleaving the hospital.

Discharge Planningn Patients are referred to a Home Nursing

Agency before they leave the hospital

n The Home Nurse will visit you afterdischarge to monitor:

– Temperature, pulse, blood pressure,weight

– Heart rhythm (EKG)

– Lung sounds and blood oxygen level

– Incisions and healing

– Medications and effects they haveon you

– Draw blood tests, if needed

Going Home 64/07

DURING YOUR RECOVERY AT HOME

General InformationEach patient who has heart surgery will responddifferently. The procedure may be done tobypass clogged heart arteries, and/or repairor replace a heart valve that is leaking or toosmall. Recovery will depend on your surgerytype and general health.

It is important to know that certain things area normal part of the recovery process. This iswhat you need to do every day to help monitoryour progress:

n Weigh yourself every morning at the sametime wearing about the same amount ofclothing and record in log on page 13.

n Cough, breathe deeply and use yourincentive spirometer every one to twohours.

n Take your temperature twice daily – inthe morning and in the evening and record.

You may have difficulty falling or stayingasleep at night. This will gradually improve.It is always wise to take a pain pill beforebedtime. You may be more comfortable ina recliner the first few nights at home.

Most patients experience constipation aftersurgery related to pain medications and adecrease in normal activity. All patients haveover-the-counter stool softeners listed on thedischarge instructions. Make sure you purchasethese stool softeners when you get the restof your prescriptions filled and take themas prescribed. If you are taking your stoolsofteners and have still not had a good bowelmovement, contact your home care nurse orsurgeon for further directions.

Feeling depressed or experiencing mood swingsmay also occur after surgery. Be sure to tellyour home care nurse or call your primarycare doctor if these feelings persist.

You may have a lump at the top of your chestincision. This will disappear with time.

What is Home Care?Before you come to the hospital, arrangeto have someone stay with you for at leastone week after surgery. Also, your surgeonusually orders home health care when youare discharged. The purpose is to support yourrecovery as much as possible. The registerednurse from a home health care agency willprovide thorough assessments and educationin your home environment. Your home carenurse will be working with your doctor aspart of your health care team for recoverymanagement. A home care nurse will visityou the day after hospital discharge and thengenerally twice a week to monitor temperature,pulse, blood pressure, weight, lung soundsand blood oxygen. The nurse will continueteaching you about your recovery managementand medications.

Going Home 74/07

MedicationsYou will receive prescriptions you need beforedischarge. Be sure to have them filled bythe time you arrive home from the hospital.A nurse will discuss your medications with youbefore your discharge and at initiation of homecare visits. You will also receive an instructionsheet about all of your prescriptions. If youhave any questions, please ask the nurse, orif you are at home, contact your surgeon orvisiting nurse. Only take medications listedon your discharge instructions.

IncisionA small amount of drainage from your legwounds can be expected for the first week to10 days. If you notice any redness, swelling,fever or unusual drainage, it could indicateinfection and you should call your surgeonimmediately. Any drainage from your chestincision should be reported immediately to thesurgeon or your visiting nurse agency. Severaloutside factors can affect your discomfortaround the incision area, including:

n A change in the weather

n Too much or too little activity

n Sleeping in one position too long(sleeping on either side is encouraged)

n Poor posture

If you experience discomfort, you may takea pain pill or two extra-strength Tylenol. It isnormal to have swelling of the foot or leg fromwhich you have had veins removed. Keepingyour foot or leg elevated will eliminate thisproblem. Check your legs daily for increase inswelling and notify your surgeon or home carenurse if this occurs. Avoid sitting in one positionor standing for a prolonged period of time.

You may have white tapes over your incisions.As they loosen, they should be removed. Theyshould all be off by 10 days after your surgerydate. Your home care nurse will assist you inremoving these tapes if needed.

Take your temperature twice a day. Call yoursurgeon or home care nurse if you experiencea fever higher than 101 degrees.

Your BreastboneDuring the first six weeks after surgery, youmust protect your breastbone. All of theguidelines listed under LLiiffttiinngg should befollowed. In addition, it is important that youavoid lifting your arms above your head andany strenuous movement of your arms at morethan a 90-degree angle from your body.

Going Home 84/07

Lifting Restrictionsn Five-pound restriction for the first

four weeks

n Five to 10-pound restriction for eightto 10 weeks

n Fifteen-pound restriction for 10 to 12weeks

n No restriction after three months unlessinstructed otherwise by your surgeon

BathingShowers are best for the first several weeksafter you return home. Since you will be weak,it is best to sit on a chair or stool during yourshower. This will help you avoid falling or deepbending. Lather your incision(s) with Dial soapand warm (nnoott hhoott) water, rinse thoroughlyand dry gently. Keep your incision(s) cleanand dry. Don’t apply lotion or ointments toincisions unless ordered by your surgeon.NNoo bbaatthhss uunnttiill aapppprroovveedd bbyy pphhyyssiicciiaann.

WeightWeigh yourself daily. You can establish aroutine by getting up, emptying your bladderand then weighing yourself. Some patientshave the tendency to gain water weight. If youshould experience a rapid weight gain in oneday, it is more than likely water. Please keepa record of your weight and if you experiencea weight gain of three to five pounds overtwo to three days, please call your surgeonor visiting nurse.

Diet Decreased appetite after surgery is common.This will gradually return to normal. Frequentsmall meals may help increase your appetite.If you wish to speak with a dietitian beforeleaving the hospital, please talk to your nurse.You will have a chance to review yourprescribed diet and ask any questions withyour visiting nurse.

DrivingNo driving the car the first four weeks afteryour return home. You can ride as a passengerin a car at any time. You may take short tripsriding in a car, but when traveling, get out ofthe car every hour to walk around and stretchyour legs. You may ride in the front seat withseat belt fastened and the seat pushed back asfar as possible. It is not necessary to deactivatethe air bag.

Drinking AlcoholAn alcoholic beverage with your eveningmeal or at bedtime is permitted. If you are ontranquilizers or other medication, do not mixalcohol with the tranquilizers, pain pills orsleeping pills.

SmokingIIff yyoouu hhaavvee nnoott aallrreeaaddyy ssttooppppeedd –– nnooww iisstthhee ttiimmee ttoo ddoo ssoo.. Studies have shown thatsmoking increases heart rate and bloodpressure, and narrows the blood vessels.Contact the Borgess Wellness Center at226699..222266..55442266 for additional smokingcessation resources.

Going Home 94/07

SexSome patients have concerns about having sexafter open-heart surgery. Avoid positions thatmight put a strain on your breastbone. Do notuse Viagra or a similar medication unless youdiscuss it with your surgeon. Other than that,there are no particular restrictions.

VisitorsPlease limit your visits during your first twoweeks at home. Although friends and familymean well, a lot of visitors can be tiring andslow your recovery. Don’t hesitate to excuseyourself from company if you feel rest isneeded. Remember, your health is whatmatters most.

Your Four- to Six-Week Check UpYou will be given an appointment date beforeyou leave the hospital to see your surgeonand cardiologist in four to six weeks followinghospital discharge. At this time, your physicianswill discuss with you when or if you may returnto work and what changes you should makein everyday activities.

EmergenciesIn case of an emergency, call 911 in yourcounty immediately. If you go to an emergencyroom, please take the name of your surgeonand cardiologist, along with your yellowdischarge papers.

Going Home 104/07

GENERAL RECOVERY FROM SURGERY

Chest Discomfort You May ExperienceAfter Cardiac SurgeryFollowing cardiac surgery, it is common toexperience some chest discomfort. Informyour home care nurse of any discomfort andhe/she will teach you about the pain scale andhow to best manage your pain. If you do nothave a home care nurse, call your surgeondirectly. You may or may not experience oneor more of the following after surgery.

n Incision discomfort

n Muscle, bone and joint discomfort

n Indigestion or heartburn

Incision DiscomfortThe amount of discomfort you may experienceis highly individualized. Incision discomfortis pain located along the site of your incision.Tenderness may be noticed when the areaaround the incision is touched. You may feela dull ache or throbbing sensation and in someinstances, a sharp or burning sensation. Youmay notice discomfort with coughing, deepbreathing, walking or exercising. The incisiondiscomfort is usually more noticeable 2 to 3days after surgery and decreases with time.

Muscle, Bone and Joint DiscomfortThe surgeon must be able to see your heart inorder to perform your surgery. A special chestinstrument is used during the surgery thatallows the surgeon to see your heart. Youmay feel discomfort in your muscles, bonesand joints after surgery due to some of the

equipment required. Muscle, bone and jointdiscomfort may be noticed in your back,shoulders and ribs. This discomfort variesfrom patient to patient. You may feel a dullache or possibly a sharper sensation.Discomfort may be noticed with increasedmovement or when touched. The discomfortshould decrease with time. If you have ahistory of arthritis before surgery and aretaking medication for arthritis, remind yoursurgeon or home care nurse. The surgeon/nursecan make sure you have a prescription foryour medication after your surgery. This willhelp to decrease your discomfort and helpwith your recovery.

Indigestion or HeartburnIndigestion or gastric discomfort may occur.If you have a history of indigestion esophagealreflux, remind your surgeon or nurse. Antacidsor other medication may be prescribed todecrease or prevent this discomfort.

Cause for ConcernAny discomfort that does not decrease withtime needs to be reported to your home carenurse. If you experience any pain that issimilar to the chest pain you had beforesurgery, contact your home care nurse orsurgeon, or call 911 immediately.

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During Your Recovery at Home 114/07

When Should I Report Something?By being aware of what to watch for and callwith questions right away, you can avoidcoming back into the hospital. Two commonreasons for return to the hospital are HeartFailure and Atrial Fibrillation.

If you are still working with a home healthagency, call your nurse ffiirrsstt and he/shewill help you decide if the doctor needs tobe called. If you have been discharged fromhome health service, call your cardiologistwith these problems.

Heart FailureIf you have had previous damage to a heartmuscle or surgery for valves that were notworking properly, you will need to watch forsigns of heart failure. This simply means thatthe heart is not working efficiently, not that ithas stopped. SSiiggnnss ooff hheeaarrtt ffaaiilluurree iinncclluuddee

n Sudden weight gain of 2 to 3 pounds in3 days, oorr not losing the water weightafter your surgery.

n Increased swelling of the legs, feetor belly.

n Increased trouble breathing, especiallyneeding to sleep with more pillows or inan upright chair to be able to breathe.

Atrial FibrillationSurgery itself can be irritating to the heartmuscle and can cause irregular heart rhythmknown as atrial fibrillation. Checking yourpulse each day is an important way to catchthis change early and let your doctor know.Many times this irregular rhythm starts in thefirst 2 or 3 days after surgery and is beingcontrolled with medication. Usually it willchange back to a regular rhythm in a fewdays. Atrial fibrillation may also occur afteryou go home. Some people may needadditional procedures or medications toregulate the heart rhythm. CCaallll iiff

n Your heart rate is faster than 120 beatsper minute.

n Your heart rate is suddenly more irregular.

n You feel pounding in your throat or chest.

n You suddenly have trouble breathing.

Reasons to Call 911n Severe sudden dizziness or

lightheadedness/unconsciousness

n Severe difficulty breathing

n Choking

n Seizures

n Persistent chest pain not related toincisions or muscle pain

n Uncontrolled bleeding, coughing upbright red blood

n Injury from a fall

During Your Recovery at Home 124/07

During Your Recovery at Home 134/07

WEIGHT AND TEMPERATURE LOG

Date Weight a.m. Temp p.m. Temp

Diet 144/07

Diet 154/07

DIET AND CARDIOVASCULARDISEASE

Following a healthy diet is important tocontrolling cardiovascular disease. The U.S.Department of Agriculture has updated the foodpyramid to reflect a more heart-healthy plan.

CCoommppoonneennttss ooff FFooooddIf you are trying to make heart-healthy changesto your lifestyle and diet, it is helpful to knowsome basics about nutrition, starting with thecomponents of food.

Facts About Calories:n You need enough calories to maintain

your energy level, but no more thanyou can burn off. This is called anenergy balance.

n If you take in more calories than youburn, you gain weight.

n If you take in fewer calories than youburn, you lose weight.

n If you balance the two, you maintainyour weight.

n Even when you are dieting, however,calories should not be cut back so muchthat your energy needs are not met. Thenumber of calories you need dependsprimarily on age, gender, and activity level.

Facts About Dietary Cholesterol:…… rreemmeemmbbeerr:: ““cchhoolleesstteerrooll--ffrreeee””

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n Dietary cholesterol is a fat-like substancefound in all foods of animal origin: eggyolks, meat, poultry, fish, milk, and milkproducts.

n Because our bodies make cholesterol,it is not required in our diets. However,because most people eat foods thatcontain cholesterol, it is important toavoid excessive amounts. The amountof cholesterol you consume can affectyour blood cholesterol levels.

Facts About Fats:n All fats contain about the same number

of calories

n tteeaassppoooonn ffoorr tteeaassppoooonn,, tthheerree iiss nnoollooww--ffaatt ffaatt.. Fat is the most concentratedsource of calories, supplying more thantwice as many calories per gram as eithercarbohydrates or proteins. Most peopletend to get far too much fat in their diets,which contribute to health problems suchas obesity, high blood cholesterol, andheart disease. While coconut and palmoils contain no cholesterol, they are highin saturated fat and should be avoided.

n Fatty acids are the basic chemicalunits in fat. They may be saturated,polyunsaturated, monounsaturated,or transfats. These fatty acids differin their chemical compositions andstructures and in the way in whichthey affect your blood cholesterollevels, according to the following:

Diet 164/07

Saturated Fatsn Is used by the liver to manufacture

cholesterol.

n Is considered the most dangerous kind offat because it has been shown to raise bloodcholesterol levels, particularly the LDL.

n Should comprise no more than 10 percentof your daily calorie intake.

n Examples include: meats, butter, cocoabutter, coconut, and palm oils.

Polyunsaturated Fats:n Do not appear to raise blood cholesterol

levels.

n Examples include: safflower, sunflower,corn and vegetable oils, margarines andsoybean oils.

Monounsaturated Fats:n Do not seem to have any affect on blood

cholesterol

n Examples include olive and canola oils.

Trans Fats:n By-products of hydrogenation, a chemical

process used to change liquid unsaturatedfat to a more solid fat. Structurally similarto saturated fat, trans fatty acids may havea great impact on raising total and LDLcholesterol levels.

n Examples include stick margarine andfats found in commercially preparedcakes, cookies, and snack foods.

n Total fat intake should be no more than 30%(30 percent) of your daily calorie intake.

Facts about Fiber:n Fiber is the indigestible portion of food.

There are two types of fiber: soluble andinsoluble.

n Soluble fiber – found in such foods asoat bran and dried beans can lower bloodcholesterol in some people.

n Insoluble fiber – found in foods such aswheat bran and is known to have manybenefits. While this type of fiber has notbeen found to lower cholesterol, it is usefulin weight control because it creates afeeling of fullness.

Diet 174/07

Facts About Sodium:n Although salt is the major contributor of

sodium in our diets. Sodium and salt arenot the same, contrary to popular belief.

n A teaspoon of table salt contains 2,300milligrams of sodium. Sodium is a mineralneeded to maintain body fluids and propernerve function. It occurs naturally in somefoods, but most of the sodium in our dietscomes from seasonings and ingredientswe add to foods. Although sodium isessential, most of us consume morethan we need. In some people, too muchsodium in the diet can cause the bloodpressure to rise, putting them at risk forheart disease or stroke.

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Facts About Cholesterol:Cholesterol is a waxy substance that can befound in all parts of your body. It aids in theproduction of cell membranes, some hormonesand vitamin D. The cholesterol in your bloodcomes from two sources: the foods you eatand your liver. However, your liver makesall of the cholesterol your body needs.

Cholesterol and other fats are transported inyour blood stream in the form of sphericalparticles called lipoproteins. The two mostcommonly known lipoproteins are low-densitylipoproteins (LDL) and high-densitylipoproteins (HDL).

What is LDL (low-density lipoprotein)Cholesterol?This type of cholesterol is commonly calledthe “bad” cholesterol, and is a type of fat in theblood that contains the most cholesterol. It cancontribute to the formation of plaque buildupin the arteries, known as atherosclerosis.

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n Avoid foods high in saturated fat, dietarycholesterol, and excess calories

n Exercise

n Maintain a healthy weight

n Stop smoking

What is HDL (high-density lipoprotein)Cholesterol?This type of cholesterol is known as the“good” cholesterol, and is a type of fat in theblood that helps to remove cholesterol fromthe blood, preventing the fatty buildup andformation of plaque.

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n Exercising for at least 20 minutes threetimes a week

n Kicking the cigarette habit

n Avoiding saturated fat intake

n Decreasing body weight

For others, medicine may be needed. Becauseraising HDL is complicated, you should workwith your physician on a therapeutic plan.

Diet 184/07

Checking Your Blood CholesterolLevel:A cholesterol screening is an overall look at,or profile of, the fats in your blood. Screeningshelp identify people at risk of heart disease. Itis important to have what is called a full lipidprofile to show the actual levels of each typeof fat in your blood: LDL, HDL, triglycerides,and others. Consult your physician regardingthe timeliness of this test.

Both Borgess-Pipp Health Center and theBorgess Health and Fitness Center offer opencholesterol screenings for total cholesterol andHDL for a cost of $10. A more complete profileincluding total cholesterol, HDL, LDL andtriglyceride levels is available for just $15.Results are given at the time of testing.CCaallll ttoo sscchheedduullee aann aappppooiinnttmmeenntt aatt eeiitthheerrBBoorrggeessss--PPiipppp HHeeaalltthh CCeenntteerr aatt ((226699)) 668855--00772233oorr BBoorrggeessss HHeeaalltthh aanndd FFiittnneessss CCeenntteerr aatt((226699)) 555522--22220000..

What is a Healthy Blood CholesterolLevel?High blood cholesterol is a significant riskfactor in heart disease. Lowering bloodcholesterol through increased physical activity,weight loss, smoking cessation and properdiet lowers that risk. However, bloodcholesterol is very specific to each individualand, for that reason, a full lipid profile is animportant part of your medical history andimportant information for your physician tohave. In general, health levels are as follows:

n LDL – less than 100 milligrams/perdeciliter (mg/dL). Less than 70, may berecommended by your doctor.

n HDL – less than 40 mg/dL puts youa high risk for heart disease.

n A total cholesterol level below 200mg/dL is considered desirable.

Statistics About Cholesterol:Elevated cholesterol is a risk for many Americans.Consider these statistics:

Approximately 100,870,000 Americanshave total cholesterol levels of 200 mg/dLand higher, which is considered borderlinehigh risk.

About 40,600,000 American adults haveblood cholesterol levels of 240 mg/dL andhigher, which is considered high risk.

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What are Triglycerides?Triglycerides are another class of fat found inthe bloodstream. The bulk of your body’s fattissue is in the form of triglycerides.

Triglyceride Levels and Heart Disease:The link between triglycerides and heart diseaseis under clinical investigation. However, manypeople with high triglycerides also have otherrisk factors such as high LDL levels or lowHDL levels.

What Causes Elevated TriglycerideLevels?Elevated triglyceride levels may be causedby medical conditions such as diabetes,hypothyroidism, kidney disease or liverdisease. Dietary causes of elevatedtriglyceride levels may include obesityand high intakes of fat, alcohol andconcentrated sweets.

A healthy triglyceride level is less than 150 mg/dL.

Diet 204/07

HEART-HEALTHY EATINGTO LOWER CHOLESTEROL

Why Lower Cholesterol?You hear it all the time: “Watch your cholesterol!”Our bodies do need some cholesterol, but toomuch can be harmful. That’s why we need tokeep it at a healthy level.

Cholesterol is a fat-like substance. It can buildup on the walls of blood vessels and block theflow of blood. That can lead to a heart attackor a stroke. But you can take steps to loweryour cholesterol and help your heart!

A diet high in saturated fat, trans fat, andcholesterol can raise your blood cholesterol tounhealthy levels. It helps to cut down on eggyolks, high-fat meats, fried foods, and full-fatmilks and cheeses. Other things can affectyour cholesterol. These include your age, sex,weight, genes, and how active you are.

First, Get Your Cholesterol CheckedThere are two types of cholesterol: LLDDLL —the “bad” kind that builds up in your bloodvessel — and HHDDLL — the “good” kind thattakes the “bad” kind away.

Recommended levels:

n Total Cholesterol . . . . . less than 200

n HDL. . . . . . . . . . . . . . . . 35 and above

n Triglycerides . . . . . . . . less than 200

n LDL . . . . . . . . . . . . . . . . less than 100

Your cholesterol level is checked by a bloodtest. You can get numbers for your totalcholesterol, your HDL, your LDL, and yourtriglycerides (another kind of blood fat). Ingeneral, your total number should be under200. If it is 200 or above, your doctor willprobably want to know what the other levelsare and watch them closely.

For women, it appears that a low HDL leveland a high triglyceride level are more likelyto predict heart disease than the LDL level.

You and your doctor can decide what yourgoals should be, based on your risk factors.

A Heart-Healthy DietIf your cholesterol is in the desirable range,great! Your goal is to keep it that way. Eat ahealthy diet, get regular exercise, and stay atyour best weight. That’s probably what youhave been doing all along.

If you need to lower your cholesterol, a dietlower in saturated fat and trans fat can helpyou do that. Eat plenty of whole grains,vegetables, and fruits.

Diet 214/07

Where Are Saturated Fat AndTrans Fat Found?SSaattuurraatteedd ffaatt is found in fatty meats andfull-fat dairy products. Coconut and palmoils also have saturated fat.

TTrraannss ffaatt is found in deep-fried foods andstore-bought baked goods and fried snacks.Oils that have been hardened (like solid whiteshortening) are high in trans fat. Use liquidoil instead, when you can. Tub or liquidmargarine is lower in trans fat than most stickmargarines. If you do use stick margarine,choose one that lists liquid oil as the firstingredient.continues

Cholesterol in food you eat also raises cholesterollevels in your body. Cholesterol is found onlyin foods that come from animals, like eggs,meat, and milk. So choose low-fat or fat-freeversions of these foods. Eat egg whites insteadof the whole egg.

YYoouu ccaann hheellpp lloowweerr yyoouurr cchhoolleesstteerrooll wwiitthh aaddiieett tthhaatt iiss::

n Low in saturated fat and trans fat.Avoid full-fat milk and cheese, butter,fried food, and high-fat meat, sauce, andgravy. Use tub or liquid margarine insteadof stick. Avoid solid white shortening.

n Low in cholesterol.Cut back on animal products. Avoid eggyolks. Try beans or soy foods instead of meat.

n Rich in fiber and whole grains.Eat five or more fruits and veggies eachday. Eat whole wheat breads and pastas,brown rices, and whole-grain cereals.

Your doctor or dietitian can help you create aheart-healthy eating plan to suit your tastesand lifestyle. There are easy ways you can cutfat from your diet and help lower cholesterol.

What About Pills?Some people try diet and lifestyle changesand still cannot lower their cholesterol. Inthose cases, a drug that lowers cholesterolmay be prescribed by the doctor. It is stillimportant to eat heart-healthy foods, getsome activity, and stay at a healthy weightwhen taking these drugs. This can helpreduce the amount of medicine needed.

Diet 224/07

Diet 234/07

DECREASE THE RISK OF CORONARY ARTERY DISEASE

EAT THESE

n Choose fish, shellfish, chicken and turkeywithout skin, lean beef, pork, veal and lamb.

n Acceptable beef cuts include: flank, round,sirloin, tenderloin, ground round, chuck roast,rump roast and stew meat.

n Trim all visible fats before cooking(including skin off poultry and fish).

n Place meats on a rack to allow fats to dripoff while cooking.

n Bake, roast, broil, stew, poach, steam, braise,grill, microwave or stiry fry with little or noadded fat.

n Limit meat, chicken and fish to 6 ounces per day.

n Try more meatless meals with rice or otherlegumes and grains. (example: kidney, garbanzo,pinto, lentil, great northern, split pea)

n Choose non-fat dairy products: 1/2%, 1%, orskim milk, non-fat cottage cheese, cheese madefrom partly skim milk, mozzarella, buttermilk,non-fat yogurt, non-fat sour cream and non-fatcream cheese.

n Limit egg yolks to two per week.

n Use egg whites or commercial egg substitutesinstead of whole eggs. (can substitute 2 eggwhites for 1 whole egg for baking purposes,or use 1/4 cup egg substitute).

n Choose cheeses that are made for skim milk orwhose labels say they have less than 5 grams offat per ounce.

n Sherbet, frozen yogurt, fudge bars, popsicles, andice milk are all good alternatives to ice cream.

INSTEAD OF THESE

n Avoid deep fried meats, poultry and fish, aswell as high fat or marbled meats, such asduck, goose, hot dogs, sausage, bacon,luncheon meats, cold cuts, canned stewsor hash, prime ribs, regular hamburger.

n Avoid organ meats: liver, heart, brain, kidneyand gizzards

n Avoid breading or flouring foods beforebrowning – bread and flour absorbs fat.

n Avoid whole milk products: whipped cream,half & half, cream, whole milk, evaporated orcondensed milk, hard cheeses, cream cheesesour cream.

n Avoid non-dairy creamers, whipped toppingsmade with saturated fats, puddings made withwhole milk, and ice cream.

DAIRY PRODUCTS AND EGGS (2 - 3 servings)

In order to decrease the risk of coronary artery disease eat wisely - lower yourintake of cholesterol, saturated fat and total fat.

your fat intake is: _______ grams of fat/day your cholesterol intake is: _______ milligrams/day

MEAT, FISH AND POULTRY (2 - 3 servings)

Diet 244/07

DECREASE THE RISK OF CORONARY ARTERY DISEASE

EAT THESE

n Choose any of the following polyunsaturatedoils in moderation: safflower, sunflower, corn,soybean and cotton seed oil.

n Choose non-stick sprays or pump margarine.

n In small amounts use Monounsaturated fats,such as peanut oil, olive oil or canola oil.

n Select soft tub margarine with oil as the firstingredient.

n Choose salad dressings and mayonnaise thatcontain polyunsaturated oils, or choose the fatfree variety.

n Choose cereals, cooked or dry, at breakfast,and for quick snacks.

n Plain pasta, noodles (except for egg noodles),rice, dried beans and peas are low in saturatedfat and cholesterol. Prepare them with acceptableingredients such as margarine and low fat sauces.

n Try to use foods rich in fiber. Bran cereal, wholewheat breads, 7 grain cereal, whole cookedgrains like millet, barley, oats couscous, andbulgar.

INSTEAD OF THESE

n Avoid these saturated fats: butter, lard, shortening,chocolate, coconut, coconut oil and palm oil.

n Avoid foods made with any of the above as amajor ingredient.

n Avoid deep fried foods.

n Avoid breads that contain a higher proportionof saturated fat: biscuits, croissants, crescentrolls, danish pastries, cheese and egg breads,fruit breads and muffin.

n Avoid granola cereals that are made withsaturated fat.

n Avoid crackers and snack foods with more than3 grams of fat per ounce.

STARCHES AND BAKED PRODUCTS (6 - 11 servings)

VEGETABLES AND FRUITS (5 or more servings daily)

FATS AND OILS (use sparingly)

n Include any fruit or vegetables prepared without fat daily.

n Avoid vegetables in butter, cream or cheese sauces or those prepared with saturated fats.

COOKING UP LOWERBLOOD PRESSURE

High blood pressure can sneak up on you.Most people who have high blood pressuredo not feel sick. But if high blood pressure isnot lowered, it can lead to a heart attack or astroke. It also can damage the kidneys and theeyes. That is why it is important to get yourblood pressure checked at least once a yearand to keep it in the healthy range.

Blood pressure is given as two numbers.AA rreeaaddiinngg aabboovvee 114400 oovveerr 9900 iiss ttoooo hhiigghh.A healthy level often can be reached withouttaking medicine. See the “recipe” for lowerblood pressure below. If you do not have highblood pressure, these guidelines can help youprevent it.

Recipe For Lower Blood Pressuren Eat 8-10 servings of fruit and vegetables

each day.

n Eat 7-8 servings of grains each day.Choose whole grains often.

n Eat 2-3 servings of foods high in calcium,such as low-fat dairy products, each day.

n Keep your diet moderate in fat.

n If you are overweight, losing just 10pounds can help lower your blood pressure.

n Get some physical activity each day. Aimfor 30 minutes, or 10 minutes three timesa day.

n Cut back on processed foods and otherfoods high in sodium.

n Limit alcohol.

The Main Ingredient: Fruits, Veggies,and GrainsChances are the servings of fruits, vegetables,and grains listed above may be more than youare used to eating. If so, increase these foodsin your diet one serving at a time.

n Add another serving of a fruit ora vegetable.

n Have whole-wheat bread instead of white.

n Choose fresh or canned fruit at snack time.

Increase your intake of vegetables and grainsby making them the main event. Eat meatlessmeals more often. Put beans and rice, pasta,vegetable lasagna, or vegetable stir-fry onyour weekly menus.

Trim The FatTo reduce fat in your diet, replace fatty foodswith less fatty foods.

n Look for low-fat or nonfat milk, cheese,yogurt, and sour cream.

n For protein, eat cooked dry beans often.When you eat meat, choose fish, poultry,and lean cuts of meat.

n Broil, grill, bake, or roast meat insteadof frying. Cook ground meat and thenrinse it under hot water before using itin the recipe.

n To avoid sauces and dressings that arehigh in fat, season food with herbs andspices instead.

n Try to use half the margarine or butteryou use now. Use spray margarine.

Diet 254/07

EEaatt aallll tthhee ffrruuiittss aanndd vveeggeettaabblleess yyoouu wwaanntt!!Whole-grain pastas, breads, and cereals aregood for your heart, too.

If you crave something crunchy at snack time,have plain popcorn, graham crackers, orpretzels. Feel like something cold or creamy?A Popsicle, Jello, sherbet, or low-fat icecream or yogurt may do the trick. Crispveggies with a low-fat dip make a good snackpacked with nutrients. A small serving ofdried fruit is sweet, chewy, and high innutrients, but low in fat.

Move A Little, Lose A LittleLosing even a little weight helps a lot. If youare overweight, dropping just 10 pounds canbring your blood pressure into the healthy range.

Being more active helps the pounds come off.Try to be physically active in some way everyday. Work your way up to 30 minutes a day.It does not have to be done all at once. Youcan break it up into 10 minutes at a time ifyou like. Do something you enjoy so it canbecome a part of your lifestyle, not just aquick fix. Buddy up with a friend or familymember to make it more fun.

Just moving around more helps! Lose theremote and get up to change the TV channel.Take the stairs. Walk the mall.

Paired with your healthy diet, a little exerciseeach day can keep you at a healthier weight.You’ll look good and feel great.

Choose Low-Sodium FoodsCutting back on sodium may help your bloodpressure. We need only a small amount ofsodium in our diet, and we usually eat morethan we need. Most of the sodium we eatcomes from foods we do not prepare ourselves.These are foods like frozen dinners, packagedmixes, canned and dry soups, cold cuts, cannedvegetable juices, white breads, and snacks likechips, salted nuts, cakes, cookies, and somecheeses. Restaurant foods are high in salt. Eatless of these foods.

Using foods that are fresh and preparing themyourself when possible can help you controlyour salt intake.

What About Alcohol?You may have heard that a glass of red wineeach day can help your heart. But if you havehigh blood pressure and you do not drinknow, it is best not to start. Drinking too muchalcohol can raise your blood pressure anddamage the heart, the liver, and the brain.Also, it may be dangerous to drink withcertain medicines. If you do drink, limit itto one serving a day.

Blood Pressure MedicineMild high blood pressure can often becontrolled with diet and exercise. You mayneed medicine to lower very high bloodpressure. But even if you take medicine foryour blood pressure, you still need to eatright and balance your healthy foods withsome physical activity! This can help youneed less medicine.

Diet 264/07

Start Now!You do not need special foods and complicatedmeal plans to lower your blood pressure. Youcan start to lower your blood pressure now byfollowing the guidelines above. Eat a diet richin fruits, vegetables, and whole grains. Keepyour diet moderate in fat. GGeett aa lliittttllee eexxeerrcciisseeeevveerryy ddaayy.. YYoouu’’rree oonn yyoouurr wwaayy!!

NOTES:

Diet 274/07

HOLD THE SALT!

Too Much Salt?Salt – also called sodium and sodium chloride –is an important mineral that helps your bodyfunction. It helps maintain fluid balance inyour body.

The adult body only needs a small amount ofsalt to function properly – about 2,400 milligrams(oorr aabboouutt 11 tteeaassppoooonn) daily. Chances are, youare eating much more than that.

WWhhyy?? Small amounts of salt are found naturallyin many foods. However, salt is often used infood processing. In fact, most of your saltintake probably comes from salt that has beenadded to prepared foods. In addition, peopleoften add salt to their food because they believeit enhances flavor.

Why Is Too Much Salt Bad ForMy Health?There are good reasons to consider reducingyour salt intake.

Extra salt in your diet may lead to hhiigghh bbllooooddpprreessssuurree, which increases your risk of heartdisease, stroke, and kidney damage.

Lowering your salt intake can lower your riskof developing these dangerous conditions.

How Do I Follow A Healthy Low Salt Diet?Fresh, fruits, fresh vegetables, fresh meat,chicken, and fish, fresh eggs, dairy products,and grain products are all part of a healthy,low-salt diet.

Look for low-salt products in the supermarket.Because many people have to reduce their saltintake, many products are made for low-saltdiets. Even foods that usually have a lot ofsalt, such as bacon and peanut butter, havelow-salt versions.

What Foods Should I Avoid?Ask your doctor or dietitian what foods to avoid.

In general, you should not eat:

n Frozen vegetables with sauces

n Pickles, relish, and olives

n Sauerkraut

n Canned vegetables

n Vegetable juices

n Frozen meals

n Lunch meats or deli meats

n Processed meats, such as hot dogsand sausages

n Packaged gravy mixes

n Boxed macaroni and cheese

n Pancake mix

n Biscuit mix

n Instant hot cereal

n Buttermilk

Diet 284/07

n Cheese spreads

n Salted crackers

n Antacids

Also, these products may have a lot of salt:

n Cheese

n Gravy mixes

n Ketchup

n Chili sauce

n Mustard

Look out for these high sodium ingredients:

n Monosodium glutamate

n Sodium chloride

n Sodium benzoate

n Disodium phosphate

n Baking soda

n Baking powder

Other Tipsn Eat a variety of foods in moderate amounts.

n RReeaadd llaabbeellss ccaarreeffuullllyy!! Choose foodswith a moderate amount of salt andsodium.

n Eat freshly prepared foods (rather thanfrozen foods) as often as possible.

n Do not add salt to recipes.

n Do not keep salt on your table. Learnto enjoy the natural flavor of foods!

n Use herbs and spices to flavor food.“Mrs. Dash” is a common favorite.

n Ask your doctor or dietitian about saltsubstitutes. Salt substitutes can be foundnear the spices in your supermarket.

n Increase the amounts of fruits and vegetablesyou eat. These foods have very little salt.They are also very healthy.

n Make small changes in your eating habitsat a time. EEvveennttuuaallllyy,, hheeaalltthhyy eeaattiinngg wwiillllbbeeccoommee ppaarrtt ooff yyoouurr lliiffeessttyyllee!!

Source: Copyright 2000, Aspen Publishers, Inc.Dietitian’s Patient Education Resource Manual Revised

Borgess Blend1/8 tsp. garlic powder1/4 tsp. onion powder1/4 tsp. white pepper powder

2 tsp. paprika1/2 tsp. parsley1/4 tsp. oregano powder1/4 tsp. celery powder1/4 tsp. ground Marjoram1/4 tsp. ground Thyme1/2 tsp. dry Mustard1/4 tsp. basil powder1/4 tsp. curry powder

Diet 294/07

READING FOR GOOD EATING

What The“Nutrition Facts”Label Does:n Creates a single system by which all

products can be compared.

n What nutrient claims about fat really mean:Helps you make better, more informeddecisions about the food you eat.

n Provides uniform definitions for nutrientclaims such as “free,” “light,” “reduced,”“high,” and “good source.”

FFaatt FFrreeee – Less than 0.5 grams of fat perserving. May also be referred to as “nonfat.”

LLooww FFaatt – 3 grams of fat or less per serving.

RReedduucceedd FFaatt – At least 25% less fat perserving than the traditional item. May alsobe referred to as “lower fat.”

LLiigghhtt – At least 33% fewer calories or 50%less fat per serving than the traditional item.

LLeeaann – Less than 10 grams of total fat,4.5 grams of saturated fat, and less than95 mg cholesterol per serving.

EExxttrraa LLeeaann – Less than 5 grams of total fat,2 grams of saturated fat, and less than 95 mgcholesterol per serving.

Adapted from Browne MB. Label Facts for Healthful Ealing.Dayton, Ohio: Mazar Cotp; 199133-38.

Dietary Guidelines For AmericansThe new food label supports the DietaryGuidelines for Americans-seven suggestionsfor a healthful diet from the US Departmentsof Agriculture & Health and Human Services.The % Daily Value on the label allows you tochoose foods to balance your intake of certainnutrients like fat, saturated fat, and cholesterol.Nutrient content claims on the food labelsuch as “high” and “good source” allow youto identify foods high in fiber and vitaminsA and C. Nutrient content claims such as“low fat” and “reduced fat” allow you todecrease the total fat in your diet. The DietaryGuidelines are the following:

n Eat a variety of foods.

n Maintain healthy weight.

n Choose a diet low in fat, saturated fat,and cholesterol.

n Choose a diet with plenty of vegetables,fruits, and grain products.

n Use sugars only in moderation.

n Use salt and sodium only in moderation.

n If you drink alcoholic beverages, do soin moderation.

Diet 304/07

Analyzing The New Nutrition Label

SSeerrvviinnggss ppeerr CCoonnttaaiinneerr :: Refers tothe number of servings included inthe package. This package contains10 frankfurters (hot dogs)

CCaalloorriieess aanndd CCaalloorriieess ffrroomm FFaatt ::Calories measure the energysupplied from food. Caloriesfrom fat reflect the number of fatcalories the product provides perserving, not the percentage ofcalories from fat.

%% DDaaiillyy VVaalluue:: The percent dailyvalues help you see how a food fitsinto a 2,000 calorie reference diet.They tell you if a food contains alittle or a lot of a nutrient. This hotdog only has 2% of the daily value forfat, which is low fat. The overall goalis to attain 100% of your daily valuethroughout the day by eating a varietyof foods.

CCaalloorriiee CCoonnvveerrssiioonn IInnffoorrmmaattiioonn::Reflects the number of calories pergram provided by carbohydrate, fat,and protein. Notice that fat containsmore than twice the calories pergram (9 calories) than carbohydrateor protein (4 calories).

Diet 314/07

NNeeww TTiittllee:: Indicates theproduct carries with the 1990nutrition labeling and the newlabel information established –L Education Act.

SSeerrvviinngg SSiizzee:: Serving size isnow based on the amount mostcommonly eaten.

TToottaall FFaatt:: The amount of fatincluded in each serving (in grams).It is recommended that your overalldiet, not necessarily any one fooditem, contain no more than 30% ofcalories from fat on average.

NNeeww RReeqquuiirreedd NNuuttrriieennttss ::Reflect the current public healthemphasis. New required nutrientsinclude saturated fat, cholesterol,sodium, dietary fiber, and sugars.

DDaaiillyy VVaalluueess FFoooottnnoottee:: Dailyvalues reflect current nutritionrecommendations. The two listingsshow daily values for both 2,000and 2,500 calorie diets. For example,the daily value for fat is 65 gramsfor 2,000 calories and 80 gramsfor 2,500 calories. Of course, yourindividual calorie needs may vary.Remember, the percent daily valuesare based on a 2,000 calorie diet.

Nutrition FactsServing Size One Hot Dog (45 g)Servings Per Container 10

Amount per Serving

Calories 45 Calories from Fat 15

% Daily Value*

Total Fat 1.5 g 2%

Saturated Fat 1 g 5%

Cholesterol 15 mg 5%

Sodium 430 mg 18%

Total Carbohydrate 2 g 1%

Dietary Fiber 0 g 0%

Sugars 2 g

Protein 5 g

Vitamin A 0% • Vitamin C 8%

Calcium 0% • Iron 2%

*Percent daily values are based on a 2,000calorie diet. Your daily values may be higheror lower depending on your calorie needs:

Calories: 2,000 2,500Total Fat Less than 65g 80 g

Sat Fat Less than 20 g 25gCholesterol Less than 300 mg 300 mgSodium Less than 2,400 mg 2,400 mgTotal Carbohydrates 300 g 375 g

Dietary Fiber 25g 30 g

Calories per gram:Fat 9 • Carbohydrate 4 • Protein 4

Above information was taken froman actual product label.

Diet 324/07

NUTRITION COUNSELING

Individual nutrition counseling isavailable with Borgess RegisteredDieticians. For an appointment, callCentral Scheduling at 269.226.6999..

The BBoorrggeessss LLiigghhtt HHeeaarrtteedd CCooookkbbooookkis available for your reference at the:

Borgess Gift Shop269.226.7380

Borgess Public Relations269.226.4878

Borgess Food and Nutrition Office269.226.5945

HOW ACTIVE SHOULD I BE?

Once you have returned home, you shouldbe able to increase your activity a little bitevery day. Pace your activity throughoutthe day. Your surgeon recommends a cardiacrehabilitation program, much like the oneoffered at the Borgess Health & FitnessCenter. Call the Borgess Cardiac Rehab Centerat 269.552.2200 for more information aboutBorgess programs available in your community.Walking is the best form of exercise andshould be done with a friend or spouse. Incold weather, walking inside at a school orshopping mall is preferred. (You may be ableto find a school or shopping mall that offersa set time for walkers). In temperatures ofabout 50 degrees, you may walk outside.Rest for 30 minutes after meals before doingyour exercises/walking.

Please make sure you get eight to nine hoursof sleep a day. In addition to that, two dailynaps up to an hour each are encouraged.

SSttoopp aannyy aaccttiivviittyy iimmmmeeddiiaatteellyy iiff yyoouu ffeeeell sshhoorrttooff bbrreeaatthh,, nnoottiiccee iirrrreegguullaarr hheeaarrttbbeeaattss,, ffeeeellffaaiinntt oorr ddiizzzzyy,, oorr yyoouu hhaavvee cchheesstt ppaaiinn.. RReessttuunnttiill tthhee ssyymmppttoommss ssuubbssiiddee.. IIff tthheeyy ddoo nnoottssuubbssiiddee wwiitthhiinn 2200 mmiinnuutteess,, nnoottiiffyy yyoouurr ddooccttoorr..

Activity 334/07

WHEN TO RESUME USUAL ACTIVITIES

Activity 344/07

Weeks 1 to 4

Light housekeeping:n Dustingn Setting the tablen Washing dishesn Folding clothes

Light gardening:n Potting plantsn Trimming flowers

Cooking meals

Climbing stairs

Church

Passenger in car

Shampooing hair

After 3 to 4 Months

Continue activitiesfrom week 1 to 3 months(but you may be able totolerate more)

Heavy housework:n Scrubbing floors

Heavy gardening:n Shoveling snown Rakingn Diggingn Mowing

Walking dog on leash

Sports:n Football/soccern Tennisn Softball/baseballn Bowlingn Golfingn Huntingn Weight liftingn Joggingn Motorcycle riding n Bicyclingn Water skiingn Push-upsn Skydivingn Swimmingn Fishingn Light aerobicsn Boatingn Horseback riding

After 4 Weeks orDischarge by Surgeon

Continue activities of weeks1 to 4 (but you may be ableto tolerate more)

Return to work part time ifapproved by your surgeon

Heavy housework:n Vacuumingn Sweepingn Laundryn Ironing

Walking on treadmill orusing stationary bike

Business or recreationaltravel (follow weightrestriction with luggage)

Driving a car or small truck

RISK FACTOR REDUCTION

What Are Risk Factors For HeartDisease?There are two main categories of risk for heartdisease — uncontrollable and controllable.

UUnnccoonnttrroollllaabbllee RRiissee FFaaccttoorrss are basicallyhereditary. They include:

n Gender — men are more likely to sufferfrom heart disease uunnttiill the age of 55when menopause and less estrogen makea woman’s risk increase to equal the riskof men.

n Age — risk increases as you age.

n Family history — your risk is greater ifyou have a father or brother with heartdisease before age 55, or a mother orsister with heart disease before age 65.

n Diabetes — although diabetes can beinherited, it is also often brought onby lifestyle and obesity, and it can becontrolled to lower the risk of onsetof heart disease.

CCoonnttrroollllaabbllee RRiissee FFaaccttoorrss are related tolifestyle choices. At the tope of the Centersfor Disease Control and Prevention’s list ofprimary risk factors for all chronic diseasesare smoking, poor nutrition and sedentarylifestyle.

Living a healthier lifestyle can help preventheart disease. A healthy lifestyle includes

n Following a heart-healthy diet

n Following a regular exercise program

n Eliminate all tobacco products

Further detailed information on healthy lifestylechanges are included in this notebook.

Risk Factor Reduction 354/07

SMOKING

Most people associate cigarette smokingwith breathing problems and lung cancer.But did you know that smoking is also amajor cause of heart and vascular diseasefor men and women?

About 30 percent of all deaths from heartdisease in the U.S. are directly related tocigarette smoking. That is because smokingis a major cause of coronary artery disease.

A person’s risk of heart attack greatlyincreases with the number of cigarettes he orshe smokes. Smokers continue to increasetheir risk of heart attack the longer theysmoke. People who smoke a pack ofcigarettes a day have more than twice the riskof heart attack than non-smokers. Womenwho smoke and also take birth control pillsincrease several times their risk of heartattack, stroke and peripheral vascular disease.

Cigarette smoke not only affects smokers,when you smoke, the people around you arealso at risk for developing healthy problems,especially children. Environmental tobaccosmoke (also called passive smoke or second-hand smoke) affects people who arefrequently around smokers. Second-handsmoke can cause chronic respiratoryconditions, cancer and heart disease.

How Does Smoking Increase the Riskof Heart Disease?The nicotine present in smoke causes

n Decreased oxygen to the heart

n Increased blood pressure and heart rate

n Increase in blood clotting

n Damage to cells that line coronary arteriesand other blood vessels

How Can Quitting Smoking Be Helpful?Now that you know how smoking can beharmful to your health and the health of thosearound you, here are some ways quitting canbe helpful. If you quit smoking you will:

n Prolong your life

n Reduce the risk of disease, includingheart disease, heart attack, high bloodpressure, stroke, vascular disease, lungcancer, throat cancer, emphysema, ulcers,gum disease and other conditions

n Feel healthier — after quitting, you won’tcough as much, you’ll have fewer sorethroats and you will increase your stamina

n Look better — quitting can help youprevent face wrinkles, get rid of stainedteeth and improve your skin

n Improve your sense of taste and smell

n Save money

Risk Factor Reduction 364/07

HHooww ttoo QQuuiittThere’s not one way to quit smoking that worksfor everyone. To quit, you must be ready bothemotionally and mentally. You must also wantto quit smoking for yourself — not to pleasefamily or friends. It helps to plan ahead. Thisguide may help you get started.

What Should I Do First?n Pick a date to stop smoking and then

stick to it

n Write down your reasons for quitting.

n Read over the list every day, before andafter you quit. Here are some tips tothink about.

– Write down when you smoke, whyyou smoke and what you are doingwhen you smoke. Your will learnwhat triggers your to smoke.

– Stop smoking in certain situations(such as during your work break orafter dinner) before actually quitting.

– Make a list of activities you cando instead of smoking. Be ready todo something else when you wantto smoke.

– Ask your health care provider aboutusing nicotine gum, patches orlozenges. Some people find theseaids helpful.

–Join a smoking cessation supportgroup or program. CCaallll yyoouurr llooccaallcchhaapptteerr ooff tthhee AAmmeerriiccaann LLuunnggAAssssoocciiaattiioonn oorr tthhee MMiicchhiiggaannTToobbaaccccoo QQuuiitt lliinnee aatt 11--880000--448800--QQuuiitt

How Can I Avoid Relapsing?n Don’t carry a lighter, matches or

cigarettes. Keep all smoking remindersout of your life.

n If you live with a smoker, ask that personnot to smoke in your presence.

n Don’t focus on what you are missing.Think about the healthier way of lifeyou are gaining.

n When you get the urge to smoke, take adeep breath. Hold it for 10 seconds andrelease it slowly. Repeat this severaltimes until the urge to smoke is gone.

n Keep your hands busy. Doodle, play witha pencil or straw or work on a computer.

n Change activities that were connectedto smoking. Take a walk or read a bookinstead of taking a cigarette break.

n When you can, avoid places, people andsituations associated with smoking. Hangout with non-smokers or go to places thatdon’t allow smoking, such as the movies,museums, shops or libraries.

Risk Factor Reduction 374/07

n Don’t substitute food or sugar-basedproducts for cigarettes. Eat low-calorie,healthy foods, such as carrot or celerysticks, sugar-free hard candies or chewgum when the urge to smoke strikes soyou can avoid weight gain.

n Drink plenty of fluids, but limit alcoholicand caffeinated beverages. They cantrigger urges to smoke.

n Physical activity. Exercising will helpyou relax.

n Get support for quitting. Tell others aboutyour milestones with pride.

n Work with your doctor to develop a planusing over-the-counter or prescriptionnicotine-replacement aids.

How Will I Feel When I Quit?You may crave cigarettes, be irritable, feelvery hungry, cough often, get headaches orhave difficulty concentrating. These symptomsof withdrawal occur because your body isused to nicotine, the active addicting agentwithin cigarettes.

When withdrawal symptoms occur within thefirst two weeks after quitting, stay in control.Think about your reasons for quitting. Remindyourself that these are signs that your body is

healing and getting used to being withoutcigarettes. The withdrawal symptoms are onlytemporary. They are strongest when you firstquite bit will go away with 10 to 14 days.Remember that withdrawal symptoms areeasier to treat than the major diseases thatsmoking can cause.

You may still have the desire to smoke sincethere are many strong associations withsmoking. People may associate smoking withspecific situation, with a variety of emotionsor with certain people in their lives. The bestway to overcome these associations is toexperience them without smoking. If yourelapse, do not lose hope. Seventy-five percentof those who quit smoke again. Most smokersquite three times before they are successful. Ifyou relapse, don’t give up! Plan ahead andthink about what you will do next time youget the urge to smoke.

Risk Factor Reduction 384/07

MEDICATION

What Medications Am I Taking?TTaakkiinngg yyoouurr mmeeddiiccaattiioonn aass pprreessccrriibbeedd iiss oonneeooff tthhee bbeesstt tthhiinnggss yyoouu ccaann ddoo ffoorr yyoouurrsseellff..You may begin with only one or twomedications and then have more added later. Itis not uncommon to start with more than oneeither. It may take days or even many weeksto find the right doses or combination ofmedicines that work best for you. Don’t bealarmed if your doctor makes a few changesalong the way.

TTaakkee tthhee mmeeddiiccaattiioonn aass iinnssttrruucctteedd.. Skippingdoses, letting your pills run out or stopping onyour own can cause serious problems. Do notstop taking any pills or take extra pills withoutchecking with your doctor.

AAnnyy mmeeddiicciinnee ccaann hhaavvee ssiiddee eeffffeeccttss.. Be sureto tell your doctor right away if you think youare having problems.

BBee ssuurree ttoo tteellll yyoouurr ddooccttoorr aabboouutt aallllmmeeddiiccaattiioonnss yyoouu aarree ttaakkiinngg, including thosefor other problems like diabetes, high bloodpressure, emphysema or kidney disease.

TTaallkk ttoo yyoouurr ddooccttoorr oorr pphhaarrmmaacciisstt bbeeffoorreettaakkiinngg hheerrbbaall pprroodduuccttss,, ssuupppplleemmeennttss,, oorr oovveerr--tthhee--ccoouunntteerr mmeeddiiccaattiioonnss.. Many over-the-counter products and supplements haveingredients similar to medication and somecombinations are dangerous.

KKeeeepp aann uuppddaatteedd,, ccoommpplleettee lliisstt ooff yyoouurrmmeeddiiccaattiioonnss wwiitthh yyoouu aatt aallll ttiimmeess.. When youtravel keep your medications with you—not ina suitcase.

IIff yyoouu ccaannnnoott aaffffoorrdd yyoouurr mmeeddiiccaattiioonnss,, tellyour health care provider. Help may be available.

DDoonn’’tt rruunn oouutt ooff aannyy mmeeddiicciinnee.. Get a refill aweek or two before you run out.

WWhheenn aa nneeww mmeeddiicciinnee iiss ssttaarrtteedd,, aasskk ffoorr ttwwoowweeeekkss ooff ssaammpplleess or ask that the pharmacyonly fill two weeks worth of the prescription.If you don’t tolerate the new medicine,you won’t waste a full prescription. If themedicine works, you can always fill the restof the prescription.

IIff iitt iiss ppoossssiibbllee,, ttrryy ttoo uussee tthhee ssaammee pphhaarrmmaaccyyffoorr aallll yyoouurr pprreessccrriippttiioonnss.. This will increasethe chance of the pharmacist finding drugs thatare dangerous when used together, repeatedmedicines and other problems.

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CCoommmmoonn MMeeddiiccaattiioonnss AAfftteerrOOppeenn HHeeaarrtt SSuurrggeerryy

Beta BlockersBeta blockers provide a combination of effectsto protect the heart from being over-stimulatedby adrenalin. Adrenalin can cause the heartto work too hard, have fast, irregular beatsor increase blood pressure.

Beta blockers decrease the workload of theheart and improve how it pumps during restand exercise. These drugs are used before andafter heart surgery to keep the rhythm regularand prevent or treat atrial fibrillation.

Beta blockers are proven to help people withmany types of heart disease to live longer.

It is common to feel worse (sad, tired, problemswith sex) before you feel better when betablockers are started. This usually clears in amatter of weeks.

Do not stop taking a beta blocker withoutyour doctor’s help or instruction. Your heartcan react to a sudden stop of a beta blockerby increasing its speed or workload, whichcan be dangerous.

CCaallll yyoouurr ddooccttoorr iiff yyoouu tthhiinnkk yyoouu aarree hhaavviinnggaannyy ooff tthheessee ssiiddee eeffffeeccttss::

n Dizziness

n Low heart rate (less than 60 per minute)

n Shortness of breath that keeps gettingworse

n Wheezing

n Tiredness that keeps you from all activities

Angiotensin Converting EnzymeInhibitors (ACE-I)AACCEE--II are used when there has been damageto the heart muscle, and the pumping abilityof the heart has been weakened. This is usuallyfrom heart attack or other damage before openheart surgery. ACE-I are also used to controlblood pressure. They have the following actions:

n Relaxes arteries to make it easier for theheart to pump blood forward.

n Increases blood flow to the kidneys tohelp clear fluid.

It is common to increase the dose of ACE-Iover time. You may feel worse for a littlewhile, but usually feel better after a coupleof weeks.

Blood tests may be ordered to measure levelsof kidney function and potassium.

CCoommmmoonn ssiiddee eeffffeeccttss tthhaatt yyoouu sshhoouulldd rreeppoorrttttoo yyoouurr ddooccttoorr aarree::

n Cough

n Rash

n Swelling of the tongue, face or difficultyswallowing

n Dizziness

n Low blood pressure (less than 90 for thetop number)

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VasodilatorsVasodilators may be used to relax bloodvessels, or decrease blood pressure if youcannot take an ACE-I or your doctor hasdetermined another drug is better for you.

Common vasodilators are nitroglycerin ina patch or pill (such as Imdur), Angiotensin-Receptor Blockers (Cozaar or Diovan), andhydralazine.

SSiiddee eeffffeeccttss yyoouu sshhoouulldd rreeppoorrtt ttoo yyoouurrddooccttoorr iinncclluuddee::

n Rash or skin irritation

n Dizziness

n Low blood pressure (less than 90)

DiureticsDiuretics are also called “water pills” becausethey make the kidneys get rid of water throughurination. Getting rid of extra water makesyour weight go down (or keeps you fromgaining water weight).

Not everyone has to take a diuretic – yourdoctor will decide if you need a diuretic todecrease or prevent water retention.

Using diuretics can cause your body to losepotassium and other electrolytes. You may beasked to take a potassium replacement tocounteract this effect.

Side Effects of Diuretics Include:n Leg cramps

n Dizziness or lightheadedness

n Skin rash

DigitalisDigitalis (also called Lanoxin) may help theheart to pump more strongly and regularly.

Digitalis is also used to control a rapid orirregular heartbeat.

Digitalis is usually added after ACE Inhibitorsand Beta Blockers, but in some cases, is usedwithout these drugs.

NNoottiiffyy yyoouurr ddooccttoorr iimmmmeeddiiaatteellyy iiff yyoouueexxppeerriieennccee aannyy ooff tthheessee ssiiddee eeffffeeccttss::

n Confusion

n Changes in vision – seeing yellow or green

n Nausea and vomiting

n Slow pulse (heart rate)

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MEDICATION SCHEDULE

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MEDICATION SCHEDULE

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[Section 8]

Home Health

(Leave this section blank—home healthprovider (hopefully Borgess) inserts patientinformation.)

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CARDIAC REHABILITATION

WWhhaatt iiss CCaarrddiiaacc RReehhaabbiilliittaattiioonn??A cardiac rehabilitation program is designedto meet the needs of the individual patient,depending upon the specific heart problem ordisease, and supervised by a cardiac physicianand a team of cardiac professionals.

The goal of cardiac rehabilitation is to helpyou reverse your symptoms and maximizecardiac function. Cardiac rehabilitation includes,but is not limited to, the following activities:

n Establishing a progressive exerciseprogram to build fitness and functionalcapacity

n Providing educational classes to helpadjust to or change lifestyle and habits,such as:

– Smoking cessation classes

– Nutrition classes

n Offering stress management techniquesand techniques to reduce anxiety

n Counseling and educating you about yourspecific heart condition/disease and thebest way to manage that specific condition.

n Preparing you to return to work – ifappropriate – able to meet the physicaland psychological demands of the job.

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Why Should I Go?

Cardiac rehabilitation is your first step torecovery. Our team of professionals willgently lead you through our comprehensiveprogram with two goals in mind

n Provide you with a safe, individualizedexercise program.

n Educate you and your family membersabout heart disease and how to reduceyour risk factors.

Throughout your rehabilitation process, ourteam will offer encouragement and supportevery step of the way. While in rehabilitation,you will have the opportunity to attendhealth-specific classes on important topics,including stress, heart disease risk factors,medications, exercise and nutrition. In addition,you will have a personalized appointmentwith a dietitian.

Class StructureMonitored cardiac rehabilitation sessions areheld on Monday, Wednesday and Friday. Youwill be monitored continuously on a heartmonitor during your exercise sessions. Wewill also take your blood pressure frequentlyand assess your needs while you exercise.

What Should I Bring?During your initial orientation, a registerednurse will evaluate you. We will obtain yourmedical history and assess your individualhealth needs. Please bring a list of yourmedications to the orientation. This will helpin hour initial health assessment.

What is the Cost?Cardiac rehabilitation is a Medicare-coveredbenefit. Private insurance companies willreimburse according to your policy.

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ADDITIONAL RESOURCES

CCoommmmuunniittyy RReessoouurrccee LLiissttffoorr CCaarrddiiaacc SSuurrggeerryy

Borgess Visiting Nurse269.343.1396

Borgess Cardiac Rehabilitation269.552.2200

Borgess LaboratoryGull Road site269.226.5917

Woodbridge269.324.8473

BBoorrggeessss PPhhaarrmmaaccyy269.226.8336

BBoorrggeessss NNuuttrriittiioonn SSeerrvviicceess269.226.8336

Smoking Cessation SupportIntegrative Medicine (acupuncture, hypnosis)269.552.2282

DeLano Outpatient Clinic269.226.5600

Borgess Center for Diabetes Care269.226.8321

Borgess Spiritual Care269.226.4898

Websites/Resourceshttp://www.borgess.com www.borgess.com

http://www.emedicine www.emedicine

http://www.americanheart.orgwww.americanheart.org

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