[HSF] Restrictions after aortic surgery

[Tea Acuff]

Yes. I don't understand what the restrictions are for or from where they came. I was reading a list of activities that included opening a car door which was listed as a force of around 15lbs. Does the patient's wife open the door for him? Getting out of bed or off the floor should be a lot more. Guidelines gone awry again, perhaps?

tea


----- Original Message ----
From: "Rwmfglycar at aol.com" <Rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, December 9, 2007 9:03:38 PM
Subject: Re: [HSF] Restrictions after aortic surgery

In a message dated 12/9/2007 2:35:40 P.M. Eastern Standard Time,  
drmitch at cox.net writes:

Colleagues,
A few months ago, I posted a case about a 59yo man that  we did asc. aortic 
aneurysm, posterior LVA, and MVR. He's doing  exceptionally well and tells 
me that in looking back, he had no idea how  bad he really felt compared to 
now. He's back to work and in being very  compliant, he hasn't lifted 
anything heavier than 10#. He'd like to lift  up to 50#, and is looking for 
less exertional work. Any opinions regarding  lifting post op restrictions?
What are you worried about Mitch? Is it the aortic anastamotic line? the  
sternum?How long postoperative is he? Is it temporary hypertension accompanying  
the isometric activity of holding a 50 lb weight against gravity? Having  
searched the literature for information on incision strengths many years  ago 
(don't ask me to find the references) I came to the conclusion that   post op 
weight restrictions were not based on evidence and just told my patients  you can 
do what you like so long as you stop when it hurts. The only incidents   that I 
had were in training:  a big and impatient man gave an almighty  cough in 
front of me and blew his bronchial stump; an obese little man disrupted   his 
guggle to zatch (apologies to James Thurber) midline abdominal incision   with very 
little effort after the skin stitches were removed. But then   examination of 
the edges showed that all the sutures on the left side  encompassed 2 cm of 
tissue and all those on the right hand side 2 to 5 mm. I  never saw anything like 
that happen with incision lines in the heart or great  vessels  I saw a few 
late false aneurysms (all in previously infected  cases). Of course 
osteoporotic sternae can do this early if extra precautions  are not taken in closing, 
but I presume you are talking about patients some  weeks after surgery.
In a similar vein I did not restrict driving because I was worried that   they 
would hurt themselves but rather because pain might interfere with an  
appropriate response to a dangerous situation and result in an accident which  
normally would have been  avoidable.
Bob









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