How to prepare for an office consultation
When you arrive for your initial consultation, we will collect your full medical history, current medications and dosages, tests that have been performed and any history of aortic disease in your family.
There are several pieces of information to have available, which will help when discussing treatment of aortic disease:
- Have you been told that you have a dilated aorta, aneurysm or dissection?
- On what part of the aorta is the aneurysm or dissection located?
- What is the size of the aneurysm?
- Do you have any relatives who have had an aneurysm or dissection?
- Have you experienced any chest pain or back pain?
- Do you have a heart murmur or any problems associated with the valves of your heart?
- Are you taking any blood thinners or medications for high blood pressure?
Please bring a complete and accurate list of all your current medications and dosages.
If there have been previous tests preformed, such as CT or MRA of the aorta, cardiac catheterization or heart echo, please bring all reports with you and the actual pictures saved on a CD or a USB thumb drive.
A nurse practitioner/physician's assistant (NP/PA) and office staff will get all this information into your chart. Our office stays in close communication with referring doctors; however, it is important that you verify all of the information we receive. The office staff will assist you in the scheduling of additional tests that may be required to complete your evaluation.
How to prepare before surgery
Prior to your pre-surgical testing, you will need to have your dentist provide a dental clearance. On most occasions, antibiotics are prescribed as a protective measure.
Pre-surgical testing is done one to two weeks before your actual surgery and typically includes:
- Routine blood work
- Studies that may not have been performed by your physician (eg, ultrasound, CT scan)
- Chest X-ray
The nurse practitioner and office staff will help you to arrange your pre-surgical testing and will follow up with the results.
You may be required to stop taking certain medications in preparation for your surgery such as Coumadin, Plavix and aspirin.
Some other drugs may be continued. Please talk with your surgeon or NP/PA about changes to the medications you will take during this time period.
Donating blood for yourself before surgery or medical procedure
An autologous donation is when you donate blood for yourself before having surgery or a planned medical procedure and require a physician prescription. Contact your doctor to find out if you are able to donate blood for yourself. This process should be performed at least 10 days prior to your surgery.
Certain cardiac conditions may prevent you from being eligible for autologous blood donation. These conditions include:
- Cardiac dysrhythmias
- Congestive heart failure
- Unstable angina
- Myocardial infarction or cerebrovascular accident within six months of donation
- High-grade left main coronary artery disease
- Low hematocrit levels – anemia or low iron levels
- Uncontrolled hypertension
- Scheduled surgery to correct aortic stenosis
- Cyanotic heart disease
- Any significant cardiac or pulmonary disease unless cleared for surgery by the physician
If you decide to donate your blood, it is a simple thing to do. The donation process takes about one hour and 15 minutes. The donation itself only takes about eight to 10 minutes on average.
The steps in the process are:
- Registration – You will complete donor registration, which includes information such as your name, address, phone number, and donor identification number (if you have one). You will be required to show a donor card, driver's license or two other forms of identification.
- Health history and mini physical – You will answer some questions during a private and confidential interview about your health history and the places you have traveled. Your temperature, hemoglobin, blood pressure and pulse will be checked and recorded.
- Blood donation – We will cleanse an area on your arm and insert a brand-new, sterile needle for the blood draw. This feels like a quick pinch and is over in seconds. You will have some time to relax while the bag is filling. (For a whole blood donation, it is about eight to 10 minutes. If you are donating platelets, red cells or plasma by apheresis the collection can take up to two hours.) When approximately a pint of blood has been collected, the donation is complete and a staff person will place a bandage on your arm.
- Enjoy refreshments – You will spend a few minutes enjoying refreshments to allow your body time to adjust to the slight decrease in fluid volume.
After 10–15 minutes you can then leave the donation site and continue with your normal daily activities. Enjoy the feeling of accomplishment knowing that you have helped to save lives.
To ensure the safety of blood donation for donors and recipients, all volunteer blood donors must be evaluated to determine their eligibility to give blood. A list of eligibility requirements can be found with the American Red Cross.
What to expect after hospital discharge
Aortic surgery is a major procedure and you will need time to recover your strength. The following are general measures you can take after you leave the hospital.
Notify your cardiologist or primary care physician that you have returned home from hospital. They will oversee the administration of your medications and develop a follow-up management plan for you. Please notify your local physician first about any problems that develop at home.
Some patients are sent home with blood-thinning medication called warfarin or Coumadin. These medications require regular blood tests for INR level (ie, clotting time). INR levels must stay in a certain range to avoid problems such as excessive tendency to bleed. Your cardiologist or primary physician will monitor the INR level and make dose adjustments according to the results. If you are receiving Coumadin, you should follow a specific diet and report immediately any signs of bleeding such as excessive nose bleeds or blood in the urine or stool.
Please call our office if you experience the following:
- Drainage, redness or excessive pain at the surgical incision site
- Temperature greater than 100 for over 24 hours
- Big sudden fluctuations in weight (may indicate fluid retention)
- Persistent swelling in hands or feet
- Heart palpitations (i.e., feeling extra or skipping heart beats)
- Sudden shortness of breath or increasing fatigue with your daily activities
Please do not hesitate to call our office with questions. The office staff and aortic surgery team will address your concerns and make appropriate recommendations.
Try to lead a healthy lifestyle. We advise the following during your three-month recovery period:
- Perform light daily activity. Start walking and moving as soon as possible. Listen to your body and increase your activity as you feel stronger.
- Avoid pushing or pulling or lifting heavy weights. Avoid unnecessary strain.
- Maintain a heart-healthy diet. Eat foods high in fiber and protein and low in sugars and fat. Some people are required to switch to a low salt and low fat diet. Your cardiologist or primary physician will give you diet instructions, specific to your case.
- Avoid driving for four weeks. People who undergo major cardiac procedures may experience limited flexibility of shoulders, arm and legs because of soreness of their incisions.
- Eat a high-fiber diet and drink plenty of water. Constipation is a frequent complaint after cardiac surgery due to the usage of certain pain medications. Eating high-fiber foods like fruits, vegetables and bran products, and drinking plenty of water can help avoid this problem. Should constipation occur, treatment with laxatives will help.
- Avoid smoking. Protect your heart from harm.
- Avoid elective dental work for three months following surgery. If this is not possible, you must take a course of antibiotics before the procedure. Your cardiologist or primary physician can prescribe the appropriate antibiotic for your case.
Post-surgery follow-up will be within two weeks after you are discharged from the hospital. If there is no concern, a repeat follow-up visit is scheduled approximately four weeks after surgery. Various tests and additional follow-up visits are arranged based on individual needs.
Our team will send a surgical report and recommendations to referring physicians and cardiologists shortly after your hospital discharge.
Caring for your surgical incision
The best way to care for your surgical incision is to use soap and water to wash the area. Rough materials such as sponges are not recommended as they may cause irritation. Daily showers are encouraged. Pat the area dry after showering and avoid lotions or ointments for four to six weeks, or until incision is completely healed.
What to do if you continue to have pain at the incision
It is normal to have pain at the incision site. The soreness may last a month or two after surgery and pain medications can be used during the first couple weeks, after your hospital discharge. The pain typically diminishes with time; however, it may reoccur with increased physical activity, coughing, sneezing or sudden changes in body position. Severe pain that fails to improve or worsening of pain, especially if it associated with redness and discharge, may indicate an infection. If this occurs, please contact our office immediately.