Your Guide to CardiaSurgeryC - Hartford Hospital Library/Services... · mINImAllY INVASIVe cABG...

Your Guide to

CardiaC Surgery

The Henry Low Heart Center at Hartford Hospital 1

Welcome1.

Welcom

e

In this section you will find:

�»� A�welcome�letter

�»� List�of�key�phone�numbers

�»� Holder�for�important�business�cards

�»� Page�to�record�your�medications

�»� Page�for�your�questions�and�notes

The Henry Low Heart Center at Hartford Hospital 1-1

Welcome

Welcome to The Henry low Heart center at Hartford Hospital.

Wearepleasedyouchoseourcenterforyourheartsurgeryandpledgetodoeverythingwecantomakeyourexperiencecomfortableandyourrecoveryasquickaspossible.

Wewantyoutobeapartnerwithusinmanagingyourhearthealth.Educationiscriticaltohelpingyouunderstandyourindividualheartproblemanditstreatment.Itisquitenormaltohavequestionsaboutwhatwillhappentoyouduringandafteryourheartsurgery.Tohelpyouunderstandtheprocess,wehaveputtogetherthisbinderwichaddressesmanyfrequentlyaskedquestions.

Everyonerespondsdifferentlytosurgery,andtherecoveryfromeachprocedurevariessomewhataswell.Despitethesedifferences,wecanmakesomegeneralizations.

Althoughthisbinderwillbehelpfultoyouandyourfamily,itcannotreplaceourpreoperativeclass.Westronglyencourageyoutoattendthisclasswhichwillreviewalltheinformationyouneedtoknowandaddressanyquestionsyoumighthave.Pleasebringthisbinderwithyoutotheclass.Youshouldalsobringthebinderwithyoutoallyourdoctorandhospitalappointmentsasyourdoctorsorothermembersoftheteammayaddinformationtothebinder.Havingeverythingyouneedinonelocationwillhelpmakeyourexperienceasstress-freeaspossibleforbothyouandyourfamily.

Itisourpledgethatwewilltakegoodcareofyouandcommunicateeffectivelywithyourfamilywhileyouareinthehospitalforyourheartsurgery.

Sincerely,

RobertC.Hagberg,MD

ChiefofCardiacSurgery

Welcome

1-2 The Henry Low Heart Center at Hartford Hospital

cARDIoVAScUlAR

Thoracic and cardiovascular SurgeonsDr. Fusco ............................................... (860) 524-5905Dr. Gallagher ....................................... (860) 525-7181 Dr. Hagberg ......................................... (860) 524-5905Dr. Hammond ..................................... (860) 524-5905 Dr. Humphrey ..................................... (860) 525-7181 Dr. Preissler .......................................... (860) 524-5905 Dr. Takata .............................................. (860) 525-7181Dr. Underhill ........................................ (860) 524-5905

cardiac Surgical Program coordinator

Mary Kate Parker ................................ (860) 545-5478In-house ......................................................... ext. 55478

or Pager 2169Assessment Center ........................... (860) 545-5355 Nurse Manager ................................... (860) 545-3700Appointments for Preoperative Testing ....................... (860) 545-2334

cardiac Rehabilitation

Hartford Hospital ............................... (860) 545-2133Farmington Valley ............................. (860) 674-8509Glastonbury Wellness Center ........ (860) 633-9084West Hartford, Blue Back Square .. (860) 570-4571

GeNeRAl INFoRmATIoN

Hartford Hospital Operator ............ (860) 545-5000Financial Assistance .......................... (860) 696-6010 Patient Relations ................................ (860) 545-1400

...........................or (888) 515-5544 Admitting/Patient Accounts .......... (860) 545-2730 Pastoral Care........................................ (860) 972-2251

AccommoDATIoNS Hudson Suites ..................................... (860) 545-1111

HoSPITAl UNITS

cardiothoracic Intensive careUnit B9I .................................................. (860) 545-5200Nurse Manager ................................... (860) 545-5446

Step-Down/TelemetryB9E/SD ................................................... (860) 545-5299Nurse Manager ................................... (860) 545-5037

oTHeR SeRVIceS

Surgery Time Line .............................. (860) 545-3208Integrative Medicine ........................ (860) 545-4444 (massage, reiki, guided imagery and more)Social Work Services ......................... (860) 545-2966Smoking Cessation ........................... (860) 545-3217Case Coord./Discharge Planning . (860) 545-3192Security ................................................. (860) 545-2147

Cardiac Surgery Patient Care TeamImportant Phone Numbers


Welcome

My Heart Team


Welcome

Pleaselistthenameanddosageofeverymedicationyoutake,includingvitamins,herbalsupplementsandover-the-countermedicationssuchasaspirin,coughsyrupandantacids.Thislistwillbeaninvaluableguidetoyourdoctors,asyouprepareforsurgery.

*Ifyouarenotawareofthedosage,pleasebringthemedicationtoyourvisitwiththesurgeon.

My Medications

PrimarycarePhysician(PcP):__________________________________________________________

PcPPhone:____________________________ PharmacyPhone: ____________________________

medication:_____________________________ Dosage*:____________________________________

Frequency:______________________________ Reason:_____________________________________













Welcome


Listhereanyquestionsyouhaveforanymemberofyourcareteam.

My Questions


2. Your Heart &

Heart Surgery

Your Heart and Heart SurgerY

this section contains explanations of heart conditions and the procedures used to correct them:

Coronary�Artery�Disease�and�its�Treatment

�»� Your�coronary�arteries

�»� Coronary�artery�disease

�»� Heart�attack

»� Bypass�grafting

Heart�Valve�Disease�and�its�Treatment

�»� Your�heart’s�valves

�»� Common�valve�diseases

�»� Heart�valve�surgery

Aortic�Aneurysm�Repair

Irregular�Heart�Rhythm�and�its�Treatment

»� Atrial�fibrillation

»� Maze�procedure

Atrial-Septal�Defect�Repair

The Henry Low Heart Center at Hartford Hospital

coRoNARY ARTeRY DISeASe AND ITS TReATmeNT

» Yourcoronaryarteries

» Coronaryarterydisease

» Heartattack

» Bypassgrafting

YoUR HeART & HeART SURGeRY

coronary Artery Disease and Its Treatment


Like all muscles in the body, the heart muscle needs a continual supply of oxygen to function.Thecoronaryarterieswraparoundtheheart,providingitwithoxygen-richblood.Theleftcoronaryarterysplitsintotwobranchescalledthecircumflexarteryandtheleftanteriordescendingartery.Theysupplybloodtothefront,leftandbackoftheheart.Therightcoronaryarterysuppliesbloodtothebottom,rightandbackoftheheart.

Your Coronary Arteries

Right coronary artery

Posteriordescendingartery

Left coronaryartery

Circumflexartery

Left anteriordescendingartery

Aorta

Venacava Pulmonary

artery


Posterior descending artery

left coronary artery

circumflexartery

left anterior descending artery



Coronary Artery Disease

Plaque

Clot

Yourheartisamuscle.Likeothermusclesinthebody,itneedsasteadysupplyofoxygen-richbloodtofunctionproperly.Theheartmusclereceivesitsbloodsupplyfromanetworkofspaghetti-likecoronaryarteriesthatlieonitsoutersurface.

Thecoronaryarteriesaresubjecttoadiseasecalledatherosclerosis,inwhichabuildupofcholesterolandotherfatsintheliningofthearteriesprogressivelynarrowstheinteriorchannel.Thiscausesbloodflowthroughthearteriestobereduced,andtheheartmuscletoreceiveaninadequateamountofoxygen.Whenmoreoxygenisneededthanthearteriescandeliver,theheartmusclecrampsinresponse.Thisiscalledangina.

Overtime,atherosclerosiscanbuilduptoadangerouslevel.Sometimes,itformsaclotthatcanhinderbloodflow.Othertimes,itformsasoftlump(plaque)coveredbyafibrouscapthatcaneasilyruptureandspillitscontentsintothebloodstream.Eitherway,aheartattack-causingclotcanoccur.

Yoursurgeonplanstobypasstheblockagestorerouteoxygenatedbloodaroundthedangerpointstorestorebloodflowtoyourheartmuscle,stopanginaandpreventaheartattack.



Heart Attack

Aheartattackoccurswhenbloodflowthroughthecoronaryarteriesisinterrupted.Theseverityofaheartattackdependsonhowlongbloodflowisstoppedandhowmuchheartmuscleisaffected.Thefasteryoureceivetreatmenttorestorebloodflow,thegreateryourchanceofhavingminimaldamage.

Doctorscallheartattacks“myocardialinfarctions(MIs).”Therearetwotypes:

• NSTemI.ThistypeofheartattackdoesnotcausechangesintheS-TsegmentofanEKG(see Figure 1a).Therefore,itiscalleda“non-STsegmentelevationmyocardialinfarction”(NSTEMI).Therefore,itiscalleda“non-STsegmentelevationmyocardialinfarction”(heartattack).Itisdiagnosedbychemicalchangesinthebloodthatindicatedamagetotheheartmusclehasoccurred.NSTEMIusuallyindicatesaclotistemporaryoroccursinaminorbloodvessel.

• STemI.Thisisamajor,full-blownheartattack,whichclearlyappearsasanelevatedSTsegmentonanEKG(see Figure 1b).STEMIheartattacksarecausedbyprolongedblockagesofbloodflowinmajorcoronaryarteries,whichaffectsasignificantareaofheartmuscle.

Q

P

S

R

T

Q

P

R

ST

Elevated ST segment

An EKG records the various electrical impulses in the heart that cause the heart to contract, pause for filling and contract again. The diagram on top shows a healthy heartbeat. The diagram on the bottom, in which the segment of the EKG between the S and T waves is elevated, indicates a heart attack.

Figure 1a

Figure 2a



Formorethan40years,coronaryarterybypassgrafting(CABG)—aproceduremostpeoplecall“bypasssurgery”--hasbeenthestandardmethodforrestoringbloodflowtotheheartsofpatientswithcoronaryarterydisease.CABGhasalowmortalityrateandahighrateofsuccessinrestoringtheflowofoxygen-richblood,relievinganginaandpreventingheartattack.

InCABGsurgery,thesurgeoncreatesanewpathwaybyusingbloodvesselslocatedinthechest(mammaryarteries),leg(saphenousveins)orarm(radialarteries).Ifthesaphenousveinsareused,theywillberemovedthroughoneortwosmallincisions(seeillustration).Yoursurgeonwillexplainwhichbloodvesselswillbeusedforyourprocedure.

TRADITIoNAl cABGAsurgeonwillmakeanincisiondownthecenterofyoursternum(breastbone)toaccessyourheart.Youwillbeconnectedtoaheart-lungbypassmachine,whichwillcirculateyourbloodthroughoutyourbodyduringsurgery.Yourheartwillbestoppedsothesurgeoncanperformthedelicatebypassprocedure.Aftersurgery,thesurgeonwillcloseyourbreastbonewithspecialwiresandyourchestskinwithinternalandexternalstitches.Thewireswillstayinyourchestpermanently.

oFF-PUmP cABGThisprocedureallowsthesurgeontooperateontheheartwhileitisstillbeating.Thesurgeonusesadvancedequipmenttostabilizeaportionoftheheartwhileperformingthebypass.Meanwhile,therestoftheheartcontinuestopump,circulatingbloodtothebody.Inoff-pumpCABG,theheart-lungbypassmachineisnotused.

Coronary Artery Bypass Grafting

Sternum Incision

mammary arteries

Radial arteries

Saphenous veins



mINImAllY INVASIVe cABGSometimesCABGcanbeperformedthroughasmallincisioninthesideofthechest(thoracotomy).Yoursurgeonwillletyouknowifyouqualifyforthisprocedure.

RoBoT-ASSISTeD SURGeRYYoursurgeonmaychoosetousearobottoassistinperformingCABG.Therobotdoesnotreplacethesurgeon,butratherenhancesthesurgeon’sabilitytoperformdelicate,precisemicrosurgicalmovements.

Coronary Artery Bypass Grafting (cont.)



Coronary Artery Bypass Grafting

Thisillustrationshowsbypassgraftsusinganinternalmammaryartery(IMA)fromtheinsideofthechestwallandasaphenousveingrafttakenfromtheleg.Ifyouhavemorethanoneblockage,morethanonebypassmaybeneeded.Yoursurgeonwilldrawthelocationsofyourgraftsonthisheartandexplainwhichconduitswillbeused.


Saphenousvein bypass

Internal mammaryarterybypass

Left anteriordescendingartery

Aorta

Venacava Pulmonary

artery

Blockages


HeART VAlVe DISeASe AND ITS TReATmeNT

» Yourheart’svalves

» Commonvalvediseases

» Heartvalvesurgery



Heart Valve Disease and Its Treatment

Thehearthasfourchambers.Theleftatriumreceivesoxygen-richbloodfromthelungs.Therightatriumreceivesbloodfromthebody.Therightventriclesendsbloodtothelungsforoxygen.Theleftventriclesendsoxygen-richbloodoutintothebody.Fourvalvescontrolproperbloodflowthroughthesechambers,servingasone-waydoorstokeepbloodmovingintheproperdirection.

• Theaorticvalvecontrolstheflowofoxygenatedbloodfromtheleftventricle(lowerleftchamber)intotheaortaandtherestofthebody.

• Themitralvalvecontrolsbloodflowbetweentheleftatrium(upperleftchamber)andleftventricle(lowerleftchamber).

• Thepulmonicvalvecontrolsbloodflowoutoftherightventricle(lowerrightchamber)intothelungs.

• Thetricuspidvalvecontrolsbloodflowbetweentherightatrium(upperrightchamber)andrightventricle(lowerrightchamber).

Anyproblemwiththeleaflets,thetoughchordsthatholdtheminplaceorthemusclesthatkeepthevalvestructurestablecancausesymptoms.

Pulmonic valve

Tricuspid valve

Mitral valve

Aortic valve

Your Heart’s Valves



Valvediseaseoccurswhenavalvedoesnotworkthewayitshould.Youcanbebornwithavalveproblemordevelopitlaterinlife.Avalveproblempresentatbirthisknownascongenitalvalvedisease.Acquiredvalvediseaseisoftencausedbyrheumaticfever, infectionsorfattyplaquedepositsonthevalveleaflets.

Themostcommonformsofvalvediseasearestenosisandinsufficiency(regurgitation).

Invalvular stenosis,thevalveleafletsbecomestiff.Thisnarrowstheopeningandreducestheamountofbloodthatcanflowthroughit.Whentheopeningbecomesverynarrow(stenotic),theheartstrainstopumpharder,andbloodflowtothebodyisreduced.

Valvular insufficiency(regurgitation)istheoppositeproblem—aleakyvalve.Itoccurswhentheleafletsdonotclosetightlyandbloodflowsbackwardsthroughthevalve.

Stenosisandregurgitationcanexistsimultaneouslyintwoormorevalves.

Commonsymptomsincludeshortnessofbreath,extremefatigue,weakness,dizziness,rapidweightgain,swellinginthefeetandankles,anginaandpalpitations.Overtime,valvediseasecanleadtodistressingheartrhythmsorheartfailure.

Common Valve Diseases

Aortic valve stenosis Open

Closed

Aortic valve stenosis Open

Closed open closed

Anterior leaflet

Posterior leaflet

Regurgitation

Annulus



Faultyvalvesmayberepairedorreplaced.Valverepairallowsthesurgeontofixafaultyheartvalve,oftenwithoutusingartificialparts.Ifvalverepairisnotanoption,thesurgeonmaychoosetoreplacethevalve.Thismeansthefaultyvalveisremoved,andanewvalveissewninitsplace.Thenewvalvemaybemechanical(man-made)orbiological(naturaltissue).

Themostappropriateproceduredependsonyourage,extentandtypeofvalvediseaseandthelocationofthevalve.ValvesurgerymaybeperformedatthesametimeasCABGorotherheartprocedure.Whenvalvesurgeryisperformedalone,itissometimesdonethroughsmallincisionsmadebetweentheribs.Suchminimallyinvasiveprocedurescanresultinlesspostoperativepain,lessbleeding,lowerriskofinfection,shorterhospitalstayandquickerreturntonormalactivities.

Minimallyinvasivesurgeryisnotappropriateforeverypatient.Yoursurgeonwillalwaysperformtheprocedurethatisbestforyou.Ifminimallyinvasiveapproachisanoption,yoursurgeonwilldiscussitwithyou.

Heart Valve Surgery



VAlVe RePAIRWheneverpossible,valvesarerepaired,ratherthanreplaced.Retainingyournaturalvalvewilleliminatetheneedforbloodthinners,decreasetheriskofinfectionandpreservemusclestrength.

Repairsmaybeperformedtoopenthevalveleafletswider,tightenthevalveleaflets,reshapethevalveorpatchatearorholeinaleaflet.

Robotsaresometimesusedtoassistinvalverepair.Robot-assistedsurgeryisminimallyinvasivesurgerytechnique,meaningitallowsheartsurgerytobeperformedthroughtinyincisionsinthepatient’schest.Therobotsdonotactuallyreplacethesurgeon,butratherenhancetheirabilitytoperformdelicate,precisemicrosurgicalmovements.Theinstrumentsusedfortheoperationareinsertedthroughsmallincisions,reducingtheopportunityforbacterialinfection,decreasingpostoperativepainandallowingforfasterrecovery.

VAlVe RePlAcemeNTWhenvalverepairisnotanoption,thevalveisremovedandreplacedwithamechanicalorbiologicalvalve.

Mechanicalvalves(right)aredesignedtoimitatethefunctionsofthenaturalvalve.Theyopenlikeadooronhinges.Theyareverydurable,butrequirebloodthinnerstopreventthedevelopmentofbloodclots.

Somebiologicalvalves(bottom)areformedfromcow(bovine)orpig(porcine)tissueanddonotrequirelong-termuseofbloodthinners.

Inspecialcases,ahomograftmaybeusedtoreplacethedamagedvalve.Yoursurgeonwilldiscusswhichoptionisbestforyourindividualcondition.

Annuloplasty ringrestores natural shape

to valve

Heart Valve Surgery



AoRTIc ANeURYSm RePAIR

Aortic Aneurysm Repair


The aorta is the largest artery in the body. It flows from the heart through the chest and abdomen, where it splits in two and continues down the legs. The aorta can develop a weakness in its wall called an aneurysm, which causes the tissue to bulge as blood flows through it. Aortic aneurysms that occur near the heart (thoracic aortic aneurysms) are repaired by cardiothoracic surgeons. Aneursyms that occur in the abdominal area are repaired by general and vascular surgeons.

Tube graftrepair

Suture line

Aortic Aneurysm Repair

Symptoms may include pain in the jaw, neck and upper back; chest or back pain; or coughing, hoarseness or difficulty breathing. However, many patients with aortic aneursyms have no symptoms at all. Large aortic aneurysms and those that produce symptoms may be treated to prevent the vessel from rupturing and causing rapid, life-threatening blood loss.

If you are undergoing thoracic aortic aneursym repair, your surgeon will remove the damaged section of aorta and replace it with a strong, flexible Dacron tube.


YOUR HEART & HEART SURGERY

IRREGULAR HEART RHYTHM AND ITS TREATMENT

» Atrial fibillation

» Maze procedure

YOUR HEART & HEART SURGERY


Irregular Heart Rhythm and Its Treatment

In a normal heart, the upper (atria) and lower (ventricles) chambers beat in perfect harmony, thanks to a complex system of electrical impulses that move with lightning speed. Any deviation in the electrical pathway can cause an irregular rhythm (arrhythmia), either fast or slow. Many arrhythmias can be controlled with medications or a pacemaker.

One of the most common arrhythmias is atrial fibrillation (Afib). Afib is not necessarily life-threatening in itself, but the episodes of racing, irregular heart rhythms can be highly distressing. Afib also causes blood to pool in the atria, where it can clot before being pumped out into the body. For this reason, Afib increases the risk of stroke.

In some people, Afib can be controlled by medication or a catheter-based procedure. When these methods fail to work, a surgeon may be needed to create a new maze of electrical pathways on the surface of the heart. This is called maze surgery.

Maze surgery is performed under anesthesia with the heart-lung machine. The surgeon opens the chest and uses an instrument with a tip that generates radiofrequency waves or extreme cold to make a series of small scars on the surface of the heart in a particular pattern that resembles a maze. As the heart heals, these scars form a barrier that channel electrical impulses into the correct path.

Maze Procedure for Atrial Fibrillation

The Henry Low Heart Center at Hartford Hospital 2-

YOUR HEART & HEART SURGERYYOUR HEART & HEART SURGERY


ATRIAL-SEPTAL DEFECT AND ITS TREATMENT

» Atrial-septaldefectrepair

Atrial-Septal Defect and Its Treatment

ASDs may not cause symptoms until mid-life, at which time the person may begin to experience shortness of breath, fainting, arrhythmias or fatigue. Large ASDs may lead to heart failure, atrial fibrillation, pulmonary hypertension, stroke and damage to other heart valves.

Some ASDs, such as patent foramen ovales (PFO), significantly increase the risk of stroke. Some people with ASDs are unaware they have the condition until a stroke occurs.

Repair techniquesDepending on their size and location, surgery may be required to close the hole with stitches or a patch. Hartford Hospital cardiac surgeons often use a robot to assist with this procedure .

Atrial-Septal Defect Repair

Before birth, blood flows freely through a hole in the membrane (septum) dividing the upper chambers of the heart (atria). The normal process is for this hole to close shortly after birth. When it fails to close, or when a separate hole develops in the septum, blood can pass back and forth between the atria. Such holes are called atrial-septal defects (ASD).

Septal Defect

Right Atrium

Left Atrium



3.

Preparing for Surgery

PreParIng for SurgerY

this section contains information on:

�»� Meeting�with�your�surgeon

�»� Your�appointment�for�preoperative�testing

�»� Meeting�the�Cardiac�Surgical�Program�Coordinator

�»� Verifying�coverage�with�your�insurance�company

�»� Attending�a�preoperative�class

�»� Preoperative�instructions

�»� What�to�do�if�you�have�diabetes


PRePARINGFoRSURGeRY

meeTINGWITHYoURSURGeoN

Yourcardiologisthasdeterminedyouneedheartsurgeryandhasreferredyoutoasurgeon.Attheappointment,calledasurgicalconsult,yoursurgeonwilldiscussyourheartconditionandexplainthetypeofsurgeryproposedtocorrectit.

Yoursurgeonwillwanttoknowwhatmedicationsyouaretaking,sincesomeofthemwillneedtobestoppedbeforeyouroperation.Ifyoutakediabetesmedications,pleaseseetheinstructionsonpage3-4anddiscussthemwithyoursurgeon.

Yoursurgeonmayusethediagramsinthisbooktobetterillustratetheoperationyouwillbehaving.Besuretowritedownanyquestionsyouhaveonpage1-5,soyoudon’tforgettoask.

Attheendoftheconsult,theofficewillscheduleadateandtimeforyoursurgery.Inmostcases,theofficewillalsomakeanappointmentforpreoperativetesting.

YoURAPPoINTmeNTFoRPReoPeRATIVeTeSTING

YourappointmentinourPre-AdmissionTestingCenter(PATC)isdesignedtotakecareofallthemedicaltestingyouneedbeforeyoursurgerycantakeplace.Theprocessnormallytakesabouttwohours,butcantakeaslongasfour.

ThePATCisopenMondaythroughFridayfrom8:00a.m.to5:00p.m.Appointmentsmaybescheduledbycalling860-545-2334.Yoursurgeon’sofficemayalsohelpyouwithschedulinganappointment.

AtthePATC,youwillundergoaphysicalexaminationandhavebloodworkdrawn.AnEKGandchestX-raywillbetaken.Dependingonyourmedicalhistory,youmayalsoundergoavascularstudyorpulmonaryfunctiontest.

Atthisappointment,youwillalsobeaskedtofilloutadetailedquestionnairethatwillusedbyyouranesthesiologist.Questionsincludewhetherornotyouhaveeverhadareactiontoanesthesiaordifficultybeingintubated,andwhetheryouweardentures.Ourgoalistounderstandyourmedicalhistory,sowecanbetteranticipateandmeetyourneedsduringyourhospitalstay.

meeTINGTHecARDIAcSURGIcAlPRoGRAmcooRDINAToR

ThefinalstepismeetingwiththeCardiacSurgicalProgramCoordinator.Thecoordinatorperformsmanyvaluablerolesdesignedtoensureyouhavethebestpossibleexperienceandfacilitatescommunicationbetweenthehospital,surgeonandallmembersofyourcareteam.Thecoordinatorwillexplainallaspectsofyourhospitalization,surgery,recoveryandrehabilitationandwillmakesureanyspecialneedsyoumayhaveareaccommodated.

PRePARINGFoRSURGeRY


Afterheartsurgery,somepatientsrequireseveraldaysofrehabilitationbeforetheyarereadytobedischargedhome.AnimportantroleoftheCardiacSurgicalProgramCoordinatoristopromptyoutothinkaboutwhereyouwouldliketogoforrecoveryandrehabilitationafterbeingdischargedfromthehospital.Someskillednursingfacilitiesarelistedalphabeticallybycountyinsection8ofthisbinder.

Wesuggestyoubecomefamiliarwiththefacilitiesinyourarea,visitthem,andchoosewhichoneyouwouldliketouseforyourpostoperativerehabilitation.Askthemtoputyournameonalist,sinceyouwillhaveabetterchanceofgettingintothefacilityofyourchoiceifyoumakeareservation.

VeRIFYINGcoVeRAGeWITHYoURINSURANcecomPANY

Beforeyoursurgery,pleaseverifyyourinsurancecoveragebycallingyourinsuranceprovider.Itisyourresponsibilitytounderstandwhatiscoveredunderyourindividualplan.

Afteryouhavespokenwithyourinsuranceprovider,yourcasecoordinatorortheCardiacSurgicalProgramCoordinatorwillbegladtohelpyou,ifyouhaveanyproblemsunderstandingwhatyourplancovers.

ATTeNDINGAPReoPeRATIVeclASS

Aswementionedinthewelcomeletter,westronglyurgeallpatientsundergoingheartsurgerytotakeapreoperativeclass.Theseclassesexplainthepreparation,surgeryandrecoveryprocessindetail,andareasourceofvaluableinformationandcomfortforpatientsandtheirfamilies.

TheCardiacSurgicalProgramCoordinatorwilltellyouwhenthenextclassisbeingofferedandencourageyoutoattend.Werecommendyoubringalongthefriendorfamilymemberwhowillbehelpingyouafteryoureturnhome.


PRePARINGFoRSURGeRY

Inthedaysbeforeyoursurgery,youwillneedtofollowcertaininstructions,asdetailedbelow.Theseinstructionsareimportant,sopleasecheckoffeachboxafteryouhavemadenoteoftheinformation:

� Yoursurgeonmayaskyoutostoptakingcertainmedicationsforaperiodoftime.Besuretonotewhichmedicationsshouldbestopped,howfarinadvanceofsurgerytheyneedtobestopped.Ifyouhavediabetes,pleaseseetheinstructionsonpage3-4forguidance.

� Ifyoutakevitamins,supplements,herbsordietaryproducts,pleasetellyoursurgeonatyourfirstmeeting.Youmayneedtodiscontinuetakingsomeofthembeforeyoursurgery.

� IfyouneedCPAPatnightforsleepapnea,tellyoursurgeonatyourfirstmeeting.YoumaybringtheCPAPmachinewithyoutothehospitalforyoursurgery.

� Ifyousmoke,youshouldquitnow.Smokinginterfereswiththehealingprocessandmakesrecoveryfromheartsurgerymuchmoredifficult.Ifyouwouldlikesmokingcessationcounseling,pleaseasktheCardiacSurgicalProgramCoordinatorforareferral.

� Ifyoudrinkalcohol,youshouldlimityourconsumptiontonomorethanoneglassofwinewithdinner.

� Yourskinisnotsterile,soyoucanhelppreventpostoperativeinfectionsbymakingsureyourskinisasgerm-freeaspossiblebeforeyoursurgery.WewillgiveyouspecialcleansingclothscalledCHGwipestousealloveryourbodythenightbeforeyoursurgeryandthemorningofsurgery.WewillalsoaskyoutoswabyournostrilswithBactroban(mupirocin),anantibioticointment,twicedailyforfivedaysbeforesurgery.

� Ifyoudevelopacoldbeforeyoursurgery,itdoesnotnecessarilymeanyouroperationmustbepostponed.However,ifyoudevelopafeverhigherthan101°Fwithinaweekbeforeyoursurgery,callyoursurgeonimmediately.

� Donoteatordrinkanything,includingwater,aftermidnightbeforeyoursurgery,unlessyouareinstructedtodootherwise.Youmaybedirectedtotakesomeofyourmedicationsonthemorningofsurgerywithasmallsipofwater.

� Thedaybeforesurgery,youwillreceiveacallbetween1:00p.m.and6:00p.m.lettingyouknowwhattimeyouroperationisscheduledtotakeplaceandwhattimeyoushouldreporttothehospital.IfyoursurgeryisscheduledforaMondayorthedayafteraholiday,youwillreceiveacallonebusinessdaybeforeyoursurgerydate.Ifyoudonotreceiveacallby6:00p.m.,pleasecalltheSurgeryTimeLineat(860)545-3208.

Preoperative Instructions

PRePARING FoR SURGeRY


Ifyoutakemedicationfortype1ortype2diabetes,followtheinstructionsbelow,unlessyourdiabetesprovidertellsyouotherwise.

Pleasenotethatcombinationpillsarenotlisted.Ifyoutakeapillthatcombinestwomedications,andoneislistedas“Donottake”or“Stop,”donottakethecombinationpill.

Besuretocheckyourbloodsugarbeforemealsandatbedtimeforatleasttwodayspriortoyourscheduledsurgery.Ifyounormallycheckyourbloodsugarmoreoften,continuetodoso.Callyourdoctorifyouhavetworeadingshigherthan150.

THe DAY BeFoRe SURGeRYYou mAY take the following medications:

Actos(pioglitazone) Prandin(repaglinide)Amaryl(glimiperide) Starlix(nateglinide)Avandia(rosiglitazone) Symlin(pramlintide)Byetta(exenatide)Glucophageorotherformsofmetformin,ifyourkidneyfunctionisnormal.Ifyourkidneyfunctionisdecreasedorunknown,stop48hoursbeforesurgery.Glucotrol(glipizide)Januvia(sitagliptin)Micronase,Diabetaorotherformsofglyburide

If you take insulin:

» Youmaytakethefollowingformsofinsulinintheusualdose:Apidra NPHExubera Regular70/30Humalog Regular75/25Novolog Regular50/50

» Ifyouhavetype1diabetes,youmayneedadecreaseddoseoftheinsulinyoutakeatbedtime.Pleasediscussthiswithyourdiabetesprovider.

THe DAY oF SURGeRYDo NoT take these medications in the morning:

Amaryl(glimiperide)Glucophageorotherformsofmetformin

check with your doctor when to restart:

Glucotrol(glipizide)Micronae,Diabetaorotherformofglyburide

Do not take the following medications the morning of your surgery. You may resume taking them after surgery:

Actos(pioglitazone) Prandin(repaglinide)Avandia(rosiglitazone) Starlix(nateglinide)Byetta(exenatide) Symlin(pramlintide)Januvia(sitagliptin)

If you take insulin, the morning of your surgery:

» Takehalftheregulardoseof:NPHRegular75/25Regular70/30 Regular50/50

» Ifyouhavetype1diabetes:YoumayneedadecreaseddoseofLantusorLevemir.Pleasediscussthiswithyourdiabetesprovider.

» Ifyouhavetype2diabetes:YoushouldtakethefulldoseofLantusorLevemir.Pleaseverifythiswithyourdiabetesprovider.

» Aftersurgery,restartthefollowingformsofinsulinwhenyoubegineatinganormaldiet:Apidra Regular70/30Exubera Regular75/25Humalog Regular50/50Novolog

If You Have Diabetes


4.

the day of Surgery

tHe daY of SurgerY


�»� Checking�in�on�the�day�of�your�surgery

�»� What�your�family�can�expect�while�you�are�in�surgery

�»� Your�care�team

�»� What�you�can�expect�in�the�operating�room

�»� In�the�Intensive�Care�Unit�(ICU)


THe DAY oF SURGeRY

cHeckING IN oN THe DAY oF SURGeRY

• Ifyouhavediabetes,besureyoufollowtheinstructionsonpage3-4abouttakingorstoppingyourdiabetesmedicationsonthedayofsurgery.

• Leavemoney,jewelryandothervaluableitemsathome.

• Leaveyourcarwiththevaletandbringtheparkingticketwithyoutobevalidated:Parkingisfreeonthedayyouareadmittedandthedayyouaredischarged.

• Pleasearriveon timetoCenter8.Takethemainlobbyelevatorstothe8thfloorandfollowthesignsfor“Center8.”WhenyouarriveatCenter8,anursewilltakeyourweightandvitalsigns.Thenursewillinsertanintravenousline(IV)inaveininyourarm,askyousomequestions,performaphysicalassessmentandclipthehairoffyourbody.Atemporarydressingwillbeplacedtoprotectyourtailbone.Onceyouareupandmovingaroundafteryoursurgery,itwillberemoved.

WHAT YoUR FAmIlY cAN exPecT

Manyofyouwillwantyourfamilytobekeptinformedaboutyourrecovery,butduetopatientprivacylaws(HIPAAregulations),ourabilitytoshareinformationaboutyourconditionoverthetelephoneislimited.That’swhywerecommendyoudecideaheadoftimewhoyourFamilySpokespersonwillbe.Itshouldbesomeoneyoucantrusttorelaymessagesaccuratelytoconcernedfriendsandfamilymembers.

Whenyoucheckin,wewillaskyouforthenameofyourFamilySpokesperson.Wewillcallthispersonwithupdates,andthispersonmaycallusforinformation.

Whenyouaretakentotheoperatingroom,yourfamilymembersorfriendsaccompanyingyouwillbeaskedtowaitintheSurgicalWaitingAreaonthe5thfloor(BlissWing).Duringandimmediatelyfollowingsurgery,ourtrackingsystemwillmakeiteasyforthemtoknowyourstatus.Whenyougototheoperatingroom,youwillbegivenacasenumbertoprotectyourprivacy.Flatscreentelevisionswilldisplayyourstatus.Whenyouareinsurgery,itwillsay,“Procedure.”WhenyouhavebeenmovedtotheICU,itwillsay,“DischargedtoB91.”B91isonthe9thflooroftheBlissWing.WhenthescreenindicatesyouhavebeenmovedtoB91,yourfamilymaygototheICUtovisityou.TheyshouldringtheintercombellontheoutsideoftheICU.Assoonasyouarereadyforvisitors,thestaffwillletthemin.

AliaisonintheSurgicalWaitingAreawillalsobeavailableforquestionsandwillbeabletohelpyourFamilySpokespersondeterminehowlongitwillbebeforeyoursurgeonwillgiveyourfamilyanupdateonyourcondition.

YoUR cARe TeAmHeartsurgeryisateameffort,andyouroperatingroomwillbefilledwithmedicalprofessionals.Inadditiontoyoursurgeon,therewillbeananesthesiologist,nurseanesthetist,perfusionist(personwhooperatestheheart-lungmachine),surgicaltechnicians,nursesandnursingassistants.

Aftertheoperation,yourcarewillbeprovidedbyanintensivist(aphysicianspecializinginintensivecare),acardiologist,nursepractitioners,physicianassistantsandnurses,whoworkwithyoursurgeon.

THeDAYoFSURGeRY


INTHeoPeRATINGRoom

Theoperatingroomwillbecold,brightandbustlingwithactivity.Anursewillcheckyournameandthenameofyoursurgeonandverifythisinformationonyourwristband.

YouranesthesiologistwilladministeryouranesthesiathroughyourIV.Althoughyouwillfallasleepquickly,yourhearingwillbethelastsensetoleaveyou.Youcanbeassuredthatbeforetheoperationbeginsyouwillbecompletelyanesthetizedandwillfeelnopain.Duringthesurgery,yourEKG,bloodpressure,breathing,pulseandotherfunctionswillbecloselymonitoredatalltimes.

INTHeINTeNSIVecAReUNIT(IcU)

Afteryoursurgeryisover,youwillawakenintheIntensiveCareUnitonBliss9I(B9I).Youmayawakenslowly,firstbyhearingnursescallingyournameandtalkingtoyou.Ifyouhaveabreathingtubeinyourthroat,youwillnotbeabletospeakwhenyouawaken.Thistubewillberemovedonceyouareawakeenoughtobreatheonyourown,usuallyaboutsixhourslater.

Youwillalsohavealargenumberoftubesandlinesattachedtoyourbodyandlinkedtothemonitoringequipmentatyourbedside.AtubecalledaFoleycatheterwillemptyyourbladder.Chesttubeswillbeplacedaroundyourhearttoremoveanyfluidthatmaycollectaftersurgery.Thetubeswillberemovedoverthenextfewdays.

Yourfaceandbodymaybeswollen.Thisisentirelynormal,andistheresultofbeinggivenfluidsduringyoursurgery.Wemaygiveyoumedicationstohelpeliminatethisextrafluid.

ICUvisitinghoursareposted,buttheyareflexible.However,weaskthatyourfamilymemberslimittheirinitialvisitto10-15minutes,sincewemustprovideyouwithagreatdealofcareduringthistime.Weaskthatyouhavenomorethantwovisitorsatatime,sinceitisimportantforthenursestohaveaclearviewofyourbedandtomonitoryoucloselyduringyourstayintheICU.NochildrenareallowedinICU.Also,itisimportantforyourfamilytoknowfood,drinkandflowersarenotallowedintheICU.

YouwillstayinICUovernightandbemovedtoatelemetryfloor(B9E)withotherheartpatientswhenyourconditionisstable,likelythefollowingday.Ifwefeelitisinyourbestinterests,wewillkeepyouinICUlonger.

On the Day of Surgery


5.

recovering in the Hospital

recoverIng In tHe HoSPItal


�»� What�to�expect�each�day�after�surgery

�»� Your�stay�on�B9E

�»� Managing�pain

�»� Caring�for�your�body�after�surgery

�»� Postoperative�nutrition

�»� Postoperative�medication

�»� Preparing�for�discharge


RecoVeRINGINTHeHoSPITAl

everyday,youcanexpectto:

• Beweighedeverymorning

• Haveyourbloodpressure,heartrate,oxygenlevelandtemperaturechecked

• Getoutofbedforeachmeal

• Useyourincentivespirometer10timeseveryhourwhileyouareawake

• Useyourheartpillowtohelpyoucoughandbreathedeeply

• Haveyourfluidintakeandoutputmonitored

• Havetubes,wiresandIVsremoved

• Seeanincreaseinyouractivitylevelandtolerance

onthefirstdayaftersurgery,youcanexpectto:

• Haveyourdressingschanged

• Sitinachairforyourmeals

• Walkinyourroomwithassistance

• Begineatingaheart-healthydiet

ondays2and3aftersurgery,youcanexpectto:

• Haveyourdressingschangedorremoved,ifpossible

• HaveyourFoleycatheterremoved

• Takeashower

• Walkinthehalls2to4timesperdaywithassistance

• Haveyouroxygenremoved

• Increasetheamountoffoodyoueat

• Begindischargeplanningwiththecareteamandyourfamily

ondays4and5aftersurgery,youcanexpectto:

• Walkinthehalls3to5timesperday

• Walkupanddownstairswithstaffassistance

• Continuetoincreaseyourfoodintaketohelpthehealingprocess

• Receivedietandmedicationinstructionsinpreparationfordischarge

• Finalizedischargeplans

What to Expect Each Day After Surgery

RecoVeRINGINTHeHoSPITAl


What to Expect After Surgery

HelPFUlINFoRmATIoNFoRYoURSTAYoNB9ePreventingpneumoniaoracollapsedlung(postoperativeatelectasis)isapriority.Weexpectyoutouseyourincentivespirometer(breathingexerciser)10timeseveryhourwhileyouareawake.Youwillbegivenaheartpillowtohugwhileyoucoughandbreathedeeplyafterusingthespirometer.Thispillowwillhelpsupportyourchestandallowyoutotakedeeperbreaths.

Everydayyouwillbeweighed,haveyourbloodpressure,heartrate,oxygenlevelandtemperaturechecked.Atmealtime,youwillgetoutofbedandwalktoachair,whereyouwilleatyourmeals.Mealswillbeservedatthefollowingtimes:

Breakfast: 8:30a.m.-9:00a.m.

Lunch: 12:30p.m.-1:00p.m.

Dinner: 5:30p.m.-6:00p.m.

Thephoneinyourroomwillbeshutofffrom10:00p.m.to8:00a.m.

Atfirst,youwillfindthesmallesttaskstiring.Beassuredthatyourstrengthandstaminawillincreaseasyouprogressthroughyourstay.Beforeyouaredischarged,youwillbeabletowalkaroundthehallsandclimbstairswiththehelpfromstaff.

mANAGINGPAINTohelpusminimizeyourpainaftersurgery,wewillaskyoutoratetheintensityofyourpainthroughtheuseofapainscale:

Ifyoustarttofeelpainatanytime,pleaseaskthenurseforpainmedication.Donotwaituntilyouareveryuncomfortable,oruntilitisoffered.Thesooneryourequestpainmedication,thebetteryouwillmanageyourpain.Whenyourpainiswell-controlled,youwillbeabletouseyourincentivespirometerandbreathedeeplyandbemoreactive.

Onceyouareabletoeatsolidfood,youwillbegivenoralpainmedications.Untilthattime,painmedicationwillbegiventhroughyourIV.Ifyouneedpainmedication,pleaseaskforit.Ifyouhaveanyconcernsaboutaddiction,pleasediscussthemwithyoursurgeonornursesbeforeyoursurgery.

excruciating-unabletodoanyactivitiesbecauseofpain

Severe-unabletodomostactivitiesbecauseofpain

Unabletodosomeactivitiesbecauseofpain

moderate

Candomostactivitieswithrestperiods

mildpain-doesnotlimitactivity

Nopain

10

9

8

7

6

5

4

3

2

1


RecoVeRING IN THe HoSPITAl

What to Expect After Surgery (cont.)

cARING FoR YoUR BoDY AFTeR SURGeRYAlmosteverypatientisswollenaftersurgeryfromwater-weightgain,butwewillgiveyoumedicationtoeliminatetheextrafluid.

Lyinginbedwillleaveyoususceptibletoskinbreakdown.Weencourageyoutogetoutofbedasoftenaspossibletositinachairorwalk.Whileyouareinbed,youshouldturnoftentorelievethepressureonanyareaofskin.

Donottouchyourincision.Donotputlotionsorcreamsonit.Donotscratchitorremovethescabs,astheyarebarrierstoinfection.Youwillbeallowedtoshowerassoonasyourchesttubesareremoved,usuallybyday3.

Theanesthesiaandpainmedicationsyoureceived,combinedwithlackofactivity,willslowdownyourbowelcycle.Donotbeconcerned.Wewillgiveyoumedicationstohelpnormalbowelfunctionresume,alongwithastoolsoftenertopreventstraining.Afewdaysaftersurgery,youshouldbebacktonormal.

PoSToPeRATIVe NUTRITIoNYouwillneedextracaloriestoheal,butthesecaloriesshouldbeintheformofhigh-qualityproteins,vegetablesandfruits.Yourcareteamwillmonitoryourdietandmodifyitasnecessary.

Evenifyoudonothaveyournormalappetite,weencourageyoutoeat.Yoursurgeonmayrecommendyoufollowalow-fat,no-added-saltdietafterdischarge.Yournursewillgiveyoumoredetaileddietinstructionstofollowathome.

mANAGING BlooD GlUcoSe leVelSAftersurgery,manypatientsexperienceelevatedbloodsugarlevels,eveniftheydonothavediabetes.Ifthishappenstoyou,youprobablyfallintooneoffourcategories:

1. Elevatedbloodsugarisatemporaryreactiontothestressofsurgeryandwillresolveinafewdaysorweeks.Youmayneedinjectionsofinsulinuntiltheconditionresolves.

2. Youhaddiabetesbeforesurgery,butdidnotknowit.Thisisacommonoccurrence.

3. Youhaddiabetesbeforesurgery,butwereabletocontrolyourbloodglucoselevelswithoralmedications.Youmayneedinsulinforashorttimeaftersurgerytoregaincontrol,butthereisagoodchanceyouwillbeabletoresumeusingoralmedicationsafewdaysorweeksafterdischarge.

4. Youhaddiabetesbeforesurgery,andcontrolledyourbloodglucoselevelswithinsulinoracombinationofinsulinandoralmedications.Youmayneedlargerdosesofinsulintocontrolyoursugarsinthefirstfewdaysorweeksaftersurgery.

RecoVeRING IN THe HoSPITAl


PoSToPeRATIVe meDIcATIoNSYoumayneedtobegintakingnewmedications.Ifyouhadbypasssurgery,thesemayincludePlavix(clopidogrel),whichyoumaytakedailywithaspirin.Ifyouhadvalvesurgeryoramazeprocedure,youmayneedtotakeCoumadin(warfarin),abloodthinner.Donotdiscontinuetakingthesemedicationsforanyreasonwithoutyourdoctor’sknowledgeandpermission.Ifyouexperienceanyworrisomesideeffects,callyourdoctor’soffice.

PRePARING FoR DIScHARGeYouwillstayonB9Euntilyouarereadyforthenextphaseofyourrecovery.Thisnextphasemayincluderehabilitation,homecareoroutpatientcardiacrehabilitation.Thelengthoftimeyouwillneedforthisphasedependsonyourindividualprogressandneeds.

Onthedayyourdoctorfeelsyouareready,ourgoalistohaveyoudischargedby11a.m.Pleasemakearrangementsforyourfamilytopickyouupthatmorning.

Ifyouaregoingtoaskillednursingorrehabilitationfacility,yourcasecoordinatororsocialworkerwillassistyouandyourfamilyinmakingthesearrangementsbeforeyouaredischargedfromthehospital.Alistoffacilitiescanbefoundinsection8ofthisbinder.

Wewillsendyouhomewithalistofthemedicationsthatyoushouldbetakingforyourheartandothermedicalproblems.Itisveryimportantthatyoutakeallmedicationsasdirected.Itisequallyimportantthatyounottakeanyothermedication(over-the-counterorprescription),vitaminorherbalsupplementthatisnotonthislistwithoutthepermissionofyourdoctor.Manymedicationsyouthinkaresafemayinteractwithyourheartmedications,makingthemstrongerorweaker.

What to Expect After Surgery (cont.)


6.

recovery after

Hospital d

ischarge

recoverY after HoSPItal dIScHarge

this section contains:

�»� Daily�do’s�and�don’ts

�»� Helping�your�incision�to�heal

�»� Your�emotional�health

�»� Follow-up�appointments

�»� Resuming�activity

�»� Progressive�walking�program

�»� Cardiac�rehabilitation

�»� Returning�to�work

�»� Watching�for�weight�gain


RecoVeRYAFTeRHoSPITAlDIScHARGe

Ifyoudevelopanyofthefollowingsymptoms,gotothenearestemergencyroomorcall911:

� Brightredstool� Angina-likechestpainsimilartothatyouexperiencedbeforeyoursurgery� Coughingupbrightredblood� Faintingspells� Heartratefasterthan150beats/minwithshortnessofbreathornewirregularheartrate� Newonsetofnausea,vomitingordiarrhea� Severeabdominalpain� Shortnessofbreathnotrelievedbyrest� Suddennumbnessorweaknessinarmsorlegs� Suddensevereheadache

Ifyoudevelopanyofthefollowingsymptoms,callyoursurgeon:

� Drainage,redness,inflammation,warmthornewsorenessatthesiteoftheincision� Feverof101degreesormore� Newpainsinthechest� Difficultybreathing� Shortnessofbreathwhilelyingflat� Increasingweaknessanddifficultydoingregularactivities� Extremefatigue� Swellinginthelegs,anklesorstomach� Dry,hackingcoughwithoutacold� Lessurinationduringthedayandmoreatnight� Dizziness,lightheadedness� Paininthecalfthatbecomesworsewhenpointingtoeupwards

Whenyourideinacar,besureyouwearaseatbeltwithashoulderharnessforprotectionagainstinjury.Yoursurgeonwillletyouknowwhenitisokaytoresumedriving.

Daily Do’s and Don’ts



• Eathealthyfoods,suchasfruitsandvegetables.

• Eatprotein-richfoods,suchaseggs,leanmeats,chickenandfish,unlessotherwiseinstructed.

• Whileyourincisionsarehealing,avoideatingfoodsthatarehighinsugar.

• Weencourageyounottosmokeandwillprovideyouwithsmokingcessationinformation.TocalltheHartfordHospitalStopSmokingforLifeProgram,pleasecall860-545-3127.

• Ifyouhavebeeninstructedtowearabra,youmaywishtoplaceagauzedressingovertheincisiontoprotectitfromrubbingandirritation.

• Takeashowerdailyandwashyourincisiongentlywithwarm(nothot)water.Avoidvigorousscrubbing.Besuretodrytheincisionthoroughly.Donottakeabath,useahottuborswimuntiltheincisionisfullyhealed.Donotputcreams,oils,powdersorlotionsonyourincision,orscratchit.Theincisionwillhealgraduallyovertime.Leavethescabsalone.Donotcoveryourincisionunlessitbeginstodrain.Inthiscase,coveritwithsterilegauze(availableatyourpharmacy)andcallyoursurgeon.

• Ifyourincisionhasadressing,changeitdailyormorefrequentlyifitbecomeswetorsoiled.

• Whenthedrainagestops,youshouldstopapplyingthedressingsandallowtheincisiontohealintheopenair.

• Notify your surgeon if you notice any of the following:» Increasedtendernessaroundtheincision» Increasedrednessorswellingaroundtheedgesoftheincision» Anydrainagefromtheincision» Youneedtochangethedressingmoreoftenduetoincreaseddrainage» Theincisionorthedrainagedevelopsabadsmell

Thereisnoneedtobeafraidofsexualintimacyafterheartsurgery.Asaruleofthumb,youarereadytoresumesexualrelationswhenyoucanwalkupaflightofstairsatanormalpace.Untilyoursternumhashealed(about6-8weeks),choosepositionsthatlimitpressureonyourarmsandchest.Ifyouhaveanyconcerns,speakwithyoursurgeon.

Itisnormaltobeemotionallyfragileaftersurgery.Youmayexperiencehighsandlows,andevenseemirrationalattimes.Thisiscommon,asare“theblues.”Ifyouremotionalhealthhasnotresolvedwithinamonth,orifyoufeelchronicallydepressed,speakwithyoursurgeon.Yourbody’schemistrymaybeout-of-balance,andyoumayneedsomehelptoputyouonthepathtohealing.

Helping Your Incision to Heal

Your Emotional Health


RecoVeRy AFTeR HoSPITAl DIScHARGe

Your Follow-Up AppointmentsYouwillbeexpectedtoseeyoursurgeonandcardiologistwithin2weeksafteryouhavebeendischargedfromthehospital.Youwillbegiventimeframesfortheseappointmentswhenyouaredischarged,anditisyourresponsibilitytobooktheappointments.

Resuming ActivityYouneedabalanceofexerciseandrestasyoucontinuetorecover.Itmaybenecessarytomodifysomeofyourdailyactivitiesuntilyourbodyheals.

Itisimportanttogetupandgetdressedeachmorning.Wearcomfortable,loosefittingclothesthatdonotputpressureonyourincisions.

Youmayclimbstairs.Whenyoufirstgohome,besuretogoslowly,takingonestepatatimeifnecessary.Rememberthatittakesmoreenergytoclimbstairsthantowalk.Ifyoubecometiredasyouclimb,stop,restandcontinue.DONOTpullyourselfupthestairs.

Paceyourself.Don’ttrytodotoomuchtoosoon,oryouwillbeverytiredthefollowingday.Restatleasttwiceaday,restfor20-30minuteswithyourlegselevated.Payattentiontoyourbody.Itmaygiveyousignalsthatyouneedtorest.Thesesignalsmayincludeshortnessofbreath,fatigue,dizziness,painordiscomfort.Ifyouexperiencethesesignals,stopyouractivityimmediately.Takeanap,ifnecessary.

Youmustavoidstrenuousactivitywhileyoursternumishealing.Donotlift,pushorpullanythingheavierthan5to10pounds—approximatelytheweightofagallonofmilk—forsixweeksaftersurgery.Thismeansyoushouldavoidcarryingchildren,groceries,mowingthegrass,vacuumingorshoveling.

Followtheguidelinestoresumeyouractivitiessafely:

WeekS 1 AND 2:Activities you can do:

• Shower,shaveandwashyourhair.

• Preparebasicfoods.

• Dolighthousework:washdishes,dust,makebeds.Donotchangesheets.

• Write,readandtype(deskwork).

• Read,watchTVandlistentomusic.

• Sew,knitanddoothercrafts.

• Playcardsandboardgames.

• Rideinacarasapassengerforshorttrips.Wearasafetybelt.

• Walk8-12stairs,oneatatime.Donotpullyourselfupthestairs.

• WalkdailyasoutlinedintheProgressiveWalkingProgramonpage6-5

Activities you should avoid doing:

• Don’tliftmorethan5lbs.

• Don’tliftinfantsorsmallchildren.

• Avoidarmmotionthatcausespainattheincisionsite.

• Avoidpush-pullarmmovements(vacuuming,sweeping,scrubbing).

• Don’tuseatreadmill.

• Don’tshovel,digorcutgrassorhedges.

• Don’twalkamedium-tolarge-sizeddog.

• Don’tdoanycompetitivesports.

continued

RecoVeRy AFTeR HoSPITAl DIScHARGe


• Don’tdriveuntilyoursurgeongivespermission.

• Don’twalkupgradesorhills.

• Avoidputtingextrapressureonyourarmswhenclimbingstairsorrisingfromachair.


• Dineoutandpreparemeals.

• Runerrandsandshopforgroceries(avoidlifting!).

• Attendreligiousservices,bingoandmovies.

• Playmusicalinstruments.

• Dolighthousework.Donotchangesheets.

• Graduallyresumesexualactivity.Usenon-weight-bearingpositions.

• Contactyourlocalcardiacrehabilitationprogram.

• ContinuetheProgressiveWalkingProgramdaily.



• Don’tliftinfantsorsmallchildren.

• Avoidarmmotionthatcausespainattheincisionsite.

• Avoidpush-pullarmmovements(vacuuming,sweeping,scrubbing).

• Don’tuseatreadmill.

• Don’tshovel,digorcutgrassorhedges.

• Don’twalkamedium-tolarge-sizeddog.

• Don’tdoanycompetitivesports.

• Don’tdriveuntilyoursurgeongivespermission.

• Don’twalkupgradesorhills.

• Avoidputtingextrapressureonyourarmswhenclimbingstairsorrisingfromachair.


• Moderatehousework-laundry,sweeping

• Painting,lightcarpentry.Noceilingorladderwork.

• Ridethemowerandgarden

• Walkthedog



• Don’tshovelheavyloads.

• Don’tplaycontactsports.

• Don’twalkupsteephills.

Manypeoplecanreturntoworkfourtosixweeksaftersurgery.Howsoonyoucangobackdependsonhowwellyouarehealingandwhattypeofjobyouhave.Yoursurgeonwilltellyouwhenitissafeforyoutoreturntowork.

Resuming Activity (cont.)

Returning to Work



Watching for Weight GainYoumaybeaskedtoweighyourselfatthesametimeeverymorningandrecordit.Besuretowearthesameamountofclothesandtousethesamescaleeveryday.Thishelpsusmonitorhowwellyourheartispumpingandwatchforthedevelopmentorworseningofheartfailure.Notifyyourdoctorifyougainmorethan2poundsinonedayor5poundsinoneweek.

Recordyourweightdailyonthispageandbringittothenextappointmentwithyourcardiologistorcardiacsurgeon.

Date Time Weight

Regularexerciseisessentialtoyourrecovery,andtheProgressiveWalkingProgramisthebestwaytoincreaseyourendurancesafely.Itaccomplishesthisgoalbygraduallyincreasingthedistanceoramountoftimeyouareabletowalk.Startingatweek1or2afterdischargeandcontinuingovera4-to8-weekperiod,youwillgraduallyincreasethelengthofyourexercisetime,whiledecreasingthenumberofwalksyoutakeperday.

Itisimportantthatyouwalkonlevelground.Ifyourneighborhoodishilly,ortheweatherisextreme,walkindoors.Walkinginamallorfromroomtoroominyourhomeareperfectlyacceptable.

Guideyourprogressionbasedonhowyoufeel.Continuerepeatingthesamestepuntilyounolongerfeelfatigued.Atthatpoint,youarereadyforthenextstep.Youshouldbeabletocarryonaconversationwhileyouwalk.Ifyoubecometooout-of-breathtotalk,theactivityistoovigorous.

The6-StepProgressiveWalkingProgram

Step1: Walk3-5minutesthreeorfourtimesdailyforatotalof12-20minutes.

Step2: Walk5-7minutesthreeorfourtimesdailyforatotalof15-28minutes.

Step3: Walk7-10minutestwoorthreetimesdailyforatotalof20-30minutes.

Step4: Walk10-15minutestwicedailyforatotalof20-30minutes.

Step5: Walk15-20minutestwicedailyforatotalof30-40minutes.

Step6: Walk20-30minutesonceaday.

Onceyouareabletowalk20minutes,youwillbenefitfromaddingwarm-upandcool-downperiods:

Warmup:Walkslowlyfor5minutes.

Exercise:Walkbrisklyfor20minutes.

Cooldown:Walkslowlyfor5minutes.

Progressive Walking Program



HartfordHospitalcardiacsurgeonshighlyrecommendthatpatientsparticipateinacardiacrehabilitationprogramafteraheartattackorheartsurgery.Cardiacrehabilitationisaprovenwaytoreducetheriskofafutureheartproblem,includingfatalornonfatalheartattack.ItissoeffectivethatmostMedicareplanscover36cardiacrehabsessions.

Youwillbenefitfromcardiacrehabilitationifyouhavehad:

• Arecentheartattack• Chestpain(angina)• Angioplastyorstentprocedure• CABG• Heartvalvesurgery• Heartfailure• Cardiomyopathy• Hearttransplant

WHATcARDIAcReHABINVolVeSCardiacrehabilitationisasupervisedexerciseandeducationprogramdesignedspecificallytohelppatientsrecoverfromhearthospitalization.Threetimesaweek,participantsexercisegently,graduallyincreasingtheirenduranceunderthewatchfuleyeofnursesandexercisephysiologists,whomonitortheirEKGandbloodpressure.

Inadditiontosupervised,safeexercise,cardiacrehabprogramsprovidegroupandindividualcounselingandeducationsessionsdesignedtohelpyoumakehealthylifestylechanges.Thesesessionscoverheart-healthydietarychanges,weightloss,smokingcessationandstressmanagement.

Youmusthaveaphysician’sreferraltobegintheprogram.Yourcardiologistwilllikelyworkwithyoutoarrangeyourrehabilitationatacardiacrehabprograminyourarea.HartfordHospitalofferscardiacrehabilitationprogramsatfourlocations:atHartfordHospitalinHartford,inWestHartfordatBlueBackSquare,andatourWellnessCentersinAvonandGlastonbury.

Cardiac Rehabilitation

“The doctors saved my life, but Cardiac Rehabilitation taught

me how to live it.” -HartfordHospitalcardiacrehabpatient

GeARINGUPFoRBeTTeRHeARTHeAlTH

Inadditiontoextendingsurvivalandimprovinghearthealth,thebenefitsofparticipatingincardiacrehabinclude:

• Improvedenergyandphysicalfitness

• Improvedsenseofwell-being

• Improvedabilitytomanagestress

• Increasedabilitytoperformjobortasks

• Lowerbloodpressure

• Lowercholesterolandbloodsugarlevels

• Weightloss

Cardiac Rehabilitation Referral

Patient’s Name: _________________________________________________ DOB:_________________

Address:_______________________________________________________________________________

Phone: ________________________________________________________________________________

_____ MI

_____ Stable Angina

_____ PCI

_____ Cardiac Surgery

________CABG _______Cardiac Valve _____Cardiac Transplantation

_____ CHF

______ Cardiomyopathy

Signature of referring physician ____________________________________ Date:_____________ Time:___________

Upon discharge, please fax referral to patient’s preferred site:

Hartford HospitalPhone: 860.545.2133 Phone: 860.545.3352

West Hartford - Blue Back SquarePhone : 860.570.4571 Fax: 860.570.4570

Glastonbury Wellness CenterPhone: 860.633.9084Fax: 860.633.9204

Avon Wellness CenterPhone: 860.674.8509Fax: 860.678.8493

Patient Label Info

HH-C-482_10/11


7.

resources

reSourceS


�»� Mended�Hearts,�Inc.

�»� Informational�websites

�»� Further�reading�on�heart�disease�and�heart�surgery

»� Circulation�article�on�benefits�of�cardiac�rehabilitation


ReSoURceS

Formorethan50years,MendedHeartshasofferedhope,encouragementandinformationtoheartpatientsandtheirfamilies.HartfordHospitalispleasedtopartnerwithMendedHeartsinordertohelppatientslikeyouhaveagoodexperience.

Beforesurgery,someonefromMendedHeartswillcallorvisityou.Aftersurgery,yourMendedHeartscontactwillbehappytoprovideanswerstoanyquestionsyoumayhaveandtoprovidereassurancethatyourlifeaftersurgerycanberichandrewarding.

Formoreinformationonthisnationalnonprofitorganization,pleasevisitwww.mendedhearts.org.

Mended Hearts, Inc.

YourHeartValvewww.yourheartvalve.comAmericanHeartAssociationwww.americanheart.org

AmericanCollegeofCardiologywww.acc.org

SocietyofThoracicSurgeonswww.sts.orgNationalHeart,LungandBloodInstitutewww.nhlbi.nih.gov/health

Web Sites You May Find Helpful

TheopenHeartcompanion:PreparationandGuidanceforopen-HeartSurgerybyMaggieLichtenberg

ThecardiacRecoveryHandbook:ThecompleteGuidetolifeafterHeartAttackorHeartSurgerybyPaulKligfield,MD

Suggested Reading on Heart Disease & Heart Surgery

ReSoURceS


littlepain,lotsofgain:Stickingwithcardiacrehabboostssurvival,studyfinds

MARILYNNMARCHIONE,APNewsDec21,2009

Study: Sticking with heart rehab boosts survival

If you’ve had a heart attack or a bypass operation, there’s an easy way to help prevent another one: stick with rehab.

People who get all 36 sessions of cardiac rehabilitation that most Medicare plans cover are less likely to die or suffer a heart attack in the next three to four years than people who have fewer sessions, a new study finds.

The research could encourage the multitudes of heart patients who don’t follow doctors’ orders to heed their advice. Only about one-fifth of heart patients even try rehab. Of those who do, few get all the sessions that are recommended.

The new study is one of the first big efforts to look at how survival is affected by the “dose” of rehab that heart patients get. Researchers saw a clear trend in this 65-and-older group.

“What this study shows in a very convincing manner is that the more sessions a cardiac patient goes to, the better off they are,” said Dr. Stanley Hazen, preventive cardiology and rehabilitation chief at the Cleveland Clinic.

He had no role in the study, which was led by Duke University scientists and published online Monday in Circulation, an American Heart Association journal. Federal grants paid for the work.

Say “rehab” and many people envision weak heart patients being pushed to run on a treadmill. Exercise is crucial, but “they don’t need to be grimacing and jogging around the track,” Hazen said. “It can be just a brisk walk or swimming or a stationary bike. That’s the key: find something you enjoy and are willing to do.”

To be covered by Medicare, rehab also must include lifestyle counseling — nutrition advice, weight management, help to stop smoking, even cooking classes and pointers on reducing stress, said the study’s leader, Duke biostatistician Bradley Hammill.

Many patients find they enjoy the counseling, he said. For some, it’s the first time anyone has explained the “how-to” of healthy living.

“After you’ve been hospitalized and somebody then talks to you about these lifestyle changes, it might be more likely to sink in. It’s the teachable moment,” Hammill said.

His study used records on more than 30,000 Medicare recipients who went for at least one rehab session after being hospitalized for a heart attack, a bypass operation, or chronic and severe chest pain due to clogged arteries.

More than three years later, 18 percent of those who attended fewer than 12 cardiac rehab sessions had died versus 11 percent of those who went to all 36 sessions. After taking into account age and other differences in these groups of patients, that works out to a 47 percent reduction in the risk of death for those attending 36 sessions. Heart attacks also were less common in that group.

There was a strong trend: as the number of classes went up, the risk of having a heart attack or dying in the next few years went down.

Surprisingly, only 18 percent of study participants went to all 36 sessions, even though Medicare — the government health care program for those 65 and over — was footing the bill. Researchers don’t know why so few stuck with it.

“It can be everything from the time required multiple times a week for so long, or transportation issues. Or it may just be that they feel better and don’t feel the need to finish,” Hammill said.

That’s the case with Tony Rugare, an 84-year-old Cleveland area man who had a quadruple bypass operation in October. He attended his fourth rehab class on Monday and plans to do only a dozen more.

“It’s a hassle getting here and parking,” he said. Once he’s had 16 classes, “by that time I think I know what to do and can go on my own.”

However, it could be that sicker patients drop out of rehab sooner, Dr. William Weintraub wrote in an editorial in the journal. He is a heart specialist at Christiana Care Health System in Newark, Del. Because the study can’t account for why people went to fewer or more sessions, it cannot prove that rehab alone accounted for better survival, he wrote.

But there’s good reason to believe it did: researchers did a separate analysis on only folks who went to at least six sessions and still saw the trend of fewer heart attacks and deaths with greater attendance.

Dorothy Roberts went to her seventh session at the Cleveland Clinic on Monday. She walks on a treadmill and is trying to quit smoking. Roberts, 62, said that her artery-opening angioplasty procedure was a “very scary” experience, so she plans to complete all 36 rehab sessions covered by her private insurer.

“If you have a second chance at life, you do what you can to stay here,” she said.


this section contains a list of skilled nursing facilities in the following counties:

�»� Fairfield

�»� Hartford

�»� Litchfield

�»� Middlesex

�»� New�Haven

�»� New�London

�»� Tolland

�»� Windham

8. SkIlled nurSIng facIlItIeS

Skilled nursing facilities


SkIlleDNURSINGFAcIlITIeS

FAIRFIelDcoUNTY

BethelBethelHealthCareCenter13ParkLawnDrive(203)830-4180

BridgeportAstoriaPark725ParkAvenue(203)366-3653

BridgeportHealthCareCenter600BondStreet(203)384-6400

BridgeportManor540BondStreet(203)384-6400

NorthbridgeHealthCareCenter2875MainStreet(203)336-0232

DanburyDanburyHealthCareCenter107OsborneStreet(203)792-8102

FilosaConvalescentHome13HakimStreet(203)744-3366

GlenHillCare&RehabilitationCenter1GlenHillRoad(203)744-2840

HancockHall31StaplesStreet(203)794-9466

PopeJohnPaulIICenter33LincolnAvenue(203)797-9300

FairfieldCambridgeManor2428EastonTurnpike(203)372-0313

CaroltonChronic&ConvalescentHospital400MillPlainRoad(203)255-3573

JewishHomefortheElderly175JeffersonStreet(203)365-6400

LudloweCenterforHealth&Rehabilitation(203)372-4501

GreenwichConnecticutHealthofGreenwich1188KingStreet(203)531-8300

GreenwichWoodsHealthCareCenter1165KingStreet(203)531-1335

NathanielWitherell70ParsonageRoad(203)869-4130

NewcanaanWavenyCareCenter3FarmRoad(203)966-8725

NewtownMasonicareofNewtown139ToddyHillRoad(203)426-5847

NorwalkHoneyHill34MidrocksRoad(203)847-9686

NotreDame76WestRocksRoad(203)847-5893

ParadigmHealthcareofNorwalk23ProspectAvenue(203)853-0010

RidgefieldLaurelRidgeHealthCareCenter642DanburyRoad(203)438-8226

SheltonAppleRehabSheltonLakes5LakeRoad(203)924-2635

BishopWickeHealth&RehabilitationCenter584LongHillAvenue(203)929-5321

GardnerHeights172RockyRestRoad(203)929-1481

HewittHealth&RehabilitationCenter45MaltbyStreet(203)924-4671

StamfordCourtlandGardensHealthCenter53CourtlandAvenue(203)351-8300

EdgehillHealthCenter122PalmersHillRoad(203)323-2323

LongRidgeofStamford710LongRidgeRoad(203)329-4026St.CamillusHealthCenter494ElmStreet(203)325-0200

SmithHouseSkilledNursingFacility88RockrimmonRoad(203)322-3428

WilliamandSallyTandetCenter146WestBroadStreet(203)964-8500

StratfordLordChamberlainManorNursing&Rehabilitation7003MainStreet(203)375-5894

SouthportConnecticutHealthofSouthport930MillHillTerrace(203)259-7894

TrumbellMaefairHealthCareCenter21MaefairCourt(203)459-5153

St.JosephManor6448MainStreet(203)268-6204

WestportWestportHealthCareCenter1BurrRoad(203)226-4201

WestReddingMeadowRidge100ReddingRoad(203)544-1000

WiltonLourdesHealthCareCenter345BeldenHillRoad(203)762-3318

WiltonMeadowsHealthCareCenter439DanburyRoad,Rte7(203)834-0199



HARTFoRDcoUNTY

AvonAppleRehabAvon652WestAvonRoad(860)673-3265

AvonHealthCenter220ScovilleRoad(860)673-2521

BloomfieldAlexandriaManor55TunxisDrive(860)242-0703

BloomfieldHealthCareCenter355ParkAvenue(860)242-8595

CalebHitchcockHealthCareCenter-Duncaster40LoefflerRoad(860)726-2000

SeaburyHealthCenter200SeaburyDrive(860)286-0243

WintonburyCareCenter140ParkAvenue(860)243-9591

BristolCountrysideManorofBristol1660StaffordAvenue(860)583-8483

ThePinesofBristol61BellevueAvenue(860)589-1682

IngrahamManor400NorthMainStreet(860)584-3400

SheridenWoods321StonecrestDrive(860)583-1827

collinsvilleCherryBrook102DyerAvenue(860)693-7777

eastHartfordEastHartfordHealthcare&RehabilitationCenter51ApplegateLane(860)568-7520

RiversideHealth&RehabilitationCenter745MainStreet(860)289-2791

eastWindsorChestnutPointCareCenter171MainStreet(860)292-5394

KettleBrookCareCenter96ProspectHillRoad(860)623-9846

enfieldBlairManor612HazardAvenue(860)749-8388

ParkwayPavilionHealthCare1157EnfieldStreet(860)745-1641

St.JosephResidence2365EnfieldStreet(860)741-0791FarmingtonAmberwoodsofFarmington416ColtHighway(860)677-1671

FarmingtonCareCenter20ScottSwampRoad(860)677-7707

ForestvilleSubacuteCenterofBristol23FairStreet(860)589-2923

GlastonburyGlastonburyHealthCareCenter1175HebronAvenue(860)659-1905

SalmonBrook72SalmonBrookDrive(860)633-5244

GranbyMeadowbrookofGranby350SalmonBrookStreet(860)653-9888

HartfordAveryNursingHome705NewBritainAvenue(860)527-9126

ChelseaPlaceCareCenter25LorraineStreet(860)233-8241

EllisManor210GeorgeStreet(860)296-9166

ParkPlaceHealthCenter5GreenwoodStreet(860)236-2901

TrinityHillCareCenter151HillsideAvenue(860)951-1060

kensingtonLedgecrestHealthCareCenter154KensingtonRoad(860)828-0583

manchesterBidwellCareCenter333BidwellStreet(860)647-9191

CrestfieldRehabilitationCenter&FenwoodManor565VernonStreet(860)643-5151

ManchesterManor385WestCenterStreet(860)646-0129

WestsideCareCenter341BidwellStreet(860)647-9191

marlboroughMarlboroughHealthCareCenter85StageHarborRoad(860)295-9531

NewBritainAndrewHouse66ClinicDrive(860)225-8608

BrittanyFarms400BrittanyFarmsRoad(860)224-3111

JeromeHome975CorbinAvenue(860)229-3707

MonsignorBojnowskiManor50PulaskiStreet(860)229-0336

WalnutHillCareCenter55GrandStreet(860)223-3617

NewingtonBel-AirManor256NewBritainAvenue(860)666-5689

JeffersonHouse1JohnH.StewartDrive(860)667-4453(Hartford Hospital is a corporate affiliate and is likely to be considered to have a discloseable financial interest)



NewingtonHealthCareCenter240ChurchStreet(860)667-2256

PlainvilleAppleRehabFarmingtonValley269FarmingtonAvenue(860)747-1637

PlantsvilleAlzheimer’sResourceCenterofConnecticut1261SouthMainStreet(860)628-9000

TheSummitatPlantsville261SummitStreet(860)628-0364

RockyHillAppleRehabRockyHill45ElmStreet(860)529-8661

MapleViewManor856MapleStreet(860)563-2861RockyHillSkilledNursing&Rehabilitation60WestStreet(860)529-2521

SimsburyGovernor’sHouse36FiretownRoad(860)658-1018

McLeanHealthCenter75GreatPondRoad(860)658-3700

SouthingtonSouthingtonCareCenter45MeridianAvenue(860)621-9559

SouthWindsorSouthWindsorNursing&RehabilitationCenter1060MainStreet(860)289-7771

SuffieldTheSuffieldHouseOneCanalRoad(860)668-6111

WestHartfordBishop’sCornerHealthcare&RehabilitationCenter2432AlbanyAvenue(860)236-3557

HebrewHomeandHospital1AbrahmsBoulevard(860)523-3960

HughesHealth&RehabilitationCenter29HighlandStreet(860)236-5623

TheReservoirOneEmilyWay(860)561-7022St.MaryHome2021AlbanyAvenue(860)570-8200

WestHartfordHealth&RehabilitationCenter130LoomisDrive(860)521-8700WethersfieldWethersfieldHealthCareCenter341JordanLane(860)563-0101

WindsorKimberlyHallNorth1EmersonDrive(860)688-6443

KimberlyHallSouth1EmersonDrive(860)688-6443

WindsorRehabilitation&HealthCareCenter581PoquonockAvenue(860)688-7211

WindsorlocksBickfordHealthCareCenter14MainStreet(860)623-4351

lITcHFIelDcoUNTY

canaanGeerNursing&RehabilitationCenter99SouthCanaanRoad(860)824-5137

kentTheKent46MapleStreet(860)927-5368

litchfieldRoseHaven31NorthStreet(860)567-9475NewmilfordCandlewoodValleyHealth&Rehabilitation30ParkEastLane(860)355-0971

VillageCrest19PoplarStreet(860)354-9365

PlymouthCook-WillowConvalescentHome81HillsideAvenue(860)283-8208

TorringtonLitchfieldWoodsHealthCareCenter255RobertsStreet(860)489-5801

ParadigmHealthcareofTorrington80FernDrive(860)482-7668

TorringtonHealth&RehabilitationCenter255WyomingAvenue(860)482-8563

ValerieManor1360TorringtonStreet(860)489-1008

WolcottHallNursingCenter215ForestStreet(860)482-8554

SalisburyNobleHorizons17CobbleRoad(860)435-9851

SharonSharonHealthCareCenter27HospitalHillRoad(860)364-1002

WatertownAppleRehabWatertow33BunkerHillRoad(860)274-5428

WatertownConvalarium560WoodburyRoad(860)274-6748

WinstedLaurelHillHealthCenter108EastLakeStreet(860)379-8591



mIDDleSexcoUNTY

chesterAaronManorNursing&Rehabilitation3SouthWigHillRoad(860)526-2436

Chesterfield’sHealthCareCenter132MainStreet(860)526-5363

cobaltCobaltLodgeHealth&RehabilitationCenter29MiddleHaddamRoadRoute151(860)267-9034

cromwellCromwellHealth&RehabilitationCenter385MainStreet(860)635-5613

PilgrimManor52MissionaryRoad(860)635-5511

RidgeviewHealthCareCenter156BerlinRoad(860)635-1010

DurhamTwinMaplesHealthCareFacility809RNewHavenRoad(860)349-1041

essexEssexMeadowsHealthCenter30BokumRoad(860)767-7201middletownAppleRehabMiddletown600HighlandAvenue(860)347-3315

MiddlesexHealthCareCenter100RandolphRoad(860)344-0353

WadsworthGlenHealthCareCenter30BostonRoad(860)346-9299

Water’sEdgeCenterforHealth&Rehab111ChurchStreet(860)347-7286

moodusChestelmHealthCare534TownStreet(860)873-1455

oldSaybrookAppleRehabSaybrook1175BostonPostRoad(860)399-6216

GladeviewHealthCareCenter60BostonPostRoad(860)388-6696

PortlandPortlandCare&RehabilitationCenter333MainStreet(860)342-0370

NeWHAVeNcoUNTY

AnsoniaHilltopHealthCnter126FordStreet(203)736-1100

BranfordBranfordHillsHealthCareCenter189AlpsRoad(203)481-6221

cheshireElimParkBaptistHome140CookHillRoad(203)272-3547

TheHighlandsHealthCareCenter745HighlandsAvenue(203)272-7285

DerbyBirminghamHealthCenter210ChatfieldStreet(203)735-7401

eastHavenAppleRehabLaurelWoods451NorthHighStreet(203)466-6850

TalmadgeParkHealthCare38TalmadgeAvenue(203)469-2316

GuilfordAppleRehabGuilford10BostonPostRoad(203)453-3725

TheGuilfordHouse109WestLakeAvenue(203)488-9142

HamdenArdenHouse850MixAvenue(203)281-3500HamdenHealthCareCenter1270ShermanLane(203)281-7555

WhitneyCenter200LeederHillDrive(203)281-6745

WhitneyManorConvalescentCenter2798WhitneyAvenue(203)288-6230

madisonMadisonHouse34WildwoodAvenue(203)245-8008

WatrousNursingCenter9NeckRoad(203)245-9483

meridenAppleRehabCoccomo33ConeAvenue(203)238-1606

ConnecticutBaptistHome292ThorpeAvenue(203)237-1206

CurtisHome–St.ElizabethCenter380CrownStreet(203)237-4338

MeridenCenter845PaddockAvenue(203)238-2645

MillerMemorialCommunity360BroadStreet(203)237-8815

SilverSpringsCareCenter33RoyStreet(203)237-8457WestfieldManorHealthCareCenter65WestfieldRoad(203)238-1291

milfordGoldenHillHealthCareCenter2028BridgeportAvenue(203)877-0371

MilfordHealthCareCenter195PlattStreet(203)878-5958



WestRiverHealthCareCenter245OrangeAvenue(203)876-5123

middleburyMiddleburyConvalescentHome778MiddleburyRoad(203)758-2471

NaugatuckBeaconBrookHealthCenter89WeidDrive(203)729-9889

GlendaleCenter4HazelAvenue(203)723-1456NewHavenJewishHomefortheAged169DavenportAvenue(203)789-1650

Leeway40AlbertStreet(203)865-0068

MaryWadeHome118ClintonAvenue(203)562-7222ParadigmHealthcareCenterofNewHaven181CliftonStreet(203)467-1666

SisterAnneVirginieGrimesHealthCenter1354ChapelStreet(203)867-8300

UniversityCenterSkilledNursing&Rehab915EllaT.GrassoBoulevard(203)865-5155

WestRockHealthCareFacility34LevelStreet(203)389-9744

NorthBranfordEvergreenWoodsHealthCenter88NotchHillRoad(203)488-8000

NorthHavenMontoweseHealth&RehabilitationCenter163QuinnipiacAvenue(203)624-3303ProspectParadigmHealthcareofProspect64SummitRoad(203)758-4431

SeymourShadyKnoll41SkokoratStreet(203)881-2555

SouthburyLutheranHomeofSouthbury990MainStreetNorth(203)264-9135

PomperaugWoodsHealthCenter80HeritageRoad(203)262-6555

RiverGlenHealthCareCenter162SouthBritainRoad(203)264-9600

WallingfordMasonicHealthCareCenter22MasonicAvenue(203)679-5900

RegencyHouseofWallingford181EastMainStreet(203)265-1661

SkyviewCenter35MarcDrive(203)265-0981

VillageGreenofWallingford55KondrackiLane(203)265-6771WaterburyAbbottTerraceHealthCenter44AbbottTerrace(203)755-4870

Buck’sHillNursing&RehabilitationCenter2017NorthMainStreet(203)757-0731

CheshireHouseHealthCareFacility3396WestMainStreet(203)754-2161

CrescentManor1243WestMainStreet(203)757-0561GroveManorNursingHome145GroveStreet(203)753-7205

MeridianManor1132MeridenRoad(203)757-1228

ParadigmHealthcareofWaterbury177WhitewoodRoad(203)757-9491

RoseGardenHealth&RehabilitationCenter3584EastMainStreet(203)754-4181

VillageGreenofWaterbury128CedarAvenue(203)757-9271

WestHavenAppleRehabofWestHaven308SavinAvenue(203)932-6411

ParadigmHealthcareofWestHaven310TerraceAvenue(203)932-2247SoundviewHealthcare&RehabilitationCenter1CareLane(203)934-7955

WoodbridgeTheWillowsCare&RehabilitationCenter225AmityRoad(203)387-0076WolcottWolcottViewManor50BeachRoad(203)879-4987

NeWloNDoNcoUNTY

colchesterAppleRehabColchester36Broadway(860)537-4606

HarringtonCourt59HarringtonCourt(860)537-2339GrotonFairview7218StarrHillRoad(860)445-7478

GrotonRegencyCenter1145PoquonockRoad(860)446-9960



mysticAppleRehabMystic28Broadway(860)536-9655

AvalonHealthCareCenteratStoneridge186JerryBrowneRoad(860)536-9700

MysticHealthcare&RehabilitationCenter475HighStreet(860)536-6070

PendletonHealth&RehabilitationCenter44MaritimeDrive(860)572-1700

NewlondonBeechwood31VauxhallStreet(860)442-4363

TheCrossingsEastCampus78VietsStreetExtension(860)447-1416

TheCrossingsWestCampus89VietsStreetExtension(860)447-1471NianticBridebrookHealth&RehabilitationCenter23LibertyWay(860)739-4007

NorwichNorwichtownRehabilitation&CareCenter93WestTownRoad(860)889-2614

RegencyHeightsofNorwich60CrouchAvenue(860)889-2631

UncasvilleOrchardGroveSpecialtyCareCenter5RichardBrownDrive(860)848-8466

WaterfordBayviewHealthCareCenter301RopeFerryRoad(860)444-1175

FountainviewCareCenter88ClarkLane(860)442-0471GreentreeManorNursing&RehabilitationCenter4GreentreeDrive(860)442-0647

TollANDcoUNTY

RockvilleFoxHillCenter22SouthStreet(860)875-0771

StaffordSpringsEvergreenHealthCareCenter205ChestnutHillRoad(860)684-6341

StorrsMansfieldCenterforNursing&Rehabilitation100WarrenCircle(860)487-2300

TollandWoodlakeatTolland26ShenipsitLakeRoad(860)872-2999

VernonVernonManorHealthCareCenter180ReganRoad(860)871-0385

WINDHAmcoUNTY

BrooklynPierceMemorialBaptistHome44CanterburyRoad(860)774-9050

DayvilleWestviewNursingCare&RehabilitationCenter130WareRoad(860)774-8574DanielsonRegencyHeightsofDanielson111WestcottRoad(860)774-9540

PlainfieldVillaMariaConvalescentHome20BabcockAvenue(860)564-3387

VillageManorHealthCare16WindsorAvenue(860)564-4081

PutnamHolySpiritHealthCare72ChurchStreet(860)928-0891

MatulaitisNursingHome10ThurberRoad(860)928-7976

WillimanticRegencyHeightsofWindham595WalleyStreet(860)450-7060

WindhamDouglasManor103NorthRoad(860)423-4636

St.Joseph’sLivingCenter14ClubRoad(860)456-1107

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