A multidisciplinary approach to cardiac care

When you think of heart surgery, you don’t immediately think of back pain. But back and neck pain are two of the most common complaints of post-cardiac surgery patients, according to medical staff at the cardiac surgery department at the Mayo Clinic at St. Mary’s Hospital in Rochester, Minnesota.

And that’s one aspect of pain that the department’s Healing Enhancement Center has been able to address. Along with relaxation and music therapy and experiments with the latest pain-medication interventions, massage therapy is now offered to the department’s patients. The results have been winning converts to hands’-on care.

“Even some of the surgeons on our team were a little skeptical about massage, but … they have patients who say it absolutely transformed [their] experience,” says cardiac surgeon Thoralf Sundt, M.D. “People say, ‘I felt awful and then I had a massage and now I feel great.’ That’s what we’re looking for.”

The combination of pre-surgery anxiety, laying flat on a surgery table for hours at a time, and, of course, having his sternum cracked and held open while surgery is performed, equals tight, sore and irritated muscles throughout the patient’s upper trunk, says Deborah Engen, a massage therapist who works part time in the healing center.

Two years ago medical staff in the cardiac department began looking at ways to make surgery less painful and to make the patients’ experiences “less terrifying,” says Sundt.

Pain was the most common complaint post-surgical patients had, so under the auspices of their new Healing Enhancement Center program, department staff began looking at ways to improve this condition. Engen, who also works as an occupational therapist at the hospital, helped develop a massage study that looked at pain, anxiety and tension before and after massage for these patients. After study results showed massage resulted in significant decreases in all three areas, it was added to the mix of treatments in March.

Any of the department’s 2,600 patients are eligible for the massage intervention, as long there is not any risk to that patient’s safety, say medical staff. Patients may be seen as soon as the second day out of surgery and up to their last day in recovery.

Engen performs massage on patients three days per week, doing three to five massages each day. She typically works on a patient one to three times during his hospital stay. The session lasts 30 minutes, and may include reflexology, acupressure, aromatherapy, manual lymph drainage, light pressure-point work, massage to the feet and legs, and, reaching behind the patient, massage to the head and neck, and in a side-lying position, to the upper body.

Engen recalls an ICU post-surgery patient in his 20’s whose heart rate and blood pressure skyrocketed because of a spasm in his rhomboids that pain medication couldn’t help. “We couldn’t roll him, so I did some acupressure and pressure-point techniques with some deep slides and got the muscle to release, and his blood pressure and heart rate came down,” she says.

Another patient couldn’t sleep after his surgery because of a migraine, so Engen performed acupressure using aromatherapy until the migraine subsided.

“[Massage] helps patients to get up and mobile faster, sleep better, use less pain medication and to get out of the hospital faster,” says Susanne Cutshall, R.N., critical nurse practitioner with the cardiac department who helped form the Healing Enhancement Center program.

“In addition to the therapy being done, it’s the presence and the attention of someone being there with them that helps,” she adds.

Engen’s massage expertise has helped in other ways. Noticing that many patients complained of low-back pain, she suggested that bolsters be placed under patients’ knees during surgery, to reduce the pressure of laying flat on a surgery table. “That’s a great example of how her knowledge and understanding have helped,” says Sundt, who calls himself a “cheerleader from the sidelines” for the interventions offered through the healing center.

Sundt says he envisions the center growing into a free-standing, fully funded entity, staffed with massage and music therapists, coaches of guided imagery and experts who do pain assessments and create personalized medication treatments, and a researcher to document the findings from these interventions.

“It’s the strength of the truly multidisciplinary approach,” he says. “Everyone’s involved, and everyone has expertise to bring to the table.”

— Kelle Walsh