2 questions in 1.

[Ovie]

I wanted to hit 2 birds with 1 stone here.

1. When patients talk about lack of concentration after surgery, or focusing, is that due to the pain medications, or something different?

2. I didn't want to stear away from another topic that was posted, and I read the comments..but still wanted to ask, what is the rarity of extreme confusion after surgery, is there a %? I saw that some of you were doing regular (simple) tasks the next day and some still hadn't really woken up yet.

I only ask because I've been reading alot into this "pump head" theory, and it really has me concerned. I feel as if I'm already sometimes having trouble remembering small tasks or other things as it is. Putting milk in places where glasses and plates go, talking to somebody on the phone, yet telling them I can't find my phone, idea one second, long gone the next. Sometimes like I've lost my mind, and not like gone crazy, but just can't think. Now it could be the meds I've been taking that may be causing this, because others I've talked to explained lost memory, etc. I'm scared that after surgery, as bad as I feel it is now..what if I come out lost, if you will. So that's kind of why I'm looking for rarity or any articles on the situation.

I did read the one miata posted, and it sounded like (though not proven) these problems that people are having, calling it pump head related are actually related to heart disease patients and not so much the valve fixer-uppers. I just found this concerning, and after reading on the other post about that woman's husband, I thought it was an odd coincidence, and timing.

So anything on either questions would be awesome.

Thank you.

 

[JimL]

The answer to question 1 is yes, both. Be aware of this, and you'll be fine. I had trouble coming up with the right word, and probably still do sometimes. More often, it was a good excuse to cover up mistakes I've been making all my life. Relax, don't worry.

 

[Madsometimes]

Everyone's different. When I woke up, everything was totally clear to me. I was a complete pita in ICU, because I wanted to know everything that was being done to me. The doctors were monitoring blood flow to my brain, and I had lots of questions about it, and everything else. When I had the breathing tube in, I bombarded my nurse with notes, and once it was out I didn't stop talking.

When I get nervous I ask questions. My surgeon's senior registrar found my constant questioning quite an effort. I think the one about if electromagnetism from solar storms can affect pacemakers nearly made him lose the will to live. I just wanted to know!

 

[Superman]

Much of it can be medication. I would try to be aware of your response to medications. In some cases a change in pain medication is warranted that a patient might respond better to, w/o the side effects.

I can't take vicodin for example. Well, I suppose I can (but just for parties and such - kidding!) - but I almost blacked out on a walk so I opted for tramadol instead and had no negative response - just pain relief. Don't be afraid to ask for different pain management options if something doesn't feel right in the hospital. Also - use your pharmacist. They can be a great resource for options to take to your doctor if something isn't working for you.

Since then, I've had other medical procedures and made sure to poin out that vicodin and I do not agree. Doctors have always been very agreeable.

 

[epstns]

Ovie,
I wouldn't worry too much about how alert you will be immediately after surgery. Your doctors and care team will take care of everything. You will just be along for the ride. Don't worry - be happy. I remember being aware of pretty much everything that went on around me (when I was awake, anyway) but I just didn't care very much. Even when I saw my heart monitor screen go "flat-line" I didn't get excited. The doc's, tech's and nurses just took care of me and I sort of hung around and began to heal. Not stressful at all.

I think I was clear-headed after surgery, too. At least once I was fully awake. I was not awake at all while the breathing tube was in place, so once I was really awake I was able to carry on conversations in a normal manner. Of course, for the first day or so, they were short conversations because sleep was more important than talking. I remember watching television, reading and even ordering my meals for the next day. All the normal things. I just lived life slowly and carefully. I don't remember being in pain, either. I did have a line from a medication pump for pain meds in place for the first day or two after surgery, but after that, they managed any pain so well that I just don't remember it. Even when I got home, pain was minimal (except when my chronic cough hit), but I needed the meds at night to sleep. If I had it to do all over again, I'd probably stop the pain meds even sooner because I had complications from them (very nasty constipation, if you need to know. . . ).

As for your recent memory episodes, I would chalk those up to stress over the pending events. Psychologists have proven that when we are under extreme stress, our short-term memory performance diminishes severely. It might be worth a talk with your doctor about anti-anxiety meds for a while.

Hang in there. The waiting is almost over.

 

[AgilityDog]

I suffered this lack of concentration for several months after my MVR. I was verrrrry verry ill before surgery, and came close to dying right afterwards. My need for surgery hit me out of the blue because I had been misdiagnosed with just lingering bronchitis, not extreme congestive heart failure! Soo all that stress, and feeling broken, depression, anxiety, etc. etc. after my first surgery certainly contributed to the inability to focus afterwards.
It took a year for me to get healthy again, and I also knew I had a second surgery to go someday, being the AVR.

Funny, I haven't had ANY concentration issues after the AVR. I feel "fixed." I'm healthy, better than I've felt in years, and can almost keep up with my speed demon dog.
Long story short, I think the short term pump-head experience is due to anesthesia and pain meds, while the longer term pump head may be as much due to psychological issues of OHS and major illiness, as it has to do with actual issues from the surgery and drugs, itself.

 

[DavesMom]

I do believe in the “pump head” theory but in my case I think it’s more the medication that has slowed me down. I was on the heart/lung machine longer than normal because scar tissue from my first surgery caused the surgeon a lot of trouble and the operation took over seven hours rather than the estimated three or four.

After the surgery I absolutely felt at the top of my game mentally for a few years. I remember throwing out one-liners like I was Jay Friggin’ Leno on the day of my discharge. The only prescription med I had at this time was Coumadin, which gave me no problem.

Then I was diagnosed with partial complex seizures and went on a med for that, which I believe is the villain and has slowed me down a lot mentally. I would love to get off this stuff since I haven’t had a problem in a few years but weaning me off it would mean no driving for three months and at this time I can’t do that.

When another aneurysm was discovered I was put on Coreg, a beta blocker, to make sure my BP is kept in range. Not too happy with this drug, either.

I have complained about this mental slow down to my doctors and after describing the symptoms (lack of concentration, struggling to find a word, short-term memory, etc.) they just say it’s the meds. I know I’m getting older (DUH!) and can handle slowing down physically but I can’t stand the thought of slowing down mentally…especially if it’s just due to meds. But where would I be without them? As Superman said, work with your doctors if you don’t feel you’re responding well to the med.

I know this is a hard time but you will make it through and end up feeling a lot better. I’m sending strength vibes so take care!

 

[Mentu]

You cannot anticipate your immediate response to surgery and statistical studies are of no help because they only describe populations not individuals. I was well medicated after surgery and just have snatches of memory from the first 48 hours. As soon as they backed off the medication, I woke up clear headed after being moved out of the ICU into my own room. I think a lack of concentration for a few days is normal as your body clears out the load of drugs and that was my experience. On day 3, I was very clear headed but I found that reading was a problem as it was for four or five days; I would find that after a few pages I would start reading the same page. Music on my MP3 player was the best thing I had with me at the hospital, that, and my own soft clothes. The telephone was ok but I wasn't interested in making many calls until I left the hospital on day 5.

Larry

 

[dick0236]

I wanted to hit 2 birds with 1 stone here.

1. When patients talk about lack of concentration after surgery, or focusing, is that due to the pain medications, or something different?

2. I didn't want to stear away from another topic that was posted, and I read the comments..but still wanted to ask, what is the rarity of extreme confusion after surgery, is there a %? I saw that some of you were doing regular (simple) tasks the next day and some still hadn't really woken up yet.

I did read the one miata posted, and it sounded like (though not proven) these problems that people are having, calling it pump head related are actually related to heart disease patients and not so much the valve fixer-uppers. I just found this concerning, and after reading on the other post about that woman's husband, I thought it was an odd coincidence, and timing.

So anything on either questions would be awesome.

Thank you.

#1.... concentration or mental focus is affected after any kind of surgery where aneshesia(sp) is used. I had a simple 10 minute caterac surgery and was under a mild anesthesia and the surgical center insisted I have someone drive me home after the surgery.

#2....I doubt that "heart disease" is the culprit, rather than the pump or the meds. Perhaps you could create that kind of a problem if you wait too long to have corrective surgery. FWIW, I have successfully retired from two careers, earned a Masters degree in Financial Service and can still tie my shoes without help. All kidding aside, I would not worry about this. As I have posted before, this surgery has doubled my life expectancy so far and in my opinion the reward of this corrective surgery far outweigh all the "what if" risks.

 

[ElectLive]

Larry is right about the uselessness of statistics, and I doubt worthwhile studies even exist. I'd look at it this way instead: yes, there's a chance you may experience some temporary disorientation, but there's also a chance, likely much higher, that you will experience no significant confusion. I was wide awake, crystal clear alert only a few hours after leaving the OR and both my family and nurses were amazed at my constant chatter and conversation topics (me telling them what they needed to remember to do!). I felt zero effects of anything, anesthesia or pain meds, and spent most of the first night watching everything else going on around me, all the other ICU patients, nurses, doctors, etc. There was nothing else to do (I had no phone/computer etc) so I just spent my time studying everything going on. It was fascinating...kind of like my own little medical drama, and I could probably talk for hours about everything I saw that night, even though it's now close to 18 months later.

Anyway, my point is that yes some experience things in the short, or even long, term that are not normal, but many also do not, and you just may not read about it as much here. My own personal story aside, you do actually have age on your side relative to some of the side effects of anesthesis and pain meds. I forget the precise medical reasons (because of lack of interest not pumphead!) but it was explained to me when one of the doctors was commenting on my alertness. But whatever you end up experiencing, Ovie, you should be just fine, just try and not get caught up in setting expectations for post-surgery normalcy, just take everything day by day, everything will be an adjustment for a while.

 

[Boston Tiger]

I'd look at it this way instead: yes, there's a chance you may experience some temporary disorientation, but there's also a chance, likely much higher, that you will experience no significant confusion. I was wide awake, crystal clear alert only a few hours after leaving the OR and both my family and nurses were amazed at my constant chatter and conversation topics (me telling them what they needed to remember to do!). I felt zero effects of anything, anesthesia or pain meds, and spent most of the first night watching everything else going on around me, all the other ICU patients, nurses, doctors, etc. There was nothing else to do (I had no phone/computer etc) so I just spent my time studying everything going on. It was fascinating...kind of like my own little medical drama, and I could probably talk for hours about everything I saw that night, even though it's now close to 18 months later.

I was wide awake from 1 or 2 AM on when I came to in the ICU. I talked to the night nurse for a while, until she headed off for something. But I then ended up watching and listening to everything going on around me. That might not have been a great idea, since the smoker in the next room was having one hell of a time while they tried to remove his tube. Just listening to his groans as he coughed the night away made me hurt. I also remember watching the different fellows make their rounds, while the attending physician who was the head of the unit made different suggestions to them. Seeing the teaching hospital in operation was quite interesting.

I wasn't in really wasn't in much pain at first, but that changed in the middle of the night when the nurses tried to have me stand up. I didn't listen to their directions, moved too fast, and immediately knew what that 10 on the pain scale meant. I'm pretty sure they upped my dosage of pain medicine at that time, because my memory gets a lot blurrier after that. It was nice when they removed the chest tubes, since they knew they could step down the pain medicine after that.

For me, any sort of mental confusion was gone before I left the hospital, since I was on different medicines once the removed many of my lines. But the real test came in the first week home, when I was able to check my work emails and answer a complex question. It wasn't until then that I realized just how much that the fear of pumphead had affected me. Sometimes, we think things through way too much when we have a long time to consider an operation like this.

 

[Jessica Marie]

I think it is different for everyone. I slept for hours then woke up and would sorta be there but drift back to sleep. That might've been my pain medication though. They had me on morphine, which also made me hallucinate.

 

[Bill B]

Although everyone is different, I want to second what Steven Epstein wrote - we had nearly identical experiences. The MOST important thing you can do after surgery (before, as well), is to try as hard as you can to not worry about every little thing. I second guessed most of what the staff were doing during my hospital stay, and all that did was impede my recovery and cause me to not be able to sleep.

 

[normofthenorth]

I really didn't want to lose any memory or clarity from my OHS, and discussed that possibility with my anaesthesiologists pre-op. The first one told me that the main amnesia culprit was the anti-anxiety drugs (benzodiazepines), and he agreed not to give me any, just to make sure. Just before I went into the OR, I met my REAL anaesthesiologist, and we had the same discussion again. He noted that my file said "no benzodiazepines", and he convinced me to let him use a low dose instead. (I've explained the reasoning on my continuing blog, "Norm's story so far. . .", on this site. E.g., the selective amnesia virtually always ONLY extends back as far as the administration of the benzodiazepines, so you'll remember everything before then just fine. . .)

I remember nothing of the surgery after I was "knocked out", of course -- after I straightened myself out on the OR table, in fact! -- but I came out of it "normal", asked my nurses a ton of questions, and finished writing and editing a complicated legal brief maybe 36-48 hours post-op, as soon as my DW brought the laptop to the hospital. I typed way slower than usual, and made WAY more typos than usual, but I had no trouble with logic and language and memory, etc. (Mind you, I'm not sure that I've gone back and re-read that brief more recently. . . ;-) )

My recovery was astonishingly pain-free, and I turned down all the opiate/narcotic pain killers except for one shot -- 1 or 2 ml of an old-fashioned opiate, maybe Codeine or Morphine? (I think my blog remembers which!) I got some strange visual side-effects from that shot, which didn't last very long.

I think it was Duke (or maybe USC?) that is/was doing a study on post-OHS cognitive impairment, which we've discussed briefly here. (I'm sure Google "knows"!) IIRC, they found that a disappointingly huge fraction -- maybe 60%? -- of patients reported some significant impairment, maybe even after being discharged. Also, a few people here have reported life-altering personality changes, 180-degree changes in their favorite foods, etc., etc. We're all different, and it's certainly invasive and major surgery. Probably easier said than done, but you'll be in good hands, and having faith in your medical professionals is probably the best option as the surgery nears.

 

[Ovie]

Thank you to each one of you for your insight, I'd like to acknowledge something from each post but browsing and commenting using my phone makes it a little difficult, so I'll just ramble a little and point out a couple things I saw.

I've basically surrendered myself to my surgeon mentally now, I have faith in him, and being calm about that took alot, I don't think I'm a control freak at all, but things such as flying in a plane is horrible, however if I knew how to and was the one flying, I don't think I'd have a problem, same goes with boats, and cars. I'm uneasy in situations when I'm not in the drivers seat, so I just had to confront that demon and allow nature to run its course. Alot of what has been said about stats, and comparing myself to you is something I shouldn't do, because than I'll be expecting specifics after my own surgery, and as its been said, we are all different. So it makes sense that I should just handle anything that comes my way. I am worried though about my body healing, when I was scoped down the throat, and than through the groin, I was told I'd be in a little pain for a couple days, and 2 weeks I was still hurting, but I'll address that as it comes up I suppose.

With surgery coming up so quickly, I'm calm, but also find myself getting caught up in the moment sometimes that this is actually happening.

As far as pain meds and being cloudy after, I think I'll handle that well, I've had lots of pain meds in my time and seemed to handle them with ease.

Last thing I wanted to address, I apologize I don't know who posted it, but about not wanting benzos in their surgery. I've actually been on 4 mg of generic Xanex XR for almost 5 years now, which is in the benzo family, and acts as my anti-anxiety/panic attack medication, so I'll talk to the anesthesiologist obviously before on my pre op appointments, but I'm nervous how that's going to factor in, because I think that's one of the leading factors in my memory loss. I'd like to get off of it and try something not so numbing, but it's going to be difficult to ween myself off of it after surgery. Hopefully it doesn't present a major problem.

SORRY! Probably ranted more than needed, but thanks for advice and for taking the time to read.