Breathing problems post surgery - some advice needed

[Simon Booker]

My Dad (Alan B) is AVR surgery +4 days. He has another thread that I'm using to update people on his progress so very sorry for any duplication but I wanted some specific advice on his breathing problem.

He cannot maintain his O2 saturation for more than one minute without a high pressure C-PAP mask (hooked up to a ventilator). His saturation falls to 80% after 1 min without the mask and then the mask needs to be reapplied to prevent it falling further. The doctors now say that the x-ray shows fibrous tissue in his lungs and that they are waiting for a potential infection to appear so that they can target it with anti-biotics.

Dad has some fluid in both lungs but not enough to need draining. Because he is on the pressure mask and cant' be taken off it he cannot use a Spirometer or easily cough up the fluid. I'm worried this is a vicious circle.

Ha anyone else had this? The doctors seem to think that an infection should be allowed to develop and then targeted. He's only had broad spectrum anti-Bios so far (routine for his surgery). They also seem reluctant to use Steriods (say that they never do).

We are getting him to sit up as much as possible. Any observations gratefully received - this is really hampering his recovery - making him sleepy all the time (he's not properly woken up, but can speak well, focus and no adverse physical signs). The doctors are tracking improvements in his Kidneys (Creotine is high, but no-where near high enough to need dialysis yet and seems to have stablised over the past two days. Urine output has improved over the last 36 hours and is now good.

Is this a familiar story? I know everyone is different but I don't know how to think about this in terms of its potential seriousness.

Many thanks

Simon

 

[laurad37]

Is he able to recieve breathing treatements from the respitory dept? they came in and gave me them about 4 times a day. I also had fluids on my lungs and it wasnt until the 3rd day when I was able to get off the oxygen. I know with me my diaphram was really high after the surgery which made breathing more difficult. It's still high and the dr. says about 6 months for that to be back in place. Not sure about the infection part. What do you mean that they think and infection will come?

 

[deek]

I had the same issues post-op and this was why they kept me in ICU for 5 days. Had fluid on the lungs and because of blood pressure issues it was hard for me to be mobile, which they said would help with this. Once I was able to get up and moving it became better. Also, the spirometer helped.

 

[bugchucker]

Damn, sorry he is having such a rough time, it is early yet. Hopefully you can get him on the spirometer, for me (being competitve) it was a daily/hourly challenge to move it higher. Hope things improve!

 

[KAJ]

I am of course not a doctor. Has he gained weight since his surgery? I did not have much fluid around my lung. However, I gained 10 pounds in 5 days after surgery. My lack of being able to breath was because of being in congestive heart failure due the fluid build up.

As Laura suggested, I was also placed on breathng treatments four times a day after that diagnosis. To make a long story short, after was I was diagnosed with congestive heart failure, I was in the hospital for another 9 days. I don't remember much about my blood pressure. I do remember it was very difficult to breath , and my oxygen level was extremely inconsistent.

Karl

 

[Simon Booker]

Thanks

Thanks

Thank you for your replies. Laura - hope that you are well, I've been following your thread. He has not been offered anything else in the way of respiratory support yet, although is having physio on his chest to help the problem. He is also on humidified ventilation support. I'll ask what else is available. In terms of his possible infection, they say thatthey prefer to treat an ifection as it shows itself (not before) and match an antibiotic to the exact infection rather than using broad spectrum anti-bios before they know whatthey are dealing with.

I have brought him a spirometer from the States - we do not seem to use them here (strangely they are not used - which seems odd given how you guys in the US say how much of a help they are) but like Deek's situation, Dad can't use it at the moment because of the ventilator.

Kaj - no weight gain as we have been watching this carefully. What breathing treatments were you on?

Many thanks and kind regards

Simon

 

[Nancy]

Sounds like a catch 22. He has fluid in his lungs, suggesting congestive heart failure, but also has poor kidney function which makes it very difficult to use diuretics to rid his fluid problem.

Joe had that quite a few times. This is what his doctors did, and he had kidney specialists plus his cardiologist working on things. They would use diuretics until his kidney function started to become problematic, then they would back off, and wait until it improved, and then they put him back on diuretics again, and waited until his kidneys were a problem, and then back off again.

They worked it slowly this way until the fluid was gone and he was able to get weaned off the C-Pap.

Along with the C-Pap, he also had respiratory treatments which helped a lot.

It was an arduous process, and took place when he was hospitalized.

When they used diuretics, they were fairly aggressive with them (using Zaroxolyn plus IV Lasix or a combination of other diuretics) because they only had a short window of opportunity, to get rid of the fluid. When one set of diuretics didn't work, they tried others. Some work one way on the kidneys, and some work in other ways.

It was quite a balancing act, and I was really impressed with the dedication of the doctors at a large teaching hospital, who devised this tricky plan.

But it worked.

 

[ALCapshaw2]

That sounds like an Excellent Example of inter-departmental cooperation Nancy, and the way things Should Work for complex cases. Glad that it worked for Joe!

Simon - I hope you can bring your Dad's Doctors together in a similar successful balancing act.

 

[MissMelis]

I can't offer any advice, unfortunately - but at least some have had this experience here and can offer some advice and hopefully comfort.
Simon, I hope that the good docs there can find some solution for your dad. I'm confident he'll come through unscathed.

Prayers continuing!
Melissa

 

[Simon Booker]

Thanks all - this was really helpful

Thanks all - this was really helpful

Thanks so much. I've spoken with Dad's doctors (I can't actually claim any credit - they had already started the plan that Nancy described when I arrived this morning), but it was reassuring to know that Nancy's experience was being followed over here. They have been treating Dad with a diuretic and it seems to be working, although they are balancing against his kidney function. His blood toxins were quite high but have now been on the way down for 24 hours so they feel bolder on the diuretics. As a result, he has been standing up twice today and eating ice cream - seeming noticeably better. He was on an O2 only mask (no C-PAP) for most of the day and maanged to keep his saturation up. he did have a 'dicey' night last night and was almost re-intubated but is much improved today and is doing great.

More small steps.... he's almostthere

 

[Nancy]

Yes-s-s-s-s!! So glad they are using the "plan" and it is working for him. It does take a little time. Just as long as things are going in the right direction. I seem to remember at one point that it got exponentially better once a lot of the fluid was gone.

 

[kfay]

Simon, I'm so glad to read that your father is starting to turn the corner. I know it has to be reassuring that his Dr's are trying to get things under control. You'll be in my thoughts. Please keep us posted.

Kim

 

[Ross]

I have significant scar tissue in the bases of both of my lungs. Actually, only about 1/3 of each lung is really functioning. For anyone with the fiberous tissue set up, it's very difficult for the first week or so. They are moving in the right direction. Once they can get him to the point of walking, the excercise will help increase the O2 saturation also.

 

[KAJ]

Hi Simon,

I really do not know the type of breathing treatment. I do know it was administered by a respiratory therapist with a machine. I remember the treatments really well, even after four years. Both the day shift and night shift therapists thanked me for always being so cooperative, especially if they had to wake me up for the treatments.

I told them I thougth it was odd they were thanking me. They both said that many patients are not very cooperative. I told them, "you are only trying to help me, I want to get out of here."

Karl

 

[laurad37]

I am so glad to hear he is improving. I tell ya, getting off the oxygen after surgery was one of my biggest hurdles. Time heals everything and he will continue to get better and better each day. You'll see.

 

[Simon Booker]

He's doing much better

He's doing much better

Thank you all. Dad is off of the humidified C-PAP now (including last night) which was a real achievement and is just on an O2 Canula - 40%. He looks so much better and has been able to walk down the ward with assistance. He's moving out of ICU this morning and onto the general ward so hopefully this will help him with his rest.

Ross - re: the Fiberous tissue - no-one mentioned this to us prior to surgery, and he had a full pre-surgical chest x-ray that did not pick this up (or if it did, the ICU team only learnt of this post-operatively through their own x-rays. Is it something that can be improved in your experience, or something that you live with and it's no real problem? I guess if he needs anything else doing in the future heart-wise, this should be factored into the pre-surgical strategy?

Kind regards

Simon

 

[Nancy]

Great news, Simon! I am so happy for him, and it must be a huge relief for all, especially him. It is important now that he keeps as active as possible, walking and moving around, even while in his chair or bed. His muscles no doubt, have atrophied some, and that will take work to improve.

But it does sound like he is on his way.

 

[Ross]

Ross - re: the Fibrous tissue - no-one mentioned this to us prior to surgery, and he had a full pre-surgical chest x-ray that did not pick this up (or if it did, the ICU team only learned of this post-operatively through their own x-rays. Is it something that can be improved in your experience, or something that you live with and it's no real problem? I guess if he needs anything else doing in the future heart-wise, this should be factored into the Prue-surgical strategy?

Kind regards

Simon

Unfortunately it will never improve. It can get worse should he develop pneumonia or perhaps even have undiagnosed cystic fibrosis. It does cut your lung capacity down because it's basically lung tissue that does not expand any longer. I can tell you it sucks!

They should have seen it clearly on the chest xrays at first. Of course, they should have seen my dissecting aneurysm when they did my cath too, but they missed it. It's all in the radiologists interpretation of the films he looks at.

 

[lilteach3234]

I had problems with my breathing after surgery. I had to stay on the ventilator longer than normal...tried to take it off and had to go right back on. I had problems with fluid but they could not figure out what was wrong because all my numbers were good and I did not have a PE. They finally took me off all pain medications and basically dried me up for several hours. They were able to finally take me off the vent but I had to wear oxygen for several days because saturations would drop. It took everything I had to try to get stuff coughed up and the spirometer was a joke.

They put me on breathing treatments every few hours and they were an answer to prayers.

Once I got home I was able to use my spirometer and got up to the levels I needed to be.

My pulmonologist was so happy when I went in for my first post op visit that he actually pulled up my scans just so he could look at them and brag about how that he had done right then. My lungs were beautiful and he was extremely excited!

 

[Simon Booker]

thanks

thanks

Sounds like a familiar story with Dad and the experiences that you have had. Ross - I'll ask to see if there is any more context I can get to this - whether we are dealing with something that was there all along or is actually a transitional issue with surgery. They definitely described it to me as fiberous tissue and Mum says that Dad has always been a shallow breather - so worth checking out - thanks.

His breathing is now ok - he can maintain O2 saturation of 90%+ with no supplemental oxygon and is being discharged tomorrow. However, this was a real thorn in his recovery so I am keen to undertand some more about it.

Kind regards

Simon