Post-op breathing/inspired volume

[jyg]

Since surgery (11/05/2013) the symptoms have improved. I'm not too worried and atelectasis was ruled some time ago with an x-ray about a week after going home. To be honest, I haven't been the most consistent with the breathing exercises (with those plastic inhale/exhale devices). At 9 weeks post-op I don't really use them at all.

I did begin to have some asthma. I've had very mild asthma on and off since I was a teenager, which has improved over time. I've rarely used a rescue inhaler in the last 20 years. After surgery though, I had a slowly growing bout and got a new albuterol inhaler prescription. It certainly helped, but its not like I'm totally locking up. It just can be uncomfortable to the point where I start using auxiliary muscles to breath. My GP spoke with my cardiologist and they agreed this was an effect of the beta-blockers. Rather than put me on a long acting bronchodilator which has medicines which would diminish the beta-blockers effect, they said to use the rescue inhaler as needed. And, really, I have needed it less and less. I think maybe I've used it once in the past week. Anyone experience this?

What got me a bit more concerned is what feels as though I cannot take in as much volume as I used to. (Strangely, I've noticed when I take a deep breath that my lower chest will sink in a bit and my belly will expand. Where as before surgery my whole torso would expand.... maybe things look different because I've lost some weight :biggrin2: Anyhow... ). The inspired volume gotten a bit better, at least its been less generally noticeable, and from what I've read its fairly common (?). I have noticed that different body positions make a sizeable difference in how difficult it is to breath. Particularly, when I sit, leaning back about 30-40 degrees from vertical its as though someone's sitting on my chest. It really catches me by surprise. My GP believes its just my lungs being unhappy about being exposed and it will get better over time. I do recall when I first started to drive again, the slightly reclined position of the driver's seat bothered me. Now, I don't noticed it. Sitting back on the couch is like putting a plastic bag over my head :rolleyes2:

Anyhow... just curious what others have experienced. Thanks.

 

[DebbyA]

Since you have had asthma, I may be way off base, but this sentence got my attention: "What got me a bit more concerned is what feels as though I cannot take in as much volume as I used to." If you feel like you're losing ground, especially after improving after surgery, you need to keep after your doctors. I had an untroubled recovery for three months, then developed pericardial effusion. It took over a week for me to finally utter some key phrase (I think it was 'losing ground after surgery') that prompted investigation, and I ended up with 3 days in the hospital being drained from pericardium and lungs. I had told my cardiologist I felt like I had a big ball in my abdomen that was keeping me from breathing deeply. It turned out that was my pericardium pressing on my diaphragm.
I hope none of this applies to you, but if it seems to describe your situation, check it out.

 

[Duffey]

Since you have had asthma, I may be way off base, but this sentence got my attention: "What got me a bit more concerned is what feels as though I cannot take in as much volume as I used to." If you feel like you're losing ground, especially after improving after surgery, you need to keep after your doctors. I had an untroubled recovery for three months, then developed pericardial effusion. It took over a week for me to finally utter some key phrase (I think it was 'losing ground after surgery') that prompted investigation, and I ended up with 3 days in the hospital being drained from pericardium and lungs. I had told my cardiologist I felt like I had a big ball in my abdomen that was keeping me from breathing deeply. It turned out that was my pericardium pressing on my diaphragm.
I hope none of this applies to you, but if it seems to describe your situation, check it out.

I agree completely with what Debby writes. I found myself in similar trouble at 3 months out.

 

[jyg]

Wow, thanks. That's great information. To be clear, however, "I cannot take in as much volume as I used to" is a reference to before surgery. I'm pretty sure I'm slowly improving from my first day post-op as a starting date.

This does make me think of something, however... The NP who took out my pacemaker wires a few day post-op botched one and it sunk into my chest. (Pretty much the only oddity/complication I've had.) The surgeon came to visit me after this and said it was unfortunate but not a big deal; he said that some surgeons even opt to leave them in so as to not take any chances on damaging the heart muscle upon pulling them out. The only concern should be to alert a doctor and technician were I to get an MRI.

So the wire is still there, I would suppose this pokes through the pericardium, no? Hmmm.. I was poking around and saw this:

http://journals.lww.com/jcnjournal/...=2005&issue=07000&article=00014&type=abstract

and

http://europace.oxfordjournals.org/content/14/2/297.abstract

Either way, I think I need to contact the surgeon...

 

[ottagal]

Since surgery (11/05/2013) the symptoms have improved. I'm not too worried and atelectasis was ruled some time ago with an x-ray about a week after going home. To be honest, I haven't been the most consistent with the breathing exercises (with those plastic inhale/exhale devices). At 9 weeks post-op I don't really use them at all.

I did begin to have some asthma. I've had very mild asthma on and off since I was a teenager, which has improved over time. I've rarely used a rescue inhaler in the last 20 years. After surgery though, I had a slowly growing bout and got a new albuterol inhaler prescription. It certainly helped, but its not like I'm totally locking up. It just can be uncomfortable to the point where I start using auxiliary muscles to breath. My GP spoke with my cardiologist and they agreed this was an effect of the beta-blockers. Rather than put me on a long acting bronchodilator which has medicines which would diminish the beta-blockers effect, they said to use the rescue inhaler as needed. And, really, I have needed it less and less. I think maybe I've used it once in the past week. Anyone experience this?

What got me a bit more concerned is what feels as though I cannot take in as much volume as I used to. (Strangely, I've noticed when I take a deep breath that my lower chest will sink in a bit and my belly will expand. Where as before surgery my whole torso would expand.... maybe things look different because I've lost some weight :biggrin2: Anyhow... ). The inspired volume gotten a bit better, at least its been less generally noticeable, and from what I've read its fairly common (?). I have noticed that different body positions make a sizeable difference in how difficult it is to breath. Particularly, when I sit, leaning back about 30-40 degrees from vertical its as though someone's sitting on my chest. It really catches me by surprise. My GP believes its just my lungs being unhappy about being exposed and it will get better over time. I do recall when I first started to drive again, the slightly reclined position of the driver's seat bothered me. Now, I don't noticed it. Sitting back on the couch is like putting a plastic bag over my head :rolleyes2:

Anyhow... just curious what others have experienced. Thanks.

Hi jyg,
I, like Debbie read from your post that you are currently concerned about not taking in as much volume. You asked what others have experienced and I did have pulmonary issues for quite some time after my surgery. However, I did have atelectasis and pleural effusions post-op. About a year post op I did go for a cardiopulmonary function test which still showed some ongoing mild pulmonary issues. I also have some 'asthma' that I was unaware of . In my case, my breathing improved incrementally and slowly but this was because of the above. Hope things get better for you. Let us know when you hear from your surgeon. All the best,

 

[T in YVR]

Have they done an echo post op yet (or recently)? If not, you should ask for one. If there was any pericardial effusion, it would show this. I had moderate pericardial effusion post op for about 2 months. It eventually went away on its own, but I imagine it could impact your breathing (not to mention the heart) if you had any. For my first 2 months after surgery my breathing was not as deep as it normally used to be. But I think part of the issue I had was that all of the muscles were very sore in my chest, making it harder to inhale (or causing a feeling of tightness). It resolved itself by the 2 month mark, coincidentally when the pericardial effusion had disappeared. Maybe muscle pain is partially contributing to this - you're only just at the 2 month mark.

 

[gerrychuck]

When you experience expansion of the abdomen with very little expansion of the chest, you are experiencing diaphragmatic breathing; the diaphragm is descending (as it should) which draws air into the chest, but compresses the contents of your abdomen in the process, which then pushes out. This is a good thing. The other half of your description (no chest expansion) is pretty typical of a post-OHS thoracic cage; it is stiff and tight after the trauma of the sternum being split and the joints between the ribs and thoracic spine being pulled well beyond their normal range of motion. Recovering that mobility is very important, and one of the main reasons that using the damnable incentive inspirometer is so necessary. In other words, all is normal, and you should be doing your breathing exercises to make sure things continue to improve