Pumphead Revisited

[ccrawford]

Several months ago we had quite a thread going on the topic of post surgery "fuzzies" or pumphead. The July issue of Scientific American just came out and it has an article on this by Bruce Stutz who is a valve repair veteran. Bruce recaps a 2001 NE Journal of Medicine article by Mark Newman that found via a long term study, long term effects of pumpheadness in 42 % of CABG patients after five years. (Note-another study found no long term effects) The discussion of causes seemed to focus on emboli (tiny flecks) that may be caused by the heart/lung machines pump, or from clamping blood vessels. These tiny emboli can cause mini strokes. Other possible causes of pumphead were mentioned such as hypoxia, lowered BP, altered heart rythyms and or body temperature. The article also had a couple of interesting diagrams: one of how a heart lung machine is typically hooked up, and another that showed a retractor with ajustable arms used to minimize heart movement during off pump surgery. There was some discussion of a possible trend towards use of more off pump surgery, as well as improved heart lung machine technology to minimize the incidence of pumphead. The author had a pretty bad case and he coped with it by working shorter work periods, getting off at a further subway stop in order to make him self navigate home, and playing the piano to improve the ability to focus. I guess I'd be interested in hearing from our members about their observations of long term effects of pumpheadness- we have a great membership to do informal surveys like this and the medical profession might be interested. Chris

 

[Granbonny]

Heart. Lung Machine

Heart. Lung Machine

Several months after my surgery..I asked my very observant daughter, how long did the surgeon say I was on the heart-lung machine and she said..he said 22 minutes. I don't like to keep them on it more than that.. After, I joined VR...I asked her again (after noticing how much longer other valvers were on it) and she said again...22 minutes.She was with me 24 hours everyday from the time they told her..your Mom needs to have surgery until 1 week after surgery.She wrote down notes, ect. and still observes me 14 months after my surgery to make sure..I am taking care of myself. .....As far as being a pumphead..only a few weeks..did not want to talk on phone, ect..but can still remember everything that happened to me 50 years ago..so I guess..the less time on heart-lung machine..patients are better .... Bonnie

 

[Marty]

22 minutes?

22 minutes?

Bonnie, I love you and know you would never tell a fib but I don't believe they could ever complete your operation in 22 minutes pump time. An hour and 22 minutes would be very good. Use the Freedom of Information Act to get your records. Your pump time will be recorded and let us know.( Or just get the surgeons secretary to check). I was on the pump one hour and 17 minutes for a mitral valve replacement and eventually back to work half time as a radiologist. I had no memory problems but had occasional vision and other problems that eventually turned out to be due to drugs like Percocet I became too fond of. Now my only drug is Coumadin and no more symptoms. I have a buddy now 80 who had Cosgrove at Cleveland Clinic do a mitral repair 5 years ago. Pump time was 57 minutes which my cardiologist thought was really fast.

 

[Nancy]

Hi Bonnie-

In another post, I remember that you mentioned that you were cooled down during your surgery "Hemiarch replacement using deep hypothermia and circulatory arrest, Retrograde cerebral perfussion".

Perhaps that allowed for shorter time on the pump, and protected your brain function.

At any rate, you seem sharp as a tack to me!

 

[ALCapshaw2]

A Big THANKS for that interesting post Chris !

'AL'

 

[hhardt]

I notice even more pumpheadiness lately. Can't seem to remember the names of lots of things that I even have in my hand. Last night it was hot pads (pot holders) to keep from burning my hands. Just seems to occur more often. I did read somewhere that there is an increase for some from years 2-5. I still know where I am, what things are used for, but not their d--- names. It frustrates me terribly sometimes which probably doesn't help. Knowing that it was the microemboli helps, but just because I have a tag. More frustrating is forgetting the words to songs while I'm singing at choir or barbershop practice. Q Does it get better after year 5?????

 

[Granbonny]

Marty and Nancy

Marty and Nancy

Here we go again woke daughter up early to ask her again about minutes. I think she thought I had lost it.. But she knows..I am a little whacky. She said, the surgeon said..I only stopped her heart for 22 minutes..Now, does that make any sense? Is that different than time on heart/lung machine? But, at any rate..take back saying I was only on heart/lung machine for 22 minutes. Unless, Marty, surgeon had the fastest hands in the South.. Nancy, being sharp as a tack? I can tell you what I did 50 years ago but not last week. that happens to all elderly peple..Anyone wanting to do their family history should visited their elders and ask questions about the old days, people, ect. Bonnie

 

[Gisele]

Hmmmm

Hmmmm

I still have difficulty with my memory. I have developed a habit of writing everything down. I have always joked and blamed my mother saying it runs in the family.

My surgery was nine hours (they had difficulty fitting a large enough valve). I am not sure how long I was on the heart lung machine, but that was 21 years ago. They are much quicker now when performing valve replacements.

I have to laugh when I am trying to make a point with my husband and for the life of me I just can't remember what I wanted to blame him for, but I know it was something! LOL

 

[Granbonny]

Gisele

Gisele

You had your valve replaced 21 years ago?...Gosh, you are up there with Nancy's Joe. Must get Ross to start a poll on ..How long have you had your valve?...Kind of valve?... Would be interesting. Bonnie

 

[hensylee]

I had CABG and don't know how long I was on pump. I find I have lost words and names. But I have always enjoyed puzzles of all kinds and like to know how things work so try to figure them out. This helps to retain brain function so we should all have some brain exercises in our lives.

My brother (who has Parkinson's) and I share things we need to remember, asking each other to remind us - we always forget, so maybe the puzzles don't help at all?

I have a calendar near the computer to write down appointments and dates to remember. It helps.

 

[carbomedic]

Out of all the things associated with my climb over the mountain, pumphead is my biggest problem by far. My biggest problem is that I can't multi function anymore. I become very confused. A person 51 years old in a business that depends on youth and new knowledge is at a definate disadvantage. the second issue is gettin to and maintaining a high level of concentration. This has become very depressing to me. I find I must just work slower. and man, I will tell you, when business is slow, youth with a memory and knowledge looks very good to employers.

 

[Georgia]

So . . .

So . . .

from what I read on this thread and previous ones, aphasia seems to be the biggest problem (or, more accurately, the most common one). I have it from chemo therapy 13 years ago; I don't think it's any worse after valve surgery (8 1/2 hours, so it was pretty major). Does anyone else have the experience that it's (the aphasia) worse verbally than while typing? Must be different nerve paths when it's written?

I have a pretty demanding job intellectually; and after being back at work for nearly 2 months I've been pretty pleased to find that I am getting back

 

[John Cochran]

My valve replacement surgery was over 14 hours long, with over 10 hours on a heart/lung machine. The first week after surgery I was a space cadet, and it took about a month before I could concentrate enough to read a whole book again.

One year later I can detect no symptoms what-so-ever of pump-headedness. I even took an IQ test to compare against my pre-op condition, and there was no drop at all.

I suspect that what is commonly called "pump headedness" has a lot to do with all the drugs administering during and after surgery. Granted, one's blood takes a terrific beating while on the pump, and plenty of other issues might contribute. But, with my extreme length of time on the pump, I can't believe it is the pump alone that causes the symptoms others have described. On the other hand, there might be a high degree of individual variability in this too. I do know that the pump filters and overall procedures are much better than in the past.

--John

 

[Gisele]

Bonnie

Bonnie

My valve is priceless you know as it is no longer available.

Actually, it is a Bjork Shiley mitral valve which is no longer available due to their manufacturing a defective valve. Actually I read about the valve recall in a Good Housekeeping magazine and I was stunned. I called my doc and he knew nothing about it, so he had to call doc in Boston who did the surgery. Phew, my model was fine. Afterwards as part of a financial settlement they had to pay Medic Alert to enroll all their valvers into the Medic ID program. Twice a year I get a form from Medic Alert and the service is paid for from Bjork Shiley.

My vavle was damaged from rheumatic fever when I was ten years old. Back then the treatment was to take penicillen three times a day. Things certainly have changed!

As far as the memory goes, I really think it is due more to genetics than my surgery, but really any excuse will work for me! LOL

 

[Nancy]

Hi John-

I really have to agree with you. I've watched Joe go through 6 major surgeries (not all of them involving the pump) and there was the same effect after all of them. I also notice that when he has fluid buildup with SOB, has been severely anemic, or has had severe medical problems--same deal. I think a lot of what I have witnessed can be attributed to surgical meds, or oxygen deprivation from various causes. Once these conditions clear up, the problem is gone.

Of course everyone is different.

 

[Nancy]

Hi Gisele-

Joe also has a Bjork-Shiley as you know, but an aortic. The Medic Alert enrollment is nice, isn't it.

Joe heard about that recall on 60 Minutes on TV. He was absolutely stunned. And he had lost his model number, and his original cardiologist had passed away. He had to go to Boston to have some sort of special xray "look-see" on his valve, all paid for by Bjork-Shiley. Those were a stressful few months before that took place.

 

[Gisele]

Nancy

Nancy

Stressful??? Talk about panic setting in when I ever read the article. The small recall article didn't mention that the recall was related to one particular model so I nearly died thinking there was no way I would go through the surgery again.

I believe it was due to that recall that manufacturers have to keep track of the patients and which valve (model and serial #) they have implanted. I feel badly for those patients affected by the recall.

Always good to hear that Joe is doing well as I can use him as a guideline......lol

 

[Nancy]

Thje worst thing about the 60 Minutes report was the "sudden death" that happened to those unfortunate patients with the defective valve. No warning at all.

 

[pillarpaul]

Chris, timely for me to revisit this as I am still post-op like you. I don't seem to have a problem with, what was it you called it? Why, I was just telling someone yesterday that I can remember, uh, things in the past. Hey, Steve, can you restate that?

Paul

 

[epstns]

Ummm, no. . .

Ummm, no. . .

Can't help much with . . . what was that?

I'm still pre-op, so not a good example. My wife claims I just suffer from MASP, otherwise known as Middle Age Selective Perception. I don't think that's true, 'cause I'm not middle aged, yet. (Middle age is always my mom's age. She's 80 now.)