Bypass Brain

[Protimenow]

There are a few things that the surgeons and others involved in your care before a valve replacement (or, perhaps they're ignorant, or outright lie).

1.Even though your damaged/defective heart valve has been replaced and, in theory, your heart and body are in better shape than they were before the surgery, it will NOT be easier to get life insurance. My doctors told me that insurance will be much easier -- I don't think that anyone here can contradict me on this.

2. The big secret is something that now has a name -- Bypass Brain. I don't know what a surgeon will tell you if you ask about it. I didn't know to ask, when my valve was replaced nearly 26 years ago. Surgeons were doing bypass surgery for many years before my valve replacement, but nobody said anything to me about it. I doubt that many surgeons will - or they'll dispute the term, saying that it's a myth, or only happens to a small percentage of patients, or who knows what?

Perhaps it DOES only affect a certain percentage of patients. Perhaps many here HAVEN'T experienced it.

Here's what it is, basically:

When they disconnect your heart, and put it on bypass, the brain is still functioning, trying to control a stopped heart. While you're on bypass something happens. After you come off bypass, and your heart is again under your brain's control, the heart is again functioning -- but something in the brain may not function as it did before your heart went on bypass.

Physically, you may be better. But mentally, you may not come back quite the same.

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Over my years on this and other similar valve replacement forums, I've seen it asked many times -- 'Are you different after your surgery than you were before your surgery?' 'Are you not all there after your surgery?'

Some have answered 'yes.' Some didn't know. Even more didn't respond at all.

From my own personal experience, I have to say that I've changed. My career was on a distinct upward trajectory. I had a good job, as Bureau Chief at a major news weekly. I was driven to get great stories. I was well respected, and hustled to get better news than the competition. I had written six books. The future looked quite rosy.

Six months after returning to work, I was out of a job. My upward path had reached its peak. Although I had found editorial jobs that, on paper, were a significant step up -- they weren't. It wasn't easy to hold a good job at a significant publication -- and I'm still not sure exactly why. The jobs that I did hold for long periods were for fourth rate publishers who underpaid their employees (myself included), and kept all the money in the owner's pocket.

Motivation was down. Drive was down. there was a stronger tendency towards depression. I had trouble completing projects without a partner sharing the task and providing motivation to complete it. After the surgery, I hit the brakes on my upward path - and hit them hard.

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I haven't looked up material on 'Bypass brain,' and I'm not using it an excuse. I've seen many on this forum who seem to have soared following surgery and recovery--especially those who were physically active before the surgery and who are much more active after the surgery.

I think that there may be factors that are probably not yet known that may predispose some people to this 'syndrome?' and not others. Perhaps there are interventions that some do soon after surgery (or maybe before surgery) that minimize or avoid this. I don't know.

There are some medical professionals who acknowledge and recognize this. If I find out more about this, I'll post legitimate clinical materials or links.

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My point in posting this rather embarrassing,autobiographical item is as one more thing to ask your surgeon about BEFORE surgery, just so that you're fully aware of potential secondary issues related to surgery.

Had I known before my surgery that I may be affected in this way (and, again, I'm assuming that my changes may have somehow been secondary to the surgery), I may have waited another year or two. OTOH, had I waited, my heart would have gotten even weaker, and, not knowing whether or not this REALLY WAS an issue, I still may have lost my job -- and the all too important insurance that paid for my surgery. It's impossible to know now.

This may be an issue that you want to ask your surgeon about. Discuss it with your family. Don't put off surgery, but be aware that there may be a possibility that you may gain your physical health -- but there may be a possible other price to pay.

 

[Juli]

Protimenow - I cannot confirm or dismiss the "pump head" or bypass brain. However, there is in my mind no doubt that the type of surgery that we went through is life altering and something that we will not forget. We all process this differently but I don't think anybody will go back to normal and there will be mental scars. I probably fall into the group of very active people who were lucky to get back into the normal routine quickly. However, the fact that I am still reading multiple forums and discussion groups 9 months post OHS tells me that I am still processing the event - and will for quite some time. Also - let's face it - we all did not have an option, this had to be done. That is what I am telling myself - but again I am not there yet.

 

[Protimenow]

Juli: It's funny. I had the surgery and remember looking forward to having it and how I would feel after I recovered. I remember a day or two before the surgery, and going in to the hospital, scrubbing my body with an antiseptic wash, and a little about going into surgery. I remember waking up in cardiac ICU after the surgery when the person in the next bed coded and died - and I remembered thanking that person, thinking that, if someone had to die that morning, I was glad that it wasn't me. I still remember some of the boring days in recovery, sitting in my bed in the room, walking up and down the halls, having visits from my wife and kids (and my mother, who brought me a barbecue beef sandwich), and I remember going to the pharmacy after I was released and being quite grouchy. I remember some of the days when I didn't do much around the house - walking a mile or so to get a greasy hamburger, and eventually getting back to work. My first day back, I flew to Oakland CA for some meetings, and learned that my mother had cancer (what a great message for the first day back).

I'm not sure about feeling mental scars from the surgery - I went in, put myself into the hands of a good surgeon and his surgical team, then going home. I don't recall any 'scars' that I can easily bring up. I'm not sure about problems processing the event.

The option that some of of us have is delaying the surgery. I was diagnosed with the murmur in my early 20s, although I probably had it all my life. I was told that I'd probably need surgery in 25 years or so. My option was choosing between how long I could wait before having the surgery - it was what was probably the same delicate dance that many of us have gone through - how much damage do you want to do to your heart while waiting against the risks of the surgery. It's like I asked my cardiologist at the time 'how sick do I have to be before I can get this done?'

In your case, you probably DID have to get this done--or choose being incapacitated or becoming too ill to have a successful surgical outcome. You undoubtedly did the right thing. As far as 'processing' this goes, I'm sure that we probably all have our own ways of 'processing' this - and I'm not disappointed that you could neither 'confirm or dismiss' the 'pump head' in your case.

I wish you well, and a full, complete recovery from your surgery. I hope that you'll only continue to get stronger, and fully accept the better you.

Thanks for weighing in on this.

 

[Superman]

I seem to recall reading a few "pump head" threads on this forum. This is the first I've heard of it referred to as "bypass brain". Perhaps something to consider if you are considering discussing with your doctor, in case they had not heard one term, but are familiar with the other.

Regarding "trajectory" - I really can't speak to that. I was in my formative years when I had my first surgery as a senior in high school. I don't know where things may have gone otherwise (assuming good health). Since my second surgery, I've been busy with five kids and finished my MBA, maintaining a 4.0 GPA while working full time. Now I teach adjunct and work full time, while my wife and I raise our children. I have assume my brain hasn't suffered too much.

Unless I missed out on being rich and famous.

 

[cldlhd]

The two brain based differences I've noticed are short term memory not being as good, although that's hard to quantify, and I get migraine auras much more frequently. Before surgery I would get the aura and a really bad migraine a couple times RS a year. Now I get a handful of auras a month but without the subsequent migraine. The cardiac team dismiss pump head out of hand while the neurologist, same institution, says he sees it all the time. Other than that I feel mostly the same.

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[epstns]

I suspect that what we are discussing as a single effect may, in fact, be two separate effects. One is the more common "pumphead" phenomenon in which the patient suffers short-term cognitive impairment for some time, even months, post-op. Many of us have noticed this effect, as we find that we make "silly" mistakes at work, forget what we were doing at home, forget names, directions, where we put our keys, etc. This phenomenon seems to gradually fade away in the months following surgery such that by our first surgical anniversary, most of us feel that we are "back to normal" and can function as well as we did before.

The second effect, the one PTnow calls "bypass brain" seems to be more profound. It appears to be longer-lasting and perhaps even permanent. The patient not only feels the "minor" impairments of pumphead, but also seems to lose their mental edge and drive.

I'm no trained psychologist, but the latter bypass brain condition sounds more like the effects of clinical depression - a condition that is a known after-effect of heart surgery in a subset of patients. I say "sounds like" because I do not know if these (bypass brain and depression) are different severities of the same condition or if they are, in fact, two different conditions.

I was very active before surgery - running, lifting weights, etc., as well as working a high-stress job for long hours and living a full life. I do know that I had a bit of a rough time for the first year or so after surgery. I had post-op complications and a lot of psychological/emotional issues. I also had some really draining side effects from meds and in getting a new pacemaker adjusted. Once those were under control, I have gotten back to a very "normal" life - especially for a guy getting close to 70 years old. Still working 50+ hours/week and getting to the gym 5 days a week, etc. Did my valve surgery afford me better quality of life? Maybe, but had I not had the surgery I would not be around by now. Some of us truly had no choice.

 

[dreamy885]

I'm am a day and a half away from the slice and I am willing myself to recover as quickly and smoothly as possible and to keep in good spirits. I truly don't know what to expect, even as much as people try to explain it, you don't know until you experience it. I have two little boys that I need to take care of, a worried boyfriend, sister, father and many friends that I need to put at ease, and a job to help people feel better about themselves. Depression scares me because I have a feeling that I would try and cover it up and not get help. I just keep picturing myself going uphill and working hard and being positive. I hope it's enough to help me get through the next few months!

 

[Zoltania]

Heather, the fact that you're aware of the possibility of depression means that you'll be aware enough to do something about it if necessary, so don't worry.

"Being positive" is a tricky thing. For some people it means forcing themselves into a sense of obligation to feel good, and feeling bad about themselves if they "fail." I prefer to think of it in cognitive-behavioral therapy terms, where you look at your thoughts and try to reframe them in a positive or neutral direction if they are negative and not based on fact (if they are what's called "cognitive distortions"). For example, if you catch yourself thinking "I'm such a failure because I'm too tired/lazy to keep the house clean," you can challenge that thought and realize that you are labeling yourself (that's a cognitive distortion) and that a more useful way to frame the thought is, "I'm tired right now, but I'm entitled to be tired, and it's OK if the dishes stay dirty tonight. That doesn't make me a failure. I do a lot of work around the house and am doing the best I can." A useful phrase I learned in a meditation class is, "Don't believe everything you think."

Also, I find it really helpful to identify familiar negative thought patterns and nip them in the bud, rather than letting my mind form a "well-worn path" of negative thoughts. It's better to let those paths get mossy and overgrown.

On the topic of not knowing what surgery and recovery will be like until you experience it, that's very true. The unknown is frightening. But you'll come out on the other side as someone who has gone through this and added it to your wealth of experience. When you were young, could you imagine yourself being 30+ and having children? That probably seemed unimaginable, like you would be someone else. And now you've come through it and have all that experience, and you're still yourself, just more so. Hopefully that will be true after your surgery too: you'll still be yourself, and also healthier.

By the way, I did not experience any "bypass brain" or "pump head." YMMV, of course.

 

[pellicle]

Myself I did not experience it except on the suegery when I was older. Some details on it here

https://en.wikipedia.org/wiki/Postperfusion_syndrome

 

[AZ Don]

I'm probably very lucky not to have suffered pumphead, my short term memory was pretty bad to begin with. I do get migraine aura's, maybe once a month or so, that I did not get before. I can also feel my heart pounding when I take a deep breath, or bend backwards - this was strange at first but it's not so bad and I've gotten used to it. All in all the side effects I've had are trivial compared to the life threatening aneurysm that I had repaired. This thread is interesting because while most of us can at most delay surgery only slightly, the valve choice affects the risk of subsequent surgeries and these side effects are rarely discussed. Personally, if my leaky BAV gets bad enough I plan to have a mechanical valve, primarily to avoid more surgeries. While my 1st went quite well and I don't regret sparing my BAV during surgery to repair my aneurysm, I don't want to push my luck - and I plan on living long enough that a tissue valve would have to be replaced.

I've read enough experiences to believe that some people lose something through the surgery. But just as strength and endurance come back after surgery, I have to think that mentally people can come back too. Maybe not to where they were, but I think we all have the capacity for improvement.

 

[Paleowoman]

I didn't suffer from any memory problems after surgery, my memory remains excellent. But I did, and do, get migraine auras, double vision and sparkles of bright light across vision - all started day after surgery - doc on cardiac ward told me this is known to happen after cardiac surgery (bypass machine ?) and they continue to this day. I get the migraine auras and double vision 3 or 4 times a month and the bright light across vision daily. There are no triggers - can happen any time of day or night, I've woken up with the migraine aura going on sometimes.

Psychologically I think that heart surgery does affect anyone to a lesser or greater extent.

 

[Protimenow]

Thanks for all the responses.

A few things: it's been nearly 26 years since my surgery. I don't recall memory issues after surgery.

I had the auras for many years before the surgery, and continue to have them. One tip - sometimes it helps to have a caffeinated drink or piece of dark chocolate when the aura starts - sometimes, this turns the aura off. If I do nothing, the aura is gone in a half hour. Other times, it's gone in 30 minutes. And, with chocolate, it often goes away entirely. Bright lights sometimes trigger my auras, and continued exposure to bright light only makes it worse.

When I had my surgery, I had a wife and two kids (and two dogs) to support, and a job that kept me mentally very busy. Although I may have leaned towards depression, I had no time to let it take hold. With most of my work indoors and little human contact (other than my wife), I've had much too much time to contemplate my navel and let bad thoughts get reinforced daily - perhaps what Zoltania was saying should resonate well with me - perhaps some of what I've experienced is less 'Bypass Brain' and more 'something else.'

I'll be checking back regularly.

 

[carolinemc]

On the insurance, protimenow, you can get on health insurance now, since that is a preexisting condition, it is covered. The problem we all have is life insurance. It has been a problem for many of us for many years and has not changed over time. My mother was lucky at one time to find a life insurance which would cover me, but she had to drop it after a few years, got too expensive on a SSDI check. Now what doctors and others are refereeing to, these days when on the bypass machine these days, is called pumphead. It happens to many of us. I had to relearn somethings at work due to it. It is a sideaffect from being on bypass. I still have occasionally have problems, not as much now. Things get strange over time when surgery is better and better. Hugs for you.

 

[epstns]

Zoltania - Thank you for putting things to words so elegantly. You obviously are a professional in the behavioral health area (or something similar). I'm just an amateur, but my daughter is a licensed practitioner, so I get lots of advice. She is often surprised at how much a layman can observe and learn.

PTNow - do I sense that we have offended you? I hope not - we are all just adding our own experiences to your observations, definitely not in disagreement. I hope you will be around and active for a long time.

 

[Protimenow]

No offense perceived or taken. None at all. Everything's good for me on this forum. I sincerely appreciate comments from all of you -- and comments that may be coming from those who haven't yet weighed in.

I may perhaps be a bit too free with my confessions and experiences, and may have tried to clarify what I may have thought needed a change in focus.
I'm always looking for honest experiences and observations from anyone on this forum, and appreciate learning from others.

Caroline -- I'm now fortunate(?) enough to be on Medicare, and that pre-existing thing has, I think, gone away. When I have to get supplemental, without the ACA to protect me, this secondary insurance may wind up costing a tremendous amount.

 

[Zoltania]

Zoltania - Thank you for putting things to words so elegantly. You obviously are a professional in the behavioral health area (or something similar). I'm just an amateur, but my daughter is a licensed practitioner, so I get lots of advice. She is often surprised at how much a layman can observe and learn.

Steve, thanks for the nice compliment. I too am just an amateur who has done a fair amount of reading and thinking about these topics. My #1 reading recommendation is "Feeling Good" by David Burns. Other books that have been helpful for me are "An End To Panic" by Elke Zuercher-White and "Treating Health Anxiety" by Steven Taylor and Gordon Asmundson.