Congestive heart failure or mitral valve failure? Need some help.....

[sylviayasgur]

Hi all, I haven't been on for some time now. I first joined about 15 years ago right before my hisband, Joey, had his ross procedure done.
I am now back with questions regarding my dad's condition. He is 82, had avr ( st. Jude's mechanical valve) and bypass surgery about 18 years ago. He also had minimally invasive mitral valve repair done at NYU 6 years ago. Seems his mitral valve has a moderate leak and will need replacement or repair.
He also has congestive heart failure and takes lasix ( as needed); he also has pulmonary hypertension as a result .
The last week he has been coughing consistently, he says he coughs up phlegm but his cough seems to be non stop. Prior to last night he was ale to sleep through the night without coughing. Last night, however, he coughed all night long.
Last week his doctor told him he had a "cough" that is going around and gave him antibiotics. I am convinced this is more than a cough and I believe it is related to his CHF and pulmonary hypertension.
Any suggestions? My dad is afraid of needles, and surgery and is in denial about all this. My mom is clearly frightened and gets upset that he is not doing more to fix this.
I am visiting with them this week and even though I hate seeing my parents get older, my dad has aged very quickly, lost weight and has slowed down immensely.
His complex heart situation seems to have taken on a life of its own. I will, hopefully, be going to doctors with him this week. I feel they are not direct with him and I will need to ask some questions.
Any suggestions, help, would be so appreciated.
Thanks so much,
Sylvia

 

[honeybunny]

Was it his cardiologist or GP who saw him last week? If the latter, I suggest having him looked at by his cardio. He may also need a cough suppressant; I'm no expert but I'd say the constant coughing would put a strain on his heart. I had a cough like that years ago - literally coughed all night and couldn't sleep -- and was given something that squelched the coughing. Don't remember what it was, but having a break from that relentless coughing allowed me to heal. Keep us posted.

 

[JulienDu]

At 82, I would say, leave the old man alone, over medication/hospitalisation for old guys make their life even more miserable. My grand father was in the military, he was a tough old bastard, would never accept much help, died at home with his family, not in a hospital surrounded by strangers, chemicals, cold walls.... Yeah could have gotten a couple years of additional miserable life but he died as he lived, as a stubborn bastard and it was the best for him. My father who was also in the military is now 75 but super healthy but he told me in case his health gets shitty :"My son do not let those guys keep me alive and **** in my pants, just unhook me".

 

[sylviayasgur]

Thanks, honeybunny, he was taking something with codeine, but didn't really help. He saw hid GP last week. Think I'll call his cardio, and if he won't see him ASAP, I'll take him to his GP this week who can insist his cardio squeeze him in.
And, yes, his cough is exhausting him; must be taxing his whole system.
Will watch him closely today, laying low.

 

[Duffey]

Hi Sylvia, good to see you here but wish it wasn't in connection to your father's health. I have suffered the type of cough your dad is experiencing, but it has always resolved once I was put on an antibiotic. When was your dad's mitral valve last checked? I would want the cardio to see him and run an echo. There's nothing invasive about it and seems like a logical step to take. Let us know how he fares and give our regards to Joey. Mary

 

[kimcdougc]

Had same kind of cough. Dr. gave me tussinex. It comes in generic form. It is a time released cough medicine and is the only cough medicine that has helped me ever. Hope all works out for you and your dad.

 

[Paleowoman]

Hi Sylvia - If your dad's cough is due to his heart failure or pulmoonary hypertension he needs to see a cardiologist. Is there any way you can speak to his doctor about your concerns re your dad's heart condition ? Wishing your dad well.

 

[pellicle]

Hi sylviayasgur

I thought about this for about an hour before writing, as there is more to this than just surgery. I agree about thoroughly checking the other points that have been raised first.

SO, on the subject of surgery, I have a friend who pushed their mother (simmilarly in denial) into OHS Valve surgery because she thought it would help her live longer. Since her mother was badgered into it by her daughter and son (and of course the surgeons she was dragged before) she didn't really willingly go into surgery.

That surgery was in 2012. After the surgery her mother was one who suffered from the cognitive issues that are well discussed and researched (for instance: here and here). Her mother felt depressed as a result of this, and her weakened state after surgery. As a result she did not throw herself into the sort of recovery regime that is needed (or that my friend hoped for).

My friend has said to me just recently that if she knew all these outcomes before she would never have pressed her into making that surgery. She said that she felt that her and her brother were only thinking of "returning their mother to how she was". I'd like to say that its normal in life that we get older. Part of that process is death. Noone really means when that say "I want to go back to how it was before my heart condition" that they want to go back to nappies. Exaggerated point I know but I hope to illustrate something.

She said quite plainly "mum has no quality of life now".

I'd say fully involve your Dad in this and see what he wants. Lay it on the table, don't bullshit around and say honestly and clearly what needs to be said.

Listen to what is said by him and be prepared to change your mind just as you would expect him to be prepared to change his. I didn't want my mum to die, but she did. I didn't want my dad to die, but he did. I didn't want my wife to die, but she did. Live and Death are joined at the hip.

You only get one chance at this so do your best and then you won't regret later "what if I had ...." because you know you did your best. Your best at caring and communicating.

Best Wishes

 

[MethodAir]

I would figure out what is causing the CHF. It's probably more than 'moderate mitral valve regurgitation'. If the cough is caused by CHF, you will want to halt the progression of the fluid levels rising (and discomfort becoming extreme). Get the echo as was mentioned and take it from there. When I was in hospital, there were patients in their 80s who were bouncing out of surgery (if that is the answer) surprisingly well.

 

[dick0236]

I've have had a similar problem with "a cough" or a "clearing of the throat" for the past dozen plus years. It started when I was put on the ACE inhibitor Lisinopril. From what I understand, coughing is a side effect of ACE inhibitors. A few months ago I started on a different BP med, Losartan, and my coughing has decreased, but has not gone completely. Like your father mentioned I still have a cough to bring up phlem in my throat from head/nasal drainage, especially in the winter. Maybe, something that simple, could be his problem.

Your father has had and, from what you describe, continues to have serious health issues. He may, or may not, be in denial of his condition. You and your mom need to listen carefully to his wishes. I am his age and my wife and family all know that quality of life is extremely important to me and what is to be done, or not done, when issues come up in my future.

 

[dornole]

I have had coughing due to congestive heart failure / pulmonary hypertension caused by mitral stenosis. A big red flag is if the cough is dramatically worse when lying down (day or night). I literally could not lie down for 20 seconds without dry hacking coughing. I had to sleep upright in a chair. I also coughed up blood. Not mucus with streaks of blood, but bright red splats of blood the size of a quarter. A very dry and painful cough. NO phlegm. I would think the doc would be able to hear whether your dad has a bunch of phlegm in there or not. And an echo would certainly show what is going on.

This article suggests it is kind of a "chicken and egg" thing with mitral valve problems and CHF. The valve can cause CHF; CHF from another cause can also cause regurgitation in the valve. I don't know how "sciency" you are but here is a link describing the debate about whether mitral valve surgery helps in these complex cases:

http://circheartfailure.ahajournals.org/content/1/4/281.full

Glad your dad has an advocate in you. Praying for wisdom for all of you to decide what steps to take.

 

[epstns]

Hi, Sylvia - It sure has been a while, but you and Joey are still on my mind. You two were among the first to welcome me here, and at the reunion in Chicago that first (for me) year. For that, I continue to thank you.

I am saddened to hear of your dad's progression. He is such a trooper, and it doesn't seem to be getting any easier. You are getting some really good advice, and technically I cannot add very much. I, too, have a chronic (but mild) cough caused, we think, by one of my meds. I call it "kennel cough" and just bear it. Your dad's cough sounds like it is getting in his life's way, so it is probably worth pressing for a better diagnosis and perhaps treatment.

CHF is a real "kick in the slats" and it makes the patient's life often uncomfortable. As you are gathering, proper treatment can make a major difference, but if you are not able to be there to take each step with dad, it can be difficult to make much progress. So much depends upon his attitude. I think the others are right, that you should try to have a proper chat with dad to find out his state of mind, and to find out how he really wants to proceed. As pellicle noted, though, be prepared for dad to have an opinion that is vastly different than what you expect.

Please keep us posted.

 

[sylviayasgur]

Oh my G-d, I am so overwhelmed by your outpouring of support and caring. You have all helped me so much in just this short time. I thank you all from the bottom of my heart for your wise words, information, and warm support.
I now have so much to consider ( that I had not thought of before).
I will keep you posted as time goes on.
Again, I find myself using words to describe this place as I did 15 years ago: supportive, caring, warm, informative, hand-holding_ best family!
Thank you!

 

[sylviayasgur]

Update.... Doctor (GP) checked lungs, tested blood, phlegm from cough, did chest X-ray , put him on antibiotics and prednisone.called next day to say that my dad has some effusion on his lung, thought he might have asthmatic bronchitis, but X-ray showed only the fluid on his lung . Bloods did not show CHF but lasix was strongly advised on a daily basis ( my dad is stubborn and won't take it regularly). Hopefully he will now realize that lasix DOES help_ cough actually seems to have eased.

 

[Duffey]

It's good to hear that your dad's cough has eased some. The Lasix on a regular basis will undoubtedly help, but down the road I would want to know if the fluid in his lungs is caused by the leaky mitral valve. In the meantime, here's hoping the diuretic can keep the fluid at bay