davidfortune is home AGAIN!!

[davidfortune]

Well,

I guess I'm one of the 2 in 10,000.....

Short Version:

I ended up back at Presbyterian Dallas due to Cardiac Tamponade (i.e. compression of the heart due to accumulation of fluid within the pericardial sack and the resultant pressure on the heart). Spent 25 hours from check-in to check-out, had a Pericardiocentesis procedure (i.e. long needle up under the rib cage into the pericardum to drain the fluid and a catheter placed to drain overnight).

They drained 990 ml of fluid from around my heart. Interesting procedure... They gave me versed but apparently not as much as I wanted since I was aware of most of the procedure and conversing with the medical team (bad luck for them I guess... ).

Back home next day (yesterday afternoon), breathing easier, glad to be home again and encouraged that cardio says this virtually never occurs twice to the same person.

He did say he thinks it is an immune response due to a "hyped up" immune system. He says he never sees it in older people so he thinks it is related to a more aggressive immune system in younger people, although nobody knows for sure why it occurs.

So - I chose the big, hunkin needle since they weren't excited about waiting to see if it got better. Cardio said intra-pericardial pressure was about 15 times the normal pressure which is not good.

Anyway - back home and walking my way healthy again.

David

 

[Mb]

Good grief David.

Please, no more excitement for awhile. Glad to hear the breathing is easier.

Marybeth

 

[Phyllis]

So sorry you had this "bump" in the road, David, although I'm sure it felt more like another mountain to you! Best wishes for an uneventful recovery from here out.

 

[tobagotwo]

Glad you're home again. Every time I hear about a transthoracic needle draw, I get an uncontrollable shiver. It sounds like a real unpleasant experience. Did they think there might be a tie-in with going off the steroids they had given you earlier?

Best wishes,

 

[lynn]

Wow! Glad you're *back* home again!

What were your symptoms??

 

[Lynlw]

Glad you're home again. Every time I hear about a transthoracic needle draw, I get an uncontrollable shiver. It sounds like a real unpleasant experience. Did they think there might be a tie-in with going off the steroids they had given you earlier?

Best wishes,

I was wonderring that too, David, I rember last wek or so, you were having problems with a fever too, how has your temp been?
Justin had bad pericardial effusions when he was a toddler, so luckily with his last surgery I rememberred what he was like so caught it early and got it under control. did they tell you anything to watch for now?
I'm sorry you had to go thru that, the only thing that was good about when Justin had the fluid, was i knew he would be to young to remeber it, of course i rember quite a bit and very vivid, lyn

 

[Karlynn]

So no more exciting adventures involving needles or hospitals. Okay?

I'm glad you are feeling better.

 

[aussiemember]

Hang on there David, we told you "boring" right??? So glad to hear that you are home again and feeling OK - I'm sure the medical staff would have enjoyed your conversations Take care of yourself!!!!! Jeanne

 

[PegB]

Hi David,

Glad they caught everything in time, and you're back home and feeling better. Please post your symptoms, as I'm wondering along with everyone else.

I went in for a routine follow up echo at 10 weeks, and they found I had a moderate amount of fluid around my heart. I had steroids for 10 days, and was feeling good, and an echo at the last day of my steroids showed a big decrease in the fluid. Now, ever since I stopped the steroids, I feel tired and mildly short of breath. I saw my cardio. last week and he couldn't hear any pericardial rub, but he thought from my symptoms there might still be some fluid. Unfortunately, I didn't get an option regarding waiting to see if it goes away. I have another echo scheduled for 2/5, at which time if it's still there, I get to have a pericardial window, since he says my fluid isn't in a place where they can reach to do a pericardialcentesis. In the meantime, I'm supposed to monitor my BP, along with any severe SOB, and be aware of any signs of Tamponade.

This is where recovery gets so frustrating. Like you, I had a real easy surgery, hospital stay, and was progressing rapidly at home. For the last several weeks, I feel like I have hit a wall. My repaired valve is perfect, no leakage at all, and yet now I have the surgical side effects.

I sincerely hope that this was your only bump in the road, and you are back to an easy recovery. We do have to pay attention to our "warning signals"
from our body, and I think this is where the "post-op paranoia" starts

Good luck, and keep posting your progress.

 

[Bradley White]

David,

Jeez! Sorry to hear about this setback, but glad to hear that everything was properly remedied. Take it easy buddy and keep us updated!

Brad

 

[Mary]

I have to agree with Peg . . . the vexing aspect of this surgery is, "It ain't over until it's over!"

As you've now experienced first-hand, the surgery is just one piece in the complicated process known as valve replacement. Even if one has a relatively pain-free surgical process and initial easy recovery period, it's still possible to have a nasty encounter with a "bump" in the road. Hopefully you will have no further issues with fluid, and you will resume your previous smooth recovery.
Knock on wood!

 

[WayneGM]

Welcome to the "2 in 10,000" club. Sorry to hear about the bump in the road but glad you're back home already.

When I had pericardial tamponade they tried to drain it several times with the needle, I felt like a pin cushion. Unfortunately, the fluid was stuborn and just wouldn't drain. Finally they put me under, drained me surgerically, and put in one of those drain tubes like we got during OHS for a few days. Because of that, I had to stay in the hospital a whole week.

It didn't reoccur, although I did have to go to the GP once of week for about a month while they checked to make sure. They also prescribed 0.6 mg of Colchicine daily for three months afterwards as apparently it helps prevent it.

Even with this bump in the road, your progress seems to be going really well. Keep it up!!!

 

[davidfortune]

Hi David,

Please post your symptoms, as I'm wondering along with everyone else.

Peg,

I originally called in regarding a distented abdomen and weight gain of 13 pounds in 7 days which seemed impossible since I hadn't been eating that much. I was thinking fluid in the abdomen. X-Ray revealed a suspected pericardial effusion so off to the hospital.

In hindsight my symptoms were:

1. Significant fatigue
2. SOB (really an inability to "breathe deep" not feeling SOB in general)
3. Significant (and strange unpredictable) muscle weakness (feeling like I just did a super heavy arm workout while washing my hair)
4. "Fullness" thru the chest/abdoment

It was suprisingly hard to put my shoes on and I was really tired. I felt more "like a post-surgical heart patient" than I did the first few days home. I had low-grade fever combined with chills virtually every evening but usually sub-normal/normal during the day.

The fever is fairly typical after heart surgery to I didn't really consider that (though maybe I should have). The weirdest for me was the significant muscle weakness and the significant fatigue. The abdominal distension was primarily related to constipation from pain meds (although I was only taking 1 each morning and night typically).

Peg - sorry you have this ongoing issue. Hopefully your body will absorb any excess fluid to avoid the need for a pericardial window.

Glad you're home again. Every time I hear about a transthoracic needle draw, I get an uncontrollable shiver. It sounds like a real unpleasant experience. Did they think there might be a tie-in with going off the steroids they had given you earlier?

Best wishes,

Bob,
Doc seems to equate it with "hyper-immune" response since he says he only sees it with young patients. But maybe the steroid suppress the immune response enough and it "goes crazy" when they are discontinued.

The procedure wasn't exactly fun but I did have enough fentanyl that it wasn't excruciating. I'm sure I got on the docs nerves because prior to the procedure he indicated he didn't need non-invasive guidance (i.e. an echo to confirm needle placement) which I thought was a bad/arrogant decision. If you have a technology that allows you to "see" where the needle is when you really can't "see" it - I think you should use it especially if your patient is me. I pushed him on it a bit and he stated he didn't need it. During the procedure when they were starting to drain the fluid. It was so red as to cause concern that there was significant blood. The doc stopped the drain and called for non-invasive guidance to verify needle position. So I asked him "I thought you weren't going to need non-invasive so what is your concern now???" He replied "I just want to verify needle placement since the fluid is so red? to which I replied "so you have a concern that you are in the wrong place currently" to which he replied "I don't believe so but I want to verify needle placement". I figured I should stop irritating the guy with a needle in my chest so I let it go. But it pissed me off that he was arrogant enough to decline the use of a technology that was obviously so valuable that he immediately called for it when something unexpected happened. Turns out needle was in the right place (which was good and both he and I were happy about).

Everyone,

Thank for you well wishes.

 

[Bridgette]

Hey David
I can totally sympathise with you as the same thing has just happened to me.
I had my surgery (mitral valve replacement and maze procedure) on 11th December. In hospital for 7 days, discharged, and to begin with all seemed to be going well, until 3 days ago, when I noticed that my upper abdomen seemed tight and swollen. I weighed myself and I had put on 3kg, but had not been eating much. Also I couldn't seem to pass water easily.
It was evening, and I lay on the couch for a while - then sat up to talk to one of my kids. The room spun around and I broke out into sweat and felt awful - really weak and dizzy. I just staggered into my room and collapsed onto my bed. To cut a long story short, my partner called an ambulance and I got taken to Accident and Emergency at the local hospital.
The doctors there were great - they quickly diagnosed pericardial effusion (had chest x-ray and quick echo) and then they did the needle aspiration thing and drained 400ml of fluid straight away.
The next morning the doctor drained another 110 mls, and I got discharged yesterday lunchtime.
I am going back for another echo today just to check on things, then a repeat one in a week's time.
The scary thing was the plummeting blood pressure, sweating, and weakness.

It was interesting to read what your cardio said about the immune system response, and about this usually only happening to younger patients. I am 43.

The doctor who treated me said yesterday that if it happens again (please no!!!!) I might have to transfer to a bigger hospital where they do an op under anaesthetic and make a little "window" in the pericardial sac, which allowss the fluid to drain out and get reabsorbed into the system. Can't remember the name of the op.
I am hoping that it doesn't come to that - and that your cardio's words about it virtually never happening twice are true in my case.

All the best for your continued recovery

Bridgette

 

[ruth]

OMG, David, so sorry you had to go through this setback! If I were sticking a needle anywhere near someone's heart I think I'd choose all the assistive technology I could get. Sigh.

Take care, all the best to you & yours.

Ruth

 

[tommy]

David, I guess I'm of the 2 in 10,000 as well, but at Med City Dallas. Mine was due to OD on Coumadin while I was in the real sensitive stage within 2 weeks of surgery. My symptoms were almost identical to yours, 2 weeks prior to Christmas 6 years ago.

Glad to hear you are on the mend!. Happy New Year.

 

[Nan]

Hi David,

Glad you are now home and OK. Wow, what an experience, the whole thing, but especially the doctor not wanting to "see" where he was putting that needle. Yikes. I think I would have gotten off the table and left prior to the procedure. I wonder if there is some reason why they don't give someone undergoing this procedure more happy juice than you got....

Let's hope that this is the last "bump" for you!

 

[davidfortune]

Hi David,

Glad you are now home and OK. Wow, what an experience, the whole thing, but especially the doctor not wanting to "see" where he was putting that needle. Yikes. I think I would have gotten off the table and left prior to the procedure. I wonder if there is some reason why they don't give someone undergoing this procedure more happy juice than you got....

Let's hope that this is the last "bump" for you!

Nan,
I don't know. I was hoping for more, but now I'm glad I didn't get it. It was a very interesting experience. They were debating (prior to the insertion of the needle) how much versed and how much fentanyl to give me. The originally quoted half the dose they actually gave me but decided to up it at the last second (which I am glad they did - I think I experienced "just enough"). It seemed that blood pressure was one of the key factors in the decision on how much to give.

I think I'll ask for the dosage they gave and the dosage I got for my TEE because I don't remember anything about the TEE once they injected the versed. That way I can help them out in the future if I have to have another "twighlight" procedure.

 

[marky]

Well,

I guess I'm one of the 2 in 10,000.....

Short Version:

I ended up back at Presbyterian Dallas due to Cardiac Tamponade (i.e. compression of the heart due to accumulation of fluid within the pericardial sack and the resultant pressure on the heart). Spent 25 hours from check-in to check-out, had a Pericardiocentesis procedure (i.e. long needle up under the rib cage into the pericardum to drain the fluid and a catheter placed to drain overnight).

They drained 990 ml of fluid from around my heart. Interesting procedure... They gave me versed but apparently not as much as I wanted since I was aware of most of the procedure and conversing with the medical team (bad luck for them I guess... ).

Back home next day (yesterday afternoon), breathing easier, glad to be home again and encouraged that cardio says this virtually never occurs twice to the same person.

He did say he thinks it is an immune response due to a "hyped up" immune system. He says he never sees it in older people so he thinks it is related to a more aggressive immune system in younger people, although nobody knows for sure why it occurs.

So - I chose the big, hunkin needle since they weren't excited about waiting to see if it got better. Cardio said intra-pericardial pressure was about 15 times the normal pressure which is not good.

Anyway - back home and walking my way healthy again.

David

David.. I had a very similar experiend..

I went back in 4 weeks after my surgery.. they took about 1500ml off then I went back 10 days later in Tamponade AGAIN! .. Yep it can happen twice..your doc can check my records..They removed every bit as much the second time, and left the drain attached to me for 3 days. 10lbs of fluid drained off.. pretty amazing!
My cardio team felt that it was coming back a 3rd time, but the effusion did not get larger than moderate.

I was pretty sick the first time, and was told that my organs had already begun to shut down, and I was severely dehydrated, and would not have survived the night (It was sunday late afternoon and they called the team in)

I however don't remember a thing! I love that Verced!! No fentinal for me (allergies) but I edited this to add that they did not us U.S. guidance the first time (too much of an emergency) but the second time they did.
I dont' recall much pain.. not compared to all that fluid pain..
but i had some pretty bad arrhythmias when they took the drain out after 3 days.

I am glad that you are home and hopefully feeling MUCH better!!

 

[Guest]

David,

Very sorry you experienced that "bump" in the road ... but, as you may've heard, "what doesn't kill us makes us stronger" ... he he.

Seriously, tho ... thoughts/prayers are continuing for you....



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