More on cognitive changes post heart surgery

[jeffp]

My cardiologist still thinks I'm imagining the cognitive changes pre vs. post surgery. I know we've discussed it here off and on but I came across this in one of my ramblings around the net. (I spend too much time on the computer! ) It's from the New England Journal of Medicine, Feb 8, 2001, Vol 344, #6, p 451-2. (Sorry, no open web link, I have a PDF though.) It studied CABG procedures but we valvers went though a whole lot more manipulation, and I would think more at risk.

Quote snips: "...Long-term cognitive changes after CABG have received less attention, despite common reports by patients that they are "just not the same" after surgery. The cognitive changes are often subtle, involving problems with following directions, mental arithmetic, and planning complex actions. Family members or colleagues may also notice that a patient is more short-tempered, is less able to withstand frustration, and has wider mood swings.....At the time of discharge, they found a high incidence of decline (53 percent) from presurgical base-line performance, which decreased to 36 percent at six weeks and 24 percent at six months. Surprisingly, at five years of follow-up, 42 percent of patients were performing below their base-line levels.... These changes may well be reversible. But superimposed on these short-term changes, more slowly evolving or delayed effects may occur, perhaps as a result of an initial injury from a combination of hypoperfusion and microemboli..."

 

[geebee]

Your cardio doesn't seem to be up to date on this issue. I can't believe he is telling you any changes are your imagination. Where has he been?

I still have moments of "brain fog", the most obvious one for me is thinking of a word or concept and taking much longer to find the word I want to describe a situation. I compare it to giving a computer a command and it taking way too long to search for the response. I KNOW what I want to say or describe, it just takes much longer to find the information.

I am also much less patient and tolerant. I get really annoyed with people who seem to put importance on stupid trivial things. I think it's because I don't waste my time anymore on trivial things and I think the rest of the world should be like me.

Anyway - cognitive problems are REAL and I think almost all of us have had some experience in that arena.

 

[Nancy]

Jeff-

Just to make sure the rest of you isn't interfering with the overall cognitive thing, make sure you have any fluid retention checked out. I can almost tell just from Joe's personality just how much fluid he's retaining. His short term memory slips a little. Once that aspect is cleared up. he's OK again.

Also anemia contributes to cognitive "malfunction", and there again, I can tell almost immediately that Joe's blood is in trouble. Once that gets corrected, he's fine again.

The other very difficult culprit which can be overlooked is high blood ammonia level. That can get dicey in those whose kidneys and liver are compromised by long term CHF. Not a problem for you, but others might have to be careful about that.

Do check out the first two though, just to be on the safe side.

 

[Ross]

Oh man, now your going to make me admit I'm guilty on all of the above counts. Can I plead the 5th here?

 

[hensylee]

I first heard about it from Dr Richard N Fogoros, an EP cardiologist in About.com if you want to go check it out with him. He has written articles about it. He is in HeartDisease/cardiology at that site -

It's called 'pumphead'.

There are two schools of thought - those who believe and those who don't - maybe a few who sit on the fence. Having been a member of VR for a very long time and either view or participated in all of those threads, I think the concensus among us is that most of us give it a lot of credence.

Not to worry, Ross.

 

[ChuckVSP]

I am 5 years out from my second ohs next Monday... which is good for me . I still have the little moments that I can't get a word to come, or be in the middle of a sentence while talking to someone and the sentence just leave my train of thought. I just call it de-railed, or a brain cramps . But, it is just my life now and I just laugh it off when it happens. Fortunately, I still function high in my work environment. Almost like I am on automatic pilot when I get to my desk. When the brain cramps start to cause me trouble at work, that would be a dangerous thing, and will be time for me to retire!

 

[Cris N]

Well, thankfully no one is attributing long term brain fog to age Good to know I can blame an occasional 'senior moment' on surgery. Wonder what excuse I can use for those moments that occurred before surgery.

Cris

 

[barbwil]

also an age thing?

also an age thing?

I would like to blame it all on OHS but how come my contemporaries who have not been near the knife have the same problem? Fortunately, when one of us can't come up with the right word or a name, one of us will be having a clear moment and fill in for us!!

These are not the Golden Years, more like rusty years!

 

[OldManEmu]

I know it is well discussed the issue of "pump head" however I am not certain if all this can be attributed to the surgery or if some of it may be more related to the medication many people are put on after surgery. From my personal experience I never experienced any of the symptoms of "pump head" in the first 6 weeks after surgery and this is when I would have expected it to be most noticable, it was only after the titration increases in beta blocker dosage that I noticed the symptoms. Each time the beta blocker was increased the "pump head" symptoms would increase. It would be interesting to know the incidence of "pump head" amongst those that do not take beta blockers, ACE inhibitors and similar cardiac drugs that are known to impair mental function. Just a thought.

 

[hensylee]

Old: wouldn't it be useful for a site like ours if they actually did testing on what you suggest. What we have to go on are statements and opinions from members but nothing concrete. That would be a good thing. Wonder if anyone is doing it. Anybody have any updates on 'pumphead' tha t we haven't heard about?

 

[Barbara Stewart]

Cognitive changes

Cognitive changes

I have always had trouble finding words sometimes, but it was much worse after my first, unsuccessful OHS, but since my second one 2 1/2 weeks ago, I am finding it much better. I still call people by the wrong names (like my family members) but then I have always done that.
In my case, I don't think my foibles are a result of "pump head" just general age, menopause and life as we know it.
Barbara

 

[Michaelena]

JeffP

Although I have not had problems with names, per say, as an accountant, what verified my difficulties with numbers (mental arithmetic) and complex problem solving, was what I was capable of doing prior to my surgeries.

After my first surgery, I was taken by surprise, and the doctors dismissed my complaints. I was able to go back to work and eventually compensate for my limitations. After my most recent surgery, again the same symptoms reared their ugly head. I have retired from my job, but have not given up on regaining my prior mental abilities. I am now learning to play the piano, and sudoku has really helped.

Bottom line, I understand what you are experiencing, it can be somewhat disconcerting and to say the least frustrating at times.

Keep a positive and remember you are not alone, no matter whata the doctors say.

Michaelena

 

[terryj]

My husband definantly has problems with his memory since surgery. My 6 year old granddaughter showed us a magic trick Saturday and then whispered the secret of how it was done to him. She wouldn't let the rest of us in on how she did it. When we asked her how come she told Pawpaw she said it was because she knew he would forget what she told him in a little while. We all had to laugh at that even him.

 

[beccaslp]

Definite Pumphead

Definite Pumphead

I have been experiencing cognitive deficits since my AVR 6 months ago. It did not seem so prevalent at first, but in that last 4 months for usre.

I am having trouble with word recall. Also NAMES! People I have known forever. Sometimes when I am talking I will stall, thinking I will think of what I need to say in a few seconds, but sometimes it never comes and I have to describe, using other words, the word I want to say.

This is especially bothersome since I am a speech language pathologist. These are the same types of things I would work to increase in a patient who had had a stroke.

I am only on warfarin and lexapro (anxiety/depression) No other meds. BECCA

 

[Georgia]

I had a touch of aphasia prior to surgery due to chemotherapy many years ago. Post ohs it and my memory were much worse (6 weeks after surgery I went to see my husband perform in "JC Superstar" and a year later I had no memory of the production - and it's one of my favorite musicals. I still can only recall a couple of scenes). I think that now my memory's much better (of course, being retired I don't have to strain the brain as much as previously). The aphasia's always lurking - but it's never as bad when typing as when speaking - must be a different neural pathway. I don't use wrong words - just have blanks.

Perhaps if I'd continued working I'd have eventually gotten back up to par, but I really doubt it.

I know the aphasia's worse when I'm tired.

But I know I'd be dead if I hadn't had surgery, so I just don't worry about it.

 

[hensylee]

I believe in brain exercise. Especially for someone like me (old). Every morning I play some mentally challenging games on my computer. It gives me a heads up for the day. Some days I just can't win but I keep at it til I am successful. I subscribe to two 'word of the day' sites to learn something new each day. I subscribed to 'knowledgement' - a learning site that tells about history, art, various subjects - just to keep on learning all the time. It isn't that I am incompetent; I just want to keep as much as God gave me to start with. I keep my own books in Quicken. I do crosswords (sorry I can't do that kuboko thingy because I am not logical), word games in magazines, etc. We are avid readers in our house - various types of books. I think if we have pumphead, if we do some brain exercises, it keeps our gray matter gray.

 

[Guest]

*sighs*

Sadly, I wonder how many of us (including myself) have lost jobs, due in part, to these "cognitive changes".....



Cort, "Mr MC" / "Mr Road Trip", 32swm/pig valve/pacemaker
MC:family.IL.guide.future = http://www.chevyasylum.com/cort/
chdQB = http://www.chevyasylum.com/cort/quilt.html
"Time is a natural healer" ... John Conlee ... 'Years After You'

 

[hensylee]

from today's heartcentersonline newsletter:

from today's heartcentersonline newsletter:

Maybe your dr isn't doing his CME (continuing medical education courses!)

News Center
Causes of cognitive loss after bypass surgery identified



Jan 24 (HealthCentersOnline) - By changing their technique, heart surgeons performing traditional bypass surgeries can significantly reduce cognitive impairment in patients, a common side effect of the procedure.
A coronary artery bypass is a procedure to restore blood flow to the heart. The procedure involves grafting a segment of healthy blood vessel taken from another part of the body to create a detour around a blocked coronary artery.

During a traditional procedure, physicians stop the heart temporarily, and blood is rerouted. A heart lung machine is used to take over the heart's functions while the heart is stopped. Other types of coronary bypass allow the patient's heart to continue beating throughout the procedure (called "beating heart" surgery).

One commonly reported side effect of all types of bypass surgery is cognitive decline (problems with thinking). However, beating heart surgery has been associated with less cognitive decline as compared to traditional bypass surgery. Not all patients are candidates for beating heart surgery.

A team of researchers from Wake Forest University School of Medicine evaluated 237 patients who underwent coronary artery bypass surgery. Some of these patients were operated on using the beating heart procedure, others had a traditional bypass operation using a heart-lung machine, and a third group had their aortas held steady with special clamps to minimize movement and trauma while using the heart-lung machine.

The aorta is a major artery that carries oxygen-rich blood from the heart to the body.

Psychological tests conducted before and after the surgery demonstrated that those patients who had a beating heart procedure and those who experienced only minimal aortic movement during surgery (because of the special clamp) had a tendency to regain any cognitive losses experienced after the procedure.

The researchers concluded that much of the cognitive loss experienced by patients was the result of trauma to the aorta when using the heart-lung machine. By minimizing the amount of trauma the aorta encounters during future surgeries, the researchers hope to greatly reduce the amount of patient cognitive loss.

"A surgical strategy designed to minimize aortic manipulations can significantly reduce the incidence of cognitive deficits in coronary artery bypass graft patients compared with traditional techniques," the study, headed by John W. Hammon Jr., M.D., professor of cardiothoracic surgery, explained.

The study was published in the January 21, 2006 issue of the Journal of Thoracic and Cardiovascular Surgery.

Copyright 2000-2006 HealthCentersOnline, Inc.
Publish Date: January 24, 2006

 

[Dennis S]

Beating Heart Surgery

Beating Heart Surgery

Can you get a heart valve replaced without using the heart lung machine? I don't think so. I gave this a pretty close look prior to my AVR last August. I actually had a surgeon I interviewed tell me he would do my surgery on a beating heart. After my enthusiastic report to one of his colleagues it turned out he had not read my chart, and thought I was seeing him for a bypass. I decided to keep looking, and I guess he is still being ribbed by his partners.

Beating heart surgery is getting to be quite common for bypass surgery. Valve replacement is a different thing. I found a few references on the Web that seemed to refer to valve replacement on a beating heart, but they never seemed to go into any detail, and I was left wondering if they were simply blurring the distinction between the two types of surgery. At any rate, after a fair amount of searching, I never ran across a surgeon who claimed to do a valve replacement on a beating heart.

 

[OldManEmu]

It may not be all the bypass pump

It may not be all the bypass pump

I posted to this thread about a month earlier with my theory that in some patients this loss of cognitive function may not entirely be related to being on the bypass pump and may be at least partly related to various cardiac drugs that patients are taking. Well last week I saw the cardio and with my heart having returned to normal have now been advised to stop taking beta-blockers. All I can say is that it feels like my brain can now function at full capacity again; the transformation has been very noticeable. I was only on a relatively low dose of beta-blocker so I can only guess at the impact on brain function that the very high doses some members are on. I would be interested to know if any other members have had a similar experience.