Old member looking around for new info

[Duffey]

I guess one drawback of living almost 19 years after replacement with a tissue valve is that you don’t stay current with new advancements in valve replacement - aneurysm repair when a family member undergoes the surgery and is experiencing difficulties. So I will explain the situation and see what the group can offer. Our son-in-law was diagnosed with a BAV and aneurysm two years ago. Two days following that diagnosis, his first ever colonoscopy revealed Stage 3 colorectal cancer. Treating the cancer was more of an immediate concern so he was operated on and underwent chemotherapy and radiation first. For brevity I will fast forward to October of 2023 when he learned that the valve was leaking like crazy and the aneurysm was now at 5.9. so surgery was scheduled for January 11. One other point, he is no stranger to post-op pain having dealt with it when his tumor was removed. Today he is two days postop after having valve replacement and the aneurysm repaired. He’s 51 and he received the Inspirus (?) valve. Recovery started off poorly. A lobe didn’t fully reinflate so they were stingy with pain meds. He had a 6 hour surgery and 4 hours later he was off the ventilator and another two hours they wanted him sitting up and taking Tylenol by mouth. I think they rushed everything but they say that’s the protocol in 2024. Whatever the reason, Brian has been in constant, debilitating pain to the extent that he can’t sit up and he’s not been able to get out of bed to start walking. This morning he says that he feels a stabbing pain when he breathes in. The doctor says it’s pain from his chest tubes. I’m dubious. He has a wound vac that should prevent fluid build up but it sounds like an effusion to me. I had relatively little pain after my own valve replacement so I am at a loss to understand or accept that Brian’s pain is par for the course. Am I out of touch?

 

[3mm]

Duffey - I am sorry to hear of your son-in-law's problems. I had my open heart surgery Sep, 2023. They wanted me walking later that day. My drain tubes were a bit painful, but I could sit up, get out of bed to walk, etc. The wound vac is draining just the surface of the wound, not inside the chest cavity. I think (based on my sample of my own body!) that any effusion should be draining from the drain tubes.

Keep talking with the nurses!

A lobe didn’t fully reinflate

Has this reinflated now? I will pray for your son-in-law!

 

[pellicle]

Good morning

firstly that sounds like a really depressing ordeal for him. I hope he has good support (emotionally) and sound advice on that front too.
wrt:

This morning he says that he feels a stabbing pain when he breathes in. The doctor says it’s pain from his chest tubes. I’m dubious.

I would be too ... pleural stuff is out of my lane so I can't offer anything, but intuitively it seems like things may not be being managed perfectly in recovery.

He has a wound vac that should prevent fluid build up but it sounds like an effusion to me. I had relatively little pain after my own valve replacement so I am at a loss to understand or accept that Brian’s pain is par for the course. Am I out of touch?

I can only say that when my dad had fluid on the lungs and other issues it was very painful for him. He's no stranger to pain either and I didn't know what I could do then either. So we just supported him as best we could and allowed the process to continue (asking questions and nodding when the answers seemed rational). I didn't have any better options. Eventually it all came good.

Best Wishes

 

[vitdoc]

I have no great information about cause of the pain, however, they might be more generous with the pain meds. The pain may actually be a problem in terms of taking deep breaths which is important to combat atelectasis. (Fluid around the lungs with incomplete lung expansion). They may be concerned that significant narcotics may blunt the respiratory drive but this is usually more important in people with primary lung disease. So I would talk to the physicians about getting more pain meds. The latest trend in medicine is to try to limit pain meds due to the high rate of addiction. However, I think this can be overdone and some patients are in more distress than need be.

 

[Chuck C]

Hi Duffey.
Sorry to hear about your son-inlaw's situation.
I had my surgery 3 years ago at the age of 53, so almost the same age as he is. I'm not sure if his pain is mostly from his lung issue or from the surgery, but I was in a significant amount of pain on the first night after surgery, once the anestesia had worn off. Two nurses informed me that young patients often experience more pain after OHS, because they have more sensitive nerve endings compared to the typical elderly patient.

The latest trend in medicine is to try to limit pain meds due to the high rate of addiction. However, I think this can be overdone and some patients are in more distress than need be.

I agree completely with Vitdoc's comment. What I found interesting was the difference in attitude towards pain meds from nurse to nurse. When my wife had her caesarian 27 years ago, the thinking in medicine was to "stay ahead of the pain" and take what you needed to do so. It seems that today there is considerable training of medical professionals warning them about narcodic addiction and to use as little pain killer as possible. But, I also found that many of the nurses still subscribed to the old line of thinking to stay ahead of the pain. I agree with Vitdoc that the new stinginess with pain meds can be overdone.

On the first night after my surgery, I had a nurse named Nurse Betty, who was very invested in "less is better", when it came to pain meds. I begged her for pain meds to ease my suffering, but my requests fell on deaf ears- after all, she didn't want me to become addicted to pain meds, as she told me. The next morning, I was very fortunate to get a nurse who worked with me. I advocated for myself for stronger pain meds, and he then advocated on my behalf to the head nurse working day shift. He was able to get me a self administered button for dilaudid. There were controls in place. I could not press the button more than once every 10 minutes. I ended up using it less than once per hour on day one and then only once every 2 or 3 hours on day 2. After day two I didn't need it anymore.

So, if he is in that much pain, I would really push for stronger pain meds. If his personal nurse is of the mindset that she does not want to give him much, he can probably request that the head floor nurse come see him and make his case to her. In my observation, the more experienced nurses seemed to be more of the mindset of staying ahead of the pain, whereas the newer ones have been convinced that they are on the front line of the narcotic epidemic and some patient suffering is ok to mitigate the risk of addiction. Also, he can put in a request to his surgeon's office, informing them that he is in extreme pain. The couple times where I felt that I wasn't being listened to, I communicated with my surgeon's head nurse and she was able to take care of whatever I needed. She had ranking on all the other nurses, as she was basically just under the ranking of my surgeon in terms of the orders for my care, and whatever she said the other nurses had to go along with.

 

[pellicle]

The latest trend in medicine is to try to limit pain meds due to the high rate of addiction. However, I think this can be overdone and some patients are in more distress than need be.

just on this, I feel that in Australia the woke have gone nuts and are throwing the baby out with the bath water. Even to the extent that codeine as a component with paracetamol is now no longer on the shelves. NFI

Its no different with even hospital administration of antibiotics ... to me, people without a background in this (aka Administrators) just misunderstand the issue.

</rant>

 

[Duffey]

Thank you for your responses. The good news is that Brian’s surgery pain has significantly lessened only to be replaced by pain in his GI tract. All pain meds were discontinued yesterday due to new concerns about his inability to have a bowel movement. Sure enough he has a postoperative illeus that is causing pressure up into the chest. The cardiologist and cardio thoracic surgeon have come in to see him; the surgeon who removed his tumor will consult, along with respiratory. The few times that he was up last night resulted in his O2 to drop to 80%. His white count is high. They’ve put a nasal gastric tube in to try and reduce the gas and fluids in his stomach. No food or liquids for 24 hours but he’s not hooked up to IV’s. They’re removing the chest tubes now so he can take deeper breaths. The cardiologist says that he’s at high probability of developing pneumonia. It’s a 3 day holiday weekend and they are short staffed. It’s a mess.

 

[pellicle]

The cardiologist says that he’s at high probability of developing pneumonia. It’s a 3 day holiday weekend and they are short staffed. It’s a mess.

based on what you've said yes ... I hope it clears up before that happens.

 

[V__]

Hi @Duffey ,

Very sorry for your son-in-law's troubles. I didn't quire realize the recovery time could be this bad...

In case the pain information is still useful, I recall being warned several times, before and after the operation, to not wait until the high pain. They preferred me to complain at the level of 5-6 (out of 10), so that I don't get to 7-8. They didn't like the higher pain levels because of the discomfort, and because it takes longer for the high pain to get down.

They used "nerve block" on me, which basically meant a thin drip line, going from a machine to a nerve location near a shoulder blade. It supplied a painkiller which was less strong and addictive than the commonly used narcotics. Don't recall the drug name, but it was supposed to be similar to what the dentists use. The machine would supply the next portion every hour. If this method of pain control is still applicable, it might be a gentler way to manage pain.

The nerve block worked very well. There were just 2 exceptions to this. The first night in ICU my left shoulder was painful. (I'm guessing b/c of being strapped to the surgery table.) So a couple pills of stronger drugs were supplied. And the first day in the hospital the pain level was higher than usual with deeper breaths (when walking). They just added lidocaine patches to the rib area, which did the trick.

inability to have a bowel movement.

I recall taking 3 laxatives. The nurse who started this regiment suggested to stay a bit ahead of the constipation. Maybe that was just to avoid straining in the bathroom. The laxatives were fairly common though (senna, etc).

His white count is high.

I recall seeing that for the first day or two in the blood tests. The white counts went down quickly though.

The cardiologist says that he’s at high probability of developing pneumonia.

Doesn't sound good... Btw, weekend or not, don't they take X-rays daily? The lung issues (pleural effusions, etc) should be known definitively in his state.

 

[vitdoc]

Thank you for your responses. The good news is that Brian’s surgery pain has significantly lessened only to be replaced by pain in his GI tract. All pain meds were discontinued yesterday due to new concerns about his inability to have a bowel movement. Sure enough he has a postoperative illeus that is causing pressure up into the chest. The cardiologist and cardio thoracic surgeon have come in to see him; the surgeon who removed his tumor will consult, along with respiratory. The few times that he was up last night resulted in his O2 to drop to 80%. His white count is high. They’ve put a nasal gastric tube in to try and reduce the gas and fluids in his stomach. No food or liquids for 24 hours but he’s not hooked up to IV’s. They’re removing the chest tubes now so he can take deeper breaths. The cardiologist says that he’s at high probability of developing pneumonia. It’s a 3 day holiday weekend and they are short staffed. It’s a mess.

Yes, narcotics will shut down the Gi tract. That is why they are useful when there is diarrhea. Another option is an enema to help clear things out. Again ask if this is an option. It might normalize things quickly. In the old days the nurses used to say about enemas “high,hot and a helliva lot” to be effective. Again, can’t hurt to ask about it. Good luck.

 

[pellicle]

In the old days the nurses used to say about enemas...

Nurses of old days be like:

even the orderlies get excited when she says "get the Vaseline, we're taking his temperature"