Persistent Shortness of Breath 6 months after surgery

[PJ206]

I'm six months out from surgery and am still much more short of breath on exertion than I was before surgery. My cardiologist says there's lots of inflammation in the left lung and a pleural friction rub all the way up into my left shoulder. I've been on colchicine for 6 weeks with no improvement. I can't take any steroids or anti-inflammatories because I'm on warfarin.

I had three pleural effusions drained in the first weeks after surgery, but they kept coming back with no symptom relief. The doc who drained the 3rd effusion said I had a trapped lung (based on pressure measurements during the tap), but the thoracic surgeon disagreed based on not seeing any adhesions on the CT.

I get horribly out of breath just walking up a flight of stairs or from the parking lot into the grocery. Before surgery, I tended to put my hand on my chest when I was short of breath. Now I grab by abdomen at the bottom of the rib cage and take huge, heaving breaths. I'm still going to cardiac rehab but haven't been able to increase the speed or the workload on the machines.

I'm 59 years old, slender and otherwise healthy and reasonably active. I'm not having any pain at all. The surgery was for congenital defects, not age-related heart disease - BAV replacement, ascending aorta graft (for aneurysm), and Dacron jump graft from ascending to descending aorta to bypass coarctation of the descending aorta.

Has anyone else had this type of shortness of breath? Persistent lung inflammation or a pleural friction rub? Any insights would be appreciated. I'm getting scared that this will never improve.

 

[MarkU]

Sorry to hear about your struggles. I had severe shortness of breath prior to my surgery, but it and my other cardic-related symptoms went away post-op. All I really had to deal with was the traumatic effects of the surgery itself.
Six months seems to be a long time to be in rehab, especially with the lack of improvement.
Have you talked to your cardiologist about getting a second opinion from another thoracic surgeon?
Wish you well.
Mark

 

[ramjet]

I am sorry to hear about the breathing/lung problems PJ, but the first thing that surprises me is the "colchicine" you say you have been taking for 6 weeks.
Did you mean to write "colchicine" or did you mean to write something else, because colchicine is an antigout medication, and I am not so sure that this medication will help your particular condition, in fact colchicine has a range of drug interactions, in particular some statins (cholesterol lowering drugs) and a range of other cardioactive medications.

What other medicatons have you been prescribed. If you are in fact taking colchine, was it prescribed, what dose (strength) are you taking, does you cardiologist know about it and maybe...just maybe, its worth double, and even triple checking that you should be taking it, because colchine (in combination with some drugs and in excess doses) can in fact cause cardiomyopathy, which will definately make you more breathless, and the list of drug interations with colchicine goes on and on, so I would definatly, positively check this drug very carefully with your doctor, cardiologist and even an experienced pharmacyst, honestly, it just rings some alarm bells for me! It may be perfectly ok, and it may have been specifially prescribed for you, but I have some grave concerns about it.

I had distressing breathlessnes episodes post surgery, and at one stage a nurse threatened to get me a paper bag to breathe into unless I didn't settle down and breathe normally, because all my "vital" signs were normal, so it was just "anxiety". When the doctor saw me a short time later, he quickly ordered a chest x-ray, and it was found I had bi-lateral pleural effusions...he then threatened to put the nurse in a paper bag if she ever came near me again!!! No wonder I was darn well anxious, I had lungs full of water....so I know just how bad it can be. I had to do breathing exercises diligently for quite a few weeks, drawing air into a device several times a day to ensure that my lungs remained inflated and free of fluid.

Here is an extract from the FDA information regarding colchicine

Understand that life-threatening and fatal drug interactions can occur with colchicine if it is given with certain medications. These interactions can occur even at prescribed doses, and with medications that are given for a limited time, such as antibiotics
Review the Medication Guide that accompanies Colcrys.
Discuss with healthcare professionals all medications being taken and check with them before starting any new medications
Avoid consuming grapefruit and grapefruit juice while using colchicine
Pay close attention for any signs or symptoms of colchicine toxicity such as muscle weakness or pain, numbness or tingling in the fingers or toes, unusual bleeding or bruising, severe diarrhea or vomiting, feeling weak or tired, increased infections, and pale or gray color of the lips, tongue, or palms of hands. If any of these symptoms occur, seek medical attention right away.


Keep going to cardiac rehab, check all your medications and any natural therpies you are taking, and keep regular appointments with your doctor, especially if it suddenly gets worse. You must get on top of this, and you must not let it get worse without getting to the doctor or hospital quickly. Given that you are slender, slim and otherwise healthy, this is definately not normal in my opinion, and your management may need to be carefully reviewed, and you may in fact need specialist care. I absolutely agree with Mark, even seek a second opinion.
"Inflammation" and a pleural rub will likely need antibiotic treatemnt in my opinion. And some antibiotics absolutely interact with colchine. The friction rub is actually the pleural layers getting suck together with puss/infection.

Good luck and let us know how you go.

 

[DebbyA]

Hi,
I'm sorry you are having this distress. I had pericardial effusion 3 months after aortic valve replacement. It took about a week for the cardiologist to understand the symptoms I was describing and I ended up spending 3 days in the hospital. However, that took care of it. I can't imagine going on with those symptoms as long as you have. As the others have suggested, I wondered if you need a different strategy. It looks like you have seen several doctors, but I couldn't determine if any of them is really in charge of your situation. Have you asked why your treatment is not working and whether something else would be better? I looked at the pleural effusion description on the Cleveland Clinic site, and it said pleural effusion is basically a symptom, so there must be an underlying condition. Is it possible you need a lung specialist rather than the cardiologist? Do you have a good primary care doctor who could advise you? You may want to look at this link to see what kind of questions you could ask--especially look at the "Suggestions for patients" section http://en.wikipedia.org/wiki/How_Doctors_Think
None of us has the knowledge to second-guess your medical team based on a forum interchange, and these are only suggestions. It's my non-medical-professional opinion that you shouldn't be so much in the dark about your condition, when it has persisted so long. I apologise if I'm way off base.

Best wishes, please let us know how you're doing.

 

[PJ206]

Thanks for all the suggestions.

I am on colchicine - it acts as an anti-inflamatory and has been useful in preventing and treating pleural effusions associated with heart surgery. The pleural friction rub is due to inflammation, not infection. In the past three months, I've seen two cardiologists (who consulted together and decided on the colchicine), a pulmonologist, and a thoracic surgeon. My pulmonary funtion test was in the low-normal range, which could possibly be bad enough to cause symptoms (but not likely).

Anyway, I'm scheduled for a stress echo on Friday. Maybe that will provide some answers.

Colchicine is a promising drug for the prevention of several postoperative complications (PPS, postoperative effusions and postoperative atrial fibrillation) based on its anti-inflammatory effects and good tolerability at the study doses. Although further studies are needed before routine recommendation of the drug will be possible for patients undergoing cardiac surgery, colchicine seems to have the potentiality of becoming a new therapeutic standard in the perioperative period.

 

[DebbyA]

It's good to read my concern was ungrounded. Hope you get some answers--and relief--soon. It's no fun being a medical mystery. Keep us posted.

 

[ramjet]

Thanks for all the suggestions.

I am on colchicine - it acts as an anti-inflamatory and has been useful in preventing and treating pleural effusions associated with heart surgery. The pleural friction rub is due to inflammation, not infection. In the past three months, I've seen two cardiologists (who consulted together and decided on the colchicine), a pulmonologist, and a thoracic surgeon. My pulmonary funtion test was in the low-normal range, which could possibly be bad enough to cause symptoms (but not likely).

Anyway, I'm scheduled for a stress echo on Friday. Maybe that will provide some answers.

Colchicine is a promising drug for the prevention of several postoperative complications (PPS, postoperative effusions and postoperative atrial fibrillation) based on its anti-inflammatory effects and good tolerability at the study doses. Although further studies are needed before routine recommendation of the drug will be possible for patients undergoing cardiac surgery, colchicine seems to have the potentiality of becoming a new therapeutic standard in the perioperative period.

Ah, ha, thanks for the additional information, and the interesting information about your specific situation PJ, and so long as your team of experts are involved then thats clearly re-assuring for you, but its going to be difficult for anyone else to provide useful comments when you have not provided much detail about your specific situation, medciations, age, timing of interventions, cardiac function results etc, honestly. I provided some information just to provoke some further thoughts about your treatment, but now you say you are already under the care of two cardiologists, a pulmonologist and a thoracic surgeon, I'm not sure what else you can hope to glean from others. Clearly they are still doing tests, such as the stress echo, so your breathlessness may in fact not be related to lung issues at all, but may be due to heart fnction. anyway, let us know how you get on.

 

[Ovie]

I remember about 6-7 months out feeling like I was having all the symptoms I was suppose to have pre op, POST OP! I recently saw my doctor about shortness of breath or feeling winded when I wasn't doing anything, Cardiologist did echo EKG the works and says I'm fine, I've noticed it slowly to go down but still creeps up on me occasionally, like today I was a bit out of breath. Hope things get better for you! As your body heals more I'm sure it will, 6 months sounds like a long time, but to be honest it really isn't considering what your body went through.