Plueral effusion - information needed

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M

Mb

Hello!

My husband is two weeks post op from a tricuspid annuloplasty. When he left the hospital he was told that he had some "fluid on the lung", but this was common from heart surgery, and that it would clear up on its own.

He had another chest xray today, which shows a moderate effusion. He has become somewhat short of breath. His back is "uncomfortable". The Dr. has told him to increase his lasix for a couple of days. FYI - He has lost 12 pounds from his presurgery weight.

I would really like to hear from anyone with knowledge as to (1) how long this might take to clear up and (2) at what point do they decide to drain it.

I would really appreciate anyone's information.

Marybeth
 
I had a mild pleural effusion located in the right lower lobe of my lung. I was having enough discomfort that they ran a CT scan to make sure it wasn't a pulmonary embolism. After it was determined that it wasn't, I was started on Lasix (I wasn't on it previously) and it slowly cleared by itself. I was told that they usually only drain an effusion when it becomes large enough that it starts really interfering with you breathing; otherwise they prefer to leave them alone and let them resolve by themselves.
I hope this helps.
 
It has to be very large and impinging enough on the lung to be causing shortness of breath in a big way. I also had one after surgery, and they just kept an eye on it and put me on lasix (which I still take, except now for blood pressure and pre-load reduction). There are not many good ways to drain one, except with a needle, and with your lungs moving back and forth it's more risky than it's worth. Or they can put a chest tube in, and that's no funh either.
 
Hello!

Phyllis, thank you for sending that link. I had researched under pleural effusion, but for some reason that link did not come up, and once I started reading the posts, I remembered the chain of events.

Perkicar, thank you also for your input.
'
Mary, perhaps they will do a CT scan on Friday, to check for a PE. IF he still is having these problems.

I did see the xray today, and his right lung seems to be diminished (all white on the film) about a third of the way up......not that I know what I am looking at. He is definitely more short of breath today, and is having some chest discomfort. He had been taking 20mg of lasix, and will be taking 40 for the next couple of days. (By the way, prior to this surgery he was on 120mg of lasix a day, for the TR fluid overload). He has also lost 12 pounds, so he really doesn't look well. I am praying that the lasix works.

Any additional information sure would be appreciated.

Marybeth
 
I had severe fluid problems (Pericardial Tamponade) 3 weeks post-OHS and had to get a chest drain. It happened so quickly that by the time it was discovered I was already at the point of conjestive heart failure so the decision to drain was immediate. In your husband's case they are already aware of the situation it shouldn't get to that point.

However, when I was released after the drain I still had some fluid on the lung, which sounds like your husband situation. I was on Lasix for about a week or so, and went for weekly check-ups to monitor the situation. I was told they wouldn't drain again unless the fluid build up impaired my breathing again. Luckily, the Lasix worked and it was completely gone in about 3 weeks. I also took Colchicine for 3 months as a preventative measure as it can reoccur. It never returned.

Hopefully, they caught it in time that the Lasix alone will do the trick. Best wishes for a speedy recovery.
 
Dear Wayne:

My husband's name is Wayne as well!

I knew you had had a problem with peridcaridal effusion. Interestingly, my husband was already taking lasix. 40mg daily post surgery, brought down to 20mg......he is now back up to 40 mg. -I too certainly hope this does the trick. I did remember your saying that yours came on quickly with the pericdial situation, and I certainly have a heads up about that, thanks to your posts.

It is over 2 weeks since his surgery, and I know he has had this fluid now for at least a week. So, he has been taking the 20-mg. for the two weeks, so I can't imagine what it would have been without taking that dose. Let's hope the new dose works.

Again, thank you for your input. Any additional information would certainly be appreciated.

Marybeth
 
Hi Marybeth,

After my OHS I was also released on Lasix. However, the prescription was only a two week supply as by that time I guess they figure you won't need it. When it was about to run out I saw my GP and I was feeling fine and there was no sign of fluid so the Lasix wasn't renewed. In that third week, I was felt fine until about Wednesday evening. By Friday morning I felt so bad I called by GP who sent me to the ER and the rest is history. I guess as soon as the Lasix was out of my system, the fluid went out of control.

Fortunately, since your husband was already on Lasix it was under some control so hopefully the increased dose will reduce it.

You may want to ask about the Colchicine. Apparently its actually a med for Gout but has proven effective at preventing peridcaridal effusion. The unfortunately thing about peridcaridal effusion is that if you are one of the lucky ones susceptible to it, it can reoccur. I was on the Colchicine for three months and the peridcaridal effusion did not reoccur. The only unpleasant side effect is that on Colchicine food tends to flow through you rather quickly if you know what I mean. ;) I figured it was a small price to pay to prevent going through this again, but I was very relieved once I no longer had to take it.

Best wishes for Wayne that the Lasix resolves this.
 
Mb said:
Hello!

Phyllis, thank you for sending that link. I had researched under pleural effusion, but for some reason that link did not come up, and once I started reading the posts, I remembered the chain of events.

Perkicar, thank you also for your input.
'
Mary, perhaps they will do a CT scan on Friday, to check for a PE. IF he still is having these problems.

I did see the xray today, and his right lung seems to be diminished (all white on the film) about a third of the way up......not that I know what I am looking at. He is definitely more short of breath today, and is having some chest discomfort. He had been taking 20mg of lasix, and will be taking 40 for the next couple of days. (By the way, prior to this surgery he was on 120mg of lasix a day, for the TR fluid overload). He has also lost 12 pounds, so he really doesn't look well. I am praying that the lasix works.

Any additional information sure would be appreciated.

Marybeth
Click to expand...

Marybeth,
I asked my husband about your question. He frequently deals with chest tube
insertions/removals, intubations, brochoscopies, etc in his line of work.
He said that the volume of fluid is sometimes difficult to determine, so they frequently rely on the symptoms the patient is experiencing. Extreme shortness of breath and/or hypoxia are symptoms which might warrant a chest tube being inserted.
I wanted to mention this since you said Wayne's sob has increased since your first post.
 
Dear Mary and Wayne:

Thank you so much for the suggestions and input.

Mary, I actually think they may have removed the chest tube too quickly. He came out of sugery at 11:00PM on Wed night, and they removed the tubes on Thursday, as he was scheduled for a pacemaker insertion Friday morning, and all of the tubes, etc. had to be removed. Do you think this is possible?

He became noticeable short of breath this past Tuesday evening, through yesterday, and this morning. Last night he was expereriencing enough back and chest discomfort to go back on the pain killers, which he took again before going to bed, and again about 6:00AM this morning. I am watching him like a hwak today. Nurse is coming in about a half hour. We will see what happens in the next 24 hours or so.

Wayne, I will certainly keep your recommendation for that medication in mind, particularly if this doesn;t improve quickly. He did loose a pound overnight.

Marybeth
 
Mb said:
Dear Mary and Wayne:

Thank you so much for the suggestions and input.

Mary, I actually think they may have removed the chest tube too quickly. He came out of sugery at 11:00PM on Wed night, and they removed the tubes on Thursday, as he was scheduled for a pacemaker insertion Friday morning, and all of the tubes, etc. had to be removed. Do you think this is possible?

He became noticeable short of breath this past Tuesday evening, through yesterday, and this morning. Last night he was expereriencing enough back and chest discomfort to go back on the pain killers, which he took again before going to bed, and again about 6:00AM this morning. I am watching him like a hwak today. Nurse is coming in about a half hour. We will see what happens in the next 24 hours or so.

Wayne, I will certainly keep your recommendation for that medication in mind, particularly if this doesn;t improve quickly. He did loose a pound overnight.

Marybeth
Click to expand...

I think it's very possible that it was removed before it was done draining. Bob says they frequently take one out, only have to put another one in further down the line.
You might want to have him take no pain meds after the 6am dose to gauge the level of discomfort. You'll be coming up on the week-end again, so if Wayne has continued, noticeable shortness of breath and pain, I would insist that someone see him. Is there any chance the nurse has a portable pulse oximeter? That would check the O2 stats.
 
Dear Mary:

That is actually a good idea...hold the pain med for a few hours. Will do that later.

The nurse did in fact have a pulse-oxometer. He measured at 95%. She said the lungs sounds were absent half way up the right lung.

Oh, and he did loose one pound overnight.

We are to call his PCP in the morning.

Marybeth
 
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