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Hospital Recovery
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Hospital Recovery

Hi everyone, im new to all this stuff so gimmie a break hah, anyways my dad is into his 2nd day after open heart surgery. He had 6 bypass's if im not mistaken. The problem is that it seems like he panics when they wake him up after anesthesia and try to let him breathe on his own. I don't know about this stuff, but when he wakes up he seems like hes a turtle on his back. He's squirms and pushs and kicks and wants to get up and its really hard to watch because he looks like hes in pain... Is this normal? Some info on him to help you guys to help me is this: he has been a smoker for most of his life, he drinks occasionally (but does so a lot when he does drink) and has a history of heart issues. They told me that today was goign to be the day he was probably going to be able to breathe on his own but when they turned off the breathing machine he seems like he was having difficulty breathing...  Does that breathing tube make it difficult to inhale? They assured me it was normal but i have a feeling they were telling what i wanted to hear and not so much the truth... Also i would like to know about any problems concerning catheders that are hard to spot at first glance. (the reason being is it seems that thats the first place he seems to try to reach for when he is coming OUT of anesthesia. He can't reach it though because his hands are tied down so he doesn't pull the breathing tube out...) Also i would like to know why he shivers or shakes a little bit when hes coming out of anesthesia, is that normal? ANY INFO WOULD HELP SORRY FOR THE BLOCK OF TEXT IM JUST CONCERNED
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Avatar_m_tn
Pallyfan, I'm not a doctor but I'm a father who has been down your Dad's path. Since I was essentially in a blackout for 20 days what I know about my behavior before and after open heart surgery is second hand, but what I've been told bears resemblence to what you've observed. I was 54 then, fairly mild mannered but I behaved bizarrely and aggressively - throwing hospital trays, trying to call a cab to escape. Calling nurses ******. So strange conduct isn't so strange considering that he's your Dad, you're used to seeing him in control, yet his body has been traumatized firecely, He's almost surely had his heart stopped for 1+ hours. The brain knows that's happening even if he doesn't seem to and the brain doesn't like it. one bit. My understanding is that the sooner a person can be "weaned" from a mechanical ventilator the safer it is -- if he's getting enough O2. But the body sometimes resists, and yeah that tube doesn't make it easier.  

You can't become a heart doctor and I can't teach you. What I can tell you is that this is not the time to be timid among doctors and nurses; yes, they will often tell you things to get rid of you. The ace you have to play here when you need to is to remind anybody that brushes you off that this is YOUR FATHER in that bed and you are not backing from being pushy if if your concerns are not being addressed - and make it clear that you will not tolerate disrespect for you OR lack of concern about your father.
If your father is acting like a turtle on its back its likle because he's feeling that way - powerless.  Reassure him, take him by the hand and squeeze it and tell him you've got his back and then GET HIS BACK. Hospitals are notorious in under-medicating semi-conscious patients for pain. Tell don't ask them if he is in pain. Relief from pain will calm him down. Even in comas people can feel pain. He needs pain medicine when he's asleep, at least if it seems to you that he does. I think you're right to be concerned that he seems cold - when he has to shiver to keep warm he's wasting energy he needs to devote to the heavy lifting his body is doing to start some serious healing.  Insist that someone tell you why he doesn't need to be warmer or have another blanket.  
When my son was in a coma from a brain injury I heard a young resident doctor mention that Drew had a certain kind of pneumonia bacteria that I knew was wrong. After he brushed me off in my son's room, I told him I needed to talk outside of the room (don't argue with doctors in front of your Dad - it will contribute to his agitation) But I spent 20 minutes arguing with him to check the chart even as he treated me like a dunce. He finally looked, his face turned red and he issued new antibiotic orders that, unlike the ones my son was on, quickly got rid of the infection. I never yelled, but I spoke with him with a growl in my voice. And one of the ICU nurses told me I might have save my son's life.

Hospitals are a *****, but every person whose stuck in a bed there needs an advocate. It's much easier to ignore a patient who doesn't have someone hovering, even if you don't say a word. You sound like your ready to be your Dad's advocate. But keep your interactions as questions not demands. If there's a battle you can't avoid, be forceful about who you are to their patient. As your Dad's son, you outrank everyone there - sometimes they need reminding.  And if something doesn't feel right about how your Dad is behaving, make sure the right person hears your concerns. And good luck. BTW, I "only' had a quintuple bypass - I didn't think anyone could beat that. When he's feeling better, tell your Dad I'm pissed!
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976897_tn?1379171202
The biggest problem with ventilators is the panic situation. Most patients get scared to death when they wake up and find a tube down their throat. I remember when I woke up, the first thing the nurse told me was there's a tube breathing for me, just relax. Luckily I've always had a strong mind to keep things in perspective and I just relaxed and let the machine do the work. It actually felt good once I had convinced my mind everything was fine. Some people simply cannot relax and try to yank the tube out. My wife was on life support for several days and they had to keep her heavily sedated to prevent her pulling the tubes out. No matter how I tried to reassure her, she was obviously too scared and wanted the thing out. Before the tube is removed, you have to be off sedation because your mind has to be aware you need to breathe. You also have to be able to cough. With my wife, they gradually reduced the sedation and kept it at the point where she was JUST conscious enough. The tube was then removed and sedation was stopped completely.
Now, there could be a more serious issue underlying the problem with your Father so I would be asking some questions. For example, is he fighting against breathing? I think this is unlikely. We know breathing is necessary and a normal reaction is to breathe. It seems more likely to me that he is unable to for some reason. The lungs are being controlled by the ventilator and he is comfortable, but when switched off he is unable to breathe. I would be leaping about in a panic if I couldn't breathe.
One question I would ask the Doctors to be on the safe side, is regarding the nerves which control the diaphram. In some cases of bypass surgery, one nerve is damaged making it harder to fully flex the diaphram and draw air into the lungs. If both nerves are damaged, maybe he has no control over the diaphram. I would ask them if this could be the case before putting him through any more trauma. When damaged, it is usual for the nerves to recover over a short period of time, restoring the full ability to breathe. I could be way off track, but it's a question I would be asking if it was a family member of mine. Maybe they haven't considered this as a problem.
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Avatar_m_tn
Thank both of you so much, your advise is more helpful and reassuring than you can imagine. quintby, my father is still under sedation because when he wake up from anesthesia he panics and his blood pressure spikes 200-215 sometimes a little higher, today while i was at home cleaning up taking a shower and stuff, my father woke up and the same thing happened. He was different this time according to my aunt, he was shaking a lot like almost a convulsion. Im happy and sad about the fact that i was able to see him and be there when that happened. todays update about him is that he has pnemonia (pneumonia)... Which is why it was difficult for him to breathe when they took him off the ventilator. they're giving him a general antibiotic for it until they can find out what specific type or strand of pnemonia (pneumonia) (to my understanding there are different types of pnemonia (pneumonia) that are resistent to certain antibiotics) it is so they can give him the more... i guess appropriate antibiotic... ed34 i will definately speak to the docter about the nerve stuff you told me about im going to push the medical team to tell me about everything, especially wheather or not hes fighting to breathe while hes on the ventilator, because thats what it seems like to me... I have a question, considering the fact that when he comes out of sedation his blood pressure spikes and he panics, is there anything that can be done to keep him awake long enough to the point where he understands what we're saying to him (such as clam down etc. etc.) I want him to be aware and able to process what im saying to him, but it seems like when he wakes up all he wants to do is pull the catheder out, breathing tube and so on, is it a good idea to keep him awake long enough for him to actually do that? Because like i said when he wakes up, hes in a panic and his blood pressure spikes and he doesn't listen to me or anyone for that matter. Please help me, im a wreck right now and I don't want to lose my dad. Ever since i moved in with him hes helped me become a better person, hes always there and the only thing i want is for him to be there untill i graduate college or have kids of my own and all of that. Hes the best thing i have in my life and I love more than anyone in this world.thank you guys in advance
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976897_tn?1379171202
Yes pneumonia is a 'general' term given to any severe chest infection and they must establish if it is viral or bacterial. There are antibiotics for each type  and one will not work for the other. They will suction fluid from the bottom of the ventilation tube and give it to a microbiologist. They seem a bit slow at reacting to this? he should have been on antibiotics as soon as they realised there was a problem.
When on the ventilator, it does the breathing for him and ensures there's a good supply of oxygen getting into his body. The ventilator can be adjusted to breathe totally for a patient, or not help at all, with all the range in between the two. It displays the air pressure in the room, it displays the pressure being given to the patient and it displays the difference, how much pressure the patient is taking in for themselves. When the patient begins to recover from the infection, which is usually a few days, then the ventilator is 'gradually' turned down so it can be seen how the patient copes. Each day the pressure is reduced but it the oxygen levels inside the body drop, it's turned back up for another 24 hours. So one small step at a time. What you never do is suddenly switch off a ventilator which is assisting a patient in breathing to see if they can breathe for themselves. This is dangerous and plain stupid. Once a patient is no longer relying on the ventilator, an extra 24 hours is usually given to be on the safe side, to make sure no complications suddenly occur. Then the patient is taken off the machine. They need to get the right antiobiotics into him as soon as possible to start fighting this infection. I don't think it's the diaphram nerve now, it's a case he had a chest infection before surgery, probably a very small one, and it has now taken over due to his weakened state from major surgery. He will take a few days to overcome this infection so don't let the Doctors try and rush things. To keep trying to turn off the ventilator and turning it back on will actually do a lot more harm than good. Tell them to look at research which proves this. The numbers displayed on the ventilator will tell them when he is ready to breathe for himself.
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I would just like to add...
When my wife was put onto a ventilator I was told she wouldn't last the night. A few days later she was fully recovered. Nobody can predict any outcome. Don't ask nurses questions, only ask the consultant. I had 10 different stories from 10 different people and soon learned only the consultant was accurate. Once they get the antibiotics into him, it becomes a waiting game and I know how frightening it is. In a couple of days you will start to see a small but significant improvement. So please hold in there.
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Avatar_m_tn
Thanks again ed34, latest update is this: hes sedated but not so much that you can't wake him up if you try, for instace talking to him will bring him out but he still panics. As for the infection they did blood cultures and are waiting for the results to find out weather its viral or bacterial pneumonia but they said that it takes time for anything to happen, like 24-48 hours. like i said though they have him on what they call a "general" antibiotic to fight the infection in his lungs. He has been waking up a lot more lately, by lately i mean just today... but as far as i know that could be good or bad, good because that means hes becoming more aware and will soon be able to take commands like "squeeze my hand, open your eyes, cough" etc.etc. Bad because it could be because he's not getting enough oxygen or hes in pain or for all i know both...  His blood pressure keeps spiking when he wakes up and panics, he seems to hate his catheder, (the thing he pees in not sure how to spell it right) because thats the first thing he goes for when he wakes up, but the nurses' say that the breathing tube is likely to be more uncomfortable than the catheder... which doesn't seem to be the case because like i said its the first thing he goes for (the catheder that is) Oh and Is the consultant the person who talks to the familys during the surgery process, because a lady did come to talk to us while he was in surgery but i dont know if her title was "consultant" I guess my question is are there other titles for that specific position or job? To clarify what I mean to ask, are there any other names they give to a person that does the job of what you call a consultant? I apologize about my jumbled up writing, i havn't slept very well or eating much more than cheese and crackers the last 3 days... so sorry, its been a rollercoaster lately, thanks so much for replying ed34. I appreciate it.
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976897_tn?1379171202
Thank you for your update. Consultant is a title for the head Doctor who is handling the case. All the other Doctors basically report to this one and follow his/her instructions. However, you can choose a Doctor to speak to, but try to make sure it's the same one as much as possible. They will get to know you over the next few days and remember the case. They have lots of patients and it can get confusing for them sometimes.
With regards to the catheter, ask the nurse to check if it needs cleaning. Sometimes they can get a little blocked and painful to pass urine. My wife had a few problems with her catheter and it needed flushing a few times. It maybe that it needs removing and reinserting. The less sedation required, the better but it's not really a problem. So long as he doesn't have to panic much which will obviously make blood pressure spike. There are two methods for controlling oxygen levels, well, I should say monitoring it. Firstly there is the standard finger clip which uses different light wave lengths to measure red cells. This is ok for the average patient but not when in intensive care. My wife was showing 99% oxygen by the finger sensor, but her real oxygen level was very low. The best method is a blood gas test where a sample of blood is taken and analysed. This gives the true oxygen reading. Believe me, they will be running regular blood gas tests so they can adjust the ventilator accordingly. You are in for a long haul with this and some days will seem like a step backwards has happened, while other days will show improvements. I think it was the most worrying time of my life for me when my wife was on a ventilator.
One thing to look out for is a large clear plastic canister by the machine. The nurse inserts a small tube down the main one and ***** out any mucus she can. At first while the infection is bad, not much is removed. Suddenly a couple of days after the antiobiotics start, there is loads of it each day. When the infection is under control, the amount lessens again. Did you ask the Doctor or nurse to explain the numbers on the ventilator to you? Ask which one states how much the patient is breathing for themselves, and you can look at this each day and see the improvement. Like I said, some days it looks better and the ventilation is reduced, but the next day it's increased again. Don't let this dash your hopes, it's perfectly normal.
Please keep us informed and I really hope you find strength through this. I know it's horrible but you must eat properly and keep your health good. In a few days you will see a huge improvement and you will feel a huge sigh of relief.
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Avatar_m_tn
I know all the numbers on the ventilator he seems to be breahing on his own when he wakes up but he's taking 40 breathes a minute because he's panickng. so their answer to that heavy breathing is to sedate him... They keep using this word and it seems to me they use it because they are hiding something, they keep saying he's " anxious" when it's clearly panic that he experinces when he wakes up. Any answer for me man? The docter came in and talked to us about what was going on and he told us that te pneumonia caused my dad to have something called Adult Respiratory Distress Syndrome (ARDS) whch scares me beacause it's apperently a very serious condition. If you can tell me about this please do.
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976897_tn?1379171202
Sedation on ventilation is very normal, virtually every patient has to be sedated because it's a very scary ordeal. It keeps them comfortable and assists recovery. Yes ARDS is a nasty thing, and the most common cause is infection. During major surgery the body becomes very weak and a small infection in the lungs can simply go wild. The tiny sacs in the lungs where oxygen exchange takes place with the lungs become infected, they swell and often fill with fluid. The patient is unable to create enough pressure in the lungs to overcome this and the body gets too little oxygen, so a ventilator is used to supply that pressure. I witnessed many patients going in and out of ICU when my wife was on a ventilator and there's one thing I learned. They first try a full face mask to see if the pressure from that is adequate. If not, they put the patient out and insert a tube into the lungs and use a more powerful ventilator. If this is not sufficient, the patient doesn't usually survive very long. If the pressure from the ventilator is adequate, the patient does usually survive. They are right in telling you it's serious, but survival rates are high. The key is to establish the cause. If it is infection, a microbiologist has to use a sample of sputum and grow a culture to establish if it's viral or bacterial. Then the best antibiotics can be used to fight it. If there is no change at all in the first 24 hours, they will try another antibiotic.
When my wife was on a ventilator they told me that it was very serious, they told me her case was very severe, and they told me she wouldn't make it through the night because the ventilator was only just giving enough pressure. A few days later she was off the ventilator, off any oxygen support and back home. So, nobody can predict anything accurately.
What I did was note the ventilator readings on day 1 and use that as a base line. As long as that base line didn't drop, I knew there was good hope. Improvements started slowly and a couple of times the readings dropped again, close to the base line, but never quite reached it. After around 3 days the readings started to show a steady upward trend. They
use a small tube to suck out fluid in the lungs a few times a day. At first hardly anything comes out because the fluid it too thick and sticky, glued to the lungs. As the infection becomes weak, this loosens and much more is sucked out. This is another good sign to watch for. When the infection has nearly gone, the level of fluid drops dramatically until nothing can be sucked out. The first day my wife was on the ventilator, they had to strap her to the bed to stop her pulling out the tubes. Not a nice sight. They then decided to keep her peaceful she required heavy sedation. I know it's not nice seeing them sedated, but it is best for them. I recently asked my wife if she remembers me talking to her while sedated. You know when you sit at their bedside talking away and you wonder if they can hear you. Well, she said she heard every single word and it was reassuring. I kept telling her every day how things were improving and she said this comforted her a lot. She said it was like she was halfway between being awake and asleep, so she could hear and understand everything. She would hear the Doctors saying bad news to each other, which scared her, but when I went in and told her how the readings were improving it made her want to fight it and not give up. So lots of encouragement is important even though you don't think they can hear you.
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