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Weight Loss Prior/Post Heart Surgery
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Weight Loss Prior/Post Heart Surgery


  My father, age 86, underwent open heart surgery on September 15.  He had a double bypass and had both the mitral and aortic valves replaced.  He is doing remarkably well, especially for someone his age (he was out of the hospital in 8 days!).  
  He is walking twice a day for about 10 minutes a walk, as instructed by the doctor (he's to work up to 30 minutes a day total).  He has been gaining strength and is getting back to his old self in general, although he still tires easily.
  My question is, before the operation when his heart condition was worsening, he lost a lot of weight.  He's about 5' 6" and was down to about 125 lbs. by the time he had his operation.  Both before and after the operation his appetite has not been great and he has lost another several pounds since he had the operation.  He is  on several medications, including Coumadin, digoxin, Lasix and a blood pressure medication (it might be Lo-Pressin, I'm not sure).
  He has become very finicky about what he eats since the operation and has developed sudden dislikes for a number of foods he used to eat.  In addition, he seems to have an aversion to meat and won't eat much of it.  Another weird thing is, he's OK mentally otherwise but has forgotten about certain foods -- he had to have my mother explain to him what a grilled cheese sandwich was, and when she asked him if he wanted oatmeal one day he asked her if he'd ever had it before and if he liked it.  
  I can't tell whether he's just still somewhat affected by the long operation and it's affected his memory somewhat in general or whether the whole finicky-food and food-memory issues are related.  Could he have had a stroke that affected his eating center in his brain or something?  Or is it more likely that the numerous medications are affecting his appetite?
  Even if he isn't eating quite as much as he should be, I still feel he should have put on some weight since getting out of the hospital 4-1/2 weeks ago, considering his heart is now "fixed" and shouldn't have to be working as hard as it was before.  Or is it now the healing process that uses up the calories he's consuming?
  Prior to the operation he had a full GI workup and a bone marrow biopsy  because he was anemic, and no cancer or other problems were found so I don't think the weight loss is from some other undiagnosed condition.
  Please let me know whether we need to just be more patient and that some of the weight should start coming back eventually, or whether this is something we should be concerned about and pursue more with his doctor.  My father saw the doctor last Tuesday and he said not to worry, he'll gain weight, but I'm still concerned that it's taking this long.
  Do some heart surgery patients never regain the weight they lost?  Should we buy him a new wardrobe?  
  Thanks for your help, this is a wonderful forum and you have all been very helpful to me throughout this whole thing.
  -Miriam
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Dear Miriam,
You need to be patient not only with the weight gain but also with the memory. You sort of answered your own questions with great insight regarding that number one, the recovery process although better than the decline in health that preceeded the surgery, is also a calorie consumer, thus it will be a few weeks yet.  A big problem in elderly patients who undergo open heart surgery is that the anesthesia causes a depressed appetite and its' effects last quite a while.
It is a possility that your father had a stroke during or just after the surgery, however it is much more likely that the memory oddities/loss that you speak of is simply a result of his brain not being well perfused during the surgery, and often this will get better over the course of the year that follows the surgery.
Your father had an especially involved surgery, and a long one at that, and it really is great how good he is doing.  His doctor is right on target asking you to be a little patient, however there is no guarentee that he will gain ever again, but it is less likely that he will lose anymore.
High calorie shakes/supplements and a daily vitamin are great things that help the patient maintain or gain a little over time, especially in those who's appetite just is not up to par so to speak.  It is very helpful that your father had all that anemia assessment prior to surgery which as you say was negative because this should help you to feel more comfortable with being patient.
I doubt that new wardrobe is in order, but as I said above it could be a year before he even gets near his prior weight.
For how sick he was prior to the surgery, I am not at all surprised at how much weight he lost, again maintaing current weight and good nutrition should be the  goals post-operatively.
Good Luck.
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