Breathing problem after BY PASS

[amalesward]

Hi All,

My dad is at 65 years old and diabetic person, he had undergone BY PASS on 7th June 2010. He was perfectly OK after operation (3 days) and doctor was abt to shift him to ward on 4th day morning at 6am. On 4th day morning got call from doctor at 4am stating that he has got breathing problem and condition is serious.

After 24 hrs doctor told me that condition under control and need a support of ventillator for few days. It is been 10 days he is on ventillator support and doctor says gradually reducing the support but I am very much tenced and unable to do anything. Is this really requires those many days pls. suggest if any one had gone through this situation.

Thanks in advance!

[bill318]

I had a bypass just over a year ago. Have had trouble with left lung . Every since.

[amalesward]

Hi.

Thanks for reply.

Since 4 days my dad is on his own breath with help of normal oxygen (they are calling it as TP) and reading shows 99-100. But still doctor hasn't removed tube inside his tounge, he says another two days monitoring is required. Also mentioned that if we don't put him on TP then oxygen level in blood is getting reduced and that needs to be maintained with out TP. Why it is not getting maintained though my dad is able breath properly?. Is there any reason?

I had asked doctor to change room inside ICU, I am suspecting whether that room doesn't have enough oxygen in the air. Also I requested doctor to remove that tube, so that we can feed my dad at least with solid food instead of liquid. I will have to wait and see when he is going to remove that tube.

Thanks in advance.

[ed34]

The fluid around the wounds is normal, it happens to most people in ICU who have had surgery. The human body tends to prioritise its repairs, dealing with major organs first. All resources will be put into the lungs, because these are obviously very important. Once off the ventilator, then the wounds can be sorted out. My wife had the same problem. They will use tubes into bags to drain the wounds while in ICU but once in a ward they can use a vacuum sponge. This is a large sponge which is placed over the wound and has a tube running from this into a pump and a collection chamber. It ***** on the wound all the time, removing moisture and keeping it dry. In no time at all, the wounds naturally heal. The fluid around the wounds is to help combat infection while all resources are sent to the lungs. The protein will help, but not very much. The real difference comes when he starts eating. I went through exactly the same things you are, and although it seems like improvement is slowing down or stopping, it isn't. The fluid problem is an easy one to resolve.
Yes your english is very good, I understand everything you are saying and please don't apologise for anything.
Take care

[amalesward]

Hi,

Thanks for the reply.

I had asked them serveral times but there is no proper response they always point me to lung infection and they never talk abt re open. Here in this hospital they handle only heart dieseas, hence managing director and surgical in charge is the same person and he only did the grafting to my dad, he is very experienced and he has done near 50k surgeries in his life time. He is at age 70 years, I daily deal with this person only, even I known him personally since 10 years. In the same hospital I had got by pass done to my friends father and they are doing fine now. Bcz of that only I came here for my dad also. Before surgery I had 30 min discussion with this person whether my dad is eligible for surgery as he is at 65 years old, then he had mentioned no need to worry and convenced me for surgery. I cam to know that he is taking some personal care to my dad due to mistake from their side or I known him personally.

Another update I had got yesterday was, he has mentioned that tube can't be removed for another two days. Again they had put another tube at chest to suck waste fluid and I had asked them and got response nothing worry wounds are getting healing and they are forming this fluid. I had asked main doctor, I am too scary now as his stay getting day by day prolonged in ICU. He had mentioned nothing to worry he is getting improved, he has crossed worrying factor. My dad is really sick and asking me to take out and questioning me how many days you are telling two days and two days. So many days coming and going, he is literally crying, I am unable to see him, I love my dad so much and he has done so much for me. He never says no to my decision but he always corrrects my decision.

It is been 22 days in ICU with out eating, only taking liquids this is also making him more sick and worrying me more. Another thing yesterday was that doctor had asked me to get Albumin Injections -10 bottles, mentioned that these injections gives lot of strength like giving protiens directly. Even these injections helps to heal wounds soon, not sure how they help here but I know these injections gives strength to him.

I don't know what to do and I am in a situation that unable to do anything to my dad. Tried to get another doctor openion they didn't allow me to do that. Even I don't have much strength to face these as I am at age 25 and unable to express my felling with anyone. I can't tell anything to my family members and I have to swallow everything myself. sorry to write abt my story here. Doctor is answering only to me, but I have to answer to so many people daily and every one ask why ICU stay is getting prolanged. Even I don't have any information on when they can shift to ward also.

Thanks for reading, I am not sure whether I am using right words to make you understand. sorry for writing such a big story.

Thanks in advance.

[ed34]

There can be a number of reasons for the urine infection. If it doesn't clear up on its own in a couple of days, then antibiotics again should resolve this. It isn't good that they haven't told you the full story why they had to reopen your Fathers chest. I would ask to see the Cardiac surgeon who was involved. They should have had a set of clear images from an angriogram or ct scan to show them where the blockages were, all of them. A precise and clear plan should have been put in place before your Father went into surgery. It is unlikely that he would have formed a new blockage in a couple of days so personally I would assume they didn't do the grafting of the bypass vessels in the right place. I would ask some serious questions to the cardiac surgeon and demand clear answers. Opening the chest a second time so soon has caused a very weakened state, it is known this happens and is much more risky. Please don't let them just get away with this, ask them for a full and clear explanation. If you don't get anywhere, or they try to ignore you, ask the main reception at the hospital for information regarding the hospital management, who is in charge of the surgical teams and the running of the hospital and make an appointment with them.  This is not to try and cause trouble, it's to gather information because you need to know what has happened. You need to know for the longer term prospects of your Father.
Your Father will find it more uncomfortable to breathe on his own than other patients with lung infection problems because his chest has been opened twice and will feel very sore. My heart really goes out to him, I can imagine how he feels having had my chest opened just once for bypass. I can imagine how much more sore it must feel, and with the added problems of the infection must have been very frightening for him. My heart also goes out to you because of what you have had to experience. The trauma is not nice and when I went through this with my wife I found it very hard to eat or sleep. Everything I did made me feel guilty because she was laying there unable to do anything.
When they remove the tube and he is allowed to eat orally, you will need to go to the shops regularly for a couple of days. The foods offered in the hospital is not usually what the patient wants. When you haven't eaten for a long time, you can't seem to face certain foods. Although you feel hungry, the food looks great, but tastes horrible and feels too heavy on the stomach. My wife had me shopping several times a day. Much of the food I purchased she decided she didn't want after all. The one thing I found that made her appetite return was cheese flavoured biscuits, small ones. Another patient in the ward had the same problem, he wasn't eating anything so I asked him to try a few. Within a few hours his appetite returned. Now, I have no idea how that worked, but even the nurses were amazed and they said it is something they will remember to try. My wife then had a real passion for fruit because they excited her taste buds and were easy to swallow. I always made sure I left lots of soft fruit to last her through the evening, and by morning it was all gone. Milk shakes, fatty ones, are good to get the weight back on.

Thank you for keeping us updated and I'm so pleased he is finally responding well to the treatment.

[amalesward]

Thanks for the reply.

Now body temp is controlled and his Oxygen level is 97-100 with out ventillator. Doctor is planing to remove ventillator tube tmrw, which was inserted in toung. In my dad case also that might be true body is fighting with infection, his swelling also has got reduced a lot. Now since two days he is on his own breath.

I daily meet docotor twice in a day, always I ask him abt the x-ray which they take daily in the morning. He said x-ray is clear and my dad is medically fit only he has to get strength to breath properly.

I would like to mention here is they had done surgery on 7th June and again they had reopened on 10th June, due to known reasons and unknown reasons to me. Known is they had left one blockage to clear hence they had reopened without informing me. Unknown is still hidden to me and I don't think they had reopend again due to one blockage. Due to this my dad body didn't accept so easily and made him more sick along with lung infection.

Doctor didn't mentioned that there is a infection in Urin, but nurses told me that there is infection in Urin, I am not sure what could be that, please give info if you have any idea.

Thanks in advance.

[ed34]

Im not sure who told you that 99F is a fever? It could simply be the body generating more heat due to having to sit up all day after laying down for so long. If he is sweating a lot they simply need to give him more fluids. Around 24-48 hours before my wife had her ventilator removed her temperature rose and they said that this was simply her body fighting the infection off. Due to her weakness and requiring antibiotics, they said it was a good sign because the body was now strong enough to do the fighting for itself. 99F doesn't seem high to me, that's around 37 celcius and many people have that temperature in the afternoon. The body goes through temperature cycles through the day, highest generally in the afternoon and lowest in the morning, if a normal sleeping pattern exists.
If his Oxygen level is 92-95 without the ventilator then this is fantastic, his lungs are virtually back to normal. Don't worry about the weight, it's simply that the food fed through tubes is not adequate for the whole body, but he will put on weight very quickly once eating. My wife went down to 119 pounds but is now 161 pounds and trying to lose weight.
How is his bypass performing? is his heart nice and strong still?

[amalesward]

Hi,

Thanks for reply.
Just want to give an update on my dad condition, yesterday they made him to sit on chair whole day. Another good news is that doctor made him to breath own on TP (Oxygen) and Ventillator support was turned off whole day. He is fine and they told me that on night they will again turn on the ventillator as can't be removed immed. But he has got fever - 99 degree F. Oxygen level maintaining in his blood is 92 to 95.

Swelling also is getting down and I could see his bones directly as he became so sick. I am not sure how long it is going to take for him to get back to normal.Hoping once he start eating solid food..he will be OK.

I am praying to god that he will be shifted to ward in 2 to 3 dyas and removal ventillator tube which is inserted inside his tounge (they are calling it as Drugieast). So that he can take solid food like bread or curd rice...

Please suggest abt fever, Thanks in advance.

[ed34]

That's very good news and I'm pleased for you. Thank you for keeping us updated. It won't be long before he will be eating normally. He probably won't be able to speak clearly for a few days, more like whisper because the tube makes your throat very sore and dry. So don't be concerned if he can't talk very loudly or clearly, this will resolve itself.

[amalesward]

Hi,

Thanks a lot.
I will keep posting updates here. Now his BP level also maintaining constant and he is able to breath his own 15 to 25. Respiratory level is 6%-this has got reduced. Hope soon ventillator can be seperated from my dad.

Thanks in advance.

[ed34]

At least the condition of the lungs is such that the Doctors can now give an estimated time for having the tubes removed. This is a good news. When in the ward, and back at home, he may seem short of breath when walking for a few weeks or even months. This is common but does improve as time goes by. Lungs do take quite some time to fully recover from such a severe infection. You would be wise to ensure nobody with a chest infection goes near him for a couple of weeks, if he contracts this it could knock him back a few steps.
I'm really pleased he is doing so well and within a week he will be eating properly and his strength will soon boost. After one good meal you start to see a huge difference.
Take care

[amalesward]

Thanks for the reply.

He is much better than yesterday and his own breath has got increased.
Yes, As you said they are sucking the fluid from lungs and that has got reduced compare to before.

Doctor has started giving another injection now daily called Albunium and mentioned that it gives some strength to him. It has been ordered for 4 days and daily 2 eggs with milk.

Today doctor has given me date with in 4 days, My dad can be shifted to ward and asked to extend my leave for a week. At least some confidence given to me,Hoping everything goes as doctor assesing the condition.

Thanks in advance.

[ed34]

Every patient responds to treatment differently, this is why it is difficult to assess when the ventilator can be removed. Progress is the important factor. 14 days may sound a long time but I saw patients on ventilators for much longer than that. Don't worry about the ventilator being increased, you do have days like this. It just means the lungs need a little longer and the ventilator has been turned down to that level too soon. Each day has to be assessed.
The nutrition isn't a real concern yet, the body can last quite a long time with little food as long as fluids are given. This will be given through a drip. To be able to sit in a chair for two hours is very good, most patients on ventilators are sedated heavily for the whole ordeal because they panic and try to pull out the tubes. Sitting up will greatly help prevent his muscles weakening. His heart is obviously doing well, this is a major benefit. You just have to remember, the older you are the longer it takes to fight off these severe infections. He will get there.
Maybe it would help to visualise what is going on in the lungs, to give you some appreciation of the scale of the problem. If you take the lungs out of a human, and completely flatten them out, they will cover the same area as a soccer pitch. Most of this has been covered with infection, preventing oxygen getting into the blood. The body then makes things worse because it essentially doubles the thickness of the restriction by covering the infection with white cells to attack the infection. Then it's much harder still for oxygen to get through. Antibiotics help to make sure you make the right cells to fight that particular infection. It is important they establish if the infection is bacterial or viral, because there are different antiobiotics for each and one will have no effect on the other. You are waiting for the white cells to dissipate and leave clear lung tissue. Each day they should be using a suction tube to remove the slime collected in the lungs and each day more fluid should come out. Once the infection has nearly gone, this slime becomes much less. This is why a patient needs to be able to cough before the tubes are removed, so they can bring up the slime by themselves, clearing the lungs. Once the white cells start to fall away, recovery becomes very quick.

[amalesward]

Hi,

Thanks a lot for positive response.

Today they made him to sit on wheel chair for two hours and his condition is OK.
They have started giving Diabetic Resource Powder in milk thrice in a day, hope this gives some strength to him.

Today doctor told that his ´condition is better than yesterday but ventillator - respiratory level has got increased to -8%, yesterday it was 6% only. I am not sure what basis doctor says he is in better than yesterday.

I am more worried how long they are going to keep him ICU, it is been 14 days he is on ventillator support in ICU. Usually these problems takes these many days... doctor says can't give any date when ventillator can be removed. This is again another worry to me, if doctor himself doesn't know... then how they can assess the patient.

Thanks in advacne.

[ed34]

"Don't worry its normal to have that after a bipass"

Well not strictly true. It is rare for lung infections to develop to such a degree after surgery, especially bypass surgery.
When my wife was removed from the ventilator I believe it had to be at 20% which means it was only representing the pressure of the air in the room (normal air pressure). Taking a patient off a ventilator too early can cause serious problems both short term and long term. Once off the ventilator, oxygen through a tube in the nose or a small mask will be required for a couple of days if the lungs have cleared with little or no damage. If there is damage to the lungs (rare), then oxygen may be required at home for up to 2 years.
The two things to keep in mind are a) his oxygen saturation is very high, which is good, b) he is improving according to the ventilator.
You have to keep positive, the signs all look good.

[muki123]

Your dad will be okay don't worry.  The ventilator helps as he gets stronger but in time he will be strong and off it.  He underwent a serious surgery and the doctors are taking precautions so that they send him in top shape.  Don't worry its normal to have that after a bipass...and he will be okay.  Please update us on his condition everyday - i will suggest some foods for him when you are ready.  

[amalesward]

Hi,

Thanks for reply and good hope you have given here.

As it is more than ten days even I also know what is the percentage they are giving ventilator support. Like I could describe here Respiratory - 6% and Own is 15 to 25%. and Oxygen support from ventillator is -40%.

His heart beat is normal and Oxygen in his blood is 97 to 99. BP also normal.

Now they are trying to remove ventilator 2 to 3 in a day or twice. As you said they have changed the nutrition like yesterday they have feeded him with egg fry for protein's I think.

Please give your feedback on this.

Thanks in advacne!

[ed34]

The problem is, a small infection in his lungs has overtaken him, due to weakness after major surgery. You say they are going to start reducing the ventilator which is a good sign. The antibiotics have obviously started to work. The ventilator is a clever machine because it tells you how much the patient is breathing for themselves. You should see a slight improvement every day now the infection is under control. You cannot put a time limit on this, you have to wait until the patient can breathe for themselves and cough hard enough to loosen the fluids in the lungs. From what I have observed in intensive care, when the ventilator is reduced, the patient is usually off the machine anywhere between 2-5 days. There is another complication which may occur and so the more nutrition they give him, the better. When patients are in this position, surgical wounds tend not to heal properly because all the bodys resources seem to aim at fighting the infection. Once off the ventilator and eating properly then the wounds start to heal quickly again.
Ask a nurse to explain the numbers on the ventilator panel to you. You will see an improvement every day for yourself. Once off the ventilator, patients are usually discharged in 2-3 days. My wife had the same problem last year. She was recovering in the ward and after 3 days was on ventilation. They said she wouldn't last the night, but just a few days later she was off life support and breathing for herself. She then spent 3 days in a ward with an oxygen mask and having nebulisers, and was then discharged. As soon as the ventilator pressure was reduced, there was a big improvement every day. I know you are scared, but things are looking good.

[amalesward]

yes. docotor said it was a lung infection but now he is mentioning it has got cured. But still he is on ventillation and taking little help from that ventillation. There is no information from doctor when they are going to remove ventillation. Today he has mentioned that he is going to change diet so that my dad get some strength to take own breath. He is trying to speak but tone is not coming due to ventillator tube which is inserted in his mouth, but he is able to listen and understand what we are saying.

Please suggest me his condition and how many days still it takes to shift him to ward.

Thanks in advance!

[ed34]

Is it a lung infection? which they term as chronic pneumonia?