Fathers Dilema

[Latenia]

Thank you!  Pleae HELP!  My father had a triple bypass surgery in September.  After two weeks at home, his Left leg, the leg that the vessels were taken from during heart surgery, has completely lost all control.  Control as in he cannot walk or put any pressure on it.  He cannot raise or lower the leg at all.  It constantly hurts and causes severe pain throughout the day and night.
Doctors are speechless.  Several MRIs were done, and the doctors state that everything looks fine.  No problems were found.  Acupuncture was done once.  It did not help.  Therefore, doctors sent him home only with pain medication that doesn't even relieve the pain at all.

Please help!  I do not know where to turn!  My local hospital will not treat him at all.  They immediately send him to the hospital where the surgery was performed.  

Do you have any suggestions ... and again, Thank  you for your time.

[usedtobecatchy]

Just wanted to add a comment. My dad had triple bypass 5yrs ago at age 75. After his surgery is when he started to experience extreme leg pain walking or standing-he was very depressed because he was an active fisherman/gardener/carpenter. They finally diagnosed spinal stenosis. He had spinal stenosis sgy at age 79 and today at 80 he is almost tearful with gratitude at how that restored his active lifestyle. I suspect increased bloodflow after bypass surgery will cause symptoms to surface that were hiding before. He is, I believe, an unusual example of bypass surgery-cholesterol was 70's, bp was 120 over 70, tall and muscular, but he was a meat and potatoes man his entire life, and a diet controlled diabetic in his 70's. Not everyone will have the same results as he.

[dizz]

I agree with christie, I don't think your getting the whole story on your dad's diagnosis. The pain in your dad's leg could possibly be from extended bedrest from surgery, many times this can lead to blood pooling in the legs or DVT. Your dad should be going back to his cardiologist who are also vascular specialists and/or part of a group that is. If blood becomes slow moving it can clot, should a thrombus dislodge it could make its way through to the heart. But I suspect your dad was placed on some kind of anticoagulant in order to prevent that from happening. A good hospital is very aware of this problem and should take steps to prevent it, it is one of the reasons they have the patient up and walking around asap after a surgery.

Keep in mind the arteries carry fresh blood to the limb and "veins" return it to the heart. It is important that if your dad is having severe pain in his legs that he have it checked immediately for possible clot (take him to the ER) right away as it could lead to worsening condition possibly even gangreen and loss of the limb.

You should also understand if your dad had blockages in the arteries of his heart requiring a by-pass then he most likely has cardiovascular disease in the rest of his arteries also including arteries in the leg. Blockages in the legs would be PVD or PAD (Peripheral Vascular Disease).

[Latenia]

Thank you both for responding to my plea!  Just to give you some more insight, following his bypass surgery, my father did come home for approx. 2 weeks.  During this time he was fine.  No problems at all with any thing.  He was walking at least a mile at a time everyday.  Then, as I stated before, it just stopped.  The pain started immediately.  Then, after a week and a lot of encouragement, he let me take him to our local hospital.  After doing some x-rays, they immediately told us to take him to the hospital where they performed his bypass surgery.  At that point, they did numerous MRIs of which they all said were negative.  They did accupuncture once.  They, at one point wanted to do an operation on his back, but said later that there was no point of it at all.  He did have a problem with his blood however.  They said that he had too much coumadin and that his blood was dangerously too thin.  Therefore, they gave him Vitamin K several times and some blood.  After nine days of staying there, they let him go on a Friday night at 9:00 P.M. and stated that they were sorry, but they just did not know why this was happening because it was a huge puzzele (that was weird also to be so late).  After dismissal, the doctor informed me to take him to another facility, about two blocks down, at 10:00 P.M. at night, in order to get another MRI done.
The people there could not understand why another MRI and why we were sent there.  Till this day, his is still not walking, and is in constant pain.  
No one will see him at all!  No local neurologist and we have one cardiologist in town, and there is a two month wait before we can see him.
He is currently going every week to a PA so that her nursing can check is blood level and that is it!  He doesn't even get to see the PA, just her nurses.
I am scared that something is being covered up, etc.  It seems that every way we turn, the doctors, etc. advice us to go back to the hospital in which done the bypass surgery.  Obviously, after staying there nine days and a bill of $106,000, in which nothing, absolutely nothing was done, enlighten, etc., he does NOT want or need to go back there.
Please help and again, thank you for your time.

Helpless family.

[nurse12hr]

I am also so sorry for the problems your dad is having.  I am a nurse, and it sounds like either A: You are not understanding the whole story or B: You are not being told the whole story.
My first question is, were you there during all conversations with the doctor?  My parents (as well as many older people) get confused about what the doctor said, and will typically go to the doctor and come back, telling me that "he said nothing is wrong".  Or, "he said he doesn't know what is wrong".  Then I call and speak to the doctor, and get an entirely different story.  A person cannot be hospitalized for that long and not have a diagnosis, because insurance will not pay for treatment.  So I sort of suspect he doesn't understand something of what he was told about what is wrong.  

So first, make an appt. and SPEAK TO THE DOCTOR FACE TO FACE.  Your father my have to give his consent.  Get a written statement from him, allowing you to talk to the doctor.  Ask what HIS DISCHARGE DIAGNOSIS was both when he left after being readmitted, and during the first surgery.  In writing, get your father to request COPIES OF HIS MEDICAL RECORDS from both surgeries.  There is usually a fee for this, but you need to understand completely what is going on.

Secondly, if you get the feeling after this that you are still not being told something, contact an attorney.  An initial consultation is usually free.  They WILL get the info for you.  Plus, if your dad's doctor knows you are going this route, you bet they will get him to a neuro ASAP.  Recently, I told my husbands doctor that if anything happened to him, because they  couldn't get him in to see a badly needed liver specialist, (3 month wait) that I would not hesitate to seek legal assistance.  He got in the next week.   You hate to do that, but this is your dad's leg you are talking about.  And he is in constant pain.  

Lastly, your dad HAS A RIGHT to see the doctor when he goes, not just a PA or a nurse.  Unless he is just going to get labs done.  Make the appt, go with him, and ASK, ASK, ASK.  Stay there until ALL your questions are answered.  Take a pen and paper and write down what you are told.  Ask the doctor to spell out any unfamiliar words.  Usually, if you just do this, it can clear up a lot of misunderstandings, and let your dad's doctor know he cannot be treated so cavelierly.  

good luck

[usedtobecatchy]

You posted this to the Neurology/Neurosurgery forum which suggests to me you suspect a nerve problem of some kind? Were the mri's of his spine? Has he had emg/ncv testing? ct scan? myelogram? What are the side effects of his heart surgery which would have been in his presurgical literature? Is it possible he needs more recuperation time? The graft from his leg is a separate surgery site just like his heart surgery site. I am not a doctor but it seems to me like a leg giving out is caused by something going on higher up the tree trunk? Or is there any chance that medication makes him lightheaded and consequently the leg gives out?

[CCF-Neuro-M.D.-JT]

The usual blood vessels taken from the leg for a bypass surgery are veins in the lower part of the leg, below the knee, which makes it unlikely that this is the cause of his leg weakness. There's a couple of things that come to mind that should be evaluated for:
1.Did he have a stroke? Shouldn't cause so much pain, but this a well known neurological complication of bypass surgery. Can be evaluated with MRI of the brain and neurological exam.
2.With bypass surgery, heparin (blood thinner IV) is given to patients to keep the blood flowing for the surgery, but can lead to a big collection of the blood in a space that can push on the nerves of the leg, causing it to be weak. Also can happen with other agents such as plavix or coumadin. WOuld expected this sooner after surgery, but a possibility.
3.Pressure on the spinal cord or a nerve root coming out from the spinal cord. Evaluate with MRI of the spine.  

Your father needs to see a neurologist, preferrably soon. He needs to be evaluated further as this may be related to the surgery and should be treated ASAP if the problem is reversible.  An EMG will be  very helpful in figuring out where  the problem is.  If the hospital won't help him, go to the  biggest hospital near you (university or major clinical center). Bring all MRIs done to the neurologist.  Call your primary care doc and discuss the urgency of the situation and whether or not this is appropriate for an ER visit, where he can be admitted for further workup. Otherwise, it may take a while before you can see a neurologist as an outpatient. GOod luck