My F-I-L is s/p cabg 7 yrs ago, and s/p TKR a year ago. His md frequently changes his meds around, and it has been playing havoc with his BP. He has a BP machine, which is fairly accurate +/- 10 mm hg, and his BP is so labile.
He is now only taking 3 meds, Starlix (oral antidiabetic -not even sure he needs this, md hasn't even given him a glucometer), lopressor 25 bid, and benicar hct. I know he really needs his ace and the Beta blocker, but his BP seems to drop alramingly low after eating. After the doc d/c all but these 3 mds, it is now only happening after dinner. It seemed like low BS, but he has just eaten a decent meal.
I thought my M-I-Lwas exaggerating his behavior until I saw for myself this weekend. He had 1/2 glass wine, eggplant parm, bread, and penne at the restaurant. After eating, he slumped over in his chair. My husband jiggled him and he was arousable, but out of it. We got him some coffee, but after my husband woke him, his behavior was like a sloppy drunk. Trust me, I have seen this guy drunk, he is never like he was this night. He was angry with me, for not knowing why this keeps happening to him, and he yelled about how we know what is happening but aren't telling him. He had an positively eveil little look in his eyes squinting them at me and pointing his finger. Next he's telling my husband how lucky they are to have each found good women, and how he likes me. This is stuff I know he would never normally verbalize out loud.
So, I know after eating blood is diverted to the gut for digestion, but how can he not eat??How else can this be avoided?
Any thoughts on why this is happening besides the fact that his ejection fraction is probably in the toilet? That he probably has cardiomyopathy (past history of long-term etoh use) which was not helped by the cabg?
What about something like neosynephrine nose spray or something to perk him up after eating? We got coffee into him and he did improve. I am at a loss as to what suggest to the doc, and he has been pretty unconcerned about it as far as I can see, which usually means he has no idea what to do about it either.
So, I am turning to you folks for your input. Has anyone ever seen this happen??
Thanks for any ideas.