Question about post carotid endarectomy

[kk2000]

Would love any thoughts from some seasoned nurses. I have a home health patient who had an endarectomy about 12 days ago. VSS, incision looks great, he feels strong and is really having no ill effects except he gets very fatigued when eating, as well as feels as if the food is "gagging" him at times. He doesn't actually vomit, just says the chewing exhausts him and then these intermittant gagging episodes. Is this a 'normal" thing given the type and location of the surgery? He is still a bit swollen aroound his neck area, I would assume internally is similar due to the trauma to the area?

He is very anxious about it, the nausea only happens when he is eating and he is usually able to finish a meal. i would like to be able to reassure him, as he is experiencing alot of anxiety over this, especially the fact that chewing him fatiigues him.

Many thanks in advance.

[Dinith88]

Would love any thoughts from some seasoned nurses. I have a home health patient who had an endarectomy about 12 days ago. VSS, incision looks great, he feels strong and is really having no ill effects except he gets very fatigued when eating, as well as feels as if the food is "gagging" him at times. He doesn't actually vomit, just says the chewing exhausts him and then these intermittant gagging episodes. Is this a 'normal" thing given the type and location of the surgery? He is still a bit swollen aroound his neck area, I would assume internally is similar due to the trauma to the area?

He is very anxious about it, the nausea only happens when he is eating and he is usually able to finish a meal. i would like to be able to reassure him, as he is experiencing alot of anxiety over this, especially the fact that chewing him fatiigues him.

Many thanks in advance.

The symptoms you describe are most likely NOT related to the surgery. Did he had a cva prior to the surgery? I would be mostly concerned that he may have swallowing difficulties (r/t prior cva?) and is at a high risk of aspiration. Speech therapist (cookie swallow?) would be very helpful in ruling this out.

If he's gagging from nausea rather than choking/coughing on his food than you'll need to explore other avenues.

[PICC ACE]

Is this a "normal" thing,no. Can it happen,yes. There are a couple of potential issues with swallowing after a CEA. First is the general swelling in the region that you noted externally--internally the swelling can impinge on oropharyngeal tissues. This far out from surgery the inflammation should be resolving. The other problem with this area is that the cranial nerves that innervate the area can be damaged during surgery or at least impinged upon by swelling. CN's IX,X,XII and to a lesser extent XI pass through this region and innervate many of the tissues involved in swallowing. Quick fix for the patient--small,frequent meals with easy to chew foods. Recommendations to the MD--Speech/Swallow eval.