SOB/dyspnea 7 months post-op CABG

[rehab nurse]

hello everyone~

as a disclamer, i know this is not supposed to be a place to ask for medical advice, and i hope that my post doesn't cross that line.

i had posted on here my experiences i had when my dad went through a five-graft CABG in march of this year. ever since his surgery, he has had a persistant cough and dyspnea on exertion, and overwhelming fatigue. of course, at first he was terribly anemic, and it was missed for about a month due to being shuffled amongst different doctors. (surgery, primary, cardiology, etc.) it was actually a phone call by me, to my dad's cardiologist (who i know personally from work) and asked him to please draw some bloodwork as no one else had, and i had thought he was anemic. his hgb was about 8.9 at that time. i know my dad had excessive blood loss both during and after surgery, and i think ended up needing about 10 bags of different blood products (ffp, prbcs, and whole blood).

so anyways, my question is to those who are smarter than me and work with these kind of patients (or perhaps those of you who had someone close to you go through this surgery). my dad has had persistent SOB and fatigue ever since his surgery. his hgb is now WNL and he has had CXR done. he has had three courses of abt for suspected pneumonia. no one can explain why this is happening. he went through cardiac rehab after surgery. he exercises daily. his latest visit to his primary doc, had a CXR and said there was "nothing". but the doc put him on abt again, as well as advair for two weeks. he still has a cough, and his breathing has not really improved. my dad said he still feels the same. my dad is nearly deaf, and he is of the type who does not ask questions about his care. of course, he made his appointment and didn't tell either me or my mom about it, so one of us could go and listen to what the doc said. anyway, he is supposed to get a CT scan done if the advair and abt doesn't help. who knows how long that will take, since my dad has an HMO that likes to put things off till last possible minute.

i am just wondering if some of you cardiac nurses or any nurse out there can help me with some of the common complications following this type of surgery...

thanks!

[zambezi, BSN, RN]

I hope that he starts feeling better soon. Did they start him on any new meds after the surgery?

[HappyNurse2005, RN]

I'm in cardiac surgery PCU-these are my types of pt's. I see CABG pt's left and right, lol.

cough and DOE could be many things, though this late after surgery, i doubt its directly related to surgery.

Now, the following would all be speculations, as I cannot say anything for sure,s ince I don't actually know the pt, etc.

could be any number of respiratory conditions-asthma, COPD, pneumonia, etc etc

could be cardiac-heart disease, CHF, etc.

I'd go back to cardiologist, personally.

[HappyNurse2005, RN]

am just wondering if some of you cardiac nurses or any nurse out there can help me with some of the common complications following this type of surgery...

With this being 7 months after his surgery, i don't know if i could be sure it was related to the surgery, it's so distant afterwards. but just a guess. if he has really been coughing and doe since surgery, he really should go back to cardiologist. CABG's usually help w/ doe.

[rehab nurse]

he has actually had these symptoms all along, all occuring after his surgery. it just seems to wax and wane in its severity is all. he's been back to his cardio twice, his PCP three times, and his surgeon once. no one knows or can explain it....they just keep giving him abt and repeating the xray. ??? and his PCP just gave him the advair two weeks ago to "try for a while". i don't know. it's just very odd to me. i understood it the first month or so post op esp, since he was so anemic and all. but now that that's resolved and the dyspnea remains and too the fatigue, i don't get it. he's diabetic, and his diet is really very good and sugars tightly controlled. takes his vitamins, exercises....i just wish i knew why he feels the way he does. he says if this were the case, that he'd feel this way for so long after surgery, he'd have rather took his chances and not have had the CABG. very hard to hear coming from your father, you know?

i just wish i could explain it to him. esp since his docs couldn't seem to care less. he said his last visit with his cardio their was an NP student in his room also. he said he'd never had a more thorough exam/questions that from her.

[HappyNurse2005, RN]

Go back to cardiologist. Go to another cardiologist. Don't let them pass him off.

[velardern]

sorry to hear your father is having problems. Was thinking, has he been cathed lately? I'm curious what his EF is and thinking along the lines of chf?? or maybe his ef is low and would benefit from a bi-ventricular icd? just a thought.

[papawjohn]

Hey Rehab Nurse

Don't sell yourself short. You've certainly got the question right!!! And asking the right question is necessary to getting the right answer.

So here's my two cents worth...has he been checked to see if he had a Pulmonary Embolism intra- or post-op? That's what I'd be thinking of if he was my Pt.

Alternative explanations are (in the cardiovascular line): Pneumonia, CHF, arrhythmia. So I endorse him getting the total satisfaction from his Cardiology guy. (Of course, you said you know that Doc--so presume you trust him.)

Going deeper--nutritional, endocrine issues?

Best of luck to you and your family

Papaw John

[NRSKarenRN, BSN, RN]

First thing i'd do is get a list of the meds your Dad's on and look up the side effects: several have COUGH as a side effect. I've seen by just changing meds, these symptoms improve. If meds don't ssem to be an issue, then an appointment with a Pulmonologist may be in order.

Routine followup CXR of my Dad post CABG showed RUL nodule: turns out to be asbestosis, not previously seen on any films. Now 2 years post CABG my Dad 'sSOB totally resolved and his bowling average is 180!