Cardiac surgery and CPAP

[sthnreb]

You've had lots of heart problems compared to mine. The ejection fraction is the amount of blood the heart ejects as it pumps. The average normal healthy heart ejects (or pumps out) approximately 55-65% of the blood entering it. So some blood remains in it. So as in my case, my ejection fraction was down to 25% due to congestive heart failure. That was why the defibrillator for me. When they did a catheter on me they found no blockage so I needed no stents. My doctor said blockage they could fix but not heart failure or a weak heart. Therefore he recommended the defibrillator. It took me about 2 months to decide to go ahead with it. I'm still taking a handful of medications a day as I am sure you are too. And yes, I take the metformin for type II diabeties. I'm going to an Endocrinologist next month to find out more about it. I don't care for my current doctor, they like pills to much. You are correct on the low firing. My doc says it may fire sometimes and you never feel or know it. That's why I'm curious to see the report. They have a Latitude patient site but it doesn't tell you that info, just the battery life from the last intergation. Sounds like you didn't perhaps take care of yourself when you should have. I don't think its a case of how tough one is and pain tolerance. It's being smart enough to know when to seek medical help and when not to.

[Ruby Vee]

I am going to have cardiac surgery as early as April or as late as 2-3 years--depending on the progression of my valve.

I'm trying to get my "ducks in a row" and was wondering what I need to do about my SA when they put me under. All my docs at Duke know about my SA and I will have a special gas passer and other docs since it is a congenital defect they are going to fix.

What special concerns should I have regarding my SA and CPAP while in surgery and afterwards in the hospital? I know this is probably jumping the gun but we say April now but something could happen between now and April that would change the schedule.

TIA for you help.

I don't work at Duke, but I do work in a surgical intensive care unit, taking care of patients who have just had cardiac surgery. First, I congratulate you for being CPAP compliant. It has been my (admittedly anedoctal) experience that those patients who admit they have OSA, use the CPAP, have informed all their doctors that they use CPAP and bring the machine to the hospital usually do well. They transfer out of our unit within a day or two and go home as projected by their surgeon in a timely fashion. On the other hand, those patients who deny having sleep apnea, even when it's documented right there in their chart for all the world to see, claim they don't need the machine or don't use it for any one of a number of wimpy "reasons" or "forget" to bring the machine to the hospital don't do well. Some of them have stayed in the ICU for months on end getting steadily worse . . .

Please bring your CPAP to the hospital with you. You won't need it during the surgery itself, but you will need it during the post operative recovery period. You sleep with it every night, don't you? Bring it to the place where you'll be recuperating for about a week: the hospital. And please make sure you have ALL the necessary pieces. (Wish I had a dollar for every OSA patient who came through my ICU with parts missing from their CPAP.)

Have your wife, SO, child, parent or best friend keep your CPAP with them while you are in the OR. When you go to the ICU after surgery, you'll need the CPAP as soon as they take the breathing tube out. If you leave the CPAP in your room, it might get lost. Hospitals do their best not to lose patient belongings, but it happens. Don't take the chance with your lifeline.

Put your name on every separate piece and on the bag itself. You don't want any overzealous cleaner (and that includes RNs who unlike me, don't use CPAP and don't know much about it) thinking your mask is the hospital's disposable mask and disposing of it.

If it's possible before your surgery, have the biomedical or engineering department at the hospital check out your PAP for electrical safety and put the appropriate tag on it BEFORE you get to ICU. When you're admitted would be a good time. You'll be awake enough to insist upon it. If the surgery is emergent, that won't happen. In that case, have your loved ones bring the PAP to the hospital and have it checked.

Some surgeons and anesthesiologists will tell patients that they don't need their PAP at the hospital. They don't mean to give you bad information, they just don't get it. They think that since we have ventilators, we can take care of all your breathing needs. And that just isn't true. We have ventilators. While it's true that you will be on a ventilator for the surgery and the immediate post-op period, you will need your CPAP once the breathing tube is out. Hospitals don't have enough CPAP machines to take care of every OSA patient that rolls through the doors. And knowing what they DO have, I'd want MY machine with me. I know it's comfortable and I know it works for me. The hospital machine may have a different algorithm (assuming they either have enough to go around or you're special enough to get one) that may make it very uncomfortable for you to breath, much less to sleep.

Have your loved one instruct your nurse in how to use YOUR CPAP. Tell them about not moving the machine with water in the humidifier. Instruct them that your headgear is all fitted to YOUR head, and it's going to look loose but it will fit fine once you turn on the PAP. Don't let them tighten your head gear. If you use REMZzzz as I do, tell the nurse how to use it. Cardiac nurses, unless we're on CPAP ourselves, are not experts either in sleep apnea or in CPAP. THIS Cardiac nurse got all of her sleep apnea and CPAP expertise from this forum, which is not required reading for nursing school graduation.

And while I'm on my soapbox, please make sure you have your paperwork in order. Now is the time, while you're contemplating having surgery, to get your Health Care Advance Directive (living will if you choose) and have it filled out, signed, witnessed -- whatever it takes to make it legal in your state. If you want everything done to keep you alive no matter what, let your Advance Directive say so. If you don't want to be kept alive on machines if there is no hope of recovery, let it say that. But please take the time to complete the paperwork and make sure each of your doctors has a copy and bring one with you to the hospital. Also, make sure you know who you want to make decisions for you regarding your health care if you're unable, and fill out the appropriate Health Care Power of Attorney paperwork appointing that person or persons. Then give that person or those persons a copy of the POA and bring another copy with you to the hospital.

Things go well most of the time and you'll never need the paperwork. But sometimes, things don't go well and you will need it. It's just stupid not to have it in place in case it's needed, and the fact that you're planning ahead for your admission means you aren't a stupid person. Good luck with your surgery and your recovery!

[sthnreb]

That's an excellent response Ruby Vee. One addition, the hospital I was in does rent the machines to people who need them. I was told to be sure and let them know it was my machine so I wouldn't be charged extra for it.

[Goofproof]

You've had lots of heart problems compared to mine. The ejection fraction is the amount of blood the heart ejects as it pumps. The average normal healthy heart ejects (or pumps out) approximately 55-65% of the blood entering it. So some blood remains in it. So as in my case, my ejection fraction was down to 25% due to congestive heart failure. That was why the defibrillator for me. When they did a catheter on me they found no blockage so I needed no stents. My doctor said blockage they could fix but not heart failure or a weak heart. Therefore he recommended the defibrillator. It took me about 2 months to decide to go ahead with it. I'm still taking a handful of medications a day as I am sure you are too. And yes, I take the metformin for type II diabetes. I'm going to an Endocrinologist next month to find out more about it. I don't care for my current doctor, they like pills to much. You are correct on the low firing. My doc says it may fire sometimes and you never feel or know it. That's why I'm curious to see the report. They have a Latitude patient site but it doesn't tell you that info, just the battery life from the last intergation. Sounds like you didn't perhaps take care of yourself when you should have. I don't think its a case of how tough one is and pain tolerance. It's being smart enough to know when to seek medical help and when not to.

You are correct about me not taking care of myself when I should, i had other more pressing concerns, 5 kids to raise and a wife being treated for depression (Very Bad)! To keep the Wolf from the door required more than one could get hold of, I had to take a job that was very demanding and consumed all. It kept us afloat, and it's allowed me to get past these medical hurtles, without feeling the monetary loss. Without that Ins the battle would have been lost again. In Life we have to chose, sometimes a choice can help, but then down the road we see the true price we have to pay.

I take two handfuls of meds daily, but I'm into high doses of Vitamins. I was on metformin for type II diabetes for years it didn't control the problem well after 10 years of out of control, I started using Insulin, I now use two kinks mixed at 200 units a day. I Can't do hardly anything that requires effort, so my ability to burn fuel is very low. When I was working I would work off 4500 cal a day easily, like I said it was a consuming job.

Now we take our health seriously, after the fact. It was while getting preped for the Quad, they found the probable Sleep Apnea problem, It to 20 minutes to tube me for the OP, When I came out of recovery I had problems matainingO2 levels even while at rest awake, so I was put on O2. A little later I took the Sleep test and had a 150 AHI,. I got my equiptment and made up my mind I was going to use it, and have been compliant from day one. @ 15 CM

"Failure is not a Option" I wish Tvmangum good luck with the surgery, and sorry for transgressing on your thread. Ruby Vee, has done a fine job explaining what is needed and how to do it, Thank You. Jim