Recover post operation questions

[OhBeAFineGuyKissMe]

My mum (79) went into hospital for a heart valve repair which went wrong and she then needed full open heart surgery for a valve replacement. The replacement surgery was nearly 4 weeks ago and she had a week in intensive / high dependency care and then a further 2 weeks on a ward due to fluid accumulating around the lungs.

She is now staying at my house until she is ready to go back home. Which is where my questions come back in. She is still very confused - she can’t remember what day of the week it is, repeatedly asks the same question, asks if she has had her tablets, forgetting information, less understanding of technology that before (asking about watching a video when she is used to streaming). She can only stay awake for about 15minutes and even then is dozing off and she can’t maintain a conversation.

On top of this she is eating very, very little - a typical meal is 2 crackers and cheese. She has Ensure drinks (currently the plus while I wait for the online order of compact).

Exercise wise she can manage one loop of the patio and getting dressed and showered needed a 2hour nap.

I know that heart valve replacement is major surgery that has a long recovery time but I am concerned with the mental deterioration near 4 weeks after the operation. How much will she improve or do we start thinking about her needing support? At the moment I am struggling to see how she can live independently in a few weeks and staying with me longer term isn’t an option.

She's had major heart surgery, and as a comparison, I'd say DH took around 16 to 18 months to recover fully (he was in his 50s). The anaesthesia alone can be a huge hit for an elderly person to recover from.

I would start to consider that she may not be able to return to living alone, and perhaps a nursing home would be a better option if she's not able to stay with you. Even if you have to sell it to her as recuperation/respite.

Even if she does improve she needs support now. Put the support in place now before you burn out. If your Mum is likely to be resistant call it rehab and say it’s until she is better.

Does she have a specialist nurse who you can seek advice from?

Hi Op.
Sounds like delirium - elderly people are very susceptible when they go into hospital. Same thing happened to my mother. Most recover (my mum didn't).
Google 'elderly delirium' - a lot of online information about it. Another possibility is urinary tract infection (did she have a catheter at any point?).

Nope and I am not even aware of any follow up. She was in Hammersmith hospital as a specialist centre so not her local hospital and I live an hour away from her house so when she is staying with me it isn’t even her regular gp practise.

Everything has been made more complicated because of locations.

She had a catheter and did get an infection when in icu but she was treated with antibiotics and she was in hospital for a further 3 weeks being closely monitored.

Could well be delirium but it feels more vague and just generally muddled than when my grab had this.

Just because she had and was treated for a UTI in hospital doesn't mean she's not got another, it's very common. I assume if she's not eating much she's probably not drinking much either. Trip to the GP to rule it out is needed I think.

She is even more fuzzy headed / muddled this morning. So I’m thinking delirium is a possibility. I don’t think I need to call out of hours today but will call the GP and try to get her seen.

Is the falling asleep after 15minutes usual? That and she is always cold, even with this glorious weather at the moment.

@OhBeAFineGuyKissMe - when mum had delirium she slept constantly and felt cold. Definitely get a GP appointment.

Medication post heart surgery can make people feel cold. If she’s prescribed beta blockers they will do it as can other regulating medication.

My husband (80’s) had a valve repair via open heart surgery plus an artery bypass 10 months ago. A 6 hour procedure in his case. He remembers nothing about the first four days post op and I would say is still not quite as mentally sharp as he was pre surgery. We were warned a long general anaesthetic in older people can cause some ongoing mild loss of cognitive ability or at the more debilitating end of a continuum post operative delirium. There was no delirium fortunately and he’s nowhere near as muddled as your mother is, certainly not enough to impact day to day life.

There should be a post op check at the hospital after about 6 weeks, definitely talk to everyone she sees (probably nurses for tests then a surgeon) about it and stress the change. There could be a surgical or medical cause. In the meantime why not ask your GP for their views.

Food-wise appetite was slow to return. Advice given pre surgery was to forget healthy eating, to opt for high calorie/fat everything and eat when and what he felt like. After a month appetite was still very low. It’s back to normal now.

Finally. the British Heart Institute produce a wealth of helpful information. They also have a nurse staffed helpline which I found incredibly helpful and supportive when I was worried. You could talk to them about your fears and I am sure get informed advice.

Good luck. I hope all goes well and your mother regains her strength. .

We had an appointment with my GP and are now waiting to be seen in A&E. Oxygen levels were 90% and she looked grey. The gp could hear fluid around the lungs and is concerned that has built up a bit more.

Very long wait ahead I think.