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The day I turned 60 the warranty on my body ran out. I’d planned a summer trip to visit my brothers in Washington State and then climb Mount Rainier while I was out there. I had climbed several 14ers in Colorado the year before, so I knew I was good at altitude,   but I decided to have a treadmill stress test done to verify my fitness. One day later I was under the knife undergoing triple bypass.

Twenty-seven years ago my better half underwent surgery for breast cancer. Her surgeon told her that one of the benefits of being a thoracic surgeon was that chest surgery patients typicaly experienced less post-operative pain. Such was indeed the case with me, to the extent that when people ask me what it was like, I enjoy telling them that it was actually kind of fun. And I am being serious. I had surgery on a Wednesday, woke up for real on Friday ( they  tell me I spoke to visitors on Thursday but I remember nothing of it), was babied by pretty nurses, including one named, I kid you not, Krystal, and went home Sunday. No codeine or narcotics needed, just an occasional acetaminophen.

The part they don’t warn you about is personality change. In about 43% of open heart surgery patients, for reasons related to the heart-lung machine but not altogether clear, some brain damage occurs, the most common symptoms of which being irritability similar to that displayed by stroke patients. Some patients exhibit less, some exhibit more. My family tells me my irritability was immediately noticeable. I was not aware of my shortness with them, but I was aware of sudden bursts of road rage when driving, screaming at other drivers and resisting the urge to swerve into them.

My cardiologist told me at this point about pump head syndrome, and prescribed a drug that was optimal for this condition, which he indicated performed much in the same way as post traumatic stress disorder. In early 2012, with much success in losing weight, lowering my cholesterol, and lowering my blood pressure on a healthy vegan diet, we cut back on most of my meds successfully. Except for the escitalopram. After tapering off over a period of four weeks, I experienced a bout of extreme depression, suicidal thoughts, and more rage. I knew in my gut that my life had been filled with blessings, and that therefore this was “just chemicals”, but it was frightening nonetheless to be the guy on the news: “...authorities said the suspect was reported to have been off of his medications for several weeks before (pause for gravitas) the tragedy at the mall.

So who am I now? When I hit bottom my wife said “you used to be kind and gentle.” I am again now, but only because of a little pill I’ll probably have to take for the rest of my life. I recently have had conversations with a gulf war vet with ptsd. She went through far more trauma than I, but her symptoms are the same. The night terrors. The looking in the mirror and sometimes seeing someone you know, and sometimes not. The rages are gone, but my grasp of reality feels more tenuous now. Or maybe I’m just getting old.

If a cardiac nurse named Krystal is reading this, I do remember you fondly.

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Comment Preferences

  •  Can you describe the drug, who has (4+ / 0-)

    prescribed that one and what exactly the drug does? What is the drug changing in your brain chemistry and how do people know what is imbalanced to begin with due to the surgery you went through?

    •  Celexa/Lexapro SSRI - antidepressant (5+ / 0-)

      Determining causality of changes in brain chemistry would involve very expensive before and after tests using methods such as FNMRI.

      look for my eSci diary series Thursday evening.

      by FishOutofWater on Sat Nov 17, 2012 at 05:21:57 AM PST

      [ Parent ]

      •  Under which conditions would the VA (1+ / 0-)
        Recommended by:

        pay for a FNMRI ?

        My niece gets these tests for her brain cancer check-ups paid by her health insurance.

        So far I find it difficult to understand how the VA refers a Veteran to a specialist to do such tests or even a disability testing to get started. Especially if the Vet is offended to be categorized as "disabled" or having a problem like "PTSD". I realize the symptoms but still can sympathize with my son's objections to get "drugged" and "categorized".

        Something is pretty hard to understand here.

    •  Lexapro is a selective serotonin reuptake inhibi- (2+ / 0-)
      Recommended by:
      yoduuuh do or do not, splashy

      -for.  It blocks the reuptake of serotonin from the space between neurons -- the synapse -- by the presynaptic neuron, thus increasing the concentration of serotonin in the synapse & thus presumably in the serotonin receptors in the post-synaptic neuron.  Low serotonin levels are associated with depression, sleep disturbance, irritability, and even suicidal and violent behavior.  Its biochemical precursor is tryptophan, the chemical in turkey meat that produces sleepiness in a lot of people if they eat enough of it.

      SSRI's are prescribed not only for depression & PTSD but for anxiety disorders & for post-concussive syndrome and stroke,  the symptoms of which usually include irritability.  The post-surgery syndrome described in the OP obviously has some things in common with concussions & strokes -- it's a form of acute brain injury.

      The cognitive side-effects of Lexapro described in the OP are not usual but not uncommon.  Sometimes they can be eliminated by switching to a different SSRI, assuming the therapeutic effects can be maintained.  Although each SSRI has a general profile of therapeutic & side effects, individuals' responses to each SSRI are often very idiosyncratic.  Lexapro is usually the default initial prescription because it's general profile has the lowest rates of the most bothersome side-effects; but that doesn't mean it's the optimal SSRI for everyone.  

      •  If your symptoms are not severe, some people have (0+ / 0-)

        found relief from moderate to mild anxiety and sleep disruption using a supplement called GABA.

        If you have severe symptoms frequently, I am unsure how much this will help, but for someone who has only occasional episodes or issues staying asleep, this can be an alternative.

        I would also highly recommend journaling, ESP when you have episodes of irratibility.

        How do you feel physically and emotionally?

        Some people who have had some form of TBI + PTSD report feeling physical pain inside the brain when they have strong emotional responses.

        Also this will help you gain some perspective, and identify the situations or stimuli in your life that are triggering some of your episodes.

        Meds and Supplements might help with symptoms, however, it is very important that you begin, as soon as you are able, to take steps to empower yourself.

        Being Irritable is a normal response. And sometimes the feelings of abnormality and fear of stigmatization exacerbate bouts of irritability. Once you learn to accept what is going on, you can take active steps to mitigate your responses, and therefor your condition.

        PTSD is a frustrating mix of emotional and physical responses, that don't necessarily make sense to people outside of your own skin, and not even to you at first. Taking steps to get a handle on what is going on inside of you is a tremendously big deal.

        •  I failed to get to my own point (0+ / 0-)
          Being Irritable is a normal response. And sometimes the feelings of abnormality and fear of stigmatization exacerbate bouts of irritability. Once you learn to accept what is going on, you can take active steps to mitigate your responses, and therefor your condition.
          You have to identify your new normal. The good news is, that this may not be a new permanent normal. That you may find treatment options that help mitigate many of your symptoms.

          But identifying what your new normal response is, emotionally and physically, to everyday stimuli helps to lower anxiety levels significantly, so that when you have an episode, it's to an association inside your brain and body, and not in addition to feelings to helplessness and bewilderment, because you don't understand what set you off to begin with.

          If you know that some encounter whether it be with a movie, a place, a smell or a sound is going to set you off, piss you off, scare you, cause low level anxiety, then you can take steps to avoid that encounter, or at least know what to expect when you have it.

          It makes all the difference in the world.

          I will give you an example: I cannot have alarm clocks going off to wake me up. Instant Adrenaline Rush, and instant--Piss Off.

          I got my spouse a clock that starts at a barely audible tone that gently increases in volume, and hey, no one has to be stuffed in the closet.

          Things that startle me out of sleep are triggers. They aren't the worst ones, but they lead to irritability and consistent low levels of anxiety.

          So I solved that problem.

          Some are not so easy to solve. But being able to remove some of these triggers helps make room for me to cope with bigger ones.

        •  current state (1+ / 0-)
          Recommended by:

          Physically I am fitter than I have been in years. Daily exercise, weights, walking, treadmill. Mentally it's a paradox. Fulfilled, grateful, but more stressed ( in the sense of being apprehensive about another bout) than I want to be. That's what I want to work on. I'll start with more deep breathing exercises. Don't smoke (duh) or drink (sigh), I'm 99.9% vegan. I do need to eliminate caffeine. I know that. I keep telling myself that. But then the only addiction left to me will be verbosity on dailykos.

          •  Maybe the verbosity on the Kos is really a good (0+ / 0-)


            With that kind of stress, it helps to work on changing your perspective where you can, with a more positive outlook. I don't mean going into denial about real issues or problems, just being mindful of negative emotional habits, that until this health problem, might have gone unnoticed or perhaps were of no real consequence.

            Right now though, it sounds as if you are very raw right now and more sensitive than usual and that this is putting a strain on you, in addition to normal stressors.

            It sounds like you are really going in a great direction with the other new habits you have built. You should pat yourself on the back. Not everyone is able to do that, even with the threat of ill health hanging over their head.

            You know you could also start with letting your immediate family knowing how you feel, when you feel it. It's a lot easier to avoid annoying a person who is pissed off, or irritable, if they know that you are already having a bad day or feeling poorly.  

            This accomplishes several things. It trains you to be more mindful about your own inner mental state, and it keeps the line of communication and trust open with your closest loved ones, like your wife. It is a positive sign that you are trying to get better, and to be better.

            •  Thanks (0+ / 0-)

              Just send me your bill. You've got to be a family therapist in the real world. Amen to everything you've just stated. I'm thinking of a follow up diary to this one on r.d. laing, in particular his work knots. You are a very compassionate person, and I'm now going to figure out what to click or where so I can follow you. One therapist I had years ago, whom I asked if I was the oldest client she'd ever had, laughed at me and said it's never too late to work on family issues. I'm not so sure, seeing as I'm turning 64 in January.

              A good teacher shows you HOW to look, not what you will find.

              by bisleybum on Mon Nov 19, 2012 at 07:52:03 AM PST

              [ Parent ]

              •  Not even close, just a person who has lived (0+ / 0-)

                with this for a very very long time. Anything I put down that helps, great. If it seems not to apply to you, ignore it. This is the interwebz after all. :)

              •  BTW, did I mention my spouse is a saint? (0+ / 0-)

                There are days, when I know for a fact, he wants to say to someone out there that occasionally sets me off--"Thanks, you know I have to go home with her, nice work."

                I learned most of my stuff the hard way, unfortunately, he also learned a lot of my lessons the hard way.

  •  Also can you be more descriptive ... (1+ / 0-)
    Recommended by:

    ... what you mean by: "but my grasp of reality feels more tenuous now?"

  •  things besides combat and natural disasters (3+ / 0-)

    can trigger PTSD.  

    how long ago was your heart surgery?  did they give you versed in the prep?  that's what can cause short-term memory loss the first few hours after you wake.  

    there is always hope.  

    Ted Kennedy: “The work goes on, the cause endures, the hope still lives, and the dream shall never die…”

    by jlms qkw on Sat Nov 17, 2012 at 05:17:51 AM PST

  •  I don't know how long it has been for you. (9+ / 0-)

    And yes the night terrors and flashbacks never go away. But the irritability and other more alarming psych symptoms do start to become less noticeable after five years or so.

    I probably would have continued to improve without meds if my back going out did not throw me on the mercy's of the bootstraps economic system.

    "Til you're so fucking crazy you can't follow their rules" John Lennon - Working Class Hero

    by Horace Boothroyd III on Sat Nov 17, 2012 at 05:22:41 AM PST

  •  Thanks for this! (9+ / 0-)

    It's extraordinarily timely in that I'm going out in less than two hours to attend a two day Equine Assisted Therapy seminar for combat vets. More than forty five years after coming home!
    Of course back then there was no "PTSD", it wasn't in the DSM anyway, and we just sort of grimaced and bore it. And made our own and all around us lives living hell with just the "irritability" and other symptoms you describe. A trail of self medicating (there certainly were no medications for a condition that wasn't officially recognized, but apparently useful substitutes are always available on every streetcorner), substance abuse, broken marriages, incarceration, and even mental hospitals is a common one.
    Today, having found a viable modus vivendi through a program called Mindfulness Based Stress Reduction (MBSR), "kind and gentle" is back on the table.
    Thanks for portraying PTSD in such vivid yet understandable terms.

    “Meditation is the only intentional, systematic human activity which at bottom is about not trying to improve yourself or get anywhere else, but simply to realize where you already are.” Jon Kabat-Zinn

    by DaNang65 on Sat Nov 17, 2012 at 06:09:30 AM PST

  •  Consider this temporary. (4+ / 0-)

    My surgery was three and a half years ago ( June 2nd, 2009, 10:15 am, but who's counting?)  I have seen one, and so far only one site, saying that the symptoms may go away after five or six years.  My cardiologist prescribed the Lexapro, and said it had been proven to be effective in ptsd patients. Note this is a "fix" for a specific symptom, i.e. rage, and not an overall cure for ptsd by any means. My reference to a tenuous grip on reality is a little hard to explain. In an Oliver Sacks patient sense, I feel that maybe the person I was, the personality type (laid back, kind to animals,  advocate for tenderness) was perhaps a chemical fiction that I was born with, and now other chemicals, or the lack of them, can cause my life and personality to turn on a dime. It's one thing to be a fan of non-dualist philosophy, but to look in the mirror each day and wonder "Who's that?" ,  well, I have a reality check list to get me through the day. Garbage out, check. Brush teeth, check. Eat well, check. I've always been a rise and shine, bright eyed and bushytailed optimist, and I'd like to stay that way, thank you. But my vet friend gave me a helpline number to keep in my wallet, since we've no health insurance now thanks to the heart surgery (whole other story, not this time) and I couldn't afford the vet's shrink. I'm glad I have her to talk to.

    •  Some things to consider, if you wish. (4+ / 0-)

      It may be you need a different dose or a different SSRI. The thing is, a cardiologist is unlikely to be well-trained to manage that. Ideally, one would see a psychiatrist who has a much greater fund of knowledge about medications and their side-effects.

      As someone who worked at a medical school for 20 years and as a long-term SSRI-user, I'd suggest you at least tell the cardiologist your symptoms. It might be as simple as adjusting the dose, as everyone's body is different, and that includes the brain. Or the cardiologist might refer you to someone. Many psychiatric nurses are well-versed in medications and much less costly than physicians.

      If the cardiologist doesn't know about your symptoms, though, she can't do anything to help.

      I'm sorry you're suffering and wish you all the best.

      "Let each unique song be sung and the spell of differentiation be broken" - Winter Rabbit

      by cotterperson on Sat Nov 17, 2012 at 08:37:58 AM PST

      [ Parent ]

      •  the doc knows (2+ / 0-)
        Recommended by:
        cotterperson, GreenMother

        he agreed I needed to go back on after I told him about my symptoms. Another drug might be one answer. With Lexapro there are only two: a start up dose of 5 mg, and a full 10 mg dose. My anesthesia was the Michael Jackson drug of choice Propofol, but the microemboli caused by the heart-lung machine is well known to cause problems. Obviously I am not well versed in neurophysiology, but another cardiac nurse in rehab said her husband was never the same after his open heart surgery. Nonetheless I have a beautiful granddaughter, a forty-four year marriage, and other blessings too numerous to count, but count them I do. I'm also not a psychiatrist ( in point of fact I am a retired bookseller!) so any buried supplemental causes will have to remain speculative. Those who suspect DEEPER problems could well be right. I just know this all started after surgery.

  •  After my husband's head injury (3+ / 0-)
    Recommended by:
    burana, TheLawnRanger, GreenMother

    I had to decide if I wanted to be married to the man I was now married to, who was not the man I married a year and a half before.

    When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

    by Alexandra Lynch on Sat Nov 17, 2012 at 08:31:20 AM PST

    •  That happened to a relative, after a vehicular (1+ / 0-)
      Recommended by:
      Alexandra Lynch

      accident. Her husband was permanently changed. She stayed with him, but in that case, I am not sure that was the right choice for her.

      But he had profound TBI which caused permanent brain damage, amnesia, and personality changes.

      I hope whatever you choose to do, works out well for you and him.

  •  Learning to meditate helps. (2+ / 0-)

    It could very well be, that it's not an organic thing that happens due to the pump, it could be that even though you were under anesthesia, that this major surgery still hurt your body and hurt your mind and soul.

    People get PTSD from Medical events too. Those events can be very painful, and scary and stressful, and during that time, you are powerless and being hurt [even if it's for your own good].

    Powerlessness, fear, stress and pain are the common ingredients for future PTSD. If you did suffer brain damage, that would just be one more thing to add to the list.

    It changes your brain chemistry and over time it can lower your ability to cope with certain kinds of stress.

    If you suspect that you have PTSD, what is immediately helpful is to identify your triggers. Triggers are things that set you off to have an episode which can cause feelings of helplessness, fear or anger that is disproportional to your surroundings at the time.

    These are only suggestions of possible triggers given your description in your story: Doctors, Nurses, anything that smells or sounds like a hospital or institutional building. If you ever go in for surgery again, you might request that you be given an amnesiac if that is possible. So that it doesn't exacerbate this condition.

    Once you ID those triggers, you can avoid them for a time, while you think about how to mitigate your response, if that is possible.

    Another thing to consider is your anniversary, and obviously, the day you went under the knife will be one, but there could be others, like the day you got your diagnosis for this condition that needed surgery. Your anniversary won't necessarily be just one day long. Sometimes there is an emotional build up a month or couple of weeks before the actual day.

    Learning to meditate helps you learn to control your emotional response. That doesn't mean that you will never have an outburst or an episode, but it can, over time give you the tools you need to grasp control in your own mind, during those times,when something triggered you into an episode. This can help reduce your reactivity to symptoms, and help restore some emotional balance.

    The big thing is to be patient with yourself. I am sorry that this happened to you, but I am glad you made it.

  •  I had open heart surgery three years ago. (2+ / 0-)
    Recommended by:
    TheLawnRanger, GreenMother

    Eight hours of surgery, almost three hours on the heart-lung bypass. I think I'm as sweet and nice to be with as ever (but that's my opinion), and I'm happy and happy to be alive. But memory and cognition are not what they were. Linear thought has become more difficult. I'm still able to function at a high level at work (actually, I function a little better now -- I'm a teacher, and I have lost some of the inhibitions I used to experience in the classroom), but organizing my life is tough! I lose things, like my bills. And then drive myself nuts trying to find them. And I repeat myself over and over. I think (maybe I'm deluding myself) that I'm too young to be doing that! I'm on Wellbutrin, so maybe that contributes to my even tempered good mood. I was also diagnosed with milk PTSD about ten years ago which stemmed from a lousy marriage. Out of the marriage now, and much better off!

    "Life and death, dispensed on a dollar basis. How ridiculous and fatally stupid, in what is still the richest country on earth?" Exmearden

    by burana on Sat Nov 17, 2012 at 11:46:42 AM PST

  •  group hug (0+ / 0-)

    or virtual version of it. Before this thread gets swallowed by the past, I want to thank each and every one of you for your thoughts and support. It has helped me more than you can know. To mimi especially for repeating your question about my "more tenuous grasp", it shows me how hard indeed it is to describe this. It's not like Hunter Thompson's lizard people in a bar, but more like one of Oliver Sack's case studies ( i.e. The Man Who Mistook His Wife For A Hat ) where a neurological impairment just provides a new, unique and disorienting perspective on everything.  I wish I could make it more clear, and I am sorry I can't. I will still maintain that I am more fulfilled in life right now than ever. Being a grandparent will do that to you. I just have to caution friends and family on occasion that I might not be nice to be around. I am going to investigate all of your suggestions, starting with more intensive breathing exercises. My normal walking meditation and qigong isn't cutting it.

    •  Consider that hug returned (0+ / 0-)

      Bless you Mimi for that too:

      To mimi especially for repeating your question about my "more tenuous grasp", it shows me how hard indeed it is to describe this. It's not like Hunter Thompson's lizard people in a bar, but more like one of Oliver Sack's case studies ( i.e. The Man Who Mistook His Wife For A Hat ) where a neurological impairment just provides a new, unique and disorienting perspective on everything.
      Sometimes that is a difficult distinction to make.

      I would be willing to bet your meditative practices have been helping you more than you know, you just need some extra help to get through this rough time.

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