Pump-Head Syndrome?

December 29, 2007 10:54 AM

Experience with Pump-Head Syndrome?

My uncle had triple bypass surgery about 2 years ago. He was on the pump for over six hours. In the year following his surgery, he lost both his mother and father-in-law. Also, he and my aunt retired and moved to a new home in a different state.

He has never been an emotional person - dry sense of humor, voluble and upbeat for the most part, but very guarded emotionally. Now, he cries alot and, to both mine and my aunt's dismay, he's become very morbid. He talks often about his own imminent death as if it's a foregone conclusion. Just this past week during our Christmas visit, he pulled me aside on two occasions and asked me, in grave tones, if I would accept the responsibility of being the "keeper of the family history after [he's] gone", and made me promise to be like a daughter to my aunt "during the twenty or so years she'll be around after [his] death."

His cardiologist has attributed this change in his temperament to "Pump-Head Syndrome". My uncle rejects this diagnosis out of hand; of course, this is part of the syndrome, according to the docs. Do any MeFites have experience with this? Did yours or someone you love's personality change this notably post bypass surgery? Has the change been permanent?

I would expect that many of the huge upheavals they've experienced over the past couple of years would stress anyone, particularly a heart patient. I'm curious what coping strategies you may have used - my aunt and uncle eschew talk therapy, plus my aunt believes the stress of that would be even worse for his health. Any advice or shared experiences are welcome. Thanks.

posted by TryTheTilapia to health & fitness (11 comments total)

My dad had his second heart attack in October. He didn't have bypass surgery this time, but his personality has changed considerably (for the better). He has been much more open with his emotions, and much more concerned with family.

I've never heard of "pump head syndrome." Perhaps being on the pump does something to the brain, but I think that this behavior is more likely due to the simple fact that he's had a near death experience. He's scared and lonely, and probably feels like the family will fall apart without him.

Talk therapy isn't for everyone, but hopefully he's open to making some lifestyle changes. Diet and exercise are always good, but since he's recently retired, he needs to find things to do that interest him and hopefully connect him with people. Hobbies? Volunteering? Retiring is a tough transition for anyone, especially if it's in conjunction with health problems.
posted by Orrorin at 11:15 AM on December 29, 2007

"Pump head", which occurs in 5-10% of patients after cardiac surgery, primarily consists of cognitive rather than emotional problems. It sounds to me like your uncle has depression, which is common after heart attacks or surgery. He needs an antidepressant; I would prescribe sertraline or citalopram.
posted by neuron at 11:30 AM on December 29, 2007

There have been several studies showing that heart surgery patients are very often clinically depressed after the surgery, that doctors often ignore this emotional component to the procedure, and that patients who get psychological treatment before and after the surgery tend to have better health outcomes, as well as not being so depressed.

In other words, depression -- sometimes severe depression -- is a common psychological reaction to heart surgery, and has medical consequences as well as emotional ones.

During recovery from cardiac surgery, depression can intensify pain, cause worsened fatigue and sluggishness, or cause a person to withdraw into social isolation. Patients who have had coronary artery bypass graft (CABG) surgery and have untreated depression after surgery also have an increased morbidity and mortality rate.... Without treatment, depression can become worse. For heart patients, depression can contribute to an increased risk of heart attack and coronary disease. Your health care provider can refer you to a mental health specialist who can provide the appropriate treatment when necessary.

It may be worth trying to get the doctor and your aunt and uncle to understand the health problems this situation may be causing. In dealing with older adults who balk at therapy, it can often help to frame the issue as a medical, rather than psychological, one. (Which it certainly is, in this case.)
posted by occhiblu at 11:35 AM on December 29, 2007 [1 favorite has favorites]

While not calling it 'pump head syndrome', Larry McMurtry, in his excellent autobiographical sketch, Walter Benjamin at the Dairy Queen, discusses the profound, and for him, unexpected emotional/mental effects of open heart surgery.
The bulk of his tale begins on p 140 in the hardback edition:

Perhaps one reason I have become increasingly fascinated by history is because I feel I have had two histories---or, put another way, because two individuals bearing my name have had sequential but largely separate histories.
I was one person up until the morning of December 2, 1991, at which date I had quadruple-bypass surgery at the Johns Hopkins hospital in Baltimore. When I woke up from the operation, after about twelve hours in deep anesthesia, I began -- although I didn't realize it immediately -- my life as a different person -- my life as someone else.

and from a review:

Larry McMurtry’s depression following heart surgery was not so devastating, but it lingered and lingered. The only sense he could make of why he felt so changed, even long after the surgery, was to believe "that I had died for a few hours, been brought back to life, and now was attempting to live as someone similar to, but not quite exactly identical with, my real self....Surgery contradicts the rules of survival, it is a Faustian bargain. You get to live, perhaps a long time, but not as yourself—never as yourself." It is surely true that "near death" experiences are particularly powerful, but we are all changing imperceptibly all the time, carrying our past with us, never exactly the same the next day. William Faulkner said it best: "The past isn’t dead...it isn’t even past."

Whatever one calls it, I don't doubt that it's real.
posted by dawson at 11:53 AM on December 29, 2007

I had bypass surgery in September and have found myself thinking very morbid thoughts. I am occasionally convinced of my imminent death, leading to some very unpleasant anxiety attacks. I am acutely nervous of every minor ache and pain, and am taking medication for depression. These changes are alarming to me. I am 46, and was on bypass for well over 6 hours and anesthetised for 36 hours.

However, I have just last week enrolled on a structured exercise programme specifically for cardiac patients, offered by my local health authority (in the UK). Even though the course doesn't actually start for a couple of weeks, I find my mood is improved by thinking that I'll have a monitored, measured programme at the end of which I'll have tangible proof, (I hope!), that I am improving physically.

I hope that your uncle can find a similar scheme. I think without the rehab course I would eventually become a recluse simply too scared to venture outdoors. This way, I hope that I'll be able to convince myself that I can regain and maintain some fitness. The mere act of committing to the scheme has made me more optimistic about my health and general mental wellbeing.

Apologies for the length, my best to your uncle, email in profile if you need any more info.
posted by punilux at 12:13 PM on December 29, 2007 [1 favorite has favorites]

I prefer to call the syndrome 'bypass brain'. I'd differ with the above posters in that I think the syndrome, which isn't very well defined, generally has cognitive and emotional components.

Post-bypass depression as a psychological process, independent (as far as we can tell) of bypass brain, isn't at all unusual; some patients experience the surgery and the recovery as events traumatic enough to produce a PTSD-like syndrome, with flashbacks, disrupted sleep, survivor's guilt, the whole shebang.

Add on the death of two parental figures within the year, retirement, and moving house to a new state, and you've pretty much hit the life-stress pentafecta. Any one of these things can be hard to adjust to; taken together they are a source of great psychic stress, requiring major adjustments.

Heart bypass is often a wakeup call for people. You think it's morbid that your uncle talks about his imminent death as a foregone conclusion. Well, you know what? It is a foregone conclusion, and if you're asking this question you need to understand that. Some people last 20 years after bypass surgery, but they're the exceptions, not the rule. Your uncle has probably looked into this. The time remaining to him is much less than the time he's already spent, and he's probably in the worst physical shape of his life to enjoy it. While this may be unpleasant for you to contemplate, it is something staring him in the face every morning when he looks in the mirror. If you want to understand how he's feeling you need to understand the truth of the matter.

The things your uncle is doing and saying to you reveal normal, healthy processes for people in his stage of life. It's not even clear to me, from what you've written here, that he's having trouble adjusting, though he may be. The idea about talk therapy being too "stressful" is silly; therapy is not threatening, it can help anyone adjust to their fears. And of course if your uncle is depressed there are medicines that can be prescribed by a doc to help with that. In my experience these medicines are vastly underutilized in the specific settings of recovery from cardiac surgery and from stroke.
posted by ikkyu2 at 12:16 PM on December 29, 2007 [1 favorite has favorites]

I would point out that depression in the elderly is often hugely undiagnosed because there's an assumption that older adults "should be" depressed, that it's normal to be depressed at the end of your life. It's not. Morbid thoughts such as the ones you describe are most common among people in their late middle ages, when they're facing the realization that they're not immortal (hence the stereotypical midlife crisis). By the time people hit their 60s, psychological health generally means that you've incorporated this knowledge into your daily life and it's not the horrifying life-paralyzing thought it may have been a few decades earlier.
posted by occhiblu at 12:26 PM on December 29, 2007

(And while it's certainly "normal" to be depressed after a major health scare (and, actually, after retiring), that doesn't mean it's ok or shouldn't be treated.)
posted by occhiblu at 12:28 PM on December 29, 2007

Thanks for all the thoughtful, caring, interesting responses.

We understand very well the stresses my uncle has been under - we have lived through them along with him. We also have dealt with our fair share of depression - bipolar disorder and depression run in our family. My uncle has never exhibited the same symptoms that his two brothers, his father, and most of the men in our family have experienced. Hence our level of concern at his uncharacteristic morbid talk now.

My aunt, in particular, is concerned because she has spent 45 years of her life with my uncle. She lived lived through it when, forty-five years ago, at age 21, he drove off the side of a mountain in a snow storm on his way to visit her while they were engaged to be married. He climbed up the side of the mountain - three and a half miles in waist deep snow - and walked to her house. He was laughing and joking about the accident and refused medical treatment; she insisted, her father drove him to the hospital, and there he was examined and found to have a lump in his testicle. He was transferred to a military hospital - his father was a marine corporal - and there he was diagnosed with testicular cancer. He subsequently received massive amounts of radiation therapy and a his testicle removed 9 months before their wedding. In fact, the radiation therapy he received was, according to his cardiologist team at Emory, six times the dosage that a patient would receive today and basically turned his chest cavity over the years into a solid calcium mass. He was - again, according to his cardiologist - within perhaps three weeks of a a major cardiac event when he presented at the emergency room with shortness of breath and lightheadeness. We are all grateful to still have him. Through all of this, he maintained his typical indefatigable, upbeat spirit - until now. And even now he is attempting to start a small beef farm, just put a fresh coat of paint on the barn he just finished building, and has plans to put in three vegetable gardens he had tilled the week before our visit. So, given what we know to be this man's life-affirming, joyful disposition, we are naturally concerned that he is talking so often about his own death. Which, yes, obviously will come. Having faced the very real possibility at 21, both he and my aunt are well aware of how fortunate they both are. As am I.

My aunt will indeed appreciate all of the thoughtful, sensitive advice and experience. dawson, I thank you in particular for the Larry McMurtry link and passages - he is one of my uncle's favorite authors and I'm sure that will be of particular interest to him. And punilux, thank you. I may indeed e-mail with further questions.
posted by TryTheTilapia at 1:58 PM on December 29, 2007

Compare to this account of a heart attack and the clinical depression that followed, on the ever-fascinating Wayne's This And That.
posted by eritain at 5:47 PM on December 29, 2007

I just accidentally found this posting. Thanks to all of you for participating. My husband is facing quintuple bypass in two days (Monday, May 6). He had a heart attack 11 years ago. At that time they wanted to do a bypass. Thankfully I convinced him to do a 6 month course of intravenous chelation instead. He has been symptom free for all this time. And now they find anywhere from 55%- 90% blockage. STRESS has been a huge factor in his/my life during the last 5 years. And he, in particular, is less able to breathe through big & little problems. (He doesn't have any of the other precipitating factors: he is not overweight, has never smoked or drank, there's no diabetes, no heart problems in his family, and he follows a gluten-free, low yeast/low carb eating pattern (mostly vegetarian). No matter, here he is with a need for this massive bypass. It's his decision and I respect that. (I would opt for chelation, but I'm not him)
These postings offer a heads up (or maybe it's an affirmation) for what might happen AFTER surgery-- provided he lives through this dreadful surgery. (I am upbeat around him --and he does have a wonderful, caring team of doctors waiting to do this-- but it is still a treacherous procedure) He is a wonderful man, good father to my two sons, I would so appreciate having more time with him--- to say the least.
I've been a Hospice volunteer for nearly 1 1/2 years. Rather than depressing I find it to be a life-affirming gift. Since I was in the 2nd grade & would see our farm animals die (sometimes at the hands of my father/brothers, as they prepared them for our table to eat) since then I knew I wanted to do some kind of work around the end of life--but I wasn't completely aware of how this would be accomplished. For me Hospice is the answer.
In the 3 short days my husband has been in the hospital, I see a deepening within him. Even his voice is different. And he looks radiant & calm (and no he isn't on any painkillers or any kind of sleep aid) As with my Hospice patients, he is talking more about what is important in life,,and he really wasn't that reluctant to talk before; he simply had too many projects/time constraints. Perhaps your uncle is wanting to have a deeper conversation with you and perhaps,---but definitely I don't know,--perhaps he doesn't feel comfortable revealing more to you because he senses you are uncomfortable. And then again, perhaps he is depressed.
But death is not going to go away, for any of us. We know that. But most of us have tried to run away from this innate knowledge.

Through my Hospice patients I've been learning how to open my heart more, learning how to accept the differences in people --whether I agree with them or not--learning how to live in the present moment, and how to be prepared for my own death--from the mundane of having a will & advanced directives in place to being okay with watching my breath, observing my emotions. There are so many births & deaths within each of us all the time, don't you think? The rising & falling of breath is one such birth and death. Maybe your uncle wants to have a larger conversation with you--or with someone-- and he's exploring if that will be possible.
Good luck with him, and your aunt. & thanks for 'listening'
posted by Prajna at 5:22 PM on May 3, 2008