81 yr old dad w/low appetite, low bp, and fatigue after surgery & shunt. Advice?

[sashazur]

Dad had his AN removed about 5 weeks ago, had a VP shunt and an IVF put in about 4 weeks after that due to symptoms caused by hydrocephalus and lung embolisms.

He's still in the hospital, but has improved to the point where he's in acute rehab, is mentally 100%, is able to sit and stand on his own, and get out of bed and to/from the WC with a walker. However, he's got the following frustrating symptoms which mostly started a week or so after his surgery and the shunt:

- Dangerously low BP when standing. They are giving him midodrine to control this, and it's mostly working (but not perfectly - sometimes his BP is still too low when sitting/standing). His doctor thinks this will eventually get better on its own, based on the theory that before the surgery, the AN was pressing on his brain stem and was pushing his BP too high, and the sudden absence of the AN is causing his BP to fall too low.

- Lack of appetite and thirst; although he usually polishes off breakfast and finishes a beverage, for lunch and dinner he mostly only has a few bites and few sips of whatever he's given. He says he's just not interested/not hungry. He's lost 20+ pounds since the surgery; his doctors say he isn't dehydrated but obviously we don't want this to continue.

- Extreme fatigue; he sleeps or dozes at least 3/4 of the time.

(He also has nearly constant headaches, but that's such a common symptom after AN removal, I'm not as concerned about it).

So... anyone experienced any of these after their AN surgery or shunt, and if so, what eventually happened?

Thanks,

Alex B.

[moe]

HI Alex,

I can't chime in about the shunt issue but of course can give my 2 cents worth on other issue....

I think that your dad's age probably has the most to do with the fatigue/low appetite, and how fast he is recovering (my opinion). He has been through A LOT, and he is no spring chicken!

And since he is in rehab setting, it's hard to know how much walking he is doing with the therapist. Could be that he is not doing enough, therefore sleeping, or that they are pushing him too hard, and he is tired and just wants to sleep in between. Plus the low blood pressure makes him more tired. Some rehabss are better than others but since he is in a hospital setting, he is hopefully getting the exercises he needs.

Just some ideas coming from my brain (I'm a home health nurse-see patients in those kind of settings....)

I would imagine it will just take longer for him to get back on his feet. 5 weeks is still pretty fresh post op and he is walking and getting out of bed so that is good.

Appetite~ just bring him whatever sounds good to him, of course within the rehab's rules/regs. Carnation instant breakfast is a good alternative if he can't stand the ENSURE type drinks.
He needs the extra calories and protein I'm sure. Do they have a dietitian seeing him?

Hope this helps. Just some insight. There are so many factors involved. One day at  a time, baby steps are still in order. Pamper him with any allowable foods
Maureen

[Crazycat]

I went through the mill with that stuff. If your dad had a shunt installed, the tumor must have been of the humongous variety; big enough to block the flow of CSF. Mine was 5cm X 5cm.

They installed the shunt first, one month before the tumor resection. The shunt had somehow become dislodged over the first night and I had to be rushed back into surgery the next morning for a reinstall after becoming very ill.

Fatigue goes along with the AN experience, before and after surgery. It's a long recovery. But then, I was 48 when I went through it and in otherwise excellent physical condition from jogging 5 miles a day, weight training for 30 years, and eating well. I cannot imagine how the trauma of such an ordeal would play-out for an elderly person though.

I could tell you more, stay in touch.

[Jim Scott]

Hi, Alex ~

I'm sorry your father is having to endure these struggles following AN removal surgery.   

I was 63 years old and in otherwise good health prior to my AN debulking surgery (I later underwent radiation) and the only similarity to your dad's experience was the extreme fatigue in the first few days immediately following the operation.  That slowly resolved but I never quite regained the same level of stamina I had prior to the surgery.  However, being retired, this doesn't pose a problem.  Due to the AN pressing on my trigeminal nerve my ability to taste food or drink was severely compromised in the weeks leading up to my AN diagnosis and subsequent surgery and radiation.  This led to a severely diminished appetite and I lost well over 30 (unwanted) pounds.  Fortunately, the surgery removed the AN enough to restore the trigeminal nerves to their normal function, my appetite returned (within 48 hours) and as a bonus, I've managed to keep the extra weight off.  I would summarize by stating that the fatigue is fairly normal, as are the headaches (unfortunately).  I regret that I'm unable to offer you any insight into the BP problem but the doctor, who is familiar with your dad's case and medical history, seems to have a good grasp of that situation.   I trust these issues will soon resolve ad that your dad can return home and enjoy a solid recovery.

Jim