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GratefulCitizen
11-19-2009, 23:14
Question for the experts: is this an unusually fast recovery?

The pastor at the church where my children attend school had a medical emergency last month (October 23).

Age ~early to mid 60s.
He had an aortic tear.
Had he not already been in Phoenix at the time, he supposedly would have not lived long enough to have the emergency surgery.

At the time of the surgery, he also was suffering from pneumonia.

He was put into an induced coma during intial recovery from surgery.
One of his kidneys failed.
The other one was failing.

His condition started improving rapidly. Apparently this is unusual.
He completed his final dialysis treatment last weekend and his kidney is GTG.
He completes rehab this week, returns to Page on Saturday, and will be preaching on Sunday.

Don't know much about this sort of thing.
Would this qualify as an unusual recovery?

PedOncoDoc
11-20-2009, 09:02
Age ~early to mid 60s.

This definitely puyts him out of my AO, although an aging pediatrician I work with defines our field as, "Anyone younger than me." :) Hopefully someone who follows patients after major vascular surgeries in an adult age group can give further insight...

He had an aortic tear. At the time of the surgery, he also was suffering from pneumonia.

Bum luck - definitely a high risk anesthesthesia case due to lung ventilation/oxygenation issues - glad he did okay. An alternative (and more likely) scenaria is that he could have developed pneumonia as a result of aspiration of stomach contents as this was an emergency surgery and they probably did not want to wait long enough for his stomach contents to pass further along the digestive tract.

He was put into an induced coma during intial recovery from surgery.

Not an uncommon practice after a major surgery - less problems with pain management and less stress on healing surgical wounds. Easier to control parameters such as blood pressure which are important after vascular surgery.

One of his kidneys failed. The other one was failing.

Probably in due to the decreased blood flow to the kidneys as a result of the aortic tear/dissection. The tear/dissection was likely in the chest or abdomen above where the blood vessels feeding the kidneys branch off. The kidneys are used to seeing a lot of blood flow so they tend to be very sensitive and show loss of function more rapidly and easily than other organs in the lower half of the body. It's not uncommon to have transient kidney failure after an emergency such as this. With good perfusion (blood flow and blood pressure) restored to the kidneys, their function will typically recover over time if the insult/ischemia was brief enough to not cause permanent damage (ischemia = lack of blood flow/oxygen.) Typically the first 7-10 days of recovery will show if the kidney will recovery over time if their workload is lightened with intermittent dialysis.

His condition started improving rapidly. He completed his final dialysis treatment last weekend and his kidney is GTG. Would this qualify as an unusual recovery?

Again - glad to hear the Padre is doing better.

In children this recovery course would be expected - either they make a fairly speedy recovery or the don't recover. In a gentleman in his 60's there are a lot of other variables including his baseline health/fitness and other medical conditions, if any, that can make recovery slower and less likely than in kids.

IMHO, knowing whether or not this was an exceptionally fast recovery is not as important as the fact that he is getting better and back to serving his community. It's kind of like when a child does a good deed - knowing whether you were the one who instilled those values is not as important as the fact that the kid the right thing.


My $.02, I'd like to hear some other thoughts on this.

wook
11-20-2009, 09:30
Question for the experts: is this an unusually fast recovery?

He had an aortic tear.


At the time of the surgery, he also was suffering from pneumonia.




I wonder if the pneumonia was a chest xray diagnosis and might have been a pleural effusion from the dissection?


Wook

Team Sergeant
11-20-2009, 11:14
Question for the experts: is this an unusually fast recovery?

The pastor at the church where my children attend school had a medical emergency last month (October 23).

Age ~early to mid 60s.
He had an aortic tear.
Had he not already been in Phoenix at the time, he supposedly would have not lived long enough to have the emergency surgery.

At the time of the surgery, he also was suffering from pneumonia.

He was put into an induced coma during intial recovery from surgery.
One of his kidneys failed.
The other one was failing.

His condition started improving rapidly. Apparently this is unusual.
He completed his final dialysis treatment last weekend and his kidney is GTG.
He completes rehab this week, returns to Page on Saturday, and will be preaching on Sunday.

Don't know much about this sort of thing.
Would this qualify as an unusual recovery?

I doubt it, probably a good physician had the case.....:D

MackallResident
11-20-2009, 14:21
Personally, I would consider him being a Preacher that still has work to be done as the cause, but only due to my beliefs.

Like they say in NASCAR, just wuddin his day

GratefulCitizen
11-20-2009, 14:26
Personally, I would consider him being a Preacher that still has work to be done as the cause, but only due to my beliefs.

Like they say in NASCAR, just wuddin his day

His biggest disappointment upon waking was that he didn't get to preach the sermon he had prepared.

The man loves what he does.

Red Flag 1
11-20-2009, 17:12
Lot of things to consider here. Hard to say much without knowing where the "tear" was. In general, the prognosis with an aortic rupture is not very good.

The "induced coma" post-op with mechanical vent support may have happened simply as a matter of course; more so with a pre-op pneumonia..His post-op vent support likely went a long way to improve his pulmonary function status and facilitate his recovery. The coma is heavy sedation, probably with Diprivan and pain meds and neuro-muscular blockade to better tolerate the vent.

As for aspiration of gastric contents , Mendelson's syndrome, it is always a possibility. It can happen with surgical emergencies, but rarely. Standard anesthesia practice includes meds and physical steps to reduce the risk. From 1975 to my "retirement" in 2002 I only saw a handfull of cases. If there was aspiration of gastric contents, it likely would have been apparent on induction and intubation.

Renal failure could have been a function of where the rupture was, where the aorta was cross clamped, general renal function pre-op, intraoperative events, meds used during surgery, etc., etc. as PedOncoDoc has mentioned. Unusual recovery, probably not IMHO.

Agree with TS, pretty damned good care! Glad to hear your sky pilot is on the mend!

RF 1

Thurman
01-17-2010, 21:37
I'm guessing by "tear" he had a dissection-- very different from an aneurysm or even rupture.

It sounds like a very nice outcome, but not unusual.

People who have aortic tears, aneurysms, ruptures, etc often have bad underlying cardiovascular disease going in, which is why their periop complication rate is so high-- MI's, strokes, kidney failure, etc.

It sounds as though in this case, the patient may have been fairly healthy going in, and so I would expect a good outcome like this.

People in their 60s can run the gamut from extremely healthy to train wrecks-- you really have to get a good sense of their "physiologic age", and treat them as such

He might have had a descending aortic dissection, which can transiently cut off the blood flow to the renal arteries.

Fix the dissection, and the kidneys should recover.

The pneumonia isn't usually an issue, except maybe getting him off the vent postop. As mentioned, it could have easily been atelectasis, pulmonary congestion, etc.

Sounds like he received excellent, rapid, aggressive care.

Modern medicine is a marvel when it goes right like this.

357SIGFAN
03-19-2010, 01:29
Lots of stuff here. I would not term his recovery "unusual", though. We usually try to have CABG's out of bed the first day post-surgery, ambulating soon after (2nd day).

His pneumonia sure didn't help things.

His ARF was due to a lack of perfusion, and once perfusion was restored, so was renal function.

Really hard to guess about more without seeing a chart.

Also, I agree with the assessment that a dissection occured. Ruptured AA's usually result in a very rapid death. Even if they occur the hospital itself, much less the town a hospital is located in. Unless of course the tear is VERY small. Still...