4 ms·

>> It was interesting to see for Lee how this seemed amplified after heart surgery. My Dad had really bad "post-operative delirium" for about a month after majo

>> It was interesting to see for Lee how this seemed amplified after heart surgery. My Dad had really bad "post-operative delirium" for about a month after major heart surgery, and while he recovered somewhat, that was definitely the start of his major decline. That is a strange coincidence. Could changes in bloodflow have an impact on brain cells?

DFHippie 7y ago
It might be the anesthetic.
- Wistar 7y ago
  There has been, for several years now, concern that general anesthesia may have a negative impact on the brain and, in particular, Alzheimer's Disease but also general cognitive damage. Here's a 2018 piece discussing research from the Mayo Clinic focused on apparent anesthetic damage in patients older than 70. https://www.sciencedaily.com/releases/2018/07/180719112024.htm https://www.sciencedaily.com/releases/2018/07/180719112024.h...
billti 7y ago
I researched it at the time (I'd not heard of it when it occurred) and it is apparently quite common. A quick search finds a few hits, e.g. from https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-016-0032-5 https://perioperativemedicinejournal.biomedcentral.com/artic... > Delirium is associated with negative hospital outcomes including a tenfold increased risk of death, a fivefold increased risk of nosocomial complications (Inouye 2006), poor 1-year functional recovery, and postoperative cognitive decline (Saczynski et al. 2012). The long-term cognitive decline seen in some patients after the development of delirium is similar to that of Alzheimer’s patients (Pandharipande et al. 2013). With reports of up to 50 % of patients over 60 years old developing postoperative delirium following cardiac surgery (Rudolph et al. 2009), this patient population poses a major burden for healthcare.
- bawana 7y ago
  When you go on bypass(needed if the heart is stopped to replace a valve) air emboli (very small air bubbles) go into the brain and can get lodged in capillaries cutting of blood flow. Personality changes are documented to occur after bypass and correlate with areas of the frontal cortex that die. Typically though this kind of injury is not progressive.
meowface 7y ago
My suspicion would be that the general anesthetic is the primary cause.
- billti 7y ago
  I think cardiac surgery is the worst offender because they often have to bypass the heart while performing the surgery, and this can result in blood supply issues while diverting/restoring flow through the heart.
- madaxe_again 7y ago
  I have been sedated a few times for minor procedures, propofol, I think, with no issues, and I’ve had a general once, for a laparoscopic cholecystectomy - about as trivial as abdominal surgery comes, only a few hours under. It had side effects. For the better part of a year afterwards, I kept finding myself unconsciously substituting completely incorrect words into written correspondence, I was irritable almost constantly, my short term memory was shot, and I had hallucinations and attacks of aphasia - I’d be walking down the street, or in the shower, or in a damn meeting, and I’d not only forget where I was but I’d lose object permanence and recognition - couldn’t tell taps from cats, cars from shoes. It got better, over time, but there was very definitely a long mental hangover from it. I do have medical quirks, like I can’t tolerate opioids (they worsen pain and make me vomit), and I’m a carrier of a whole bunch of degenerative diseases (thanks, inbred aristo dad), and when I had surgery I was weakened from years of still mysterious illness - they thought my GB was the root cause, but no - stress - leaving tech fixed me. Anyway. I can readily see how, with someone with a poised avalanche of genetic mental disorder, it can be enough to completely push them into the abyss.
  - xupybd 7y ago
    I've experienced this too. I had a tumor removed from my head. It was pretty serious. I'm not sure if it's due to the anesthesia, physical stress of the operation, changes to brain blood flow or radiation that my brain was hit with. Either way my memory has not been great since. My wife is disappointed when I forget meaningful conversions from a week ago. I struggle at times to notice trivial errors, really struggle. I can look over the same email and miss several mistakes. Other days I'm clear, I don't make many mistakes and I can spot them easily. I still managed to get an Engineering degree and hold down regular employment as a software developer. But there are periods of time where my focus and productivity are just not there. I suspect this will hold me back in my career. But I'm thankful I can function as well as I can and have survived to this point.
eastdakota 7y ago
It could be something physical. My sense was it was something else in Lee's case: a change in his routine. I think the routine of coming into work kept him in a pattern that kept him from deteriorating quickly (or, at least, kept us from recognizing his deterioration). When he had heart surgery, he took several months off to recover. When he returned, he seemed dramatically different. I also noticed a dramatic change immediately after he took time off for his wedding/honeymoon. And, after he left Cloudflare, the article talks about how it seemed like the effects of the disease accelerated. I'm not a doctor, and there very well may be some other connection, but my sense in this case was the routine of work actually allowed him to hold the effects of the disease off and, at those times when he didn't have it, those effects accelerated.
stef25 7y ago
Serious medical interventions can make a patient "age" quite a bit and this exacerbates other medical conditions they may have, I doubt there was any direct connection between the two conditions

DFHippie 7y ago

It might be the anesthetic.

Wistar 7y ago
There has been, for several years now, concern that general anesthesia may have a negative impact on the brain and, in particular, Alzheimer's Disease but also general cognitive damage. Here's a 2018 piece discussing research from the Mayo Clinic focused on apparent anesthetic damage in patients older than 70. https://www.sciencedaily.com/releases/2018/07/180719112024.htm https://www.sciencedaily.com/releases/2018/07/180719112024.h...

billti 7y ago

I researched it at the time (I'd not heard of it when it occurred) and it is apparently quite common. A quick search finds a few hits, e.g. from https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-016-0032-5 https://perioperativemedicinejournal.biomedcentral.com/artic... > Delirium is associated with negative hospital outcomes including a tenfold increased risk of death, a fivefold increased risk of nosocomial complications (Inouye 2006), poor 1-year functional recovery, and postoperative cognitive decline (Saczynski et al. 2012). The long-term cognitive decline seen in some patients after the development of delirium is similar to that of Alzheimer’s patients (Pandharipande et al. 2013). With reports of up to 50 % of patients over 60 years old developing postoperative delirium following cardiac surgery (Rudolph et al. 2009), this patient population poses a major burden for healthcare.

bawana 7y ago
When you go on bypass(needed if the heart is stopped to replace a valve) air emboli (very small air bubbles) go into the brain and can get lodged in capillaries cutting of blood flow. Personality changes are documented to occur after bypass and correlate with areas of the frontal cortex that die. Typically though this kind of injury is not progressive.

meowface 7y ago

My suspicion would be that the general anesthetic is the primary cause.

billti 7y ago
I think cardiac surgery is the worst offender because they often have to bypass the heart while performing the surgery, and this can result in blood supply issues while diverting/restoring flow through the heart.
madaxe_again 7y ago
I have been sedated a few times for minor procedures, propofol, I think, with no issues, and I’ve had a general once, for a laparoscopic cholecystectomy - about as trivial as abdominal surgery comes, only a few hours under. It had side effects. For the better part of a year afterwards, I kept finding myself unconsciously substituting completely incorrect words into written correspondence, I was irritable almost constantly, my short term memory was shot, and I had hallucinations and attacks of aphasia - I’d be walking down the street, or in the shower, or in a damn meeting, and I’d not only forget where I was but I’d lose object permanence and recognition - couldn’t tell taps from cats, cars from shoes. It got better, over time, but there was very definitely a long mental hangover from it. I do have medical quirks, like I can’t tolerate opioids (they worsen pain and make me vomit), and I’m a carrier of a whole bunch of degenerative diseases (thanks, inbred aristo dad), and when I had surgery I was weakened from years of still mysterious illness - they thought my GB was the root cause, but no - stress - leaving tech fixed me. Anyway. I can readily see how, with someone with a poised avalanche of genetic mental disorder, it can be enough to completely push them into the abyss.
- xupybd 7y ago
  I've experienced this too. I had a tumor removed from my head. It was pretty serious. I'm not sure if it's due to the anesthesia, physical stress of the operation, changes to brain blood flow or radiation that my brain was hit with. Either way my memory has not been great since. My wife is disappointed when I forget meaningful conversions from a week ago. I struggle at times to notice trivial errors, really struggle. I can look over the same email and miss several mistakes. Other days I'm clear, I don't make many mistakes and I can spot them easily. I still managed to get an Engineering degree and hold down regular employment as a software developer. But there are periods of time where my focus and productivity are just not there. I suspect this will hold me back in my career. But I'm thankful I can function as well as I can and have survived to this point.

eastdakota 7y ago

It could be something physical. My sense was it was something else in Lee's case: a change in his routine. I think the routine of coming into work kept him in a pattern that kept him from deteriorating quickly (or, at least, kept us from recognizing his deterioration). When he had heart surgery, he took several months off to recover. When he returned, he seemed dramatically different. I also noticed a dramatic change immediately after he took time off for his wedding/honeymoon. And, after he left Cloudflare, the article talks about how it seemed like the effects of the disease accelerated. I'm not a doctor, and there very well may be some other connection, but my sense in this case was the routine of work actually allowed him to hold the effects of the disease off and, at those times when he didn't have it, those effects accelerated.

stef25 7y ago

Serious medical interventions can make a patient "age" quite a bit and this exacerbates other medical conditions they may have, I doubt there was any direct connection between the two conditions