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Why can't my father swallow after bypass surgery?

Dear DrRich:

My father is 72 years old and has just recently had bypass surgery.  He suffered many complications after that.  CT Scans show that he has not suffered a stroke.  He is however unable to swallow and suffers from severe dysphagia, which he has had for 3 months.  The oral phase of swallowing is getting better but the phase which involves his pharynx show that after one swallow he is unable to protect his airway.

The doctors feel it is a mystery as to why he can't swallow.  They do say that dysphagia after by pass surgery is common. My question to you is why does dysphagia occur after by pass surgery and what is the prognosis for the return of swallowing?

Sincerely,

S.

DrRich replies:

Dear S,

There could be several potential reasons for your father's swallowing difficulty (dysphagia).  These include local trauma from intubation during surgery, local damage to a nerve (probably a subset of local trauma), stroke, or something entirely unrelated to the surgery.  However, in my experience dysphagia after bypass surgery is not a common long-term problem at all.

One thing you might want to take note of: patients who have bypass surgery can suffer a certain amount of brain damage that is more diffuse than with a classic stroke (which is highly localized).  This brain damage presumably is due to showering the brain with microemboli (very tiny clots) that arise from the heart-lung bypass machine used during this procedure.  It is a poorly recognized problem which, frankly, many doctors are unaware of (or deny the existence of). It may not show up on a CT scan. It is generally characterized by a memory deficit and personality changes, but I see no reason it couldn't cause swallowing difficulties. Cardiac surgeons refer to this post-op brain disorder (in private, not around patients) as "pump head."

I would recommend a) seeing a neurologist, since swallowing problems involving the pharynx (the throat muscles) are often due to neurological problems, b) having a speech therapist work with him (since speech therapists deal frequently with pharyngeal swallowing problems that follow a stroke, and may be able to help him, whatever the cause of his problem), c) seeing a gastroenterologist if these things fail.

The most disheartening thing to me (as a member of the profession) is that your father's doctors assert, on the one hand, that they see this problem all the time, and on the other hand, they have no idea what's causing it. And, by gosh, they're fine with that.  If any doctor sees a severe, recurrent problem with a procedure he/she is doing, it immediately becomes their number one priority in life to stop what they're doing until they figure it out.  This is utterly astounding. You are entirely within your rights to absolutely insist they figure out what's going on with your father.  Of course, you might think twice about asking these guys anything ever again.  It might be better to look elsewhere for answers.

Best of luck,

DrRich

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