Post surgery symptoms and medications

ccb23

My DH was diagnosed with AD in Jan '24. I started noticing problems a year before that, when he couldn't seem to comprehend things that were being said to him, couldn't remember who he'd talked to on the phone or what had been said, got very upset and cried about things very easily, said he felt like he was losing his mind. Back then, his PCP put him on Prozac every day, and Hydroxyzine for anxiety - as needed. We only used the Hydroxyzine one time. The change with the Prozac was like night and day - he could joke and laugh and carry on a conversation - he still didn't remember things, but he was so much better! He went through a sleep study, got on a C-PAP, eventually got sent to a neurologist, and got diagnosed. Neurologist put him on Donepezil and Memantine.

When he got diagnosed, I read 5 books about AD and Dementia and how the fewer medications a patient is on, the better.

Through all of this time he also had worsening arthritis in his hip which progressed to the point that he could barely walk, when his PCP finally referred him to an ortho surgeon.

So, three and a half weeks ago, he had his hip replaced. Very painful and extra traumatic due to the AD. 4 days in the hospital, 9 days in a rehab hospital. I stayed with him all the time through both hospitals, but both were very difficult for him. They were giving him Oxycodone and Hydroxyzine whenever he needed them.

He's been home for 2 weeks now, and his anxiety and pain are much less than when in the hospitals. He isn't taking the oxycodone anymore, and only takes Hydroxyzine once in a while.

The problem is, he is soo sleepy and has light-headed, weak, faint spells every time he walks or does his exercises. In the hospitals, I associated this with the pain meds, but he's hardly taking them now, and is still having these symptoms. His cognitive abilities are also less than they were before. I was aware of this risk, and talked with all the doctors and neurologist about my concerns and we were hoping the effects would only be temporary.

I'm concerned (and becoming a little scared) about the number of medications he's on - Prozac, Donezipil, Memantine, Celecoxib, and Hydroxyzine (as needed).

I'm curious as to other's experiences of major surgery with their AD LOs and how long the effects of anesthesia and the whole traumatic experience have lasted?

As well as how much and what medications other people's LOs are taking. Should I get his meds adjusted? The neurologist wants to up his dosage of Memantine.

Sorry this is so long.

White Crane

Hello, ccb23 and welcome to the forum. My DH was diagnosed in 2016 and started on generic Donepezil and generic Prozac. He had an emergency appendectomy right before the pandemic. I was worried about how this would affect his cognition and if it would cause progression of his Alzheimer's. It might have affected him a little but he was able to come back to close to baseline fairly quickly. He is now in MC and is on several medications.

Have you talked to his doctor about the weakness and fainting? My DH used to faint at times when he got up. I think his blood pressure dropped. Please address your concerns with his doctor. I'm sure others will offer you their experience.

Iris L.

Donepezil and memantine are for his memory and cognition. The effects are better earlier in the disease. They may help him remain home for a longer period of time.

Celecoxib is an anti-inflammatory, used for pain. I was on it for years for arthritis pain. I don't know how effective it is for post operative pain. You might consider extra strength Tylenol, or Tylenol with codeine if he still needs pain meds.

Prozac is for depression. Hydroxyzine is for anxiety. You should read about the side effects of these drugs and their interactions.

If he is fainting after doing exercises, this is very serious. It could be related to blood pressure, heart disease, low blood sugar or something else. Was he fainting after exercise at the rehab hospital? What did the doctor say then?

Iris

M1

welcome to the forum. Just fyi, I’m an internist. I would stop the hydroxyzine right away. While used off label for anxiety, it is a potent type 1 antihistamine and contraindicated in dementia, can increase confusion and fall risk, and can also cause somnolence and urinary retention in older men. Ask for something else for anxiety. While Prozac is a good antidepressant, it’s fairly stimulating and may increase anxiety. Other drugs in that class-specifically Celexa, lexapro, and Zoloft- have a better track record in treating the anxiety of dementia.

The narcotics are actually one of the safer things he could take. If he needs it for pain I’d let him have it.

harshedbuzz

You've already gotten some excellent advice.

Another thing to consider regarding the sleepiness, dizziness and fainting could be anemia. Blood loss with hip replacement can be significant. It can take a while for this to reverse itself especially if his appetite is impacted by pain meds.

Gyrogearloose

My DW was diagnosed with Parkinson’s disease in 2016. In 2021 she had an urgently needed fusion of vertebra in her lower back. That surgery, or probably the anesthesia for it, triggered delirium that slowly faded over a few weeks, but she never fully recovered. In late 2023 she was diagnosed with dementia. 

In hindsight, the surgery either triggered or coincided with my wife’s decline into dementia.

We had no choice and would do the surgery again for that reason. However, I wish I had known more and could have pressed the anesthesiologist to do whatever possible to minimize the risk of delirium after surgery.

ccb23

Thank you all for your insights.

He isn't actually fainting - just feeling very light-headed and like he's going to faint. His blood tests from the hospital showed his RBCs were a little low but his PCP doesn't think they are low enough to be of concern.

We currently have a home health PT and OT coming to the house. Both have witnessed these episodes and have taken his BP, heart rate and blood oxygen, and nothing has been abnormal.

I have read about the side effects of the meds and so many of them have the side effects of weakness, sleepiness, light-headedness, difficulty with concentration. That' why I've been feeling concerned about the number of meds that he's on.

His PCP did give us some Buspirone to use instead of the Hydroxyzine, but I didn't like what I read about it, so we only used it a couple of times. He only needs something for anxiety once in a while.

M1- thank you for that info about Hydroxyzine and Prozac.

I messaged his neurologist yesterday about all this. She didn't seem to think there was a problem of too many meds. I think I need to talk to his PCP and see about maybe getting off of Prozac and using just Buspirone instead. In the beginning he was put on Prozac for the extreme anxiety he was experiencing.

While in the hospital, we just assumed the sleepy, light-headedness was due to the Oxy more than anything else. I thought it would ease up once he stopped taking it.

I'm hoping some of it is just general weakness and will clear up as he gets stronger.

Gyrogearloose - I am sorry about your DW. We also felt we did not have a choice, but to have the surgery. I did make a point of it to the anesthesiologist. All I can do now is pray that the effects are not permanent. Best of luck to you and you wife.

Again, thank you all for your input.

SDianeL

I found that a Geriatric Psychiatrist was the best doctor to adjust meds for my DH. They know more about dementia. Keep letting the doctors know what’s going on. Please keep us posted.

Iris L.

Read about polypharmacy in older adults. It's a general problem for all older adults.

Iris