Expert: Rex Russell - 9/1/2011

Question
A 62 year old woman who has recovered physically from a recent heart surgery has lost her appetite, has trouble with most foods, forcing herself to swallow and is intolerant of the smell of most foods.  The surgery was over 6 weeks ago. She was experiencing acid reflux before doctors discovered two heart valves that were narrowing and had a heart cath completed on her. She also has lost her sense of humor and enjoyment for life.  Could the anesthesia be the cause of this and could there  be some disruption in her brain chemistry?  She is taking multiple medications to treat anxiety and depression.  What is causing this aversion to food?

Answer
I do not believe that this is a result of the anesthesia.  Open heart surgery is associated with large fluxes in the physiology of the brain.  There is a higher incidence of post operative cognitive changes after open heart surgery than most other types.  It is believed that it is a result of very tiny emboli (or mini blood clots) that form or other debris that may be lodged loose from the aorta (main artery leading from heart), that are then flushed into the circulation of the brain and result in small mini strokes.  

Patients often find themselves battling depression when contending with major illnesses and surgery only seems to make this worse.  

Loss of appetite is very common in patients with clinical depression.  So this needs to be addressed by a qualified psychiatrist.

Loss of appetite is also common in patients with systemic illness and in particular we see this in patients who have cancer.  Chronic low grade infections as well as auto-immune disorders may also result in loss of appetite.

A family physician needs to evaluate this patient to ensure their are no serious underlying medical reasons for this loss of appetite (i.e. Cancer), and then consider if a re evaluation of the medications she is using for depression is necessary (assuming this may be related to poorly treated clincial depression).

I wish you the best of luck.

Dr. Russell