My Mother in Law was suffering from dementia. It was most often exacerbated by dehydration. When she was hydrated she was still pretty close to the woman I had known and loved for years. However, on Friday, February 12th, 2016 she was admitted as an inpatient awaiting a surgery to remove a kidney to bladder stent and a kidney stone that was too large for lithotripsy. She was 87 years old. We were told the surgery went well and that she should be fine. When she came back to her room she was not awake. A sister in law and niece were told to try and wake her up. After 3 hours another nurse found my sister in law in tears and devastated that ‘her Mother was not waking up’. The nurse left the room, reviewed the information, and came back to tell the family, ‘that was because she had not been given the correct information. My Mother in Law had not been given anesthesia reversal agents after surgery….’ We were told it was better for the geriatric population. She did eventually come out of this state. However, by the following Sunday, February 14th, 2016 she was having problems breathing and it was recommended she be sedated and intubated, ‘to allow her lungs to rest’. On a couple instances they did turn off the vent to see how she would do. At the approximate 4 hour mark she would have issues and the vent would be turned back on. However, she did continue to breathe ‘over’ the vent. On day 6 on the vent the sedation agents were discontinued and we waited for her to wake up. She did begin to open her eyes but cognitively she was never there again. We are now on day 3 of Hospice. She will soon pass. I can tell you that given what has happened to my husband and his 6 siblings had they been given all the information they would never have chosen this for their Mother. My sister in law, that she lived with, is a very intelligent woman. But she would have said ‘no’ had she been told this outcome was even remotely possible. I believe that, with an increasing older population of its citizens, the world medical associations must make Geriatric Medicine a priority. I loved the book, ‘Being Mortal: Medicine and What Matters in the End’ by Dr. Atul Gwande, M.D. Until we know enough to stop adding time to the lingering and focus more on making the time living matter more people will suffer the sadness that now plagues my family. Debie Pacheco, Fort Worth, Texas
I wish I'd been informed of these risks. My 95 year old mother just had hip surgery, and is not responding well at this point. I was asked about the possibility of needing to intubate, but zero mention of risks of dementia. Surgery vs weeks in bed to heal, it seemed an easy choice. Now I fear she won't come out of this non-responsive outcome.
Recently my sister who at 88 was living in a assisted living facility, enjoying her life. She had a fall in her home and broke both shoulders. The surgeon who set her shoulders did a great job but sadly she never regained her right mind and did not recognize her children. She died of complications a few days later. Up until this happened I never gave a thought to the dangers of anesthetics in elderly people. I am 88. I will not be subjecting myself to any surgery that requires general anesthetic. I am happy to have this information.
I am going through this situation right now. The day before Thanksgiving my husband had what is called a pericardial window, explained as a rather simple procedure that is used to drain water from around the heart. Just prior to the surgery, the surgeon explained the procedure and ended by telling us that if all went according to plan the drain he had put in during the one-hour surgery would be no longer by Friday late morning. The surgeon would remove the drain, clean the site and incision and my husband would be discharged within a few hours. Well, forget any plan. About 90 minutes after the scheduled surgery the surgeon came out to tell me there was much liquid to remove (around 600 cc's) but the worse part is twice, he could not get my husband to "oxygenate." Rather than try again my husband was "turned over" to a lung specialist, and the surgeon (a friend who's married to a heart surgery "nurse" called him "just a chest cutter." I was not allowed to see my husband in recovery and was led away by a snarky little nurse who "felt sorry for me" standing all alone outside his ICE room. That's because it looked like a party in there. There must have been 10-12 people I could see and count before it dawned on one of them, to pull the blinds. My husband was put on a ventilator and an IV of profurol (I forget the spelling) kept him constantly out of it. He remained on the vent for 11 days under sedation (said to keep him unaware of the experience of the tube in his throat and to make certain he would come out of the experience with no memory of it. It is the same drug that killed Michael Jackson, the name of which escapes me right now. No one would give me any REAL information. And there was a strange overlap in what I was told: the successfulness of the pericardial window (the drain did come out on Friday but my husband most certainly did not come home that day) vs. knowledge of several tests and/or biopsies to find out what might have been the cause of the effusion (the liquid around the heart). What really bothered me is why he had to be put on the ventilator to begin with. No one would or could answer that. After eleven days he was finally above to get removed from the machine and the following day moved out of ICU. He was so weak he could not stand unassisted. He was discharged on December 16. I will try to make this short. When we got the Medicare EOB there was a separate line for 'EMERGENCY", one which had occurred during the surgery and this was a part of the anesthesiologist's bill (for which yeah, Medicare would not pay). There were three or four additional procedures undoubtedly created by this emergency. When we showed up for the usual surgeon's follow up appointment, he sent out a partner physician to see us who claimed he had been in, "checking up" on my husband several times, this even I had never seen him in my life and the actual "chest-cutting" surgeon had told me ever so emphatically that he had signed off on my husband on the Sunday following the surgery. Of course immediately following the botched surgery he also told me then he already had passed my husband's care along to a lung specialist, with the inference he was out of it. He must have had Thanksgiving plans and wanted out of that hospital. (So did I!) When I met the lung specialist the day following surgery he was pleasant but had the most stunned look on his face. Maybe he thought my husband had no next of kin, a situation that must simplify every doc's life in situations like this. My husband turned 72 while on the ventilator. He was always "young" and fit for his age, had a successful corporate career before going the consultant route with clients mostly in mainland China, Hong Kong and Europe, traveling internationally and helping small business grow by sourcing product in Asia. He loved his work! Until as a primary care patient at the Mayo Clinic in Jacksonville he was prevented from seeing an orthopedic specialist when quite suddenly he began to have tremendous pain in his hip, thigh, buttocks and lower back. A physiatrist, called the "gatekeeper" in this new triage program Mayo was only starting out, insisted the pain was caused by the sciatic nerve and ordered P.T. and a home exercise regime. The treatment was a joke but the outcome not so much. My husband had avascular necrosis of the hip, which could have (and SHOULD HAVE) been treated early and perhaps successfully if only he had gotten a thorough examination and the necessary tests. Instead quite by accident after several very long and painful months, my husband was being prepped for a painkilling injection when the doctor was shocked to see under the fluoroscope that my husband's hip had already collapsed. It was dead and in shards and pieces. Now he needed a hip replacement and Mayo wanted $44000.00 up front for the surgery. I cannot print the words I would have liked to use in response to the financial services rep who blithely informed us of this. Rather my husband had his replacement surgery done in Ghent, Belgium by the most gifted surgeon as part of a spectacularly-constructed package that included everything (except perhaps our particular preference in bottled water!), even the surgeon's wife as my husband's attending nurse, although it was necessary that I share the beautiful modern suite and do the small attention-demanding things a recovering patient often needs but which don't have to be done by a medically trained professional. All around it was a terrific experience, especially to see my husband walking totally pain-free and just three days following his surgery. The fourth night we were able to walk a short block to a local Thai restaurant for dinner. After all of those months of being given the run-around by the Mayo Clinic, the fact I had to go with my husband to beg for him to be given pain medicine -- all horrible memories -- we now thought we had died and gone to heaven. Sometimes, Heaven is just pain-free Thai food in a friendly little joint next to the perfect little Clinic where for all intents and purposes, one's life was saved. Oh, and all for less than one-third of what the extortionist Mayo Clinic wanted.
It appears that once again my husband's health has been damaged by medical error but that of course remains to be seen. I suppose to start we will have to demand time with the surgeon just to hear his rendition of what occurred and what emergency came up. Life just never lets up!
The first time I ever heard of anesthetics possibly pushing one over to dementia was this year on this forum. I was so glad to have read that because last month a doctor wanted to do a knee replacement on my Dad who is 93... I was so relieved when my Dad immediately said *no* to the surgery.
Now I am facing minor surgery for myself, and I am scared silly as my memory hasn't been that good of late, my primary doctor said it is stress related because of dealing with my aging parents. I hope she is right.
One thing I do know, I cannot have ketamine in the anesthetics, as once awaken I was confused and had double vision for quite a while. A more recent surgery, without ketamine, I awoken fine with no side effects. Whew.
A year ago my, now 90, mother had a cochlear implant. The anesthesia did effect her. If I had to do it over again I would have discouraged her from having the surgery. Nothing good came of it.
Do you know what anesthesia is? It is a substance that puts the brain to sleep! If one is bordering on dementia why would you put that brain to sleep? It can only get worse. The best that you could hope for is that there would be no affectation at all. I personally would not want to take that chance. I would hope that I would have my "facilities", "marbles" whatever you call it, right up until the end of life. I don't even take a sleep-aid like Tylenol PM. The Michael Jackson case is the most severe form of anesthesia delivery that I have ever heard. He wasn't seeking pain relief, but wanted to go to sleep. They over did it and used the incorrect drug. Sad.
Wow, this sums up my Dad in Law's story. He had a triple bypass operation, and when he came out of it, he was very fuzzy for a period of time ( a couple of months). He then convinced himself he was a Broadway singer. He has a great voice, so we've humored him. Unfortunately, his dementia is taking hold of him. We appreciate the good days he has when we visit in the Nursing hone,
Anesthesiologists work on these questions all the time. A great deal of research has gone into various types of anesthesia since 1982. Some drugs will put you to sleep for a short time, some longer, some with no effects and some with short-term effects. The drug known as Versed, for example, is supposed to be a short-term, IV, affecting the memory, however several stories that I've heard about this drug tell about a different outcome. Sometimes the memory does not return to what it was prior to surgery. Do you want this? In addition, not all surgery is absolutely necessary. There are risks. Do you want to take those risks? John Murtha just died of complications following Gall Bladder surgery. Apparently, there was perforation and a severe infection set in. The same event occured on that 71-year old woman on 60 Minutes who had a colonoscopy. There was perforation and an infection set in (probably E-Coli). IV antibiotics could not control the infection, and she died of Sepsis. Both of these elderly patients walked into the hospital on their own two feet, expecting good results.
My mother had an outpatient procedure for which she had to be mildly anesthetised a couple of years ago when she was 70 years old. The anesthesia that was used was the kind that knocks you out enough that you have no memory of the procedure, but supposedly you can come out of it quickly. She did not fully come out of the anesthesia for approximately 4 days. When I got her home following the procedure, I could not rouse her up enough to even get her out of the car. I had to call my husband to come home from work and we finally got her in the house using a wheel chair. We had to take her to the ER later that night because I didn't know what else to do - she was very woozy and incoherent. They didn't find anything wrong with her in the ER and sent her home. She has since sworn she will never again have any surgery of any kind. The bottom line is, even the mildest forms of anesthesia can have adverse effects on the elderly.
To Carol Bradley Bursack: You are very wise and seem genuinely concerned about giving advice to caregivers and patients alike. You also gave the answer to many who ask "What would you do, if you were in the same situation yourself?" I agree that surgery in one's eighties is risky no matter if dementia is an issue or not. It may be risky to a patient in their seventies. One aspect not mentioned, is intubation. When one is put to sleep under anesthesia, a breathing tube is immeditely inserted down the throat of the patient. This may cause a multitude of issues. First of all, not everyone CAN be intubated. There may be blockage, distortions of the esophagus, throat, mucus pockets etc. Then there is the ever looming problem of "Will the patient wake up soon enough?" One might try accupuncture for short surgeries. I had a tooth extraction under hypnosis, and it worked beautifully....no pain, no bleeding, but that is vey unusual. The types of surgery that can NOT be excluded are : Appendectomy, Bladder or Vaginal Prolapse, Removal of Foreign Objects.. Good Luck with your advice to all those who seek it. Norene p.s. No matter what they tell you, a Colonoscopy is not necessary in every case.
I have to deal with this issue every day when my mother, age 89 and with just a half set of dentures on top, bemoans about her lack of teeth. When we checked out getting new set, or getting these relined or fixed, the dentist said she'd have to have oral surgery to tighten the skin. Bone loss had made skin loose, and in that case dentures would always slide around.
This is something I wish I had known, that she had taken action on herself while she could still handle it. She hasn't had her dentures worked on in the 8 years I've been caring for her...probably years before that. So good idea to keep on top of these things. Now her mental condition is so fragile that she would probably have major panic attack at the work being done.
Of course, something like a broken bone or a hip...am thinking to ask dentist that if Mom does need some major surgery, could an oral surgeon be slipped in the same session?
Also, why can't anesthetic be injected, a spinal at the right place, a shot to calm the person, a short hit of laughing gas. Hope someone is working on this problem, cause the elderly ain't going away.
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Should Your Parent Risk an Anesthesia Disaster or Forego Surgery?
We were told the surgery went well and that she should be fine. When she came back to her room she was not awake. A sister in law and niece were told to try and wake her up. After 3 hours another nurse found my sister in law in tears and devastated that ‘her Mother was not waking up’. The nurse left the room, reviewed the information, and came back to tell the family, ‘that was because she had not been given the correct information. My Mother in Law had not been given anesthesia reversal agents after surgery….’ We were told it was better for the geriatric population. She did eventually come out of this state. However, by the following Sunday, February 14th, 2016 she was having problems breathing and it was recommended she be sedated and intubated, ‘to allow her lungs to rest’. On a couple instances they did turn off the vent to see how she would do. At the approximate 4 hour mark she would have issues and the vent would be turned back on. However, she did continue to breathe ‘over’ the vent. On day 6 on the vent the sedation agents were discontinued and we waited for her to wake up. She did begin to open her eyes but cognitively she was never there again. We are now on day 3 of Hospice. She will soon pass.
I can tell you that given what has happened to my husband and his 6 siblings had they been given all the information they would never have chosen this for their Mother. My sister in law, that she lived with, is a very intelligent woman. But she would have said ‘no’ had she been told this outcome was even remotely possible.
I believe that, with an increasing older population of its citizens, the world medical associations must make Geriatric Medicine a priority. I loved the book, ‘Being Mortal: Medicine and What Matters in the End’ by Dr. Atul Gwande, M.D. Until we know enough to stop adding time to the lingering and focus more on making the time living matter more people will suffer the sadness that now plagues my family.
Debie Pacheco, Fort Worth, Texas
I am 88. I will not be subjecting myself to any surgery that requires general anesthetic. I am happy to have this information.
It appears that once again my husband's health has been damaged by medical error but that of course remains to be seen. I suppose to start we will have to demand time with the surgeon just to hear his rendition of what occurred and what emergency came up. Life just never lets up!
Now I am facing minor surgery for myself, and I am scared silly as my memory hasn't been that good of late, my primary doctor said it is stress related because of dealing with my aging parents. I hope she is right.
One thing I do know, I cannot have ketamine in the anesthetics, as once awaken I was confused and had double vision for quite a while. A more recent surgery, without ketamine, I awoken fine with no side effects. Whew.
The drug known as Versed, for example, is supposed to be a short-term, IV, affecting the memory, however several stories that I've heard about this drug tell about a different outcome. Sometimes the memory does not return to what it was prior to surgery. Do you want this?
In addition, not all surgery is absolutely necessary. There are risks. Do you want to take those risks? John Murtha just died of complications following Gall Bladder surgery. Apparently, there was perforation and a severe infection set in. The same event occured on that 71-year old woman on 60 Minutes who had a colonoscopy. There was perforation and an infection set in (probably E-Coli). IV antibiotics could not control the infection, and she died of Sepsis. Both of these elderly patients walked into the hospital on their own two feet, expecting good results.
You also gave the answer to many who ask "What would you do, if you were in the same situation yourself?" I agree that surgery in one's eighties is risky no matter if dementia is an issue or not. It may be risky to a patient in their seventies. One aspect not mentioned, is intubation. When one is put to sleep under anesthesia, a breathing tube is immeditely inserted down the throat of the patient. This may cause a multitude of issues. First of all, not everyone CAN be intubated. There may be blockage, distortions of the esophagus, throat, mucus pockets etc. Then there is the ever looming problem of "Will the patient wake up soon enough?" One might try accupuncture for short surgeries. I had a tooth extraction under hypnosis, and it worked beautifully....no pain, no bleeding, but that is vey unusual.
The types of surgery that can NOT be excluded are : Appendectomy, Bladder or Vaginal Prolapse, Removal of Foreign Objects..
Good Luck with your advice to all those who seek it.
Norene
p.s. No matter what they tell you, a Colonoscopy is not necessary in every case.
This is something I wish I had known, that she had taken action on herself while she could still handle it. She hasn't had her dentures worked on in the 8 years I've been caring for her...probably years before that. So good idea to keep on top of these things. Now her mental condition is so fragile that she would probably have major panic attack at the work being done.
Of course, something like a broken bone or a hip...am thinking to ask dentist that if Mom does need some major surgery, could an oral surgeon be slipped in the same session?
Also, why can't anesthetic be injected, a spinal at the right place, a shot to calm the person, a short hit of laughing gas. Hope someone is working on this problem, cause the elderly ain't going away.