As POA for my dad, I have a huge decision: Surgery or pain management?

You have a difficult choice, and both choices are risky. It's too late to talk to your father about his medical wishes, but do you have an idea of what he would want to do, given his state of health? Does his doctor have any suggestions for the aneurysms, other than surgery? Is it time to discuss hospice with his doctor, where his medical care won't be to fix anything, but rather to provide comfort care? I did this with my mother, and with advanced dementia she lived a much more peaceful and better lifestyle with hospice care, for the last couple of years of her life, rather than constantly being sent to the hospital.

If your father had one you would have mentioned it, but does he have an advanced directive? This is a legal document that explains how a person wants medical decisions made if they can't make them. Most likely he doesn't have one but you might look through his papers. One might say that he probably has let you know what he does and does not want done medically, but I think a lot of people actually never discuss that, even with their medical POA agent. You might check to see if he has a Do Not Resuscitate order in his chart.

Cherbal, have you ever read a book by Atul Gwande called "On Being Mortal"? When my mother was declining, it clarified for me what was important.

One thing I like to remember about caring for elders in that at some point, there are no "good" choices, only "least bad" ones.

My heart goes out to, needing to weigh these 2 not so great choices.

thank you all. You have been very helpful. No one has judged me and I appreciate that. I spoke to my husband and my son and basically they said the same as all of you. They also said to wait to talk to surgeon. But I think that is to allivate my guilt. My mind knows what needs to be done, but my heart doesn't want to accept that.

I should wait for the vascular surgeon's advice and just try to let the decision rest until you have it. None of the options seems attractive, you can only take the least worst. They already did an ultrasound, did they?

How is he? Are his legs bothering him currently?

I would not do the dye test if his kidneys are compromised. My Mom had one Kidney that worked 50%. She had a lump in her neck they wanted to check out. The NP happened to mention before they did that, her kidney function need to be checked because the dye is not recommended for people with kidney problems because it can cause kidney failure. TG I was there, because Mom needed no more prodding. She also suffered from Dementia and was in her 80s.

I would not put Dad through any of this. With his heart conditions he could die on the table.

Letting go is so very difficult for most. Thankfully Hospice and Palliative Care is available. Did Dad file his end-of-life medical forms along with his will? If he didn't prepare for his end-of-life, then I guess you will need to do that for him.

Have you contacted an Elder Law Attorney? Please learn from this lesson and make sure YOU prepare for your end-of-life needs so that no one has to make decisions for you.

I have been working on this issue a lot, lately, because this forum has shown me that what happens to me is up to me. I'm just trying to figure out how and when to act in different scenarios...........it's quite a challenge to die pain free and with my dignity. I pray that I have a quick event in my sleep and that I don't linger in misery.

Aneurysms in his legs are no as serious as aneurysms in the chest or abdomen. Surgery is only indicated if the aneurysms are about to burst. If they are small, a wait and watch period is the best way to go. If surgery becomes absolutely necessary, it could be performed with spinal anesthesia, not general. He has a good probability to recover.

I personally would opt NOT to have any further testing or surgery.
I would contact Hospice and let them help manage pain.
Recovery from any surgery is difficult when you have but 1 of the conditions you mention. Add in another and another and recovery is even more difficult. (that is if he survives the surgery, sorry)
You have known him for your whole life, what would he want? He chose you to make decisions based on what you know he would want and knowing all the risks or those decisions. And lastly..if this were you what decision would you want someone to make on your behalf?

My FIl has had six operations including two brain and two heart ops since his stroke a year and a half ago. He had been on blood thinners for a fib, copd that contributed to his aneurysm and brain bleed, hence said operations.

He is alive, yes, but given all this general anesthesia, the falls started happening. Since fracturing his back and pelvis, he now can stand, only with help, to transfer onto the commode for no 2.

The docs answer to this is of course investigating more surgery, this time for what they think is a torn tendon. The pt and recovery are painful and protracted, and fil has never complied fully with pt anyway.

Seems to me that the surgery will probably mean he loses the last bit of him being able to stand amidst more pain. I hate that careless loser opiate addicts have made pain management so complicated. Gabapentin won’t do s against actual post surgery pain and either will your nsaids. Did I mention he had two thirds of his intestine removed plus has one kidney?

You shouldn’t have to go on hospice to get pain management. Thanks, useless opiate idiots for making it so hard, when in fact over 90 percent of legit users only use them to alleviate physical pain as opposed to partying with them.

Pain management could be such that he retains his ability to stand with less pain without surgery, or increase his resolve to do pt after it. Putting surgery first without addressing pain management will probably mean he loses his ability to stand at all.

I saw more complications for surgeries on the extremities for circulatory problems than on any other surgeries, and that is no matter the age. It isn't only that you are operating on vessels but it is after surgery, the need and the complications of thinning the blood for some time. Often a clot was the result
Aneurysms have often been with us from birth, may develop at any time, and are often not found for decades. Yes, they may rupture at any time. And they may NEVER rupture. One cannot know. When in his 90s and already admitting he was terribly tired of living and ready for rest, my Dad was diagnosed with a very large abdominal-aortic aneurysm. They let him know but they far from "recommended" surgery. Basically let him know when that puppy ruptured he might not even have time to say ouch. He had no surgery.
I would not for myself choose surgery. You cannot discuss with your father; as you said this falls to you. I would listen to the recommendations of the doctor and of the SURGEON himself; I am hoping they will make very clear to you the risks and complications. Because your father has dementia the hospitalization alone will be tricky and will be terrifying for him.
My answer would be no. It is always hard for people to make these decisions for another. My guess would be that you will have your Dad longer without surgery. Do know that AFib ads another huge complication here due to the irratic nature of the heartbeat and the tendency for clot complications heightened thereby. And the COPD, well, you can guess.
I will be very very surprised if a doctor encourages you toward surgery in this case. VERY surprised. In fact I would want to know if he just lost in Vegas or something and has bills to pay.
I wish you luck. Your Dad counted on you to make these decisions when he has no dementia. I hope you will have talked with him about end of life and quality of life care and know somewhat what HE would want. That's what you are guessing. And I will remind you again, our opinions are only that; this is entirely your decision. And whatever way it goes it is not your responsibility or your guilt to bear as you are doing the best you can with a tough decision. Best to you.

I believe man’s medicine often gets in the way of God’s plan..

Recovering from a surgery like this may not happen.. and be in worse shape…

I worked years ago at a hospital as a physical therapy aide. We had to get this 90 year old, women up just to stand. She had a pacemaker placed the year before…it made an imprint on my heart , as she cried to just die…

i would get Hospice involved ,

I agree with previous posters. I am so sorry he is going through this and for you too for trying your best. I can't imagine his suffering and confusion.

Please consider hospice and allow him to go gentle into that good night.

Definitely hospice.

Remember that you are not making yourself an instrument in his loss by seeking comfort treatment. That’s just not the way it works.

My LO did very well on hospice for a year, and is now slipping away from me, but she is peaceful and cozy and beautifully cared for. And at this point, although I wish I could do more, this is the best I can do for her.

Be at peace that you have no “good” decisions to make on his behalf, investigate the hospice services he has access to, and make his safety but also his comfort be your guides.

Ditto what Glad says.

Get an evaluation by hospice.