I found asking the doctor(s), "If this was your parent, what would you do?" Was a great way to make them give me honest information.
Asking specific questions about the odds of something happening during surgery, prognosis with and without surgery, potential for adverse reactions after surgery can get them to slow down and answer.
I don't know anyone that has had a heart procedure that didn't have a stroke afterwards. Just my experience.
Any doctor that won't give me information, is NOT treating me or my loved ones. That is a waving red flag that says they couldn't care less and they just want to operate for the experience. NOT on my watch.
I watched my mother suffer beyond description following a brutal hemorrhagic stroke. This surgery risks that, in a person whose mind is already confused and likely frightened by lack of understanding much of what’s going on around her. There is no good option or answer, perhaps consider the oath our doctor’s take, “first, do no harm” I wish you peace
I think that only you can make the decision whether to go ahead with this surgery. While I as a nurse did not often see complications from it (recovery is often quick and without much pain at all) there is some chance of a stroke DURING the surgery when plaque is loosened. As stroke from a blocked carotid is what you are attempting to PREVENT, that risk should be recognized. Also, your loved one has a poor quality of life due to advancing dementia, and there is some chance that the administration of anesthesia may make this dementia a good deal worse. Like Barb, I would consider what your loved one's wishes might be were she able to make this decision for herself, and I think I would likely ask for Hospice consult. There is no good answer here. While your loved one is in danger of a stroke with this amount of blockage, she is also in danger of a stroke from its "cure", as well as from other complications from medications such as blood thinners. Strokes don't always kill; they often just make the remaining life more miserable. This isn't an easy question. And if the doctors don't have time to FULLY discuss risk and complication, choices and recommendations, then I definitely would not go forward with this surgery.
When I made this response I thought your spelling a bit off but thought you were speaking of Carotid Artery. If this is a coronary artery, which our admins I am assuming it has been corrected by indicate, no I would not do any bypass surgery nor accept it myself (I am 80). Way too risky for a person this age.
Not to be too blunt, but eventually something gets us all. The decisions should be made based on how well the patient would tolerate the surgery, recover from the surgery, and their quality of life. Dementia throws another wrench in the whole thing.
My mother had congestive heart failure and various other issues including dementia, but eventually I had to make the decision that we were done with hospitals because she'd go nuts in hospitals. The staff at hospitals are terrible at dealing with dementia patients, so I finally said we'd treat whatever ailed her at her nursing home or not at all. (Had she fallen and broken a hip, that would have warranted a trip to the hospital, though.)
That's when we started hospice care, and it was wonderful. She had better care under hospice than she did in hospitals.
The most important question to ask is: What is the hoped-for outcome of this procedure? If it is to "improve" the health in hopes of prolonging the life of someone who already has mid-range dementia... this would be an easy "no" for me.
Surely you are not talking about coronary bypass surgery for an 81 year old with moderate dementia at play? For any surgeon to even consider such a thing is beyond ludicrous, in my experience. My DH was 62 when he underwent triple bypass surgery; his breastbone was broken open and spread apart in order to access his heart, which was stopped and placed on the bypass machine for the duration of the 5 hour surgery. Veins were taken from his lower legs to use to replace the clogged arteries in his heart; that was a separate and painful surgery to recover from in and of ITSELF. His breastbone was wired shut after the surgery was over with, and his entire chest was black & blue for months afterward. He was totally out of it on Fentanyl and other opioids to manage his severe pain for a few days after the surgery, then sent home with a list as long as a roll of toilet paper of instructions for ME to follow in care for him. Including but not limited to daily weighing to make sure he wasn't retaining fluid, daily temperature, daily blood pressure readings, daily meds in the AM, afternoon & PM, a strict diet to follow which at first was a HIGH CALORIE HIGH FAT diet to help him regain the 30 lbs he dropped like a hot potato from the stress of the surgery, about 15 follow up appointments, a strict schedule of cardiac rehab across town 3x a week, and about 100 other things I can't recall off the top of my head.
Within 2 weeks time, DH found it harder & harder to breathe and his shortness of breath became a crisis situation. He had a pleural effusion which is a pocket of fluid built up (due to the enormity of the bypass) between his lung and chest cavity, which required ANOTHER large surgery to be performed to drain it and scrape his lung of the build up. He was hospitalized for another week for that situation, general anesthesia was used yet again, and that surgery was almost as difficult to recover from as the original bypass! To this day, he still does not have full lung capacity back & suffers shortness of breath from that pleural effusion.
It's absurd to even consider such a surgery for an elder with dementia, never mind an elder of 81 w/o dementia.
It would be a hard NO for me.
I prayed daily for God to take my mother who was suffering with vascular dementia and loudly asking TO die on a daily basis as a result. The last thing on earth I ever wanted to do was to extend her life in any way, shape or form.
You have written the script for my husband's by-pass surgery (quadruple)....even the age is the same. Pleural Effusion was also a nasty side affect that required yet another hospitalization and procedure. To think an 81 yr. old with mid stage dementia (been there as well) would undergo such a difficult surgery and recovery is unconscionable to even consider.
My GFs father, diagnosed with ALZ, had this surgery and it did not help with his cognitively. An operation where anesthesia is used can make Dementia worse. It takes a while to leave the body in the elderly.
This is a hard decision. Alva is a Nurse so she is very aware what can happen. Make a list of pros and cons. The cons will probably win out.
Since vascular dementia only has a 5 year life expectancy, why would you want to put her through this? And for what....to give her another maybe 6 months to live with her broken brain? I mean really. Let her live whatever time she has left in peace and without doctors poking and prodding her for no good reason. And yes, my late husband had vascular dementia, and lived only 3 years with it.
Is this for open-heart surgery where she'd be under general anesthesia, with a breathing tube, and on a bypass pump with a surgeon performing the procedure?
Or are they offering something like stenting of the coronary artery under mild sedation, where a cardiologist advances the equipment up to her heart from her leg or wrist artery (done inthe cardiac cath lab)? They would be doing the fixing the same route that they used to take the pictures to look for the blockages?
Asking specific questions about the odds of something happening during surgery, prognosis with and without surgery, potential for adverse reactions after surgery can get them to slow down and answer.
I don't know anyone that has had a heart procedure that didn't have a stroke afterwards. Just my experience.
Any doctor that won't give me information, is NOT treating me or my loved ones. That is a waving red flag that says they couldn't care less and they just want to operate for the experience. NOT on my watch.
I would almost, to be honest, be glad that she may have an OUT of the awful dementia that imprisons her.
But, that’s me. Watching my mother suffering with this awful condition is brutal for me. And, it’s brutal for her to be living with it.
Like Barb, I would consider what your loved one's wishes might be were she able to make this decision for herself, and I think I would likely ask for Hospice consult.
There is no good answer here. While your loved one is in danger of a stroke with this amount of blockage, she is also in danger of a stroke from its "cure", as well as from other complications from medications such as blood thinners. Strokes don't always kill; they often just make the remaining life more miserable.
This isn't an easy question. And if the doctors don't have time to FULLY discuss risk and complication, choices and recommendations, then I definitely would not go forward with this surgery.
My mother had congestive heart failure and various other issues including dementia, but eventually I had to make the decision that we were done with hospitals because she'd go nuts in hospitals. The staff at hospitals are terrible at dealing with dementia patients, so I finally said we'd treat whatever ailed her at her nursing home or not at all. (Had she fallen and broken a hip, that would have warranted a trip to the hospital, though.)
That's when we started hospice care, and it was wonderful. She had better care under hospice than she did in hospitals.
Within 2 weeks time, DH found it harder & harder to breathe and his shortness of breath became a crisis situation. He had a pleural effusion which is a pocket of fluid built up (due to the enormity of the bypass) between his lung and chest cavity, which required ANOTHER large surgery to be performed to drain it and scrape his lung of the build up. He was hospitalized for another week for that situation, general anesthesia was used yet again, and that surgery was almost as difficult to recover from as the original bypass! To this day, he still does not have full lung capacity back & suffers shortness of breath from that pleural effusion.
It's absurd to even consider such a surgery for an elder with dementia, never mind an elder of 81 w/o dementia.
It would be a hard NO for me.
I prayed daily for God to take my mother who was suffering with vascular dementia and loudly asking TO die on a daily basis as a result. The last thing on earth I ever wanted to do was to extend her life in any way, shape or form.
Wishing you the best of luck.
This is a hard decision. Alva is a Nurse so she is very aware what can happen. Make a list of pros and cons. The cons will probably win out.
I mean really. Let her live whatever time she has left in peace and without doctors poking and prodding her for no good reason.
And yes, my late husband had vascular dementia, and lived only 3 years with it.
Is this for open-heart surgery where she'd be under general anesthesia, with a breathing tube, and on a bypass pump with a surgeon performing the procedure?
Or are they offering something like stenting of the coronary artery under mild sedation, where a cardiologist advances the equipment up to her heart from her leg or wrist artery (done inthe cardiac cath lab)? They would be doing the fixing the same route that they used to take the pictures to look for the blockages?
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