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My dad, who has moderate and fairly quickly advancing Alzheimer's, fell on Saturday and fractured his jaw and nose. It's a Le Fort II fracture, in case that's meaningful. He's due to have surgery this afternoon, and I'm rethinking it.

From 3 PM to 1 AM, he was agitated and combative, despite sedation and even wrist restraints. I'm worried about the surgery/anesthesia because of the risk of death and the risk of additional cognitive decline. And yet, if he doesn't have surgery, he'll have a significant underbite, his jaws won't meet well enough for him to chew, and he may have significant pain and/or infection.

When deciding about surgery and both options carry significant down sides, how do you make the decision? Any guidelines or personal experience would be appreciated.

Thank you.

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Merry, glad everything worked out well through the surgery, and thanks for the update. Good news is always welcome!
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thank you all so much for your input. After consulting with a trusted family friend who's also an MD, we went ahead with the surgery and he came through well. He's definitely delirious afterward, but he seems to returning to baseline or something approaching baseline. Such a scary decision, and I really appreciate the supportive help here. Thank you!
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The surgery will stabilize the area and minimize pain. Age is a factor in healing and I would not expect him to fully recover, surgery or no surgery. Ask for a Hospice evaluation, this in effect would be a second opinion and one not motivated by any financial gain.
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Perhaps you could ask the medical team to help objectify the situation by identifying worst case scenarios: Is he doesn't have the surgery, will the resulting jaw dysfunction affect his mental and physical health more than if he did have the surgery and it complicates his mental state?

Personally, I would go for the surgery. Being able to eat comfortably even in the presence of AD is a basic human function and I think would make him more miserable than if he didn't have it.

My father couldn't eat for 10 months after intubation and a long slow recovery. He joked that dreams of a Big Mac kept him alive while he was struggling to regain his swallowing function. Living on tube feeding was really challenging for this strong man. But he prevailed only because he kept pushing and because I fought to find speech therapists who wouldn't give up, as some of them did quite easily.

Take some downtime for yourself to just relax and help clear your mind before you make the decision. Nice long shower, favorite book or magazines...just something to refocus so that when you consider the issue again (and I'm assuming that will occur soon), you'll feel more comfortable that you've evaluated all the options and chosen the best under the circumstances.
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It's so difficult to have to make these type of decisions. I suspect my loved one is going to need abdominal surgery in the future, so I've doing research on having it with AD. From what I've read, it's best to avoid it if at all possible. Every case is different. I hope it works out well, whatever you decide.
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Yours is a very difficult decision.

It's true that anesthesia can and does worsen cognition and will probably exacerbate your dad's Alzheimer's. But in the long run, without the surgery, your dad will have problems eating, he'll experience pain, and is at risk for infection, all of which will worsen the Alzheimer's as well.

Since he's in kind of a no-win situation I'd go with the surgery. At least with the surgery your dad will physically improve. Without the surgery you've got the mental issue AND the physical issue to deal with.

Good luck with your decision.
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I can hear the panic and fear in your post, MerryHeart. I am so sorry. Considering the conditions and difficulty your father will have without the surgery, it becomes a question about the quality of life. Would you rather be "safe" and want him to. live like that or take a chance on the surgery, which might alleviate what you described? I can't tell you what is best in your situation. If the doctors were fairly confident that surgery will provide him with the ability to eat and improve his chances of avoiding more pain and infection, I think my decision would be to go on with the surgery. Since he has Alzheimers, it may put a different light on the decision. Perhaps some of the people who have dealt with AD can give you a more informed opinion. My heart goes out to you. I am an only child and had to make similar decisions with my parents.. It is difficult to make objective decisions when you love them so much.
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