Decisions about pacemaker or heart catheter operation. Any advice?

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So sorry for what you are going through. My dad had right-bundle branch blockage heart issues and the doctor suggested a pace maker...but then also said it might just prolong the inevitable. I agreed, as his heart issue was electrical and never seemed to cause him pain (I have the same thing apparently), but with dementia he would have been unable to understand what was going on to get a pace maker.

I elected not to do that to him, and am glad I didn't put him through that.

NO judgements if you do go with the pace maker...just describing my situation.

Not only his mental health but yours in regards to prolonging his life with a disease that will only get worse not better. But how do you not do these seemingly simple procedures? It goes against everything we are taught in regards to saving a loved ones life at all costs. It certainly is a moral dilemma and not a choice I would ever want to make. But you have to decide between quality and quantity of life.

We faced the decision about a pacemaker for my mom about 2 years into her Vascular Dementia dx (prognosis for VaD is 5 years from date of dx).

In the end, we asked mom what she wanted to do and she wanted the surgery.

Based on what my mom had told me years before, she didn't want to live "like this" but in the moment, in real time, she wanted to extend her life.

If she hadn't been able to make the choice for herself, I wouldn't have said yes.

Hospice. I decided to go ahead with a pacemaker for my mom with dementia back in October. Worst decision I’ve ever made. I have only prolonged this misery indefinitely. I wish I had chosen hospice at the time.

Sorry your hubby is being recommended for these surgeries. But that's what doctors want to do - surgery or medicate to resolve issues are what they're kind of trained to do.

In reading your profile, I am so happy to see that you are using natural remedies to help your husband. I have my mom on most of those same supplements and will check out the doc you mention. My mom has mild/moderate (getting more solidly into the moderate level) dementia and I do not intend to have any surgeries performed on her. She was never big on medical intervention, always just letting her life decline as issues like bone-on-bone in both knees curtailed her ability to be active. When she moved in with us, I demanded she get them done. This has given her many good years on her feet where otherwise she would have been in a wheelchair and in a nursing home because I could not deal with that.

Anyhow best of luck. See what non-surgical suggestions they have, if any.

I am going with he is 82 and diagnosed with ALZ 11 yr ago.

I just read up on the catherization. I may not have that done. If they find out his arteries are clogged you won't have bypasses done anyway. I may consider a pacemaker. Like lea said, they can have a local for that. Look on-line, there are videos showing how the procedure is done.

Nature is giving you notice as to who's in charge. As I've said before, just because we have the medical technology to do something doesn't mean we have to use it.

We all die of something someday. I'd bring in hospice and not subject him to medical procedures.

Neither of these minimally invasive surgeries require general anesthesia, just conscious sedation. Unless DHs doctor has determined otherwise in his case.

Choosing to extend someone's life who's suffering from advanced Alzheimer's is an act of cruelty in my opinion. For what purpose? To watch them continue to decline and suffer as they reach the end of their life????

I got a hospice evaluation for my mother when it was time to stop with all the medical interventions.

Best of luck to you

I agree that your rite not to jump to surgery. I’m assuming that since you are asking about these decisions his Alzheimer’s has progressed to the point that he can’t make them for himself. It is so difficult to decide to do nothing and for me the decision would be influenced by his quality of life. Does he have a good quality of life now, is he happy, is his family? Does he know and enjoy his family and if it were 10 years ago and he knew he had this awful disease what would he want presented with the heart issues?

I would also recommend while you are considering all of this to get a second opinion from a cardiologist of your choice and or perhaps recommended by his primary. Afib can be handeled all kinds of different ways, some people can live with it, some are medicated (like my mom) for it and others need a pacemaker but typically they exhaust other options. Find a cardiologist or better yet a gerientologist to frankly discuss the pros and cons of either surgery as well as reasons to he e them. Personally depending on what stage he is at and not being able to make his own decision makes me lean toward palatine care, I don’t think I would put he or his family through surgery, stent may be a local anesthetic which is preferable but will he understand enough to be aware through it? I don’t know about the pacemaker, probably depends on the type but again is it all worth whatever trauma it causes him, if you think it could be traumatic for him.I guess I’m thinking about my situation with my mother, I think at this stage hard as it would be, I would choose not to do anything more and let her go naturally from afib or a heart attack if that’s what is to happen. I would and we do medicate her though for afib so not working to let her go if that makes sense.

Do consider asking for a palliative care consult.
You may choose now to do no surgeries.
Do know that not all atrial fib patients need pacemakers. I have had fib more than a decade with no pacer. My partner has had fib and has a pacemaker. Only for low heart rates is the pacer needed in most instances.
I would speak with Palliative Care MD to decide what measures you wish to address in future.
Wishing you the best.

Cyn, what advantage is there going to be if he has this surgery? The anesthesia alone can cause a rapid progression of the dementia that he may not recover from. Are you his POA or is this his decision? Does he have DNR in place? In my mind, if he has a DNR he does not want extreme measures taken to save his life. Surgery of this sort I would consider an extreme measure.

Any surgery can have long lasting effects. The anesthesia is the problem it can take a while for the drugs to leave the system and it can effect the cognition. Some return to the pre-surgery "baseline" some do not. (there might be a bit of a recovery or not. )
It is actually your decision if he can not make an informed decision himself. And at this point he probably can't. NO ONE should try to talk you into doing this and no one should try to make you feel "guilty" if you elect not to have the surgery done.
YOU are the one that is taking care of him.
YOU are the one that knows how much you can handle.

If he had CPR preformed there is a good possibility that he is also dealing with broken ribs at this point.
ALSO will he be able to participate in Cardiac Rehab?

If I were in your shoes...If it were my husband I would elect NOT to do any surgery. I would request a Hospice referral and let Hospice manage his care from this point on.