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My Mom has had several surgeries on her back. In recent years, she has had crushing vertebrae, and bursitis inside the vertebrae too. She had surgery about 4 years ago to clean out the burs in her spin to let the pressure off her spinal cord. The condition is pretty painful. At that time she swore she was never letting anyone cut on her again. As you folks know...she had a stroke in July last year. She has very profound aphasia. She is probably not really cognizant a lot of the time. But, not always. So...she is in a lot of pain. Several doctors and diagnostic procedures later....she has a lot of pressure again on her spinal cord from bursitis again. This was explained to her by the orthopedic. He said to her..do you want surgery to fix this. She cried, and said " I guess I have to...I hate to, but will". This was reasonably clear to both myself and the doc. But, not even a day later, she told her therapist that she will NOT have surgery, but just an injection in her back. I hold her medical proxy, but I am at a complete delimia... do I proceed with surgery...do I arrange another injection instead (I know they no longer work..she had one in October ...and the relief was very short lived). Rehab from back surgery is not a minor thing at 90. Seems like if I do this...she will be hugely upset because surgery is a very big deal...if she doesn't want it...how would I ever get over thinking I forced this on her....if she does want it...how could I deny her? Help... any ideas where to turn? I just cannot act without her agreeing.....

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See if you can find a good acupuncturist and talk to him/her to see if s/he thinks that acupuncture could help. Would she be able to lay on her stomach for 30-45 minutes in order to receive the treatment? The needles do not hurt - they are the thickness of a strand of hair.
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Before I do anything..make any appointments, I first must have a clear understanding of what mom actually wants.

So, I know that talking is one of the worst means of communication with her. So, I wrote it all down. Keeping it simple, but complete. I just wrote what happened at the orthopedic and what she agreed to there...and what she then later told the speech therapist. I asked her to read it a couple of times...slowly.

Tomorrow I will ask her to read it again. Then, if she remembers reading it today....maybe she can make a choice that she really has decided on. THEN I will proceed to move forward in whatever way she desires.
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I had back surgery when I was 18 and had a cortozone injections in 2002. The reason, I had a series of injections was because my dr said that when I got older, I would probably need surgery again and it would be harder to do because of scar tissue from surgeries and recovery is worse as you age. You stated your mom has heart problems so your first step in making the decision may be to consult her cardiologist to see if she is a candidate for surgery to begin with and potential outcomes of the surgery. I do think you may want to consult another dr because not increasing pain meds sounds a little harsh to me.
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Would the ortho operate on his / her 90 year old mother in a similar situation ?

Mom is no longer a candidate for even the procedure to inject cement into her collapsed vertebrae and last year when she initially agreed to have cortisone injections to relieve the pain, I spoke to her quietly about it after the doctor appointment and she said, she didn't want it
Even with dementia, I felt it was her pain and her decision

You mentioned her therapist ? Did he/she share any thoughts?
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Hmm. Trazadone is not a pain medication. (It is an antidepressant often prescribed at night because it is sedating. I happen to have used it.) The Mayo website lists meds that shouldn't usually be taken with Trazadone, and Tramadol is on that list. But it does say that sometimes it is necessary to use them together, and then the dose is usually adjusted.

Is Tramadol the only pain med she is using? Does she take it more than once a day? You may find what Mayo Clinic says about dosage for pain interesting.

I don't envy you this decision process!
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Dear KatieKate,

I'm so sorry. I know you are trying so hard to do the right thing for your mom. At 90 having surgery would not be the easiest. But yet she is having such terrible pain. Is there anyway you can get a second or third opinion, is there really no option except for surgery. I have to agree with you, it would be best if your mom was fully aware of all her options. After suffering a stroke and having a heart condition is surgery going to be safe? I'm so sorry, I would try talking to your mom again and try to understand her wishes.
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She takes 100 mg trazadone and 100 mg tramadal to get to sleep each night.

More painkillers are not going to be OKed by the Doc.
She has been complaining of constant pain for the last 3-4 months. Docs have tried everything. Lots of diagnosis and procedures. Shots in back, shots in hip, you name it.

She is a heart patient too. With afib, and arrhythmia.

I wish there was someone who could talk with her and know her true wishes in this matter. I cannot figure it out. I cannot trust what she says...cannot tell if she doesn't understand, knows what she is saying and then forgets, doesn't know what she is saying, is thinking one thing and saying another...etc. any of those could be what is happening...and maybe all.
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Oh wow. What a hard place you are in!

Have you tried pain management specialists? At age 90, would dulling the pain be as good as fixing the problem?
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