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My LO has been diagnosed with significant dementia and is in a AFL.

I'm waiting the exact cause from the Neurologist, but her MRI seems to indicate both vascular dementia and Alheimers. She has lost weight, lost most of her appetite, and is seems weaker since she fell and fractured her spine, then weeks later fell and fractured her hand. The orthopaedic doctor says these fractures are painful, but they will heal. She also has osteoprosis, diabetes, hypertension, and high cholesterol. She's only 63 years old.

She has an unexplained mass on her side. She claims it doesn't hurt, but they have scheduled a CT scan of it. She also seems to have a lot of fluid around her middle. All of her body is super skinny, except for her middle and that is very large. The two doctors who examined her looked very disturbed at her middle. They didn't venture any diagnosis, but just ordered the CP scan. Whatever it is, can't be good. I'm fearing the worst.

Is surgery every advisable for someone who is so advanced in dementia? From the stages I have looked at, she's next to the Last stage. Whether this mass is cancer, hernia, fibroid tumor, etc., I can't predict, but it's likely a surgical remedy will be offered. I just don't see how she could handle any more pain or strain on her fragile body. Any information would be welcomed.

The staff at the ALF have discussed palliative care. I'm researching that now.

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I'm so sorry. Sixty three isn't very old so that makes this doubly hard on you.
Still, with all of the other health issues - especially dementia - I'd echo the feeling of others that talks with the palliative care people at the hospital as well as hospice are in order.

I've seen what anesthesia can do in such circumstances and the results can be devastating so I may be biased, but I also have a good feeling about what I'd want if I were in your mother's shoes. I'd choose hospice.

Much goes to what your mother would have wanted if she'd been presented with this scenario when she was healthy. Would she have said, "Oh, I'd choose surgery anyway," or would she have said, "There's no way I'd want to live that way." You can't know for sure, of course, but you may have a feel for what she'd have thought.

The other consideration, of course, is how strong of a case the doctor can make for improvement vs. risk of the surgery.

Still, in the end, hospice would be my choice.

Please let us know what you decide and how you both are doing.
Carol
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I can only tell you what my Mom would choose, and I for her if she were in a similar situation. I have been caring for my Mom with AD for more than three years now. Each day, there has been a progression. She is now entering the later stages of the disease. When I first arrived we would sit on the porch on summer evenings watching American Idol videos on YouTube. One night she asked me what was wrong with her. I explained the disease to her and she told me "I do not want to live like this if it will not get better, I would rather be dead. Would you help me? I will tell you how to do it."

No question, if she were to develop some sort of a condition of any sort, it would be palliative care and hospice.
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This is a very good question. The doctors will be able to help you answer it when they know what the mass is. It may be something simple or something worse. However, surgery is always a concern when someone is in your LO's condition. I would discuss with the doctors about what the outcome could be. If together you don't feel surgery is the best way to go, you may want to see if she could qualify for hospice. Hospice can help you keep your LO comfortable as she lives out her life. Most areas have several companies -- some good, some not so good -- that provide hospice care. You may want to shop for the one that comes with the best recommendations and fits your LO's circumstances. Good thoughts coming your way.
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I highly recommend a consultation with the palliative care doctor. We had a great experience. Bring a list of questions. I went through every part of my mother's care, medications, treatment in an emergency situation (like if she had a cut or broken bone), DNR, etc. Palliative care helps the whole family. Good luck.
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This sounds a lot like the situation involving my wife's mom. The large fluid filled mass turned out to be nonmalignant cancer and a cyst. She went through surgery as a last ditch effort to save her life, and it worked. She's still alive. It's hard to say how much the anesthesia impacted her dementia but safe to say it probably didn't make things better. Balacing the outcome we have from what would have been a very painful death, we're glad this was the path taken for her. MIL enjoys our visits and company each day. Life is a precious gift from God. May He grant wisdom in the midst of these very difficult decisions in how to manage it and especially the end of it!
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My dad (who didn't have dementia but did have terminal lung cancer) had a mass the size of a golf ball on his side. We had a surgeon look at it and he said we needed to have it removed, even though Dad was 10 months into his expected 12 months of predicted time left. I felt pressure to have it done, so he had it removed as an outpatient. It was metastasized lung cancer.

Would I do it again, knowing what I know now? No. I would have left it and sought palliative care. My dad did have hospice in the last month of his life. He passed away about two months after having the mass removed. Surgeons pressure you to do what they do - operate. You have to weigh whether it's right for your loved one in the fullness of their life and their situation. Only you and your family can answer that question.
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My situation is a bit different with an older parent (87) and a heart attack. Hospital ER cardiologist not familiar with our situation was pushing for open heart surgery to remedy blocked arteries. I knew my mother could not handle the anesthesia & has refused other procedures requiring that, due to how it affects her cognitive skills, not to mention the extensive rehab. Not understanding what was being proposed , she had said Ok. I raised questions & thank goodness her own cardiologist stepped in to consult and followed through with less invasive stents/angioplasty. He was fully compassionate of our situation with dementia along with other health issues. Instead of the either do nothing or extreme surgery, my mother received treatment on her terms and with better quality of life, even if it won't be as prolonged as with the open heart surgery.

Once you have the diagnosis you will better be able to advocate for your LO. You can't make decisions when you don't know what the options are. It sounds like you are a doing a good job as advocate. I wish you and your LO well.
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My 80 year old mother-in-law who isn't demented had knee surgery a few years ago and regrets it. It cost her more than a year of her life as she tried to recuperate. The gains were very short lived. She was always very aggressive in her treatment plans and trusted what surgeons said. She has fabulous health insurance on top of Medicare and may not have thought about the consequences beyond payment. All of her children including us in-laws advised her not to have the surgery. But her husband is also a believer in the medical system and didn't agree with those who were advising pain management. Now she's in a wheelchair and frail. Even when an old person is mentally together surgery is an extreme undertaking.
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I don't know what LO is, but if she were in my care, I would do only what would relieve pain. Anesthesia only makes dementia worse. I know this because I used to work at a hospital, reading records. It always told how people were worse after anesthesia, some never returning to normal. Since she is already bad, I would take her to hospice where they manage pain very well. I hope for your sake she goes painlessly and quickly! Prayers coming your way and for your LO too.
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Is she taking any supplements? Magnesium is often a good choice for osteoporosis. Consult her physician because magnesium also helps govern the heart rhythm. Usually it will only cause a loose stool if too much is given, but just to be on the safe side... As for the rest, I would probably refrain from surgery under the circumstances. Again, what would she choose if she were herself?
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