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My mother is 80 years old and has early onset dementia and Osteoporosis. She has lost a lot of weight and is down to 93 pounds. She doesn't feel like eating and says she isn't hungry even when her stomach is growling. My sister and I have tried everything to get her to eat more including having her try Ensure and other similar drinks which she refuses. Recently we took her to the doctor who is very concerned about her weight loss. He also said that my sister and I should discuss whether or not to have surgery on my mother to remove an enlarged artery sitting on her abdomen. The doctor is keeping an eye on any development but is concerned because it could enlarge and burst and kill her. He said we could decide on surgery but because of her weight and the fact that she has no 'reserves' left for her body to fight against any kind of infection it might make the surgery risky. There is the possibility of infection, stroke or a fatal heart attack with any surgery but especially surgery on an artery in the abdominal area. He told my sister and I to think about it and discuss it with my mom (which isn't easy considering that her dementia makes her easily confused and frightened about everything). My concern is that her low body weight might make her surgery riskier than it normally would be. My fear, of course, is that if we leave it alone the artery could swell and burst and kill her instantly. I have no idea what to do.

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Well my mother is at the point where while she still has a decent amount of awareness she gets very easily confused about things like this and becomes agitated...we have to approach her cautiously...even if we explain things to her within a certain amount of time she will forget it and we will have to explain it all over again and go through the same runaround routine regarding her health....it can get exhausting...She has Kaiser and frankly I'm not too impressed with them regarding seniors....I hate the 15 minute per patient mentality with hospitals like Kaiser...some patients, especially those with conditions such as my mothers, require more time and care....as far as I know they don't have geriatric specialists...I wish they did so someone would have a working knowledge of being around dementia patients for long periods of time...I hope to be able to discuss with more doctors but it may take some time....thank you for your concern...
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I would definitely talk to a surgeon, probably a vascular surgeon, with experience operating on abdominal arteries. Also, I would talk with an experienced anesthesiologist. Questions listed above are good. Can you and/or doctors discuss with your mother in simple terms, and let her desires or comments guide you ?
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Julie, this is so very hard, and my heart goes out to you and your sister.
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Babalou I believe the only fear my doctor had was that if the artery enlarged it could burst and she would bleed out in minutes therefore killing her....I don't believe that it is a matter of improving the quality of her life and since I do believe her weight issues are related to her dementia (I worked in a skilled nursing facility for 18 months with dementia patients so I'm familiar with their behavior and the symptoms) it wouldn't do much as far as her appetite is concerned. I'm frankly leaning towards not having it done as her weight is too low which compromises her immune system and should something occur during or shortly after surgery I'm not so sure she would adequately recover from it which was also a concern of the doctor's....I do like your questions and will pose them to him but I'm not so sure he knows enough about dementia....her appetite isn't connected to swallowing...her problem is what so many with dementia experience and that is she is not aware of being hungry even when her stomach is seriously growling...it's a cruel symptom of dementia and there isn't always much to be done about it...you can only reason so much with somebody who has dementia as I'm sure most of you know....it's very frustrating...If she were to gain at least 15 pounds I would be more confident about the surgery as would the doctor but right now I don't think it would be so good.....of course the other alternative is to simply hope that her artery never bursts.....I sometimes feel as if the responsibility comes down to me and my sister....either way I think we'll both feel devastated should something happen either way....thank you all for your suggestions...it really helps
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With regard to her eating, please have her doctor order a swallow study by a speech and language pathologist.
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I think you need to ask this doctor ( or better yet, a surgeon) some more specific wuestions.
1. Is this surgery going to reverse her weight loss?
2. Is this surgery going to improve the QUALITY of her life or just extend it?
3. What does the post surg recovery look like for a patient with dementia? Will she need to be kept sedsted? What are the implications of being bedridden for many days on her mobility?
4. What are her chances of improvement through pt?
5. What are the risks to her cognition from anesthesia ?
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My mom had breast cancer many years ago and has since been free of it....her doctor regularly checks her for cancer and she has blood tests....The doctor did not say it was an aneurysm...just an enlarged artery. He seems very concerned about it but I am apprehensive because of my mother's low body weight....I did not discuss anesthesia with him yet because he told us to think it over and let him know our response....The doctor did say that she would be in the hospital for awhile and she has never been hospitalized for anything longer than one night....
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The question is would it improve the quality of her life? There are a lot of things worse than death. If she dies instantly of her burst artery it may be a blessing over the long gradual death from dementia. Osteoporosis is often very painful for pts, and it won't get any better over the years. Does her doctor know why she's not eating and has lost so much weight? Does she have some other pathology (ie cancer etc) going on that they haven't found yet?
It's a tough decision you have to make. I don't envy you. May I suggest that you read up on dementia/Alzheimers disease, if you haven't already. Especially noting the stages of the disease so you will be fully informed of what your Mom's future may look like, it may help you make a decision. I know I may sound harsh in my comment but after watching my own Mom slowly dying from dementia, it is a horrible way to go. If I was you I would not have the surgery done and I would enjoy every day I could with her.
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Baba brings up a very valid concern about the anesthesia. It could very likely speed the progression of dementia. My Mom had a hysterectomy because of uterine cancer when she was 80. The result of the surgery was a much more confused Mom that caused her constant worry. Soon before whe was diagnosed with Alzheimer's. Knowing now what we did not know then, cancers spread very slowly in the elderly, and the effects of anesthesia may never allow her to return to her base line.
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Did the doctor say that mom has an aneurysm in her abdomen? It seems that elders sometimes develop an aneurysm of the descending abdominal artery. Indeed these are dangerous, and may eventually cause death. But they are also mostly slow to progress, I think.

Ask what the anesthesia is like. For dementia patients, anesthesia generally seems to accelerate the progress of the dementia. If this is a procedure that can be done in a minimally invasive way, then you might consider it. If it's a big surgery which will involve being immobilized, tubes, etc, that seems like it would be very confusing and frightening for mom.

Would it increase the quality of her day to day life?
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