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My Mom is 87 and has a stone in her common bile duct. It has flared only once that we know of and it was short lived. They want to do a procedure to remove the stone but she would have to be put under general anesthesia. Do we leave it and risk problems later or do it and risk making dementia worse!

My step father age 90 just had a stent put in his leg. Everything went well until it was time for him to go home, his blood pressure plummeted, scary he ended being there for an other 7 hours, they finally got his BP up. Me? I'd avoid unless it is a life threatening situation.
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Reply to DollyMe
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My husband has had the same issue. About 15 years ago, he had the same issue: passed a pancreatic stone through the common bile duct and left scarring, that increases over time. Recently he lost weight (from normal 160 lbs. down to 109, and had to be anesthetized to examine the bile ducts.
This was last year. Since then, he's been diagnosed with a stricture and temporary stent placed in the duct to stretch it. He's been anesthetized 4 times in the past year for internal exam for cancer (none), and replacement of temp stents. Dr. will not put in permanent one since there's no cancer (why is that?), so we "look forward" to 2 more procedures within the next two months. All this has produced anxiety. I agree with the guinea pig remark!
His dementia has been showing signs of both progressing and receding alternatively.
He's been declining physically and mentally for 14 years, but seems to rally for months at a time. He's 85, and keeps announcing he'll live 5 more years when he's feeling good (about once every two weeks). If so, that will be the death of me, his caretaker. I love him dearly, but I really need to outlive him to take care of him and then dispose of his thousands of books and tools so the kids don't have to, that he refuses to give up!
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Reply to sometimer
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Antibiotics can also cause decline so it is unclear a lot of times which caused the decline, anesthesia or antibiotic or stress?
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Reply to Weeroo
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sanhoro12 10 hours ago
General anesthesia causes the blood pressure to drop which decreases the amount of oxygen to the brain. The risk is commensurate with the mental condition of the patient related to age and how long they're under the anesthesia.

Some antibiotics can reduce dementia since they eliminate the infection that's causing a temporary decline in the mental state. Don't let people talk you out of getting treated.

The author might look at changing the diet to see if it'll reduce or eliminate flare-up's.
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Any anesthesia will have an adverse effect.
I would avoid it if at all possible.
If sh currently has no problems and the situation resolved on it's own previously I would opt for the leave it alone course of (in)action.
If there is a flare up I would opt for the least invasive method.
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Reply to Grandma1954
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I would try to avoid anesthesia like the plague. Leave it alone & it will eventually pass naturally. That’s my opinion. You can also get a second dr opinion.
hugs 🤗
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NYDaughterInLaw Feb 15, 2020
I agree 100%.
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I'm in the same situation, Different155, just a different surgery. My mom has a polyp just inside her rectum that is causing increasing pain and some bleeding. Surgery has been recommended, but we are getting a second opinion next week to see if there are any other options available. My mom moved in with us 2 1/2 years ago and the neurologist told us she was just getting older and forgetful. I didn't know about anesthesia at that point so when she went in for cataract surgery 6 months later I was surprised at the change in her behavior. She was then diagnosed with first stage dementia and ALZ. She had a colonoscopy last month with "twilight anesthesia" and was assured by everyone it was safe, but she has had a significant decline in her cognitive abilities as well as her emotional stability in the past 4 weeks. Needless to say, I'm scared, too. I'm bracing for having to make the decision for surgery, since I don't really expect there to be any other option. I do hope the very best for you and your mom.
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Reply to kirahfaye
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Dear Different, you've decided to get it done (prob only real choice really). Short anaesthetic so fingers crossed should be fine.

I think it's the longer time/surgeries that seem to push folk along the dementia levels but I'm sure it varies a lot.

Best of luck. Remember delerium is tempory & so easily confused with dementia. Expect a few *off times* at the start & hopefully things return to normal.

Otherwise it is what is called adjusting to *the new normal*. Which you will do because you sound like an intelligent, caring person & you've got this. All the best.
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Reply to Beatty
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Here is a link about anesthesia and dementia from the Alzheimer's Society in the United Kingdom:

https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/general-anaesthetics

If it's only flared once, why isn't the doctor considering high energy extracorporeal shock wave lithotripsy? Here's an article from the British Medical Journal "Treatment options for common bile duct stones": https://pmj.bmj.com/content/79/929/181.1
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Reply to NYDaughterInLaw
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My dad had hernia surgery at around 80 years old just as his dementia was beginning. I noticed a definite increase in his dementia afterwords, much more repeating questions, and this didn’t improve over time, just got worse as he aged.

Dad ended up in memory care and broke a hip this past September. He’s now 89. It required a pretty simple repair surgery of about 20 minutes under anesthesia. I was pleasantly surprised that it didn’t seem to increase his dementia. However his dementia is still slowly increasing. I visit him just about every day. Yesterday he was getting me confused with his long dead brother. This is a new decline.
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Reply to Windyridge
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I can’t source articles but from my personal experience with my mother, anesthesia definitely triggered an increase in my mom’s dementia.
She had 3 surgeries in the last 7 yrs of her life. First a mastectomy at 81- mom didn’t have dementia before or after this surgery.
At age 83 mom needed a double CABG. That was heavy duty for her. ICU, ventilator, 100%. Mom made it through this surgery with no change in her mental status.

When she fell & broke her hip at age 87, that surgery and anesthesia made her a totally different woman. She was never the same after this- couldn’t always remember who my brother nor I were, always confused.
By the time she passed she still couldn’t remember who we were. It was 2-2 1/2 yrs after the hip repair. Then she had to go to a SNF/NH where she was for 14 months before she passed.

Your mother needs this surgery. That stone needs to be removed or she can develop sepsis. I would go in knowing the risks and making preparations for where your mom will be cared for afterwards & realize her needs and care requirements will most likely increase.
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Reply to Shane1124
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There is documented evidence that patients with cognitive impairment will be Negatively effected by anesthesia. Are there other avenues to explore that may be helpful to your Mom?
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ExhaustedPiper Feb 14, 2020
Tide, do you have any links handy on that evidence. If so I would like to read it. My mom doesn't have a stone like the OPs but is considering a surgery that will require anesthesia. I don't feel the surgery is necessary and I'm worried she will come out of it worse.
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This procedure is done through an endoscope through the mouth. No incisions but will be put completely asleep. GI doc says usually takes only about 10-20 minutes. Hoping the anesthesia will be propofol like for colonoscopy but don’t know that yet. The doc called the stone “a ticking time bomb” therefore we have decided to have it done.
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Reply to Different155
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You have no choice but to have the stone removed since both the stone and the general anesthesia can contribute to mental decline.
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Reply to sanhoro12
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Different155, I remember when my Dad [90+] had bile duct surgery as it was making Dad quite ill. After the surgery he needed to go to Rehab for 21 days to regain his strength.

Note that with any surgery, even with much younger patients, every hour one is under with anesthesia, it will take one month for each hour to get rid of the brain fog.

You have to weight the pro and con with any type of surgery. If your Mom waits, what would be the risks, if any.
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Reply to freqflyer
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With a stone you often have no choice if there is pain. With a stone without movement and periodic checks on growth, it can be benign until death and not need surgery.
As a nurse I OFTEN saw dementia after anesthesia. Only a few cases were new onset, sudden and lasting. Many dissipated with time. However some did NOT. There is much controversy about this in medicine with doctors denying it can happen and others seeing it actually happen in the elderly and not without frequency. To tell the truth, an elder in the hospital who has early stages of dementia can become very confused and discombobulated in hospital, and better on discharge.
I would act only if there is pain, danger, and problems, or problems that could occur emergently. Also ask about the surgeon's expectations for removal. A large incision is rare today. This is almost always done by endocopic, and some can now do it through the throat without anything invasive (UCSF able to do this some years ago, was teaching it at the time).
If this was diagnosed due to symptoms, such as nausea, vomitting, pain you really have very little choice.
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Reply to AlvaDeer
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If the procedure is done with small incisions he may not be under all that long and should recover better. A stone in the bile duct is serious. I would do it.
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Reply to JoAnn29
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I found that the side effect (increased dementia) was temporary with my Dad. For the first week it was very profound, but diminishing as the weeks went by.

I think he was back to were he started after about a month. It was sure not a fun month, but he did recover from it.
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Different155 Feb 12, 2020
Thank you that is comforting!
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