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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!

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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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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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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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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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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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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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My mom is 79 and has moderate dementia and we have decided not to do anything that requires anesthesia.  I know she would not want steps taken to prolong her life so that she can have more years with dementia.  I know to some folks that may sound horrible, but to many of us, there is a huge difference between "living" and "existing".

If it were me and mom had only had one short lived situation with the stone, I would not do the surgery.
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Update! My Mom had the procedure on Monday and did well. Yes, the anesthesia has increased her symptoms of dementia somewhat but hopeful she will return to her “new normal” in a few days! As it turns out it was very necessary as they found a mass as well as a stone. She now has stent to keep the duct open.
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sanhoro12 Feb 19, 2020
There seems to be a lot out there on dealing with this problem. Get her back to being active, staying hydrated, having someone around to talk to and observe her state of mind, and avoid certain medicines that can exacerbate it.

https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium
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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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sanhoro12 Feb 16, 2020
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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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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lala195 Feb 17, 2020
You're doing the best you can with what you know. Be prepared for hospital delirium and potential pneumonia. Please read to the end. Good news to be found there! Recently, MIL, 87 with bronchiectasis, had hip surgery (fractured femur, ORIF procedure). She was ambulatory and enjoyed living prior to surgery, and has shown only slight dementia. Some docs recommended hospice but said it was our call. She couldn't have general anesthesia because of lung disease, so we went with a spinal, she went to surgery, and we prayed. After the surgery, MIL had hospital delirium; threw things, was in a dream all the time. She could not self feed/drink at rehab or get therapy. MIL developed pneumonia around this time and was treated with Rosefin. Then, back at ALF, her O2 level dropped, and she had to be transported twice to the ER because her Raynaud's didn't allow the finger pulse oximeter to register more than 60. In the ER her 02 was 92 with the better oximeter. Since she had the low 02 drama, couldn't complete sentences, was sleeping all the time with a BiPap, having to be fed by us, we chose hospice to be done at the ALF. As caregivers for the last decade, it's a mercy that we only know the difficulty in hindsight. We were prepping for a funeral, when my hubby went to visit and feed her this last week. Nearly six weeks after surgery, MIL began to speak in complete sentences as before. She thought she might want to go to the ALF Valentine's lunch (which she did). She wanted a haircut and wanted to know where all her shoes were! She's ravenous and wants real food, not pureed. What a turnaround! It's as though she woke up! So, her stamina isn't quite what it used to be, but her will to live is back on display. She's a tough 85 pounder! We're going to have to talk with hospice and decide if we continue or make changes to her care plan. She wants to walk again, but one more fall would do her in. Always more decisions, but that comes with the responsibility. Prayers for you!
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