Last month I took DH to the doctor just on general principles as it was approaching a year since he saw his PCP. Also, he was sometimes pale and tired. I mentioned that I had stopped his BP med because he always was running low. The doc took the bp, noted it was low, and this is months now that he's been off bp meds. So, she sends us over for cardiac echo to check for reasons for the low bp. Afterward we were told the doc would contact us if there were any concerns/abnormalities. That was October 23.
In mid November I tossed this envelope into a basket and didn't look at it until today. I guess I assumed it was a "form" letter telling us "THE RESULTS OF YOUR RECENT ........ are normal." Because of the time that has passed, and the fact I figured I'd get a call if there was a concern. Well, today I start going through stuff I put aside, and here is what this letter from the family practice clinic said.
Dear Paul,
Your echocardiogram from Oct. 23 show mild leaking of the mitral valve, and moderate leaking of the tricuspid valve. Neither one of these would cause low blood pressure. However, the mitral valve is also heavily calcified.
The walls of the pumping chamber contract normally and fully, but they are stiff on the recoil. This also would be unlikely to cause low blood pressure, though it could make you short of breath and tired.
You should discuss treatment options and any questions you might have with Dr. S. She can let you know when you should have a repeat study.
Best wishes,
Dr. blah blah blah
OK, I've done some googling. Yes, DH had rheumatic fever as a youngster. Much of the info I was looking at mentions valve repair, or replacement surgery. Anyone elses ADLO had any of these procedures since AD was diagnosed? Last thing in the world I want is for DH to have to have any anesthesia, regardless of the type.
How low is it? DH bp has always run low. Sometimes they take it twice and everybody always comments on how low it is. I can't remember the number but Dr. has never sent him for a test. Of course, he has never been on bp meds, so that may be the difference. I think anesthesia would do my dh in. What stage is your h. in? Looks like they would have called instead of sending a letter if they thought it needed immediate attention.
Diana, from the little information available in that letter (!!! imagine sending a letter like that !!!), it doesn't sound like a crisis situation. The letter seems more focused on treatment and "let's see you again in x months, to see how you're doing". The actual calcification can't be treated by anything other than surgery, but your husband may not need it, if it isn't blocking the blood flow very much. Meds can be used to alleviate or prevent various symptoms -- diuretics to relieve pulmonary congestion, beta blockers, calcium channel blockers, and/or digoxin to control ventricular rate, to treat atrial fibrillation if that develops, and/or anticoagulants to prevent strokes in patients with a history of atrial fibrillation or arterial embolism. If they don't know that your husband had rheumatic fever as a youngster, then they might also be thinking that he should be on antibiotics -- one web site recommended five years on antibiotics after the initial infection, to make sure the disease is knocked completely out.
If the calcification is blocking the valve to the point that enough blood can't flow through, so that the valve itself needs to be "unblocked", it is possible that a catheter-based technique could be used. From the description, this sounds very similar to the "balloon" procedure that they use to open blocked arteries, and the patient is awake for that procedure -- my father had a couple of those and, being a doctor, was only too happy to give me all the details afterwards. They insert the catheter in the femoral artery in the groin, and the patient helps them guide the catheter to the blocked location by moving his body, as directed. They set up the computer screen so that Father got to watch the catheter move, along with the doctors...
DH is in about stage 6 (some 5, some 6+++). He used to have BP a little high. A few years ago he was having some mild chest pressure, shortness of breath and "wooziness." He had an EKG, and it was normal. Then he wore a holter monitor for 24 hours and it was essentially normal. That is when they put him on a BP med. Can't remember the exact reason. The BP wasn't dangerously high. There was some other thing they thought it would help with. He's running about 106/60, give or take a few points.
Anesthesia was a disaster for DH in 2005 (shoulder surg), and tho' I know he shouldn't have inhaled Isoflurane again...... and locals or twilights are considered easier on dementia patients, still............ its just the stress of surgery on the human body that can cause problems all by itself.
lmohr, in my experience, you can't count on the doctor's office, or hospital, to call if there's a serious problem. My husband has had, what, seven basal cell carcinomas and one squamous cell carcinoma, all requiring surgery. The squamous type can develop pretty quickly, and his was on the lower lid of his eye, where it could cause a lot of damage. I think they called me once with the results. Every other time, I had to call them. They always SAY they're going to call, but they get busy, charts start to drift toward the bottom of the chart, maybe they try once or twice and you don't answer ...
Always, always, always call them. Always. NEVER assume things are OK if you don't hear back. Never.
You posted as I was writing. I appreciate the info you've provided.
I am (was) an LPN in acute care for 20+ years, and had accompanied patients to the cath lab before. I knew about their procedures, but not great detail about their diagnosis.
Oh, I just think I'm frustrated by the what ifs of it all. Its like, "come on God. The AD is enough to handle. I don't need any more."
Diana, stress from MAJOR surgery is a concern, yes, but the stress is primarily from staying in a hospital, with that wonderful, calm, home-y hospital environment(!) Most dementia patients do well even for surgeries that require an overnight stay. Honest. I looked into that for a friend whose ADLO was facing major surgery.
The balloon procedure is an out-patient procedure. It takes a few hours but most of that is because the patient has to lie still for quite a while with pressure on the femoral artery after the procedure is over, to make sure he doesn't start bleeding.
And you don't even know that the valve needs to be fixed yet. So try to calm down, please? I know it must have been a horrible shock to open that letter, plus the frustration of doing it on the weekend when you can't call (isn't that always the way) ... ! But I really do think the letter would have been worded differently if the valve needed to be replaced or something major like that.
...and you posted while I was writing. Yeah, I know what you mean. AD is more than enough, without anything else added on top. And you've had LOTS of other things added on top. I keep waiting for another bout between you and the mower...
I didn't know you were an LPN. Have you ever admitted that on the boards before?
My husband has just delicately hinted that he is starving to death. Please postpone any additional crises until tomorrow, OK? You take care. Have some wine -- it's good for you, there's been another study on its benefits:
OMG, I just can'at imagine....DH seems to be in good health. His BP is controlled. His heart rate is low which is a good thing, I guess. He looks pale to me. And his hands are always cold. He does not volynteer to do any kind of exercise at all. He asked me today how old I am. I told him 77. How old are you, I asked. He was completely bewildered. He said, I don't know. I think I'm about 80. He's almost 83. That made me very sad. I hope he never has to have any major surgery. I just don't know what' I'd do. It can't be an easy decision. I'm praying for you. So many prayers to ask but I'm so glad I'm able to do that for my friends on this site. Blessings!
I didn't know an AZ/Dementia patient shouldn't have anaesthesia ...... so I must as why? My husband is on Reminyl ER 24mg and Citalopram 20mg once daily.
My husband has an inguinal hernia which we have been dealing with for 8 years by using a truss. Now, however, it appears the truss is no longer doing it's job and our GP has made a referal to a Surgeon - the appointment isn't until January.
Now I don't know what to do ...... can anyone bring some light on the subject for me?
With any luck Sunshyne will be along in a few minutes with a whole list of things for you to read. But to just begin...
Basically it depends on where your husband is in this journey. Because with some anesthetics he won't come out of surgery in the same condition he went into it. And again, depending on where he is in the journey, just being in the hospital can send a dementia patient into a permanent downturn. So unless it is an absolutely necessary surgery, as a broken bone would be, most of us try very hard to avoid it at all costs.
In addition to reading up on the subject, you need to talk not only to the surgeon, but also to the anaesthesiologist. And in this case, not just the day before the surgery, but well before. It is very likely that the decision to do the surgery won't be the call of the surgeon, but the call of the aneasthesiologist.
We have also talked about this stuff before. Here is one thread. Maybe someone will be able to come up with more of them:
The important thing to consider is the degree of necessity for the surgery, and your loved ones stage in the AD journey. A hernia at the stage you describe is dangerous. Surgical repair of the hernia wouldn't be elective. It would be necessity.
It's just very important to be aware of anesthesias and discuss them with both the surgeon and the anesthesiologist, the latter being the most important. One needs to be aware of the possibility of decline, or extremely delayed return to baseline post-surgery.
Bar-bra-hernia repair can be done under local anesthesia and you can arrange to be with your husband pre and post op. He will be under light sedation and should do just fine. Trust me-as an RN I would love to have you with your husband to reassure him and keep him calm.
"Luck"??? You would not want my list on this topic, trust me!
The thread that Starling references contains a pretty fair summary of my findings. I read dozens of lengthy papers, and looked at the abstracts of dozens more. I did not find much (if anything) that gave a concise, readily-understood synopsis. The whole area is still very controversial. Basically, however, it appears that the anesthesia may not be the culprit. There are some meds that are sometimes used pre- or post-op that can cause a problem, and the hospital environment itself is confusing and upsetting to the patient.
What New Realm (the nurse!) says is true. Look at whether the surgery is necessary. If it is, then do what you can to mitigate any potential problems. Express your concerns to the PCP AND the surgeon AND the anesthesiologist.
Do look at that thread for things that CAN cause problems *other than* the anesthesia. Most of these have to do with hospitalization itself (which has been shown to cause a decline in cognitive function withOUT any surgery at all). So be very pro-active during your loved one's stay in the hospital.
The use of certain meds should be avoided, including diazepam used pre-operation, or benzodiazepines or meperidine used post-op. Factors associated with the hospital environment, such as sleep deprivation, immobility, dehydration, sensory overloading (bright lights, noise) and lack of a home environment, have been linked with delirium, which increases the risk of decline in cognitive function, and there are things you can do to help mitigate their impact which are discussed in that thread Starling references.
Also, you need to remember that, as New Realm says, many patients do have some decline during the days and sometimes weeks following surgery, but these usually resolve. So do not panic if your ADLO seems worse at first. Continue doing what you can to keep him/her oriented and free from distractions and sleep deprivation, and loved one is very likely to regain his/her former level of function.
One thing that I did not mention in that thread was a 2007 review of knee and hip surgery done on 36,025 patients over 90 years old, and on 687 patients over 100 years old. The data showed that these patients can benefit from such major surgery, despite the very high precentage of patients who were suffering from moderate to severe cognitive impairment prior to the operation.
Yes, I became an LPN in '84. The RN program "Lottery" was too long to wait for. I was a single parent of a toddler and needed to get working quickly. Obviously, I never made it back to school to finish up my RN...yet. Matter of fact I should be doing it now as my Mom begged me to -before she died. Just weeks after she passed away DH had the shoulder surgery which drastically pronounced his AD which was suspected at early stage before surgery, but had not been diagnosed. The kids were early teens, and I was having to take over everything.................so no school for me----yet. My day will come, only I'll be feeling too old for the hospital routine which I prefered over private duty.
I was given a mandatory lay-off from my last hospital stint (end of 2003) because the admin. decided to go with the "RN only" staffing in all acute care departments. Totally sucked. And working the nursing home circuit did not appeal to me then. As fate would have it, I have been caregiver for Mom, then my DH continuously since then. Hmm! Wonder how well that will help me in my future job search. I'll be fifty-something, and no job history for well over 5 years.
Private practice for five years, for two satisfied clients. You just have to put the right spin on it. <grin>
Seriously, though, if you have any interest at all in nursing home work when you finally get back into the "real world", I'd think this experience would indeed be relevant. And many hospitals are experiencing a really bad shortage of nurses, so if you went back for your RN, you might not have any trouble finding a good job. Depends on the part of the country where you're living, I think.
New Realm, my DH also had shoulder surgery before he was diagnosed and gall bladder surgery 2 months later. I knew he had some cognitive problems before the surgeries but he took a definite downturn. After that we had no doubt that he had AD and he never returned to his former level of functioning.
I would avoid any more surgery unless it absolutely has to be done.
By the way, I agree with Sunshyne that your personal caregiving experience should count for a lot when you get back into the real world. We need more RN's. Hope you can finish your schooling.
THANK YOU all so very much for all the information you've shared and the other posting information regarding surgery and dementia.
The hernia is such that when I take his truss off at night it bulges right away, thus the need for a hernia repair although I, like many of you, would much rather avoid surgery of any sort ....... even for one without AZ/dementia ...... however, I don't think we can avoid this one.
Bar-bra there is one additional part of the surgery that has not been talked about. That is what you and he have to do afterwards. Not only can surgery make AD temporarily (or permanently) worse, but the decline can make a huge difference in their ability to follow doctor's orders.
My husband had to have rotator cuff surgery (just prior to diagnosis). He came out of the surgery and was sitting on the bed with the huge contraption on his shoulder and asked if he was going for surgery yet. He also managed to pull the ball of pain meds out of his shoulder. I had a horrible time keeping him in the splint too - he kept taking it off. This was done as out patient surgery. I think that if I had known about the AD and the type of care that he would need after the surgery, I would have asked that he be kept in the hospital at least overnight. There would also have been a discussion on the meds that he was given and their affects.
You could have written an exact scenario for my DH. His rotator cuff surgery immediately preceded diagnosis. He was so noncompliant, and dramatrically declined from his pre-surgery status.
This is THE REASON his ortho doc doesn't want to do his knee. He won't be able to follow rehab, and chances are too great that he won't even get back up on his feet.
therrja .......... I don't really think, knowing my husband, that post-surgery care would be a problem as far as his compliance is concerned - I do find he is very compliant regarding health matters which is quite strange 'cuz he can be most *non-compliant* if you tell him NOT to do something he's set his mind to do ..... LoL !!!!!! - just like a kid !
I totally agree that while hernia repair can be done as an outpatient, I think when we (the doctor and I) get to the point of discussing the why, the when and the where of the issue, that I will strongly request an overnight hospital stay .... just to be sure. I do understand that there could be somewhat of a downward spiral but there again perhaps discussing my husband's present situation with the anaestheologist will look after that and, of course, I will definitely ask if he would be able to have just a *light* anaesthetic as others have mentioned and would also indicate to the staff that I am more than willing and comfortable to stay with him post-op and overnight to keep things calm and contained.
Oh boy ..... these side health issues certainly do cause one's plate to more than overflow ...... don't they!