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Friday, April 20, 2012
A QUESTION
Do you think that doctors/ surgeons should be suggesting, proposing / contemplating open heart surgery with all its huge complications and risks to replace a severely narrowed aortic valve on a 90 year old man ?
I guess that depends on the likely outcome if they don't do the surgery and the wishes of the person who is having the surgery.
If the prognosis for recovery is good and will have significant benefits for the quality of life of the recipient post surgery then I think a doctor has an obligation to look at all the options.
And it would be unethical for a doctor not to discuss surgical options with a patient based on age.
(Sorry - I slipped into my old nursing mode for a moment )
That's a tough call. If he's in otherwise good health, sure why not. People are living longer and longer. If he has a 50% chance of surviving, I would say no.
Yes Shay and MM ,it is my Dad. I think he is too old to go through such an ordeal especially with all the risks that go with surgery at his age. He has opted for a less invasive approach but there is a 6-12 month waiting list. Let's just hope he makes the distance.
Actually Helen this is a difficult issue, and one that we discuss frequently here with a high retired population. Shay is right of course, but i would think the less invasive course be the better option at your Dads age. He is at a very high risk of developing post operative complications, and may shorten his life considerably, or end up on a ventilator and not recover at all.
My thoughts exactly Mrs A. At the moment he feels fine and life is good though it may change quite dramatically at any time. But the thought of him spending his final days hooked up to machines fills me with dread.
So sorry to hear you're all in this situation, getting older is no fun at all, I'm not thrilled so it must be awful for the next generation up. My mother had a single heart by-pass at 78 and it has taken her 18 months to recover fully. She did have some of the complications they warned us of but naturally never expected; the heart surgery was very successful but she had serious kidney problems and a deflated lung too but she came through it thankfully. She seems ok now but has slowed down considerably, which could be age related as opposed to the operation of course. At 90 I guess all the risks are going to be a great deal higher but a 6-12 month wait might be risky too. Difficult one, and I hope I haven't said the wrong thing but you do need to be prepared for all eventualities I suppose. Of course, he could sail through it and feel like a completely new man in no time at all, all things are possible. Wishing him and you all the best.
Helsie, I agree that it all comes down to what your dad wants, his understanding of the procedure, risks, rehabilitation, complications and access to follow-up. The surgeon should spell all this out as many times as it takes to be understood. Frequently, procedures aren't explained thoroughly and clearly. Age is not as much a factor as his general condition, stamina, and wishes. It is up to him to decide. In the US we have something called advance directives. This is a legal document about a person's wishes for procedures to prolong life. I hope this has been helpful. Will be keeping you all in my thoughts and prayers.
I think you have to weigh up what his quality of life is now and what it would be after an op.I have a neighbour who is 90.She still drives and has been very active up till now but she had a fall two weeks ago and just isn't bouncing back as she usually does.Any op carries a risk and if it was my Dad I would be thinking very carefully about it.The second option sounds better to me.
Hey sweetie, that's a tough one at his age. I know you want the best for him. Can you get a second opinion over there. It seems like every doc I've seen here lately has their nose in a computer screen typing away. They don't even look at you anymore.
Will keep you all in my prayers. We have the same going over over here with big decisions and the senior. Mom's hubby just told absolutely no more driving with Alzihimer's getting worse very quickly. Glad to have gotten my break away in. I think I'm in for a long long summer and year to come.
It is right that they should be suggesting it but that doesn't mean to say that your father should accept. If he is of sane mind then it is of course up to him but in my opinion modern human beings must learn to accept more readily that death is inevitable and when you're old you must expect to die. If possible we should die with dignity, not grasping at straws for perhaps one more month, one more year and risk dying on an operating table surrounded by strangers.
I would have said it depends on the man's fitness and whether he would be likely to really benefit from it or not. On the other hand I think like YP. It really all depends on the individual. I hope your Dad keeps going for the waiting period. Just make the most of him, that's the main thing. A very good friend's mother has just died suddenly and unexpectedly in her sleep. No warning. Makes you resolve to live every day as though it were your last.
I guess that depends on the likely outcome if they don't do the surgery and the wishes of the person who is having the surgery.
ReplyDeleteIf the prognosis for recovery is good and will have significant benefits for the quality of life of the recipient post surgery then I think a doctor has an obligation to look at all the options.
And it would be unethical for a doctor not to discuss surgical options with a patient based on age.
(Sorry - I slipped into my old nursing mode for a moment )
Im assuming this is your Dad Helen?
That's a tough call. If he's in otherwise good health, sure why not. People are living longer and longer. If he has a 50% chance of surviving, I would say no.
ReplyDeleteYes Shay and MM ,it is my Dad.
ReplyDeleteI think he is too old to go through such an ordeal especially with all the risks that go with surgery at his age. He has opted for a less invasive approach but there is a 6-12 month waiting list.
Let's just hope he makes the distance.
Actually Helen this is a difficult issue, and one that we discuss frequently here with a high retired population. Shay is right of course, but i would think the less invasive course be the better option at your Dads age. He is at a very high risk of developing post operative complications, and may shorten his life considerably, or end up on a ventilator and not recover at all.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteMy thoughts exactly Mrs A. At the moment he feels fine and life is good though it may change quite dramatically at any time. But the thought of him spending his final days hooked up to machines fills me with dread.
ReplyDeleteSo sorry to hear you're all in this situation, getting older is no fun at all, I'm not thrilled so it must be awful for the next generation up. My mother had a single heart by-pass at 78 and it has taken her 18 months to recover fully. She did have some of the complications they warned us of but naturally never expected; the heart surgery was very successful but she had serious kidney problems and a deflated lung too but she came through it thankfully. She seems ok now but has slowed down considerably, which could be age related as opposed to the operation of course. At 90 I guess all the risks are going to be a great deal higher but a 6-12 month wait might be risky too. Difficult one, and I hope I haven't said the wrong thing but you do need to be prepared for all eventualities I suppose. Of course, he could sail through it and feel like a completely new man in no time at all, all things are possible. Wishing him and you all the best.
ReplyDeleteKate x
Helsie,
ReplyDeleteI agree that it all comes down to what your dad wants, his understanding of the procedure, risks, rehabilitation, complications and access to follow-up. The surgeon should spell all this out as many times as it takes to be understood. Frequently, procedures aren't explained thoroughly and clearly.
Age is not as much a factor as his general condition, stamina, and wishes. It is up to him to decide.
In the US we have something called advance directives. This is a legal document about a person's wishes for procedures to prolong life.
I hope this has been helpful. Will be keeping you all in my thoughts and prayers.
I think you have to weigh up what his quality of life is now and what it would be after an op.I have a neighbour who is 90.She still drives and has been very active up till now but she had a fall two weeks ago and just isn't bouncing back as she usually does.Any op carries a risk and if it was my Dad I would be thinking very carefully about it.The second option sounds better to me.
ReplyDeleteHey sweetie, that's a tough one at his age. I know you want the best for him. Can you get a second opinion over there. It seems like every doc I've seen here lately has their nose in a computer screen typing away. They don't even look at you anymore.
ReplyDeleteWill keep you all in my prayers. We have the same going over over here with big decisions and the senior. Mom's hubby just told absolutely no more driving with Alzihimer's getting worse very quickly. Glad to have gotten my break away in. I think I'm in for a long long summer and year to come.
Hang in there.
It is right that they should be suggesting it but that doesn't mean to say that your father should accept. If he is of sane mind then it is of course up to him but in my opinion modern human beings must learn to accept more readily that death is inevitable and when you're old you must expect to die. If possible we should die with dignity, not grasping at straws for perhaps one more month, one more year and risk dying on an operating table surrounded by strangers.
ReplyDeleteMy thoughts completely YP
ReplyDeleteI would have said it depends on the man's fitness and whether he would be likely to really benefit from it or not. On the other hand I think like YP. It really all depends on the individual. I hope your Dad keeps going for the waiting period. Just make the most of him, that's the main thing. A very good friend's mother has just died suddenly and unexpectedly in her sleep. No warning. Makes you resolve to live every day as though it were your last.
ReplyDelete