Open Heart Surgery at 86?

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posted on Jan, 21 2013 @ 11:35 AM
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My 86 year-old mother in-law was rushed to the hospital on New Years eve. She was having a difficult time breathing, and since her husband who is 87 years old was fighting the flu and she was starting to get sick, they thought maybe her flu was turning into ammonia.

The doctors in the emergency room realized she was having heart failure and it wasn't due to the flu. She's on a blood thinner, has hypertension, sugar peaks at times and is over-weight. They sent her home and increased her blood thinner, which her husband talked her out of, because of a personal experience he had a couple years ago when doctors increased his blood thinner medication to the point where he almost bled to death.

Luckily she listened to him. She was back in the hospital and had to wait until her blood thickened so they could perform a catheter exploration to find out why her heart wanted to fail. The results of the catheter came back poor, she had 99% blockage in one area of the heart and 80% in another. A stent was out of the question because her veins were not in good condition.

Here's the amazing thing, the surgeon wanted her to undergo quadruple by-pass surgery even though the veins they would use to do the by-pass were not in that good of shape. So she and her family had a tough decision to make, either go ahead with the high risk surgery or just have her medicated to try to improve what little blood flow she had.

I offered up my experience in this situation since my uncle had open heart surgery at the age of 83, and he never recuperated after his surgery. They could never get his lungs working again and he was bed ridden in a nursing home with a ventilator for the last 2 months of his life.

I was amazed that the surgeon said there was only a 17% mortality rate with open heart surgery. Really? Seemed quite low when everyone I talked to, who had an elderly loved one, died after getting open heart surgery.
I did some research on the web and found out some sites had the risk of mortality for the elderly, at more than 70%. Quite a stretch from a measly 17%.

Lets face it, once you make it to your 80's the chance of dying is like waiting to pull the ace of spades out of a deck of cards. I told my wife if she even made it through the surgery her quality of life would probably never be the same. I truly believe if my uncle never did the surgery he would still be alive today. They're still debating what to do. Their mother in law really doesn't look bad considering the blockage. One of the cardiologists said even though she has blockage, there are other veins off the main ones that provide blood to the heart.

The question I have for everyone out there, have you ever had a loved one in their 70's and 80' undergo open heart surgery, and what were the results? Your responses may give them peace of mind since they are leaning with not to go ahead with the surgery.




posted on Jan, 21 2013 @ 11:45 AM
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It sounds to me like the doctor/hospital wants money for the surgery.



posted on Jan, 21 2013 @ 11:45 AM
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reply to post by WeRpeons
 



They're still debating what to do. Their mother in law really doesn't look bad considering the blockage.



Your responses may give them peace of mind since they are leaning with not to go ahead with the surgery.


First question is she lucid and able to make her own decisions?

Second question, if she is, does it matter what "they" want in the slightest, shouldn't it be her decision and her's alone?

Third question, if she isn't lucid, and they are tasked with this difficult decision and the procedure can be afforded financially (unfortunate to have to include) then I would say go for it. 17% or 70% mortality, either way there is a chance and if the "mother-in-law" is loved and these people want to try every approach to try and extend their time with her, then why not?



posted on Jan, 21 2013 @ 11:58 AM
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I take it your not from a nation with free health care. The doctor probably just wants a fee from the surgery as these surgerys dont come cheap if you or your insurance has to pay it. The blood thinning tablets could be part of the same money grabbing scheme.

Imo once you are that old then you should just go gracefully if you can and heart failure will be a lot shorter and sweeter than months/years in care slowly dying from a morphine habit.



posted on Jan, 21 2013 @ 12:00 PM
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It is definitely her decision, and she should make it knowing it could leave her facing an end of life outcome, either way she chooses.

Surgery always carries the risk of death, whether you are 19 or 90. Various risk factors come into play according to the individuals health that increase the risks. Those include health issues like diabetes, hypertension, and age. If she has the surgery, she could have a stroke. A lot of risks, and she has every right to be told all of them, and then be allowed the time, pressure free, to make the decision for herself.


Sometimes, people decide that they have lived a rich and fulfilling life, and this is their time to go. Grant them the right to go, with the knowledge ahead of time, with the time to say their peace and goodbyes. It's something some never get the chance to do.

She may have many good days left with proper medical care, or she may die tonight in her sleep. None of us knows, but always give her the freedom, without pressure, to decide what is best for her. Most of all, be sure to say I love you. Sometimes, we just forget, or assume people know.
edit on 21-1-2013 by Libertygal because: (no reason given)



posted on Jan, 21 2013 @ 12:01 PM
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reply to post by UberL33t
 


She is lucid, but she also wants her families opinion. Ultimately, it is her decision. There's nothing wrong with family members expressing their concerns to help in her decision making.

What she is concerned about, is being bed ridden or having the quality of life diminished to the point where she's in pain, can't leave her bed, be stricken to a nursing home, or simply the surgery causing her to die sooner than later. The doctors have already stated that recuperation in the elderly can take 6 months or more. Some never recuperate and than some lose the quality of life they once had.



posted on Jan, 21 2013 @ 12:06 PM
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Originally posted by kimish
It sounds to me like the doctor/hospital wants money for the surgery.


Yep. Not to be blunt, but when it seems the patient is at EOL, I guess it is better for the hospital to get paid for a surgery than to not get paid for one they don't do, when the end result will likely be the same.

This is what we have become.



posted on Jan, 21 2013 @ 12:14 PM
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I take it your not from a nation with free health care. The doctor probably just wants a fee from the surgery as these surgerys dont come cheap if you or your insurance has to pay it. The blood thinning tablets could be part of the same money grabbing scheme. Imo once you are that old then you should just go gracefully if you can and heart failure will be a lot shorter and sweeter than months/years in care slowly dying from a morphine habit.
reply to post by lewman
 


Yep, I'm part of the great American Health Care system, where if you don't have health insurance or the money to pay for it you die. Fortunately, the little money my mother in-law and father in-law live on, they pay the majority toward their health care insurance, but yet they have no life insurance.


I question why some of the cardiologists have steered away from pushing for the surgery. Yet the surgeon comes in smiling, and acts like the surgery is a walk in the park. I personally think the statin and beta blocker drugs are the way to go. If it were me, I would rather die with dignity than lie in bed struggling every day of my life. I already saw my sister in-law die that way, and ever since than, I have decided I would never pro-long my life if their really was no positive options.



posted on Jan, 21 2013 @ 12:18 PM
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I am so sorry. This is a difficult decision no doubt. Her age and condition is part of the normal aging process. I have seen a lot of patients completely lose their quality of life after a high risk surgery such as this.

If it were me, I would NOT do it! Sometimes people have to realize that they cannot live forever. 86 is, not to mean,is VERY elderly.....She may want to live the rest of her life on her own terms rather than give away what she has left to doctors. The pain and recovery time for her age is way too risky.....I am a nurse and of course this is just my own opinion.....This will be a hard decision but one that she should make without medical pressure for profit......
Blessings to your family...



posted on Jan, 21 2013 @ 12:20 PM
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reply to post by kimish
 


I was thinking the same thing. You kind of wonder if they value the life of the elderly. Kind of like, "who cares if she doesn't make it through the surgery, she's 86 years old, she has to die sometime and we might as well make money off it." Not to say that is what they're thinking, but you wonder if it was their mother would they take the risk?



posted on Jan, 21 2013 @ 12:22 PM
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reply to post by WeRpeons
 



but she also wants her families opinion. Ultimately, it is her decision. There's nothing wrong with family members expressing their concerns to help in her decision making.


I agree, and I extend my sympathies to you and yours for having to deal with such decisions. I am sure that whatever is decided will be in the best interest of the patient (on the side of the family that is). Good luck to her and may she live many years to come.



posted on Jan, 21 2013 @ 12:29 PM
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reply to post by WeRpeons
 


Then, the best way to make an informed decision is to know how the procedure is done. Do you know?

The veins that are used are generally taken from the legs. The incisions on the legs can be rather large, and are painful. If her diabetes has been severe or poorly tended, leg wounds tend to take a very long time to heal. This could be a potential hinderance to her walking. Recuperation from any surgery is getting up and moving agin, walking is so important. Without proper pain control or motivation, she may not feel compelled to move as much as she should.

Next, a large, 6-7 inch or longer, incision is made in the center of the chest. The breastbone is broken free and removed from the ribcage. The patient is connected to a heart/lung machine, as the heart will be totally stopped. All blood will be re-routed through the heart/lung machine to circulate, oxygenate, and filter the blood during surgery.

The chest cavity is then packed with ice until the heart slows down and ceases to beat. Once that happens, any blood left in the heart is removed, and the veins that have been harvested from the legs are carefully placed into their bypass positions.

This is the most delicate part of the surgery, and doctors have stated that it is like trying to sew through a tiny wet, soggy noodle. Sometimes, this tedious part takes the longest, because they have to make multiple attempts.

Once this is done, it still isn't over, as they must then test the grafted veins by flushing blood through to test for patency, to make certain there are no leaks.

Once they are as certain as can be there are no leaks, the heart is then attempted to be restarted, and the heart/lung machine is turned off. This is done with electrical shock paddlesapplied directly to the heart, and sometimes manual heart massage with the hand. If the heart does not start, drugs are used in conjuction with these methods.

Sometimes, the heart will not restart. Usually, this is not the case, but obviously one of the largest risk factors if the surgery along with the change to and from the heart/lung machine.


Search online for a video, or ask the doctor for one.

After the heart is restarted, the breastbone is re-placed and screws are used to hold it in place. The chest incision is then closed, and usually staples are used.

Morphine or dilaudid pain pumps that are patient controlled are used for a day or two, and the patient will be in ICU. They will also be given breathing treatments and exercises, called incentive spirometer to prevent pneumonia. She may be intubated and on a ventilkator for a few days, as well, placed into a drug induced coma. All that depends on how she responds in surgery.

Without this information, she is not well informed. She has the right to know how it is done, and what can potentially happen.


You can probably find lots of information online.




edit on 21-1-2013 by Libertygal because: (no reason given)



posted on Jan, 21 2013 @ 12:30 PM
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If it were me, I would NOT do it! Sometimes people have to realize that they cannot live forever. 86 is, not to mean,is VERY elderly.....She may want to live the rest of her life on her own terms rather than give away what she has left to doctors. The pain and recovery time for her age is way too risky.....I am a nurse and of course this is just my own opinion.....
reply to post by Starwise
 


I appreciate your thoughts on this. I have talked to a few nurses I know and they have relayed the same thoughts. There comes a time where you have to realize your life is coming to an end and the best way to leave this world is to just let it happen. She lost her daughter to ovarian cancer 3 years ago, so knowing she will be with her again sometime down the road, has to bring her some kind of comfort. I think everyone would rather leave this world in a peaceful manner rather than struggling for every breath on a daily basis.



posted on Jan, 21 2013 @ 12:46 PM
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reply to post by Libertygal
 


She does know some of what you outlined, but not as detailed though. Having read the open heart procedure scared me! When you read everything that they have to do, you really have to question if the elderly have the strength to recuperate after such an extensive and brutal surgery.

When you talk about exercise after the surgery, I immediately thought to myself no way. She already has a bad knee and elected 2 years ago to forgo knee replacement surgery. So not only will she be in pain from the surgery, but exercising herself back to health will be trying in itself.

One of the cardiologists stated that the veins that they take from the leg to replace the clogged vein do not handle the blood pressure as well as the original heart vein. The heart veins are made in a manner to handle the heavy blood pressure needed to supply the heart. That's why he said by-pass surgery is only good for 10 years because eventually those replacement veins breakdown because of the constant blood pressure.

I appreciate your eye-opening outline of open heart surgery. I'm sure this will help her understand the extent of the surgery and let family members know whats all involved.



posted on Jan, 21 2013 @ 12:54 PM
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Sorry to hear about Mother in law. I hope everything turns out OK. My grandma had double or triple bypass surgery at 77, she will turn 91 this year. Both her and my gramps had it, but he was younger when he had his and they are both still living. For a few months after the surgery its pretty painful waiting on your sternum to fuse back together. Other than the pain, it never slowed either of them down. Now they have alzheimers/dementia which is pretty sad. My grandmother hardly knows anyone except for the 4 family members shes sees daily.



posted on Jan, 21 2013 @ 12:59 PM
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reply to post by WeRpeons
 


You are very welcome.

Sometimes, people never ask, or want to know, what is going to be done to them when they go under the knife. I am one of those that wants to know everything, scary or not.

My dad had a bypass, too, but he was younger. It was very hard on his legs, and he ended up with a cane to walk.

If she is a very energetic, lively person, it may be so hard for her and the family to say no. Sometimes, no is just best, but it is all so personal.

Sometimes, too, people find certain things so hard to talk about. They hide things, or walk on eggshells. I quit that in my family, and bruised a few egos, but in the end people were grateful for the truth and honesty. Tiptoeing around wastes precious moments.

Whatever the decision, like I said, love and support her. It's all she needs.



posted on Jan, 21 2013 @ 03:37 PM
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I am so saddened to hear this. Whatever the decision, I wish her and the family the strength and courage needed to get through this.



posted on Jan, 21 2013 @ 04:57 PM
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reply to post by geldib
 


Was she in pretty good shape at 77? Sounds like she pulled through well at the age.

My mother is 91 and she is in better shape than me.
She's not on any medication not even blood pressure pills. She's walked her entire life. Not just normal walking but fast paced. She could still walk as fast as someone in there 50's. Unfortunately her memory is now going. She still thinks her mother and father's are still alive. Some times she calls me her father and I'm her son.



posted on Jan, 21 2013 @ 05:00 PM
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I am so saddened to hear this. Whatever the decision, I wish her and the family the strength and courage needed to get through this.
reply to post by Night Star
 


Thank you for your kind words. She has 14 grandchildren, and her husband is with her everyday at the hospital. She's never alone throughout the day. With everything she has gone through, she's still in good spirits.



posted on Jan, 22 2013 @ 11:48 PM
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reply to post by WeRpeons
 
Well my grandparents were both born and raised in Mississippi, I don't remember either of them ever exercising but they always worked hard. My grandfather was raised on a farm and was taken out of school for a few weeks each school year to help plant or harvest the crop so he finally quit in the 8th grade. He worked hard all his life. Thats about all the exercise they ever got. Hes had a brain tumor, quadruple bypass, knee replacement, hernia operations and no telling what else. Now my grandma on the other hand was always healthy, and pretty active, getting up around 6am to cook breakfast and 2 other meals all homemade from fresh ingredients, even after retiring. She stayed active as soon as she was partially healed from the bypass surgery she was on the move again. The only the that slowed her down was throat cancer, and she never smoked. She hasn't been right since the chemo therapy. It seems like it made the alzhiemers 1000x worse. Now she forgets where she is, what bed she sleeps in, etc.. Its sad watching then get old and slowly falling apart, My grandpa still trys to do some type of work everyday bit his artificial knee slows him down, it stays infected so he has to be on strong antibiotics, if not his knee swells up. I think it all boils down to Attitude, if your mother in law has a positive outlook and the surgery goes OK without complications then she will be fine. Make sure to research the Dr. before she agree. I hope this helps.





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