Surgery and Alzheimer's

[marionq]

My 81 year old husband was scheduled for full knee replacement shortly. Yesterday he went for his pre-op which took five hours of thorough medical and discussion. He was found to be in excellent general health as we expected. The surgeon and also a second opinion brought in advised strongly against the operation. The knee surgery on its own would be like all the others they do but his Alzheimer's which is mild/ moderate would possibly be affected badly by the anaesthetic and even if only temporary would render him less likely to cope with the aftercare.

They reckoned it would take him a year to get back to the level of movement he currently has albeit with a straighter leg.

This was a shock as we thought the op was a done deal. They gave us a lot of time and were very concerned so I must conclude that they are right but I wondered if anyone else had a similar experience due to dementia.

 

[Spamar]

I don't have Alzheimer's but I have had knee op. They can do it under epidural and light anaesthesia. Surprised that option wasn't offered. Straight leg? Whats that all about? OK, granted I was younger and fitter, but bending knees was one of the first things on the agenda post-op.

 

[marionq]

His knee is very bowed with all the damage done so straightening it would be part of the op. They did talk about the epidural as part of the anaesthesia. They have had experience of Alz patients with this kind of surgery and according to them it is high risk and does not always go well.

 

[Beate]

It is true that anaesthesia and dementia don't mix well as it could hasten someone's decline and as such it was responsible of the GP to tell you of the risks. They do need to be weighed up against the benefits though so if you feel you are not in possession of all the facts yet, ask to speak to the doctor again. Basically, how would your husband be affected if the op did NOT take place?

 

[MrsTerryN]

My mum had surgery three weeks ago for a broken hip. She has/had moderate dementia with bladder incontinence.
Mum has no memory of the break and is quite frustrated by the fact she needs to use a walking frame. Her compliance with the rehab is only due to the physios they have in the nursing home. Her short term memory previously not too bad, now she forgets within minutes of comments and discussions
I am hoping this is a temporary regression but I have been warned that though physically she is recovering well (she is in a nursing home and they are doing appropriate therapy) she may have slipped further into her dementia.
Her surgery had to happen as she was a very mobile person.

I have to say I am not sure I would want mum to have general anesthesia if the surgery was not crucial.

 

[rajahh]

I feel my husband's decline was hastened by surgery. so I would think long and hard before you press for surgery for your husband. It depends of course on how painful it is now for him.

Both my brothers had knee replacements, one because his leg was very bowed and it took a long time for him to recover movement, and lots of exercises . Will your husband comply with physio do you feel. It could actually render him immobile if he did not do full recovery regime.

Jeannette

 

[teahound]

Hi Marionq,

I know it's not the exactly the same but in case it helps, I was recently at the hospital with my mum as she had broken her wrist a short while ago. At this follow up they talked about an operation to pin it. My mum is further along than your husband and so wouldn't have understood the operation at all. After speaking with me the consultant checked with another consultant and it was decided that the operation wouldn't take place as mum is able to move her fingers and she is not in pain.

Following this we went straightaway to have her temporary plaster covered and made more hard wearing. I was wondering at this stage if mum should be having the operation or not and had this been the right decision. The nurse doing the cover asked if mum was going to have any other treatment and I explained what had been decided. She said she wished that the doctors would take the after effects of these operations into account more when arranging surgery. She said they had many visits from people with dementia who were made far worse by the anaesthetic. They were very distressed and unable to understand what was going on and were pulling out pins from frames and trying pull off the plaster. She said this increased their risk of infection and it was often a downward spiral. She made me feel a lot better about mum not having the operation.

Best wishes to you and your husband,

teahound

 

[marionq]

I feel my husband's decline was hastened by surgery. so I would think long and hard before you press for surgery for your husband. It depends of course on how painful it is now for him.

Both my brothers had knee replacements, one because his leg was very bowed and it took a long time for him to recover movement, and lots of exercises . Will your husband comply with physio do you feel. It could actually render him immobile if he did not do full recovery regime.

Jeannette

That is what they are afraid of Jeanette. John is very lucid and would agree with everything and then forget and either do nothing or the opposite. I can see the point they are making. At present he can handle the discomfort and the " seizing up " of his knee but of course how much worse it will get is anyone's guess. Your post was helpful as are the others. Thanks.

 

[Griffen2]

My own husband was told three years ago he needed a knee replacement.He is 56 & does not suffer from dementia. He is postponing the op for as long as possible for work related reasons.

The latest scan show practically bone on bone with little cartilage left. He has good days & bad days depending on the weather & how much walking he does. About 400 yards is OK ..anymore & he is limping badly. Having cushion soles to his shoes helps alot as does avoiding walking or standing for a while on a hard surface. He usually spends the evenings with his legs up. He takes 400mg isobrufen twice a day on a bad day ..which takes the edge of the pain. He is in agony though if he twists his knee accidentally.

I know everyone feels pain differently but this this might give you an idea of some of the problems with the knee that could be ahead.

 

[Poddy]

General anaesthetic

In 2006 my late husband had 5 hours of surgery(he died in 2012) and although not diagnosed with dementia at that time, on reflection he was not his real self for awhile before and was slowly changing. Then, in 2012, he had 10 hours of surgery, and my real anxiety was confirmed and he was a lot worse when he came round from the anaesthetic, and he died 6 months later. I would counsel extreme caution with the use of general anaesthetic in those already diagnosed with dementia.Poddy

 

[Linda Irving]

Thanks for the advise

Thanks for your comments on the affect that general anasthetic will have on dementia. The fingers on my Mother's right hand have curled in completely due to initially a trigger finger. I asked the GP if he could refer her for surgery to release the fingers as she is unable to use this hand. Also the carer's are unable to open her finger to cut her nails and I am fearful that they may cut into her hand and cause infection and pain. In my mind surgery was the best option, but having read the posts on how it can affect the dementia I am having second thoughts. Has anyone got any comments on positive outcomes from surgery?

 

[marionq]

Having read all your posts I am convinced the doctors got it right. I have tried without success to get John to do the exercises to strengthen his knee muscles but he has no coordination. He thinks he is doing it correctly but is not doing it at all!

I am going to try the cushion soles Griffen as he does feel jarring on hard surfaces. Once again thanks for advice.

 

[katehh16]

My mum fell and broke her hip almost 6 weeks ago now and there was no option but to have surgery. However, it has been very traumatic and she is now immobile and her dementia seems to have accelerated massively. She now rarely opens her eyes and doesn't speak to me much but does shout out a lot..most of it incomprehensible but angry. I am devastated by the rapid decline and have been told she may improve but 6 wks on sge is not showing any positive signs.

Sent from my GT-I9300 using Talking Point mobile app

 

[Heckers]

My MIL is 84 and she has not long had a laparoscopy op for bowel cancer, she had it with an epidural and light sedation. She is currently recovering at home and is having a warfarin injections everyday, her op was beginning of October. She seemed pretty much the same after her op in the hospital even though she got a nasty chest infection, but I think from what my FIL has said she is worse memory wise now then before. Unfortunately she had a hip replacement three years ago that has never been right and now he is just waiting for to see the specialist to see how long it will be before he can pay privately for her hip to be redone. I have mentioned to him re more surgery causing more problems with her memory but he is insistant that she gets it done! Sadly she isnt very mobile at all and she didnt cope well with the physio last time, not sure how she would cope if she has another op.... Think my FIL is expecting her to be able to cartwheels down the footpath!

I just wish that all Doctors would really consider the effects and outcomes of operations before they do them. Sometimes I think it is best for things to take there natural course.

 

[marisarose]

General anaesthetic

My Mum had the beginnings of vascular dementia, had lots of little strokes (TA's) but was in her sheltered flat with support from me and my sister, plus a nurse to give medication in the morning (Mum was waking 5 a.m. took her tablets, then took them again around 9 forgetting she'd taken them) and a carer tea time to check door was locked and all safe. However she then broke her hip and had the op and when she came round she seemed so much worse and couldn't remember she'd had a fall or an operation. Bless her, she was so confused and kept picking at the dressing. I wrote a big sign for her over bed tray saying that she's broken her hip and was recovering in hospital but of course though she could read she couldn't really understand what she was reading so it didn't help. after this she went into a care home (nightmare) and broke her other hip as they had taken all the zimmers away to try and stop everyone walking around! And of course Mum had forgotten she couldn't walk ! Shocking. This time they gave her a strong sedative for the op as felt general anaesthetic too risky. It does affect you definitely, it's a known fact. I had open heart surgery in Jan and was under for 5 hours and my memory was a bit iffy for a while and still room for improvement!

 

[oliviab]

Avoid the anaesthetic!

My Mum had a new hip with a general anaesthetic. Before that she was starting to have memory problems but afterwards, there was a marked decline in her memory. After about 3-4 months, she was pretty much back to where she'd been before the op. Unfortunately, she then needed an aneurysm repair and because they didn't have the correct stent (!!!) she had general anaesthetics on 2 consecutive days. This had a HUGE effect on her memory and she never got much better.
There's lots of anecdotal evidence about the effects of anaesthetics on the older brain. I hope your Dad can have a spinal to avoid this. It would be great if he could remain active with a new knee. Good luck.

 

[melimou]

Surgery and dementia

My husband was diagnosed with early onset dementia about 5 years ago and has since had 7 operations, 2 for prostate cancer, a kidney removal with malignant tumour, twisted bowel, pacemaker, and this year the kidney cancer has spread to his bones, so a total hip replacement in April total and most recently an operation to remove 2 discs from his spine because the cancer is there as well. All of these were done under general anaesthetic of varying lengths, and I am convinced they are accelerating the dementia, but without any real proof, just gut instinct. He cannot remember about the spinal op at all but keeps complaining of bad pain in his back. Luckily he is mobile so can walk well and goes off for walks, still on his own, although I wait for the day when he gets lost. But how can I think of suggesting yet another op might be a bad idea, when it is likely to be the cancer spreading to yet another site. And I could not bear him to be in pain because he didn't have an op, but I dread another op and the struggle to make him understand what has happened, why he feels lousy and am sometimes at my wits' end to cope, its the combination of the physical and mental problems which are so hard to bear. Know everybody out there will understand how it feels. And I do believe hospital is the worst place for someone with dementia - in spite of all the publicity nursing staff do not have the time or training to really understand dementia although they try. Oh, feel better for putting this in print!

 

[Emac]

Kidney stone op

My Mum is going into hospital this Thursday, 6th Nov for a kidney stone operation. I know there is a link between general anesthetic and the worsening of alzheimers symptoms, in fact there is a concern about giving an elderly person without any form of dementia general anasthetic as it can cause confusion (sometimes called delirium) for weeks or more afterwards. It usually clears up given time and the person returns to normal - whether that will be the case with Mum remains to be seen, but what can we do?

The surgeon says she needs the op. It's a large stone,almost blocking the tube to the bladder and has the potential to cause a life-threatening infection. If we do nothing that is the risk we run. If we treat her we will worsen her dementia and hasten the end of her life that way. Catch 22!

The trouble with doctors and consultants is they deal only in their specialism, urology, stroke whatever- they will most likely know nothing at all about demetia. To a hospital the patient is a collection of malfunctioning parts - not a whole person and its down to you to ask the questions for your relative.

If the person is not in any pain, and the situation is not life threatening I don't think I would put a relative with Alzheimers through an operation. If further down the line Mum were to be diagnosed with cancer or other terminal disease, would I want her to have treatment? Possibly not. We all have to die of something and if she was not in pain perhaps cancer would be preferable to dying of dementia? This is a horrible disease and my heart goes out to the lady and her husband dealing with successive cancer operations on top of that. Sometimes the universe is very cruel. All we can do is try and make the best decisions we can, perhaps factoring in what we think the person would have wanted when they could think for themselves.

After discussion with the psychiatrist we decided to proceed with the op. Let's hope it is the right choice. Cross your fingers for us.

 

[Hitheranthither]

Local versus general anaesthetic - Comparative experience

My mum (83) broke her hip whilst on holiday in Sri Lanka. She was given a local anaesthetic (epidural), for the relatively quick operation in the hospital in Colombo and recovered well without incontinence or memory loss. After three weeks we brought her home and unfortunately she fell again; this time sustaining a complicated fracture of her thigh bone. She was operated in the UK (four hours) under general anaesthetic and has suffered double incontinence and memory loss ever since with a recent diagnosis of Alzheimers. Life for her and me has changed forever.

It surprises me that there is no screening for dementia risk (if that is possible), prior to the operation (and administering of general anaesthetic) in the UK, even though mum was experiencing some forgetfulness prior to both falls.

 

[Ding Dong]

The nurse told us an op could worsen dementia - the doctors told us nothing

When my mum was 75 and in the early stage of vascular dementia, she discovered a breast lump herself. She had a biopsy and cancer was confirmed. 2 doctors at the hospital advised us to have a lumpectomy. They knew she had dementia and her behaviour at the appointments was very confused, but they still pushed for her to have the lumpectomy, stressing we were lucky she had found it in early stages.

When we went for the pre-op blood tests, the nurse asked if anyone had told me it would worsen her dementia and that it may or may not be a permanent deterioration, but would almost certainly last for months not days. She also said mum would have to do daily exercises for life to drain her arm because the lymph glands which normally do the job would be taken out. Failure to do the exercises would result in pain and infection. I could not even get mum to have a daily wash, never mind exercises!

I was shocked. No-one had said anything about that. Although the op had been scheduled for 2 days time, I did a bit of research and insisted on seeing the 2 surgeons again. They more or less shrugged their shoulders when I asked about effects of an operation on her dementia.

When I refused permission for the operation (power of attorney) they said they could try treating her with hormone tablets,but that they would only slow the cancer down. No-one had offered that as an option previously.

I had to hide the pills in museli bars. She had a six month check up, and the lump had not increased in size. At the one year check, the doctor examined the right breast, the left breast, then the right breast again, then asked me which breast the lump was in as he could not find it!

Mum is now 82 and her dementia has progressed considerably, but she has no sign of cancer. She is still on the hormone tablets, although she quite often refuses to take them. Thank goodness for that sensible and caring nurse.

I advise anyone faced with an operation to say that there is strong evidence of severe effects on dementia and specifically ask if there are any none surgical alternatives which could be considered.