Op not going ahead - not sure if I am right or wrong

[Ann Mac]

We had a pre-op assessment for Mil's cataract surgery today. At a previous appointment, the hospital expressed concerns over her ability to cope with the procedure under local anaesthetic - concerns I shared, I may add - as they didn't think she could remember instructions to keep still, especially as it was clear the thought of surgery whilst awake was something that really scared her and her confusion obviously worsens the more stressed she is. So, today was about the possibility of her having a general anaesthetic.

I went in with 3 concerns. Firstly, the administration of the anaesthetic - it could be she would handle it, but equally, a combination of fear and the fact that stress increases agitated behaviour means its equally likely she would not cooperate, or agree to the procedure at the last minute. Secondly - the massive worry about the possible impact of the G.A. on her dementia. And thirdly, post op - I can handle eye drops, dressings and so on - but what I can't do is guard against her rubbing at her eye, 24/7 - she had an infection several months ago, and constantly rubbed, especially during the night, and the infection took nearly 3 weeks, rather than the 4 or 5 days the GP predicted, to finally clear up as a result.

With the first problem, they said it would be OK for me or OH to be with her till she went under - and yes, that could help a lot. But the second and 3rd issues, not so easily dealt with. They simply could not say what likelihood there would be of her dementia worsening, even with a light G.A. - they have no way of knowing in advance if an individual will be OK, will suffer minor, reversable deterioration, or if it will have a massive impact. Its up to us to decide if its worth the risk. With the 3rd, yes - if she rubs, she could potentially cause her eye significant damage. They also said that both her being on metformin (diabetes) and her having COPD and Angina need to be considered.

It didn't help, by the way, that Mils notes had gone completely AWOL - so they had no information from either the diabetic or the COPD clinic to hand! However, I also have to add that the nurse specialist we saw, and the anaethetist who made the time to come and talk to us, were absolutely fantastic.

Mil - who was unbelievably chatty and who was determined to be helpful - providing them with no end of information on her medication and how long she had had this or that condition (though, every bit of information was a completel confabulation, bless her - she told them she was on 25 metformin tablets a day, but only one blue tablet at night!) just kept saying at first that she would leave the decision to myself and OH - but as soon as they said it might make her 'memory problems worse', she then said No thank you, very clearly.

So in the end, when asked, I said that no - on balance I would personally rather not take the risk, and OH said the same. The GA is the major point for us both, and I am as sure as its humanly possible to be that she would be at constant risk from problems because she just wouldn't be able to leave her eyes alone after surgery. I also figured in that due to the dementia, her mobility is going fast anyway, her ability to read seems to be going quite quickly, and she hasn't the concentration to watch or follow TV much now, either - I kind of suspect that the dementia will cause problems quickly enough to render the benefits of any surgery as pretty much useless.

But OH and I have spent the afternoon wondering if we are right to have made that choice - for all we know, the dementia could stay stable for several months or longer, and not having the surgery could possibly mean that deteriorating eyesight has an effect on her quality of life. We just don't know, and all we can do is hope we have got it right

 

[jeany123]

It is the decision I would make as well, my husband is supposed to have cataracts done, the first time he went for his pre-op his blood sugar was too unstable he is a diabetic, it has stabilised now, he is just 67 I think probably he should but I am hesitating in going to the GP to get referred as I am so worried about the anaesthetic affecting his dementia and his ability to cope afterwards he will forget he has had it done and might rub the eye or worse,

If he was elderly i definitely wouldn't even consider it but you have to weigh it up really,

 

[Grannie G]

I agree with your decision Ann Mac. I`m sure you are right.

I made the same decision for my husband as he would not have managed a local anaesthetic and it was the right decision for him.

 

[Ann Mac]

It is the decision I would make as well, my husband is supposed to have cataracts done, the first time he went for his pre-op his blood sugar was too unstable he is a diabetic, it has stabilised now, he is just 67 I think probably he should but I am hesitating in going to the GP to get referred as I am so worried about the anaesthetic affecting his dementia and his ability to cope afterwards he will forget he has had it done and might rub the eye or worse,

If he was elderly i definitely wouldn't even consider it but you have to weigh it up really,

Its the fact that there is just no way of predicting the effects of the anaesthetic, isn't it? It seems mad that , when its well known that that it can, in some instances, cause problems, that there is no way of saying if someone is at risk in advance. They can say that if you are over 70, any anaesthic can increase your risk of developing dementia, I was told today - but if you actually are diagnosed already, then all bets are off - no way of knowing what will happen. In the end, partially because she seems to be going downhill quite steeply over the last 14 months, I just don't want it to be worse

 

[Moonflower]

I've made the same decision for my mother
She has macular degeneration as well as cataracts and AZ
They could operate on the cataracts, but would need a GA, and no guarantee that mum would be able to read after the operation

I decided against the operation - Mum agreed, but would change her mind every 5 minutes. I don't feel comfortable with it - she really "feels" her loss of eyesight, but the risk seems so great, and there is no way she would remember not to rub her eyes - could end up with less sight than she has at the moment

 

[cragmaid]

I turned down a Cataract op for Mum..Like you I know that the physical care could be managed easily, but the hands off bit....not a snowballs chance in Hades!!

 

[Owly]

My Mum's mild memory problems were turned into dementia by 2 broken hip operations, one year apart. I'm sure it was an effect of the anaesthetic. It is an established fact that it can make dementia worse. The aftercare issue is also very important.

Your MIL said herself, she didn't want her memory to risk getting worse. She understood there was a risk, and she didn't want that risk.

I'd say you made an excellent decision, all of you together.

 

[Ann Mac]

Thank you so much, everyone - you have made me feel a whole lot better! Its the old guilt monster taking advantage of the second guessing, I suppose!

 

[ellejay]

My mums first cataract op was when she was still living alone ( 3 carer visits a day for meds only) so, not too far along the road. The after care was a nightmare, she "lost" don't know how many eye patches & the drops were a bit hit & miss , depending how cooperative she felt at the time.

The second eye remains un operated on.

I think you've made the right decision.

Lin x

 

[Canadian Joanne]

We made the same decision for my mother and have never regretted it. We knew that the aftercare would be impossible, we were worried about the effect of the GA plus the specialist said that the surgery would only marginally improve Mum's quality of life, as she no longer was reading or watching much television.

 

[Ann Mac]

Thanks again - as soon as we walked out of the hospital, I began to worry, so you have all really helped Mil is just home from day care, and has completely forgotten the appointment this morning, I've had a long and convoluted tale of her getting two buses to the 'wards' (she means day care) this morning and how she only just got 'to work' on time - the visit, and the decision have just vanished!

I've made the same decision for my mother
She has macular degeneration as well as cataracts and AZ
They could operate on the cataracts, but would need a GA, and no guarantee that mum would be able to read after the operation

I decided against the operation - Mum agreed, but would change her mind every 5 minutes. I don't feel comfortable with it - she really "feels" her loss of eyesight, but the risk seems so great, and there is no way she would remember not to rub her eyes - could end up with less sight than she has at the moment

I really feel for you - Mil, when asked, says her eyes are 'fine' - it was only the odd comment she made about what seemed to be something like 'tunnel vision', combined with us not knowing when she last had an eye test, organising one and the optician spotting a possible problem that we found out she had cataracts in the first place - so Mil isn't feling the loss at all. So much harder for you, though I have to say, the fears about GA and post care, in a situation like yours, would probably make me still inclined to say no to the op, as you have.

I guess we can only do our best, hun xxx

 

[CollegeGirl]

I agree with everyone else Ann, that you have made the right decision. You have certainly made this decision for all the right reasons, and that's all any of us can ever do.

Also, remember that your MiL, when the possibility of her memory problems getting worse was mentioned, also said a very firm 'no' and even if this was just an 'in the moment' statement that she soon forgot, it was still her choice for herself.

So there is nothing to reproach yourself for.

xxx

 

[Hair Twiddler]

I believe that you have come to the right decision.

My mum had both cataracts replaced about 6 and 5 years ago, before Az.

Since her dementia was diagnosed mum had had the follow up laser surgery to tidy up the "fogging" on one cataract - only needed a local anaesthetic. This proved problematic, mum didn't grasp what was happening on the day, the eye drops which I had to administer regularly throughout the day were either rejected, resented and frustrating for both of us as mum couldn't/wouldn't relax her head back far enough to allow the drops to "hit the spot" - it was a nightmare.

And this was the EASY follow-up procedure. Is her sight better you ask? Pass. Mum can't compare "now" to anything she may have experienced "before".

Like I said at the beginning I believe that you have made the best decision you could in very difficult circumstances.

 

[beelady]

I was an opthalmic theatre nurse and wouldn't recommend any one with dementia having cataract op. They'd panic the first moment a drape is put over their face. You'd need someone holding both hands to stop them from moving and dirtying the
sterile field. It's vital that they remain very very still. Some one with dementia wouldn't remember this.

 

[loveahug]

Mum has been receiving injections for her wet macular degeneration. I can manage the 5 days of eye drops but can't find a way to stop her wiping the eye with her handkerchief on which she has just blown her nose! She also rubs and wipes so hard, on two occasions causing the eye to bleed quite badly. We have now agreed with the consultant that she will get one more injection and then we will have to stop. The strange thing is, when she goes in for the injections she sits perfectly still and is able to follow their instructions but by the time she gets back to the waiting room has totally forgotten she's had an injection. She will go on and on about needing to see the optician because she can't see properly and looks astounded when I say it's because she's just had an injection

I think you have made exactly the right decision, you are looking at the bigger picture and, as gut wrenching as it is, the decision not to go ahead may well have saved your MiL and the family a heartbreaking, no return, journey.

 

[MrsTerryN]

I agree with your decision Ann. Mum had cataracts done Nov 2012 and then Jan 2013. The only reason why I think it worked was dad was there and kept reminding her. He also did all the drops.
I don't think she should have had second one done after seeing the issues from the first but the specialist's office dealt with mum and organised it.
I definitely wouldn't agree to any surgery now that required her to 'not do something' because she wouldn't comply and even in the nursing home they can't monitor her 24/7.
The only surgery would be mandatory e. G. Her broken hip

 

[annie h]

hi Ann,
There was a similar thread on TP in the last few weeks on which I posted something a bit longer, but basically from a different angle I went ahead with my mum's cataracts when she was at a pretty advanced stage of AD. I accompanied her to theatre, it was very quick and she was fine apart from of course trying to remove the patch because she didn't know why it was there. She didn't have a G.A. And we booked her into respite care for a week afterwards to cover the worst of the post-op eye drop regime and ensure that interfering with her eye was kept to a minimum. I won't pretend it was easy but her sight had been pretty bad and over the subsequent two years of declining physical health until she passed away a couple of months ago I was very relieved that she'd had them done as she was quite confused enough without the additional problem of being unable to see.

I'm not saying you should go ahead, just that if you do, then with some extra support ways can possibly be found of making it work. The most important thing is that you make the decision you think is right for your relative and you and that you never look back and question the decision you've made.

 

[Ann Mac]

Thank you again, everyone

I believe that you have come to the right decision.


And this was the EASY follow-up procedure. Is her sight better you ask? Pass. Mum can't compare "now" to anything she may have experienced "before".

Like I said at the beginning I believe that you have made the best decision you could in very difficult circumstances.

The bit I've put in bold is similar to how I feel she is - Mil claims her eyesight is fine, no worse than its been before - I honestly don't think Mil is aware of any deterioration, and she certainly doesn't complain or comment on anything about her sight that may be bothering her. She can't sustain focus to read or watch TV for long - in fact, havent seen her pick up a book (she never was a great reading fan) for a couple of years. She will read out the odd place name sign when we are in the car (especially when its anywhere near where she used to live!) and she seems to be able to see the time or programme name of the TV - anything longer, like a letter, and she'll attempt to read, but say 'Oh I can't be bothered with that' within a couple of minutes - I don't know how good her reading skilss are now And with the TV, whatever the impact on her vision, she never says she can't see it or she is having problems, she just can't maintain concentration. She has Parkinsons gait - waiting to see a specialist - and that means that she can't walk more than a very short distance, and we use a wheelchair anyway, so the sight has - so far - little impact on her being mobile, other issues are and have already affected that. The Anaethetist told me that he would expect her to have problems with seeing small details first, which would impact on anything 'fiddly' that she needed to do, like buttons or threading a needle - but she already can't do those things due to the tremor in her hands

I think - trying to put it in words - from what I've been told, the things likely to be affected by her sight are things that are being affected by the dementia, and improved vision is unlikely to bring much of a benefit because of that?

hi Ann,
There was a similar thread on TP in the last few weeks on which I posted something a bit longer, but basically from a different angle I went ahead with my mum's cataracts when she was at a pretty advanced stage of AD. I accompanied her to theatre, it was very quick and she was fine apart from of course trying to remove the patch because she didn't know why it was there. She didn't have a G.A. And we booked her into respite care for a week afterwards to cover the worst of the post-op eye drop regime and ensure that interfering with her eye was kept to a minimum. I won't pretend it was easy but her sight had been pretty bad and over the subsequent two years of declining physical health until she passed away a couple of months ago I was very relieved that she'd had them done as she was quite confused enough without the additional problem of being unable to see.

I'm not saying you should go ahead, just that if you do, then with some extra support ways can possibly be found of making it work. The most important thing is that you make the decision you think is right for your relative and you and that you never look back and question the decision you've made.

Thanks Annie h - I think the thing with what you say is that in your Mums case, an L.A. was possible. The hospital were very clear in that they didn't believe that would be the case with Mil - she simply could not cope with any medical procedure whilst awake, she couldn't keep still, and couldn't remember any reassurance/instructions for long enough to guarantee that she would follow them. We've had issues, occasionally, with even a simple blood test, where she kept jerking her arm . She has quite bad delusions, always worse when ill or stressed, and there just is no predicting what her reaction/behaviour would be like, which could put her at risk of injury, in that situation. After care, if it involved her having to go into a respite setting, would also be problamatic - she retains enough awareness that the fear of 'being put in a home' still looms large in her mind, poor thing, and she just wouldn't remember that the stay was temporary, or why she is there - at the moment, even an overnight respite break is out of the question because of this - though I do think we are getting nearer the time where she won't be as aware and it will be possible. Maybe, at that point, the op would be possible - but as I said, the very things that would be affected by failing vision are things that are already being affected by the dementia, so the benfit would most likely be minimal, if there were any benefit at all

 

[gillyhoney]

Dementia and anaesthetic

I have had several operations on my back and hips and have recently been diagnosed with vascular dementia. My replacement hips are deteriorating and I am waiting to be admitted for a resurfacing. I was perfectly ok with this until a friend told me that the anaesthetic can cause dementia. Since then I have looked on the forum and am shocked to read that the anaesthetic caused my dementia.
I am so worried and would like more information on this topic. Is it possible that my dementia was caused by all the operations and anaesthetics that I have had

 

[Owly]

Hi Gillyhoney, welcome to the forum and I can understand your concern. It does appear to be the case that general anaesthetic can cause lasting memory problems in some patients, as it did to my Mum on her 2 hip operations (she was 83 & 84).

The NHS says that anaesthetics can cause confusion and memory loss, which are usually temporary. That means sometimes they are permanent.

http://www.nhs.uk/conditions/Anaesthetic-general/Pages/Definition.aspx

Recently I came across the idea that nitrous oxide that is used in some anaesthetics depletes vitamin B12 in the body, and if you look up B12, you will find it is critical to good brain health.

I found this page that says that if you are already depleted in B12, then you may come off worse from an anaesthetic -

https://en.wikipedia.org/wiki/Nitrous_oxide

"Nitrous oxide inactivates the cobalamin form of vitamin B12 by oxidation. Symptoms of vitamin B12 deficiency, including sensory neuropathy, myelopathy, and encephalopathy, can occur within days or weeks of exposure to nitrous oxide anaesthesia in people with subclinical vitamin B12 deficiency. Symptoms are treated with high doses of vitamin B12, but recovery can be slow and incomplete. People with normal vitamin B12 levels have stores to make the effects of nitrous oxide insignificant, unless exposure is repeated and prolonged (nitrous oxide abuse). Vitamin B12 levels should be checked in people with risk factors for vitamin B12 deficiency prior to using nitrous oxide anaesthesia."

As you have already got a dementia diagnosis, you might be able to discuss with your anaethetist before your next op whether he will be using nitrous oxide and whether there are alternatives. You could make sure you are well topped up beforehand anyway by taking extra (especially if you eat little meat/dairy). They say that sublingual drops or tablets are sometimes absorbed better by the body in people who cannot any longer absorb B12 in their stomach.

It is probably not definite that your last operations "caused" your vascular dementia, but it might have been a contributory factor. Other factors might have included your blood pressure being unchecked, or having an acidic, inflammatory diet. There are many reasons why the circulatory system 'goes wrong' in various parts of the body.

There are also threads on this forum about vascular dementia and how you can help yourself, also check the "Health and Wellbeing" section for some dietary idea threads.

For example, there are enzymatic substances like pineapple, papaya, and serrapeptase which can help to dissolve bits and bobs of unwanted stuff in your circulatory system which can only help to keep your circulation to your brain healthy. Dilatory minerals like magnesium will also help. It's said that most people are very short of magnesium.